Dr. Rena Malik
Appearances
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
This is a great question. I'm surprised no one's asked me that before, but we know that having a, sex is a barometer of health. Sexual health is health. So when you're having issues with sex, it's often a sign of other issues. So because there's blood flow, the arteries to, for example, the penis are much smaller than the arteries to the heart.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So very often when men develop sexual dysfunction or erectile dysfunction, it's because they're having vascular dysfunction and they have not yet developed problems that are dramatic enough to affect their heart. And so having good sexual function is basically showing you that you have a good healthy vascular system, a good healthy neurologic system, good, healthy hormones.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Your brain is functioning well, right? That your mindset is able to focus and not be distractible by other things. So having a good sex life and having to have good continued function is actually a barometer of good health. And so in terms of
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
things you need to do to maintain your sexual health it's the same things that you need to do to maintain good heart right you need to eat right you need to exercise you need to um continue to uh monitor how you improve with those things and and get outside get sunlight those sorts of things are all going to help you have good sexual function because they're going to help with good hormone health good blood flow good nerve function and so generally speaking
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And then there's also the benefits of orgasm, right? So having orgasms regularly has a multitude of benefits, better sleep, better focus, better mood, and even some benefits with cardiovascular effects and better heart rate, better blood pressure. And so those things, just incorporating them in your life, right?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Having good sexual function throughout life, having regular intimate moments, whether it's with yourself or with someone else and having orgasm are really positive.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
You know, it depends. And obviously I'm biased because I see a lot of the physical issues, right? And so unfortunately, things like erectile dysfunction and menopause for women can have really detrimental effects to people's sex life, right? And so those things do play a big role, particularly as we age. So as you age, the physical side starts to take over.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
When you're a little bit younger, it's very more often the stress, the mental anxiety, the other sort of mental roadblocks that come into play.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Yeah, so desire is complex, and a lot of people combine desire with testosterone, and a lot of part of it is testosterone. And so in terms of boosting testosterone for both men and women, women have a lot of testosterone. In fact, they have more testosterone in their bodies than estrogen, and it's also very linked to desire.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And so in both cases, to boost your natural testosterone, exercise is a very excellent way to do that. And so it can absolutely improve your desire and your interest in sex.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So having sort of regular exercise, combining both aerobic activities and anaerobic activities, meaning resistance and cardiovascular training, and doing that consistently has shown to not only improve testosterone, but it will improve other parameters. Like it will improve your vascular flow.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So you'll have more blood flow to your genitals, which will then allow you to have for men, better erections, for women, better arousal. And so all those things, can be easily improved by exercise. And so being consistent is the hardest thing.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
I think people will exercise for short periods of time, but doing it consistently will help overall improve many facets of your sexual function, including desire.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Yeah, I mean, being sedentary in general is so bad for so many different reasons. One is that obviously you're not getting exercise, but being sedentary, if you're sitting a lot, you're actually sitting on the nerves that give innervation to your genitals, right? So you're sitting on the pudendal nerve, one of the nerves that gives a lot of innervation to your genitals.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So you can start developing numbness in that area. You can start getting dysfunction from sitting all the time. And so that's not great. And then in general, you know, when you're sitting and you're eating and drinking, you're just gaining more fat.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So there's so much data on having people who have greater amounts of obesity, metabolic syndrome, which you get from sitting all the time and not exercising like diabetes, high blood pressure, high cholesterol, all those things are going to have negative impacts on your health, which is ultimately going to affect your libido, your ability to function sexually.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So overall, there's really, if you're going to have, if you have a job that makes you sit, it really is up to you to make that time, like throughout the day to get little activity, right? Like go up and down the stairs, go get up, walk around. throughout the day, put a timer on your phone, and just do it.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Like, it doesn't have to be a huge workout every day, but actually making sure you have consistent movement throughout the day is gonna go a long way.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Absolutely, and I think desire is very complex. Like I said, a lot of stress, anxiety, mental, psychological disorders, they can all affect desire. Medications you're on can affect desire. So sort of figuring out like, okay, which areas of my life do I need to improve? And if they have fixed all those other things, then maybe there's a medical issue going on
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
that those are important things to assess because like I said, if certain medications, like a lot of people are antidepressants, they can affect desire quite significantly. Even things that people use for hair growth, like finasteride or Propecia can affect desire. So things like that can affect desire. You may not even realize it.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So just sort of looking at the things you're putting in your body can affect your desire. And so it's important always to sort of assess, am I getting enough sleep? Am I exercising enough? Am I eating right? Those things need to be good. What am I putting in my body? And then, okay, is there a medical issue? Is my hormone health okay? Is my vascular health okay?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Are all those things working together that can help me get normal desire and normal function?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
In women, there's so many reasons. So one, very often we see in midlife, women's desire plummets. And that's often because they're taking care of children, they're working, they're cooking, they're cleaning, they're doing all the, sorry, a large burden of household chores, right? So they're taking care of the majority of the household duties and that can very much weigh into desire.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So that's a very common indicator, right? And then other things can occur as well. particularly when you're in a longer term relationship, we see less of this, but sometimes women are having less sensation or less ability to orgasm. And that can change because as we age, sensation can decrease a bit. So that can play a role in desire.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
If you're not having climax during sex, people may feel like, well, I'm not getting the same results from intercourse as I was before or whatever. And so why my desire goes down, right? Yeah. There's that too. Obviously, there's hormone changes that occur during perimenopause and menopause. And perimenopause can start around the age of 40. So it's not that old.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
In fact, you can have symptoms as early as your 40s. And so people can start having changes in their hormones that can cause changes in desire, particularly your testosterone can decrease.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
testosterone can decrease and that can really affect desire overall so in and also in women who are taking some some subset of women who are taking oral contraceptives can also develop a low testosterone because a lot of that testosterone gets bound up by something called sex hormone binding globulin which goes up and that can then affect desire so certainly like i said medications you're taking can affect you and then lifestyle and then of course physiologic issues so
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Difficulty orgasming, probably the number one reason we see is that women are not getting sufficient clitoral stimulation. So when people see sex on TV or wherever, it's always vaginal penetration. But some women don't climax. In fact, 15% of women, 15-20% probably don't climax through vaginal penetration. Only 15% of women climax through vaginal penetration alone.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
The remainder needs some sort of clitoral stimulation in order to penetrate or to climax. And that's basically because the clitoris is the homologue of the penis. And so a lot of people don't know that. It's very simple, but they just don't know that that is the area that needs to be stimulated for women, just like the penis needs to be stimulated for men.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Absolutely.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So this is a long answer, but generally speaking, when we talk about hormones for women, you think about systemic hormones. So things that will affect the levels of hormones in your blood versus vaginal hormones. And so we'll start with vaginal hormones. It's a little bit of a more concise discussion, but vaginal hormones. So when women go through menopause, a lot of changes happen.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
their labia actually shrink, their clitoris can get smaller, they can get atrophy, and they can get thinning of their vaginal epithelium. And so that I can see on exam, but women may come saying, it feels dry down there, I'm not getting as much lubrication during sex, or I'm getting recurrent urinary tract infections.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So those are sort of the very common things that people will complain of, and that can be very easily addressed with hormones. Vaginal estrogen is very, very safe. There's a lot of misinformation, but vaginal estrogen is not absorbed systemically. Not a lot of it. Very, very minimal amounts get absorbed systemically. Most of it is just local for the tissues.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And so if you're having those symptoms, vaginal estrogen, either in a cream, a pill, or a ring can actually, a ring that goes in the vagina can all help support the normal vaginal epithelium and the tissues to keep them healthy. And so one, it's really great for recurrent urinary tract infections. A lot of people don't know this and are getting antibiotic after antibiotic after antibiotic.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And all they really need is vaginal estrogen to help prevent UTIs. It's actually one of the highest levels of evidence we have for preventing UTIs is with vaginal estrogen. And so there's that. And then we're talking about systemic hormones.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Now, systemic hormones, at least by the book, are used for vasomotor symptoms, which are hot flashes, feeling palpitations, those sorts of symptoms that occur very commonly that people hear about and bone health. So those are kind of the most common things we know that bone health deteriorates and estrogen can prevent bone loss. So it's very helpful for that.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
It's very helpful for vasomotor symptoms, but there's more and more data on, I mean, estrogen receptors are everywhere in the body. So we have estrogen receptors in the brain. We have estrogen receptors, um, that, so that can help with cognition and prevent dementia. There's some data that shows that it actually prevents dementia. There was some studies.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
recently that talked about how it actually was linked with dementia, but it was because these women were started on hormones for vasomotor symptoms, which are also linked with dementia. And so there's sort of a correlation with the other things that people were starting hormones for and not the hormones themselves. So there's a sufficient amount of data that it helps with cognition.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
helps with bone health, helps with, you know, somewhat of modulating weight, right? Because it helps with metabolic syndrome. So people who have hyperglycemia from insulin resistance, they actually see an improvement in their glycemia when they're on estrogen. Now, these are not reasons to, in terms of like what the...
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
societies say but this is the data right so it does show improvements in hyperglycemia shows improvements in metabolic syndrome shows improvements to small degrees in weight better sleep because one if you're having vasomotor symptoms or hot flashes and you're waking up at night your sleep is poor and sleep has a huge association with dementia and other issues so your sleep is better and so there's a lot of benefits to having hormone therapy
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
systemically when you're having, if you're having symptoms or when you're going through menopause, because it supports so many factors that even improve skin health. So it improves collagen content in your skin. It improves, it reduces the fine lines and wrinkles on your skin.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
It helps prevent like your skin from getting hollowed in because it supports there's estrogen receptors in the epithelial layer of the skin. So there's so many benefits to getting hormones. And if you are don't have a uterus and estrogen, if you have a uterus and you need progesterone to prevent endometrial cancer, both of those can be used systemically.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So you can take them in pill form and patch form. injectable form, topical like gels. There's lots of different formulations and you can talk about those with your doctor to see what is best for you. But ultimately there's lots of options available. And so deciding, are you a candidate? Interestingly, we don't always look at hormones, at least as a whole. People don't say that it's required.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
It's more of a clinical diagnosis. But I often look at hormones because I want to see, are we seeing an improvement? What are the levels when we start? And are we seeing improvements? Because that's sort of how we measure men. When we give testosterone for men, we check their hormones and we follow them to see how they're doing. And does it correlate with their symptoms?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
But bottom line is we're treating the person and not the numbers.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So in terms of libido, usually hormone therapy can help a little bit if it's going to help with lubrication. So that can help with a sensation of arousal. A lot of times our brain like connects arousal with libido, right? Even though they're two separate things.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So feeling aroused, meaning having lubrication and having that response can make you feel like, oh, that kind of your brain makes a link with that as desire. So that can help with that part of it. But generally speaking, when you're thinking about libido in postmenopausal women or perimenopausal women, there's a few things that we assess. One is how's their testosterone level?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So the testosterone for women should be about one tenth of a male amount of testosterone. And so we check the testosterone level. And if it's low, then we can supplement it with topical testosterone, a very small amount of topical testosterone. You put on the back of the calf every day and see if they improve. There's also some medications that we have available.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Those are technically FDA-approved for premenopausal women, but they're also available to use off-label for women postmenopausal for low libido that are called flubanserin and bremelanotide, which are medications that work centrally on different receptors in the brain to help with desire. Because as I said, desire is very complex.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
It's that you have some receptors that are up-regulated, some are down-regulated. And so there's inhibitors and there's promoters of desire. And so we're trying to kind of balance, make the promoters higher and the inhibitors lower with these types of medications.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So 12% of women experience pain with sex, at least, and it can vary, but that's sort of the average number we say. That's not a small number, consistent pain with sex. Now, people can have pain with sex for a variety of different reasons, and sometimes some studies will say it's as high as 40%, but it's very common. Now, pain with sex is never normal.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So people say, oh, you know, it's okay, drink a glass of wine, you'll be fine. No, no, it's not okay. Like you should never experience pain with sex. So it's about determining where that pain is and what's causing that pain. Is it pain on initial penetration, deep penetration, after sex, and then kind of parsing out what's causing that.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So I'll go through some of the things that cause pain with sex.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
one is inadequate lubrication so i don't know why but in society in general we feel like we shouldn't be using lubrication but lubrication is great it makes things slippery it makes things fun and it's relatively affordable and it helps so a lot of times what what happens is women need a significant amount of time to develop adequate lubrication they need a significant amount of foreplay
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
to get the adequate amount of lubrication to be ready, to be penetrated. Our bodies actually change when we're getting aroused. So women will actually, the length and width of their vagina will increase almost double. Their cervix will move up and out of the way. They will develop adequate lubrication. If they don't have enough time for that, it'll be painful, right?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So that's one of the most common things. One is that, and two is having low lubrication doesn't always mean that they're not interested or they're not into it, right? There could be medication issues. There could be just natural genetic differences. And so using lubrication is not like a bad thing. It's a great thing. It makes sex better, right?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So those are a couple of the common things we see, particularly in younger people where they're just not ready to be penetrated, and they are, and then it hurts. Um, you can also see pelvic floor dysfunction, which is, um, which I see a lot of, so I'm biased because I see a lot of it, but basically it's when, um, you have tension in your pelvic floor.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So when your, your pelvic floor is essentially this bowl of muscles that sits in your pelvis that holds up all your organs. So your bladder, your rectum and women, the uterus. And these muscles, just like any other muscle, usually relax and contract when needed.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
But when some people develop a lot of stress, anxiety, or they may even just have like hip pathology or other kind of factors that can affect function of the pelvic floor, their pelvic floor can become tense and it doesn't relax normally. And so that can create a lot of pain with sex because normally you need a relaxed pelvic floor to allow something to penetrate it.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And so that can be very uncomfortable. And the good news is that can be treated through pelvic floor physical therapy. And if that doesn't work, we have other options like Botox in the pelvic floor and things that can help relax it. But essentially learning how to relax that pelvic floor is actually very beneficial. And sometimes people overdo Kegels, right?
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
They'll do too many Kegels and they'll develop high tone pelvic floor because they don't really know how to do them. And they're just clenching, clenching, clenching, clenching, and they're not relaxing. It's just like going to the gym. You need to have rest. You need to relax the muscle in between sets. Very similar for doing Kegels. You need to actually relax the muscle.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
And so it's important to sort of do those with caution if you're going to do them. And then there's also a whole host of other things. But since we've been talking about hormones, the vestibule, which is this area right outside the vagina, is very hormone sensitive.
Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
So that can become exquisitely tender during perimenopause and menopause, or if you're taking certain medications when you're younger, like oral contraceptives, that can become exquisitely tender, and then that can cause problems and pain with sex. So there's a whole host of things, but those are just kind of a few of the more common ones.