have you ever heard that ejaculating more might reduce your risk for prostate cancer I'm Dr Reena Malik urologist and pelvic surgeon and welcome back to the Reena Malik MD podcast today we have our monthly AMA and we are going to be answering your questions from our membership and our subscribers if you want to be a member and see the full length episode of our AMA make sure to sign up at renam malik. supercast outcom where you can ask me anything and get early access to all of our podcast episodes as well as transcripts from the
membership so let's get right to it okay uh my doctor prescribed me Calis for Ed but I remember using VI a Viagra pill a long time ago that I got from a friend and I recall it working well too is one better than the other if so should I be asking my doctor for one of these yeah great question I get this question a lot and I think that really what you need to understand is that these medications work by the same mechanism what essentially they do is they inhibit a certain enzyme which then allows
blood flow to stay in the penis for longer so that you can get an erection and maintain an erection for longer but there are distinct differences in these medications and these differences may be more relevant to you or not these do work about 60 to 80% of the time in men with erectile dysfunction now what is the big differences so big differences when you think about seleny and tadalfil or viagran Calis which are the brand names with both medications you can have some similar side effects and these can include things like having a stuffy nose
or feeling like congested or flu like after taking the medication or having headaches or flushing of the skin with selenop typically it has a shorter halflife what this means is that when you take it you take it an hour or so before sex and it works somewhere between 30 minutes and an hour after taking it and you can take it even before cuz it'll last about 4 hours and so if you want to have sex in 2 hours you can still take it it will just be ready when you need it it doesn't give you
spontaneous erections none of these medic ations do so that's really important to realize I think a lot of people tend to worry that you're going to get this spontaneous erection and um you're not going to be able to get rid of it which is not the case now in terms of tadalfil it lasts a little bit longer it has a longer halflife which means it sticks around for about 36 hours so for some people that allows for more spontaneity meaning that you can take it and then you can have it last for up to 3
days you can use it over the weekend and maybe have multiple episodes of sexual intercourse now the other thing is cenil is absorbed through the stomach and so you don't want to take it with food if you take it with food it actually reduces what we call the bioavailability mean it's less available for your body to use you still might get side effects but it won't be as effective whereas tadalfil you don't need to worry about taking it with or without food for so depending on what time you like to have sex if you tend
to like to have sex after dinner then talil might be better for you also there's been studies that have shown that taking these medications the first time you use them medication it doesn't always work it can take up to eight times to get to up to 80% efficacy with a medication like selenophile now when you look at tadalfil the first time the efficacy is around 75% but remember how I mentioned that selenop tends to work within 30 minutes to an hour we say that typically that's very similar for to delil but some in some cases
it can take even longer and so if you want something that works relatively quickly maybe selenophile is better for you other side effects that are different in terms of selenophile is that sometimes you can get blue green Vision discoloration because it affects some of the same receptors in the eye if that happens you want to stop the medication immediately now with tadalfil it can cause muscle aches and so sometimes that's really bothersome to people and they can't tolerate it but generally speaking both medications work both medications can be effective now some people will prefer the
erection they get with seleny and some people will prefer the erection they get with tadalfil and the good news is if one doesn't work that doesn't mean you can't try the other one so absolutely try one and if that works well continue with it if it doesn't work well you try the other one and there are also other options like venail and aahil that are usually a little bit more costly and usually not as readily used at least in the United States because of the cost but if you're interested you could certainly try those as
well next question I saw a clip of you on a podcast and it said something like quote if you ejaculate 20 times a month end quote or some version of this that it will help protect protect against prostate cancer what's the story behind this I'd like to understand this more yes so there's one study that looked at ejaculation frequency and its risk with prostate cancer so they categorized men in how often they ejaculated was it 0 to seven times per month was it 7 to 14 14 to 21 and more than 21 times per month
and they tried to control for a whole bunch of other things like diabetes other comorbidities heart disease all those sorts of things lifestyle a variety of different things and what they found was that when men in jaculated 21 times or more per month versus less than seven times per month they were significantly less likely to get diagnosed with prostate cancer now does that mean that a jaing more frequently is protective in some way so there's some theories as to why this might actually be so theory is one that you're having some stagnation of fluids around
the prostate when you're not ejaculating and that potentially that stagnated fluid May then create inflammation or create other sort of niduses to create abnormal cells and and that will then lead to prostate cancer now is that 100% true is that universally true we don't know this is just the theory behind it so the idea that you're ejaculating more frequently you're sort of cleaning the pipes and that's sort of protective in some way now this is one study it is a retrospective study it is not where you randomize people to ejaculate or not ejaculate and then
follow them for 10 20 years to see if they got prostate cancer so it has limitations but I use this study to tell people that you can ejaculate whether it's with your partner or by yourself through masturbation and it is safe to do so and so you're not going to harm yourself in any way by ajac 21 times or more a month in fact it might help you now is 21 times is like Benchmark you have to reach to get that protective effect no probably not and so again I think the take home from this
study is that feel free to ejaculate whether it's by yourself or with a partner without guilt and understand that there is potential benefit and so um really there's little downside for it in terms of a physiologic benefit you talked to Dr Stacy L about that I believe right yeah we talked I talked to Dr Stacy lobe who is a prostate cancer expert on the podcast I've also made a video about it so check that out I also put some videos from our last question about the medications that I've uh made on tadalfil and sanil as
well all right so do check that out um next question if in a pinch I run out of lube what is something I have in my kitchen or bathroom products that I can use that won't harm my vagina or my man's penis during sex absolutely so this is a good question I like Lube a lot I think Lube is really great it allows sex to have less uncomfortable friction and I think that everyone should use it if they so desire because lubrication can vary over time and is not always indicative of arousal lubrication can change
when women are go lactating through hormones through certain medications and it doesn't necessarily mean that they're not aroused or not turned on by you it just means that they necessarily at that point in time are not making as much lubrication as they are and of course we want sex to be pleasurable and when it hurts it can't be pleasurable so making it more comfortable for both you and your partner and honestly a little bit more fun can be great now I've made videos about lubrication and talking about different kinds of lubs water-based silicone based oilbased
all of which have pluses and minuses are really down to personal preference for the most part in terms of what you like or do not like now in terms of what can you do at home a lot of people will tend to go towards like things like Vaseline which I don't recommend but you can use oils and so specifically coconut oil is one that tend people tend to like because a little thicker when you take it out and doesn't like make a big mess but you can also use olive oil and those are generally safe
and generally don't cause a lot of damage or harm to your genitals now some people can be sensitive even if you're using an oil and that's just because maybe their microbiome is a little more sensitive and needs a very specific pH but for the most part it's safe it's natural and with coconut oil there are some sort of antibacterial Properties or anti-inflammatory properties in coconut oil and so that can be beneficial as well all right I won't be looking at uh coconut oil and olive oil the same after that um all right next question I
am curious as to your thoughts on the impact of finasteride on prostate health and Sexual Health more broadly okay finasteride is a medication that we use for enlarged prostate and some people use it for hair loss at lower doses or you you know you've called propia is the other brand name for it so essentially fasid and gasteroid are two medications that work by blocking the conversion of testosterone to DHT DHT or dihydrotestosterone is the main Androgen in the prostate and so that tends to slow down prostate growth and even cause prostate shrinkage up to 50%
of its original size and so that's why it works it's effective in reducing the size of the prostate it also reduces your PSA which is a blood test that screens for prostate cancer by 50% and so you need to sort of assess and see when you get your PSA if you're on phas you need to double it to get the actual PSA value so finasterid has been really studied we had a very big study neurology called the mtop study that looked at finasteride as a prevention for prostate cancer or does it actually cause a reduction
in the incidence of prostate cancer and what they found was that it didn't actually increase the incidence of prostate cancer but when prostate cancer was found in men who were on these medications it was of a higher grade and likely I think that's because to some degree there is this decrease in PSA with the medication but obviously this was in a controlled setting and and so people who were doing the stud knew that obviously your PSA would decrease by half so a very good study that shows that information but this medication as I mentioned is
really great for BPH now typically when we talk about medications for BPH we'll talk about things like Flomax or telosin or pelosin or alfuzosin these sort of medications that are called alpha blockers now those work by relaxing the bladder neck to allow urine to flow better past the prostate and relaxing the prostate and so these medications are typically first line and when you add a medication like finasteride to those medications you actually so significantly improved overall urinary symptoms so people are urinating more better they're not having a weak stream they're not waiting for their stream
to start they're not having a stop and go stream they're not waking up so much at night um and so they're seeing Improvement in their urinary symptoms with both those medications together and so those are sort of the benefits and potential risk with the prostate cancer issue with finasteride now the other issue is sexual and so we definitely see a risk of sexual side effects I've made a full video on the you know side effects with tamsulosin and finasterid so check that one out I'll put it in the show notes as well but ultimately these
U medications can have sexual side effects and most commonly it's decreased ejaculation or or having less volume of ejaculate but it can also be low desire and so there's this thing called post finasteride syndrome and essentially men who there's a a very small subset so this is like very small numbers of people who've taken finasteride and they've noticed that they have a significant decrease in desire after taking finasteride which persists for some time even after stopping the medication and so that is something that is you know still sort of under you know we're still trying
to figure out the best optimal way to treat those patients but I think this is a real thing and something that I caution people on very frequently now if you have BPH and you're taking hosin and you're thinking about taking finasteride there's one other medication a lot of people don't know about that can help you with your symptoms and that's tadalfil so the medication we talked about earlier you can actually take a low dose 5 milligrams every single day and that also helps relax the prostate and allow urine to flow better so for men who
have both an enlarged prostate and some struggles with erections actually taking a low dose of talil may be able to knock two birds with one stone thank you guys so much for joining me today if you want to get the rest of the questions that I answered on today's AMA make sure to sign up for our membership at renam malik. supercast dcom where you can access our AMA and ask questions there you can also get access to early releases of the podcast as well as transcripts from the podcast so make sure to check that out
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