Interview with Dr. Mohit Khera, Sex and Infertility Expert
Who Is Mohit and What Does He Do?
Dr. Mohit Khera is a urologist specializing in male and female sexual dysfunction, testosterone replacement therapy, and infertility. With 17 years of experience as a professor at Baylor College of Medicine in Houston, he focuses on improving sexual health through research and clinical practice. His work emphasizes the importance of both partners in addressing sexual dysfunction, highlighting that sexual health is a couple's issue.
What Is a Sexspan and Why Does It Matter?
Sex span is a term that refers to the duration of time an individual can engage in satisfying sexual activity. It parallels the concepts of lifespan and health span, where lifespan represents how long one lives, and health span represents how long one lives in good health. Dr. Khera believes that maximizing sex span is crucial for overall well-being and relationship satisfaction.
Is It Possible to Make Sexspan Last as Long as Lifespan?
Dr. Khera argues that it is indeed possible to extend one's sex span to match lifespan by focusing on four key pillars: diet, exercise, sleep, and stress reduction. These lifestyle factors can significantly enhance both sexual function and overall health. Hormonal balance, particularly testosterone levels, also plays a crucial role in maintaining a healthy sex span.
Mohit's Professional Experience and the People He's Worked With
Dr. Khera completed his residency in 2006, followed by a fellowship in men's health. Since then, he has been dedicated to research in sexual medicine, overseeing a clinical practice where he sees around 150 patients weekly. His experience ranges from treating erectile dysfunction to infertility, and he also works with veterans, reflecting his commitment to diverse patient populations.
The Most Popular Things People Ask Mohit and Why They Come to See Him
Patients often come to Dr. Khera with concerns about erectile dysfunction and low libido. They may express feelings of inadequacy or frustration regarding their sexual health. Common inquiries include questions about the effectiveness of medications and how to improve sexual performance. Dr. Khera emphasizes the importance of understanding the psychological components behind these conditions.
Most Common Reason for Low Libido: How Much of It Is Related to Lack of Compatibility?
Low libido can stem from various factors, including hormonal imbalances, lifestyle choices, and psychological issues. Compatibility between partners plays a significant role; if one partner feels disconnected or unsupported, it can lead to decreased sexual desire. Dr. Khera stresses the need for open communication and mutual support in relationships to address these issues effectively.
What Is Libido?
Libido is defined as the desire to engage in sexual activity. It is influenced by a complex interplay of hormones, neurotransmitters, and psychological factors. Both men and women can experience variations in libido, and understanding these fluctuations is crucial for addressing sexual health concerns.
Connection Between Erectile Dysfunction and Low Libido
Erectile dysfunction (ED) and low libido are closely linked. When men experience ED, it can lead to anxiety and avoidance of sexual activity, which further reduces libido. Dr. Khera notes that improving erectile function can often help restore sexual desire, creating a positive feedback loop that enhances both physical and emotional intimacy.
What Are the Side Effects of ED Pills?
ED medications, such as Cialis and Viagra, can have side effects, although they are generally well-tolerated. Common side effects include headaches, back pain, and nasal congestion. Dr. Khera emphasizes the importance of consulting a healthcare professional to address any concerns regarding these medications.
The Biggest Side Effect of Cialis
The most notable side effect of Cialis is back pain, which can occur in some users. While it is typically mild and temporary, it can be bothersome for those affected. Dr. Khera advises patients to weigh the benefits of the medication against any potential side effects they may experience.
Who Shouldn't Take Cialis?
Cialis is contraindicated for individuals taking nitrates for chest pain, as it can cause a dangerous drop in blood pressure. Additionally, those with certain cardiac conditions or severe liver problems should consult their physician before using this medication. Dr. Khera emphasizes the importance of a thorough medical evaluation before starting any ED treatment.
Treatment for Sexual Dysfunction in Women
Women experiencing sexual dysfunction have limited treatment options compared to men. While there are FDA-approved medications, such as Addyi and Vyleesi, the research and funding for female sexual health are significantly lacking. Dr. Khera advocates for increased awareness and better treatment options for women facing these challenges.
Connection Between Stress and Dopamine
Stress can negatively impact dopamine levels, leading to decreased libido and sexual function. Dr. Khera explains that high cortisol levels associated with stress can inhibit the body's ability to experience pleasure and arousal. It's essential to manage stress effectively to maintain a healthy sexual desire.
Types of Activities That Raise Dopamine Levels
Activities that can boost dopamine levels include regular exercise, engaging in hobbies, and spending quality time with loved ones. Dr. Khera emphasizes the importance of lifestyle choices in maintaining a healthy balance of neurotransmitters, which can positively influence libido and overall sexual health.
How Much Does Pornography Contribute to Low Libido?
The impact of pornography on libido is complex and somewhat controversial. Dr. Khera notes that excessive consumption of pornography can lead to unrealistic expectations regarding sexual experiences, potentially contributing to erectile dysfunction and low libido. He often encourages patients to evaluate their pornography use and consider cutting back to improve their sexual health.
Why Do People Have Less Sex Nowadays?
Recent statistics indicate a troubling trend: younger adults, particularly men aged 18 to 24, are reporting significantly less sexual activity. This shift can be attributed to a combination of factors. The rise of erectile dysfunction (ED) and sexual dysfunction is notable, heavily linked to lifestyle choices, such as obesity and diabetes, which have become pandemic issues worldwide.
As obesity rates soar, testosterone levels decline, adversely affecting sexual desire and function. The relationship between these health issues and sexual activity is clear; as physical health deteriorates, so too does sexual health. Furthermore, societal changes play a role. With increased reliance on technology for social interaction, many find themselves less engaged in real-life relationships, leading to decreased sexual encounters.
Role of Pornography in Shifting Sexual Behaviors
Pornography has emerged as a significant factor influencing sexual behaviors and attitudes. Studies show that regular consumption of porn can lead to unrealistic expectations regarding sexual performance and intimacy. This can create a disconnect between partners, as individuals may struggle to find satisfaction in real-life relationships compared to the curated experiences they view online.
Moreover, the accessibility of pornography can lead to a reliance on it for sexual gratification, reducing the motivation to pursue intimate connections with partners. As relationships become more virtual, the traditional dynamics of courtship and intimacy are altered, leading to a decrease in sexual activity.
Connection Between Obesity and Sexual Dysfunction
Obesity is a major contributor to sexual dysfunction, particularly in men. The physiological effects of excess body fat can lead to lower testosterone levels, which are critical for libido and erectile function. Fat cells produce aromatase, an enzyme that converts testosterone into estrogen, further diminishing testosterone levels.
This cycle creates a feedback loop: as testosterone drops, libido decreases, leading to reduced sexual activity. The alarming rise in obesity rates, especially among adolescents, signals a potential future crisis in sexual health. Young people starting with low testosterone levels are likely to face fertility challenges later in life.
Losing Weight Boosts Testosterone Levels
Weight loss can have a profound effect on testosterone levels. Research indicates that losing as little as 10% of body weight can result in a significant increase in testosterone levels. This relationship is bidirectional; as individuals gain weight, testosterone levels drop, leading to a cycle of declining sexual health.
Bariatric surgery has shown particularly promising results in boosting testosterone levels post-surgery. Individuals who undergo this procedure often see a remarkable improvement in their hormonal balance, highlighting the importance of maintaining a healthy weight for optimal sexual function.
Impact of Testosterone Therapy on Sexual Activity
Testosterone therapy can be a game-changer for men suffering from low testosterone and related sexual dysfunction. By restoring testosterone levels, many patients report significant improvements in libido, erectile function, and overall sexual satisfaction. However, it's essential to approach therapy cautiously, particularly in younger patients who may wish to preserve fertility.
For older men, testosterone therapy can lead to substantial benefits, including increased muscle mass, improved mood, and enhanced sexual health. It's crucial for individuals considering this therapy to consult with healthcare professionals to determine the best approach tailored to their specific needs.
Should Someone Like Steven Be Taking Testosterone?
For individuals like Steven, who experience symptoms of low testosterone, it’s vital to assess both hormonal levels and associated symptoms. If low testosterone correlates with significant symptoms such as low energy, decreased libido, and erectile dysfunction, testosterone therapy may be warranted. However, younger individuals should explore lifestyle modifications and natural methods to increase testosterone before considering therapy.
Ultimately, a comprehensive evaluation by a healthcare provider can help determine the most appropriate course of action, balancing the benefits of therapy against potential risks, including impacts on fertility.
Testosterone Therapy in Women
While testosterone is often associated with male health, it plays a crucial role in women's sexual health as well. Women produce testosterone, which impacts libido, muscle mass, and overall well-being. However, the availability of testosterone therapy for women is limited compared to men.
Many women experience significant improvements in sexual function and quality of life when testosterone levels are optimized. Despite the lack of FDA-approved testosterone therapies for women in the U.S., off-label use of existing treatments shows promise in enhancing sexual health.
HRT for Women
Hormone replacement therapy (HRT) for women typically focuses on estrogen and progesterone, especially during menopause. However, incorporating testosterone into HRT protocols can enhance benefits, particularly in terms of libido and overall vitality.
Women experiencing hormonal imbalances should discuss the possibility of integrating testosterone into their HRT regimen with their healthcare provider, as it can lead to significant improvements in sexual health and quality of life.
The Decline in Testosterone
The decline in testosterone levels among men over recent decades is alarming. Studies indicate a decrease of nearly 300 nanograms per deciliter over the past 40 years. Factors contributing to this decline include increased obesity rates, sedentary lifestyles, and exposure to environmental toxins.
This decline has implications not just for sexual health but also for overall well-being, including increased risks of cardiovascular disease, diabetes, and mental health issues. Addressing these lifestyle factors is crucial for reversing this trend and promoting better health outcomes.
What Lifestyle Changes Should We Make to Increase Fertility?
Improving fertility requires a holistic approach to health. Key lifestyle changes include adopting a balanced diet rich in whole foods, maintaining a healthy weight, and engaging in regular physical activity. These changes can enhance hormonal balance and improve overall reproductive health.
Additionally, managing stress through mindfulness practices and ensuring adequate sleep can further support fertility. Couples trying to conceive should prioritize these lifestyle factors to optimize their chances of success.
If a Couple Came to You With Sexual Problems, What Would You Focus on Naturally?
When addressing sexual problems in couples, the focus should be on lifestyle modifications before resorting to medications. Key areas include diet, exercise, sleep, and stress management. A Mediterranean diet, rich in fruits, vegetables, and healthy fats, can improve sexual function.
Regular exercise, particularly cardiovascular activities, can enhance blood flow and improve erectile function. Additionally, ensuring 7 to 8 hours of quality sleep can significantly impact sexual health and overall well-being.
40% of Men at 40 Will Have ED
The statistic that 40% of men at the age of 40 will experience erectile dysfunction is staggering. This prevalence increases with age, highlighting the importance of addressing sexual health earlier rather than later. Men often hesitate to discuss these issues, leading to untreated conditions that can impact their quality of life.
By raising awareness and reducing stigma around sexual dysfunction, more men may seek help and receive appropriate interventions, improving their sexual health and overall well-being.
The Stigma Around ED
The stigma surrounding erectile dysfunction is profound. Many men feel embarrassed discussing such a personal issue, often viewing it as a sign of weakness. This stigma can prevent them from seeking help, leading to untreated conditions that affect their sexual relationships and mental health.
It’s crucial to destigmatize ED and promote open conversations about sexual health. Education and awareness can empower men to seek the support they need, leading to better outcomes.
Photo by Personal Experiences With Sexual Dysfunction
Many individuals experience sexual dysfunction at some point in their lives, often leading to feelings of anxiety and frustration. Understanding that sexual dysfunction can be temporary and influenced by various factors, including stress and lifestyle, is essential.
Sharing personal experiences can help normalize these feelings and encourage others to seek support. It’s vital for individuals to realize they are not alone and that effective treatments and lifestyle changes can significantly improve their sexual health.
The Impact of Kids on Sex Lives
Having children can significantly affect a couple's sex life. The increased responsibilities and stress associated with parenting often lead to a decline in sexual intimacy. Many couples report that their sexual activity diminishes in the months following the birth of a child, as they navigate the challenges of new parenthood.
It's essential for couples to prioritize their relationship amidst the demands of parenting. Engaging in regular date nights or short getaways can help rekindle intimacy and strengthen their bond.
Premature Ejaculation
Premature ejaculation is a significant concern for many men, affecting approximately 30% of the male population globally. This condition can be classified as either lifelong or acquired. Lifelong premature ejaculation refers to a consistent pattern since the onset of sexual activity, while acquired refers to a recent change in ejaculatory control.
The definition of premature ejaculation has evolved, with current standards indicating that ejaculation occurring in less than two minutes after penetration constitutes the condition. However, it is essential to consider whether the individual is bothered by this issue. If a man ejaculates quickly but feels satisfied with his sexual experiences, there may be no need for intervention.
Interestingly, the average time it takes for men to ejaculate in the United States is around 5.4 minutes, while women typically take about 13.4 minutes to reach orgasm. This discrepancy highlights the importance of addressing premature ejaculation, as it can be a source of anxiety and dissatisfaction in relationships.
Despite the prevalence of this condition, only about 9% of men seek treatment. This lack of action can lead to emotional distress and relationship problems. Treatment options include sex therapy, which focuses on techniques to delay ejaculation, such as the start-stop and squeeze techniques. While many men prefer a quick pharmaceutical solution, sex therapy offers a more sustainable approach.
Topical desensitizing sprays and certain antidepressants can also be effective in managing premature ejaculation. These treatments can help increase the time to ejaculation, allowing for more satisfying sexual encounters.
Is Testosterone Dangerous?
The perception of testosterone as dangerous has been a longstanding concern in the medical community. Historically, many believed that testosterone therapy could lead to severe health risks, including heart attacks and prostate cancer. However, recent research, particularly the Traverse trial, has challenged these assumptions.
In this landmark study involving over 5,200 patients, researchers found no significant increase in cardiovascular events associated with testosterone therapy. Additionally, the study revealed no correlation between testosterone and an increased risk of prostate cancer or worsening urinary symptoms, which had been common fears among patients and healthcare providers alike.
With these findings, it is crucial for men considering testosterone therapy to consult with healthcare professionals to evaluate their individual risks and benefits. Testosterone therapy can provide significant improvements in quality of life, including enhanced libido, energy levels, and overall well-being.
Will Testosterone Injections Reduce My Lifespan?
The concern about testosterone injections and their potential impact on lifespan is valid but often misunderstood. Research suggests that low testosterone levels can be detrimental to health, potentially leading to a shorter lifespan. In contrast, appropriately administered testosterone therapy can improve various health markers and enhance quality of life.
It's essential to differentiate between therapeutic testosterone levels and the super physiological doses often used by athletes and bodybuilders. Therapeutic doses aim to restore testosterone to normal ranges, which can result in improved physical health, mood, and sexual function.
Men considering testosterone therapy should undergo thorough evaluations to determine their testosterone levels and any underlying conditions. For those experiencing symptoms of low testosterone, such as fatigue, reduced libido, and increased body fat, therapy can be a beneficial option.
Links Between Depression and Testosterone
The relationship between testosterone levels and depression is complex and significant. Research indicates that men with low testosterone levels are more likely to experience depressive symptoms. In fact, a study involving nearly 850 patients found that about 92% of men with low testosterone reported some degree of depression.
When these individuals underwent testosterone therapy, there was a dramatic reduction in depressive symptoms, with rates dropping from 17% severe depression to just 2%. While testosterone therapy should not be seen as a primary treatment for major depressive disorder, it can play a supportive role in managing depression in men with low testosterone levels.
Therefore, it is crucial for healthcare providers to evaluate testosterone levels in men presenting with depressive symptoms, as addressing hormonal imbalances could lead to significant improvements in mental health and overall quality of life.
The Importance of Communication for Sex
Effective communication is fundamental to healthy sexual relationships. Dr. Khera emphasizes that many men avoid discussing issues like erectile dysfunction (ED) with their partners, leading to a cycle of silence and dissatisfaction. In fact, only 44% of men experiencing ED communicate their struggles to their partners.
Open dialogue about sexual health issues can alleviate feelings of blame and rejection. Couples should prioritize creating a safe space for discussing their sexual experiences, desires, and concerns. By fostering communication, partners can better understand each other's needs and work collaboratively to enhance intimacy.
Establishing regular check-ins about sexual health can help normalize these conversations, leading to improved satisfaction and emotional connection within the relationship.
Improving Sexual Dysfunction in Men and Women
Addressing sexual dysfunction requires a comprehensive approach tailored to the unique needs of both men and women. For men, treatment options may include testosterone replacement therapy, oral medications for ED, and psychological support for underlying issues. Women, on the other hand, often face more limited options, with FDA-approved treatments for female sexual dysfunction being scarce.
Dr. Khera advocates for increased awareness and research into female sexual health, emphasizing the importance of local estrogen therapy for postmenopausal women. This therapy can alleviate symptoms of vaginal atrophy, reducing pain during intercourse and improving overall sexual satisfaction.
Both partners should engage in discussions about lifestyle modifications, such as exercise, diet, and stress management, which can significantly impact sexual function. By approaching sexual health as a shared responsibility, couples can enhance their intimacy and overall relationship satisfaction.
Pain During Sex for Women
Pain during intercourse, known as dyspareunia, is a common issue for many women, particularly postmenopausal women experiencing vaginal atrophy due to decreased estrogen levels. This atrophy can lead to thinner vaginal walls, making intercourse uncomfortable or painful.
Local estrogen therapy can be a game-changer for these women, helping to restore vaginal health and reduce pain. Implementing this treatment can lead to improvements in sexual function and an overall increase in quality of life.
Additionally, younger women may experience pain during sex for various reasons, including vaginismus or other pelvic floor disorders. Addressing these concerns with a healthcare provider can lead to effective treatment options, allowing women to enjoy satisfying sexual experiences.
How Do We Improve Communication in the Bedroom?
Improving communication in the bedroom requires intentional effort from both partners. Couples should establish regular times to discuss their sexual relationship, focusing on desires, boundaries, and any concerns they may have. Creating an environment of trust and openness can help partners feel more comfortable sharing their thoughts and feelings.
Using "I" statements can also be beneficial, allowing individuals to express their needs without placing blame on their partner. For example, saying "I feel more connected when we take time for intimacy" can foster a more positive dialogue.
Couples may also benefit from seeking guidance from a sex therapist, who can provide strategies for enhancing communication and intimacy. These professionals can help partners navigate difficult conversations and improve their overall sexual relationship.
Are There Any Risks to Vibrators?
The use of vibrators and other sexual wellness devices can enhance sexual experiences for both men and women. However, concerns about potential risks, such as desensitization or reliance on these devices for arousal, have been raised. Dr. Khera reassures that studies indicate vibrators can actually improve sexual satisfaction and intimacy when used as a tool for exploration and communication between partners.
By openly discussing preferences and experiences with vibrators, couples can deepen their understanding of each other's desires, leading to more fulfilling sexual encounters. Rather than detracting from intimacy, these devices can serve as a valuable addition to a couple's sexual repertoire.
Abnormal Curvature of the Penis
Peyronie's disease, characterized by an abnormal curvature of the penis, affects approximately 9% of men globally. This condition can lead to significant psychological distress and relationship difficulties. If the curvature exceeds 60 degrees, it can hinder sexual intercourse, causing many men to suffer in silence.
Fortunately, there are treatment options available, including FDA-approved injections that can help break down the plaque causing the curvature. Surgical interventions are also options for more severe cases, allowing men to regain both physical and emotional comfort.
Raising awareness about Peyronie's disease is crucial, as many men may not realize that effective treatments exist. Encouraging open discussions about this condition can lead to more men seeking help and finding relief.
Cures for ED, Not Pills
As awareness of erectile dysfunction (ED) increases, men are seeking more comprehensive solutions beyond traditional medications. The emphasis is shifting towards lifestyle changes, such as improving diet, increasing physical activity, and managing stress, which can lead to significant improvements in sexual health.
Emerging therapies, such as shock wave therapy and regenerative treatments like stem cells and PRP (platelet-rich plasma), show promise in addressing the underlying causes of ED. These innovative approaches aim to enhance blood flow and promote tissue healing, offering potential cures rather than temporary fixes.
Men are encouraged to explore these options and discuss them with their healthcare providers, as they may offer long-lasting solutions to erectile dysfunction.
The Role Trauma Plays in Sexual Dysfunction
Trauma, whether physical or emotional, can significantly impact an individual's sexual health. Many patients may hesitate to disclose past trauma during initial consultations, but it often emerges during therapy sessions with specialists. Understanding the role of trauma is essential in addressing sexual dysfunction effectively.
Healthcare providers should create a safe space for patients to discuss their experiences. By acknowledging and addressing trauma, individuals can begin to heal and improve their sexual relationships. Incorporating therapy into treatment plans can help patients navigate the complex emotions associated with trauma and work towards recovery.
Erection Devices
Erection devices, such as vacuum erection devices (VEDs), can be an effective non-invasive treatment for men experiencing erectile dysfunction. These devices create a vacuum around the penis, drawing blood into the erectile tissue and facilitating an erection.
While some men may feel hesitant to use such devices, studies show high satisfaction rates among users. These devices can provide a reliable solution for men who may not respond to oral medications or prefer not to use them.
Educating patients about the effectiveness and safety of erection devices can empower them to take charge of their sexual health and explore alternative treatment options.
Is There Anything You Cannot Explain?
In the field of medicine, there are often cases that remain unexplained despite thorough investigation. Dr. Khera notes that many patients present with idiopathic conditions, particularly in areas such as fertility, where the causes of infertility remain unknown in a significant percentage of cases.
While science continues to advance, there are still many mysteries within human health that challenge even the most experienced practitioners. Acknowledging these uncertainties can foster a deeper understanding of the complexities of sexual health and encourage ongoing research and exploration.
FAQ
What are the common causes of sexual dysfunction?
Sexual dysfunction can result from a variety of factors, including hormonal imbalances, psychological issues, lifestyle choices, and medical conditions. Open communication between partners and with healthcare providers is essential to identify and address these underlying causes.
How can lifestyle changes improve sexual health?
Adopting a healthy lifestyle that includes regular exercise, a balanced diet, stress management, and sufficient sleep can significantly enhance sexual health. These changes can improve hormonal balance and overall well-being.
Is it normal to experience changes in libido as I age?
Yes, it is common for libido to fluctuate with age due to hormonal changes, physical health, and psychological factors. However, significant changes that cause distress should be discussed with a healthcare provider.
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