Speaker 1: Perry.
Speaker 2: You know, I'm not sure if people know this, but
Speaker 2: you and I we went to college together and we
Speaker 2: were like, like we knew each other, we were acquaintances.
Speaker 2: We dated each other's roommates in various Yeah, yeah, correct.
Speaker 2: Guess if you had told me at that time, like
Speaker 2: one day you and Francis Perry Wilson the Third will
Speaker 2: do a podcast about sexual dessert like I would have
Speaker 2: told you you were crazy person. I do not have
Speaker 2: this on my Bango card.
Speaker 3: That's that's funny because I, you know, for the past
Speaker 3: twenty five years, have been thinking to myself, you know,
Speaker 3: someday Emily and I are going to sit down talk
Speaker 3: about sexual dysfunction together. So you know, but that's whatever.
Speaker 3: Different strokes for different folks.
Speaker 2: No strokes, It's totally right. So I'm excited and somewhat
Speaker 2: apprehensive to discuss this complicated and nuanced topic.
Speaker 3: Do we need to say that, although this is an
Speaker 3: explicit podcast, it is going to acknowledge the existence of
Speaker 3: sex and sexual function, and if you're listening with your kids,
Speaker 3: be aware of that.
Speaker 1: Absolutely, this is probably not the episode for the.
Speaker 3: Car Let's do it, Let's fall in love?
Speaker 2: Okay, I'm Emily Oster. I'm an economist and a data expert.
Speaker 3: And I'm Perry Wilson. I'm a medical doctor.
Speaker 2: It's Thursday, June eleventh, twenty twenty six. And this is
Speaker 2: wellness actually.
Speaker 3: Because you're getting a staggering amount of health and wellness
Speaker 3: information nowadays from every source imaginable, and some of it
Speaker 3: is awesome and some.
Speaker 2: Of it is well actually both Fortunately we are both
Speaker 2: people who know how to read studies, how to parse
Speaker 2: the data, and can tell you what's worth thinking about
Speaker 2: and what you can safely ignore.
Speaker 3: But before we dig in, a note that this podcast
Speaker 3: is for educational purposes and should not be construed as
Speaker 3: medical advice. We don't know your unique situation, so talk
Speaker 3: to your doctor for personal health decisions.
Speaker 2: This week, we're asking what's the deal with hypoactive sexual
Speaker 2: desired disorder? Perry and I will give the official smasher pass,
Speaker 2: and then we'll get to your question of the week.
Speaker 1: I like the idea that we're going to smasher pass
Speaker 1: a disorder about sex.
Speaker 2: That's fine, Okay, we're good, but first let's do the
Speaker 2: health news roundup after the break. Now for the health
Speaker 2: news of the week, Perry, there was an American Diabetes
Speaker 2: Association conference this week and police removed people for handing
Speaker 2: out an editorial. This is not something that typically happens
Speaker 2: at our conferences. Can you please enlighten me.
Speaker 3: Yeah. Traditionally at medical conferences, people only get escorted out
Speaker 3: for being just too drunk or hungover from the night before.
Speaker 3: So this is definitely outside the box. The American Diabetes Association,
Speaker 3: the largest diabetes conference in the world. What was happening.
Speaker 3: Was scheduled to speak was our friend, doctor j. Badicharia,
Speaker 3: the head of the NIH. Now the backstory actually is
Speaker 3: that he had canceled. I don't think the people who
Speaker 3: were handing out the editorial knew that, and he he
Speaker 3: was going to send a deputy from the NIH. But
Speaker 3: the plan was doctor J was going to speak, and
Speaker 3: so several members of the ADA were handing out a
Speaker 3: recent editorial which criticized NIH policies and the Trump administration
Speaker 3: in terms of their medical science. So this editorial was
Speaker 3: I mean, this wasn't just like some random editorial. This
Speaker 3: was an editorial in Diabetes Care, which is the flagship
Speaker 3: journal of the American Diabetes Association, and it criticized drastic
Speaker 3: cuts in funding opportunities from the NIH, this thing where
Speaker 3: they're doing multi year grant forwarding, which is limiting the
Speaker 3: amounts of grants that can be funded at any given time,
Speaker 3: decimation of the NIH workforce, promotion of pseudoscience conspiracy theories,
Speaker 3: and I think maybe most importantly, the politicization of funding decisions,
Speaker 3: taking funding decisions out of the hands of scientific peer review. Now,
Speaker 3: these people who were escorted out by the police were
Speaker 3: not Rando's. One of them was Stephen Kahn. He's a
Speaker 3: professor of medicine at the University of Washington and the
Speaker 3: editor in chief of Diabetes Care as well as a
Speaker 3: co author of that editorial, So he's handing out his
Speaker 3: own work. He's the editor in chief of the most
Speaker 3: important diabetes journal in America. The ADA did come out
Speaker 3: with a statement saying, look, this isn't political, but people
Speaker 3: are not allowed to hand out materials like you can't
Speaker 3: disseminate materials at our conference, which I like look somewhat
Speaker 3: askance at because people kind of are handing out materials
Speaker 3: all the time, like handing on editorials.
Speaker 2: Come on, yeah, I mean, it feels to me like
Speaker 2: there's there's a letter of the law, which perhaps says
Speaker 2: you can't hand out materials. But my guess is that
Speaker 2: frequently people are handing out a variety of random materials
Speaker 2: and there are no consequences for doing that. So it's
Speaker 2: sort of obviously a political obviously a political decision.
Speaker 1: Yeah, I'm really sure what is accomplish What is a
Speaker 1: I always wondering these things. What is accomplished by this?
Speaker 2: Surely there's more attention to this editorial now that this
Speaker 2: news has been covering than Oh, I mean if you
Speaker 2: just let them give out this editorial to a bunch
Speaker 2: of people who probably already saw it.
Speaker 3: Yeah, yeah, yeah, exactly. It's always sort of like it's
Speaker 3: the stressand effect, where you know, you draw attention to
Speaker 3: something now can never be lost. But actually this was
Speaker 3: somewhat brilliant on the part of these editorialists. I think
Speaker 3: the conferences, particularly scientific conferences, need to think a little
Speaker 3: bit more carefully about who they're inviting, particularly if they
Speaker 3: don't want to engender any kind of backlash. You know,
Speaker 3: scientific conferences like to have famous people giving you addresses
Speaker 3: and having leaders of scientific organizations like the NIH is
Speaker 3: a long and storied part of that. But in an
Speaker 3: era where the NIH has become somewhat hostile to the
Speaker 3: people in the room who are, you know, trying to
Speaker 3: get funding and get grants in advanced science. The committees
Speaker 3: that are deciding on these speakers might want to think
Speaker 3: just reasonably about that. Not that they shouldn't have leaders
Speaker 3: of the NIH, but they should be prepared that there's
Speaker 3: going to be some tough questions and pushback from the audience.
Speaker 2: Yeah, and I mean, I think for me it's that
Speaker 2: it's I would definitely say you should be open to
Speaker 2: having J. Bodicheria come and talk at your conference. He's
Speaker 2: ahead of the NIH. Whether you agree with that or not,
Speaker 2: that's his job. This is an important organization. But you
Speaker 2: have to understand some people are not going to like
Speaker 2: that and be prepared for whatever is the consequence of
Speaker 2: that activity. And I guess here they prepared by having
Speaker 2: the police, which is perhaps not the take I would have,
Speaker 2: you know, used not the right move.
Speaker 3: All right, let's move on. There's a paper making the
Speaker 3: rounds now that is stressing me out even more about
Speaker 3: my sleep than I was before. This is a paper
Speaker 3: appearing in Nature which says that there is a U
Speaker 3: shaped curve between the time you spend a sleep and
Speaker 3: various important clinical outcomes. So like, if you sleep too little,
Speaker 3: it's bad, if you sleep too much, it's bad. You
Speaker 3: want to be in that sweet spot of like sixt
Speaker 3: eight hours. Emily, this is keeping me up at night.
Speaker 3: What do you think?
Speaker 1: I hate this literature?
Speaker 2: Okay, so first of all, I want to say sleep
Speaker 2: is super important, and if you want to know some
Speaker 2: science about sleep, you can listen to next week's episode
Speaker 2: where we discuss sleep. Yeah, however, this particular kind of
Speaker 2: finding which is not new, like these guys have a
Speaker 2: different set of outcomes they're measuring. It's things about how
Speaker 2: well you're functioning, your organs are or whatever. But there
Speaker 2: are many parts of this, many pieces of literature that
Speaker 2: will show this you shaped relationship, and people take from
Speaker 2: that like, Okay, there's an optimal amount of the sleep,
Speaker 2: which is in their case, like between six point five
Speaker 2: and like seven point eight four.
Speaker 1: Hours or something like that.
Speaker 2: The problem is people who sleep a lot are generally sick.
Speaker 2: So if you if there's somebody who's sleeping for eleven
Speaker 2: hours a day, there's something else that's wrong.
Speaker 3: For the most part, or my teenager can one hundred
Speaker 3: percent of this, but that's not what you're talking about, right.
Speaker 2: But like, for if you take an adult who is
Speaker 2: sleeping for eleven hours a day on average, that person
Speaker 2: has something else going on. It could be mental health,
Speaker 2: it could be physical health, you know, so to say
Speaker 2: like it's unhealth.
Speaker 1: That's different from saying if you you a person.
Speaker 2: Who typically sleeps seven hours, if you decided to sleep
Speaker 2: eleven hours, would that be bad for you? That is
Speaker 2: not what this data says. You probably couldn't sleep eleven hours.
Speaker 3: Yeah, But the.
Speaker 2: Fact is the people who sleep eleven hours or something
Speaker 2: else going on. And similarly, people who are sleeping three
Speaker 2: or four hours a night generally have a lot of
Speaker 2: other things that are going on. That's more likely to
Speaker 2: be shift workers. People are you know, generally have fewer resources.
Speaker 2: There's like other things that are happening that made people
Speaker 2: sleep less. So it's like this complicated thing where the
Speaker 2: paper sort of wants you to think that this is
Speaker 2: causal and it wants people to think, you know, you
Speaker 2: have to get exactly this amount and if you go
Speaker 2: outside of it, then you're going to die.
Speaker 1: But that's really not what the data says.
Speaker 2: It's much more that we're identifying different groups of people
Speaker 2: with other different different things.
Speaker 1: Now, having said that, I think sleep is.
Speaker 2: Very important, so I think people should should prioritize sleep.
Speaker 2: But like, my brother sent me this article and it
Speaker 2: was like the headline is like, is like you don't
Speaker 2: really need eight hours of sleep, And he was like,
Speaker 2: oh my god, I'm getting eight hours of sleep, Like
Speaker 2: is that bad?
Speaker 4: Yeah?
Speaker 3: Yeah, get the sleep. You've got to give your body
Speaker 3: the opportunity to sleep the amount that your body wants
Speaker 3: to sleep, basically, like, that's that's great for you actually.
Speaker 2: And for most healthy adults, if you give your body
Speaker 2: the opportunity to sleep, you will generally sleep something up
Speaker 2: like seven to seven half hours. That is what a
Speaker 2: typical adult will sleep given the opportunity in a sleep lab.
Speaker 2: So anyway for sleeping eleven hours a day is probably
Speaker 2: because something else is wrong, that's all.
Speaker 1: Okay. I hate you shaped things.
Speaker 2: It's like I hate I hate so, I hate you
Speaker 2: shapes in research. It just drives me nuts. It's like
Speaker 2: one of my bugget boots.
Speaker 1: Okay, duly noted. So don't bring me any.
Speaker 3: Bringing you exclusively U shaped findings for that. What about
Speaker 3: BMI and death? Okay, do that right?
Speaker 4: Yeah?
Speaker 2: Okay, all right, so let's talk about what's going on
Speaker 2: with HIV in South Africa. There is some very promising
Speaker 2: new data about PREP shots and their effects on transmission.
Speaker 2: Although in the US we don't talk as much about
Speaker 2: HIV as as we once did in much of Sub
Speaker 2: Aheran Africa, this is still as tremendously important problems. About
Speaker 2: eight million people were HIV positive in South Africa. A
Speaker 2: lot of the new infections are in adult girls.
Speaker 1: What is the good data here?
Speaker 3: Yeah, I mean this was really encouraging news coming from NPR,
Speaker 3: and it's about PREP so pre exposure profile axis for HIV.
Speaker 3: So these are medications you take when you don't have
Speaker 3: HIV but you're in a high risk environment and South Africa,
Speaker 3: as you point out, is very high risk. There are
Speaker 3: eight million people living with HIV in South Africa and
Speaker 3: there's about a thousand new infections per week, almost entirely
Speaker 3: unfortunately in young and adolescent girls and women. And you know,
Speaker 3: pre exposure profile axis typically is an oral medication that
Speaker 3: you either take daily, some can be less frequent than that.
Speaker 3: But what South Africa has started using is every six
Speaker 3: month injection called length of Year, and this essentially eliminates
Speaker 3: the risk of transmission of HIV. So for those six months,
Speaker 3: we're wardless of what's happening to people. And of course,
Speaker 3: you know, I should say that a lot of these
Speaker 3: adolescent women are in exploitative relationships like this is yeah,
Speaker 3: and this is bad independent of the transmission of HIV,
Speaker 3: but obviously transmission of HIV makes the situation even worse.
Speaker 3: And for the six months that you after the injection,
Speaker 3: you essentially like there's basically no transmission. This as a
Speaker 3: public health intervention is just way easier, right, You have
Speaker 3: to get You've got to get a hold of these
Speaker 3: these people who are at risk, you know, twice a year,
Speaker 3: as opposed to getting them drugs much more frequently than that.
Speaker 3: The big problem now is one of funding.
Speaker 2: Honestly, there's the drugs are very very expensive.
Speaker 3: It's being funded right now by the Global Fund out
Speaker 3: of the un like the Global Fund to Fight AIDS,
Speaker 3: and you know, funding there is unfortunately limited, But there
Speaker 3: are a large number of philanthropies that do have an
Speaker 3: interest in this area. So to the extent that we
Speaker 3: can draw attention to this like relatively successful program and
Speaker 3: scale it up, I think would be ideal and of
Speaker 3: course if people, if people feel like donating, you can
Speaker 3: donate to the Global Funds Fight AIDS directly if that's
Speaker 3: a choice.
Speaker 2: Yet another reason why it was very unfortunate that they
Speaker 2: cut all the funding for PEPFAR, which has been one
Speaker 2: of our most successful global health interventions over the past
Speaker 2: twenty years. It is on that note, that's it for
Speaker 2: the health news of the week, and after the break,
Speaker 2: we'll ask what's the deal with hypoactive sexual desire disorder?
Speaker 3: All right, we are back. We're asking what's the deal
Speaker 3: with hypoactive sexual desire disorder? Okay, I'm lee this is
Speaker 3: one of the topics, maybe not HSDD per se, but
Speaker 3: like sexual activity, sexual function in my age group, in
Speaker 3: my cohort, presumably in your cohort as well, is something
Speaker 3: a lot of people sort of allude to without really
Speaker 3: digging down on. There's a lot of like there's a
Speaker 3: lot of sly comments, like sort of the boomer humor
Speaker 3: stuff that I hear about, you know, like, uh, you know,
Speaker 3: my wife's got a headache, like that kind of thing,
Speaker 3: but no one ever really sits down and compares notes.
Speaker 3: I mean, I think fortunately, but but that's sort of
Speaker 3: what we're here to do, because if something is a
Speaker 3: disorder and it's out there, people might naturally wonder like
Speaker 3: do I have it? What do I have it? And
Speaker 3: I think maybe the place to start before we talk
Speaker 3: about like a disorder of sexual function is what is
Speaker 3: normal here? Like when we think about this, especially you
Speaker 3: know for people our aged, you know, forties kids, that
Speaker 3: kind of thing. You actually have some really interesting data
Speaker 3: on this.
Speaker 2: Yes, I want to start by by I once did
Speaker 2: a really great podcast with Emily Nigoski, who is a
Speaker 2: writer who writes about sex, and I asked the question,
Speaker 2: you know, what's a normal amount of sex?
Speaker 1: And she was like, that is the worst possible question.
Speaker 2: And I came to think that she was right because
Speaker 2: of course, like there is no, no, there's average. I
Speaker 2: can tell you in the data what is the average,
Speaker 2: But the word normal has this like connotation about what
Speaker 2: is appropriate or what you should do, and I think
Speaker 2: that's actually not very helpful in a place where people
Speaker 2: are going to vary in like what makes them happy.
Speaker 2: So I'm going to tell you the average, but I'm
Speaker 2: not going to tell you what's normal.
Speaker 3: I think that is very well said. It doesn't imply
Speaker 3: that if you're less than the average or more than
Speaker 3: the average, that you are per se abnormal or pathological,
Speaker 3: but please go okay.
Speaker 2: So we I get very interested in this question a
Speaker 2: couple of years ago because I talked to a lot
Speaker 2: of parents of young kids and it comes up all
Speaker 2: the time, the question of are people having sex and
Speaker 2: how much are they having And it's a place where
Speaker 2: people just like to have data. So we did this
Speaker 2: big survey of parents. People were very I do a
Speaker 2: lot of surveys actually on my website, and.
Speaker 1: This was by far the most popular.
Speaker 2: So I got twenty six thousand people to report their sexual.
Speaker 3: It's pretty amazing data. It's pretty amazing. It's one of
Speaker 3: the largest studies of its type. Like as I was
Speaker 3: looking at the literature too.
Speaker 2: So you know, the answer is that for parents at least,
Speaker 2: sex varies quite a lot with the age of the
Speaker 2: youngest kid. So in the data, for people with kids
Speaker 2: under a year, the like modal frequency was once to
Speaker 2: twice a month. For people with kids over five years,
Speaker 2: the mode was more like.
Speaker 1: One two times a week.
Speaker 2: There's a reasonable share of people who say that they
Speaker 2: never have sex or less than once a year. It's
Speaker 2: not very high, but it's it's certainly, you know, for
Speaker 2: almost ten percent basically for people with very small children,
Speaker 2: and there are a very small number of people, like
Speaker 2: less than one percent even with older kids, who say
Speaker 2: they have sex every day, So you know, like we're
Speaker 2: kind of if you ask what's the average, it's something
Speaker 2: in the range of.
Speaker 1: Twice a week too, uh, once a month.
Speaker 3: I think one of the really interesting things that was
Speaker 3: in your data was this relationship with age of parents
Speaker 3: and age of kids. So what you found is that
Speaker 3: if you holding the age of kids steady, like, statistically,
Speaker 3: the older the parents were sort of the less frequently
Speaker 3: they would have sex, which kind of makes sense, right
Speaker 3: you get older, like things happen. But then the older
Speaker 3: the kids are, the more often the parents would have sex,
Speaker 3: And of course those are correlated because older parents tend
Speaker 3: to have older children everything. So it's this really complex
Speaker 3: interplay between biology, which is as we get older, like
Speaker 3: the hormones that drive our sex drive decrease, and then
Speaker 3: like logistics, which is like, as our kids get older,
Speaker 3: there's just more opportunity.
Speaker 1: Do you think that's true? This is a different topic.
Speaker 2: I feel like there are some ways in which having
Speaker 2: older children presents less opportunity. Okay, I mean because then
Speaker 2: they could catch like it well anyway.
Speaker 3: Okay, oh no, I think this is a critical thing
Speaker 3: to discuss. And if any of my children are listening
Speaker 3: to this, please turn it off. Turn it off, go
Speaker 3: to bed, Go to bed, stay in your room.
Speaker 2: So one of the things I thought was was interesting,
Speaker 2: which maybe sort of leads into the question of how
Speaker 2: we sort of pathologize this is actually a pretty large
Speaker 2: share of people said that they were not having enough sex,
Speaker 2: not as much as they would want to, right. And
Speaker 2: so even the people who are having sex one to
Speaker 2: two times a week, a little bit forty percent of
Speaker 2: them said they were having somewhat too little or way
Speaker 2: too little sex. As you get to people who are
Speaker 2: having sex a few times a year, almost one hundred
Speaker 2: percent of them say that's not enough. And this for
Speaker 2: me was actually a much more telling piece of the
Speaker 2: of the data than the frequency, because I think if
Speaker 2: you say, you know, we're having sex twice a year
Speaker 2: and that works for us, like that's that feels like enough,
Speaker 2: then it's great. It is more concerning when you have
Speaker 2: almost everyone saying, well, actually i'd love to have more.
Speaker 2: But something else is happening, that's getting in the way. Yeah,
Speaker 2: I and obviously are more likely to say they don't
Speaker 2: they're not having Men would like to have more sex
Speaker 2: than women.
Speaker 3: Oh yeah, when you stratified, when you stratified by sex.
Speaker 3: But many women in your survey, in fact, the majority,
Speaker 3: are also saying, yes, I'd like to have more. So,
Speaker 3: you know, in theory, you've got these couples, right, both
Speaker 3: members of the couple are like, you know, I really
Speaker 3: wish we would have more sex, and yet we don't.
Speaker 2: Yeah, And I mean it was it saying Okay, I'll
Speaker 2: just say one more thing about this, which is that
Speaker 2: people left a lot of comments, like thousands and thousands
Speaker 2: of people left comments, and some of this is just
Speaker 2: I'll just read this because I think it summarizes a
Speaker 2: little bit of how people often feel with little kids.
Speaker 2: It's not that the sex is bad or that I
Speaker 2: don't love my spouse as much. It's just that we're
Speaker 2: both so tired all the time that the sex is
Speaker 2: very bland and feels like something we do quickly just
Speaker 2: for basic maintenance while the kids are temporarily asleep. The
Speaker 2: best analogy I can think of is forcing yourself to
Speaker 2: eat because you know, you should even though you're not
Speaker 2: actually very hungry.
Speaker 3: Okay, that's a little bleak.
Speaker 2: It's bleak, But I think we should come back to
Speaker 2: it later because actually there is some stuff in the
Speaker 2: data suggesting that that actually may not be a terrible
Speaker 2: approach to sex in some cases. So that's probably a
Speaker 2: good place to move into what we actually mean when
Speaker 2: we say hypoactive sexual desire disorder.
Speaker 3: Right, so let me start by saying, we don't mean
Speaker 3: like everyone like sometimes isn't in the mood, right, Like
Speaker 3: that's normal, that's natural. It's not you're you know, you're
Speaker 3: not going to be there all the time. This is
Speaker 3: Hypoactive sexual desire disorder is a clinical disorder, and because
Speaker 3: it's clinical disorder, it now appears in the d s
Speaker 3: M five. So the Diagnostic and Statistical Manual is the
Speaker 3: big book of psychological diagnoses. It's where you find like, oh,
Speaker 3: what do I you know, what criteria do you need
Speaker 3: to fulfill to have major depressive disorder, bipoloy disorder or
Speaker 3: schizophrenia or anything. And as of the fifth edition, which
Speaker 3: is the most recent, HSDD was put in here, although
Speaker 3: in the DSM five they call it female sexual interest
Speaker 3: slash arousal disorder. This actually engendered some controversy, which I'll
Speaker 3: get to in a second, but just to say it,
Speaker 3: in order to be diagnosed with this, you need to
Speaker 3: have decreased or absent three of the following things. Interest
Speaker 3: in sexual activity, sexual erotic thoughts are fantasies, initiation of
Speaker 3: sexual activity or unreceptive to partner's attempts to initiate sexual
Speaker 3: excitement or pleasure. And almost all encounters sexual interest slash
Speaker 3: arousal to erotic cues, genital or non genital sensations during
Speaker 3: sexual activity. It needs to be going on at least
Speaker 3: five months. It needs to not be better explained by
Speaker 3: something else like a medical condition or medications you're taking,
Speaker 3: or stress or the million other things that obviously can
Speaker 3: cause all these things. And here's the kicker for all
Speaker 3: psychological disorders. It has to be causing you significant distress.
Speaker 3: You have to be upset about it.
Speaker 2: So the piece of this that I find a little
Speaker 2: hard in diagnosis is all of these things are kind
Speaker 2: of in the abstract, but most of the time we're
Speaker 2: thinking about sexual behavior in the context of a relationship,
Speaker 2: and so there's actually maybe an important distinction between like
Speaker 2: am I interested in sexual activity or initiation from the
Speaker 2: person who I am have available?
Speaker 1: Or am I interested at all?
Speaker 2: Right, there is an important distinction here, which is would
Speaker 2: you like to have sex with someone or would you
Speaker 2: like to have sex with the person that you can
Speaker 2: have sex with? And those things may not be the same.
Speaker 2: And in principle that seems like quite important distinction, because
Speaker 2: a sexual interest arousal disorder is not a it's not
Speaker 2: a marriage problem. It's not like there's a partnership problem.
Speaker 2: It's supposed to be a thing about your sexual function,
Speaker 2: not about the other person. But it feels almost impossible
Speaker 2: to separate those.
Speaker 3: Yeah, And as I said, there was some controversy about this.
Speaker 3: In two parts number one, the d s M five
Speaker 3: links sexual interest and sexual arousal in the same disorder,
Speaker 3: which is really not the same thing. One is a
Speaker 3: physiologic thing, you know, like arousal is a little clearer
Speaker 3: to document in a man because of penises and direction
Speaker 3: penises and so men have an arousal disorder. Men can
Speaker 3: have impotence, and there's like a drug to there are
Speaker 3: many now drugs to treat that. That's different then interest,
Speaker 3: And it's the same with women. And so the DSM
Speaker 3: did get some criticism for that because those things are separable.
Speaker 3: There are women who are very interested in sex but
Speaker 3: just physically don't become aroused in that way. Lumping these
Speaker 3: together doesn't seem necessarily appropriate. The other controversy is that
Speaker 3: you'll see some people arguing that hyperactive sexual desire disorder
Speaker 3: basically was created to sell drugs, you know, by the
Speaker 3: pharmaceutical industry. And we'll get to what those drugs are
Speaker 3: and their FDA approved and whether or not they work.
Speaker 3: But this is kind of a new thing, and I
Speaker 3: think it's important to tease out, as you say, like
Speaker 3: whether this is truly something inside the woman with hyperactive
Speaker 3: sexual desire disorder, or if it is a result of
Speaker 3: external things, whether that's the relationship, whether that's the result
Speaker 3: of life stress, et cetera.
Speaker 2: Yeah, I mean this feels to me, like, you know,
Speaker 2: if you think about some of the symptoms we associate,
Speaker 2: say with perimenopause or menopause, like baginal dryness, it's like
Speaker 2: a very specific reas in that you might not be
Speaker 2: like that, you might have trouble having sex or not
Speaker 2: find it as pleasurable because of this particular symptom, and
Speaker 2: that is something that deserves treatment. It has various kinds
Speaker 2: of treatment. Is totally different from interest, but is going
Speaker 2: to show up in some sense in the same way like.
Speaker 1: If you are not.
Speaker 2: If you're not going to enjoy this, you're not going
Speaker 2: to want to do it again. Those things are not
Speaker 2: the same, and so you almost want to diagnosi as like, well,
Speaker 2: do you like watching porn?
Speaker 1: Like if you.
Speaker 2: Watch the po like, how do you react to that?
Speaker 2: And that's separate from do you want to do it yourself?
Speaker 1: Or would you enjoy doing this?
Speaker 3: Yeah? Absolutely, I mean that's what one of the criteria
Speaker 3: of in the DSM five is like a difficulty or
Speaker 3: decreased or absence aroused her to erotic cues. So it
Speaker 3: is clear that like, you know, this is supposed to
Speaker 3: be something, right, regardless of what you're watching, regardless of
Speaker 3: whether you're reading you know, fifty Shades of Gray or
Speaker 3: you're with the partner that you love or you with
Speaker 3: the partner that you hate, Like, it's all the same, right. Yeah,
Speaker 3: let's talk about distress though, so.
Speaker 2: Can I ask another thing about the diagnosis also, which
Speaker 2: is are they looking for changes over time? So I
Speaker 2: think you know, we can. There's so much variation of
Speaker 2: in just general interest in sex. I think across across
Speaker 2: the pod really sho some people have a higher taste
Speaker 2: for sex than others.
Speaker 1: Just yeah, in general, I would have.
Speaker 2: Thought that we'd be looking here for things that are
Speaker 2: changes from your norm.
Speaker 1: Is that part of the diagnosis or not?
Speaker 3: No, it's not. That's not in any of the criteria.
Speaker 3: It does have to be persistent for five months, but
Speaker 3: of course if that has been your norm forever, that's
Speaker 3: your norm, and it has been persistent for more than
Speaker 3: five months. But again it has to be causing distress.
Speaker 3: So they actually call out in the DSM five they
Speaker 3: call out a sexual orientation and as like, this is
Speaker 3: not hyperactive sexual desire disorder. So if you, you know,
Speaker 3: are asexual, if that's your sexual or and it's not
Speaker 3: causing you distress, and you've been that way, you know
Speaker 3: you've been that way, then that's it. You don't have
Speaker 3: a disorder, that's just who you are. I think this
Speaker 3: distress thing, though, is the one I keep getting hung
Speaker 3: up on. And by the way, this appears in every
Speaker 3: like DSM five, It's almost like for every diagnosis you
Speaker 3: can have psychologically there's always like and it's harming your
Speaker 3: everyday life or it's causing you distress or something the
Speaker 3: same with like alcoholic disorder and everything. But when it
Speaker 3: comes to sex, there's other people involved often and so
Speaker 3: you know, I do wonder how you tease out like
Speaker 3: this is causing me distress because gosh, I wish I
Speaker 3: could get more interested and it's just a fun zesty
Speaker 3: part of life that I'm not engaging in and I
Speaker 3: want that to change, versus it's causing me distress because
Speaker 3: my partner is upset with me, And like, how do
Speaker 3: you know the difference?
Speaker 2: Yeah, I mean there's a thing in the DSM about
Speaker 2: you know, this is not explained by relationships stress. Yeah,
Speaker 2: but it seems awfully difficult in the context, particularly of
Speaker 2: you know, long term marriage and so on, for this
Speaker 2: to not be wrapped up in you know, disconnects between
Speaker 2: people and in relationship stress. I mean, this is a
Speaker 2: huge source of stress in many marriages. So I guess
Speaker 2: I worry with this diagnosis in general, that we are
Speaker 2: pathologizing a set of issues which are really not at
Speaker 2: all about something physical and are just things we should
Speaker 2: be trying to address to make people happier and we've
Speaker 2: gotten to well, well we're going to give you some
Speaker 2: drug for it.
Speaker 3: Yeah yeah, yeah, well that's much more profitable totally just
Speaker 3: trying to make people happy.
Speaker 1: Yeah. So true.
Speaker 3: You know, you've alluded to the fact that there are
Speaker 3: baseline the bido differences in people, and I think that's
Speaker 3: true and relatively well established that, like there's some kind
Speaker 3: of the beatinal set point that people have, and yes,
Speaker 3: it changes over time and generally as you get older,
Speaker 3: and well at least post puberty, as you get older,
Speaker 3: that sort of wanes kind of difference between men and women.
Speaker 3: What that means, of course, is that in partnered relationships
Speaker 3: there is the potential to have a discrepancy. And this
Speaker 3: is again where I kind of keep coming back to
Speaker 3: with HSDD, is like is it the discrepancy that's causing
Speaker 3: the problem or not. And so I was looking into
Speaker 3: this a little bit into the data, and there's actually
Speaker 3: like a really rich body of literature about assessing lbidinal
Speaker 3: discrepancies and married couples of all genders and sexual orientations,
Speaker 3: and it's fairly robust. So I'll let me tell you.
Speaker 3: I'll go through one of these from the archives of
Speaker 3: sexual behavior in twenty fourteen. And I'm curious what you
Speaker 3: think here. So this is a study that looked at
Speaker 3: over a thousand married couples. They assessed the desire like
Speaker 3: they asked each member of the couple how often they
Speaker 3: would like to have sex, how often they were having sex,
Speaker 3: And I wonder if any of these findings are surprising.
Speaker 3: So fifty two percent of females indicated the desired frequency
Speaker 3: was equal to the observed frequency, so they were like,
Speaker 3: this is we're at the right spot. Thirty seven percent
Speaker 3: of males said that forty eight percent of husbands reported
Speaker 3: a higher desire reality score, So that's like they want
Speaker 3: more than what is happening than the wives did. Eighteen
Speaker 3: percent of wives reported higher than their husbands. Greater discrepancies
Speaker 3: between this were associated with lower relationship satisfaction, greater conflict,
Speaker 3: lower positive communication, all with sort of modest effect sizes.
Speaker 3: So how do you take this literature? I mean, you know,
Speaker 3: this is both men and women actually saying that they
Speaker 3: could do more. But men again, men are men wanted
Speaker 3: more and more than women.
Speaker 2: I don't find either of these sort of any of
Speaker 2: this thing in this space surprising. I think exactly what
Speaker 2: they mean is again a little hard to tease out.
Speaker 2: So one issue that comes up all the time is
Speaker 2: the question of what direction is the causality. So is
Speaker 2: it that people have a discrepancy in their desire and
Speaker 2: that's leading to relationship dissatisfaction, which is leading to more
Speaker 2: desiral discrepancies. Is it that they have relationship dissatisfaction that's
Speaker 2: leading to the discrepancy, you know, And then when we
Speaker 2: think about the amounts the sort of desire for more,
Speaker 2: there's a glass half full, glass af empty, which kind
Speaker 2: of comes back to some of this discussion of you know,
Speaker 2: what happens with kids, Like a lot of what happens
Speaker 2: when people have children, I should say, which is that
Speaker 2: a lot of what people are saying when they talk
Speaker 2: about wanting to have more sex is almost like it's
Speaker 2: almost a positive frame. It's like I wish I had
Speaker 2: more time for this, yeah, as opposed to like I
Speaker 2: wish I were involved with someone else that I was
Speaker 2: more interested in having sex with, the sort of like
Speaker 2: I want to do this. When we do it, it's great.
Speaker 2: It's like just hard to find the time. But I'm like,
Speaker 2: but it's it's a it's a positive statement. And yeah,
Speaker 2: that feels different than you know, I'm frustrated that my
Speaker 2: partner doesn't want to have sex with me as much
Speaker 2: as I want.
Speaker 3: Yeah, I like, I like thinking of it that way,
Speaker 3: and I think to some extent even being able to
Speaker 3: communicate that between partners can be helpful. Right, There's like
Speaker 3: just like, hey, by the way, we're on the same
Speaker 3: page here. It's not always going to work, but you
Speaker 3: know it's still the desire is still there, right, because
Speaker 3: there's there's You mentioned that one of the comments that
Speaker 3: you got with someone talking about sex is just kind
Speaker 3: of like maintenance on a car, right, just like something
Speaker 3: that you know you got to do periodically to kind
Speaker 3: of keep things together. And yeah, I said that feels bleak.
Speaker 3: But but the truth is some of the data and
Speaker 3: maybe you can walk us through this like suggests before
Speaker 3: we get to drugs and stuff like that, that this
Speaker 3: is a strategy.
Speaker 1: Yeah.
Speaker 2: So I before I talk about the date, I want
Speaker 2: to read you this quote, which I love so much
Speaker 2: from someone we're both so tired, but when we do it,
Speaker 2: we're always like, man, that's great.
Speaker 1: We should do that more.
Speaker 2: That may be very happy because I think that is
Speaker 2: you know, for some set of people that this is
Speaker 2: is really about, Like, you know, we're just it's not
Speaker 2: a phase of life in which this is the thing
Speaker 2: we're doing as much as we would as much as
Speaker 2: you would like. Of course, there are many other people
Speaker 2: who will say, you know, I just don't want to
Speaker 2: do this anymore.
Speaker 1: It doesn't make me happy.
Speaker 3: So and of course there's other things that we don't
Speaker 3: have time to do that, like like I didn't get
Speaker 3: to go to the gym today like I wanted to.
Speaker 3: I didn't have time, you know, I had there was
Speaker 3: too much other stuff going on. So this is not
Speaker 3: like exclusive to sex for people with kids.
Speaker 1: And no totally. People actually also say they want to
Speaker 1: talk to their spouse more. Yeah, on date to talk
Speaker 1: to them or have sex with them either.
Speaker 3: One got multitask people multi.
Speaker 1: Task all right.
Speaker 2: So there are a bunch of strategies that people have
Speaker 2: tried to use to like mitigate these issues, which have
Speaker 2: some at least I would say, survey based evidence that
Speaker 2: they work for some people. So one is communication. Talking
Speaker 2: about how you feel about things is almost always a
Speaker 2: good idea, and a very large share of people more
Speaker 2: or less one hundred percent of couples say that having
Speaker 2: some communication about differences in sexual.
Speaker 1: Desire is helpful. This is why therapy is helpful.
Speaker 2: But another thing, perhaps almost as almost as helpful as communication,
Speaker 2: is an activity people call have sex anyway, which is
Speaker 2: actually a core part of some marital counseling advice when
Speaker 2: people are struggling with this, which is just to say,
Speaker 2: you know, just even though it's like eating your actually
Speaker 2: the starting of it may feel like eating your your vegetables, Like,
Speaker 2: just put it on the schedule, say twice a week,
Speaker 2: we're going to have sex on these times, and this
Speaker 2: is going to be on the schedule, and we're going
Speaker 2: to do it. Partly because for many people you do,
Speaker 2: you're like, oh that was pretty fun, and there's a
Speaker 2: moment of connection and then you kind of get are
Speaker 2: reminded that this is an enjoyable activity.
Speaker 1: Have sex anyway.
Speaker 3: Yeah, I mean, this is you're quoting data. The numbers
Speaker 3: I'm looking at are pretty pretty impressive. So you're quoting
Speaker 3: data from this study of two hundred and thirty couples
Speaker 3: from the Archives of Sexual Behavior in twenty twenty, and
Speaker 3: as you say, zero percent, not a single couple said
Speaker 3: communication was unhelpful. Like every single couple said you should
Speaker 3: talk about this. That's the number one thing, but coming
Speaker 3: in hot at number two of the coping strategies, with
Speaker 3: only five percent of couples saying it's not helpful. Was
Speaker 3: this have sex anyway?
Speaker 1: Six anyway? Six anyway?
Speaker 2: There are other things which seem to work, you know
Speaker 2: for some people, So engagement in another activity with the partner,
Speaker 2: So doing something else to try to connect with your partner.
Speaker 2: About eighty eight percent of people said that that was.
Speaker 1: Date night helpful. Date night.
Speaker 4: Yeah.
Speaker 2: The other thing people say is you know, to do
Speaker 2: it by yourself, which this that he refers to as
Speaker 2: engagement and activity alone masturbate and and I will say
Speaker 2: eighty percent of.
Speaker 1: Couples here said that that was useful.
Speaker 2: And I think part of it is, you know, if
Speaker 2: really the issue is one person just wants more orgasms
Speaker 2: and the other person maybe that the compromises that they
Speaker 2: get to have some of them by themselves. What it
Speaker 2: is a thing that people found no almost no one
Speaker 2: found helpful was doing nothing disengagement.
Speaker 1: Nobody likes that, so don't do nothing.
Speaker 3: Don't do nothing, and it's it is this can be
Speaker 3: obviously something that's difficult to talk about, you know, going
Speaker 3: back to communication. In part, and it's not just because
Speaker 3: it's like, ooh, it's a taboo subject and whatever, because
Speaker 3: you know, most people after they've been married for a
Speaker 3: while have talked about a lot of things. But in part,
Speaker 3: it's because that all also takes time, which we've already
Speaker 3: established we don't have a lot of and so it's like,
Speaker 3: and by the way, let's cut out some extra time
Speaker 3: to talk about our sex lives and stuff like that.
Speaker 3: It is also something else to that fills up the schedule,
Speaker 3: which I think can be you know, it's easy to
Speaker 3: put off. I guess is maybe the way to say that.
Speaker 2: I also think you're understating how difficult people find it
Speaker 2: to discuss find to discuss this with a partner, you
Speaker 2: particularly if it wasn't something that you needed to discuss
Speaker 2: as much, you know, but you like in earlier parts
Speaker 2: of relationships and there was more time and you know,
Speaker 2: people were but we get good. Older people's bodies change,
Speaker 2: they want different things, like maybe they're feeling like the
Speaker 2: idea of bringing up you know, well, why aren't we
Speaker 2: doing this more like is it because you aren't as
Speaker 2: excited about me?
Speaker 1: Or is it like I think people have. This is hard.
Speaker 2: Talking about sex and talking about money are really hard,
Speaker 2: even with people that you love.
Speaker 3: This is fair, and I think we're all afraid of
Speaker 3: opening a can of worm do right, Like, you know
Speaker 3: what am I going to hear? And am I going
Speaker 3: to hear something I don't want to hear? Especially hard
Speaker 3: from people you love? So Emily, let me put on
Speaker 3: my pharmaciel hat and say, like talking is tough and
Speaker 3: takes time, how about you just pop a pill? How
Speaker 3: about that you don't even have to do it. You
Speaker 3: don't even have to tell your partner.
Speaker 1: Sounds amazing. I mean, look it worked for me. Okay.
Speaker 2: I think part of the thing here is, you know,
Speaker 2: this is all coming out of again like a very
Speaker 2: clear medical diagnosis. Right, Rectile dysfunction is like a real game.
Speaker 2: It's like a real physical thing. You need the penis
Speaker 2: to be away. It's not the way. We came up
Speaker 2: with a system to make it the way that you need.
Speaker 2: Like that was like a solid and they made a
Speaker 2: really just an absolute ton of money on that.
Speaker 3: Yeah. Yeah, banger drug.
Speaker 2: That's a banger drugs. One of our best drugs. It's
Speaker 2: probably one of our best drugs.
Speaker 3: You know, I think most people know this, but just
Speaker 3: to say that viagra was originally developed for pulmonary hypertension.
Speaker 3: It's a phase of dilator And this was just a
Speaker 3: very pleasant side effect that the initial trials revealed as
Speaker 3: part of adverse event reporting. People were like, something's going
Speaker 3: on here. So I was like, uh, pivot.
Speaker 1: Lungs. Those are not important, yes.
Speaker 4: So.
Speaker 3: Let's talk drugs. We have two f d A approved
Speaker 3: drugs for hyperactive sexual desire disorder whatever that may be.
Speaker 3: One is flabanserine or ad ye ad ye addie, which
Speaker 3: is taken.
Speaker 1: Why do they name them these things.
Speaker 3: I don't know. It's it's a pill that is taken
Speaker 3: daily at bedtime. The mechanism, it's always like, it's really interesting,
Speaker 3: Like we don't know enough about sex and arousal and
Speaker 3: desire and the complexities the human mind to actually know
Speaker 3: why a lot of these drugs work. So like this drug,
Speaker 3: flibanserin is a partial serotonin agonist, which like, okay, serotonin
Speaker 3: is important, but like we have SSRIs, which you know,
Speaker 3: have a well described side effect of decreasing right sexual interest.
Speaker 3: Like it's it's it's way too complicated to fully understand
Speaker 3: one of the things. I'm curious what you think Emily
Speaker 3: is in these trials. Right, So if you're going to
Speaker 3: get a drug approved by the FDA, you have to
Speaker 3: say there's a disease that it treats. Okay, So all right,
Speaker 3: we've created hyperactive sexual desire to sort and there's an
Speaker 3: outcome that we can show with statistical tests improves. And
Speaker 3: so these researchers and from school companies had to come
Speaker 3: up with that outcome, something measurable that they could send
Speaker 3: back to the FDA and say, look, this thing increased.
Speaker 3: And the thing that they used in all the flab
Speaker 3: aanswerin trials was an outcome called satisfying sexual events. So
Speaker 3: a satisfying sexual event is a sexual event that could
Speaker 3: happen with or without a partner. It could happen with
Speaker 3: or without an orgasm, it could, uh, you know, anything
Speaker 3: that the woman taking the drug would define, but it
Speaker 3: had to be satisfying in however she wanted to define that.
Speaker 3: And the pivotal trial for flull banswering showed that the
Speaker 3: change in satisfying sexual events per month was one point
Speaker 3: two in the placebo group. So placebo effect, once again
Speaker 3: rearing its beautiful heads one extra sexually satisfying event in
Speaker 3: the pacibo group two extra sexually satisfying events in the
Speaker 3: full banswering group. Is that the correct outcome should this
Speaker 3: have been FDA approved.
Speaker 2: I mean, I don't very difficult to say what would
Speaker 2: be the right outcome. You know, you could say how
Speaker 2: many times you know, there's a more direct thing, which
Speaker 2: was just like how many times did you and gauge
Speaker 2: a in asexual event, either alone or with a partner.
Speaker 1: My guess is that they didn't.
Speaker 2: The issue with that is that the placebo effects are
Speaker 2: like too strong, particularly if you start taking this drug
Speaker 2: and people are like, okay, now I'm taking this, I'm
Speaker 2: going to have more sex with my partner. My guess
Speaker 2: is the placinbo effect is too big and that you
Speaker 2: don't get anything right.
Speaker 3: It's like oysters, right, which which have no afrodisiac effect. Actually,
Speaker 3: but like if you.
Speaker 2: Think they do, so, I can see why they didn't
Speaker 2: go with just counts and they went with something else.
Speaker 2: But it's it's sort of oddly defined. I mean, it's
Speaker 2: just an unfortunate aspect. Like I guess you could go
Speaker 2: with something more science y, which I would have been
Speaker 2: inclined towards if you really thought this worked, which was like,
Speaker 2: you know, put there are ways to like probe how
Speaker 2: much blood flow there is to the vagina, right, and
Speaker 2: so you could say, like I'm going to put a
Speaker 2: probe in the vagina.
Speaker 1: I'm going to have.
Speaker 2: People watch porn, and I'm going to see like whether
Speaker 2: this drug gets them more aroused in those settings. Like
Speaker 2: I think that would have been an interesting alternative approach
Speaker 2: to this. It's a little more sciencey, a little less
Speaker 2: real world. You probably also get some placebo effects, but
Speaker 2: I suspect that you would get much more minimal effects.
Speaker 1: So this feels like, yeah.
Speaker 3: I mean these are effects. It's hard to it's hard
Speaker 3: to know. Like that, I think it was right.
Speaker 2: Like the meta analysis here is a half a sexual
Speaker 2: half a satisfying sexual event per month. So it's like
Speaker 2: I don't know, like every day I take this pill
Speaker 2: every day, and then like one half of one time
Speaker 2: every thirty days.
Speaker 1: Like something good happens. Yeah, it feels like.
Speaker 3: And I'll tell you this pill is not entirely benign.
Speaker 3: It can cause significant hypotension, low blood pressure, and fainting.
Speaker 3: And I think forty percent or so of women in
Speaker 3: the pivotal trial. Uh complained of nausea on this pill,
Speaker 3: which I don't know how that is compatible with having
Speaker 3: more sexually satisfied events.
Speaker 2: But here we are one half of the one day
Speaker 2: when you don't feel nauseous.
Speaker 3: You have I don't know, Like, Okay, I'm not nauseous.
Speaker 3: Let's go.
Speaker 2: Is there anything else I'm not this? The ad campaign
Speaker 2: for this is uh, it's so pink. It's like the
Speaker 2: pinkest ad campaign I've ever seen, the little pink till
Speaker 2: that everyone's talking about.
Speaker 1: It's so pink.
Speaker 3: Yeah, they really leaned into this for men, female ladies.
Speaker 1: Ladies love pink.
Speaker 3: Let's say you don't want to take a drug every day.
Speaker 3: The other FDA approved medication is called brim Lana Tide
Speaker 3: or vleisi. It is emily.
Speaker 1: A peptide, our favorite.
Speaker 3: Yeah, so one of the.
Speaker 1: Few verine stack it it's not the Wolverine stack.
Speaker 3: No, it would be the we're gonna stick with the
Speaker 3: X men. It would be like the rogue or Gene
Speaker 3: Gray stack. I guess maybe the.
Speaker 1: Geen graystack. That's solid. I like it.
Speaker 3: Okay, okay, Jean Gray stack. So this is a subcutaneous
Speaker 3: injection as needed so the recommendation is take it forty
Speaker 3: five minutes beforehand, so maybe a more via agra.
Speaker 1: Is more like viagra.
Speaker 3: It works by binding another brain receptor we don't fully understand,
Speaker 3: called the alpha malanta coortin receptor. They appear to modulate
Speaker 3: sexual behavior and mice. It also seems to do something
Speaker 3: in humans. The trials in this case looked at a
Speaker 3: survey was their outcome called the female Sexual Function Index,
Speaker 3: and they use the desire score subscore of that index.
Speaker 3: So this is a survey asking like how much how's
Speaker 3: your sexual desire doing? And there was a significant increase
Speaker 3: in sexual desire by zero point three points or so,
Speaker 3: and there's also less distress by a similar amount. These
Speaker 3: are very modest effect sizes, but at least it's only
Speaker 3: it's at least it's taken as needed.
Speaker 2: I don't know, there's no difference in sexually satisfying events.
Speaker 2: It makes forty percent of people nauseous, and it causes
Speaker 2: you to tan.
Speaker 3: It can make your little tan. Yeah, that's right. It's
Speaker 3: a variant of you guys might have seen in the
Speaker 3: we talked about in the peptide episode. There's a peptite
Speaker 3: called milano tan which literally like causes your melanocytes to
Speaker 3: make more melanin, and like you inject yourself and turn
Speaker 3: yourself tan. It's kind of crazy. And this is a
Speaker 3: related peptide, so it's not you don't get quite as tan,
Speaker 3: but it is listed on the side effects and and
Speaker 3: you know tan people have more sex for sure.
Speaker 1: What they watch or whatever.
Speaker 2: My read of let's talk about before we can like
Speaker 2: overview this, Like, I think the the third thing that
Speaker 2: is disosterone, which we talked about in the tesosterone episode,
Speaker 2: which probably does work. Actually write for this, but not
Speaker 2: FDA proof for this, but in there are a bunch
Speaker 2: of trials that show kind of I would say, comparable
Speaker 2: effects to the little pink the.
Speaker 1: Adie little pill.
Speaker 2: You know about one increase, one more satisfying event per month.
Speaker 3: Yeah, testosterone clearly works. You can listen to the hormone
Speaker 3: replacement therapy episode to hear more about that. But those
Speaker 3: are the those are the drug options. Again, if you
Speaker 3: don't want to talk about.
Speaker 2: It, look, I think that you should talk about Like
Speaker 2: I find this space pretty hard to think about because
Speaker 2: it doesn't it feels like I'm kind of with the
Speaker 2: people who work complaining that the DSM has you know,
Speaker 2: created a disease for a.
Speaker 1: Drug, because so much of what actually seems to.
Speaker 2: Be going on feels like it's just people are struggling
Speaker 2: through some things in their partnerships that they could do
Speaker 2: a better job communicating about. And telling them if you
Speaker 2: just take this pill it will fix your relationship problems
Speaker 2: is misleading and probably will leave them in a worse
Speaker 2: position having not improve their marriage and having one half
Speaker 2: of one additional sexually satisfying event per month, possibly alone.
Speaker 3: Right, yeah, all right, let's do it then, So Emily,
Speaker 3: with that said, smash. This is the This is the
Speaker 3: this is the most appropriate smash or pass ever. Okay,
Speaker 3: but what am I sash?
Speaker 5: You got to be a little more specific, like hyperactive
Speaker 5: sexual desire disorder as a I don't know as a
Speaker 5: as a treatable condition, smash your pass pass.
Speaker 2: I think this is something people should be talking more
Speaker 2: about with their partner if they have one, they should
Speaker 2: be thinking about it. I am passing on medical treatment
Speaker 2: options for it. But what I am smashing, if you
Speaker 2: are listening to this and you are thinking this is
Speaker 2: really resonating. What I am smashing is Emily Nagoski's book
Speaker 2: Come Together which is a really really good book talking
Speaker 2: about some of these issues in relationships, and I would
Speaker 2: really really recommend people pass on the drugs.
Speaker 3: I am going to smash here. I I think that
Speaker 3: we've done I think we've done a bad job like
Speaker 3: exploring female sexuality, understanding female sexuality. And I am cautious
Speaker 3: about too quickly attributing to like attributing everything to the
Speaker 3: environment as opposed to acknowledging that there's the possibility that
Speaker 3: there are underlying biological things that you know, could be
Speaker 3: addressed here, Like I don't want to write that off.
Speaker 3: So I'm going to smash for the research, but probably
Speaker 3: I would do testosterone before some of these other agents.
Speaker 1: Amazing.
Speaker 2: All right, that's it for hypoactive sexual desire disorder your
Speaker 2: male back. Question of the Week after the Break.
Speaker 6: Hi, Emily and Perry, this is Tamar, your producer. My
Speaker 6: question is, even though we all know that sticking c
Speaker 6: tips in your ears is probably the greatest feeling in
Speaker 6: the world, after the topic of this episode, why shouldn't
Speaker 6: I do it? Even though I don't want to know
Speaker 6: the answer? Thanks?
Speaker 3: Does this creep you out? Emily?
Speaker 2: Like?
Speaker 3: Is this one like when you like think about it? Yeah,
Speaker 3: I get a little bit of it.
Speaker 2: Yeah, I don't love I don't I don't like it.
Speaker 1: My impression was.
Speaker 2: The bad thing is that it compacts all of the
Speaker 2: wax all the way into your ear, where it can
Speaker 2: be potentially problematic. And I will say once one of
Speaker 2: my children had to have like some impacted wax removed
Speaker 2: from their ear, not because of cutips, but like they'll
Speaker 2: stick like tweezers into the ear and like it's horrible, Yeah, disgusting.
Speaker 1: Is that is that correct? Doctor?
Speaker 4: Yeah?
Speaker 3: Yeah, no, so that's that's definitely part of it. Like
Speaker 3: ear wax naturally like gets slowly comes out of the
Speaker 3: ear and like on its own, but yes, if it
Speaker 3: gets compacted, it can get stuck in there and build up.
Speaker 3: There's also risk of damaging the ear drum itself if
Speaker 3: you push to uh far. That's a sensitive area. And lastly,
Speaker 3: the cotton on Q tips and particularly on off brand cutips,
Speaker 3: but also onqtips can come off the tip and get
Speaker 3: stuck in there, and then you have cotton in your
Speaker 3: ear that someone needs to pull out. So there, you know,
Speaker 3: I know everyone kind of does this because it's satisfying,
Speaker 3: but you probably shouldn't.
Speaker 2: Do it when I sometime during the pandemic, I started
Speaker 2: getting fed and I do not know whether this was
Speaker 2: COVID or related or else elsewhere, Instagram started feeding me
Speaker 2: ads for like this product that was like it was
Speaker 2: like it went in your ear and it had like
Speaker 2: a little camera and then you could like watch what
Speaker 2: you were doing on your phone and like and like
Speaker 2: sort of clean out the ear wax with like your
Speaker 2: like phone camera.
Speaker 1: Is that a good idea?
Speaker 3: That seems also dangerous. I think like the middle ear,
Speaker 3: which you're coming up to when you get to the
Speaker 3: ear drum, is a really important part that gives you
Speaker 3: hearing that and.
Speaker 1: Don't and balance and stuff.
Speaker 3: Yeah, like well that's the interior is balance. But yeah,
Speaker 3: like just don't mess with it.
Speaker 2: I don't know, nothing larger than your elbow in your ear,
Speaker 2: Like my mom said, this seems right.
Speaker 3: Thanks Emily's mom. All Right, that's it for today. Stick
Speaker 3: with us next week when we'll ask what's the deal
Speaker 3: with sleep?
Speaker 2: Wellness actually is produced in association with iHeartMedia. Our senior
Speaker 2: producer is Tamar Avishai. Our executive producer at iHeart is
Speaker 2: Jennifer Bassett. Our theme music is by Eric Deutsch. And
Speaker 2: our content is for educational purposes only.
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Speaker 1: We'll let the influencers have the last word.
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