WEBVTT - What's the deal with hypoactive sexual desire disorder (HSDD)? 0:00:00.880 --> 0:00:01.240 Perry. 0:00:01.440 --> 0:00:03.960 You know, I'm not sure if people know this, but 0:00:04.040 --> 0:00:06.480 you and I we went to college together and we 0:00:06.480 --> 0:00:09.760 were like, like we knew each other, we were acquaintances. 0:00:09.840 --> 0:00:15.000 We dated each other's roommates in various Yeah, yeah, correct. 0:00:15.240 --> 0:00:19.040 Guess if you had told me at that time, like 0:00:19.160 --> 0:00:23.320 one day you and Francis Perry Wilson the Third will 0:00:23.320 --> 0:00:27.560 do a podcast about sexual dessert like I would have 0:00:27.600 --> 0:00:30.080 told you you were crazy person. I do not have 0:00:30.120 --> 0:00:31.080 this on my Bango card. 0:00:31.840 --> 0:00:34.400 That's that's funny because I, you know, for the past 0:00:34.640 --> 0:00:37.559 twenty five years, have been thinking to myself, you know, 0:00:37.640 --> 0:00:40.400 someday Emily and I are going to sit down talk 0:00:40.400 --> 0:00:44.080 about sexual dysfunction together. So you know, but that's whatever. 0:00:44.159 --> 0:00:46.080 Different strokes for different folks. 0:00:45.800 --> 0:00:52.440 No strokes, It's totally right. So I'm excited and somewhat 0:00:52.479 --> 0:00:55.800 apprehensive to discuss this complicated and nuanced topic. 0:00:56.480 --> 0:00:59.959 Do we need to say that, although this is an 0:01:00.280 --> 0:01:04.200 explicit podcast, it is going to acknowledge the existence of 0:01:04.520 --> 0:01:07.720 sex and sexual function, and if you're listening with your kids, 0:01:07.840 --> 0:01:08.399 be aware of that. 0:01:08.680 --> 0:01:11.240 Absolutely, this is probably not the episode for the. 0:01:11.160 --> 0:01:13.560 Car Let's do it, Let's fall in love? 0:01:13.640 --> 0:01:20.240 Okay, I'm Emily Oster. I'm an economist and a data expert. 0:01:19.920 --> 0:01:22.000 And I'm Perry Wilson. I'm a medical doctor. 0:01:22.360 --> 0:01:25.440 It's Thursday, June eleventh, twenty twenty six. And this is 0:01:25.520 --> 0:01:27.200 wellness actually. 0:01:27.040 --> 0:01:30.520 Because you're getting a staggering amount of health and wellness 0:01:30.560 --> 0:01:34.399 information nowadays from every source imaginable, and some of it 0:01:34.440 --> 0:01:36.000 is awesome and some. 0:01:35.880 --> 0:01:41.080 Of it is well actually both Fortunately we are both 0:01:41.120 --> 0:01:43.680 people who know how to read studies, how to parse 0:01:43.720 --> 0:01:46.400 the data, and can tell you what's worth thinking about 0:01:46.480 --> 0:01:48.240 and what you can safely ignore. 0:01:48.560 --> 0:01:50.840 But before we dig in, a note that this podcast 0:01:50.920 --> 0:01:53.480 is for educational purposes and should not be construed as 0:01:53.480 --> 0:01:56.720 medical advice. We don't know your unique situation, so talk 0:01:56.760 --> 0:01:58.880 to your doctor for personal health decisions. 0:02:00.080 --> 0:02:03.560 This week, we're asking what's the deal with hypoactive sexual 0:02:03.560 --> 0:02:07.240 desired disorder? Perry and I will give the official smasher pass, 0:02:07.400 --> 0:02:09.000 and then we'll get to your question of the week. 0:02:09.480 --> 0:02:11.280 I like the idea that we're going to smasher pass 0:02:12.760 --> 0:02:13.960 a disorder about sex. 0:02:14.000 --> 0:02:17.160 That's fine, Okay, we're good, but first let's do the 0:02:17.160 --> 0:02:31.520 health news roundup after the break. Now for the health 0:02:31.560 --> 0:02:36.040 news of the week, Perry, there was an American Diabetes 0:02:36.080 --> 0:02:41.480 Association conference this week and police removed people for handing 0:02:41.480 --> 0:02:44.360 out an editorial. This is not something that typically happens 0:02:44.400 --> 0:02:47.280 at our conferences. Can you please enlighten me. 0:02:47.720 --> 0:02:51.720 Yeah. Traditionally at medical conferences, people only get escorted out 0:02:51.800 --> 0:02:55.400 for being just too drunk or hungover from the night before. 0:02:55.520 --> 0:02:59.760 So this is definitely outside the box. The American Diabetes Association, 0:03:00.320 --> 0:03:04.560 the largest diabetes conference in the world. What was happening. 0:03:04.800 --> 0:03:09.560 Was scheduled to speak was our friend, doctor j. Badicharia, 0:03:09.960 --> 0:03:14.320 the head of the NIH. Now the backstory actually is 0:03:14.320 --> 0:03:16.440 that he had canceled. I don't think the people who 0:03:16.440 --> 0:03:18.640 were handing out the editorial knew that, and he he 0:03:18.680 --> 0:03:20.320 was going to send a deputy from the NIH. But 0:03:20.360 --> 0:03:22.960 the plan was doctor J was going to speak, and 0:03:23.040 --> 0:03:26.120 so several members of the ADA were handing out a 0:03:26.120 --> 0:03:31.600 recent editorial which criticized NIH policies and the Trump administration 0:03:31.880 --> 0:03:36.680 in terms of their medical science. So this editorial was 0:03:37.000 --> 0:03:40.560 I mean, this wasn't just like some random editorial. This 0:03:40.720 --> 0:03:44.360 was an editorial in Diabetes Care, which is the flagship 0:03:44.440 --> 0:03:49.840 journal of the American Diabetes Association, and it criticized drastic 0:03:49.880 --> 0:03:53.400 cuts in funding opportunities from the NIH, this thing where 0:03:53.400 --> 0:03:56.440 they're doing multi year grant forwarding, which is limiting the 0:03:56.480 --> 0:03:58.760 amounts of grants that can be funded at any given time, 0:03:59.480 --> 0:04:03.760 decimation of the NIH workforce, promotion of pseudoscience conspiracy theories, 0:04:03.840 --> 0:04:07.600 and I think maybe most importantly, the politicization of funding decisions, 0:04:07.640 --> 0:04:12.080 taking funding decisions out of the hands of scientific peer review. Now, 0:04:12.240 --> 0:04:14.680 these people who were escorted out by the police were 0:04:14.680 --> 0:04:19.320 not Rando's. One of them was Stephen Kahn. He's a 0:04:19.360 --> 0:04:22.160 professor of medicine at the University of Washington and the 0:04:22.279 --> 0:04:25.480 editor in chief of Diabetes Care as well as a 0:04:25.839 --> 0:04:29.440 co author of that editorial, So he's handing out his 0:04:29.480 --> 0:04:31.520 own work. He's the editor in chief of the most 0:04:31.560 --> 0:04:37.040 important diabetes journal in America. The ADA did come out 0:04:37.040 --> 0:04:41.839 with a statement saying, look, this isn't political, but people 0:04:41.839 --> 0:04:44.800 are not allowed to hand out materials like you can't 0:04:44.839 --> 0:04:49.000 disseminate materials at our conference, which I like look somewhat 0:04:49.040 --> 0:04:52.960 askance at because people kind of are handing out materials 0:04:53.000 --> 0:04:55.239 all the time, like handing on editorials. 0:04:55.520 --> 0:04:57.800 Come on, yeah, I mean, it feels to me like 0:04:57.960 --> 0:05:00.560 there's there's a letter of the law, which perhaps says 0:05:00.560 --> 0:05:02.800 you can't hand out materials. But my guess is that 0:05:02.880 --> 0:05:06.080 frequently people are handing out a variety of random materials 0:05:06.480 --> 0:05:10.240 and there are no consequences for doing that. So it's 0:05:10.279 --> 0:05:14.880 sort of obviously a political obviously a political decision. 0:05:17.640 --> 0:05:19.760 Yeah, I'm really sure what is accomplish What is a 0:05:20.120 --> 0:05:22.039 I always wondering these things. What is accomplished by this? 0:05:22.520 --> 0:05:25.200 Surely there's more attention to this editorial now that this 0:05:25.320 --> 0:05:27.440 news has been covering than Oh, I mean if you 0:05:27.560 --> 0:05:29.920 just let them give out this editorial to a bunch 0:05:29.960 --> 0:05:31.320 of people who probably already saw it. 0:05:31.640 --> 0:05:35.200 Yeah, yeah, yeah, exactly. It's always sort of like it's 0:05:35.200 --> 0:05:37.760 the stressand effect, where you know, you draw attention to 0:05:37.760 --> 0:05:40.599 something now can never be lost. But actually this was 0:05:40.680 --> 0:05:44.159 somewhat brilliant on the part of these editorialists. I think 0:05:44.320 --> 0:05:48.919 the conferences, particularly scientific conferences, need to think a little 0:05:48.960 --> 0:05:52.560 bit more carefully about who they're inviting, particularly if they 0:05:52.560 --> 0:05:55.520 don't want to engender any kind of backlash. You know, 0:05:55.560 --> 0:06:00.919 scientific conferences like to have famous people giving you addresses 0:06:00.960 --> 0:06:03.680 and having leaders of scientific organizations like the NIH is 0:06:04.520 --> 0:06:08.320 a long and storied part of that. But in an 0:06:08.360 --> 0:06:12.880 era where the NIH has become somewhat hostile to the 0:06:13.160 --> 0:06:15.359 people in the room who are, you know, trying to 0:06:15.360 --> 0:06:19.000 get funding and get grants in advanced science. The committees 0:06:19.000 --> 0:06:21.159 that are deciding on these speakers might want to think 0:06:21.320 --> 0:06:25.040 just reasonably about that. Not that they shouldn't have leaders 0:06:25.040 --> 0:06:26.840 of the NIH, but they should be prepared that there's 0:06:26.880 --> 0:06:29.520 going to be some tough questions and pushback from the audience. 0:06:29.920 --> 0:06:31.680 Yeah, and I mean, I think for me it's that 0:06:31.800 --> 0:06:35.640 it's I would definitely say you should be open to 0:06:35.640 --> 0:06:37.800 having J. Bodicheria come and talk at your conference. He's 0:06:37.800 --> 0:06:39.960 ahead of the NIH. Whether you agree with that or not, 0:06:40.080 --> 0:06:43.000 that's his job. This is an important organization. But you 0:06:43.080 --> 0:06:44.919 have to understand some people are not going to like 0:06:44.960 --> 0:06:47.359 that and be prepared for whatever is the consequence of 0:06:47.800 --> 0:06:50.720 that activity. And I guess here they prepared by having 0:06:50.760 --> 0:06:52.760 the police, which is perhaps not the take I would have, 0:06:53.240 --> 0:06:55.520 you know, used not the right move. 0:06:55.680 --> 0:06:59.120 All right, let's move on. There's a paper making the 0:06:59.200 --> 0:07:03.000 rounds now that is stressing me out even more about 0:07:03.040 --> 0:07:06.640 my sleep than I was before. This is a paper 0:07:06.640 --> 0:07:10.360 appearing in Nature which says that there is a U 0:07:10.480 --> 0:07:14.200 shaped curve between the time you spend a sleep and 0:07:14.320 --> 0:07:18.280 various important clinical outcomes. So like, if you sleep too little, 0:07:18.320 --> 0:07:20.880 it's bad, if you sleep too much, it's bad. You 0:07:20.920 --> 0:07:23.080 want to be in that sweet spot of like sixt 0:07:23.080 --> 0:07:26.240 eight hours. Emily, this is keeping me up at night. 0:07:26.400 --> 0:07:26.960 What do you think? 0:07:27.400 --> 0:07:29.560 I hate this literature? 0:07:30.080 --> 0:07:32.520 Okay, so first of all, I want to say sleep 0:07:32.600 --> 0:07:35.080 is super important, and if you want to know some 0:07:35.160 --> 0:07:37.280 science about sleep, you can listen to next week's episode 0:07:37.320 --> 0:07:42.240 where we discuss sleep. Yeah, however, this particular kind of 0:07:42.280 --> 0:07:45.720 finding which is not new, like these guys have a 0:07:45.760 --> 0:07:49.320 different set of outcomes they're measuring. It's things about how 0:07:49.480 --> 0:07:52.320 well you're functioning, your organs are or whatever. But there 0:07:52.360 --> 0:07:56.400 are many parts of this, many pieces of literature that 0:07:56.440 --> 0:08:00.360 will show this you shaped relationship, and people take from 0:08:00.400 --> 0:08:03.600 that like, Okay, there's an optimal amount of the sleep, 0:08:03.640 --> 0:08:06.120 which is in their case, like between six point five 0:08:06.160 --> 0:08:08.360 and like seven point eight four. 0:08:08.000 --> 0:08:09.160 Hours or something like that. 0:08:09.600 --> 0:08:13.880 The problem is people who sleep a lot are generally sick. 0:08:14.200 --> 0:08:16.720 So if you if there's somebody who's sleeping for eleven 0:08:16.760 --> 0:08:18.560 hours a day, there's something else that's wrong. 0:08:19.520 --> 0:08:22.200 For the most part, or my teenager can one hundred 0:08:22.200 --> 0:08:24.200 percent of this, but that's not what you're talking about, right. 0:08:24.040 --> 0:08:26.040 But like, for if you take an adult who is 0:08:26.080 --> 0:08:29.280 sleeping for eleven hours a day on average, that person 0:08:29.400 --> 0:08:31.600 has something else going on. It could be mental health, 0:08:31.800 --> 0:08:35.079 it could be physical health, you know, so to say 0:08:35.559 --> 0:08:36.960 like it's unhealth. 0:08:37.040 --> 0:08:39.679 That's different from saying if you you a person. 0:08:39.559 --> 0:08:43.160 Who typically sleeps seven hours, if you decided to sleep 0:08:43.200 --> 0:08:46.720 eleven hours, would that be bad for you? That is 0:08:46.760 --> 0:08:50.079 not what this data says. You probably couldn't sleep eleven hours. 0:08:50.360 --> 0:08:52.160 Yeah, But the. 0:08:52.200 --> 0:08:54.440 Fact is the people who sleep eleven hours or something 0:08:54.480 --> 0:08:56.719 else going on. And similarly, people who are sleeping three 0:08:56.800 --> 0:08:58.880 or four hours a night generally have a lot of 0:08:58.920 --> 0:09:01.400 other things that are going on. That's more likely to 0:09:01.440 --> 0:09:04.720 be shift workers. People are you know, generally have fewer resources. 0:09:04.760 --> 0:09:07.040 There's like other things that are happening that made people 0:09:07.080 --> 0:09:11.160 sleep less. So it's like this complicated thing where the 0:09:11.200 --> 0:09:13.160 paper sort of wants you to think that this is 0:09:13.280 --> 0:09:16.200 causal and it wants people to think, you know, you 0:09:16.280 --> 0:09:18.480 have to get exactly this amount and if you go 0:09:18.640 --> 0:09:20.880 outside of it, then you're going to die. 0:09:21.520 --> 0:09:23.000 But that's really not what the data says. 0:09:23.000 --> 0:09:26.280 It's much more that we're identifying different groups of people 0:09:26.320 --> 0:09:28.160 with other different different things. 0:09:28.240 --> 0:09:29.800 Now, having said that, I think sleep is. 0:09:29.800 --> 0:09:32.600 Very important, so I think people should should prioritize sleep. 0:09:32.640 --> 0:09:34.520 But like, my brother sent me this article and it 0:09:34.559 --> 0:09:36.920 was like the headline is like, is like you don't 0:09:36.920 --> 0:09:38.720 really need eight hours of sleep, And he was like, 0:09:38.760 --> 0:09:40.960 oh my god, I'm getting eight hours of sleep, Like 0:09:41.120 --> 0:09:41.800 is that bad? 0:09:43.440 --> 0:09:43.680 Yeah? 0:09:43.840 --> 0:09:46.640 Yeah, get the sleep. You've got to give your body 0:09:46.679 --> 0:09:49.360 the opportunity to sleep the amount that your body wants 0:09:49.520 --> 0:09:52.800 to sleep, basically, like, that's that's great for you actually. 0:09:52.840 --> 0:09:55.080 And for most healthy adults, if you give your body 0:09:55.160 --> 0:09:58.520 the opportunity to sleep, you will generally sleep something up 0:09:58.679 --> 0:10:01.120 like seven to seven half hours. That is what a 0:10:01.120 --> 0:10:04.640 typical adult will sleep given the opportunity in a sleep lab. 0:10:04.760 --> 0:10:07.360 So anyway for sleeping eleven hours a day is probably 0:10:07.360 --> 0:10:09.400 because something else is wrong, that's all. 0:10:10.720 --> 0:10:12.680 Okay. I hate you shaped things. 0:10:12.840 --> 0:10:15.679 It's like I hate I hate so, I hate you 0:10:15.800 --> 0:10:18.480 shapes in research. It just drives me nuts. It's like 0:10:18.520 --> 0:10:20.280 one of my bugget boots. 0:10:20.559 --> 0:10:23.920 Okay, duly noted. So don't bring me any. 0:10:23.920 --> 0:10:27.880 Bringing you exclusively U shaped findings for that. What about 0:10:27.880 --> 0:10:29.960 BMI and death? Okay, do that right? 0:10:30.160 --> 0:10:30.319 Yeah? 0:10:30.840 --> 0:10:35.080 Okay, all right, so let's talk about what's going on 0:10:35.160 --> 0:10:38.960 with HIV in South Africa. There is some very promising 0:10:39.320 --> 0:10:45.480 new data about PREP shots and their effects on transmission. 0:10:46.400 --> 0:10:49.160 Although in the US we don't talk as much about 0:10:49.280 --> 0:10:51.559 HIV as as we once did in much of Sub 0:10:51.600 --> 0:10:54.520 Aheran Africa, this is still as tremendously important problems. About 0:10:54.520 --> 0:10:58.600 eight million people were HIV positive in South Africa. A 0:10:58.600 --> 0:11:00.880 lot of the new infections are in adult girls. 0:11:01.800 --> 0:11:03.240 What is the good data here? 0:11:04.280 --> 0:11:10.239 Yeah, I mean this was really encouraging news coming from NPR, 0:11:10.640 --> 0:11:13.679 and it's about PREP so pre exposure profile axis for HIV. 0:11:13.800 --> 0:11:16.760 So these are medications you take when you don't have 0:11:16.960 --> 0:11:21.400 HIV but you're in a high risk environment and South Africa, 0:11:21.400 --> 0:11:23.840 as you point out, is very high risk. There are 0:11:23.840 --> 0:11:27.120 eight million people living with HIV in South Africa and 0:11:27.160 --> 0:11:30.520 there's about a thousand new infections per week, almost entirely 0:11:31.480 --> 0:11:37.640 unfortunately in young and adolescent girls and women. And you know, 0:11:37.800 --> 0:11:42.520 pre exposure profile axis typically is an oral medication that 0:11:42.559 --> 0:11:46.079 you either take daily, some can be less frequent than that. 0:11:46.640 --> 0:11:50.959 But what South Africa has started using is every six 0:11:51.080 --> 0:11:56.360 month injection called length of Year, and this essentially eliminates 0:11:56.400 --> 0:11:59.480 the risk of transmission of HIV. So for those six months, 0:11:59.679 --> 0:12:03.439 we're wardless of what's happening to people. And of course, 0:12:03.679 --> 0:12:05.480 you know, I should say that a lot of these 0:12:05.520 --> 0:12:14.480 adolescent women are in exploitative relationships like this is yeah, 0:12:14.559 --> 0:12:17.080 and this is bad independent of the transmission of HIV, 0:12:17.160 --> 0:12:19.960 but obviously transmission of HIV makes the situation even worse. 0:12:20.040 --> 0:12:23.240 And for the six months that you after the injection, 0:12:23.440 --> 0:12:27.199 you essentially like there's basically no transmission. This as a 0:12:27.240 --> 0:12:30.440 public health intervention is just way easier, right, You have 0:12:30.480 --> 0:12:32.640 to get You've got to get a hold of these 0:12:33.200 --> 0:12:35.720 these people who are at risk, you know, twice a year, 0:12:36.040 --> 0:12:39.720 as opposed to getting them drugs much more frequently than that. 0:12:40.400 --> 0:12:43.040 The big problem now is one of funding. 0:12:43.200 --> 0:12:48.280 Honestly, there's the drugs are very very expensive. 0:12:48.360 --> 0:12:51.520 It's being funded right now by the Global Fund out 0:12:51.559 --> 0:12:53.640 of the un like the Global Fund to Fight AIDS, 0:12:53.960 --> 0:12:59.400 and you know, funding there is unfortunately limited, But there 0:12:59.440 --> 0:13:01.280 are a large number of philanthropies that do have an 0:13:01.320 --> 0:13:02.920 interest in this area. So to the extent that we 0:13:02.920 --> 0:13:06.080 can draw attention to this like relatively successful program and 0:13:06.080 --> 0:13:07.880 scale it up, I think would be ideal and of 0:13:07.920 --> 0:13:11.120 course if people, if people feel like donating, you can 0:13:11.160 --> 0:13:13.840 donate to the Global Funds Fight AIDS directly if that's 0:13:14.040 --> 0:13:14.640 a choice. 0:13:15.600 --> 0:13:17.520 Yet another reason why it was very unfortunate that they 0:13:17.559 --> 0:13:19.679 cut all the funding for PEPFAR, which has been one 0:13:19.720 --> 0:13:23.360 of our most successful global health interventions over the past 0:13:23.480 --> 0:13:28.920 twenty years. It is on that note, that's it for 0:13:28.960 --> 0:13:30.840 the health news of the week, and after the break, 0:13:30.960 --> 0:13:34.680 we'll ask what's the deal with hypoactive sexual desire disorder? 0:13:40.040 --> 0:13:43.199 All right, we are back. We're asking what's the deal 0:13:43.440 --> 0:13:49.840 with hypoactive sexual desire disorder? Okay, I'm lee this is 0:13:50.320 --> 0:13:54.240 one of the topics, maybe not HSDD per se, but 0:13:54.480 --> 0:13:58.840 like sexual activity, sexual function in my age group, in 0:13:58.880 --> 0:14:02.079 my cohort, presumably in your cohort as well, is something 0:14:02.200 --> 0:14:06.320 a lot of people sort of allude to without really 0:14:06.400 --> 0:14:08.720 digging down on. There's a lot of like there's a 0:14:08.720 --> 0:14:11.120 lot of sly comments, like sort of the boomer humor 0:14:11.200 --> 0:14:14.280 stuff that I hear about, you know, like, uh, you know, 0:14:14.320 --> 0:14:16.760 my wife's got a headache, like that kind of thing, 0:14:17.040 --> 0:14:20.240 but no one ever really sits down and compares notes. 0:14:20.240 --> 0:14:24.360 I mean, I think fortunately, but but that's sort of 0:14:24.360 --> 0:14:27.240 what we're here to do, because if something is a 0:14:27.280 --> 0:14:30.000 disorder and it's out there, people might naturally wonder like 0:14:30.120 --> 0:14:33.040 do I have it? What do I have it? And 0:14:33.920 --> 0:14:37.000 I think maybe the place to start before we talk 0:14:37.080 --> 0:14:42.160 about like a disorder of sexual function is what is 0:14:42.360 --> 0:14:46.560 normal here? Like when we think about this, especially you 0:14:46.600 --> 0:14:49.480 know for people our aged, you know, forties kids, that 0:14:49.600 --> 0:14:53.040 kind of thing. You actually have some really interesting data 0:14:53.080 --> 0:14:53.240 on this. 0:14:53.600 --> 0:14:56.560 Yes, I want to start by by I once did 0:14:56.600 --> 0:15:00.320 a really great podcast with Emily Nigoski, who is a 0:15:00.360 --> 0:15:03.280 writer who writes about sex, and I asked the question, 0:15:03.720 --> 0:15:05.440 you know, what's a normal amount of sex? 0:15:05.520 --> 0:15:10.000 And she was like, that is the worst possible question. 0:15:10.080 --> 0:15:12.600 And I came to think that she was right because 0:15:12.680 --> 0:15:16.080 of course, like there is no, no, there's average. I 0:15:16.080 --> 0:15:18.520 can tell you in the data what is the average, 0:15:18.560 --> 0:15:22.800 But the word normal has this like connotation about what 0:15:22.920 --> 0:15:25.440 is appropriate or what you should do, and I think 0:15:25.480 --> 0:15:28.960 that's actually not very helpful in a place where people 0:15:29.000 --> 0:15:32.120 are going to vary in like what makes them happy. 0:15:32.320 --> 0:15:34.800 So I'm going to tell you the average, but I'm 0:15:34.800 --> 0:15:36.240 not going to tell you what's normal. 0:15:36.440 --> 0:15:40.000 I think that is very well said. It doesn't imply 0:15:40.080 --> 0:15:41.680 that if you're less than the average or more than 0:15:41.720 --> 0:15:45.160 the average, that you are per se abnormal or pathological, 0:15:45.360 --> 0:15:46.480 but please go okay. 0:15:46.560 --> 0:15:49.720 So we I get very interested in this question a 0:15:49.720 --> 0:15:51.280 couple of years ago because I talked to a lot 0:15:51.280 --> 0:15:54.400 of parents of young kids and it comes up all 0:15:54.440 --> 0:15:57.520 the time, the question of are people having sex and 0:15:57.560 --> 0:16:00.480 how much are they having And it's a place where 0:16:00.480 --> 0:16:02.400 people just like to have data. So we did this 0:16:02.480 --> 0:16:06.880 big survey of parents. People were very I do a 0:16:06.880 --> 0:16:09.760 lot of surveys actually on my website, and. 0:16:11.360 --> 0:16:13.200 This was by far the most popular. 0:16:13.280 --> 0:16:17.480 So I got twenty six thousand people to report their sexual. 0:16:18.040 --> 0:16:20.720 It's pretty amazing data. It's pretty amazing. It's one of 0:16:20.760 --> 0:16:23.400 the largest studies of its type. Like as I was 0:16:23.400 --> 0:16:24.760 looking at the literature too. 0:16:25.800 --> 0:16:29.840 So you know, the answer is that for parents at least, 0:16:30.280 --> 0:16:32.400 sex varies quite a lot with the age of the 0:16:32.600 --> 0:16:36.680 youngest kid. So in the data, for people with kids 0:16:36.760 --> 0:16:40.520 under a year, the like modal frequency was once to 0:16:40.640 --> 0:16:44.000 twice a month. For people with kids over five years, 0:16:44.040 --> 0:16:45.440 the mode was more like. 0:16:45.720 --> 0:16:47.600 One two times a week. 0:16:47.920 --> 0:16:50.240 There's a reasonable share of people who say that they 0:16:50.320 --> 0:16:54.000 never have sex or less than once a year. It's 0:16:54.040 --> 0:16:56.680 not very high, but it's it's certainly, you know, for 0:16:57.200 --> 0:17:00.640 almost ten percent basically for people with very small children, 0:17:01.040 --> 0:17:03.960 and there are a very small number of people, like 0:17:04.280 --> 0:17:06.440 less than one percent even with older kids, who say 0:17:06.440 --> 0:17:10.040 they have sex every day, So you know, like we're 0:17:10.119 --> 0:17:12.760 kind of if you ask what's the average, it's something 0:17:12.800 --> 0:17:14.360 in the range of. 0:17:15.640 --> 0:17:18.040 Twice a week too, uh, once a month. 0:17:18.640 --> 0:17:20.639 I think one of the really interesting things that was 0:17:20.680 --> 0:17:25.680 in your data was this relationship with age of parents 0:17:25.720 --> 0:17:28.600 and age of kids. So what you found is that 0:17:28.680 --> 0:17:32.640 if you holding the age of kids steady, like, statistically, 0:17:32.880 --> 0:17:36.440 the older the parents were sort of the less frequently 0:17:36.560 --> 0:17:38.840 they would have sex, which kind of makes sense, right 0:17:38.880 --> 0:17:41.720 you get older, like things happen. But then the older 0:17:41.800 --> 0:17:46.160 the kids are, the more often the parents would have sex, 0:17:46.240 --> 0:17:48.639 And of course those are correlated because older parents tend 0:17:48.680 --> 0:17:51.400 to have older children everything. So it's this really complex 0:17:51.400 --> 0:17:55.359 interplay between biology, which is as we get older, like 0:17:55.680 --> 0:17:59.600 the hormones that drive our sex drive decrease, and then 0:17:59.680 --> 0:18:03.560 like logistics, which is like, as our kids get older, 0:18:03.640 --> 0:18:05.000 there's just more opportunity. 0:18:06.359 --> 0:18:08.680 Do you think that's true? This is a different topic. 0:18:08.920 --> 0:18:11.320 I feel like there are some ways in which having 0:18:11.400 --> 0:18:17.399 older children presents less opportunity. Okay, I mean because then 0:18:17.440 --> 0:18:20.120 they could catch like it well anyway. 0:18:19.960 --> 0:18:22.880 Okay, oh no, I think this is a critical thing 0:18:23.040 --> 0:18:26.760 to discuss. And if any of my children are listening 0:18:26.760 --> 0:18:30.560 to this, please turn it off. Turn it off, go 0:18:30.640 --> 0:18:36.600 to bed, Go to bed, stay in your room. 0:18:37.160 --> 0:18:39.800 So one of the things I thought was was interesting, 0:18:39.840 --> 0:18:43.040 which maybe sort of leads into the question of how 0:18:43.080 --> 0:18:46.800 we sort of pathologize this is actually a pretty large 0:18:46.800 --> 0:18:50.480 share of people said that they were not having enough sex, 0:18:51.480 --> 0:18:55.119 not as much as they would want to, right. And 0:18:55.200 --> 0:18:58.399 so even the people who are having sex one to 0:18:58.520 --> 0:19:00.800 two times a week, a little bit forty percent of 0:19:00.840 --> 0:19:03.360 them said they were having somewhat too little or way 0:19:03.400 --> 0:19:05.760 too little sex. As you get to people who are 0:19:05.800 --> 0:19:07.840 having sex a few times a year, almost one hundred 0:19:07.880 --> 0:19:11.119 percent of them say that's not enough. And this for 0:19:11.200 --> 0:19:13.639 me was actually a much more telling piece of the 0:19:13.880 --> 0:19:16.480 of the data than the frequency, because I think if 0:19:16.560 --> 0:19:18.760 you say, you know, we're having sex twice a year 0:19:18.760 --> 0:19:21.120 and that works for us, like that's that feels like enough, 0:19:21.240 --> 0:19:25.520 then it's great. It is more concerning when you have 0:19:25.760 --> 0:19:28.960 almost everyone saying, well, actually i'd love to have more. 0:19:29.240 --> 0:19:33.000 But something else is happening, that's getting in the way. Yeah, 0:19:33.040 --> 0:19:37.639 I and obviously are more likely to say they don't 0:19:38.040 --> 0:19:39.920 they're not having Men would like to have more sex 0:19:40.040 --> 0:19:40.520 than women. 0:19:40.760 --> 0:19:43.200 Oh yeah, when you stratified, when you stratified by sex. 0:19:43.200 --> 0:19:47.080 But many women in your survey, in fact, the majority, 0:19:47.080 --> 0:19:49.080 are also saying, yes, I'd like to have more. So, 0:19:49.560 --> 0:19:52.880 you know, in theory, you've got these couples, right, both 0:19:53.000 --> 0:19:54.800 members of the couple are like, you know, I really 0:19:54.800 --> 0:19:57.359 wish we would have more sex, and yet we don't. 0:19:57.720 --> 0:20:01.280 Yeah, And I mean it was it saying Okay, I'll 0:20:01.320 --> 0:20:02.879 just say one more thing about this, which is that 0:20:02.920 --> 0:20:05.639 people left a lot of comments, like thousands and thousands 0:20:05.680 --> 0:20:09.919 of people left comments, and some of this is just 0:20:10.160 --> 0:20:12.680 I'll just read this because I think it summarizes a 0:20:12.680 --> 0:20:14.720 little bit of how people often feel with little kids. 0:20:15.280 --> 0:20:17.159 It's not that the sex is bad or that I 0:20:17.200 --> 0:20:19.280 don't love my spouse as much. It's just that we're 0:20:19.320 --> 0:20:21.280 both so tired all the time that the sex is 0:20:21.400 --> 0:20:24.520 very bland and feels like something we do quickly just 0:20:24.560 --> 0:20:27.480 for basic maintenance while the kids are temporarily asleep. The 0:20:27.520 --> 0:20:29.840 best analogy I can think of is forcing yourself to 0:20:29.840 --> 0:20:31.560 eat because you know, you should even though you're not 0:20:31.600 --> 0:20:32.600 actually very hungry. 0:20:33.200 --> 0:20:34.640 Okay, that's a little bleak. 0:20:35.359 --> 0:20:36.960 It's bleak, But I think we should come back to 0:20:37.000 --> 0:20:39.760 it later because actually there is some stuff in the 0:20:39.840 --> 0:20:42.720 data suggesting that that actually may not be a terrible 0:20:43.320 --> 0:20:48.240 approach to sex in some cases. So that's probably a 0:20:48.320 --> 0:20:53.080 good place to move into what we actually mean when 0:20:53.119 --> 0:20:56.720 we say hypoactive sexual desire disorder. 0:20:57.400 --> 0:21:00.920 Right, so let me start by saying, we don't mean 0:21:01.720 --> 0:21:04.959 like everyone like sometimes isn't in the mood, right, Like 0:21:05.280 --> 0:21:08.840 that's normal, that's natural. It's not you're you know, you're 0:21:08.880 --> 0:21:10.280 not going to be there all the time. This is 0:21:12.040 --> 0:21:18.080 Hypoactive sexual desire disorder is a clinical disorder, and because 0:21:18.080 --> 0:21:21.000 it's clinical disorder, it now appears in the d s 0:21:21.119 --> 0:21:23.720 M five. So the Diagnostic and Statistical Manual is the 0:21:23.720 --> 0:21:27.440 big book of psychological diagnoses. It's where you find like, oh, 0:21:27.520 --> 0:21:29.360 what do I you know, what criteria do you need 0:21:29.400 --> 0:21:32.280 to fulfill to have major depressive disorder, bipoloy disorder or 0:21:32.320 --> 0:21:35.040