July 10, 2020
Testosterone, Muscle Memory & Lasting Longer in Bed
Urologist and sexual wellness expert Dr. Jed Kaminetsky joins us to talk about all things sex including:
- Multiple approaches to lasting longer in bed
- The role or testosterone in sexual desire and functioning
- Orgasm difficulties
- Premature ejaculation
- Delayed orgasm
- The role of muscle memory and neuropathways in orgasm
- Promescent (Use code JESS15 at checkout for 15% off!)
Not everyone wants to last longer in bed, but if you’re interested in learning more about ejaculatory control, check out our Last Longer in Bed: 6 Steps to Master Premature Ejaculation course which includes exercises in mindfulness, muscle mastery and communication.
This podcast is brought to you by Let’s Get Checked. Use code DRJESS to save at checkout!
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This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.
Testosterone, Muscle Memory & Lasting Longer in Bed
00:00:05 – 00:05:01
You’re listening to the sacs with Dr, Jess, podcast, sacks and relationship advice. You can use tonight. Welcome to the sex with Dr Chess podcast I’m your co Host Brandon? Where here with my lovely other half Dr Jess. How you doing I’m hanging in there. Seems to be the trend lately. Yeah, doing pretty well, actually so today we’re going to be talking about lasting longer in bed seems like it’s the topic on many men’s mind. Yeah, and so many women as well people of all genders and I hear from women who have sex with men I hear split. Some of them complained that their partners don’t last long enough. And some of them complained that their partners last too long. We’re GONNA. Talk about that as well. It’s very interesting to hear because I remember growing up that the thing was. You need to last long. It’s never. Focus on her pleasure or your partner’s pleasure. You learn growing up. No I was saying I didn’t if I said that I meant the opposite, it was like we didn’t learn about that. We learned about the idea that you should just last a long time because that was what you needed to do. And that’s what you saw in porn. You saw these videos. People lasted forty five minutes and you watch porn for forty five minutes. No I didn’t. I knew that there were forty five minute long porn videos we’re done with. The listen I watched the squiggly late at night. You needed late thirty seconds and a half boob. So. was there pressure when you think about early on in your? In your sex life. Is there pressure to last longer? You embarrassed if you didn’t did you talk about? It certainly did not talk about it with my first few partners I. Remember the first time that I ever had sex that I was embarrassed after because it was not my most memorable performance and you know open book Brandon here. Disclosing all the details I remember feeling embarrassed after because it wasn’t what I had. had seen on the videos, or at least my performance was, and so I was performance well I. Mean You mean by that performance I? Just mean how long I lasted and what I did, and and no I I mean listen. It was a short initial experience and I remember thinking feeling embarrassed, being around my partners friends after because I thought to myself if she had said something to them. Wow, that was not. At all what it was supposed to be now, I remember and I’m not just saying this to redeem myself. But I remember the second time taking forever, and maybe it was because I was super nervous. The second time that it was going to be too quick and I got into my own head in this idea that. I couldn’t you know thinking of your grandpa or like a a bunch of bunnies or anything else to distract yourself but I remember the second time it was like well. This took forever, so it was this weird. Both ends of the spectrum, the first couple of times that I had had sex, which was not what I expected when we have really unrealistic expectations in terms of how long sex last and that is really tied number one to the fact that we have very specific and limiting definitions of what sexist I know that you were having sex with women and we. We have this notion that sex is when the penis goes in the vagina until when the penis pulls out. When in fact of course I know, everybody here knows this sex means different things to different people one person for is another person’s main event. One person’s Tuesday afternoon is another person’s you special anniversary celebration, and so sex is anything you do. For erotic pleasure anything at all and so I, think we need to get away from the notion that it’s one. The pianist goes inside the vagina. Now of course I know people. Are, interested in data and there is data on how long sex in terms of P Envy Pena’s in vagina intercourse last, and if you look into all the studies, there’s quite a range you’ll see somewhere. It’s as it lost a little bit longer. A little bit shorter. It sort of if I had to sum it up. It’s in the five minute range could be three four five six seven minutes i. I saw a steady or some research around sex therapists saying that it should last around seven minutes I would say that’s on the very high end. I would also say what’s so important is like. Why are we timing ourselves? I have no clue. How long are sex last? Because other than like? If I’m late for something and I’m kind of looking after I’m like okay now. I’m really later and. Not As late as I thought I was. But. I don’t feel like I. Ever Time It. I would say that the duration of sex for me. Is Really. Especially intercourse I mean I could do without intercourse. is really you’re welcome.
00:05:03 – 00:10:14
I’m just saying there’s lots of other things that feel good feel good I. Don’t think the duration is a top five factor, or even a top ten factor in whether or not sex is really good for me growing up though. The the idea of four foreplay and sex outside of P and V activity the to me, it did not exist. It was like sex is when you insert the IV, and then the man or the gentleman finishes so. The good news is that such a we know that that’s ridiculous definition, because many sexual experiences don’t even have a penis there. Oh, I think my first few sexual experiences didn’t involve at all right. Yeah and I. Do think that we think of sex always about a penis and penis lasting, and I mean so. Many of us aren’t even having sex with penises. You can be having sex two of US three volvos a strap on toy, a vibrator, a hand as a soft furry. It really can be anything, so I think that so many of the problems that exist around sex would be radicati if we broadened our definition of sex and we’re GONNA talk today. I always receive questions for you and I’m not always fully equipped to answer them, so we are bringing an expert in to help with some of these questions, specifically that are related to urology, joining us to answer all of your questions, and some of ours is Dr Jedd Kempinski aboard certified urologist, specializing in men’s health, sexual wellness and low testosterone. Thanks for being here here. Now, you specialize in low testosterone. Can you tell me how important is testosterone to sexual functioning? And how does it shift or decline over a lifetime? Yeah, so testosterone naturally decreases as a man gets older, so men reached that peak and testosterone thirties. It decreases at varying great, saying in different man’s They’re different factors that can contribute to that, but testosterone is really the fuel that makes a man a man so. It gives a man energy focus. Muscle Mass Libido erections. So, men with load generally more body fat, the less Muscle Mass May. Difficulty focusing. Less energy does the same apply to women in terms of focus and Libido and energy. Well, that’s a really good question and women do have testosterone. Oh yeah, and has there Testa at menopause? Their testosterone goes down low. Women have a fraction of the testosterone. That man has so a normal testosterone for. Let’s say a forty year old man would be in the four hundred. A woman might be forty or fifty, but yes, if a woman has low testosterone, it will affect her libido affect her sexual pleasure, and in fact, we sometimes treat women with very low doses of testosterone to improve their. Sexual arousal and La, Vida. How do you test for testosterone levels? While to blood test. Okay in man to diagnose low testosterone. You need to have two consecutive over the course of a week. Low Testosterone, Z- in the morning. So men have their highest testosterone in the morning. So that’s why men wake up with erections, and some a lot of men are. They’re cornyist in the morning, because testosterone is highest. So what the for me to diagnose? Somebody were low testosterone. We have to have two criteria. We have to have a low level. And that’s a little arbitrary. What the level is the? Guidelines in the Endocrine Society and the American urologic association defined as less than three hundred nanograms per deciliter, but you also need to have symptoms. So what are the symptoms low energy low Libido poor rations? Lack of muscle mass, so if you have one without the other. Generally, we won’t treat you. And and how do you differentiate between lifestyle factors that lead to some of these symptoms versus the the hormone, the hormone levels, so for example you know you can have low energy, but maybe you’re dealing with a depressed mood, or you can have low libido, but maybe you’re dealing with a lot of stress in your life. Is that where the t test comes in to to show that you have both of the both sides of the coin? Yeah, I mean you’re one hundred percent right, low testosterone and depression. Can present with the very same symptoms, so it can be hard to diagnose I’ve seen countless patients who come to me and they’d been on antidepressants and nobody checked their testosterone and low behold.
00:10:14 – 00:15:03
Testosterone is very low. We treat them with tea and look no longer depressed, but lifestyle things are really important so. TESTOSTERONE GETS BROKEN DOWN INTO ESTROGEN FAT? So more fat, less testosterone, more estrogen, so we which is not good for men, so we always any patient that I started on testosterone. We talk about diet healthy diet. We talk about weight loss. We talk about excess is so it’s got to be a more holistic approach. A more lifestyle focused approach rather than just. Here’s a prescription in Disarray Fountain of Youth. Right, and what does that mean that testosterone gets broken down into estrogen and fat. So there’s something called Aroma tastes so aroma taste converts testosterone to estrogen in fact in some men we use. aroma taste inhibitors something for example in astor’s all the blocks, the conversion of testosterone to estrogen. Because guys who are have a lot of body fat, just break down the testosterone. So even if I’m treating a man with testosterone his levels. Don’t get to where we want them to be so we might add something like an Astra salt to block that. Chemical are in one last question about T- levels How what does treatment look like? Is it a pill? Is it an injection? Itself administered something? You administer all of the up so okay. There’s jost. Recently. We were in fact, of very involved in Manhattan medical. Research into development. Every drug that’s on the market for low testosterone. There’s just an the first oral believe it or not. The first oral was approved and it’s taken twice a day. It’s taken With fatty foods, so you have to take with a meal, most testosterone ‘s or not Orel and historically they’ve been either jails that you rub on. The worry about rubbing against your partner because you don’t want to transfer the testosterone. There’s injections or pellets. We put in a lot of long acting pellets that you put in every three to four months. Where do you put it in you? Put it in the like the upper glued area in the back with us a little bit of fat. In fact, we’ve done that in women as well in men, we might pretend to twelve pellets every three to four months in woman, women will put in one pellet. Maybe every four to six months. So you you do that when you said pellets. Okay, this is maybe my I was thinking you put it in the penis. into the ARETHA, this isn’t. This is giving a long acting like a long acting deep depth. Of Testosterone okay, okay all right now. I know you also work with with the brand that some of my clients are big fans of and that’s promise, and so this is a climax controls split spray so i. do want to ask you about that, but before we get there, I’d like to fire through a few questions from listeners and the first one is actually the opposite of. Of wanting to last longer, this is somebody who says it’s difficult for them. To a Jackie late about seventy five percent of the time. The sex seems to last too long and he and his wife get frustrated. He said he hasn’t always had this issue, but it started about five years ago and he wants to know. What can I do to not make it last so long? SO THAT’S A. A very difficult problem and it can be very frustrating because it’s the opposite of what people expect anything. That’s opposite the norm, his very frustrating so. He classically there’s this pleasure gap orgasm gap where men come ninety eight percent, time, sex and women. With without clitoral stimulation, much less so anything, so that creates frustration. So when I see these patients first thing I WANNA do is rule out low testosterone. rule allowed a neurologic problem, but you have to talk to the patient and so what I want to knows. Like what happened so sometimes? They have a kid and the guy does want to have a kid. So! He has difficulty climaxing. Sometimes. It’s You know the guy the guys. Know from watching porn, from whatever has this image that you supposed to last for thirty minutes sixty minutes, and he tries so hard to do that.
00:15:03 – 00:20:05
He creates these new neural pathways. And he’s blown behold. He can come if it’s somebody who’s had this problem their whole life I talk about. How how do they make themselves? So this is a very similar conversation. I have with women more commonly of difficulty orgasms. How do you make yourself calm? You fantasize well. You fantasize during sex if you don’t. Maybe should do you masturbate with pornography? Well, do you watch pornography during sex well? Maybe you should watch pornography during sex or stop watching pornography. When you masturbate, we have to try to. Close the gap between how you climaxed by yourself, and how you climax with your partner, and to try to because you, you create this muscle memory. You Rachi pleasure. and. It’s none of that lurks. Then we, there’s medicine, so there’s. Some to call Cabrera Galina, there’s something called oxytocin that we we give, but I China I I always try to work with my sex therapy colleagues like yourself in these sorts of cases, because there’s a big psychological overlay but I think the important thing is trying to understand. What happened? Why did this occur right and I? Really appreciate the bridging the gap between how you masturbate, and how you have sex with a partner because you’re right. I think for so many people with penises. The goal is last as long as I can stay hard as long as I can, and that can be a good thing at times, but also you know some of us that we’re things to do people to see places to go well, maybe no places to go right now, but certainly if you’re doing things differently like for example, maybe you need a little bit more friction at the base. Base and so maybe a penis ring would help. Maybe you just need a little more stimulation, and so it’s. It’s like a vibrating Penis Ring Brennan. Like something called the we vibe pivot. Or maybe you need more friction where you just reach down and give a hand right I’ve heard from so many men who say they just need to hold onto the base of the penis little, and that brings them to orgasm, but you’re right. We get into this mindset that the way we see in porn is the way we must do it. When in fact you just need to do what works for you, right? Yeah, and some women might WANNA have sex for thirty minutes. And a lot of women don’t WANNA have sex with thirty minutes so I. Think you have to be matched the desires of the couple. has to be matched. Right absolutely and I think that’s you know regardless of gender, because sometimes you’re gonNA. Want you. You have one partner who wants it for longer, one partner who wants it for less time and again if if you’ve got a penis, your you kind of are trained to believe that Europeans is the magic stick like this is how I pleasure you went. In fact, you’ve got hands and fingers and tongues and lips, and faces toys will maybe only one face, but. You’ve got all of these other You know options, so the opposite of that of course is that there are many people who want to last longer in bed, and there are products on the market like promise and I’m sure based on everything you’ve said so far. You also probably take a more holistic approach. So where do you begin? If people not necessarily, they may not be dealing with premature ejaculation may not be super-quick, but they just like to experiment sometimes with lasting longer bed. Yes, so This is obviously a more common problem You may not realize this is premature. EJACULATION is the most common sexual dysfunction sexual a complaint in. More than erectile dysfunction. So I, think it’s. I it’s important to frame the topic, so people understand. What’s the average time? People have sex with five to six minutes, so that’s probably less than people think. the definition of Premature ejaculation has changed. We do a lot of clinical research and I’ve done. Research and countless drugs oral drugs injectables creams. It used to be to get into a clinical trial for premature ejaculation was less than two minutes. Now it’s less than one minute, so that’s pretty severe, but we’re not talking about clinical trials now. We’re talking about real life. So. I talked to patients. About what their expectations are I talked to them a lot about. How they masturbate. had. They learn to masturbate, so if you most guys when they masturbate I’m particularly when the young and learned to masturbate that trying to get it done as quickly as they can right.
00:20:06 – 00:25:01
They just WANNA come and they don’t want to get caught by their parents girlfriend so again you create these neural pathways and this muscle memory that that’s how they finish. Sometimes, you know well. Talk about how they have sex. So if the guy is just you know pounding away up and down in and out. That’s very similar to the way most people masks. So I recommend they change positions maybe more of A. A rocking movement So. He might that gives more stimulating the clitoris and less to the penis. But if if we want to do something. Medically. Or prescribed something to help them some aid. The first line of therapy is a topical. And you mess mentioned present. My go-to topical I’ve done some research. We’re doing some studies at Manhattan Medical Research. Right now. On New Topical ‘s, but I haven’t found anything that’s better than and it’s. It’s an aerosol spray. So a man sprays it on his Pena’s. He rubs it on. It works very quickly, and it gets absorbed very quickly now. Why why is this important? because. We don’t want a number of vagina. Donald Defeat the purpose so I found This is very quickly absorbed. We don’t see any num- hook none this of the vagina. And, it doesn’t make the demand control the dose, so he can do to sprays three sprays, depending on how severe his P is, so it’s easy to get people get it online Dot Com and It said you know patients are happy. It’s easy happy. They’re happy. easy to use if that doesn’t work. There’s a sometimes we use the antidepressant medicines. Right like they S. SRI and or yet. So with regard to numbing so it it doesn’t numb. You mentioned the vagina. I assume the same applies whether you’re putting it in in an anus or mouth or hand, obviously, our listeners are having sex with all sorts of bodies. Does it numb? The Penis at all won’t short doesn of the penis, but it doesn’t number to the point that you can feel so that’s yeah, so you don’t want that. You don’t want to feel like you’re having sex with an inanimate object, so you can feel you still climax. You still have pleasure, but it desensitizes so these guys have oversensitivity, so we want to desensitize it and the beauty is. Because the man can control it. It They, can you know moderate the dose? And where do you spray it? Are you spraying it like on the underside or near the base of the shaft? Where do you spray? Spray it on the glands, which is the head of the Penis, but then Robert? Down the shaft, okay, and what is it about I? Guess the technology that doesn’t That doesn’t transfer to the partner. Is it because it’s quick absorbing right, so it gets? gets absorbed very quickly. But what I? What? I recommend to patients, you don’t spray it on and then. Jump right into intercourse or, oral sex. You spray it and you know four play is important, so these guys have. Problems with rapid ejaculation. Usually it’s rapid after penetration so. You want to preheat the oven of before you you put in the The state right and well, that’s interesting, because so often I. think in the Hetero context. In binary context that women need more time to warm up and what more foreplay, but regardless of gender and of course all the studies most of the is binary men also desire for play and the buildup and the excitement, and when we’ve trained ourselves from a young age, especially young men to masturbate as quickly as you can to not get caught you, you lose all of that. You lose all that pleasure. You miss out on the capacity to enjoy your entire body and I know like Brennan. For example. You’re better at slowing down than I have well I mean for me slowing down. I, I know that I need to be relaxed, so you made reference to. Spring present, and then taking the time to warm up more about the oven and for me. That’s what I need anyway, so if I were to to use I’d need to ensure that I. engage in that four, and you’re right.
00:25:01 – 00:30:01
I mean thinking back onto. Adolescence. The process of masturbating was really get done as quickly as you can. Because there was either shame or fear of being caught so definitely have that idea that you get it done like just rush through the process of reaching climax well and I think when we think of sexual shame, many of the courses and books and programs that are directed around you know relinquishing sexual shame are very focused at women, and we forget that you know people of all genders are raised with sexual shame, right? You are judged for masturbating, even though it is certainly more openly talked about I, think with guys and I think that the. Just, eliminating some of that fear of understanding, and you know that holistic approach that you had made reference to initially where. Before, we start assuming that there’s a physiological problem like let’s dive into some of the psychological elements, and again for me I’ve learned over the years that although I have had moments where I’ve been concerned about either performing or perhaps not being able to climax or whatever the case is. A big part of it for me was getting into my own head I was very much in the process. This snowballing effect where it’s like Oh, my God is this. Going to happen is is not going to happen. Am I going to am I? GonNa Finish Him. I’M NOT GONNA finish in. It’s like once I got into my head. It it either. It means that maybe it didn’t happen or maybe I couldn’t finish or whatever the case was so again for me. Get. Don’t get into my head. Take a minute think about what are the elements that I’m considering that actually penetrating making penetrating my mind. And making me not finish. Most sex happens between your ears right. So. You said get into your head. So. That is so on point because what happens is. Guys who. Have problems with premature ejaculation while guys who have even to a lesser degree delayed orgasm. They get anxious. So what happens when you get anxious will one gets worse and to you develop erectile dysfunction. So what what happens physiologically with anxiety? It’s decision pathetic nervous system. Gets active. So what happens when the sympathetic nervous systems active you get a contraction of blood vessels, so you guys are up in Canada. You know cold weather. If you go out into cold fingers get numb. Why because the sympathetic nervous system is trying to keep blood in the center of the body of core, and it contracts the blood vessels to the periphery while your penis and your clitoris par periphery, so the blood flow to the penis and the clitoris get active when the nervous and is less blood flow so what you are saying about when you get in your head and am I gonNA. Finish on my not gonNA finish. That’s so common with women, isn’t it? That’s like when they’re trying to have sex that they might gonNA come a mock gonNA com getting close. Is He getting You know tired. He wants he’s going down on me for twenty minutes, and you can’t come, but with vibrator by yourself. You can come in. So the head is so important. That that’s a such an important piece that working on mindfulness to reduce anxiety. Can Be so effective. I do I should mention to folks that I have a course on happier. Couples Dot com on lasting longer in bed, and it’s really focused on mindful practices, so the opposite of tuning out the opposite of trying to think about your grandma baseball really tuning into this incisions and understanding those sensations to reduce anxiety as you said because you don’t want that sympathetic nervous system to take over. And so you’ve mentioned a few times. Neuro pathways creating these neuro pathways that. Force you to finish more quickly or force you to have a result that you’re not looking for so? How do we I don’t know if the word is retrain or rebuild narrow pathways in our favor? Yeah, you just have to do it, so you have to figure out like you know. What why? Why am I doing this? What was the cause of this? What initiated this? And how can I change? So if it’s you know masturbating with corn and. Now I’m having sex with my girlfriend. And I don’t look like a porn star and she doesn’t look like a porn star, and she doesn’t act like a porn star, and now can’t get it up. Well I’m either have to.
00:30:02 – 00:35:01
Know figure, watch different porn or stop watching porn or watch you know. Figure this out. What’s going on and? Also watch together. You know I’m. I’m to on talking very holistically because I think a lot of sex the is. Happens in the brain, but I’m also a surgeon. I’m also a medical doctor urologist so I do use medications so if some I use. a lot of the PD inhibitors by Agrelo Beatrice I alice I. Think you know these are wonderful drugs. They changed the way we We treat sex. Sexual problems view sexual problems. They sort of brought sexual problems into the mainstream so I. We use a lot of that. I like in guys who have anxiety or trying to retrain them low dose daily Cialis, so they don’t have to think about it. It doesn’t not stress I have to take a pill to have sex We try to enforce a healthy lifestyle, so promise isn’t actually going back to them. They have this fabulous supplement. We’ve been using called. Vita flocks. Let’s say it’s It has these amino acids. Large Gina. Corner Team Newseum Zinc in pretty high levels and improves vascular help, so what is? Sexism. It’s ninety eight percent is in the brain. We’ve established that the other two percent is plumbing, its hydraulics. You need healthy blood flow blood flow to the penis in needs blood flow to the clitoris so. Healthy body and healthy healthy mind, and you’re going to have happier sex. It’s interesting you bring up a large Janine and blood flow and the. Did Increases Vaso dilation, and have you heard of a product called wave? This is a new product that came across my radar came onto my radar, and it’s for the clitoris or I guess as the Americans say the clitoris. Depending on where you’re from, and it’s, it’s topical and also very fast absorbing a ended. It’s active. Ingredient is also Allergen, and so it’s interesting in a good reminder of course that the class and the penis have so much in common so much in common. Yeah, so in fact many years ago I. Developed one of the first topical products for female arousal dream crane, and we had a ton of publicity, and it was on on Howard stirrer and every media broadcast. And we I sort of move in another direction. ’cause we were building up our clinical research. And I felt the tour in conflict, but we had a lot of fun with dream cream and helped a lot of women, so and now you’re on the opposite of Howard Stern. Right well. The thing is. You just want to get out there. Of course, both of us in healthcare care and focused on sexual health. There’s so much misinformation out there. There’s so many people who are frustrated and so any way we can spread the word I’m with you. Yeah, no, no arguments before we let you go ahead. One kind of left turn questioned from from a listener he asks. Why does it feel like one of my balls goes up into my body as I get close to orgasm, it sort of feels like I have to pull it back down. What is the sensation? You have a very common. That’s called a retractable testicle. And, all men have something called Cream Derek reflex, so it’s it their muscles around the spermatic cord, the cord that the whole testicles from And his blood vessels and the vast difference carries the sperm, but there’s the Christmas. Derek Muscles and young men particularly that muscle can be active and there’s a elicits. Reflex where the chemical gets pulled up. usually has men get older asked reflex diminishes. It’s absolutely nothing to worry about it. It’s very very common. It’s common plant. Concern or complaint that we get thank you all right. Brennan is helpful to you very hopeful. This is answered many questions. Retract hell testicles almost sounds like a transformer or something like that I would agree with that. Really appreciate this. A Dr. Jed Kim Manetzky. Thank you so much for joining us. Really appreciate it. Today was great. And people can learn more about your work at university urology DOT COM so I. Encourage people to follow along I. See you just joined Instagram, so make sure you also follow on Instagram Yeah. We have Dr J.
00:35:01 – 00:35:57
Cabinets. We had a instagram account, but this one is going to be just focused on. Information and sexual health. Okay, awesome, we’ll be following along. Thanks again for joining us. Thank you and thank you for listening and a big thanks to our sponsor this month. Let’s get checked at home tests that you complete in the comfort of your home, and then you check your results confidentially online. They test everything all the S.. T. is as well as cortisol cholesterol kidney hormone levels testosterone prostate PSA Colin. Liver firearms all of these again from the comfort of your home. Let’s get checked dot com. Please use code Doctor Jess at checkout so that they know that I sent you folks wherever you’re at have great week, we’ll be back next week in every week with a brand new episode. You’re listening to the sex with Dr Jazz podcast. Improve your sex life. Improve Your Life.