Dr. Rena Malik: Improving Sexual & Urological Health in Males and Females

Andrew Huberman: Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

Andrew Huberman：欢迎来到 Huberman 实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, my guest is Dr. Rena Malik.

今天，我的嘉宾是 Rena Malik 博士。

Dr. Rena Malik is a board-certified urologist and pelvic surgeon.

Rena Malik 博士是一位经过委员会认证的泌尿科医生和盆腔外科医生。

She is an expert in both male and female urological, pelvic floor and sexual health.

她是男性和女性泌尿科、盆底和性健康方面的专家。

During today's episode, Dr. Malik answers the most commonly asked questions about urinary pelvic and sexual health, for instance, how to avoid getting UTIs, urinary tract infections.

在今天的节目中，马利克医生回答了有关泌尿盆腔和性健康的最常见问题，例如如何避免感染尿路感染、尿路感染。

We also discuss pelvic floor anatomy and function as it relates to overcoming an overly tight or an overly relaxed pelvic floor.

我们还讨论盆底解剖结构和功能，因为它与克服盆底过度紧张或过度放松有关。

This is a key distinction that most people aren't aware of.

这是大多数人没有意识到的一个关键区别。

Many people hear about the need to so-called strengthen their pelvic floor, but in fact, many people need to do the exact opposite.

很多人听说需要所谓的强化骨盆底，但事实上，很多人需要做的恰恰相反。

They need to learn to relax their pelvic floor in order to achieve proper urologic and sexual function.

他们需要学会放松盆底以获得适当的泌尿和性功能。

So today you'll learn about that.

那么今天您将了解这一点。

You will also learn about sexual health as it relates to erectile function, as it relates to things like vaginal lubrication, as it relates to orgasm.

您还将了解性健康，因为它与勃起功能有关，与阴道润滑等有关，与性高潮有关。

We separate out very carefully the difference between psychological desire and arousal that occurs within the genitals themselves.

我们非常仔细地区分了心理欲望和生殖器本身发生的性唤起之间的区别。

And Dr. Malik highlights some important misconceptions about sexual dysfunction.

马利克博士强调了一些关于性功能障碍的重要误解。

For instance, that many people believe that hormones are responsible for sexual dysfunction, but in reality, hormone dysregulation is responsible for only a very small percentage of sexual dysfunction.

例如，许多人认为激素是导致性功能障碍的原因，但实际上，激素失调只导致很少比例的性功能障碍。

And yet, pelvic-floor and blood-flow-related issues can account for a large number of cases of sexual dysfunction in both males and females.

然而，盆底和血流相关问题可能是导致男性和女性性功能障碍的原因之一。

So I assure you that today's discussion is going to illuminate many new areas of information, many new tools and protocols that I'm guessing most people have not heard of.

因此，我向您保证，今天的讨论将阐明许多新的信息领域、许多新的工具和协议，我猜大多数人都没有听说过。

We talk about the neural, vascular — that is, blood flow related — and muscular aspects of bladder function, prostate function, Skene's glands.

我们讨论膀胱功能、前列腺功能、斯基恩腺的神经、血管（即与血流相关）和肌肉方面的问题。

We talk about vaginal health as well as penile health.

我们谈论阴道健康和阴茎健康。

We talk about these things as it relates to different stages across the lifespan.

我们谈论这些事情是因为它涉及生命周期的不同阶段。

It is a far-reaching and in-depth and practical conversation that I'm certain everyone will glean important takeaways from.

这是一次影响深远、深入而实用的对话，我相信每个人都会从中获得重要的收获。

Now, before we go any further, I do want to highlight that the content of today's episode is sexual in nature.

现在，在我们进一步讨论之前，我想强调一下，今天这一集的内容本质上是性的。

We talk very directly about different types of sexual behavior, and we talk about it from the standpoint of the clinician and biologist.

我们非常直接地谈论不同类型的性行为，并且我们从临床医生和生物学家的角度来谈论它。

So it is a medical/scientific discussion.

所以这是一场医学/科学讨论。

That said, we can't be aware of where this podcast is being played and who is listening.

也就是说，我们无法知道这个播客在哪里播放以及谁在收听。

And I assert that there are certain themes within today's discussion that would not be suitable for young children.

我断言今天的讨论中有某些主题不适合幼儿。

How young?

多年轻？

Well, that is certainly not for us to discern.

嗯，这当然不是我们能辨别的。

We realize that different parents and different households should be the arbiters of what sorts of information their children are exposed to or not.

我们意识到，不同的父母和不同的家庭应该成为孩子接触或不接触哪些信息的仲裁者。

So my suggestion would be that if you have any concern whatsoever that the content of today's episode would not be appropriate to be heard by some member of your family, that you please listen to the podcast first, or at least check the timestamps where we've detailed what specific topics are covered, and then to make your decision accordingly.

因此，我的建议是，如果您担心今天这一集的内容不适合您的家人听到，请先收听播客，或者至少检查我们详细说明了所涵盖的特定主题的时间戳，然后做出相应的决定。

I should mention that not only is Dr. Malik still an active clinician, she sees patients daily out of her clinic in Southern California, and we've provided a link to that clinic in the show note captions.

我应该提到的是，马利克医生不仅仍然是一名活跃的临床医生，她每天都在南加州的诊所看望患者，我们在节目说明标题中提供了该诊所的链接。

She's also authored dozens of high-quality, peer-reviewed publications in the fields of urology, pelvic health, and sexual health, and we've also provided a link to that bibliography in the show note captions.

她还在泌尿学、盆腔健康和性健康领域撰写了数十篇经过同行评审的高质量出版物，我们还在节目注释标题中提供了该参考书目的链接。

And she is also a spectacular public educator.

她也是一位出色的公共教育家。

She provides zero-cost content about sexual health, pelvic floor health, and urology as it relates to both men and women on her YouTube channel.

她在 YouTube 频道上提供有关性健康、盆底健康和泌尿科的零成本内容，因为这些内容与男性和女性相关。

And there, too, we've provided a link to Dr. Malik's YouTube channel in the show note captions to this episode.

我们还在本集的节目说明字幕中提供了马利克博士的 YouTube 频道的链接。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public.

然而，我的愿望和努力的一部分是将有关科学和科学相关工具的零成本消费者信息带给公众。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Our first sponsor is Roka.

我们的第一个赞助商是 Roka。

Roka makes eyeglasses and sunglasses that are of the absolute highest quality.

Roka 生产绝对最高品质的眼镜和太阳镜。

I've spent a lifetime working on the biology of the visual system, and I can tell you that your visual system has to contend with an enormous number of challenges in order for you to be able to see clearly.

我一生都在研究视觉系统的生物学，我可以告诉你，你的视觉系统必须应对大量的挑战，才能让你看得清楚。

Roka understands this and has developed their eyeglasses and sunglasses so that you always see with perfect clarity.

Roka 深知这一点，并开发了眼镜和太阳镜，让您始终拥有完美的清晰度。

In addition, they are extremely lightweight and they won't slip off your face if you get sweaty.

此外，它们非常轻巧，即使出汗也不会从脸上滑落。

Indeed, Roka eyeglasses and sunglasses were initially designed for performance in sports, but now they include aesthetics and styles that are really designed to be worn anytime.

事实上，Roka 眼镜和太阳镜最初是为运动表现而设计的，但现在它们包含了真正适合随时佩戴的美学和款式。

I, for instance, wear readers at night.

例如，我晚上会戴阅读器。

I'll sometimes wear sunglasses during the day when I drive.

白天开车时我有时会戴太阳镜。

And of course, I do not wear sunglasses when I do my morning sunlight viewing, which I highly recommend everyone do their morning sunlight viewing.

当然，我在早晨观看阳光时不会戴墨镜，我强烈建议每个人都进行早晨阳光观看。

If you'd like to try Roka eyeglasses or sunglasses, you can go to Roka, that's roka.com, and enter the code Huberman to save 20% off your first order.

如果您想尝试 Roka 眼镜或太阳镜，您可以访问 Roka（即 roka.com），并输入代码 Huberman 即可在首次订单时享受 20% 的折扣。

Again, that's Roka, roka.com.

再说一遍，这就是 Roka，roka.com。

Enter the code Huberman at checkout.

在结帐时输入代码 Huberman。

Today's episode is also brought to us by Helix Sleep.

今天的节目也是由 Helix Sleep 为我们带来的。

Helix Sleep makes mattresses and pillows that are customized to your unique sleep needs in order to allow you to get the best possible night's sleep.

Helix Sleep 生产根据您独特的睡眠需求定制的床垫和枕头，以便让您获得最佳的夜间睡眠。

Now, sleep is the foundation of mental health, physical health and performance.

现在，睡眠是心理健康、身体健康和表现的基础。

When we are sleeping well and enough, mental health, physical health and performance all stand to be at their best.

当我们睡眠充足、心理健康时，心理健康、身体健康和表现都会处于最佳状态。

One of the key things to getting a great night's sleep is to make sure that your mattress is tailored to your unique sleep needs.

获得良好睡眠的关键之一是确保您的床垫适合您独特的睡眠需求。

Helix Sleep has a brief two-minute quiz that if you go to their website, you take that quiz and answer questions such as, do you tend to sleep on your back, your side, or your stomach?

Helix Sleep 有一个两分钟的简短测验，如果您访问他们的网站，您可以参加该测验并回答诸如以下问题：您倾向于仰卧、侧卧还是俯卧？

Do you tend to run hot or cold in the middle of the night?

你半夜容易发热还是发冷？

Maybe you don't know the answers to those questions, and that's fine.

也许您不知道这些问题的答案，但这没关系。

At the end of that two-minute quiz, they will match you to a mattress that's ideal for your sleep needs.

在两分钟的测验结束后，他们将为您匹配最适合您睡眠需求的床垫。

I sleep on the DUSK, a D-U-S-K mattress, and when I started sleeping on a DUSK mattress about two years ago, my sleep immediately improved.

我睡在 DUSK 床垫上，大约两年前，当我开始睡在 DUSK 床垫上时，我的睡眠立即改善了。

So if you're interested in upgrading your mattress, go to helixleep.com/huberman.

因此，如果您有兴趣升级床垫，请访问 helixleep.com/huberman。

Take their two-minute sleep quiz, and they'll match you to a customized mattress for you, and you'll get up to $350 off any mattress order and two free pillows.

参加他们的两分钟睡眠测验，他们会为您匹配一张定制床垫，并且您可以在任何床垫订单上享受高达 350 美元的优惠，并免费获得两个枕头。

Again, if interested, go to helixleep.com/huberman for up to $350 off and two free pillows.

同样，如果有兴趣，请访问 helixleep.com/huberman，最高可享受 350 美元的折扣，并免费获得两个枕头。

We are always striving to make the Huberman Lab podcast better, and to that end, we need your help.

我们始终致力于让 Huberman Lab 播客变得更好，为此，我们需要您的帮助。

Over the next month, we are going to be carrying out a survey.

下个月，我们将进行一项调查。

The purpose of the survey is to improve the Huberman Lab podcast according to your feedback.

该调查的目的是根据您的反馈改进 Huberman Lab 播客。

We put together a brief survey to understand what you love about the podcast — hopefully you love a few things at least, or maybe just one thing — as well as what you think could be improved, or perhaps the many things that you think could be improved about the Huberman Lab podcast.

我们整理了一份简短的调查，以了解您对播客的喜爱程度 - 希望您至少喜欢一些事情，或者可能只是一件事情 - 以及您认为可以改进的地方，或者您认为 Huberman 实验室播客的许多事情可以改进。

Basically what we are asking is to get your feedback so that we can improve any and all things about the Huberman Lab podcast.

基本上，我们要求的是获得您的反馈，以便我们可以改进有关 Huberman 实验室播客的所有内容。

The survey does not take long and every single response will be reviewed.

调查不会花费很长时间，每一个回复都会受到审查。

As a thank-you for completing the survey, we are offering two months free of the Huberman Lab Premium channel.

为了感谢您完成调查，我们将免费提供两个月的 Huberman Lab Premium 频道。

If you're already a member of the Huberman Lab Premium channel, do not worry, you will get an additional two free months for carrying out this survey.

如果您已经是 Huberman Lab Premium 频道的会员，请不用担心，您将获得额外两个月的免费时间来进行这项调查。

You can find the link to the survey in the show notes for this podcast episode and on our website, hubermanlab.com.

您可以在本播客节目的节目说明和我们的网站 hubermanlab.com 上找到该调查的链接。

So if you would be so kind as to take a few minutes to fill out the survey and help us continue with bringing you the best possible content here at the Huberman Lab podcast.

因此，请您抽出几分钟时间填写调查问卷，并帮助我们继续在 Huberman 实验室播客中为您提供最好的内容。

And as always, thank you for your interest in science.

一如既往，感谢您对科学的兴趣。

And now for my discussion with Dr. Rena Malik.

现在我与 Rena Malik 博士进行讨论。

Dr. Rena Malik, welcome.

雷纳·马利克博士，欢迎光临。

Dr. Rena Malik: Thank you.

雷纳·马利克博士：谢谢。

Thank you so much.

太感谢了。

It's an honor to be here.

很荣幸来到这里。

Andrew Huberman: I'm delighted to have you here.

安德鲁·胡伯曼：我很高兴你能来到这里。

I'm a huge fan of your content.

我是你内容的超级粉丝。

I find that you are able to deliver critical information about sexual health, urology, pelvic floor, libido, and so many other things that are of immense interest to people, but that ordinarily people don't really know where to get the high-quality information, and coming to you for that information means they are going to get the highest-quality information.

我发现你能够提供有关性健康、泌尿科、盆底、性欲以及许多其他人们非常感兴趣的事情的重要信息，但普通人并不真正知道从哪里获得高质量的信息，而向你寻求这些信息意味着他们将获得最高质量的信息。

I truly believe that because as everyone will soon hear today, we're going to have a very frank discussion, but one that's really grounded in science and medicine around sexual health and related topics.

我真的相信，因为正如今天每个人很快就会听到的那样，我们将进行一次非常坦率的讨论，但这种讨论真正基于围绕性健康和相关主题的科学和医学。

These are topics that typically people learn about, perhaps a little bit in school, maybe at home, from friends, usually overhearing things as opposed to direct exploratory conversation, online, pornography.

这些都是人们通常会从朋友那里学到的话题，也许是在学校、也许是在家里、从朋友那里学到的，通常是无意中听到的，而不是直接的探索性对话、在线、色情内容。

And at least in my experience growing up, there was education around sexual health, reproductive health, et cetera that was more oriented toward the fear of things like STIs, fear of unwanted pregnancy, all of which, of course, is extremely important for people to learn about, but far less about sort of the healthy versions of sexual health.

至少在我的成长经历中，有关性健康、生殖健康等的教育更多地是针对对性传播感染、对意外怀孕等事物的恐惧，所有这些当然对人们来说非常重要，但对健康版本的性健康的了解却少之又少。

Right?

正确的？

Dr. Rena Malik: Yeah, absolutely.

Rena Malik 博士： 是的，绝对如此。

Andrew Huberman: So this is an especially important conversation.

安德鲁·胡伯曼：所以这是一次特别重要的对话。

It's also one that I think has a backdrop that we should just acknowledge right off the bat, that because the information is gleaned from multiple sources, and because there are, let's just say, influences out there that relate to the morality of different practices, that there can be shame, there can be misunderstanding, there can be secrecy, and that further leads to misinformation.

我认为这也是一个我们应该立即承认的背景，因为信息是从多个来源收集的，并且因为存在与不同实践的道德相关的影响，所以可能存在羞耻，可能存在误解，可能存在保密，这进一步导致错误信息。

So I'm confident that today you can clarify things for us and we're going to stay out of those trenches.

所以我相信今天你可以为我们澄清事情，我们将远离那些战壕。

And the last thing I'd like to say is that because a number of terms will certainly come up that I think for some people, they're not used to hearing in general discourse.

我想说的最后一件事是，因为我认为对于某些人来说，肯定会出现一些术语，他们不习惯听到一般性的话语。

I'm just going to get them out of the way now.

我现在要把他们赶走。

Penis, vagina, anus, prostate, what else is there?

阴茎、阴道、肛门、前列腺，还有什么？

We're going to talk about libido.

我们要谈谈性欲。

We're going to talk about intercourse, oral sex, anal sex.

我们将讨论性交、口交、肛交。

We're going to talk about all of that.

我们将讨论所有这些。

So I just want to get that out there so that we can reduce the shock response.

所以我只是想把它说出来，这样我们就可以减少冲击反应。

Dr. Rena Malik: I love it.

雷纳·马利克博士：我喜欢它。

We got to talk about all of it.

我们必须谈论所有这一切。

Andrew Huberman: Great.

安德鲁·休伯曼： 太好了。

So to start things off, in anticipation of this episode, I solicited for questions on social media, and I got thousands of questions, but there was a lot of overlap in the questions.

首先，为了期待这一集，我在社交媒体上征求了问题，我收到了数千个问题，但问题有很多重叠。

So to start off, I'd like to talk about pelvic floor, because both males and females have a pelvic floor.

首先，我想谈谈盆底，因为男性和女性都有盆底。

And my understanding is that there's a muscular component, there's a neural-muscular component, there's a blood flow component.

我的理解是，有肌肉成分，有神经肌肉成分，有血流成分。

What is a healthy pelvic floor?

什么是健康的盆底？

What does a healthy pelvic floor do?

健康的盆底有什么作用？

And then we can talk about some of the health issues that an unhealthy pelvic floor creates and some of the ways to ameliorate an unhealthy pelvic floor.

然后我们可以讨论不健康的盆底造成的一些健康问题以及改善不健康的盆底的一些方法。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

So a pelvic floor, very simply, is basically a bowl of muscles that's connected to bones that hold up all your organs.

因此，非常简单，骨盆底基本上是一碗肌肉，与支撑所有器官的骨骼相连。

So basically, in your pelvis, there's all these muscles there, and their function is essentially many.

所以基本上，在你的骨盆里，有所有这些肌肉，它们的功能本质上是很多的。

It helps with urination, defecation, sexual function.

它有助于排尿、排便、性功能。

It helps with posture.

它有助于调整姿势。

And so having a strong, healthy pelvic floor can mean that you're having normal urination, you're having normal defecation, you're having great sex, and that you are also not having ailments like back pain or issues related to those functions and those organs.

因此，拥有强健、健康的盆底意味着您可以正常排尿、正常排便、性生活愉快，而且您也不会出现背痛等疾病或与这些功能和器官相关的问题。

And so pelvic floor is so important in so many different aspects, and we deal with it a lot as urologists because it's so integral to these functions that we take care of.

因此，盆底在许多不同的方面都非常重要，作为泌尿科医生，我们经常处理它，因为它是我们所照顾的这些功能中不可或缺的一部分。

And so when you have an unhealthy pelvic floor, it can vary from person to person.

因此，当您的骨盆底不健康时，情况可能因人而异。

And while you hear about it a lot in women, men also suffer from pelvic floor dysfunction or problems with the pelvic floor.

虽然女性经常听到这种情况，但男性也患有盆底功能障碍或盆底问题。

So, basically, pelvic floor dysfunction happens a lot when you're doing things like, if you were to go to the gym and do repetitions of any sort of exercise and you didn't rest, then that muscle would become contracted and short.

所以，基本上，当你做一些事情时，盆底功能障碍会经常发生，比如，如果你去健身房重复进行任何类型的锻炼，但没有休息，那么肌肉就会收缩和缩短。

Very similarly, if your pelvic floor is overstrained, it can become contracted and short and tight all the time.

非常相似，如果您的骨盆底过度紧张，它可能会一直收缩、短而紧。

And you may not know it.

你可能不知道。

It may just be a function of stress, anxiety, or overuse or posture problems, things of that nature that can affect your pelvic floor.

它可能只是压力、焦虑、过度使用或姿势问题的结果，这些因素都会影响你的骨盆底。

And so this can lead to issues.

因此这可能会导致问题。

Let's start with urination.

我们先从排尿开始。

You can have symptoms of urgency, frequency, meaning you have to go a lot to the bathroom, or you have to go and have a sudden desire that you can't delay, sometimes even have leakage.

您可能会出现尿急、尿频的症状，这意味着您必须经常去洗手间，或者您必须去洗手间并突然有一种不能拖延的欲望，有时甚至会出现漏尿。

In some cases, it can make it difficult to urinate because the pelvic floor is so tense.

在某些情况下，由于盆底非常紧张，可能会导致排尿困难。

Andrew Huberman: Or perhaps to incompletely vacate the bladder.

Andrew Huberman：或者可能是不完全腾空膀胱。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Andrew Huberman: Like, you go to urinate and then you go back to your desk, or then five minutes later, you have to urinate again.

安德鲁·休伯曼：就像，你去小便，然后回到办公桌前，或者五分钟后，你必须再次小便。

Dr. Rena Malik: Exactly.

雷纳·马利克博士：没错。

Andrew Huberman: Something of that sort.

安德鲁·休伯曼：类似的事情。

Dr. Rena Malik: Well, it can be either that you're not emptying completely or that the pelvic floor muscles are so tense that they're stimulating the bladder so it feels like there's more to go.

雷纳·马利克医生：嗯，可能是你没有完全排空，或者是盆底肌肉太紧张，刺激了膀胱，所以感觉还有更多的东西要排空。

So it's not always that you're not evacuating it.

所以你并不总是不疏散它。

It can present in a number of different ways.

它可以以多种不同的方式呈现。

And then with sexual function, if it's very tense, you can have pain.

然后对于性功能，如果非常紧张，你就会感到疼痛。

So you can have pain with sex, you can have pain with erections, you can have pain with ejaculation.

所以你可能会在性交时感到疼痛，你可能会在勃起时感到疼痛，你可能会在射精时感到疼痛。

Sometimes it can be a lot of different kind of pain syndromes.

有时可能是多种不同类型的疼痛综合症。

And you're like, I have all these different things going on, and it's really just pelvic floor dysfunction.

你会说，我发生了所有这些不同的事情，这实际上只是盆底功能障碍。

With GI function, you can definitely have constipation, and then often you can also have back pain.

有了胃肠功能，肯定会出现便秘，然后经常还会出现背痛。

And so all of these things can happen when your pelvic floor is too tense.

因此，当您的骨盆底过于紧张时，所有这些事情都可能发生。

Sometimes your pelvic floor can be too weak.

有时您的骨盆底可能太弱。

And that can be often because of, we see this in women a lot, because of childbirth, delivering children.

这通常是因为，我们在女性身上经常看到这种情况，因为分娩、生孩子。

With some people who have neurologic disorders, they can have weak pelvic floors or connective tissue disorders like Ehlers-Danlos syndrome, for example.

对于一些患有神经系统疾病的人来说，他们可能患有骨盆底薄弱或结缔组织疾病，例如埃勒斯-当洛斯综合征。

These sorts of things can cause weakness to the pelvic floor, which can then cause, very often what I see is, like urinary incontinence or leakage, which can, you know, create problems for people down the line.

这类事情会导致骨盆底虚弱，从而导致，我经常看到的是，例如尿失禁或漏尿，这可能会给人们带来问题。

Andrew Huberman: Thank you for that.

安德鲁·休伯曼：谢谢你。

So, first question, how does somebody know if their pelvic floor is too tight from an overcontraction or chronic contraction of the muscles there versus too weak?

那么，第一个问题，人们如何知道他们的骨盆底是否因肌肉过度收缩或慢性收缩而太紧，还是太弱？

And one of the challenges in having this conversation is that if we were talking about contraction of the calf muscle or the bicep, I think everyone intuitively knows, because they've seen the shortening of the muscle is when the muscle is quote, unquote flexed, and the lengthening of the muscle is when it is relaxed.

进行这次对话的挑战之一是，如果我们谈论小腿肌肉或二头肌的收缩，我想每个人都直观地知道，因为他们已经看到肌肉缩短是在肌肉弯曲时，而拉长是在肌肉放松时。

Is there a way to describe pelvic floor muscular shortening in a way that everyone can understand?

有没有一种方法可以用大家都能理解的方式来描述盆底肌肉缩短？

Would this be — like I said, we're going to be direct today?

就像我说的，我们今天会直接说话吗？

Would this be like tensing up one's anus and the opposite of the movement that one would do before initiating a bowel movement, and relaxation is sort of the pattern of pelvic floor muscular relaxation just prior to initiating a bowel movement.

这是否就像绷紧肛门一样，与开始排便之前所做的运动相反，而放松是开始排便之前盆底肌肉放松的一种模式。

Dr. Rena Malik: So I will say most people can't recognize it because it's very difficult to notice.

Rena Malik 博士：所以我会说大多数人无法识别它，因为它很难注意到。

It's sort of gradual, and so it can, over time, become noticeable with these symptoms.

这是渐进的，因此随着时间的推移，这些症状会变得明显。

But otherwise, it's very difficult because it's not a muscle that we were ever trained to recognize.

但除此之外，这是非常困难的，因为我们没有接受过训练来识别它。

Right.

正确的。

Like, you hear about Kegel exercises, for example, and people talk about how to do them, but that's all you ever hear about the pelvic floor.

例如，您听说过凯格尔练习，人们谈论如何进行这些练习，但这就是您所听到的有关骨盆底的所有内容。

And so you don't really know how to kind of do things in a way that protects your pelvic floor or kind of how to even tell when it's too tight or not relaxing.

所以你真的不知道如何以保护你的骨盆底的方式做事，或者甚至不知道如何判断它何时太紧或不放松。

And so that takes a sort of training.

这需要某种培训。

And so usually when people come to, first you get an examination to see if your pelvic floor is tight.

因此，通常当人们来时，您首先会进行检查，看看您的骨盆底是否紧张。

So for women, it's a pelvic exam, and for men, it's usually a rectal exam.

因此，对于女性来说，这是盆腔检查，对于男性来说，通常是直肠检查。

Andrew Huberman: How does that exam go?

安德鲁·休伯曼：考试进行得怎么样？

Dr. Rena Malik: So it's essentially palpating the muscles and also looking at the function.

Rena Malik 博士：所以它本质上是触诊肌肉并观察其功能。

So we'll say for---

所以我们会说——

Andrew Huberman: So digital palpation, where, that's a medical technology for, fingers are called digits.

Andrew Huberman：数字触诊是一种医疗技术，手指被称为数字。

So I'm old enough to recognize what a digital prostate exam is, right.

所以我已经足够大了，知道什么是数字前列腺检查，对吧。

The physician inserts their fingers through into the anus and feels the prostate to see whether or not it's swollen or not.

医生将手指插入肛门，触摸前列腺，看看它是否肿胀。

And as I'm saying this, I'm realizing sometimes we think of medicine, quote, unquote, modern medicine, as so evolved.

当我这么说的时候，我意识到有时我们会想到医学，引用，不引用，现代医学，就像这样进化而来的。

This has basically been the practice for, what, 50 years, 60 years, maybe 100 years, in the same way that the old school practice for glaucoma, excessive eye pressure, was for the physician to just touch the eyeball.

这基本上是50年、60年、也许100年的做法，就像传统的治疗青光眼、眼压过高的做法一样，医生只需触摸眼球即可。

So, folks, for those of you that think that medicine has evolved much, it clearly has in many ways.

所以，朋友们，对于那些认为医学已经进化了很多的人来说，它显然在很多方面都发生了变化。

But in any event, so a prostate exam goes as I just described.

但无论如何，前列腺检查就像我刚才描述的那样。

What would a pelvic floor exam for a male and a pelvic floor exam for a female involve at a kind of granular level here?

男性盆底检查和女性盆底检查在某种程度上涉及什么？

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So for women, you can feel the pelvic floor muscles through the vagina.

所以对于女性来说，可以通过阴道感受到盆底肌肉。

So you can feel the iliococcygeus, the pubococcygeus, the levator ani, those are all names of different muscles in this bowl.

所以你可以感觉到髂尾骨肌、耻骨尾骨肌、提肛肌，这些都是这个碗里不同肌肉的名称。

Andrew Huberman: This is the physician, who can feel them with their fingers.

安德鲁·休伯曼：这是医生，他可以用手指感觉到它们。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

And you could, too.

你也可以。

You could put your finger in, but you don't have a reference of normal.

你可以把手指放进去，但你没有正常的参考。

Right.

正确的。

So you wouldn't know what a normal pelvic floor feels like versus a tight one versus a weak one.

所以你不知道正常的骨盆底、紧张的骨盆底和脆弱的骨盆底感觉如何。

And so you can assess the tenseness based on palpation.

因此您可以根据触诊来评估紧张程度。

You can also see if there's tenderness.

您还可以看看是否有压痛。

And so you can assess that based on just a general physical examination.

因此，您可以仅根据一般体检来评估这一点。

And then also you can observe.

然后你也可以观察。

So I can say, contract your...

所以我可以说，合同你...

Squeeze your pelvic floor up and in.

向上并向内挤压骨盆底。

I can look and see, are they squeezing or are they pushing?

我可以观察，看看他们是在挤压还是在推挤？

Like, are they coordinated or not?

比如，他们协调不协调？

Right.

正确的。

Because that's a function of normal use of the pelvic floor.

因为这是骨盆底正常使用的功能。

And sometimes you'll see that they're discoordinated.

有时你会发现它们不协调。

You can also assess for sensation in the area and things like that.

您还可以评估该区域的感觉等。

That could be consequences of dysfunction.

这可能是功能障碍的后果。

Andrew Huberman: Can there be dysfunction in laterality?

Andrew Huberman：偏侧性会出现功能障碍吗？

Like the pelvic floor is pulling up into the right or up into the left?

就像骨盆底向右侧或左侧向上拉动一样？

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

So what typically when you see a pelvic floor therapist.

那么当您去看骨盆底治疗师时通常会发生什么。

Now, I'm not a pelvic floor therapist, but these are the people who do the work, right?

现在，我不是盆底治疗师，但这些是做这项工作的人，对吗？

They work with you on a prolonged basis to help you normalize the function of your pelvic floor.

他们长期与您合作，帮助您使盆底功能正常化。

It's like going to the gym with a trainer.

这就像和教练一起去健身房一样。

Right?

正确的？

They really work with you to get your pelvic floor functioning correctly.

他们确实与您合作，让您的骨盆底正常运作。

And the first step to that, a lot of pelvic floor therapists will just align your bones and the way you sit and walk to make sure that you're not straining those muscles by pulling in different directions.

第一步，许多骨盆底治疗师只会调整您的骨骼以及您坐姿和行走的方式，以确保您不会因向不同方向拉动而拉伤这些肌肉。

Andrew Huberman: And if a male goes to the physician to get a pelvic floor exam, there's obviously difficulty in putting fingers into the urethra, one would hope too small an opening.

安德鲁·休伯曼：如果一名男性去看医生进行骨盆底检查，显然将手指放入尿道会很困难，人们会希望开口太小。

So how are they doing the pelvic floor exam?

那么他们如何进行盆底检查呢？

Is it external to the body or is it through the anus?

是在身体外部还是通过肛门？

Dr. Rena Malik: So some of it's through the anus.

Rena Malik 博士：所以有些是通过肛门的。

You can feel the muscles through the anus, and then you can feel the perineal area and feel the muscles there as well as sensation.

你可以通过肛门感觉到肌肉，然后你可以感觉到会阴区域，感觉到那里的肌肉以及感觉。

Andrew Huberman: Okay, so perineal area.

Andrew Huberman：好的，所以是会阴区域。

So from the outside of the body, the region between the scrotum and the anus?

那么从身体外部看，阴囊和肛门之间的区域呢？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

So it sounds to me like if people want to get a high-quality assessment of whether or not their pelvic floor is healthy or not, they need to see a pelvic floor specialist.

因此，在我看来，如果人们想要获得关于盆底是否健康的高质量评估，他们需要去看盆底专家。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Andrew Huberman: That it's not the sort of thing that they could intuit on their own, necessarily.

安德鲁·胡伯曼（Andrew Huberman）：这不一定是他们凭直觉就能直觉到的事情。

Dr. Rena Malik: It would be difficult.

Rena Malik 博士：这会很困难。

I mean, so there are things you can buy online, like probes that you can insert in the vagina that will teach you how to do Kegel exercises and give you some readings, but they're not really meant to diagnose.

我的意思是，你可以在网上购买一些东西，比如可以插入阴道的探针，它会教你如何进行凯格尔运动并为你提供一些读数，但它们并不是真正用于诊断。

They're usually something people use if they say, have a weak pelvic floor and they want to try to do it at home on their own.

如果人们说骨盆底较弱并且想尝试自己在家做，他们通常会使用它们。

So there's nothing that's going to give you like a baseline reading — is this normal or abnormal?

因此，没有什么比基线读数更能给您带来帮助了——这是正常还是异常？

Andrew Huberman: Let's talk about Kegels.

安德鲁·休伯曼：我们来谈谈凯格尔运动。

First of all, who's Kegel?

首先，凯格尔是谁？

Dr. Rena Malik: So he is a gynecologist.

雷纳·马利克医生：所以他是一名妇科医生。

I don't remember all the specifics, to be quite honest, but basically he came up with Kegels, which are a strengthening exercise for the pelvic floor.

老实说，我不记得所有细节，但基本上他想出了凯格尔运动，这是一种增强骨盆底的运动。

And so what it is, what we describe it to for patients is we say, you're going to, there's a few different ways to describe it.

所以它是什么，我们对患者的描述是，我们会说，有几种不同的方式来描述它。

You're going to use the muscles that you use when you urinate, but try to stop the flow, but you don't want to do them when you're urinating because that can create dysfunction.

您将使用排尿时使用的肌肉，但要尝试阻止尿流，但您不想在排尿时使用这些肌肉，因为这会造成功能障碍。

You want to learn what the muscles are and then you squeeze those muscles and relax in between sets, so to speak.

可以这么说，你想了解肌肉是什么，然后挤压这些肌肉并在组间放松。

And so the other way people describe it is pulling up and in the vagina, or for men, sometimes you'll say it's like the feeling that you're trying to lift your penis off the floor without touching it.

因此，人们描述它的另一种方式是在阴道中拉起，或者对于男性来说，有时你会说这就像你试图将阴茎从地板上提起而不接触它的感觉。

Right.

正确的。

So those are kind of using---

所以这些都是使用——

Andrew Huberman: That's a good way to describe it.

Andrew Huberman：这是一个很好的描述方式。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Dr. Rena Malik: So those are kind of the ways that you can describe those muscles.

雷纳·马利克博士：这些是描述这些肌肉的方式。

And so you can squeeze for 5 seconds and relax for 5 seconds and do them in repetitions.

所以你可以挤压 5 秒，放松 5 秒，然后重复进行。

And they're just like any sort of exercise you do, you don't want to start doing 100 of them, right?

它们就像你所做的任何锻炼一样，你不会想开始做 100 次，对吗？

You want to do them...

你想做他们...

I tell them people, I tell patients, do them lying down so that you're only focusing on those muscles, you're not working on your posture, you're not doing anything else.

我告诉他们，我告诉病人，让他们躺下，这样你就只关注那些肌肉，你就不会调整你的姿势，你不会做任何其他事情。

And as you get better with them lying down, you then sit up and do them.

当你躺着做这些动作变得更好时，你就可以坐起来做这些动作。

And then once you're good with them sitting up, you can do them standing and start with 10 to 15 at a time, like once.

一旦你习惯了坐姿，你就可以让他们站着，开始时一次做 10 到 15 个，就像一次一样。

Andrew Huberman: Ten to 15 repetitions.

Andrew Huberman：重复 10 到 15 次。

So, yeah, let's talk sets and rep.

所以，是的，我们来谈谈设置和代表。

Dr. Rena Malik: So, yeah, 10 to 15 repetitions in the morning, 10 to 15 repetitions at night, maybe one more during the middle of the day, but don't overdo it, because just like anything, especially when you're starting out, you can.

Rena Malik 博士：所以，是的，早上重复 10 到 15 次，晚上重复 10 到 15 次，也许中午再重复一次，但不要过度，因为就像任何事情一样，尤其是当你开始时，你可以。

And if you're doing tons and tons of Kegels, then you will get a tight, short pelvic floor muscles, and you will then develop pelvic floor dysfunction.

如果你做大量的凯格尔运动，那么你的盆底肌肉就会变得紧绷、短小，然后你就会出现盆底功能障碍。

So it's really important to kind of understand those mechanics, which is why a lot of people think they know how to do Kegels, but they really don't.

因此，了解这些机制非常重要，这就是为什么很多人认为他们知道如何进行凯格尔运动，但实际上他们并不知道。

And so I always encourage people, if you have the time and the resources, to go to a pelvic floor physical therapist so they can really work with you and make sure you're doing them correctly.

因此，如果您有时间和资源，我总是鼓励人们去看盆底物理治疗师，这样他们就可以真正与您合作，并确保您做得正确。

Andrew Huberman: What are some of the benefits of Kegels for those that need them?

Andrew Huberman：凯格尔运动对于那些有需要的人有哪些好处？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

So they are typically prescribed for urinary incontinence, specifically stress urinary incontinence.

因此，它们通常用于治疗尿失禁，特别是压力性尿失禁。

So leakage that occurs when you have an increase in your intra-abdominal pressure, like a Valsalva, or coughing, sneezing, lifting heavy things, jumping on a trampoline.

因此，当腹内压增加（如瓦氏呼吸法）或咳嗽、打喷嚏、举起重物、在蹦床上跳跃时，就会发生渗漏。

So for those purposes, we use Kegels to strengthen the pelvic floor, and also in women, pelvic organ prolapse.

因此，出于这些目的，我们使用凯格尔运动来强化盆底，以及女性的盆腔器官脱垂。

So when you have weakness of the pelvic floor, that leads to a bulge that you can visibly see or feel in the vagina.

因此，当您的骨盆底无力时，就会导致您在阴道中明显看到或感觉到隆起。

For men, we often prescribe them for people who have had a prostatectomy, who then subsequently develop leakage after the prostatectomy, that is, again, stress urinary incontinence.

对于男性，我们经常为接受过前列腺切除术的人开药，这些人在前列腺切除术后随后出现渗漏，即压力性尿失禁。

Now, a lot of people use Kegels recreationally because improving the pelvic floor musculature can lead to more intense pelvic floor contractions during orgasm, which can be more pleasurable.

现在，很多人休闲地使用凯格尔运动，因为改善盆底肌肉组织可以导致性高潮时盆底收缩更强烈，从而更令人愉悦。

And so some people do it for those purposes.

所以有些人就是为了这些目的而这样做的。

But again, I caution people not to overdo it, because then you can lead to a more tense pelvic floor, which is not where we want to end up.

但我再次提醒人们不要过度，因为这样可能会导致骨盆底更加紧张，这不是我们想要的结果。

Andrew Huberman: Yes, I will underscore that cautionary note.

安德鲁·休伯曼：是的，我会强调这一警告。

Years ago, I heard about Kegels.

几年前，我听说过凯格尔运动。

I was like, okay, I'll try.

我当时想，好吧，我会尝试一下。

It sounds all good, right?

听起来一切都不错，对吧？

I only heard good things about Kegels, and what it quickly resulted in was painful urination.

我只听说过有关凯格尔运动的好消息，但它很快导致的就是排尿疼痛。

And I thought, this is weird.

我想，这很奇怪。

Everyone's saying Kegels are so great.

每个人都说凯格尔运动太棒了。

And the best thing I could do for my pelvic floor, it seemed, was to avoid Kegels.

看来，我能为骨盆底做的最好的事情就是避免凯格尔运动。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Andrew Huberman: And a little bit later, when we're talking about prostate, I'll explain at least what my experience was as it relates to the prostate.

安德鲁·胡伯曼：稍后，当我们谈论前列腺时，我至少会解释我的经历与前列腺有关。

But I guess the take-home message that I'm gathering from what you're telling us is that strengthening the pelvic floor is great.

但我想我从你告诉我们的内容中收集到的重要信息是，加强骨盆底是很棒的。

If you have a weak pelvic floor, strengthening your pelvic floor further, if you have a strong pelvic floor, can be detrimental.

如果您的骨盆底较弱，那么进一步加强骨盆底（如果您的骨盆底较强壮）可能是有害的。

Dr. Rena Malik: It can be.

Rena Malik 博士：可以。

It can be if you overtrain it, just like if you overtrain anything else.

如果你过度训练它，就像你过度训练其他任何东西一样。

And so if you really want to do Kegels, if you have any symptoms at all like you described, painful urination, or the things I've described, like pain with erections, pain with ejaculation, pain, difficulty emptying, any of those symptoms, stop and go see a urologist so that they can kind of assess your pelvic floor.

所以，如果你真的想做凯格尔运动，如果你有任何像你所描述的症状，排尿疼痛，或者我所描述的事情，比如勃起疼痛，射精疼痛，疼痛，排空困难，任何这些症状，停下来去看泌尿科医生，以便他们可以评估你的盆底。

Andrew Huberman: What is the anti-Kegel?

Andrew Huberman：什么是反凯格尔？

In other words, if somebody decides that they have a tight pelvic floor, how can they learn to relax their pelvic floor?

换句话说，如果有人认为自己的骨盆底很紧，他们如何才能学会放松骨盆底呢？

Dr. Rena Malik: So there's a lot of different sort of things that you can do.

Rena Malik 博士：所以您可以做很多不同类型的事情。

So for women, you can do massage of the area.

所以对于女性来说，可以进行该部位的按摩。

You can use vaginal dilators to help relax the muscles.

您可以使用阴道扩张器来帮助放松肌肉。

You can take suppositories that have medications like Valium or baclofen, which are muscle relaxants.

您可以服用含有安定或巴氯芬等肌肉松弛剂的栓剂。

And that can help as well.

这也有帮助。

Although they're not treatments, they're more of a band-aid, but they can help with the symptoms that you're having.

虽然它们不是治疗方法，但更像是创可贴，但它们可以帮助缓解您的症状。

And then you can also, I think the best thing is to work with a physical therapist because they can teach you certain exercises that will help down train the pelvic floor.

然后你也可以，我认为最好的事情是与物理治疗师合作，因为他们可以教你某些有助于降低骨盆底训练的练习。

For example, one of the ones I tell my patients is like, happy baby pose.

例如，我告诉我的病人的一个动作是“快乐婴儿姿势”。

It actually stretches and elongates the pelvic floor muscles.

它实际上可以拉伸和拉长骨盆底肌肉。

So doing these exercises regularly will help you lengthen the pelvic floor muscles.

因此，定期进行这些练习将帮助您延长骨盆底肌肉。

Andrew Huberman: One thing that I've experienced extreme pain from and that stopping was one of the best things that ever happened for my pelvic floor, was to not do any kind of crunching movement with my legs crossed.

Andrew Huberman：我经历过极度疼痛的一件事是，停止双腿交叉时不要做任何类型的嘎吱嘎吱的动作，这对我的骨盆底来说是最好的事情之一。

I would go to these yoga classes at one point in my life, and they'd have everybody do these crunches.

我一生中的某个时刻会去参加这些瑜伽课程，他们会让每个人都做这些仰卧起坐。

And I've always done some abdominal work here and there during the week if I'm being diligent.

如果我勤奋的话，我总是会在一周内到处做一些腹部运动。

But they would have us cross our feet, and that seemed to lead to some pelvic floor discomfort that was similar to what I had experienced when I did the Kegels.

但他们会让我们交叉双脚，这似乎会导致盆底不适，类似于我做凯格尔运动时所经历的情况。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: So, again, for me, ceasing the Kegels was one of the best decisions I ever made.

安德鲁·休伯曼：所以，对我来说，停止凯格尔运动是我做过的最好的决定之一。

I only did them for a short while.

我只做了很短一段时间。

I was like, okay, this is clearly not for me.

我当时想，好吧，这显然不适合我。

And I guess that's another point that tell me if you agree or not, that if you hear about something online or on this podcast or anywhere else, and you try it, and it seems to be sending things in the wrong direction.

我想这是另一点告诉我你是否同意，如果你在网上或在这个播客或其他任何地方听到一些东西，并且你尝试它，它似乎正在将事情发送到错误的方向。

Either you're doing it wrong, or it might not be the right thing for you.

要么你做错了，要么这可能不适合你。

Dr. Rena Malik: Exactly.

雷纳·马利克博士：没错。

Andrew Huberman: I think all too often we hear, this thing is great, and people jump on that bandwagon, and then they end up worsening their problems or developing problems where they didn't have them previously.

安德鲁·休伯曼：我想我们经常听到，这件事很棒，人们就跟风，然后他们最终使问题变得更糟，或者在以前没有的地方出现问题。

But is there anything about the anatomy of the neuromuscular connections or vasculature of the pelvic floor that would provide support for my experience there?

但是，盆底神经肌肉连接或脉管系统的解剖学是否可以为我在那里的经历提供支持呢？

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: That doing crunches with legs crossed is essentially, is it possible that it's creating asymmetries in the pelvic floor?

Andrew Huberman：双腿交叉做仰卧起坐本质上是，它有可能造成骨盆底不对称吗？

And now I'm sure I'm angering yoga teachers and crunchanistas everywhere.

现在我确信我正在激怒各地的瑜伽老师和瑜伽爱好者。

But, you know, hey, if it's a question of your pelvic floor or a few extra delineations in your abs, you know where my vote is going.

但是，你知道，嘿，如果这是你的骨盆底或腹肌的一些额外轮廓的问题，你知道我的投票会投向哪里。

Dr. Rena Malik: So there's a couple of things here that we should dive into.

Rena Malik 博士：所以这里有一些事情我们应该深入探讨。

One is that people don't often breathe correctly during exercise, right.

一是人们在运动时经常不正确呼吸，对吧。

And so diaphragmatic breathing is really important, which is like a deep breath that expands the diaphragm.

所以横膈膜呼吸真的很重要，就像深呼吸一样扩张横膈膜。

Not kind of shallow breathing.

不是那种浅呼吸。

That's just in your mouth and throat.

那只是在你的嘴里和喉咙里。

And that is actually when you do any sort of exercise, your trainer will tell you, exhale on the effort.

事实上，当你进行任何形式的锻炼时，你的教练都会告诉你，努力时呼气。

Right?

正确的？

And there's a reason for that, because when you inhale, your pelvic floor relaxes.

这是有原因的，因为当你吸气时，你的骨盆底会放松。

When you exhale, your pelvic floor contracts.

当你呼气时，你的骨盆底会收缩。

And so, actually, that contraction stabilizes the pelvic floor, so whatever intra-abdominal pressure you're causing to increase from the exercise, whether it's a squat or a crunch or whatever, you're increasing your abdominal pressure.

所以，实际上，这种收缩可以稳定骨盆底，所以无论你在运动中导致腹内压力增加，无论是深蹲还是仰卧起坐或其他什么，你都会增加腹部压力。

Your pelvic floor is then contracting to help stabilize that.

然后你的骨盆底会收缩以帮助稳定它。

And so part of the reason people tend to hold their breath during crunches, right.

这也是人们在仰卧起坐时屏住呼吸的部分原因，对吧。

They don't do the appropriate breathing.

他们没有进行适当的呼吸。

And so that can be part of it.

所以这可以成为其中的一部分。

The other thing that can happen with certain things is that there are nerves and arteries, particularly the pudendal nerve and the pudendal artery that run through the pelvic floor.

某些事物可能发生的另一件事是存在神经和动脉，特别是穿过盆底的阴部神经和阴部动脉。

So when you get pelvic floor dysfunction, you can cause decreased blood flow to the pelvic floor muscles, which can affect sexual function, and you can get nerve inflammation as well, that can also cause pain.

因此，当您出现盆底功能障碍时，会导致盆底肌肉的血流量减少，从而影响性功能，并且还会出现神经炎症，这也会引起疼痛。

And so this is kind of how it all comes together.

这就是这一切的结合方式。

Andrew Huberman: I'm so glad that you mentioned blood flow.

Andrew Huberman：我很高兴你提到血流。

I think our entire discussion today should be framed up, at least in the back of our minds and the minds of our listeners and viewers, as involving at least three things.

我认为我们今天的整个讨论应该至少在我们以及听众和观众的脑海中构建，至少涉及三件事。

Anytime we're talking about erectile function or dysfunction or pelvic floor function or dysfunction or vaginal lubrication or lack thereof, we need to think about the hormonal influences, the blood flow related influences, and the neural influences, including the neural influences that come from the brain, the signals of arousal, for instance, or lack of arousal, and so on.

每当我们谈论勃起功能或功能障碍、盆底功能或功能障碍、阴道润滑或缺乏润滑时，我们都需要考虑荷尔蒙的影响、血流相关的影响和神经影响，包括来自大脑的神经影响，例如，性唤起或缺乏性唤起的信号等。

So we won't be overly systematic in our parsing of all this, but I think what you just mentioned raises a really important point, that sometimes in an effort to do something that's good for the muscles, like strengthen the muscles, one will cut off blood flow.

所以我们不会过于系统地解析所有这些，但我认为你刚才提到的提出了一个非常重要的观点，有时为了做一些对肌肉有益的事情，比如增强肌肉，人们会切断血液流动。

In fact, one of the more common questions I got, and I consulted with a couple of exercise physiologists about this, and they confirmed that a lot of people who squat and deadlift heavy in the gym or even who just tense their pelvic floor when they're doing things like dumbbell curls or other exercises, and especially people who seem to do a lot of abdominal work, reported to me in the questions that they experienced things like erectile dysfunction, that they experienced things like pain during vaginal intercourse, that essentially they had created some sort of what sounds to me like a hypercontraction of the muscles in that area that were impeding all the things that they wanted, as either side effects or direct effects of exercise, because many people are exercising for aesthetic reasons and health reasons, but nowadays, it seems, especially on the male side...

事实上，我遇到的一个更常见的问题是，我就此问题咨询了几位运动生理学家，他们证实，很多在健身房进行深蹲和硬拉的人，甚至在做哑铃弯举或其他运动时只是收紧骨盆底的人，尤其是那些似乎做了很多腹部运动的人，在问题中向我报告说，他们经历过勃起功能障碍之类的事情，他们在阴道性交时经历过疼痛之类的事情，基本上他们有在我看来，该区域的肌肉过度收缩，阻碍了他们想要的一切，无论是锻炼的副作用还是直接影响，因为许多人出于审美原因和健康原因而锻炼，但现在，似乎，尤其是在男性方面......

But we will also talk about the role of testosterone on the female side.

但我们也会讨论睾丸激素对女性的作用。

A lot of males lift weights in order to increase their testosterone and, for reasons that are obvious, also want to have healthy sexual function.

许多男性举重是为了增加睾丸激素，并且出于显而易见的原因，也希望拥有健康的性功能。

And here they are doing this thing that's very good for increasing testosterone if they're doing it correctly.

如果他们做得正确的话，他们正在做的事情对于增加睾丸激素非常有好处。

And testosterone is involved in libido and the male sexual response, and the female sexual response, of course, but they are impeding their erections.

睾丸激素参与性欲和男性性反应，当然还有女性性反应，但它们会阻碍勃起。

So you can start to see how there are probably a lot of confused and maybe even distraught people out there.

所以你可以开始看到外面可能有很多困惑甚至心烦意乱的人。

They're trying to do all the right things, and they're setting up roadblocks and even sending themselves backward in some cases.

他们试图做所有正确的事情，但他们却设置了障碍，甚至在某些情况下让自己倒退。

So the question is, how does one know whether or not something like, let's say, low lubrication or pain during vaginal intercourse or loss of erectile strength or some sort of erectile dysfunction, whatever it may be, because it can take on different forms, as we'll talk about.

所以问题是，人们如何知道是否存在诸如阴道性交过程中润滑不足或疼痛、勃起强度丧失或某种勃起功能障碍之类的情况，无论是什么，因为它可以采取不同的形式，正如我们将要讨论的那样。

How does one know if it's blood flow related, hormone related, or neural related?

如何知道它是否与血流相关、激素相关或神经相关？

And if it's neural related, how does one know if it's an issue of lack of appropriate signals from the brain, oversuppression or lack of arousal from the brain, or whether or not it's some peripheral neural thing of innervation of the penis or vagina?

如果它与神经有关，如何知道这是否是大脑缺乏适当信号、大脑过度抑制或缺乏唤醒的问题，或者是否是阴茎或阴道神经支配的一些周围神经问题？

Dr. Rena Malik: So I think there's a lot that we can go into here, but essentially, first you want to find out very specifically what is going on.

Rena Malik 博士：所以我认为我们可以在这里讨论很多内容，但本质上，首先你要非常具体地了解正在发生的事情。

Are you getting aroused?

你被唤醒了吗？

Are you having erections?

你有勃起吗？

Are you masturbating?

你在手淫吗？

Like, there's all these questions that will help us go down the route.

就像，所有这些问题都将帮助我们走上这条路。

Andrew Huberman: Sorry to interrupt, when you say aroused, for sake of this discussion, I just want to make sure that we distinguish between psychological arousal, the desire.

安德鲁·休伯曼：抱歉打断一下，当你说“唤起”时，为了便于讨论，我只是想确保我们区分心理唤起和欲望。

I guess here we also have to be precise.

我想在这里我们也必须精确。

Arousal to engage in intercourse, arousal to desire, essentially, that I think people would learn to recognize.

从本质上讲，我认为人们会学会认识到性交的唤起、欲望的唤起。

Or are we talking about arousal as the response of the genitals?

或者我们正在谈论性唤起作为生殖器的反应？

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

So desire and arousal, this is a very important concept, doesn't always go in one direction.

所以欲望和唤醒，这是一个非常重要的概念，并不总是朝一个方向发展。

Sometimes you can feel arousal, meaning you have the telltale signs of arousal.

有时您会感到兴奋，这意味着您有兴奋的迹象。

Your nipples get erect, you have more lubrication if you're a female.

如果您是女性，您的乳头会直立，润滑程度会更高。

Andrew Huberman: Do both male and female nipples get erect during arousal?

安德鲁·休伯曼：男性和女性的乳头在性兴奋时都会勃起吗？

Dr. Rena Malik: I believe so.

Rena Malik 博士：我相信是这样。

Andrew Huberman: I think so.

安德鲁·休伯曼：我想是的。

Dr. Rena Malik: You maybe get the sex flush, right?

雷纳·马利克博士：你也许会性欲旺盛，对吧？

You get some redness or warmth feeling.

您会感觉到一些发红或温暖的感觉。

That's your body's response to arousal.

这是你的身体对兴奋的反应。

And sometimes that can be an erection, and sometimes that's not.

有时这可能是勃起，有时则不是。

Not having an erection does not mean you're not aroused.

没有勃起并不意味着你没有性兴奋。

It may mean other things, but certainly that's part of it.

它可能意味着其他事情，但肯定是其中的一部分。

And then desire, do you want to have sex?

然后欲望，你想发生性关系吗？

When you think about your partner or whoever you want to engage with, is there a desire to actually do that?

当您想到您的伴侣或任何您想与之交往的人时，是否有真正这样做的愿望？

Right?

正确的？

Or is it just more of obligation or other things?

或者只是更多的义务或其他事情？

And it doesn't matter if the desire comes after arousal.

欲望是否在性唤起之后出现并不重要。

For some women in particular, we see that they may not have the desire right away, but they want to be intimate or close with their partner, and so they'll start just being close with them, and then arousal will come.

特别是对于一些女性，我们看到她们可能不会立即产生欲望，但她们想与伴侣亲密或亲密，所以她们会开始与伴侣亲密，然后性唤起就会到来。

And then, oh, yeah, I like this.

然后，哦，是的，我喜欢这个。

So then the desire comes after, and that's normal.

所以欲望随之而来，这是正常的。

That's totally fine.

那完全没问题。

So you want to kind of parse that out.

所以你想把它解析出来。

And then for men, you can ask, are you getting erections at night?

那么对于男性，你可以问，你晚上勃起吗？

Because that will tell us the function of your organ at night versus during the day, where you have also psychogenic components.

因为这会告诉我们你的器官在夜间和白天的功能，白天也有心因性成分。

Right.

正确的。

You can really get in your head about erections when you have a problem in the bedroom with performance; it becomes a vicious cycle.

当你在卧室里遇到性能问题时，你真的可能会想到勃起；这变成了一个恶性循环。

Right.

正确的。

So you have a problem the next time you're really stressed.

所以下次当你真的有压力的时候你就会遇到问题。

You're not present, you're not mindful in the moment with sex, and you're thinking about, oh, my God, am I going to perform okay?

你不在场，你没有在意性爱的那一刻，你在想，哦，天哪，我会表现得好吗？

Am I going to perform okay?

我的表现还好吗？

And then it doesn't perform again, and it's getting worse and worse, and the anxiety is through the roof, and that's actually causing your sexual dysfunction.

然后它就不再表现了，而且变得越来越糟，焦虑感达到了顶峰，这实际上导致了你的性功能障碍。

So I think it's important first to identify those issues and then also for blood flow.

因此，我认为首先要确定这些问题，然后再确定血流问题，这一点很重要。

A lot of times, we can assess based on, well, what other comorbidities do you have?

很多时候，我们可以根据您还有哪些其他合并症来进行评估？

Do you have other issues ongoing that may be affecting your blood flow?

您是否还有其他可能影响您的血液流动的问题？

Most common, high blood pressure, diabetes, heart disease, and if you smoke, all of those things will affect blood flow to the genitals.

最常见的是高血压、糖尿病、心脏病，如果你吸烟，所有这些都会影响流向生殖器的血液。

And so that will point us---

这将为我们指明——

Andrew Huberman: Negatively.

安德鲁·休伯曼： 是否定的。

Dr. Rena Malik: Negatively.

雷纳·马利克博士： 是否定的。

Negatively.

消极的。

So that will point us to a more vascular issue.

因此，这将向我们指出一个更多的血管问题。

Hormonal issues are very important for desire, as far as sexual function in terms of erections, there's only 3% of erectile dysfunction that's related to hormones.

荷尔蒙问题对于性欲来说非常重要，就勃起方面的性功能而言，只有3%的勃起功能障碍与荷尔蒙有关。

Andrew Huberman: But that's pure erectile function.

安德鲁·休伯曼：但这只是纯粹的勃起功能。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Andrew Huberman: As opposed to desire.

安德鲁·休伯曼：与欲望相对。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Desire is predominantly modulated by the hormone testosterone for both men and women.

对于男性和女性来说，欲望主要受睾酮激素的调节。

In fact, a lot of people don't know this, but women have more testosterone in their bodies than they actually have estrogen.

事实上，很多人不知道这一点，但女性体内的睾丸激素比实际的雌激素还要多。

So testosterone is very important for both men and women for a variety of reasons.

因此，出于多种原因，睾酮对男性和女性都非常重要。

And so using that discussion with the patient will help you kind of identify where you're headed in terms of what you need to focus on for treatment.

因此，与患者进行讨论将帮助您确定治疗需要关注的方向。

There are certain things you can use to assess blood flow.

您可以使用某些东西来评估血流量。

You can do Doppler ultrasounds of the penis as well as the clitoris to see if there is good blood flow.

您可以对阴茎和阴蒂进行多普勒超声检查，看看血流是否良好。

You can assess the peak systolic velocity, which will tell you if there's a problem with arterial inflow versus the end-diastolic velocity, which will tell you if there's a problem with venous outflow.

您可以评估收缩期峰值速度，它会告诉您动脉流入是否存在问题，而舒张末期速度会告诉您静脉流出是否存在问题。

And so that can assess those things.

这样就可以评估这些事情。

There are some tests you can do for nerve function, although they're very uncommonly done, because mostly we can kind of get that through clinical report.

您可以对神经功能进行一些测试，尽管这种测试很少见，因为大多数情况下我们可以通过临床报告来获得这些测试。

And unfortunately, if you're having nerve problems, sometimes it depends on what's causing them, but sometimes they can be very difficult to reverse, and that's kind of a problem.

不幸的是，如果你有神经问题，有时这取决于引起问题的原因，但有时它们可​​能很难逆转，这就是一个问题。

We know that as people age, their sensation becomes less.

我们知道，随着人们年龄的增长，他们的感觉会减弱。

So just through aging, the nerves, the receptors become less sensitive, and so you will generally have less responsiveness to the same sensations you did when you were younger.

因此，随着年龄的增长，神经、受体会变得不那么敏感，因此你对年轻时的感觉的反应通常会减弱。

And so that kind of overlays all of this.

这样就覆盖了所有这些。

So it's complex, but really, a lot of it comes from the discussion you have with your patient, or you kind of really doing a deep dive in what's going on, like really thinking about each of those aspects and also what's going on in your relationship and what's going on in your life, stress, anxiety, how are those playing a role?

所以这很复杂，但实际上，很多都来自于你与病人的讨论，或者你真正深入了解正在发生的事情，比如真正思考每个方面，以及你的关系中发生了什么，你的生活中发生了什么，压力，焦虑，这些是如何发挥作用的？

Andrew Huberman: As many of you know, I've been taking AG1 daily since 2012, so I'm delighted that they're sponsoring the podcast.

Andrew Huberman：正如你们很多人所知，自 2012 年以来我一直每天服用 AG1，所以我很高兴他们赞助这个播客。

AG1 is a vitamin-mineral-probiotic drink that's designed to meet all of your foundational nutrition needs.

AG1 是一种维生素-矿物质-益生菌饮料，旨在满足您的所有基本营养需求。

Now, of course, I try to get enough servings of vitamins and minerals through whole food sources that include vegetables and fruits every day, but oftentimes I simply can't get enough servings.

当然，现在我尝试每天通过包括蔬菜和水果在内的天然食物来源获取足够的维生素和矿物质，但通常我根本无法获取足够的份量。

But with AG1, I'm sure to get enough vitamins and minerals and the probiotics that I need, and it also contains adaptogens to help buffer stress.

但有了 AG1，我肯定能获得足够的维生素和矿物质以及我需要的益生菌，而且它还含有适应原来帮助缓冲压力。

Simply put, I always feel better when I take AG1.

简而言之，当我服用 AG1 时，我总是感觉更好。

I have more focus and energy, and I sleep better.

我的注意力更加集中，精力更加充沛，睡眠质量也更好。

And it also happens to taste great.

而且它的味道也很棒。

For all these reasons, whenever I'm asked if you could take just one supplement, what would it be?

出于所有这些原因，每当我被问到是否可以只服用一种补充剂时，我会选择什么？

I answer AG1.

我回答AG1。

If you'd like to try AG1, go to drinkag1.com/huberman to claim a special offer.

如果您想尝试 AG1，请访问 Drinkag1.com/huberman 以获得特别优惠。

They'll give you five free travel packs plus a year supply of vitamin D3K2.

他们将为您提供五个免费旅行包以及一年的维生素 D3K2 供应量。

Again, that's drinkag1.com/huberman.

再说一遍，这是 Drinkag1.com/huberman。

Gosh, lots there to unpack.

天哪，还有很多东西需要打开。

And I'm glad you mentioned the relationship itself, because there are all sorts of things that can impact the arousal response — novelty.

我很高兴你提到了这种关系本身，因为有各种各样的因素可以影响唤醒反应——新奇感。

Not everyone's in a committed relationship.

并不是每个人都处于忠诚的关系中。

Whether or not people are engaging in a lot of masturbation to the point of ejaculation or climax or not, pornography, et cetera, we will get into that.

无论人们是否进行大量手淫以达到射精或高潮的程度，是否色情，等等，我们都会讨论这个问题。

It's a vast space to explore.

这是一个广阔的探索空间。

Before we go any further, I want to make sure, however, that we cue people to where and how they could find a really good, let's say, pelvic floor therapist, and where they could find a really great urologist to do the sorts of exams and perhaps the sorts of treatments that we've talked about.

然而，在我们进一步讨论之前，我想确保我们提示人们在哪里以及如何找到一位真正优秀的盆底治疗师，以及他们在哪里可以找到一位真正优秀的泌尿科医生来进行我们已经讨论过的各种检查和治疗。

Because at least as far as I understand, much of what people want to learn on this podcast is how things work and what happens when things break down, but also how to resolve those issues.

因为至少据我了解，人们想在这个播客中学到的大部分内容是事物如何运作以及事物发生故障时会发生什么，以及如何解决这些问题。

So let's say somebody wants to check out their pelvic floor, figure out what's going on there.

假设有人想要检查他们的盆底，弄清楚那里发生了什么。

Maybe they're having issues, maybe they're not.

也许他们有问题，也许没有。

If they are male or female, where do they go?

如果他们是男性或女性，他们会去哪里？

Is there a place online that has a great list of some of the best ones in one's area?

网上有没有一个地方列出了某个地区最好的一些地方？

Can it be done over telemedicine?

可以通过远程医疗来完成吗？

How does one go about that?

怎样做呢？

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So in terms of your pelvic floor, it's good to get assessed by a physician who specializes in pelvic floor.

因此，就您的盆底而言，最好由专门研究盆底的医生进行评估。

Now, that could be a urologist, that could be a gynecologist or even a physical medicine rehabilitation doctor that specializes in pelvic floor health.

现在，这个人可能是泌尿科医生，也可能是妇科医生，甚至可能是专门研究盆底健康的物理医学康复医生。

So typically you'll see in urology, you'll look for people who are board-certified in female pelvic medicine and reconstructive surgery if you're a woman, if you're a man, maybe sexual medicine, someone who specializes in sexual medicine would be a good place to look.

因此，通常您会在泌尿科看到，如果您是女性，您会寻找在女性盆腔医学和重建手术方面获得委员会认证的人，如果您是男性，也许是性医学，专门从事性医学的人会是一个不错的选择。

For gynecologists, again, you want to look at someone who has interest in this area, who does manage pelvic floor.

对于妇科医生来说，同样，您需要寻找对这个领域感兴趣并且确实管理盆底的人。

And then in terms of pelvic floor physical medicine rehabilitation, at least when I was in training, there was about 20 PMRs doctors around the country who really focused on this, so it's not a lot of people.

然后在盆底物理医学康复方面，至少在我培训的时候，全国大约有20个PMR医生真正专注于这个，所以人数不是很多。

If you can go to a pelvic floor physical therapist and you have one near you, that's great as well.

如果您可以去找骨盆底物理治疗师并且您附近就有一位物理治疗师，那也很好。

You do want to make sure that one, they do, are certified in pelvic floor physical therapy and that they have taken care of your gender.

您确实想确保他们确实获得了盆底物理治疗认证，并且他们已经照顾到您的性别。

So if you have male anatomy, then you want to go to someone who's actually seen men, because a lot of the pelvic floor physical therapists tend to treat a lot of women.

因此，如果您有男性解剖学知识，那么您应该去找真正见过男性的人，因为很多盆底物理治疗师往往会治疗很多女性。

And so that's kind of what I tell my patients, generally speaking.

一般来说，这就是我告诉我的病人的。

There's no, at least to my knowledge, no great resource.

至少据我所知，没有什么很棒的资源。

And maybe we'll look that up and see if we can find one.

也许我们会查一下，看看是否能找到一个。

Andrew Huberman: That's very helpful.

安德鲁·休伯曼：这非常有帮助。

Thank you.

谢谢。

Because again, going back to what I said at the beginning of our conversation, I think there's a lot of shame, or at least a lack of clarity as to how one gets help for issues that relate to the genitals.

因为再次回到我在谈话开始时所说的话，我认为有很多耻辱，或者至少对于如何获得与生殖器相关的问题的帮助缺乏明确性。

Because if you have a headache or you're having an eye issue, I mean, you sort of know where to go.

因为如果你头痛或者眼睛有问题，我的意思是，你知道该去哪里。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: Hopefully your headache doesn't warrant going to a neurologist, but it might.

安德鲁·休伯曼：希望你的头痛不需要去看神经科医生，但也有可能。

Eye stuff tends to be ophthalmologists, optometrists.

眼睛的工作人员往往是眼科医生、验光师。

Right.

正确的。

So I don't think we hear often enough about where to access the best quality care for these things, so thank you for that.

所以我认为我们没有经常听到关于在哪里可以获得这些事情的最优质护理的信息，所以谢谢你。

In thinking about sexual dysfunction, I'd like to have that conversation, more or less in parallel, if we can, around male sexual dysfunction and female sexual dysfunction.

在思考性功能障碍时，如果可以的话，我希望或多或少并行地围绕男性性功能障碍和女性性功能障碍进行对话。

And I want to make sure that before we do that, that I'm creating the correct parallel construction as they say.

我想确保在我们这样做之前，我正在创建正确的并行结构，正如他们所说的那样。

Erectile dysfunction in males is clearly a form of sexual dysfunction.

男性勃起功能障碍显然是性功能障碍的一种形式。

What is the parallel to erectile dysfunction in females?

女性勃起功能障碍有何相似之处？

Is it lack of vaginal lubrication and lack of relaxation of the vagina to have nonpainful intercourse?

是否缺乏阴道润滑和阴道松弛而无法进行无痛性交？

Is it even possible to have a parallel conversation about these two things?

是否有可能就这两件事进行平行对话？

Dr. Rena Malik: So, it's different.

Rena Malik 博士： 所以，这是不同的。

In some circumstances there are homologues, right?

在某些情况下存在同系物，对吧？

So the penis is the homologue of the clitoris.

所以阴茎是阴蒂的同源物。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

Dr. Rena Malik: So the clitoris is essentially the same sort of spongy erectile tissue that you see in the penis; it gets erect with arousal, and it actually extends very deep into the pelvis.

雷纳·马利克博士：因此，阴蒂本质上与您在阴茎中看到的海绵状勃起组织相同。它会随着性唤起而直立，并且实际上延伸到骨盆深处。

So it's not just a small little organ, it's actually quite long.

所以它不仅仅是一个小器官，它实际上相当长。

And so you can, in men you can have erectile dysfunction because you can see it, but in women, you may have difficulty with orgasm.

所以你可以，在男性中，你可能会出现勃起功能障碍，因为你可以看到它，但在女性中，你可能难以达到性高潮。

And it's not exactly a parallel, but difficulty orgasming in women is multifactorial, and we can get into that.

这并不完全是相似的，但女性性高潮困难是多因素造成的，我们可以深入探讨这一点。

But I think they're different, and I think also sexual dysfunction presents differently in both genders.

但我认为它们是不同的，而且我认为性功能障碍在两性中的表现也不同。

So when you talk about men, the one visual they see of arousal is erections.

所以当你谈论男人时，他们看到的性唤起的唯一视觉效果就是勃起。

And so it becomes very ingrained in your psyche that if I don't have an erection, I'm not aroused.

因此，如果我没有勃起，我就不会被唤起，这在你的心灵中变得非常根深蒂固。

Right.

正确的。

But there's a lot of reasons that you might not have an erection that we've sort of touched on, vascular problems, hormonal problems, neurologic problems, psychogenic issues, and other medications you're taking.

但是，有很多原因可能导致您无法勃起，如我们所提到的，血管问题、荷尔蒙问题、神经系统问题、心因性问题以及您正在服用的其他药物。

So there are issues that can affect erectile function, that can be a part of it, where you might feel like you have low desire because your arousal is not there.

因此，有些问题可能会影响勃起功能，这可能是勃起功能的一部分，您可能会觉得自己的性欲低下，因为您的性唤起不存在。

And that becomes a little bit confusing for women.

这对女性来说有点令人困惑。

What they can assess is their level of lubrication, if sex hurts, and if they get an orgasm.

他们可以评估的是自己的润滑程度、性交是否疼痛以及是否达到性高潮。

And so those are kind of the ways you can look at it.

这些都是你可以看待它的方式。

Andrew Huberman: Thank you for fleshing all of that out.

Andrew Huberman：感谢您充实了这一切。

You know years ago, I worked on sexual differentiation and in particular the role of hormones in sexual differentiation.

你知道，几年前，我研究了性别分化，特别是激素在性别分化中的作用。

And indeed, as you described, we learned because we were taught, and I think people still generally agree, that if one looks at the embryological origins of the penis and the clitoris, they are essentially analogous structures.

事实上，正如你所描述的，我们学习是因为我们被教导，而且我认为人们仍然普遍同意，如果人们观察阴茎和阴蒂的胚胎起源，它们本质上是类似的结构。

And that a lot of male genital development involves, literally the regression, the disappearance of the female sexual genitalia and associated organs, müllerian ducts and things like that, and what would become the ovaries become the testes, et cetera, et cetera.

许多男性生殖器的发育实际上涉及女性性生殖器和相关器官、苗勒氏管等的退化和消失，而卵巢变成了睾丸，等等。

Those are anatomical parallels.

这些是解剖学上的相似之处。

But what you just described for us very beautifully is the sort of functional parallels as it relates to sexual function and dysfunction.

但你刚才为我们描述的非常漂亮的是与性功能和功能障碍相关的功能相似之处。

So I'm hoping with that framing that we can knock down a few of these pins in a little less time, because there's a lot to tackle here.

所以我希望通过这个框架，我们可以在更短的时间内击倒其中一些销钉，因为这里有很多事情需要解决。

First off, I'd like to address the hormonal issues.

首先，我想解决荷尔蒙问题。

You mentioned that only 3% of erectile dysfunction, and by extension, can we say also female issues with sexual arousal, are hormonal in origin, is that right?

您提到，只有 3% 的勃起功能障碍，以及，我们是否可以说，女性的性唤起问题也源于荷尔蒙，对吗？

Dr. Rena Malik: So with desire, yes.

雷纳·马利克博士：所以，对于欲望来说，是的。

Andrew Huberman: Ok.

安德鲁·休伯曼：好的。

Dr. Rena Malik: They are hormonal in general.

Rena Malik 博士：它们总体上是荷尔蒙。

And arousal in terms of lubrication, if you're using that as a barometer, yes you can see less vaginal lubrication due to hormones, and I guess I would say 3 to 6% more, you know.

就润滑而言，如果您将其用作晴雨表，是的，您会发现由于激素而导致的阴道润滑减少，我想我会说增加 3% 到 6%，您知道。

Up to 6% we see of erectile dysfunction is hormonal.

我们发现高达 6% 的勃起功能障碍与激素有关。

It's a small percentage of the entirety of erectile dysfunction.

它只占整个勃起功能障碍的一小部分。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

So I think in looking on the landscape of social media, podcasts, and just in the common mindset, we've all come to believe that testosterone is pro-libido.

因此，我认为，纵观社交媒体、播客的格局，以及普通思维方式，我们都开始相信睾丸激素有利于性欲。

It's pro-desire in men and women.

它有利于男性和女性的欲望。

I think now people are starting to appreciate that it's pro-desire in women as well, but certainly in men, and that dopamine is also associated with desire.

我认为现在人们开始认识到它对女性也有促进欲望的作用，但对男性来说当然也是如此，而且多巴胺也与欲望有关。

And the general public tends to have this view of estrogen as being sort of anti-libido or anti-male, which is frankly false.

公众往往认为雌激素具有反性欲或反男性的作用，这显然是错误的。

In fact, and I've covered this on the podcast with Dr. Kyle Gillett and with Dr. Peter Attia and another fellow YouTuber, Derek from More Plates, More Dates, has talked a lot about the fact that if people, if men take drugs like an anastrozole to suppress their estrogen, thinking that, oh, it's all about having high testosterone, low estrogen, oftentimes they crush their libido.

事实上，我在播客中与 Kyle Gillett 博士、Peter Attia 博士以及另一位 YouTuber 同事（来自 More Plates, More Dates 的 Derek）谈了很多这样的事实：如果人们，如果男人服用阿那曲唑等药物来抑制雌激素，认为，哦，这都是因为睾酮水平高、雌激素水平低，他们常常会抑制性欲。

Just abolish it.

就废除它吧。

Which has led to a slowly growing, but I think, positive shift in how people are thinking about estrogen.

这导致人们对雌激素的看法发生了缓慢但我认为积极的转变。

Estrogen is great for brain function, estrogen is great for libido in men and women.

雌激素对于大脑功能非常有用，雌激素对于男性和女性的性欲都非常有用。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Andrew Huberman: And that is a revision of, I think, how most people think of the male sexual response.

安德鲁·休伯曼：我认为，这是对大多数人对男性性反应的看法的修正。

It's more in keeping with how people think about the female sexual response.

这更符合人们对女性性反应的看法。

Oh, estrogen in the female sexual response.

哦，雌激素在女性性反应中的作用。

That makes sense, but what we're trying to do here is clarify some of the misconceptions.

这是有道理的，但我们在这里试图做的是澄清一些误解。

Now, the reason I mentioned dopamine is that my understanding is that dopamine is involved in the desire response.

现在，我提到多巴胺的原因是我的理解是多巴胺参与欲望反应。

We will distinguish desire, the psychological arousal, from genital arousal, physical arousal, and that prolactin is associated with the refractory period during which erection can't occur, another, perhaps, orgasm can't occur in females, et cetera.

我们将把欲望、心理唤起与生殖器唤起、身体唤起区分开来，催乳素与不应期有关，在此期间勃起不能发生，女性可能无法出现性高潮，等等。

But my understanding is, that's also not that simple, and we need to take a step back, perhaps, and just talk about the physiological underpinnings of the desire and arousal response.

但我的理解是，这也没有那么简单，我们也许需要退后一步，只讨论欲望和唤醒反应的生理基础。

So I'll tell you what I was taught, and then you can tell me where it's wrong.

所以我会告诉你我所学到的，然后你可以告诉我哪里错了。

Dr. Rena Malik: Sure.

雷纳·马利克博士：当然。

Andrew Huberman: I hope.

安德鲁·休伯曼：我希望如此。

I was taught that the erection response and the vaginal lubrication response is generated by the parasympathetic nervous system, the relaxed, the rest-and-digest aspect of the nervous system.

我被告知勃起反应和阴道润滑反应是由副交感神经系统产生的，副交感神经系统是神经系统的放松、休息和消化方面。

Hence why some people can get psychogenic sexual issues of lack of erection or lack of vaginal lubrication, but that there are individuals out there for whom a lot of alertness, maybe even, and this is a controversial thing, but for some people, even some sense of aggression or kind of edginess or excitement, adrenaline, in other words, can stimulate erection or vaginal lubrication.

因此，为什么有些人会出现缺乏勃起或缺乏阴道润滑的心理性性问题，但有些人可能会非常警觉，甚至这是一个有争议的事情，但对某些人来说，即使是某种攻击性或某种急躁或兴奋，换句话说，肾上腺素也可以刺激勃起或阴道润滑。

So it gets tricky.

所以事情变得很棘手。

It's not like the textbooks.

这和教科书上的不一样。

It's not like they taught us in high school, as far as I know.

据我所知，这不像他们在高中时教我们的。

I was taught that the arousal response in males and females is initiated by a parasympathetic sort of relaxed tone.

我被告知，男性和女性的唤醒反应是由副交感神经的放松语气引发的。

And that as sexual desire and arousal and sex or masturbation progresses, that it shifts more towards the sympathetic nervous system, which has nothing to do with emotional sympathy and has everything to do with arousal.

随着性欲和性唤起以及性或手淫的进展，它会更多地转向交感神经系统，这与情感同情无关，而与唤起密切相关。

The catecholamines — dopamine, norepinephrine, and epinephrine, also called adrenaline and noradrenaline — are released.

儿茶酚胺——多巴胺、去甲肾上腺素和肾上腺素，也称为肾上腺素和去甲肾上腺素——被释放。

And that the climax response, which may or may not include ejaculation, we have to separate that out, is one that is really of the stress system of the body.

高潮反应，可能包括也可能不包括射精，我们必须将其分开，它实际上是身体压力系统的反应。

And then in the postcoital or postejaculatory or postclimax phase, then there's a shift back to the parasympathetic nervous system.

然后在性交后或射精后或高潮后阶段，就会回到副交感神经系统。

That's where the pillow talk and the exchange of odors and tastes and other molecules is known to enhance pair bonding through things like oxytocin, vasopressin, and so on.

众所周知，枕边谈话以及气味、味道和其他分子的交换可以通过催产素、加压素等物质增强夫妻关系。

And what I just described is exceedingly oversimplified, I realize.

我意识到我刚才所描述的过于简单化了。

But is that more or less how the physiology works?

但这或多或少是生理学的运作方式吗？

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So the way we're taught in medical school is point and shoot.

所以我们在医学院的教学方式是傻瓜相机。

So point is the parasympathetic nervous system.

所以重点是副交感神经系统。

Andrew Huberman: All the male audience will like that one.

安德鲁·休伯曼：所有男性观众都会喜欢那个。

Dr. Rena Malik: And then you go on to the sympathetic nervous system.

Rena Malik 博士：然后你继续研究交感神经系统。

But it makes sense.

但这是有道理的。

And the reason that I think you're hearing about this aggression, or these things that are leading to arousal is because there needs to be a stimulus, right?

我认为你之所以听到这种攻击性，或者这些导致性唤起的事情，是因为需要刺激，对吗？

A visual stimulus, a tactile stimulus, some sort of stimulus that you're getting that is then causing the release of nitric oxide from the parasympathetic nervous system.

视觉刺激、触觉刺激、某种刺激会导致副交感神经系统释放一氧化氮。

And that could be, for some people, aggression or some form of that, right.

对于某些人来说，这可能是攻击性或某种形式的攻击，对吧。

Andrew Huberman: Can you tell people about nitric oxide?

Andrew Huberman：你能给人们介绍一下一氧化氮吗？

Because we'll get into this when we talk about drugs that increase blood flow, Cialis, Viagra, and also nonprescription drugs, things like L-citrulline, arginine, and watermelon, for that matter.

因为当我们谈论增加血流量的药物（西力士、伟哥）以及非处方药（例如 L-瓜氨酸、精氨酸和西瓜）时，我们会讨论这个问题。

Right?

正确的？

So I read on the internet.

所以我在网上阅读。

Dr. Rena Malik: So nitric oxide is essentially the ignition for, what we say, for erections.

雷纳·马利克博士：所以一氧化氮本质上是我们所说的勃起的点火剂。

The ignition for erections.

勃起的点火。

The reason I talk about erections more often is when you look at the data, in fact, there was a paper on this where they looked at the number of articles that came up when you put in the word "penis" and the number of articles that came up when you put in the word "clitoris." And it was 50,000 about penis and 2000 about the clitoris.

我更频繁地谈论勃起的原因是当你查看数据时，事实上，有一篇关于此的论文，他们查看了当你输入“阴茎”一词时出现的文章数量以及当你输入“阴蒂”一词时出现的文章数量。阴茎有 50,000 个，阴蒂有 2000 个。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

This was actually a major section of the comments when I asked for questions on Instagram, and comments on comments, and yeah, how come?

这实际上是我在 Instagram 上提问时评论的主要部分，以及评论的评论，是的，怎么会呢？

Why not?

为什么不呢？

Et cetera?

等等？

Is that because the urology and sexual health field was dominated by men?

这是因为泌尿科和性健康领域由男性主导吗？

That's going to be the presumption.

这将是假设。

Or is it because it's easier to study mean?

还是因为学习平均数更容易？

What's going on here?

这是怎么回事？

Dr. Rena Malik: Yeah, I think there's been a lot, I mean you can go back to, like, Freud, where he thought that the female sexual response was less valuable.

雷纳·马利克博士：是的，我认为有很多，我的意思是你可以回到弗洛伊德，他认为女性的性反应不那么有价值。

And so there are some reasons---

所以有一些原因——

Andrew Huberman: Less valuable?

Andrew Huberman：价值较低？

Dr. Rena Malik: I guess, I don't know if that's the right term, but he---

Rena Malik 博士：我想，我不知道这个词是否正确，但他——

Andrew Huberman: Oh no, no, I'm not challenging your term, I just meant---

Andrew Huberman：哦，不，不，我不是在挑战你的术语，我只是想说——

Dr. Rena Malik: Like, you know, it was sort of dismissed.

Rena Malik 博士：就像，你知道，它有点被驳回了。

Andrew Huberman: He seemed to be obsessed with it, right?

Andrew Huberman：他似乎对此很着迷，对吧？

Dr. Rena Malik: But it was more about the male sexual response than the female sexual response.

雷纳·马利克博士：但这更多的是关于男性的性反应，而不是女性的性反应。

And so in general, yes, there is, you know, there were more men in medicine, there was more, and it is easier to study.

所以总的来说，是的，你知道，医学界有更多的男性，更多，而且更容易研究。

Right.

正确的。

You can't study the clitoris as, quite as easy as you can study the male penis response because you can see it visually, you can inject it and see an erection response.

你不能像研究男性阴茎反应那样简单地研究阴蒂，因为你可以通过肉眼看到它，你可以注射它并看到勃起反应。

Right.

正确的。

We do this for people who have erectile dysfunction, they'll take medications that increase blood flow, like Trimix.

我们为患有勃起功能障碍的人这样做，他们会服用增加血液流动的药物，例如 Trimix。

And you'll inject it into the penis, and you'll see an erection.

你将其注射到阴茎中，你会看到勃起。

So you can actually---

所以你实际上可以——

Andrew Huberman: Trimix.

安德鲁·休伯曼：Trimix。

Dr. Rena Malik: Trimix.

Rena Malik 博士：Trimix。

So there's, it's, it includes---

所以有，有，它包括——

Andrew Huberman: The entire male audience just went, wait, what are you injecting?

安德鲁·休伯曼：所有男性观众都说，等等，你在注射什么？

Dr. Rena Malik: So, there are three, basically, brand names of intracavernosal injections that we use for erectile dysfunction.

Rena Malik 博士：所以，我们用于治疗勃起功能障碍的海绵体内注射剂基本上有三个品牌名称。

Andrew Huberman: I hear "injection in penis," and I think it's, I like to think that it reflects a natural male response.

安德鲁·休伯曼：我听到“阴茎注射”，我认为它反映了男性的自然反应。

I sort of, I...

我有点，我...

taken aback.

吃了一惊。

I don't know, maybe there's a pelvic floor contraction in there someplace.

我不知道，也许是骨盆底某处收缩了。

Dr. Rena Malik: So it is scary to hear about.

Rena Malik 博士：所以听到这个消息很可怕。

It's a very small needle.

这是一根非常小的针。

It is very well tolerated.

它的耐受性非常好。

I've done it to patients in the office and they look at me and say, you're done.

我在办公室里对病人做过这样的事，他们看着我说，你已经完成了。

It's not as painful as it seems.

它并不像看起来那么痛苦。

And when you are not having erections and you've tried multiple things, people get to the point where they're willing to try that.

当你没有勃起并且尝试了多种方法时，人们就会愿意尝试。

And so, it is very effective.

所以，它非常有效。

It is the most effective nonsurgical treatment we have for erectile dysfunction.

这是我们治疗勃起功能障碍最有效的非手术治疗方法。

And it's usually either one medication, two medications or three.

通常是一种药物、两种药物或三种药物。

So you can have alprostadil, papaverine, and what's the third one?

那么你可以服用前列地尔、罂粟碱，第三种是什么？

Andrew Huberman: That's okay, we can look at, someone will put it in the comments.

Andrew Huberman：没关系，我们可以看看，有人会把它放在评论中。

Dr. Rena Malik: Sure.

雷纳·马利克博士：当然。

Andrew Huberman: Surely they will.

安德鲁·休伯曼：他们当然会的。

What is it designed to do?

它的设计目的是什么？

Is it a vasodilator of sorts?

它是某种血管扩张剂吗？

Dr. Rena Malik: So they work in different mechanisms, but similar to the medications that we have.

Rena Malik 博士：所以它们的作用机制不同，但与我们现有的药物相似。

PDE5 inhibitors.

PDE5抑制剂。

PDE5 inhibitors work in the erection cascade.

PDE5 抑制剂在勃起级联中发挥作用。

Basically, what happens, actually, let's take it back to the nitric oxide thing and we'll get there.

基本上，实际上发生了什么，让我们回到一氧化氮的事情上来，我们就会到达那里。

So nitric oxide essentially is released by the endothelium in response to a visual-tactile stimulating cue.

因此，一氧化氮本质上是由内皮细胞响应视觉触觉刺激信号而释放的。

Right?

正确的？

And so your body releases nitric oxide, which then sets off the cascade for the erection.

因此，您的身体会释放一氧化氮，从而引发勃起的连锁反应。

And so that releases c-GMP, which causes the erection,  and it's degraded by phosphodiesterase.

这样就会释放出 c-GMP，导致勃起，并被磷酸二酯酶降解。

And so medications that inhibit phosphodiesterase, like Viagra and Cialis, tend to prevent the breakdown of that c-GMP, so you have longer-lasting erections.

因此，抑制磷酸二酯酶的药物，如伟哥和西力士，往往会阻止 c-GMP 的分解，从而使勃起更持久。

And so similarly these medications work sort of similar to that.

同样，这些药物的作用与此类似。

Some of them, we don't know exactly how they work, but they work by increasing cGMP or cAMP that are involved in those cascades.

其中一些，我们并不确切知道它们是如何工作的，但它们通过增加参与这些级联的 cGMP 或 cAMP 来起作用。

Andrew Huberman: And what about L-citrulline?

Andrew Huberman：那么 L-瓜氨酸呢？

I hear about L-citrulline used, it's an over-the-counter supplement, and it's in the arginine pathway.

我听说使用了 L-瓜氨酸，它是一种非处方补充剂，并且位于精氨酸途径中。

And my understanding is that it works similarly to things like Cialis, Viagra, but is perhaps not as potent.

我的理解是，它的作用与西力士、伟哥类似，但可能没有那么有效。

I also just — cautionary note out there, L-citrulline can give people vicious cold sores and canker sores.

我还只是警告，L-瓜氨酸会给人们带来恶性唇疱疹和口腔溃疡。

Vicious.

恶毒。

You hear about this on the internet.

您在互联网上听说过此事。

It's been verified by grotesque images that you do not want to Google for, and not everyone tolerates it well.

它已经被你不想用谷歌搜索的怪诞图像所证实，而且并不是每个人都能很好地容忍它。

Dr. Rena Malik: So these actually work by increasing nitric oxide.

Rena Malik 博士：所以这些实际上是通过增加一氧化氮来起作用的。

So they're not later down the pathway, they're actually increasing the availability of nitric oxide.

所以他们并不是后来才走上这条路的，他们实际上是在增加一氧化氮的可用性。

So L-arginine is the more direct pathway, but it's very low bioavailability.

所以L-精氨酸是更直接的途径，但它的生物利用度非常低。

L-citrulline converts to L-arginine, but it lasts much longer in the bloodstream, which is why people tend to use L-citrulline.

L-瓜氨酸会转化为 L-精氨酸，但它在血液中的持续时间要长得多，这就是人们倾向于使用 L-瓜氨酸的原因。

Now, you know, in sexual medicine, these supplements, while there has been some studies on them and they are effective, there's no regulation on the supplement industry, so we can recommend them, but we just can't say that for sure that the supplement is exactly what's said on the bottle.

现在，你知道，在性医学中，这些补充剂虽然已经有一些研究并且它们是有效的，但补充剂行业没有监管，所以我们可以推荐它们，但我们不能肯定地说补充剂与瓶子上所说的完全一样。

We see lots of studies where they'll say, I read one about melatonin and there's a variation of melatonin from what's on the bottle to 400% times more.

我们看到很多研究，他们会说，我读过一篇关于褪黑激素的文章，里面的褪黑激素与瓶子上的含量有 400% 的差异。

And so that's kind of the struggle that we as medical doctors have.

这就是我们作为医生所面临的斗争。

And I know we get a lot of slack for it, that we don't talk about supplements, but it's really the challenge there is like finding the quality supplements.

我知道我们对此有很多懈怠，我们不谈论补充剂，但这确实是一个挑战，就像寻找优质补充剂一样。

Andrew Huberman: A great site, which I have no relationship to, except that I mention them all the time, is examine.com, which has references to human studies and where there's a lot of efficacy shown and will get into some side effect.

Andrew Huberman：一个很棒的网站，除了我一直提到它们之外，我与它没有任何关系，它是一个关于人体研究的参考文献，并且显示了很多功效，并且会产生一些副作用。

Can't address quality by brand issues, but thanks for mentioning that.

无法通过品牌问题来解决质量问题，但感谢您提到这一点。

What percentage of males who take Cialis, aka tadalafil, or Viagra, for erectile dysfunction get relief from that?

服用西力士（又名他达拉非或伟哥）治疗勃起功能障碍的男性中有多少比例能得到缓解？

Because you mentioned only 3% of erectile issues in males are hormonal in origin.

因为你提到只有 3% 的男性勃起问题是由荷尔蒙引起的。

But what percentage are likely to be blood-flow related in origin?

但有多少百分比可能与血流起源有关？

Dr. Rena Malik: So a large percentage are blood-flow related.

Rena Malik 博士：所以很大一部分与血流相关。

That doesn't mean that the medication will be effective for everyone.

这并不意味着该药物对每个人都有效。

If you look at the large percentage are vascular in nature, right?

如果你看一下大部分都是血管性质的，对吗？

That's the number one cause as men age.

这是男性衰老的首要原因。

So we know that about 50% or 52% of men over the age of 40 will have erectile dysfunction, and that continues to increase as you age.

所以我们知道，40 岁以上的男性中，约有 50% 或 52% 会出现勃起功能障碍，并且随着年龄的增长，这种情况会持续增加。

So 50% of 50-year-olds, 60% of 60-year-olds, and so on and so forth.

50 岁的人占 50%，60 岁的人占 60%，依此类推。

So it's very, very common.

所以这是非常非常常见的。

And the success rate in the studies is about 60% to 70%.

研究的成功率约为60%至70%。

So when you give someone a medication, they will have sustained erections that are sufficient for penetrative intercourse, which is the way we kind of discuss erectile dysfunction in studies and with patients, is about 60% to 70%.

因此，当你给某人服用药物时，他们会持续勃起，足以进行插入式性交，这就是我们在研究中和与患者讨论勃起功能障碍的方式，大约为 60% 至 70%。

So not everyone will have success, but not all of that is because the medication doesn't work.

所以并不是每个人都会成功，但也并非全部都是因为药物不起作用。

Sometimes people are not taking them correctly, sometimes people need to try different doses, and then there's still this issue of your brain is still active, and so if you're having anxiety or you're having other issues or stress in your life, that can have an effect on your ability to create an erection.

有时人们没有正确服用它们，有时人们需要尝试不同的剂量，然后您的大脑仍然处于活跃状态，因此如果您感到焦虑或生活中遇到其他问题或压力，这可能会影响您勃起的能力。

So there's lots of factors that go into it, but generally speaking, they are effective and they do work quite well and they're tolerated pretty well.

因此，影响因素有很多，但总的来说，它们是有效的，效果很好，而且耐受性也很好。

Andrew Huberman: Sixty percent to 70% is not a small number.

Andrew Huberman：百分之六十到百分之七十不是一个小数字。

That's a significant number.

这是一个很大的数字。

That's the majority, but by a significant margin.

这是大多数，但比例很大。

Is there a basis for the use of Cialis, tadalafil, Viagra, L-citrulline in females?

女性使用西力士、他达拉非、伟哥、L-瓜氨酸有依据吗？

Dr. Rena Malik: So, yeah, there's not a lot of data on this, but certainly, if you have surmised that there is a blood-flow issue and they're having difficulties with orgasm, it's certainly something you can try off-label.

Rena Malik 博士：所以，是的，这方面的数据并不多，但当然，如果您猜测存在血流问题并且性高潮有困难，那么您当然可以尝试标签外的方法。

And certainly people do try these medications off-label to see if they improve sexual function for women.

当然，人们确实会在标签外尝试这些药物，看看它们是否能改善女性的性功能。

But there's not a whole bunch of robust, randomized, controlled trial studies on women with these medications.

但目前还没有针对服用这些药物的女性进行大量稳健、随机、对照试验研究。

Andrew Huberman: A little bit later, we will talk about prostate health specifically, but I'm just going to make a note here that nowadays there's increasing use of low-dosage Cialis/tadalafil.

Andrew Huberman：稍后，我们将具体讨论前列腺健康，但我只想在此指出，如今低剂量希爱力/他达拉非的使用越来越多。

So rather than, what I found online was that the erectile dysfunction treatment dosage of Cialis/tadalafil is somewhere in the 15-to-20-mg range.

因此，我在网上发现西力士/他达拉非治疗勃起功能障碍的剂量在 15 至 20 毫克范围内。

What we're talking about here is daily use of 2.5 to 5 mg of Cialis/tadalafil for prostate health.

我们在这里讨论的是每天使用 2.5 至 5 毫克西力士/他达拉非以保持前列腺健康。

And I learned in researching for this episode that tadalafil/Cialis was actually developed as a drug for the treatment of prostate health to essentially increase blood flow of the prostate, to increase prostate health, not for the treatment of erectile dysfunction.

我在研究这一集时了解到，他达拉非/西力士实际上是作为一种治疗前列腺健康的药物而开发的，本质上是增加前列腺的血流量，改善前列腺健康，而不是用于治疗勃起功能障碍。

So I found that to be somewhat interesting, and a lot of people are now starting to use that.

所以我发现这有点有趣，现在很多人都开始使用它。

I also learned that if you dive into the guts of the internet, one can find that now there's a growing use of combined low-dosage Cialis and apomorphine, which is a prodopaminergic agent.

我还了解到，如果你深入了解互联网，就会发现现在越来越多地使用低剂量西力士和阿朴吗啡（一种促多巴胺能药物）的组合。

And we'll get back to dopamine a little bit later, but is there any basis for low dosage, say, 2.5 to 5 mg daily use of Cialis/tadalafil  in females?

稍后我们会回到多巴胺，但是女性每天使用 2.5 至 5 毫克希爱力/他达拉非的低剂量是否有任何依据？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Well, let's talk about it for males and females.

好吧，我们来谈谈男性和女性。

I think low-dose daily Cialis is excellent for erectile function in men, even---

我认为每日低剂量西力士对于男性勃起功能非常有效，甚至——

Andrew Huberman: Is that true even, sorry to interrupt, but is that true even for men that are not experiencing erectile dysfunction?

安德鲁·胡伯曼（Andrew Huberman）：抱歉打扰，这是真的吗？但即使对于没有勃起功能障碍的男性来说也是如此吗？

Dr. Rena Malik: It's not indicated for that purpose, but there's a thought that it's increasing blood flow to the area.

Rena Malik 博士：这并不是为了这个目的，但有人认为它会增加该区域的血流量。

So people, I've personally used it for men who have pelvic pain to help with increasing blood flow, you can also use it potentially as a preventative.

所以各位，我个人曾将它用于患有骨盆疼痛的男性，以帮助增加血液流动，您也可以将其用作潜在的预防措施。

So some people have kind of thought, okay, it's increasing blood flow, it's preventing fibrosis of that erectile tissue that can happen with age or other vascular problems, so it may be beneficial for that as well.

所以有些人有一种想法，好吧，它可以增加血流量，它可以防止勃起组织纤维化，这种纤维化可能会随着年龄或其他血管问题而发生，所以它也可能对此有益。

Although, again, that's off-label and not something that we generally promote.

不过，这又是标签外的，而不是我们通常提倡的。

As far as for women, again, it can help with blood flow.

对于女性来说，它可以帮助血液流动。

So if you're having issues, so if you have a female who's having sexual dysfunction and she's got signs of vascular problems, like she's got diabetes, high blood pressure, she smokes, then yes, it's certainly reasonable to try and see how they do.

所以，如果你有问题，如果你有一位女性有性功能障碍，并且她有血管问题的迹象，比如她患有糖尿病、高血压、她吸烟，那么是的，尝试看看他们的表现当然是合理的。

Usually you want to give at least a four-week trial to see if there's any benefit with those medications.

通常您需要进行至少为期四个星期的试验，看看这些药物是否有任何益处。

Andrew Huberman: Great, thank you for that.

安德鲁·胡伯曼：太好了，谢谢你。

Why is it that I get so many questions about erectile dysfunction from males who are in their 20s and 30s?

为什么我收到这么多 20 多岁和 30 多岁男性关于勃起功能障碍的问题？

Because everything you said up until now was mainly focused on men 40 years and older.

因为到目前为止你所说的一切主要针对的是40岁以上的男性。

Is it from lack of physical activity, overuse of nicotine?

是因为缺乏体力活动、过度使用尼古丁吗？

By the way, vaping, as far as we know, vaping and smoking, bad for erectile function and perhaps sexual health in males and females generally.

顺便说一句，据我们所知，电子烟和吸烟都不利于男性和女性的勃起功能，甚至可能不利于性健康。

Because nicotine is a vasoconstrictor.

因为尼古丁是一种血管收缩剂。

Nicotine does have certain benefits, and I covered this in an episode on nicotine.

尼古丁确实有一定的好处，我在尼古丁的一集中介绍了这一点。

Neurocognitive benefits in the elderly in particular.

对老年人的神经认知益处尤其明显。

But it is a vasoconstrictor, so it runs against all of the sexual arousal stuff that we're talking about.

但它是一种血管收缩剂，因此它与我们正在谈论的所有性唤起物质背道而驰。

But okay, let's assume that a male in their 20s or 30s is sleeping enough, six to eight hours a night, is exercising, isn't doing anything to punish their pelvic floor in the gym, and they're not doing legs-crossed Kegels while doing crunches or something while inhaling on the crunch.

但是好吧，让我们假设一个 20 多岁或 30 多岁的男性睡眠充足，每晚六到八小时，正在锻炼，没有在健身房做任何伤害骨盆底的事情，并且他们没有在卷腹时做盘腿凯格尔运动或在卷腹时吸气的时候做其他事情。

That was a quiz, by the way, folks.

顺便说一句，伙计们，这是一个测验。

For earlier topics covered.

对于之前涵盖的主题。

Let's assume they're eating pretty well.

我们假设他们吃得很好。

The majority of their foods are coming from nonprocessed or minimally processed foods.

他们的大部分食物来自未加工或最低限度加工的食物。

They're doing a little meditation each day.

他们每天都会进行一些冥想。

They're engaging in, hopefully healthy relationships.

他们正在建立健康的关系。

They're not masturbating like crazy to porn.

他们不会像色情片那样疯狂地自慰。

And let's assume that they are not on any SSRI, why are all these 20- and 30-year-olds on the internet asking — mainly you, they mainly run to you — but also to my direct messages about their erectile issues?

假设他们没有服用任何 SSRI，为什么所有这些 20 岁和 30 岁的人都在互联网上询问——主要是你，他们主要跑向你——但也询问我关于他们的勃起问题的直接信息？

Dr. Rena Malik: So I will say I have seen a lot of young men in my clinic, and I will say that they very often have pelvic floor dysfunction.

雷纳·马利克医生：所以我会说我在诊所见过很多年轻男性，我会说他们经常患有盆底功能障碍。

So even though they're doing all the right things, we're in a stressful society.

因此，即使他们做了所有正确的事情，我们仍然生活在一个充满压力的社会中。

So you can try all the things to decrease your stress.

因此，您可以尝试所有方法来减轻压力。

But a lot of us are sitting long periods of time, especially during COVID I mean, people sat for months, right, years, like, just sitting at their home computer.

但我们很多人都长时间坐着，尤其是在新冠疫情期间，我的意思是，人们在家里的电脑前坐了几个月，对，几年，就像。

And so exercising one hour is not going to offset the day full of sitting.

因此，锻炼一小时并不能抵消一整天的久坐。

And so all of those things can affect pelvic floor function.

因此，所有这些因素都会影响盆底功能。

So my theory is that that's probably the more common cause---

所以我的理论是，这可能是更常见的原因——

Andrew Huberman: So walk more.

安德鲁·休伯曼：所以多走路。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: I've actually heard that---

Andrew Huberman：我确实听说过——

Dr. Rena Malik: Or use a standing desk.

Rena Malik 博士：或者使用站立式办公桌。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Walk more.

多走路。

Standing desk.

站立式办公桌。

Okay, so, and then my guess is that there's some psychogenic feedback loop.

好的，那么我的猜测是存在一些心理反馈循环。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

Andrew Huberman: Which is just nerdspeak for things aren't working as well as they would like, then they're stressing about it, and the stress is making things worse.

Andrew Huberman：这只是书呆子的说法，因为事情没有按照他们想要的方式进行，然后他们对此感到压力，而压力会让事情变得更糟。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

And you mentioned that people are not masturbating or using porn, but a lot of people learn about sex through porn.

你提到人们不会自慰或使用色情内容，但很多人通过色情内容了解性。

Whether it's good or bad, it's not a great thing, but that's accessible now.

不管它是好还是坏，这都不是一件好事，但现在已经可以实现了。

When we were growing up, you had to find a VCR, you had to find a quiet room that no one was going to walk in.

当我们长大的时候，你必须找到一台录像机，你必须找到一个没有人会走进去的安静的房间。

Andrew Huberman: I'm old enough to remember when the kid down the street, I won't mention him by last name, but, yeah, the kid down the street had porno magazines.

安德鲁·休伯曼：我已经足够大了，可以记得街上那个孩子的时候，我不会提到他的姓氏，但是，是的，街上那个孩子有色情杂志。

Dr. Rena Malik: Yeah, or magazines.

Rena Malik 博士：是的，或者杂志。

Andrew Huberman: And then there was actually a library of these.

Andrew Huberman：然后实际上有一个这样的图书馆。

Goodness I shouldn't say where they were.

天哪，我不应该说他们在哪里。

In the town I grew up in, where kids would stash them in specific locations in parking lots, and then boys would bike or skateboard over or walk over, and then they would take turns looking at them.

在我长大的小镇里，孩子们会把它们藏在停车场的特定位置，然后男孩们会骑自行车、滑板或步行过去，然后轮流看它们。

But that actually is to raise perhaps a more important point, which is that looking at pornography is different than masturbating to pornography, which is also different than masturbating to pornography to the point of ejaculation.

但这实际上是为了提出一个更重要的观点，那就是看色情内容与对色情内容自慰不同，这也与对色情内容自慰到射精的程度不同。

Right.

正确的。

Because I also get a lot of questions from people about their porn addiction issues.

因为我也收到了很多关于色情成瘾问题的问题。

And there's a growing theory out there that overuse that, meaning not just looking at but masturbating to pornography to the point of ejaculation, is creating a deficit of seeking out and cultivating healthy, real-world sexual interactions.

越来越多的理论认为，过度使用色情内容，不仅意味着观看色情内容，还对色情内容自慰直至射精，这会导致人们无法寻找和培养健康、现实世界的性互动。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So I want to start this before I get into that is to say that if you're masturbating to porn and you have normal, healthy relationships and you're going to work and you have a great partner, and everything's great in your life, it's okay.

所以在我开始之前我想先开始这个话题，也就是说，如果你对色情片自慰，并且你有正常、健康的人际关系，你要去工作，你有一个很棒的伴侣，而且你生活中一切都很好，那就没关系。

Like, shame is a real problem, and---

就像，羞耻是一个真正的问题，而且——

Andrew Huberman: Maybe they're watching pornography together.

安德鲁·休伯曼：也许他们一起看色情片。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So I think it's important, though, that at least in the literature, they don't describe porn addiction, they call it problematic pornography use, and it's only described in about 4% of people in these studies.

所以我认为重要的是，至少在文献中，他们没有描述色情成瘾，他们称之为有问题的色情使用，而在这些研究中，只有大约 4% 的人描述了这种情况。

So it's a small subset of people.

所以这只是一小部分人。

I think it's becoming more common because pornography is so accessible, and it activates the dopamine pathways just like any other sort of addiction.

我认为它变得越来越普遍，因为色情内容很容易获得，而且它像任何其他类型的成瘾一样激活多巴胺通路。

Right.

正确的。

You watch pornography, you get a dopamine response.

你看色情片，你会产生多巴胺反应。

Your brain then says, oh, I want that again.

然后你的大脑会说，哦，我又想要那个。

And you keep seeking more novel, more aggressive, different types of pornography to get that same response.

你不断地寻找更新颖、更激进、不同类型的色情内容来获得同样的回应。

But it doesn't happen to everybody.

但并不是每个人都会发生这种情况。

Andrew Huberman: But also, I would say, sorry to interrupt, but that the dopamine response, as a hardwired biological mechanism, for adaptive behaviors, including, and let's just define healthy sexual behavior, because I feel like there's such a range on that, depending on one's background, religious beliefs, et cetera.

安德鲁·胡伯曼：但是，我想说，抱歉打断一下，多巴胺反应作为一种固有的生物机制，对于适应性行为，包括，让我们定义健康的性行为，因为我觉得这有一个范围，取决于一个人的背景、宗教信仰等。

Anytime we talk about sex on this podcast, I like to say that involves at least four things — obviously, consensual, age appropriate, context appropriate, species appropriate.

每当我们在这个播客上谈论性时，我想说这至少涉及四件事——显然，双方同意、适合年龄、适合背景、适合物种。

Dr. Rena Malik: Yes, absolutely.

Rena Malik 博士：是的，绝对如此。

I'm really glad you brought that up.

我真的很高兴你提出这个问题。

So I've heard you say that before, but it's very important.

我以前听过你说过这句话，但这非常重要。

I think there is a large spectrum of people who watch pornography, ejaculate to pornography, and have a normal life, and so that's fine.

我认为有很多人观看色情内容、向色情内容射精，并且过着正常的生活，所以这很好。

I think that if we shame those people, we're creating problems.

我认为如果我们羞辱那些人，我们就是在制造问题。

Right?

正确的？

We say, like, oh, you do that, that's horrible.

我们说，哦，你这样做，那太可怕了。

And then they're in their head.

然后他们就在他们的脑海里。

Right?

正确的？

And then they're causing problems in their life because of shame.

然后他们因为羞耻而在生活中造成问题。

And so I think there's a little bit of cultural shame that comes of this discussion.

所以我认为这次讨论会带来一点文化耻辱。

And so it's a problem in the long term if we say that, oh, this is going to create problems, because not everyone has, there's so many people who watch pornography and have no problems.

因此，从长远来看，如果我们说，哦，这会产生问题，因为不是每个人都有问题，有很多人看色情内容并且没有问题。

Who you know, have normal, healthy relationships, great sex with their partner, and it's fine.

你认识的人有正常、健康的关系，与伴侣有愉快的性生活，这很好。

Andrew Huberman: Or they're between relationships.

Andrew Huberman：或者他们处于人际关系之间。

Dr. Rena Malik: Yeah

雷纳·马利克博士：是的

Andrew Huberman: And they're relying on masturbation specifically.

安德鲁·休伯曼：他们特别依赖手淫。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Andrew Huberman: Are there any data that distinguish between just pure imagination, fantasy versus visual fantasy as it relates to developing or inhibiting sexual health?

安德鲁·胡伯曼：是否有任何数据可以区分纯粹的想象、幻想与视觉幻想，因为它与发展或抑制性健康有关？

And here we're talking about the desire aspect.

这里我们谈论的是欲望方面。

Let's assume physical arousal is handled, no pun intended.

让我们假设身体的唤醒得到了处理，没有双关语的意思。

Dr. Rena Malik: So I think that the thing about young people, I wanted to get back to that, then I'll answer your question, but the thing about young people who are watching pornography, that's what they think sex is supposed to be like, they don't get an education about what sex is.

雷纳·马利克博士：所以我认为关于年轻人的问题，我想回到这个问题，然后我会回答你的问题，但是关于观看色情内容的年轻人，这就是他们认为性应该是什么样子的，他们没有接受过关于性是什么的教育。

Right.

正确的。

No one has a conversation with their kids like, hey guys, this is what happens when you have sex, this is how long it should take, this is what foreplay is.

没有人会和他们的孩子这样对话，嘿伙计们，这就是发生性行为时会发生的事情，这就是应该花多长时间，这就是前戏。

And this is not normal.

这是不正常的。

This is a production.

这是一个制作。

This is a produced product that's meant to arouse you.

这是一款旨在唤醒您的产品。

Right.

正确的。

And to give you ideally an ejaculation or an orgasm.

并为您提供理想的射精或性高潮。

Right.

正确的。

So no one has that discussion.

所以没有人进行这样的讨论。

So then go to relationships like, why did my partner not react like that woman did on the porno, right?

那么接下来就谈恋爱吧，为什么我的伴侣没有像色情片上那个女人那样反应，对吧？

Or why did I not react like that woman did on the porno?

或者为什么我没有像色情片上那个女人那样做出反应？

Andrew Huberman: Or why didn't he react like they would in porn?

安德鲁·休伯曼：或者为什么他不像色情片中那样做出反应？

Because again, I think females are watching porn as well.

因为我再次认为女性也在看色情片。

Dr. Rena Malik: Exactly.

雷纳·马利克博士：没错。

Yeah.

是的。

Andrew Huberman: So I think that you raise a really critical point, which is that the shame can extend both ways.

安德鲁·休伯曼：所以我认为你提出了一个非常关键的观点，那就是羞耻感可以是双向的。

Dr. Rena Malik: And so I think to that end, that's a problem.

Rena Malik 博士：所以我认为为此，这是一个问题。

And because it's so accessible, I think we need to have conversations.

因为它是如此容易接近，我认为我们需要进行对话。

I think it needs to be open, we have to talk about sex.

我认为它需要开放，我们必须谈论性。

And that's kind of why I do what I do.

这就是我做我所做的事情的原因。

We have to have these conversations so people know what normal is.

我们必须进行这些对话，以便人们知道什么是正常的。

Andrew Huberman: Thank you for that.

安德鲁·休伯曼：谢谢你。

I do think that people need to know what normal is and what the range on normal is.

我确实认为人们需要知道什么是正常以及正常的范围是什么。

Keeping the constraints that we talked about place earlier, because I do think those are universal, healthy constraints.

保留我们之前讨论过的限制，因为我确实认为这些是普遍的、健康的限制。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Andrew Huberman: Consensual, age appropriate, context appropriate, species appropriate.

Andrew Huberman：双方同意、年龄适当、环境适当、物种适当。

I'd like to take a quick break and acknowledge our sponsor, Inside Tracker.

我想稍微休息一下并感谢我们的赞助商 Inside Tracker。

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Inside Tracker 是一个个性化营养平台，可分析您的血液和 DNA 数据，帮助您更好地了解您的身体并帮助您实现健康目标。

I'm a big believer in getting regular blood work done, for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test.

我坚信定期进行血液检查，原因很简单，影响您当前和长期健康的许多因素只能通过高质量的血液测试来分析。

However, with a lot of blood tests out there, you get information back about blood lipids, about hormones and so on, but you don't know what to do with that information.

然而，通过大量的血液测试，您可以获得有关血脂、激素等的信息，但您不知道如何处理这些信息。

With Inside Tracker, they have a personalized platform that makes it very easy to understand your data, that is, to understand what those lipids, what those hormone levels, et cetera mean, and behavioral, supplement, nutrition and other protocols to adjust those numbers to bring them into the ranges that are ideal for your immediate and long-term health.

借助 Inside Tracker，他们拥有一个个性化平台，可以让您轻松了解您的数据，即了解这些脂质、激素水平等的含义，以及行为、补充剂、营养和其他方案来调整这些数字，使其达到适合您近期和长期健康的理想范围。

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Inside Tracker 的最终计划现在包括 APO B 和胰岛素的测量，它们是心血管健康和能量调节的关键指标。

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如果您想尝试 Inside Tracker，可以访问 insidetracker.com/huberman，享受任何 Inside Tracker 计划 20% 的折扣。

Again, that's insidetracker.com/huberman to get 20% off.

同样，在 insidetracker.com/huberman 上可以获得 20% 的折扣。

I asked whether or not imagined, pure imagination-based arousal versus visual arousal.

我问是否是想象的、纯粹基于想象的唤醒与视觉唤醒。

And for some people, the sounds of people having sex is extremely arousing.

对于某些人来说，做爱的声音非常令人兴奋。

If you've ever lived in a major city like New York, which I've spent summers in, lot, you hear more often than you do in areas where people are living further apart.

如果你曾经住在像纽约这样的大城市（我曾在纽约度过很多夏天），那么你会比在人们居住距离较远的地区听到更多的声音。

You hear people having sex.

你听到人们在做爱。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: It's part of the auditory landscape.

Andrew Huberman：这是听觉景观的一部分。

Dr. Rena Malik: Yes, you're very close together.

Rena Malik 博士：是的，你们的关系非常亲密。

But yeah.

但是是的。

So there's not exactly, at least to my knowledge, I don't know of the data that looks at fantasy versus visual versus auditory, but I will say that you can get habituated to certain things, and there is that data that maybe you can get habituated to watching a certain type of thing to get aroused, and then normal things do not get you aroused, right?

所以，至少据我所知，不完全是关于幻想、视觉和听觉的数据，但我会说，你可以习惯某些事物，并且有数据表明，也许你可以习惯观看某种类型的事物来唤起，然后正常的事物不会让你唤起，对吗？

Like you may watch pornography and then you may have difficulty getting aroused or turned on when you see your partner.

就像你可能会看色情片，然后当你看到你的伴侣时，你可能很难被唤起或兴奋。

You may get used to masturbating a certain way, right?

您可能习惯了某种方式自慰，对吧？

So if you use certain vibratory stimulation or certain pressure sensation every single time you masturbate, you can get habituated to that, and you may not be able to replicate that during penetrative intercourse.

因此，如果您每次自慰时都使用某种振动刺激或某种压力感觉，您可能会对此习惯，并且在插入式性交时可能无法复制这种感觉。

And so I think that's really important.

所以我认为这非常重要。

And I think the take-home is to try and vary what you're doing.

我认为最重要的是尝试改变你正在做的事情。

Masturbation is a fine, healthy way of self-exploration.

自慰是一种良好、健康的自我探索方式。

Again, with the caveat that as long as you're not masturbating to excess and avoiding your obligations or your family or your partners or your friends, right, like you are just masturbating for the benefits of maybe sleep improvement, mood boosting, reduction in anxiety.

再次强调，只要你不过度自慰，避免逃避你的义务、家人、伴侣或朋友，就好像你自慰只是为了改善睡眠、提振情绪、减少焦虑一样。

Those things are great.

这些东西都很棒。

And so I think with that being said, you just want to be thoughtful about varying it up.

所以我认为话虽这么说，你只是想考虑一下改变它。

Andrew Huberman: One of the issues with masturbation that I've talked about when I was a guest on other podcasts, mainly in the context of male masturbation and perhaps with pornography, perhaps not, is that it's pretty clear, based on the data surrounding addiction, that anytime there are big increases in dopamine without a lot of effort required to generate that dopamine, like turning on pornography on the internet versus asking someone out on a date, going out on a date.

安德鲁·胡伯曼：我在其他播客上做客时谈到的手淫问题之一，主要是在男性手淫和色情内容的背景下，也许不是，很明显，根据有关成瘾的数据，任何时候多巴胺都会大幅增加，而无需付出很大的努力来产生多巴胺，例如打开互联网上的色情内容与约某人出去约会，出去约会。

You know again, we're talking about going through the conversations and the mating ritual, that is the human mating ritual, that, of course, in the context of healthy interactions involves getting mutual consent and these kinds of things, right.

你又知道了，我们谈论的是通过对话和交配仪式，这是人类的交配仪式，当然，在健康互动的背景下涉及获得相互同意和诸如此类的事情，对吧。

That you could imagine how, without placing any moral judgment on it, without shaming anybody, you could imagine that if somebody exclusively masturbated and didn't develop the skills of courtship and building healthy sexual relationships, that pornography and or masturbation could start to create, quote, unquote, problems, right.

你可以想象，在不对其进行任何道德判断的情况下，在不羞辱任何人的情况下，你可以想象，如果一个人专门自慰，并且没有发展求爱和建立健康性关系的技能，那么色情和/或手淫可能会开始制造，引用，取消引用，问题，对吧。

Whereby somebody only felt comfortable in those domains.

人们只在这些领域感到舒服。

And I think that's what I'm hearing more and more about when, it seems to be young men reach out.

我认为这就是我越来越多地听到的，年轻人似乎伸出援手。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

And I think it's definitely the ease of access.

我认为这绝对是访问的便利性。

Right.

正确的。

But I think that's pervasive in the young society now.

但我认为这在现在的年轻社会中很普遍。

Like, you don't have to actually go and find a mate.

就像，你不必真的去寻找伴侣。

You can just go on an app and look for somebody.

您只需打开应用程序即可寻找某人。

Right?

正确的？

Andrew Huberman: That's a form of finding a mate.

安德鲁·休伯曼：这是寻找伴侣的一种形式。

I mean, I was weaned in the era when no smartphones or anything.

我的意思是，我是在没有智能手机或任何东西的时代断奶的。

Dr. Rena Malik: No, my point is, I think that we've become very connected to technology in our world, which also means that we're having less conversations.

雷纳·马利克博士：不，我的观点是，我认为我们已经与世界上的技术紧密相连，这也意味着我们的对话越来越少。

The younger generation is having less conversations and more online conversations.

年轻一代的对话越来越少，网络对话越来越多。

And I think that's a skill that needs to be developed as well and I think part of that is contributing to all this as well.

我认为这也是一项需要发展的技能，我认为这也是促成这一切的一部分。

Andrew Huberman: Well, one thing that I can attest to, is that I grew up in a community of mostly male friends.

安德鲁·休伯曼：嗯，我可以证明的一件事是，我在一个主要由男性朋友组成的社区中长大。

I have female friends, always have.

我有女性朋友，一直都有。

Where a lot of what we learned about sex came from older, my case, guys.

我们学到的很多关于性的知识都来自于我的例子，那些年长的人。

My sister probably learned a lot about sex from her female friends.

我姐姐可能从她的女性朋友那里学到了很多关于性的知识。

And there was always that one guy who would just say stuff that years later I realized was incredibly misleading.

总有一个人会说一些几年后我意识到非常具有误导性的话。

Maybe even just detrimental.

甚至可能只是有害的。

And I just want to remind people that when you are on Reddit or anywhere on the internet and there's people saying things with certainty, they might be that guy.

我只是想提醒人们，当你在 Reddit 或互联网上的任何地方，有人在肯定地说出事情时，他们可能就是那个人。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

Absolutely.

绝对地。

And if I look at the long arc of those people, that guy's life, it didn't speak to tremendous success in the domain for which they were asserting such confidence.

如果我看看那些人的长长的弧线，那个人的生活，这并不能说明他们在他们所声称的领域取得了巨大的成功。

Let me put it that way.

让我这样说吧。

Okay.

好的。

I'd like to slightly pivot to a different aspect of this conversation because it's just really critical, which is the female sexual response.

我想稍微转向这次谈话的另一个方面，因为它非常关键，那就是女性的性反应。

This is something that does not get enough discussion.

这是没有得到足够讨论的事情。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

Andrew Huberman: And there's a lot of stereotypes, Right.

Andrew Huberman：有很多刻板印象，对吧。

The stereotype that we hear about is, oh, they need more foreplay, which can be true.

我们听到的刻板印象是，哦，他们需要更多的前戏，这可能是真的。

Some cases is not true.

有些情况并不属实。

The stereotype is that women are more intimacy and relationship based in their sexual response.

人们的刻板印象是，女性的性反应更加亲密和关系。

That can be true.

这可能是真的。

I have female friends and have known women who also are just really interested in having sex for sex sake at times, or maybe all the time.

我有一些女性朋友，也认识一些女性，她们有时甚至可能一直对为了性而发生性行为非常感兴趣。

I think, I like to think that we are past the stage of human development where the stereotypes around this are fixed.

我想，我喜欢认为我们已经过了人类发展的阶段，在这个阶段，围绕这个问题的刻板印象是固定的。

Right.

正确的。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: And we hear more about this and we see more about this now.

Andrew Huberman：我们听到了更多关于此的信息，我们现在也看到了更多相关信息。

But what is the real deal around the female arousal response?

但女性性唤起反应的真正意义是什么？

And then we will talk about female orgasm response.

然后我们将讨论女性高潮反应。

And there, I'm just going to earmark now that anytime we say something like arousal or orgasm, there are multiple forms of that, and we will talk about the multiple forms of female orgasm.

在那里，我现在要指出的是，每当我们说到性唤起或性高潮之类的东西时，都有多种形式，我们将讨论女性性高潮的多种形式。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So if you talk about the response cycle, you can go back to the research of Masters and Johnson.

所以如果说到反应周期，可以回到Masters和Johnson的研究。

And so what they did, this was way back when, and they actually watched sex workers have sex.

所以他们所做的，这是很久以前的事了，他们实际上观看性工作者做爱。

And this was, I guess, okay, back then.

我想，这在当时是可以的。

Andrew Huberman: Female sex workers,

安德鲁·休伯曼：女性性工作者，

Dr. Rena Malik: Yeah, with men.

Rena Malik 博士：是的，与男性。

So they watched, and they took note of the steps of the female arousal or sexual response.

所以他们观察并记录女性性唤起或性反应的步骤。

And so the first phase is excitement.

所以第一阶段是兴奋。

Right.

正确的。

And during that phase, your heart rate goes up, you're breathing a little heavier.

在这个阶段，你的心率会上升，你的呼吸会变得更重。

There is this sex flush, you can see redness in areas like in the vulva, in the breast, I mean in the nipples.

有这种性潮红，你可以看到外阴、乳房，我是说乳头等区域发红。

And then you go to...

然后你去...

and that can last a variety of different times.

这可以持续多种不同的时间。

You'll also start seeing some lubrication vaginally.

您还会开始看到阴道有一些润滑。

Right.

正确的。

And then the plateau response is when that is kind of at its peak, and it kind of stays steady, and then you reach orgasm.

然后平台反应是指达到顶峰，并保持稳定，然后你达到性高潮。

And so orgasm essentially is a response of the body where you will have, again, increased sympathetic response, and you will have pelvic floor muscle contractions, which are rhythmic, about 0.8 seconds or so, you're having a rhythmic pelvic floor contraction along with the sensation of orgasm.

所以性高潮本质上是身体的一种反应，你会再次增加交感神经反应，并且你会有盆底肌肉有节奏的收缩，大约0.8秒左右，你会随着性高潮的感觉而有节奏的盆底肌肉收缩。

And then you'll have your recovery period, which you talked about briefly earlier, which can have sort of a refractory time period, at which point you can no longer orgasm again, if you'd like to.

然后你就会进入恢复期，正如你之前简单提到的，这可能有一个不应期，在这一点上你不能再达到高潮，如果你愿意的话。

Or for men, obtain another erection again for a short period of time.

或者对于男性来说，可以在短时间内再次勃起。

And that can be kind of an absolute refractory period, so where it's definitely not happening, and then a relative refractory period where you need something more novel and exciting to then again, resume that cycle again.

这可能是一个绝对的不应期，所以它绝对不会发生，然后是一个相对的不应期，你需要一些更新颖和令人兴奋的东西，然后再次恢复这个循环。

Andrew Huberman: The Coolidge effect.

安德鲁·休伯曼：柯立芝效应。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: I've talked about the Coolidge effect before on this podcast.

安德鲁·休伯曼：我之前在这个播客上谈到过柯立芝效应。

I'll just cue people to a timestamp link in the show note caption so we don't go down the path.

我只会提示人们查看注释标题中的时间戳链接，这样我们就不会走上这条路。

But one thing that's really important to understand is that the Coolidge effect is present in both males and females, meaning if a male ejaculates and is of the feeling that they can't have another erection for some period of time, the presentation of a novel, I guess we should say partner, because we could be talking about homosexual relationship here, not just heterosexual.

但真正需要理解的一件事是，柯立芝效应在男性和女性中都存在，这意味着如果男性射精后感觉自己在一段时间内无法再次勃起，那么小说的呈现，我想我们应该说合作​​伙伴，因为我们可以在这里谈论同性恋关系，而不仅仅是异性恋。

But a novel sexual partner, female or male, depending on their proclivities, can override the refractory period and they can have another erection and ejaculation.

但是，新的性伴侣，无论是女性还是男性，根据他们的倾向，可以克服不应期，并且可以再次勃起和射精。

Similarly, a female will have a postorgasmic refractory period.

同样，女性也会有高潮后不应期。

If they are given an adequate stimulus, something arousing enough, they can experience arousal and orgasm again.

如果给予他们足够的刺激，足够引起性的刺激，他们就可以再次体验到性唤起和性高潮。

And we know, based on really good pharmacology, that this is a dopamine-driven thing.

我们知道，基于非常好的药理学，这是一种多巴胺驱动的东西。

The prolactin is essentially establishing the refractory period, and the dopamine is essentially overriding the refractory period.

催乳素本质上是建立不应期，而多巴胺本质上是超越不应期。

Fascinating neurochemistry there.

那里有令人着迷的神经化学。

And speaks to the incredible extent to which the brain is controlling the genitals.

并说明了大脑对生殖器的控制程度令人难以置信。

Dr. Rena Malik: Yeah, we always say in sexual medicine that the brain is the most powerful organ for sex.

雷纳·马利克博士：是的，在性医学中我们总是说大脑是最强大的性器官。

Not your genitals, but the brain.

不是你的生殖器，而是大脑。

Because it is so powerful, and I'm not sure if we're going to touch on this later, but I'll bring it up now, there are some centrally acting medications now available for, they're FDA-approved for premenopausal women with low libido.

因为它是如此强大，我不确定我们稍后是否会谈到这一点，但我现在会提出来，现在有一些中枢作用的药物可供使用，它们已获得 FDA 批准用于性欲低下的绝经前女性。

Andrew Huberman: Oh, maybe just throw those out because the one that I'm aware of that's often used in, let's say, niche cultures is melanocyte-stimulating hormone in men, which gives people a tan, makes them erect.

安德鲁·休伯曼：哦，也许只是把它们扔掉，因为据我所知，在小众文化中经常使用的一种是男性的黑素细胞刺激激素，它使人晒黑，使他们勃起。

That melanocyte-stimulating hormone, MSH, comes from the medial pituitary, if I'm not mistaken.

如果我没记错的话，这种黑色素细胞刺激激素 MSH 来自垂体内侧。

One of those weird regions — everyone talks about, anterior, posterior.

那些奇怪的区域之一——每个人都在谈论前部、后部。

And people are now injecting this as a peptide.

人们现在将其作为肽注射。

It can cause priapism.

它可能导致阴茎异常勃起。

I have not had that experience.

我没有这样的经历。

I've never tried this MSH, but I'm told that if people are getting cavalier with it, they can have issues.

我从未尝试过这种 MSH，但有人告诉我，如果人们对此变得漫不经心，他们可能会遇到问题。

A priapism being enduring and perhaps even final erection.

阴茎勃起是持久的，甚至可能是最终的勃起。

Is that true?

这是真的吗？

Dr. Rena Malik: So, a priapism---

Rena Malik 博士：那么，阴茎异常勃起——

Andrew Huberman: Priapism

安德鲁·休伯曼：阴茎异常勃起

I mean, it's actually from Priapus, the Greek god who's often photographed with a really big erection.

我的意思是，它实际上来自希腊神普里阿普斯（Priapus），他经常被拍到勃起很大的照片。

Oh, wow.

哦，哇。

We didn't hear enough about that Greek god in school.

我们在学校里对希腊神的了解还不够。

Dr. Rena Malik: Is it Roman?

Rena Malik 博士：是罗马人吗？

Roman or Greek?

罗马还是希腊？

But anyways.

但无论如何。

Andrew Huberman: Either way.

安德鲁·休伯曼：无论哪种方式。

Dr. Rena Malik: It's an erection that lasts longer than four hours.

Rena Malik 医生：勃起持续时间超过四个小时。

And it is actually a surgical or, it's not a surgical, but it's actually an emergency.

这实际上是一次手术，或者，这不是一次手术，但它实际上是一个紧急情况。

If you have an erection that lasts longer than four hours in the absence of sexual arousal, then it is important to get to an emergency room because at that point you can start developing decreased blood flow and ultimately changes to the actual tissues, scarring, fibrosis.

如果您在没有性唤起的情况下勃起持续超过四个小时，那么去急诊室很重要，因为此时您可能会开始出现血流量减少，并最终导致实际组织发生变化，形成疤痕，纤维化。

So it's really important to actually go to the emergency room.

所以去急诊室真的很重要。

Don't wait because you're embarrassed.

不要因为尴尬而等待。

Really get there and get treated.

真正到达那里并接受治疗。

Andrew Huberman: However, if I'm not mistaken, earlier you mentioned that it is exceedingly rare that people who take Cialis/tadalafil or Viagra for erections are getting true priapism.

Andrew Huberman：但是，如果我没记错的话，您之前提到服用西力士/他达拉非或伟哥来勃起的人获得真正的阴茎勃起的情况非常罕见。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

And it's mostly from those injectables we talked about earlier, those intracavernosal injections.

它主要来自我们之前讨论过的那些注射剂，即海绵体内注射。

People can get priapism from those, a little bit more commonly.

人们可能会因此而出现阴茎异常勃起，这种情况更为常见。

And so that's something we always counsel on.

所以这是我们一直建议的事情。

And also certain medications like trazodone, or if you have sickle cell anemia, those are the most common reasons that we see people coming in with priapism.

还有某些药物，如曲唑酮，或者如果您患有镰状细胞性贫血，这些是我们看到人们出现阴茎异常勃起的最常见原因。

Andrew Huberman: Really?

安德鲁·休伯曼：真的吗？

Okay.

好的。

I'm going to refrain from my desire to figure out that one so I don't take us down a rabbit hole here.

我将克制自己想要弄清楚这个问题的欲望，这样我就不会把我们带入一个兔子洞。

Dr. Rena Malik: Sorry, I wanted to get back to the MSH.

Rena Malik 博士：抱歉，我想回到 MSH。

There is actually an FDA-approved medication called bremelanotide is the brand name.

实际上有一种 FDA 批准的药物，其品牌名称为布雷默诺肽。

Vyleesi is the, sorry bremelanotide is a generic name, Vyleesi is the brand name, which is FDA-approved for women with low desire.

Vyleesi 是，抱歉，布雷默诺肽是通用名称，Vyleesi 是品牌名称，经 FDA 批准，适用于性欲低下的女性。

Hypoactive sexual desire disorder, premenopausal women.

性欲减退症、绝经前妇女。

Premenopausal because that's what they studied.

绝经前，因为那是他们研究的内容。

But it is basically the same peptide.

但它基本上是相同的肽。

Right.

正确的。

So it is a melanocortin receptor agonist, and it works on the brain pathways to increase desire.

所以它是一种黑皮质素受体激动剂，它作用于大脑通路以增加欲望。

It's taken as an injectable, again, just like you said, about an hour, 45 minutes before, when you want to want, you take it 45 minutes before.

它是作为注射剂服用的，就像你说的，大约一个小时，45分钟前，当你想要的时候，你可以在45分钟前服用。

And it works quite effectively in increasing desire.

它对于增加欲望非常有效。

Andrew Huberman: How long does it last?

安德鲁·休伯曼：它会持续多久？

Dr. Rena Malik: About 24 hours.

Rena Malik 博士：大约 24 小时。

Some people maybe up to 48.

有些人可能高达48。

Andrew Huberman: Has it been?

安德鲁·休伯曼：是吗？

I mean, I know of men using melanocyte-stimulating hormone peptides.

我的意思是，我知道有男性使用黑素细胞刺激激素肽。

I also really want to caution people about obtaining gray market peptides.

我还想提醒人们不要获取灰色市场的肽。

Sorry for this insertion here, but there are a lot of peptides available without a prescription on the internet.

抱歉在这里插入，但是互联网上有很多无需处方即可获得的肽。

They are almost all contaminated with something called LPS, lipolysaccharide, which is not something you want to be injecting a lot over time.

它们几乎都被一种叫做脂多糖（LPS）的物质污染，随着时间的推移，您不希望大量注射这种物质。

That's actually how we induce an immune response in animals in the laboratory.

这实际上就是我们在实验室中诱导动物产生免疫反应的方式。

And it is amazing to me how many websites are selling this stuff, and it arrives to you easily.

令我惊讶的是，有这么多网站在销售这些东西，而且它很容易到达你的手中。

You just buy it on the internet.

您只需在互联网上购买即可。

It says not for human or animal use, and people are injecting it.

上面写着不适合人类或动物使用，而人们正在注射它。

And the LPS issue is something I think is potentially going to shut down that whole market at some point.

我认为 LPS 问题可能会在某个时候关闭整个市场。

But if you are interested in using a peptide, you should be obtaining it by a prescription from a quality physician.

但如果您对使用肽感兴趣，您应该通过优质医生的处方获得它。

Dr. Rena Malik: Exactly.

雷纳·马利克博士：没错。

And because we have bremelanotide, we can prescribe that for men as well.

因为我们有布雷默诺肽，所以我们也可以为男性开处方。

So sometimes we'll do it off-label for men who are having delayed ejaculation because it will help them achieve orgasm a little bit better.

因此，有时我们会为射精延迟的男性进行标签外治疗，因为这会帮助他们更好地达到性高潮。

So, you know, this is available for premenopausal women.

所以，你知道，这适用于绝经前女性。

The other medication that's available for low libido is called flibanserin, also known as Addyi is the brand name, and that also works on serotonin.

另一种可用于治疗性欲低下的药物称为氟班色林，品牌名称也称为 Addyi，也适用于血清素。

It's got kind of a mixed response, serotonin and dopaminergic areas of the brain, and essentially works as a daily medication taken before bedtime, 100 milligrams a day, that actually helps with decreasing hypoactive sexual desire disorder.

它有一种混合反应，大脑中的血清素和多巴胺能区域，基本上可以作为睡前服用的日常药物，每天 100 毫克，实际上有助于减少性欲减退症。

Works in about 45% to 60% of patients, and you need to take it for some time.

对大约 45% 至 60% 的患者有效，但需要服用一段时间。

Now, both of these are brand name medications, so they are a little bit costly, and sometimes insurance doesn't cover them, but they are available, and I think very few people know about them, and I think they're really great and useful tools in the toolbox.

现在，这两种药物都是品牌药物，所以它们有点贵，有时保险不承保它们，但它们是可用的，我认为很少有人知道它们，我认为它们确实是工具箱中很棒且有用的工具。

Andrew Huberman: And these are for desire?

安德鲁·休伯曼：这些都是为了欲望？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

They're FDA approved for what we call hypoactive sexual desire disorder, which is essentially low libido that causes distress and bother.

它们已获得 FDA 批准用于治疗我们所说的性欲减退症，这种疾病本质上是性欲低下，导致痛苦和烦恼。

Andrew Huberman: I don't want to take us off course about vaginal lubrication, arousal, and female orgasm, but as long as we're talking about arousal and reduced arousal, that requires treatment, I have to ask this now.

安德鲁·休伯曼：我不想让我们偏离关于阴道润滑、性唤起和女性高潮的话题，但只要我们谈论性唤起和性唤起减少，就需要治疗，我现在就必须问这个。

Anytime we talk about arousal and libido, there's no BMI, which, by the way, the body mass index is probably not the best tool either.

每当我们谈论性唤起和性欲时，都不会提到体重指数，顺便说一句，体重指数可能也不是最好的工具。

But there's no chart.

但没有图表。

It's not like a thermometer that says you're 98.6 plus or minus 2 degrees, you're good.

它不像温度计那样说你是98.6正负2度，你就很好。

If it's too high, much higher than that, you have a fever.

如果它太高，远高于这个值，你就会发烧。

If much lower than that, you're hypothermic.

如果远低于此值，则说明您体温过低。

So my understanding, I don't want to say naive understanding, but my understanding is that one determines whether or not their libido is normal, high or low, largely based on some intuitive understanding of what their partner or partner's desire, whether or not they can meet those desires, and if they sort of accrue enough of a sample size, they date enough people where they have sexual interactions, they figure out over time whether or not they have a low, medium, or high sex drive.

所以我的理解，我不想说幼稚的理解，但我的理解是，一个人决定他们的性欲是否正常、高还是低，很大程度上取决于对他们的伴侣或伴侣的欲望的一些直觉理解，他们是否能够满足这些欲望，如果他们积累了足够的样本量，他们会和足够多的人约会，进行性互动，随着时间的推移，他们会弄清楚他们的性欲是低、中还是高。

And people tend to compare to how they felt in earlier years or at different times of the year or under different psychological conditions and stress conditions, that kind of thing.

人们倾向于比较他们早年或一年中不同时间或不同心理条件和压力条件下的感受，诸如此类。

But we really don't have a benchmark for this, right?

但我们确实没有一个基准，对吧？

I mean, we can't say that, for instance, that if people are not desiring sex or thinking about sex with blank frequency, that they have low libido.

我的意思是，例如，我们不能说，如果人们不渴望性或以空白频率思考性，他们的性欲就低。

Right.

正确的。

It's sort of what is working or not working for you in the context of your life.

这就是在你的生活背景下什么对你有效或无效。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Andrew Huberman: Is that a reasonable way to think about it?

Andrew Huberman：这是一个合理的思考方式吗？

Dr. Rena Malik: There's no right or wrong.

Rena Malik 博士：没有对错之分。

Basically, what you're saying, there's no right or wrong amount of libido.

基本上，正如你所说，性欲的大小没有正确或错误之分。

There's many people who identify as asexual and they are happy with that.

有很多人认为自己是无性恋，他们对此感到满意。

There are people who like to have sex once a month and they're happy with that.

有些人喜欢每月做爱一次，他们对此感到满意。

It really is a matter of distress.

这实在是一件令人苦恼的事。

Are you bothered by it?

你是否为此烦恼？

So when we look at studies for female sexual dysfunction, using validated questionnaires like the FSFI, you can actually see that about 40% of people qualify for having sexual dysfunction.

因此，当我们使用 FSFI 等经过验证的问卷调查女性性功能障碍的研究时，您实际上可以看到大约 40% 的人有性功能障碍的资格。

But really bother is only seen in about 12%.

但真正烦恼的人只占12%左右。

And you can be bothered because you're bothered, you can be bothered because your partner is bothered, but it's really up to you.

你可能会因为你被打扰而被打扰，你可能因为你的伴侣被打扰而被打扰，但这实际上取决于你。

Right.

正确的。

Like, if you feel like there's something that you want to improve on, then that's when you go see your doctor.

就像，如果您觉得有什么地方需要改进，那么就该去看医生。

But there's no right or wrong answer.

但没有正确或错误的答案。

Right.

正确的。

This is very subjective and a lot of times we'll see couples who have mismatched libidos.

这是非常主观的，很多时候我们会看到性欲不匹配的夫妇。

Now, does that mean one person's right and one person is wrong?

那么，这是否意味着一个人是对的，一个人是错的？

No, it's just a matter of like, well, if you want to come to a point where you agree, how do we get there?

不，这只是一个问题，好吧，如果你想达到你同意的地步，我们如何到达那里？

And what is your end goal?

你的最终目标是什么？

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Later we'll talk a little bit more about chemistry, which I find infinitely fascinating, because in my life experience, I've just been struck by the fact that occasionally you have a physical interaction with someone, or sometimes it's not even physical interaction, and they are just so unbelievably arousing to you or somewhere in between, or sometimes it just sort of ain't there, or it's just not there that much, or nobody likes to talk about this, or it's there until you sleep together and then it's not there.

稍后我们会更多地讨论化学，我觉得化学非常有趣，因为在我的生活经历中，我只是被这样一个事实所震惊：偶尔你与某人进行身体互动，或者有时甚至不是身体互动，他们对你来说是如此令人难以置信的兴奋或介于两者之间，或者有时它只是不存在，或者它只是不存在那么多，或者没有人喜欢谈论这个，或者它一直存在直到你一起睡觉然后它就存在了不在那里。

And this is not just put on males, this is put on females.

而且这不只是戴在男性身上，这也是戴在女性身上。

I hope she doesn't kill me for saying this.

我希望她不会因为我说这些而杀了我。

I know somebody who is a family member, who once said, sometimes you have to realize you never want to sleep with somebody again by sleeping with them.

我认识一个家庭成员，他曾经说过，有时你必须意识到，通过和某人上床，你就再也不想和他们上床了。

And here we're not talking about traumatic experience.

在这里我们谈论的不是创伤经历。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Right.

正确的。

Andrew Huberman: So, again, the discussion around libido, as you so aptly pointed out, engaging what is healthy levels of libido has a lot to do with what oneself desires as well as the hopes and expectations of the people that we are sexually involved with.

安德鲁·胡伯曼：所以，再次，关于性欲的讨论，正如你恰当地指出的那样，健康的性欲水平与我们自己的欲望以及与我们发生性关系的人的希望和期望有很大关系。

So we'll get back to that a little bit later in the context of chemistry, because I find it so fascinating, and it's something that isn't talked about enough.

所以我们稍后会在化学的背景下回到这个话题，因为我发现它非常有趣，而且它的讨论还不够。

But thank you for that.

但谢谢你。

Let's get back to female sexual arousal response and orgasm.

让我们回到女性性唤起反应和性高潮。

Dr. Rena Malik: So, physiologically, what happens to the body is it prepares for penetration.

雷纳·马利克博士：所以，从生理上来说，身体会发生什么，为渗透做好准备。

Now, that could be a penis, that could be a sex toy, that could be a digit — finger, to be more specific.

现在，那可能是阴茎，可能是性玩具，可能是手指，更具体地说。

So what it does is the cervix moves up and out of the way.

所以它的作用是子宫颈向上移动并移开。

The inner one third, two thirds of the vagina lengthens and elongates to allow for penetration, and it can actually nearly double in size of the baseline vaginal length.

阴道内部的三分之一、三分之二会延长并拉长以允许插入，实际上它的尺寸几乎是阴道基线长度的两倍。

And so it is preparing for that.

因此它正在为此做准备。

That's part of it.

这是其中的一部分。

In some people who have painful intercourse, it's because they haven't had adequate time for arousal.

对于一些性交疼痛的人来说，这是因为他们没有足够的时间进行性兴奋。

And so the penis is penetrating before they've had those adaptations to occur.

因此，在这些适应发生之前，阴茎就已经渗透了。

And also the labia open up to allow for that penetration.

而且阴唇也会张开以允许渗透。

So these things actually happen physiologically to allow for preparation.

所以这些事情实际上在生理上发生是为了做好准备。

So while some people may be aroused and get to that point quicker, some people do need a longer period of time of what, as you described, foreplay.

因此，虽然有些人可能会被唤醒并更快地达到这一点，但有些人确实需要更长的时间，正如您所描述的，前戏。

And not everyone is the same, but I think it's important to have that discussion with your partner, and you know lubrication is one of the ways that people assess arousal, but that's not the be all end all.

并不是每个人都是一样的，但我认为与你的伴侣进行讨论很重要，而且你知道润滑是人们评估性唤起的方式之一，但这并不是全部。

Some people just make a lot of lubrication, and some people don't.

有些人只做大量润滑，而有些人则不做。

And certainly that changes with age and hormones.

当然，这会随着年龄和荷尔蒙的变化而变化。

So certainly we know that after menopause, with a drop in estrogen and testosterone, you will see a decrease in lubrication.

所以我们当然知道，绝经后，随着雌激素和睾酮的下降，你会发现润滑能力下降。

And sometimes, if people are on medications that can alter their hormonal axis, they may also see changes in lubrication after, during breastfeeding, you can see changes in lubrication, and again, they're not aroused necessarily, this is like a physiologic problem that they're having.

有时，如果人们服用可以改变荷尔蒙轴的药物，他们也可能会在母乳喂养期间看到润滑的变化，你可以看到润滑的变化，而且，他们不一定会被唤起，这就像他们遇到的生理问题。

Andrew Huberman: Can we distinguish between arousal-based lubrication, let's say sexual arousal-based lubrication?

Andrew Huberman：我们能否区分基于性唤起的润滑，比如说基于性唤起的润滑？

And again, folks, forgive me for being so hyper-specific in language, but there are other forms of arousal besides sexual arousal that we know from, it's not a pleasant topic from reports following sexual assault, that, you know, oftentimes the victim is demonized for having been lubricated.

再说一次，各位，请原谅我在语言上如此具体，但我们知道，除了性唤起之外，还有其他形式的唤起，从性侵犯后的报告来看，这不是一个令人愉快的话题，你知道，受害者常常因为受到润滑而被妖魔化。

And they will say, well, then people will presume that somehow they wanted that interaction, and that's not true in those cases, it's clear that the lubrication occurred independent of libido type arousal.

他们会说，好吧，然后人们会认为他们想要这种互动，但在这些情况下情况并非如此，很明显，润滑的发生与性欲类型的唤醒无关。

Dr. Rena Malik: Exactly right.

Rena Malik 博士：完全正确。

Andrew Huberman: Okay, so let's set that aside again, unpleasant topic, but one that's important to flag.

安德鲁·休伯曼：好吧，让我们再次把这个话题放在一边，这个令人不快的话题，但也是一个值得标记的重要话题。

Are there forms of non-libido type arousal lubrication that allow for nonpainful or even pleasureful penetration that are important to distinguish from the arousal-based lubrication?

是否存在非性欲型唤醒润滑的形式，可以实现无痛甚至愉快的渗透，这对于区分基于唤醒的润滑很重要？

In other words, I have to imagine that women will have sex and it can be pleasureful or at least not painful, and that might relate in some way to baseline levels of lubrication.

换句话说，我必须想象女性发生性行为时会感到愉快，或者至少不会痛苦，这可能在某种程度上与润滑的基线水平有关。

And here we've been talking about lubrication mainly in the context of arousal, you know, postmenopausal reductions in lubrication, but are there also postmenopausal reductions in baseline lubrication?

在这里，我们主要在性唤起的背景下讨论润滑，你知道，绝经后润滑减少，但是绝经后基线润滑是否也减少？

Are some people's vaginas just more lubricated?

有些人的阴道只是更润滑吗？

I want to say at rest.

我想说休息时。

It's like a scientist in me.

这就像我身上的科学家一样。

When they're asleep, for instance, I mean, men are having erections in their sleep.

例如，当他们睡着时，我的意思是，男人在睡梦中会勃起。

Are women getting vaginal lubrications in their sleep periodically?

女性是否会在睡眠中定期获得阴道润滑？

My guess is yes.

我的猜测是肯定的。

Dr. Rena Malik: Well, they're definitely getting clitoral engorgement, right?

雷纳·马利克博士：嗯，他们肯定会出现阴蒂肿胀，对吗？

They're getting clitoral engorgement.

他们的阴蒂肿胀。

There's been some studies on that, that they are also getting nocturnal tumescence, right?

有一些研究表明它们也会在夜间肿胀，对吗？

Just like men do.

就像男人一样。

As far as lubrication, the data, at least from what I understand, is, like, there is a protective mechanism whereby women, when there's any sense that there may be penetration, that their body will immediately start creating lubrication, and that is protective to avoid trauma and injury.

就润滑而言，至少根据我的理解，数据是，有一种保护机制，当女性感觉到可能存在渗透时，她们的身体会立即开始产生润滑，这是避免创伤和伤害的保护机制。

There's also baseline vaginal discharge.

还有基线阴道分泌物。

That's completely normal.

这是完全正常的。

Women will make physiologic discharge.

女性会出现生理性分泌物。

In fact, in our examinations, when we examine, women will say normal physiologic discharge because we see it, there's always discharge, and it can be up to, like, 5 milliliters.

事实上，在我们的检查中，当我们检查时，女性会说正常的生理分泌物，因为我们看到它，总是有分泌物，而且可能高达5毫升左右。

So it's not a small amount, it can be quite a lot.

所以这不是一个小数目，它可能是相当多的。

Andrew Huberman: And it's menstrual cycle dependent in terms of the viscosity.

Andrew Huberman：粘度取决于月经周期。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

It changes over the cycle, and it can be different in color and different in thickness, and that's completely normal.

它会随着周期的变化而变化，颜色和厚度可能会有所不同，这是完全正常的。

And I think that's a real problem in the feminine hygiene industry.

我认为这是女性卫生用品行业的一个真正问题。

You don't need to smell a certain way or reduce that discharge, this is, like completely normal, healthy.

您不需要闻某种气味或减少分泌物，这就像完全正常、健康的一样。

And you talked about chemistry, and I know there's not a ton of data on this, but there's, like, pheromones, right?

你谈到了化学，我知道这方面的数据并不多，但是有，比如，信息素，对吧？

There's scents that are coming from you which are actually attractive to a partner, potentially, and in whatever physiologic.

你身上散发出的气味实际上对伴侣具有潜在的吸引力，无论生理上如何。

I don't know, there's not a lot of ton of data on this, but there is that part of it.

我不知道，这方面的数据并不多，但确实有这一部分。

So there's a lot of marketing towards women that you're dirty, you should be smelling like peaches or whatever.

所以有很多针对女性的营销，说你很脏，你应该闻起来像桃子什么的。

Andrew Huberman: Really?

安德鲁·休伯曼：真的吗？

Dr. Rena Malik: There's a lot of marketing.

Rena Malik 博士：有很多营销活动。

Andrew Huberman: Maybe this is a generational thing, but I learned early on, I think, my behavioral neuroscience courses, that vaginal lubrications were part of the arousal response for both.

安德鲁·休伯曼：也许这是一代人的事情，但我想，我很早就在行为神经科学课程中了解到，阴道润滑是两者性唤起反应的一部分。

These were always framed in the context of heterosexual relationships.

这些总是在异性关系的背景下进行的。

But both partners, let's just say both partners, because this could be a homosexual female relationship, too.

但是双方，我们就说双方，因为这也可能是同性恋女性关系。

Right.

正确的。

We want to make the conversation as broad as possible, and that the odor, let's just be frank here, the odor and the taste played a role in both arousal, but also the pair bonding response that would establish future arousal.

我们希望使对话尽可能广泛，并且气味，让我们在这里坦率地说，气味和味道不仅在唤醒中发挥了作用，而且在建立未来唤醒的配对反应中也发挥了作用。

And anyone that's ever been in a relationship that, let's say, had healthy sexual relations, I like to think has experienced remembering somebody's smell or thinking about somebody's smell, and that itself could be very arousing.

任何曾经有过一段关系的人，比如说，有过健康的性关系，我想都经历过记住某人的气味或思考某人的气味，而这本身就可能非常令人兴奋。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Andrew Huberman: Partners even smelling different articles of each other's clothing and that being arousing.

Andrew Huberman：伴侣甚至可以闻彼此衣服上不同的气味，这很令人兴奋。

So, I mean, this is the stuff of real physiology.

所以，我的意思是，这是真正的生理学内容。

We're not making this stuff up.

我们不会编造这些东西。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

But there is.

但确实有。

There is a lot of marketing towards women that they should use douching or other things to clean themselves, and it's damaging.

有很多针对女性的营销宣传称她们应该使用冲洗或其他东西来清洁自己，这是有害的。

Right.

正确的。

It's actually, one it can affect the vaginal microbiome.

实际上，它可以影响阴道微生物组。

So their pH is changing, and that can affect their risk for UTIs or bacterial vaginosis.

因此，他们的 pH 值正在发生变化，这可能会影响他们患尿路感染或细菌性阴道病的风险。

And so they're buying these, spending their money on these things because they're being told that they're not clean.

所以他们购买这些东西，把钱花在这些东西上，因为他们被告知这些东西不干净。

And they come to the doctor saying, oh, I think I have an STD, but it's like normal physiologic discharge.

他们来找医生说，哦，我想我患有性病，但这就像正常的生理分泌物。

And so I think it's important to say that this is normal, and it's normal to have an odor that is distinct to you, and that there's, of course, if you have, like, a fishy odor, that may be a sign of, like, a very strong, new, novel odor that wasn't there before, that may be a sign of a sexually transmitted infection.

所以我认为重要的是要说这是正常的，有一种对你来说独特的气味是正常的，当然，如果你有鱼腥味，这可能是一种以前不存在的非常强烈的、新的、新颖的气味的迹象，这可能是性传播感染的迹象。

But if it's your general odor that you've always had, that's normal.

但如果这是您一直有的一般气味，那是正常的。

Andrew Huberman: And what about other infections, like yeast infections or bacterial infections?

Andrew Huberman：那么其他感染呢，比如酵母菌感染或细菌感染？

I got a number of questions about mycoplasma infections, which we don't hear that often about.

我收到了一些关于支原体感染的问题，但我们不常听到这种情况。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So you can see if your discharge has changed and become more like cottage cheese like.

这样您就可以看到您的分泌物是否发生了变化，变得更像干酪一样。

Or there's other symptoms, like itching or discomfort, then those are signs to go get evaluated.

或者还有其他症状，例如瘙痒或不适，那么这些都是需要进行评估的迹象。

Mycoplasma is another infection that we see in the vagina, but we also actually sometimes see in the urine.

支原体是我们在阴道中看到的另一种感染，但实际上有时我们也会在尿液中看到。

And while it's not something we routinely test for, when we have people who have symptoms of urinary tract infection and they're not improving, sometimes we will check for mycoplasma that could be causing symptoms in the urethra itself.

虽然这不是我们常规测试的东西，但当我们有尿路感染症状且没有改善的人时，有时我们会检查是否有可能引起尿道本身症状的支原体。

Andrew Huberman: We've had a couple episodes about the gut microbiome.

Andrew Huberman：我们已经播出了几集有关肠道微生物组的节目。

My colleague Justin Sonnenburg at Stanford, his laboratory is directly above from mine, is an expert in the gut microbiome.

我在斯坦福大学的同事贾斯汀·索南伯格（Justin Sonnenburg）是肠道微生物组方面的专家，他的实验室就在我的实验室的正上方。

I've done a couple episodes about this, and he reminded me, and I like to remind people, that every mucosal lining of your body has a robust microbiome.

我已经做了几集关于这个的节目，他提醒我，我喜欢提醒人们，你身体的每个粘膜内层都有一个强大的微生物群。

So that means intranasal, intravaginal, intraurethral in males and females, there's an anal microbiome.

这意味着男性和女性的鼻内、阴道内、尿道内都存在肛门微生物组。

There's a microbiome on your skin, on your eyes.

你的皮肤、眼睛上都有微生物组。

And you mentioned douching and other ways of, I don't want to say quote, unquote, cleaning it.

你提到了冲洗和其他方式，我不想说引用、取消引用、清洁它。

Because that language falls in line with the idea that it's a good thing.

因为这种语言符合“这是一件好事”的想法。

You're telling me it's a bad thing in many cases, because it's wiping out the microbiome.

你告诉我，在很多情况下这是一件坏事，因为它正在消灭微生物组。

What are some of the things that females can do in order to promote the health of their vaginal microbiome?

女性可以做哪些事情来促进阴道微生物组的健康？

Dr. Rena Malik: So, it's really, our bodies are amazing.

雷纳·马利克博士：所以，我们的身体真的很棒。

The vagina is a self-cleaning oven.

阴道是一个自洁烤箱。

You don't have to do anything.

你不需要做任何事。

You just wash.

你就洗洗吧。

Andrew Huberman: I love that.

安德鲁·休伯曼：我喜欢这个。

The vagina is a self-cleaning oven.

阴道是一个自洁烤箱。

I'm not going to repeat that too often in too many different contexts, but I'm going to remember it forever.

我不会在太多不同的情况下重复太多次，但我会永远记住它。

Dr. Rena Malik: You will.

雷纳·马利克博士：你会的。

You will.

你会。

And so all you need to do is wash the hair-bearing areas, because those are the ones that create sweat and should be cleaned.

因此，您需要做的就是清洗有毛发的区域，因为这些区域是产生汗水的区域，应该进行清洁。

But other than that, let soapy water run down.

但除此之外，让肥皂水流下来。

You don't need to do anything.

你不需要做任何事情。

Your body will take care of it itself.

你的身体会自己照顾它。

Andrew Huberman: When I was five years old, I pulled my parents in the bathroom and I said, they still talk about this?

安德鲁·胡伯曼：当我五岁的时候，我把父母拉进浴室，我说，他们还在谈论这个吗？

I said, I want to know everything about sex.

我说，我想知道关于性的一切。

I want to know everything.

我想知道一切。

And they were like, oh, my God, what are we dealing with?

他们就像，天啊，我们在面对什么？

And I'll never forget, my dad just looked at me, he's Argentinian and he said, just remember, kids are the one thing in life you can't give back.

我永远不会忘记，我父亲只是看着我，他是阿根廷人，他说，记住，孩子是生命中你无法回报的一件事。

That's all he said.

他就是这么说的。

That was it.

就是这样。

Dr. Rena Malik: That's it.

Rena Malik 博士：就是这样。

Andrew Huberman: That was it.

安德鲁·休伯曼：就是这样。

Dr. Rena Malik: Oh, gosh.

Rena Malik 博士：哦，天哪。

Well, I will tell you, my discussions with my sons are, my son, my older son has been much more graphic than that.

好吧，我会告诉你，我和我儿子们的讨论是，我的儿子，我的大儿子比那要生动得多。

I tell him---

我告诉他——

Andrew Huberman: Amazing.

安德鲁·休伯曼：太棒了。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: Amazing.

安德鲁·休伯曼：太棒了。

Well, I went out into the world and, anyway.

好吧，无论如何，我已经走进了这个世界。

Dr. Rena Malik: You figured it out.

Rena Malik 博士：你已经明白了。

Andrew Huberman: Let's spend a few minutes or more talking about female orgasm.

安德鲁·休伯曼：让我们花几分钟或更长时间来讨论女性高潮。

One of the more cryptic topics on the internet, not because it isn't discussed, but because I think that the nuance of it isn't discussed often enough or in full depth.

互联网上比较神秘的话题之一，不是因为它没有被讨论，而是因为我认为它的细微差别没有被足够频繁地或充分深入地讨论。

So let's take the time we need to parse this.

因此，让我们花点时间来解析一下。

I think that the simplest way to parse it is going to be, from the anatomical standpoint, clitoral orgasm versus so called G-spot, or penetration-based orgasm.

我认为从解剖学的角度来看，解析它的最简单方法是阴蒂高潮与所谓的 G 点或基于渗透的高潮。

But of course, penetration-based orgasm is also a bit of a misnomer because there can be clitoral stimulation by pelvic pressure or by digit.

但当然，基于插入的性高潮也有点用词不当，因为骨盆压力或手指可能会刺激阴蒂。

We're talking about fingers as digits, because we're both in the medical science profession, but we're talking about fingers here or something else.

我们将手指视为数字，因为我们都从事医学科学行业，但我们在这里谈论手指或其他东西。

Right.

正确的。

Vibrator, toy, whatever.

振动器、玩具等等。

Toe, for it, depends on how flexible you are.

脚趾，这取决于你的灵活性。

I don't know.

我不知道。

But the point being that I think the simplest way to go about this is going to be to talk about the distinction between clitoral orgasm and G-spot orgasm, however those are achieved, and to also talk about this idea of graded versus absolute.

但重点是，我认为解决这个问题最简单的方法是讨论阴蒂高潮和 G 点高潮之间的区别，无论它们是如何实现的，并讨论分级与绝对的概念。

Okay, so this has actual parallels to neuroscience, where we talk about communication between neurons being graded.

好的，这与神经科学有实际的相似之处，我们讨论神经元之间的通信被分级。

Meaning it's kind of one level, then a higher level, then a lower level, or all or none.

这意味着它是一个级别，然后是更高级别，然后是更低级别，或者全部或没有。

Right?

正确的？

How shall I say this?

我该怎么说呢？

It is clear in my life experience and observation that there are multiple kinds of female orgasm.

根据我的生活经验和观察，女性高潮有很多种。

Those that are graded and in some cases cumulative, they sort of build towards a larger and larger orgasm.

那些是分级的，在某些情况下是累积的，它们某种程度上是为了达到越来越大的高潮。

And then there are what some people have described as cliff-type orgasms, where there's a refractory period.

还有一些人所说的悬崖式高潮，其中有一个不应期。

I think that's a fair way to frame this.

我认为这是一个公平的框架方式。

And clearly, there are different responses to the orgasm response.

显然，对性高潮的反应有不同的反应。

Some people get sleepy, some people get energized.

有的人会困倦，有的人会精力充沛。

Some people, it heightens their desire for more.

有些人，它增强了他们想要更多的欲望。

Some people, they need a period of time in which they become hypersensitive to touch.

有些人，他们需要一段时间，让他们对触摸变得过敏。

So lots of different things going on there.

那里发生了很多不同的事情。

Psychologically, physiologically.

心理上、生理上。

Yeah, tell us all of it.

是的，告诉我们一切。

Dr. Rena Malik: So, in terms of orgasm, right, I think it's important to distinguish that there is orgasm and then there's different areas that you stimulate to achieve orgasm.

雷纳·马利克博士：所以，就性高潮而言，我认为区分性高潮和刺激不同区域以达到性高潮很重要。

So some people will stimulate...

所以有些人会刺激...

The clitoris is probably the most reliable form of stimulation that will achieve orgasm.

阴蒂可能是达到性高潮最可靠的刺激形式。

And when you look at the data, and again, female sexual dysfunction data is not super robust, but what we find is that about 85% of women require clitoral stimulation in order to climax.

当你查看这些数据时，你会发现，女性性功能障碍的数据并不是非常可靠，但我们发现，大约 85% 的女性需要阴蒂刺激才能达到高潮。

So very few actually climax through just vaginal penetration alone.

因此很少有人真正通过阴道插入达到高潮。

This is a real problem we're seeing on the media that you have sex and you penetrate, and immediately women are having orgasms.

这是我们在媒体上看到的一个真正的问题，你发生性行为并插入，女人立即就会达到高潮。

That's not the reality for a lot of women, and in terms of stimulation, so like we've talked about throughout this podcast, the clitoris is the homologue of the penis, or the penis is the homologue of the clitoris, however you want to say it.

对于很多女性来说，这并不是现实，就刺激而言，就像我们在整个播客中讨论的那样，阴蒂是阴茎的同源物，或者阴茎是阴蒂的同源物，无论你想怎么说。

Andrew Huberman: Good on you for getting it both directions.

Andrew Huberman：很高兴你能实现两个方向的发展。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: I probably would have screwed that one up.

Andrew Huberman：我可能会把那件事搞砸。

Dr. Rena Malik: So clitoral stimulation is just like penile stimulation — for women that is very reliable.

雷纳·马利克博士：所以阴蒂刺激就像阴茎刺激一样——对于女性来说这是非常可靠的。

And there's a huge orgasm gap.

并且存在巨大的性高潮差距。

For men, it's pretty consistent that when they have a first-time sexual encounter, 95% of men are having an orgasm.

对于男性来说，相当一致的是，当他们第一次发生性行为时，95% 的男性都会达到性高潮。

When you look at first-time sexual encounters for women, with, in heterosexual relationships, it's about 45% to 50% are having an orgasm.

当你观察女性在异性关系中的第一次性接触时，大约有 45% 到 50% 的人会达到性高潮。

And when you look at homosexual relationships of women, it's again 90%.

当你观察女性的同性恋关系时，你会发现这一比例仍然是 90%。

So there's clearly some lacking in---

所以显然还缺少一些——

Andrew Huberman: Ninety percent of female homosexual interactions that are first-time interactions, 90% are having orgasm.

Andrew Huberman：90% 的女性同性恋互动是第一次互动，其中 90% 都达到了性高潮。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Andrew Huberman: Presumably because they understand the anatomy of other by way of understanding the anatomy of self.

安德鲁·休伯曼：大概是因为他们通过了解自我的解剖结构来了解他人的解剖结构。

Dr. Rena Malik: So there's a huge gap.

Rena Malik 博士：所以存在巨大的差距。

Andrew Huberman: And physiology and psychology of that, too.

Andrew Huberman：还有生理学和心理学。

Dr. Rena Malik: But you know there's a huge gap there.

Rena Malik 博士：但你知道那里存在巨大的差距。

And so I think to bring it home is that clitoral stimulation is the most reliable way.

所以我认为带回家的是阴蒂刺激是最可靠的方法。

And as you mentioned, when you're stimulating vaginally, you're often, the clitoris is like a wishbone, and it goes around the vagina.

正如你提到的，当你刺激阴道时，你经常会发现阴蒂就像一根叉骨，它围绕着阴道。

And so you're often stimulating the crura is what we call the legs, I guess, for lack of a better term, of the clitoris.

所以你经常刺激我们所说的腿，我想，因为没有更好的术语，就是阴蒂。

And so you're stimulating that.

所以你正在刺激这一点。

You're also stimulating the clitoral shaft, which goes deep into the pelvis.

您还刺激了深入骨盆的阴蒂轴。

The G-spot is an area, it's an erogenous zone where it's kind of in the anterior wall of the vagina, about 2 to 3 cm in.

G点是一个区域，是一个性感地带，位于阴道前壁，大约2到3厘米长。

That's the location of these periurethral glands called the Skene's glands.

这就是尿道周围腺体的位置，称为斯基恩腺。

And they are analogous or homologous to the male prostate.

它们与男性前列腺相似或同源。

So just like some men have prostate play and enjoy pleasure from prostate stimulation, some women enjoy G-spot stimulation.

因此，就像有些男性有前列腺功能并享受前列腺刺激带来的快感一样，有些女性也喜欢 G 点刺激。

Now, that's not universal, right?

现在，这并不普遍，对吧？

Not all men enjoy prostate play, and not all women are going to be aroused by G-spot stimulation.

并非所有男性都喜欢前列腺游戏，也不是所有女性都会因 G 点刺激而性唤起。

And so I think there's a huge variety of ways you can stimulate anyone.

所以我认为有很多种方法可以刺激任何人。

It can be man or woman.

它可以是男人或女人。

Some people will have orgasms through just nipple stimulation alone.

有些人仅通过乳头刺激就能达到性高潮。

Some will just hear something or see something and be able to achieve an orgasm.

有些人只是听到一些东西或看到一些东西就能够达到高潮。

And it's so varied from person to person.

而且因人而异。

And I think that the big take-home from this for people listening is like, you have to talk to your partner.

我认为，对于倾听的人来说，最大的收获就是，你必须与你的伴侣交谈。

And this is the hardest thing, we never learned how to talk about sex.

这是最难的事情，我们从来没有学过如何谈论性。

Like, what do you like?

比如，你喜欢什么？

What do you not like?

你不喜欢什么？

And don't take it personally.

不要把它当成是针对你个人的。

Right.

正确的。

I think a lot of times people feel like you have to orgasm to have pleasure, which may not be the case for everybody.

我认为很多时候人们觉得你必须达到高潮才能获得快乐，但并非每个人都是如此。

And if it is, how do you prioritize that for your relationship?

如果是的话，你如何优先考虑你们的关系？

So, I don't know if I got off track there, but that's kind of, I think the take-homes for this and also the vaginal penetration.

所以，我不知道我是否偏离了轨道，但这就是我认为的收获以及阴道渗透。

It's actually usually from cervical stimulation, not necessarily vaginal, because the large density of innervation of the vagina is in the first outer third of the vagina.

它实际上通常来自宫颈刺激，不一定是阴道刺激，因为阴道的神经支配密度很大，位于阴道的前三分之一。

The deeper two-thirds of the vagina has much less innervation.

阴道深处三分之二的神经支配要少得多。

Andrew Huberman: And yet there is such a thing as cervical orgasm.

安德鲁·休伯曼：然而，宫颈高潮确实存在。

And the cervix being further up the vaginal canal is cervical orgasm.

宫颈位于阴道管的更上方，就是宫颈高潮。

Specifically, the foci of an orgasm that starts in the back of the vagina.

具体来说，是从阴道后部开始的高潮焦点。

Is that.

是这样吗。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

So it's from stimulation of the cervix through whatever means.

所以这是通过任何方式刺激子宫颈。

Right.

正确的。

And that can be pleasurable and lead to orgasm.

这会令人愉悦并导致性高潮。

And again, orgasm is defined differently, but the one thing we know is that there are pelvic floor contractions, which are measurable.

再说一次，性高潮的定义不同，但我们知道的一件事是，盆底收缩是可以测量的。

So you can kind of tell that your partner is having an orgasm if you have a female partner, because you can actually feel those contractions.

因此，如果您有女性伴侣，您可以告诉您的伴侣正在经历性高潮，因为您实际上可以感觉到这些宫缩。

Right.

正确的。

Whether it's on your digit or your organ or a sex toy.

无论是在您的手指、器官还是性玩具上。

Andrew Huberman: Okay, super nerdy question here.

Andrew Huberman：好的，这是一个超级书呆子的问题。

Years ago, when I worked on hormone-based sexual differentiation, which, by the way, we've done an episode of the podcast on previously, I learned that the levator ani muscle is the muscle that controls erection in males, and presumably clitoral tumescence and engorgement in females.

几年前，当我研究基于激素的性别分化时，顺便说一句，我们之前已经做过一集播客，我了解到提肛肌是控制男性勃起的肌肉，大概也是控制女性阴蒂肿胀和充血的肌肉。

Is there an equivalent muscle responsible for the orgasm response?

是否有同等的肌肉负责性高潮反应？

Or is the contraction of the pelvic floor part of a more general theme of muscular contraction and a bunch of different nerve roots contracting.

或者盆底收缩是肌肉收缩和一堆不同神经根收缩的更普遍主题的一部分。

The reason I ask this is that eventually, in this conversation, we're going to migrate up toward the brain.

我问这个问题的原因是，最终，在这次对话中，我们将向上迁移到大脑。

But because this is a science and health podcast, when we talk about orgasm, of course many people recognize that as their experience of it and their recognition of it in other people and descriptions, et cetera.

但因为这是一个科学和健康播客，当我们谈论性高潮时，当然很多人都会认识到这是他们的经历以及他们在其他人和描述中对其的认可等等。

But are we talking about a response that originates at a foci, kind of like in the brain?

但我们谈论的是源自某个焦点（有点像大脑）的反应吗？

We talk about a seizure starting at a focus, a foci, and then spreading out?

我们谈论的是从一个病灶开始的癫痫发作，一个病灶，然后扩散？

Or are we talking about a bunch of different nerve roots and brain centers firing in synchrony and that's why some people experience it as behind their forehead and in their genitals.

或者我们谈论的是一堆不同的神经根和大脑中心同步放电，这就是为什么有些人在前额后面和生殖器中感受到它。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: Or as a whole-body response.

Andrew Huberman：或者作为全身反应。

And here we're not talking about the flood of neurochemicals into the body, I'm talking about during those moments of orgasm.

在这里，我们不是在谈论神经化学物质大量涌入体内，而是在高潮时刻。

What is happening neurally?

神经发生了什么？

I mean, it does have certain parallels to seizure, right?

我的意思是，它确实与癫痫发作有某些相似之处，对吧？

Dr. Rena Malik: It does.

雷纳·马利克博士：确实如此。

It does.

确实如此。

So let me go back to your first part of the question, which was about orgasm and, sorry, erection and tumescence being related to levator ani.

那么让我回到问题的第一部分，即关于性高潮，抱歉，勃起和肿胀与提肛肌有关。

So actually, what happens during...

所以实际上，期间发生了什么...

the reason you get an erection, and presumably clitoral stimulation the same way, is blood flows into the erectile tissue and the tunica, which is the outer layers of the erectile tissue, which are two basically cylindrical-shaped structures in the penis and in the clitoris.

你勃起的原因，大概也是以同样的方式刺激阴蒂的原因，是血液流入勃起组织和被膜，这是勃起组织的外层，是阴茎和阴蒂中的两个基本上圆柱形的结构。

They will fill with blood, and then that tunica will compress veins on the outside to prevent blood flow from leaving.

它们会充满血液，然后被膜会压迫外面的静脉，以防止血液流出。

So it's not a muscular event, it's an actual blood flow event.

所以这不是肌肉事件，而是实际的血流事件。

Andrew Huberman: Then how come when we wanted to study erection behavior in rodents, we would give them injections of testosterone, females or males, and observe changes in sexual behavior accordingly?

Andrew Huberman：那为什么当我们想要研究啮齿动物的勃起行为时，我们会给它们注射睾酮，无论是雌性还是雄性，并相应地观察性行为的变化呢？

Erection and clitoral tumescence.

勃起和阴蒂肿胀。

Although it's harder to measure in rodents, there's a way of indirectly measuring that.

尽管在啮齿类动物中测量这一点比较困难，但有一种间接测量的方法。

And then we would measure the size and weight of the levitor ani muscles as a readout of how androgenized that whole system was.

然后我们会测量肛提肌的大小和重量，作为整个系统雄激素化程度的读数。

Dr. Rena Malik: So the muscles---

Rena Malik 博士：所以肌肉——

Andrew Huberman: In other words, what is the role of the levator ani in the sexual response?

Andrew Huberman：换句话说，提肛肌在性反应中的作用是什么？

Dr. Rena Malik: So the levator ani---

Rena Malik 博士：所以提肛肌——

Andrew Huberman: Well, you would know.

安德鲁·休伯曼：嗯，你会知道的。

Dr. Rena Malik: So those muscles are part of the pelvic floor, right?

Rena Malik 博士：那么这些肌肉是盆底的一部分，对吧？

And so those contract when you climax.

因此，当你达到高潮时，这些会收缩。

Right.

正确的。

So whether it's orgasm for male or female, they're contracting and they're exercising.

因此，无论男性还是女性达到高潮，他们都会收缩并锻炼。

Right?

正确的？

So that's how they would increase their strength or their density, if you're measuring that through the actual climax, of which you can't see in rodents.

这就是它们增加强度或密度的方式，如果你通过实际的高潮来测量，而在啮齿类动物中你看不到这一点。

Right?

正确的？

So, like, you're kind of using it as a surrogate in that way.

所以，就像，你以这种方式使用它作为替代品。

So that's what happens.

这就是发生的事情。

Those muscles contract as a response, and climax is a brain-initiated event.

这些肌肉作为反应而收缩，而高潮是大脑发起的事件。

Orgasm is a brain-initiated event.

性高潮是大脑发起的事件。

So that's why, to answer your second part, you obviously feel focal response, but you also can feel a variety of responses because it's all coming from the brain.

这就是为什么，为了回答你的第二部分，你显然会感受到焦点反应，但你也可以感受到各种反应，因为它们都来自大脑。

It's not kind of the way you described it as, like a ripple effect.

这不像你所描述的那样，就像连锁反应一样。

It's more of like, it's the way your body responds to that particular stimuli.

它更像是你的身体对特定刺激的反应方式。

And it's actually like the ultimate form of mindfulness.

它实际上就像正念的终极形式。

You can't think of anything else when you're orgasming.

当你达到高潮时，你无法思考任何其他事情。

Right.

正确的。

So it's like you have this moment of clarity and everything.

所以就好像你拥有了这一刻的清晰和一切。

You are very present in that moment.

那一刻你非常在场。

And so people will feel different stimulations depending on how their nerves are, their sensations are, and things like that.

因此，人们会根据他们的神经状况、感觉状况等感受到不同的刺激。

Andrew Huberman: It's perhaps a good time to mention dopamine.

Andrew Huberman：也许现在是提多巴胺的好时机。

We've talked about it a few times earlier when talking about the arousal arc that starts with parasympathetic sort of calm and then move, typically starts as calm and then moves to the orgasm response.

我们之前已经讨论过几次，当谈论从副交感神经平静开始然后移动的唤醒弧时，通常从平静开始，然后转向性高潮反应。

We know that the orgasm response is associated with release of dopamine and then prolactin, which sets up the relative or absolute refractory period.

我们知道性高潮反应与多巴胺和催乳素的释放有关，催乳素设定了相对或绝对不应期。

The interesting thing, and I got some questions about this, is that there's literature, as I understand, about the elevation in dopamine caused by, say, antidepressants like Wellbutrin, bupropion, which increases dopamine and norepinephrine.

有趣的是，据我所知，有一些文献提到，诸如维布特林、安非他酮等抗抑郁药会增加多巴胺和去甲肾上腺素，从而导致多巴胺升高。

People who recreationally use drugs like cocaine or other stimulants, people who take Adderall, Vyvanse, or other drugs that increase levels of dopamine.

娱乐性使用可卡因或其他兴奋剂等药物的人，服用阿得拉、Vyvanse 或其他增加多巴胺水平的药物的人。

Because I did whole episode about those drugs, and they are different forms of amphetamine, unless we're talking about Ritalin, which is a little bit different.

因为我整集都是关于这些药物的，它们是不同形式的安非他明，除非我们谈论的是利他林，它有点不同。

And I got a lot of questions about people who experience feeling a lot of desire, sort of arousal, but not being able to achieve the physical arousal, erection or vaginal lubrication.

我收到了很多关于那些感受到强烈欲望、某种性唤起，但无法实现身体唤起、勃起或阴道润滑的人的问题。

So it's almost as if they're sitting further along that arousal arc.

所以就好像他们沿着唤醒弧线坐得更远。

Hence the importance, I think, of people learning to have calm states of mind when going into sexual interactions.

因此，我认为，人们在进行性行为时学会保持冷静的心态非常重要。

Now, I realize that in saying that, it might be confusing, because a lot of people think, well, that's anything but calm, right?

现在，我意识到这样说可能会令人困惑，因为很多人认为，这根本就不平静，对吧？

Sexual arousal is anything but calm, but maintaining enough calm that they can ride that arc for whatever duration is appropriate for that interaction in them.

性唤起绝非平静，但要保持足够的平静，以便他们可以在这段弧线上停留适合他们互动的任何时间。

Right.

正确的。

Because, again, and we should probably get back to this, some people will have sex for long periods of time, some for shorter periods of time.

因为，我们可能应该回到这一点，有些人的性生活时间较长，有些人的时间较短。

And here, people don't really know what other people are doing, except by way of pornography and self-report and discussion.

在这里，人们除了通过色情内容、自我报告和讨论之外，并不真正知道其他人在做什么。

So is it the case that drugs that increase dopamine can inhibit the sexual response?

那么增加多巴胺的药物是否会抑制性反应呢？

Do they tend to promote the sexual response?

它们是否倾向于促进性反应？

Because I also mentioned earlier, there's this growing trend of people taking, by way of prescription, of course, from a physician, combined apomorphine, which is a dopaminergic drug, with tadalafil, which is a PDE5 inhibitor, so it's going to increase blood flow.

因为我之前也提到过，人们越来越倾向于通过医生处方的方式服用阿朴吗啡（一种多巴胺能药物）和他达拉非（一种 PDE5 抑制剂），因此它会增加血流量。

And I'm hearing about men and women, but mainly men doing this.

我听说有男性和女性，但主要是男性这样做。

So ramping up their dopamine, ramping up their blood flow to their genitals in order to have, presumably, more arousal and sex.

因此，增加他们的多巴胺，增加流向生殖器的血液，大概是为了获得更多的性唤起和性行为。

Does that make sense as a mechanism?

作为一种机制，这有意义吗？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

So in terms of apomorphine, that has been studied, and it's mostly been approved outside of the United States.

因此，就阿朴吗啡而言，已经进行了研究，并且大部分在美国境外获得了批准。

So we don't use it very often here in the United States because it hasn't been FDA approved.

所以我们在美国不经常使用它，因为它尚未获得 FDA 批准。

But it's a very complex response.

但这是一个非常复杂的反应。

So, like I mentioned, that flibanserin, which is a centrally acting medication, it actually has not only stimulatory but also inhibitory effects on dopamine.

所以，就像我提到的，氟班色林是一种中枢作用药物，它实际上不仅对多巴胺具有刺激作用，而且还具有抑制作用。

So the way it sort of works to enhance interest or libido is sort of complex and kind of confusing.

因此，它增强兴趣或性欲的方式有点复杂，也有点令人困惑。

When it was actually approved, it was being studied for an antidepressant, and what they found was that women were actually having better interest in sex or more interest in sex.

当它真正获得批准时，人们正在对它进行抗抑郁药研究，他们发现女性实际上对性有更好的兴趣或对性更有兴趣。

And so that's kind of how it was discovered.

这就是它的发现方式。

Similarly, Viagra was actually studied for high blood pressure.

同样，伟哥实际上也被研究用于治疗高血压。

And when they went to, it was horrible blood pressure medication, but then the men who took it actually didn't return the samples for the study, so they realized, like, what's going on here?

当他们去那里时，这是一种可怕的降血压药物，但后来服用它的人实际上没有返回研究样本，所以他们意识到，这里发生了什么事？

And it was because they were having better erections.

这是因为他们的勃起效果更好。

Andrew Huberman: Is it true that at some urology meeting that the first description of Viagra as a treatment for erectile dysfunction involved the speaker actually coming out from behind the podium and revealing his erection?

安德鲁·休伯曼：在一些泌尿科会议上，第一次描述伟哥作为治疗勃起功能障碍的演讲者实际上从讲台后面走出来并暴露了他的勃起，这是真的吗？

Is that a true story?

这是一个真实的故事吗？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

I don't think it was Viagra.

我不认为这是伟哥。

I think it was an intracavernosal injection, though.

不过，我认为这是海绵体内注射。

I think he came out, it is a true story, there's actually a published article, I'll send it to you so you can share it if you'd like.

我认为他出来了，这是一个真实的故事，实际上有一篇发表的文章，我会把它发给你，这样你就可以分享它，如果你愿意的话。

Andrew Huberman: I'm not sure I want to see it, but I'll read the article.

Andrew Huberman：我不确定我想看它，但我会读这篇文章。

Dr. Rena Malik: There's a published article about people who were attending at the meeting.

Rena Malik 博士：有一篇关于参加会议的人的文章已发表。

And, yes, he came out, and at the time, it was mostly men in urology, but there were, like, spouses, I guess, in the audience, which is not typical now.

是的，他出来了，当时，大多数是泌尿科的男性，但我猜，观众中也有配偶，这在现在并不常见。

So there were women in the audience, and he came out with a full-on erection to show that it worked.

所以观众中有女性，他出来时完全勃起，以表明它有效。

Andrew Huberman: Well, I suppose at the Urology meeting or OB-GYN meeting, where a woman comes out and reveals her enhanced vaginal lubrication, then we will have gender and sex balance at the meetings on urology.

Andrew Huberman：嗯，我想在泌尿外科会议或妇产科会议上，一位女性站出来并展示她增强的阴道润滑，然后我们将在泌尿外科会议上实现性别平衡。

It'll be interesting to attend one of those someday.

有一天参加其中一场会很有趣。

Differences in arousal as a function of stage of the menstrual cycle.

觉醒程度随月经周期阶段的变化而存在差异。

Really interested in this.

真的对此很感兴趣。

I did a long episode on fertility and we're going to have a few other IVF experts, fertility experts on the podcast.

我做了一个关于生育力的长集，我们将在播客中邀请其他几位体外受精专家、生育专家。

But, clearly, there are differences in hormones across the menstrual cycle.

但是，显然，整个月经周期中的激素存在差异。

We know that for sure.

我们肯定知道这一点。

Clearly there can be psychological variation according to those hormones for probably other things across the menstrual cycle.

显然，根据这些激素的不同，整个月经周期中的其他事情可能会产生心理变化。

And it's always an imperfect experiment because we aren't laboratory rats and people are having different interactions across the menstrual cycle.

这始终是一个不完美的实验，因为我们不是实验室老鼠，人们在整个月经周期中有不同的相互作用。

Is there any known correlation between desire and stage of the menstrual cycle?

欲望和月经周期阶段之间是否存在已知的相关性？

There are some obvious assumptions that one might make: prior to ovulation, et cetera, around the time of ovulation.

人们可能会做出一些明显的假设：排卵前，等等，排卵前后。

But what about the other direction, too?

但另一个方向呢？

Is there a category of women that are very interested in sex at certain stages of their menstrual cycle and then not at all interested in sex at other stages of the menstrual cycle?

是否有一类女性在月经周期的某些阶段对性非常感兴趣，而在月经周期的其他阶段对性完全不感兴趣？

Dr. Rena Malik: You know, all, the data that I've heard, and maybe a gynecologist could speak more on this because they study those variations a little better.

雷纳·马利克博士：你知道，我听到的所有数据，也许妇科医生可以就此发表更多言论，因为他们对这些变异的研究更好一些。

But there is data to suggest that libido does increase prior to ovulation and during ovulation, I think it's like a couple of days prior, because that's the optimal time for fertility.

但有数据表明，性欲在排卵前和排卵期间确实会增加，我认为就像是在排卵前几天，因为那是生育的最佳时间。

So, yes, there is data to suggest that.

所以，是的，有数据表明这一点。

In terms of completely lack of interest, I don't believe there's data, but I'm not sure.

就完全缺乏兴趣而言，我不相信有数据，但我也不确定。

Andrew Huberman: Is there evidence that females who perhaps have not experienced so called G-spot orgasm or cervical orgasm can learn to do that?

Andrew Huberman：是否有证据表明，那些可能没有经历过所谓的 G 点高潮或宫颈高潮的女性可以学会这样做？

And I always find it interesting that whenever there's a discussion about different forms of female orgasm, people are careful to point out that many women don't have penetration-based orgasm, and then they separate out clitoral stimulation as a more common route to orgasm.

我总是觉得有趣的是，每当讨论不同形式的女性高潮时，人们都会小心地指出，许多女性没有基于插入的高潮，然后他们将阴蒂刺激作为一种更常见的高潮途径。

But of course, there can be clitoral stimulation with penetration.

但当然，通过渗透可以刺激阴蒂。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

Andrew Huberman: Right.

安德鲁·休伯曼：对。

And depending on the physical arrangement, there can be clitoral stimulation purely by way of penetration through pelvic contact, fingers, et cetera.

并且根据身体布置，可以纯粹通过骨盆接触、手指等的渗透来刺激阴蒂。

How should we think about this?

我们应该如何思考这个问题？

How should we talk about it?

我们应该如何谈论它？

Dr. Rena Malik: So there was an interesting study that I just read recently where they gave women words for these things, right?

雷纳·马利克博士：我最近读到了一项有趣的研究，研究中她们给了女性关于这些事情的词语，对吗？

So there's like the rocking stimulation.

所以就有了摇摆的刺激。

So that can also stimulate.

这样也能刺激。

So, meaning that you're penetrating, but there's like a rocking motion that can also penetrate the clitoris.

所以，这意味着你正在插入，但有一种摇摆运动也可以插入阴蒂。

There's stimulation of just the outer part of the vagina, which, again, as I mentioned, the G-spot is there, it's more highly innervated, so that can be more stimulating.

刺激仅针对阴道外部，正如我提到的，G 点就在那里，它的神经支配程度更高，因此可以更具刺激性。

There's also ways to align yourself so that when you're penetrating, you're putting pressure on the clitoris, and then there's stimulation with actual stimulation of the clitoris, like intentional stimulation either by yourself or by the partner.

还有一些方法可以调整自己，这样当你插入时，你就可以对阴蒂施加压力，然后通过对阴蒂的实际刺激来刺激，比如你自己或伴侣的有意刺激。

And so there are multiple different ways to do that.

因此有多种不同的方法可以做到这一点。

Right.

正确的。

And so I think that it's important to really kind of, it's okay to explore and not always be a home run.

所以我认为真正重要的是，探索并且不总是全垒打是可以的。

And I think that's like when you get into a relationship where you're maybe second, third, fourth time having intercourse with someone, that you can try and explore these different things or if the partner themselves knows what they like to actually tell the other partner.

我认为这就像当你进入一段关系时，你可能第二次、第三次、第四次与某人发生性关系，你可以尝试探索这些不同的事情，或者伴侣自己是否知道他们喜欢告诉对方什么。

Right.

正确的。

There's a huge part of communication that I think plays a huge role in this because we know ourselves better than anyone else.

我认为沟通在其中发挥着重要作用，因为我们比其他任何人都更了解自己。

So you can tell your partner what you like.

所以你可以告诉你的伴侣你喜欢什么。

And I think that we have never been taught how to do that.

我认为我们从未被教导过如何做到这一点。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Such important conversations for so many reasons.

如此重要的对话有很多原因。

And as you point out, definitely not something they teach people in school, except they might say something about communication is important.

正如你所指出的，这绝对不是他们在学校教给人们的东西，除非他们可能会说沟通很重要。

And that almost always circles back to the key four things we talked about earlier, which is that consent and age-appropriate, context-appropriate, these kinds of things.

这几乎总是回到我们之前讨论过的关键四件事，即同意和适合年龄、适合背景的事情。

And obviously, substances like alcohol and other drugs can strongly confound those issues, and so we'll just leave that as a kind of an obvious one.

显然，酒精和其他药物等物质可能会严重混淆这些问题，因此我们将其作为一种明显的问题。

As long as we're talking about communication around sexual interactions, perhaps it would be useful to people to cultivate a language or a nomenclature there, too, to facilitate that.

只要我们谈论围绕性互动的交流，也许人们培养一种语言或术语来促进这一点也是有用的。

Some of the language that I've heard that is quite useful is things like people have different arousal templates.

我听过的一些非常有用的语言是人们有不同的唤醒模板。

Some people, certain ideas are stimulating to them and other ideas are aversive to them.

有些人，某些想法对他们来说很刺激，而另一些想法则令他们厌恶。

And then there's this category in between, where sometimes people sort of either don't know because they haven't tried it or haven't thought about it, or they're sort of curious but kind of unsure.

然后还有介于两者之间的这一类，有时人们要么不知道，因为他们没有尝试过或没有考虑过，要么他们有点好奇但有点不确定。

Or it might work in the right context, but maybe not all the time.

或者它可能在正确的环境中起作用，但可能并非总是如此。

So is there any kind of structure that's been put out there as a way to improve communication around sexual interaction?

那么是否有任何一种结构可以作为改善性互动沟通的方法？

Dr. Rena Malik: Yeah, I mean, there's no like script, but I think, in general, you want to have the conversation outside of the bedroom.

雷纳·马利克博士：是的，我的意思是，没有类似的剧本，但我认为，一般来说，你希望在卧室外进行对话。

So not like right before sex or right after sex, because that leads to a sense of insecurity for the other person.

所以不像性行为之前或性行为之后那样，因为这会给对方带来不安全感。

Right.

正确的。

Did I do something wrong?

我做错了什么吗？

Did something go wrong here?

这里出了什么问题吗？

So you want to kind of move those to a neutral location.

所以你想把它们移到一个中立的位置。

So, like kitchen table, in the car, whatever, somewhere where sex is not going to happen, at least for that particular moment.

所以，就像厨房的桌子上，在车里，无论什么地方，在不会发生性行为的地方，至少在那个特定的时刻。

Andrew Huberman: For folks listening, some challenging conversations on this podcast.

Andrew Huberman：对于听众来说，这个播客上有一些具有挑战性的对话。

Previously challenging because you're trying to get things clear and as clear as possible.

以前很有挑战性，因为你试图让事情变得尽可能清晰。

This one's challenging because there's so many caveats to everything.

这很有挑战性，因为每件事都有很多警告。

Right?

正确的？

Of course people have sex in cars, right?

当然人们在车里做爱，对吧？

Or they did when I was growing up, and sometimes they still do.

或者在我成长的过程中他们就这样做了，有时他们仍然这样做。

Okay, please continue.

好的，请继续。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

So that's one, and then two, when you're discussing it, I mean, this kind of goes for any difficult conversation is like you make "I" statements, right?

所以这是一个，然后是两个，当你讨论它时，我的意思是，这种情况适用于任何困难的对话，就像你做出“我”的陈述，对吧？

You say, I like it when this, I don't like it with this, it's not something you did, right?

你说，我喜欢这个，我不喜欢这个，这不是你做的，对吧？

It's not, you didn't do this, you didn't do that.

不是的，你没有做这个，你没有做那个。

It makes kind of an animosity sort of situation.

这造成了一种敌意的情况。

And then I think also part of it is like being open about those things and it's not going to happen in one conversation.

然后我认为其中一部分就是对这些事情持开放态度，而这不会在一次谈话中发生。

I think that's the hard part.

我认为这是最难的部分。

Like, you think you're going to have a conversation, it's going to go great, and things are going to be better.

就像，你认为你们要进行一次对话，事情会进展顺利，事情会变得更好。

It's going to be like multiple conversations, and some of them are not going to go well.

这就像多次对话，其中一些对话不会顺利进行。

Right?

正确的？

So that's another place where you can actually get the help of a sex therapist.

所以这是您实际上可以获得性治疗师帮助的另一个地方。

And there is a website for that.

有一个网站。

It's A-A-S-E-C-T, aasect.org, where you can look for a sex therapist near you, and you can even do those things virtually.

这是 A-A-S-E-C-T，aaect.org，您可以在其中寻找您附近的性治疗师，您甚至可以虚拟地做这些事情。

And so that can be really helpful when you're having difficulty having a conversation.

因此，当您在交谈时遇到困难时，这确实很有帮助。

Andrew Huberman: Yeah, I think, again, such important conversations.

安德鲁·休伯曼：是的，我再次认为，如此重要的对话。

And then when people differ in terms of their level of experience, it gets potentially problematic, but also it can be potentially educational.

当人们的经验水平不同时，就会出现潜在的问题，但也可能具有教育意义。

And then, of course, there are the twists and turns that occur with when one is asking about somebody else's arousal template.

当然，当一个人询问别人的唤醒模板时，会出现一些曲折。

Oftentimes you'll learn things about people's sexual past, and that can be either neutral, stimulating, or aversive.

通常，你会了解到人们过去的性经历，这些经历可以是中性的、刺激的，也可以是令人反感的。

Right.

正确的。

That can open up all sorts of other issues related to the psychological interplay.

这可能会引发与心理相互作用相关的各种其他问题。

So there's no way we can parse all of those now.

所以我们现在无法解析所有这些。

I just think it's worth highlighting that it's understandable why those conversations are challenging, and it also is understanding why pornography isn't going to involve those conversations.

我只是认为值得强调的是，为什么这些对话具有挑战性是可以理解的，而且也可以理解为什么色情内容不会涉及这些对话。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Right.

正确的。

Andrew Huberman: The only conversations there are between your brain, your hands, and your eyes and your ears.

安德鲁·休伯曼：唯一的对话是在你的大脑、你的手、你的眼睛和你的耳朵之间进行的。

Not going to highlight any particular order there.

不会突出显示任何特定的顺序。

I want to switch gears slightly and talk about UTIs.

我想稍微换个话题，谈谈尿路感染。

I got a lot of questions about urinary tract infections.

我收到很多关于尿路感染的问题。

Let's make it related to both females and males, because, yes, males get urinary tract infections, females get them.

让我们把它与女性和男性联系起来，因为，是的，男性会患尿路感染，女性也会感染。

More females asked about urinary tract infections, how common are they?

更多女性询问尿路感染，它们有多常见？

Should they always be treated with antibiotics.

他们是否应该始终接受抗生素治疗？

Is cranberry really a good treatment?

蔓越莓真的有很好的治疗作用吗？

If so, why?

如果是这样，为什么？

Are there other things that are better as it relates to the acidity or alkalinity?

还有其他与酸度或碱度相关的东西更好吗？

How does one prevent getting UTIs?

如何预防尿路感染？

Can you get them from swimming?

你能通过游泳得到它们吗？

Should you urinate after sex?

性交后应该小便吗？

Tell us about UTIs and how not to get them and how to get rid of them.

告诉我们有关尿路感染的信息，以及如何避免感染和消除尿路感染。

Dr. Rena Malik: Happy to.

Rena Malik 博士：很高兴。

So UTIs are very common in women.

因此，尿路感染在女性中非常常见。

Probably up to 50% of women get at least one UTI in their lifetime, and up to a third of them get recurrent UTIs.

可能高达 50% 的女性一生中至少患过一次尿路感染，其中高达三分之一的人患有复发性尿路感染。

And what that means is they have two or more in six months or three or more in a year.

这意味着他们在六个月内有两个或更多，或者在一年内有三个或更多。

Now, this is common, and so we'll see a lot of it.

现在，这种情况很常见，因此我们会看到很多这样的情况。

And it's not as, until you're having recurrent UTIs, say you just have one a year or you have one every few years, it's not a huge issue.

这并不是说，除非您患有复发性尿路感染，比如说您一年一次或每隔几年一次，否则这不是一个大问题。

In men, however, UTIs are much less common, and that's because the urethra is longer, so there's less entry from the outside world into the bladder, which causes infections.

然而，在男性中，尿路感染则不太常见，这是因为尿道较长，因此外界进入膀胱的机会较少，从而导致感染。

And so when men get a UTI, it's concerning.

因此，当男性患上尿路感染时，就会令人担忧。

Why is a man getting a UTI?

为什么男人会患上尿路感染？

There's multiple reasons that it could happen, but it should be investigated so that you can make sure there's no anatomic abnormality or functional abnormality with the bladder that's causing the UTIs.

发生这种情况的原因有多种，但应该进行调查，以确保膀胱不存在导致尿路感染的解剖异常或功能异常。

In terms of prevention, there are kind of major things that are highlighted in the guidelines that we all talk about.

在预防方面，我们都在谈论的指南中强调了一些重大事项。

So one is hydration.

所以一是补水。

So making sure you're drinking about two to three liters of fluid, ideally water, a day, because dilution is the solution to the pollution.

因此，请确保您每天喝大约两到三升的液体，最好是水，因为稀释是解决污染的方法。

Right.

正确的。

So drinking more fluids is going to get that bacteria and you're going to pee it out.

因此，多喝水就会感染细菌，然后你就会将其排出体外。

It's going to help keep, not let it sit around in the bladder very often.

它将有助于保留而不是让它经常留在膀胱中。

Another thing in women who have altered states of estrogen, whether it's postmenopausal, surgical menopause, or maybe have reduced estrogen for postpartum or other reasons...

对于改变雌激素状态的女性来说，另一件事是，无论是绝经后、手术绝经，还是由于产后或其他原因雌激素减少......

Andrew Huberman: What about during the second half of the menstrual cycle?

安德鲁·休伯曼：月经周期的后半段怎么样？

Dr. Rena Malik: Not necessarily for those specific people, but for those specific times, because it's pretty short-lived, I guess you could use it.

Rena Malik 博士：不一定是针对那些特定的人，而是针对那些特定的时间，因为它的寿命非常短暂，我想你可以使用它。

But is vaginal estrogen.

不过是阴道雌激素。

So vaginal estrogen, meaning estrogen that's applied in the vagina either through a cream, a suppository, or a ring, is highly effective in reducing the occurrence of recurrent UTIs.

因此，阴道雌激素，即通过乳膏、栓剂或环施用在阴道中的雌激素，对于减少复发性尿路感染的发生非常有效。

And this is because when you have low estrogen, the pH in the vagina goes up and the pH in the vagina goes up because there's less conversion of glycogen to lactobacilli, and then those lactobacilli are preventative for UTIs.

这是因为当雌激素水平较低时，阴道内的 pH 值会升高，而阴道内的 pH 值会升高，因为糖原转化为乳酸菌的次数较少，而这些乳酸菌可以预防尿路感染。

So essentially, you want to reduce the pH back to its normal acidic pH.

因此，本质上，您需要将 pH 值降低至正常的酸性 pH 值。

And vaginal estrogen is very effective at doing that.

阴道雌激素在这方面非常有效。

In fact, in our clinics, we'll actually check a vaginal pH to see if there is an indication that their pH is too high, that maybe they do need vaginal estrogen, particularly around like, perimenopause, because it's hard to tell just by looking if they are really heading into a lower estrogen state sometimes.

事实上，在我们的诊所，我们会检查阴道 pH 值，看看是否有迹象表明他们的 pH 值太高，也许他们确实需要阴道雌激素，特别是在围绝经期，因为有时很难通过观察来判断他们是否真的进入了较低的雌激素状态。

And so that's very, very effective and very, very safe.

所以这是非常非常有效而且非常非常安全的。

So when you look at estrogen, the Women's Health Initiative, way back when, sort of made a big stink about how estrogen is related to cancer.

因此，当你看看雌激素时，女性健康倡议早在那时就对雌激素与癌症的关系进行了大肆宣传。

However, vaginal estrogen has never, ever been a reported breast cancer, uterine cancer, or any other blood clot, any other adverse event associated with vaginal estrogen.

然而，阴道雌激素从未被报道过乳腺癌、子宫癌或任何其他血栓、任何其他与阴道雌激素相关的不良事件。

You can get some breast tenderness, some discharge, those things can occur, but the absorbed amount vaginally is so little that your estrogen level barely goes up.

你可能会出现一些乳房胀痛，一些分泌物，这些情况都可能发生，但阴道吸收的量很少，你的雌激素水平几乎不会上升。

It doesn't even reach premenopausal levels.

它甚至没有达到绝经前的水平。

So it just goes up very slightly in the bloodstream, not enough to create any sort of abnormality.

因此，它在血液中的升高非常轻微，不足以造成任何异常。

So vaginal estrogen is extremely safe, and it's pretty affordable.

因此阴道雌激素非常安全，而且价格相当实惠。

You could actually use coupons if your insurance doesn't cover it, through GoodRx or Mark Cuban's pharmacy, and get it very affordably.

如果你的保险不承保，你实际上可以使用优惠券，通过 GoodRx 或 Mark Cuban 的药房，以非常实惠的价格购买。

And it's very effective.

而且非常有效。

It does take about three months to work, so you have to be consistent.

工作确实需要大约三个月的时间，所以你必须保持一致。

You apply it about twice a week at night, sometimes three times a week, and it's very effective.

大约每周晚上涂抹两次，有时每周涂抹三次，非常有效。

The ring you put in once and it lasts for three months.

您戴上一次的戒指可以使用三个月。

So generally speaking, that's the most effective option for low estrogen states.

一般来说，这是低雌激素状态下最有效的选择。

Other kind of simple things are trying to make sure you're completely emptying your bladder.

其他简单的事情就是尝试确保您完全排空膀胱。

So over a lifetime, people can develop some mild pelvic floor dysfunction, right?

所以在一生中，人们可能会出现一些轻微的盆底功能障碍，对吗？

Not enough to create pain or discomfort, but maybe they're not emptying completely, right?

不足以造成疼痛或不适，但也许它们还没有完全排空，对吗？

Because maybe they used to hold their urine for long periods of time when they were a kid, or maybe they're always hovering over the toilet because they don't want to sit on it at work.

因为也许他们小时候经常长时间憋尿，或者也许他们总是在马桶上徘徊，因为他们不想坐在上面工作。

And over time, that can create a little bit of mild dysfunction, which can make it more difficult to completely empty the bladder.

随着时间的推移，这可能会造成一些轻微的功能障碍，从而使膀胱更难以完全排空。

And when urine is sitting in the bladder for long periods of time, it's basically food for bacteria to grow.

当尿液长时间滞留在膀胱中时，它基本上就是细菌生长的食物。

And so bacteria grows.

因此细菌就会生长。

And then you get recurrent UTIs.

然后你就会出现复发性尿路感染。

So making sure you completely empty by sitting, relaxing on the toilet, sometimes leaning forward and then maybe going a second time.

因此，请坐下来，在马桶上放松，有时向前倾身，然后可能再去一次，以确保您完全排空。

So standing up, sitting back down, going again.

于是站起来，又坐下来，再继续。

And even for men, sometimes trying to sit and see if you completely empty because sometimes standing you're not able to empty completely.

即使对于男人来说，有时也会尝试坐下来看看你是否完全排空，因为有时站着你无法完全排空。

Andrew Huberman: Whoa.

安德鲁·休伯曼：哇哦。

A lot of men are going to...

很多男人都会...

because it was fun to research for this episode because there are entire discussions on Reddit about what percentage of males sit while urinating.

因为研究这一集很有趣，因为 Reddit 上有很多关于男性坐着小便的比例的讨论。

I mean, my understanding, based on having visited many male bathrooms in my lifetime and just being in the world that I assumed that men stood up in order to urinate.

我的意思是，我的理解是基于我一生中参观过许多男厕所，并且我认为男人站起来是为了小便。

But there are a decent percentage of men that sit down to urinate.

但有相当比例的男性会坐下来小便。

Dr. Rena Malik: There are.

Rena Malik 博士：有。

And in fact, it's variable by country.

事实上，它因国家/地区而异。

And probably the reason it's become more interesting lately is the media.

最近它变得更有趣的原因可能是媒体。

Andrew Huberman: By country?

安德鲁·胡伯曼：按国家划分？

Dr. Rena Malik: So a certain country was recently surveyed, I think it was Germany, but essentially this recent picked up by the media that Germans sit more often to pee.

Rena Malik 博士：最近对某个国家进行了调查，我认为是德国，但最近媒体报道称，德国人更经常坐着小便。

And so then people are like, oh, is this better for me to sit to pee or stand to pee?

于是人们就会想，哦，我是坐着尿尿好还是站着尿尿好？

And there was this whole big discussion on the media.

媒体上对此进行了广泛的讨论。

But the reason being is when you're sitting, your pelvic floor is most relaxed.

但原因是当你坐着时，你的骨盆底是最放松的。

And so if you're having any issues emptying your bladder, you're going to pee better.

因此，如果您在排空膀胱时遇到任何问题，您会排尿得更好。

Also if you have an enlarged prostate, which I'm sure we're going to talk about prostate enlargement, that can sometimes allow you to develop a little bit more intra-abdominal pressure because you're sitting and you can lean forward to overcome sort of a blockage.

另外，如果您患有前列腺肥大（我相信我们会谈论前列腺肥大），有时可能会让您产生更多的腹内压力，因为您坐着，并且可以向前倾以克服某种阻塞。

And so there are some indications where sitting is better, but if you're peeing fine and you're standing, that's fine too.

因此，有一些迹象表明坐着更好，但如果你站着小便也很好，那也没关系。

I don't think you have to.

我认为你不必这样做。

I think it's just something that in other countries they do more and here we don't.

我认为这只是在其他国家他们做得更多而我们在这里没有的事情。

And I don't think it's right or wrong.

我不认为这是对还是错。

It just depends on your individual circumstance.

这仅取决于您的个人情况。

Andrew Huberman: Can spermicides or condoms or both increase the frequency of UTIs for females?

Andrew Huberman：杀精剂或避孕套或两者都会增加女性尿路感染的频率吗？

Dr. Rena Malik: So spermicides, absolutely.

Rena Malik 博士：所以，绝对是杀精剂。

So spermicides, if your condom has spermicide on it or you're using spermicides, that is a known risk factor for UTIs.

因此，杀精剂，如果您的避孕套上有杀精剂或者您正在使用杀精剂，那么这就是尿路感染的已知危险因素。

Other things I want to touch on, you did ask about cranberry.

我想谈谈其他事情，你确实问到了蔓越莓。

So cranberry is actually in the American Urological Association guidelines for prevention of recurrent UTIs in women.

所以蔓越莓实际上被列入美国泌尿外科协会预防女性复发性尿路感染的指南中。

Now how does cranberry work?

那么蔓越莓的功效如何呢？

Right.

正确的。

Like, do I just drink juice?

比如，我只喝果汁吗？

It's actually a specific active ingredient in the cranberry, which is called proanthocyanidins, or PACs.

它实际上是蔓越莓中的一种特定活性成分，称为原花青素或 PAC。

And they've actually looked at the amount of PACs you need and what formulation.

他们实际上研究了您需要的 PAC 数量以及配方。

So you need 36 milligrams of PACs in a soluble form.

因此，您需要 36 毫克可溶性 PAC。

So a lot of the supplements on the market will say that they're 36 milligrams of PACs, but they're like the whole berry.

所以市场上很多补充剂都会说它们是 36 毫克 PAC，但它们就像整个浆果。

So they're using the skin of the berry and the stem of the berry, and that's not going to help you.

所以他们使用浆果的皮和浆果的茎，这对你没有帮助。

So you need to make sure that the supplement you're using is a soluble form of the cranberry.

因此，您需要确保您使用的补充剂是蔓越莓的可溶形式。

And it's actually very effective at reducing the risk of UTIs.

它实际上对于降低尿路感染的风险非常有效。

Andrew Huberman: So do you mean capsules, like a gel cap?

Andrew Huberman：那么你是指胶囊，比如凝胶帽吗？

Dr. Rena Malik: Yeah, it's a capsule that you take once a day.

Rena Malik 博士：是的，这是一种每天服用一次的胶囊。

And there is some, although not as much, data that if you're having them around sex, which some women do always have postcoital UTIs, that you can take two on the day of sex and two on the day after, and that may be helpful, but there's not a lot of data there, but certainly an option that you can try that's pretty low risk.

有一些数据，虽然不是那么多，但如果你在性行为时服用它们，有些女性确实总是有性交后尿路感染，你可以在性行为当天服用两次，在性交后第二天服用两次，这可能会有所帮助，但那里没有很多数据，但肯定是你可以尝试的一个选择，风险相当低。

So that's kind of the guidelines.

这就是指导方针。

Now, there's a ton of other things that you can do to help prevent that are kind of available and have some data behind them.

现在，您可以采取大量其他措施来帮助防止这种情况的发生，并且这些措施背后有一些数据。

So D-mannose is one of them.

所以D-甘露糖就是其中之一。

Where you take about 2 grams a day of D-mannose and you drink it, and that actually helps reduce UTI risk.

每天服用约 2 克 D-甘露糖并饮用，这实际上有助于降低尿路感染风险。

It's been studied in a small, randomized, controlled trial to be effective.

一项小型、随机、对照试验表明它是有效的。

So those are kind of the bigger ones.

所以这些都是较大的。

There's other things that people use, like probiotics, but there's a lot of heterogeneity, as you know, in probiotics and what to take.

人们还使用其他东西，比如益生菌，但正如你所知，益生菌和服用什么有很多异质性。

And are they really effective vaginally in the flora there?

它们对阴道菌群真的有效吗？

So those are kind of the big things.

所以这些都是大事。

And there is actually a lot of microbiome study in UTIs going on, actually at UCLA, where they're looking at the microbiome of people who are more at risk for UTIs or even overactive bladder, other conditions like that.

实际上，在加州大学洛杉矶分校，正在进行大量关于尿路感染的微生物组研究，他们正在研究那些更容易患尿路感染甚至膀胱过度活动症或其他类似疾病的人的微生物组。

And they're trying to figure out, is there something here that we can target or that we can figure out is causing problems?

他们试图弄清楚，这里是否有我们可以瞄准的东西，或者我们可以找出导致问题的东西？

Because sometimes we just can't figure out why it's happening.

因为有时我们就是无法弄清楚为什么会发生这种情况。

In terms of wiping from front to back, and swimming, and peeing after sex, there's no good data on any of those things.

至于从前往后擦拭、游泳、性交后撒尿等方面，目前还没有关于这些事情的良好数据。

Wiping from front to back, I think it does create a little bit of shame.

从前往后擦拭，我认为这确实会产生一点羞耻感。

Like it's not a big deal if you wipe back to front as long as you've cleaned yourself, so to speak.

可以这么说，只要你把自己擦干净了，从后往前擦也没什么大不了的。

So I think it's less of an issue.

所以我认为这不是一个问题。

Andrew Huberman: What we're talking about is, you're referring to any contamination from anal.

安德鲁·胡伯曼：我们所说的是，你指的是肛门造成的任何污染。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

Andrew Huberman: Any bacteria around the anus?

Andrew Huberman：肛门周围有细菌吗？

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

And a lot of women who have recurrent UTIs tend to come and feel very dirty, like there's something wrong with them.

许多患有复发性尿路感染的女性往往会感觉自己很脏，好像她们出了什么问题。

They're like, oh, I wash all the time, I'm really clean, I'm really this, and it's not something they're doing.

他们就像，哦，我一直在洗，我真的很干净，我真的就是这样，而这不是他们在做的事情。

It's probably a microbiome effect or a hormonal effect, or there's something going on that we need to investigate further.

这可能是微生物组效应或荷尔蒙效应，或者发生了一些我们需要进一步研究的事情。

It could also be anatomical or functional problem where you're not emptying the bladder correctly.

也可能是解剖或功能问题，导致您没有正确排空膀胱。

So there's lots of different factors.

所以有很多不同的因素。

It could be, and it's very infrequent, I would say, like, I've never seen a patient who's dirty and that's the reason they're getting UTIs.

有可能，而且这种情况非常罕见，我想说，我从来没有见过一个病人因为肮脏而患上尿路感染。

Andrew Huberman: Perhaps even the opposite is true.

安德鲁·休伯曼：也许事实恰恰相反。

They're cleaning too much, based on what you told us earlier.

根据您之前告诉我们的情况，他们清洁得太多了。

Dr. Rena Malik: Yeah.

雷纳·马利克博士：是的。

Andrew Huberman: And they're eliminating the gut micro, excuse me, just rolls off the tongue again, no pun intended.

Andrew Huberman：他们正在消除肠道微生物，对不起，只是再次脱口而出，没有双关语的意思。

Perhaps they are abolishing the local microbiome on the skin.

也许它们正在消除皮肤上的局部微生物群。

Too much cleaning eliminates the microbiome on the skin.

过多的清洁会消除皮肤上的微生物群。

Not that we don't want to wash, but when Sonnenburg was a guest on this podcast, he said, actually, kids can develop a very healthy gut microbiome and general microbiome, oftentimes by, sorry parents, not washing their hands before eating.

并不是说我们不想洗手，而是当 Sonnenburg 做客这个播客时，他说，实际上，孩子们可以培养出非常健康的肠道微生物组和一般微生物组，对不起父母，通常是因为饭前不洗手。

If they've been playing with soil outside or dirt, a little bit of that is actually healthy.

如果他们一直在外面玩泥土或泥土，那么一点点实际上是健康的。

Pets actually offer microbiome support.

宠物实际上提供微生物组支持。

This is so weird, I know it sounds dirty, but we have to imagine how we evolved as a species was not with antibacterial soaps and alcohol swabs everywhere.

这太奇怪了，我知道这听起来很脏，但我们必须想象我们作为一个物种是如何进化的，而不是到处都有抗菌肥皂和酒精棉签。

And obviously, we don't want infections, but overcleaning can disrupt the microbiome, which presumably can lead to UTIs.

显然，我们不希望感染，但过度清洁会破坏微生物组，这可能会导致尿路感染。

So perhaps someone who's cleaning excessively is more at risk than somebody who's cleaning a little less.

因此，也许过度清洁的人比清洁较少的人面临的风险更大。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

And actually, the cleaning can irritate the dermis, right.

事实上，清洁会刺激真皮，对吧。

So you can actually get contact dermatitis-type symptoms from overcleaning.

因此，过度清洁实际上可能会导致接触性皮炎类型的症状。

And so that's one of the things, we're like, I definitely have a UTI, I definitely have one.

这就是其中一件事，我们就像，我肯定有尿路感染，我肯定有。

Well, no, you don't, but there's a host of other things that it could be.

嗯，不，你不知道，但是还有很多其他的原因。

One of them could be that another very common one that we already touched on is pelvic floor dysfunction.

其中之一可能是我们已经提到的另一个非常常见的问题是盆底功能障碍。

So very often, pelvic floor dysfunction, just like you had pain with urination, women can also develop pain with urination that doesn't go away.

很多时候，盆底功能障碍，就像排尿疼痛一样，女性也会出现排尿疼痛，而且持续不断。

And it can start where they had a UTI that triggered the pelvic floor, and then the pelvic floor just didn't relax, but the pain just triggered the pelvic floor to tense up.

它可以从尿路感染引发盆底肌开始，然后盆底肌并没有放松，但疼痛只是引发盆底肌紧张。

And it didn't relax because, again, we're not taught how to relax our pelvic floor.

它并没有放松，因为我们没有被教导如何放松我们的骨盆底。

And then they've developed pelvic floor dysfunction.

然后他们出现了盆底功能障碍。

Like, why is the UTI not going away?

比如，为什么尿路感染没有消失？

Or why does it keep coming back?

或者为什么它会不断回来？

And so that's another common thing that we see in people who have, quote, unquote, recurrent UTIs but don't really have them.

因此，这是我们在患有复发性尿路感染但实际上并没有尿路感染的人身上看到的另一个常见现象。

Andrew Huberman: To be clear, I experienced the pain in urination as a consequence of trying those damn Kegels that everyone's talking about stopping.

安德鲁·胡伯曼（Andrew Huberman）：需要明确的是，我在尝试了每个人都在谈论停止的该死的凯格尔运动后经历了排尿疼痛。

That was informative in two directions.

这在两个方面提供了信息。

One, it relieved the pain very quickly, so that was good.

第一，它很快就能缓解疼痛，所以这很好。

The other was, I realized that it is possible to have a pelvic floor that's neither hypercontracted nor overrelaxed, and in some cases, just not doing anything for it is the best circumstance.

另一个是，我意识到骨盆底有可能既不过度收缩也不过度放松，在某些情况下，不做任何事情就是最好的情况。

Dr. Rena Malik: Right.

雷纳·马利克博士： 是的。

Andrew Huberman: And the only reason I mentioned that is because, obviously, this discussion is not about my pelvic floor, this discussion is about the fact that some people perhaps need to clean less.

安德鲁·休伯曼：我提到这一点的唯一原因是，显然，这个讨论不是关于我的盆底，这个讨论是关于有些人可能需要减少清洁的事实。

Some people maybe more, but probably not, based on what you said.

根据你所说，有些人可能更多，但也可能不是。

Some people might need to strengthen their pelvic floor, some people might need to relax their pelvic floor, and some people's pelvic floor is probably A-OK.

有些人可能需要加强骨盆底，有些人可能需要放松骨盆底，而有些人的骨盆底可能还不错。

I think any discussion about anything medical or especially hormone stuff, this happens a lot in the discussions around that I get into.

我认为任何关于医学或特别是激素问题的讨论，在我参与的讨论中经常发生。

It seems with males, every male now seems to wonder if their testosterone is too low, except the ones that are blasting testosterone, because they know it's excessively high.

对于男性来说，现在每个男性似乎都想知道自己的睾酮水平是否太低，除了那些睾酮水平很高的男性，因为他们知道睾酮水平过高。

And as you point out earlier, at least in terms of sexual function, that's unlikely to be the case.

正如您之前指出的，至少在性功能方面，情况不太可能是这样。

Maybe less desire, but in terms of genital-based arousal function, probably, yeah.

也许欲望较少，但就基于生殖器的唤醒功能而言，可能是的。

Dr. Rena Malik: And I mean, you've talked about testosterone a lot on the podcast, so I'm sure your audience knows very well the multitude of benefits for testosterone.

雷纳·马利克博士：我的意思是，您在播客上多次谈论了睾酮，所以我相信您的听众非常了解睾酮的众多好处。

So I think there is value in assessing hormone panels and assessing your level of free testosterone, testosterone, and assessing if you're having...

所以我认为评估激素组和评估你的游离睾酮水平、睾酮水平以及评估你是否有……是有价值的。

symptoms are not always sexual.

症状并不总是与性有关。

Right.

正确的。

It can be depression, it can be weight gain, that you're not gaining muscle mass.

这可能是抑郁症，也可能是体重增加，导致你的肌肉质量没有增加。

You can have cognitive changes.

您可能会发生认知变化。

So those things can still be a sign of low testosterone and very valuable and important to assess.

因此，这些事情仍然可能是睾丸激素水平低的迹象，并且非常有价值且需要评估。

Andrew Huberman: That reminds me of another thing, and then we'll get back to UTIs.

Andrew Huberman：这让我想起了另一件事，然后我们将回到尿路感染。

And I want to talk about kidney stones, but I've heard of women using a small amount of testosterone cream directly on the clitoris as a way to amplify the, maybe it's the desire and arousal effect, or perhaps just one or the other.

我想谈谈肾结石，但我听说女性直接在阴蒂上使用少量睾酮霜作为放大的一种方式，也许是欲望和性唤起效果，或者也许只是其中之一。

Dr. Rena Malik: So the way that we discuss testosterone use, and there are, like, consensus statements, and there's actually an abundance of data on testosterone use, particularly in postmenopausal women, for low libido or low sexual desire.

雷纳·马利克博士：我们讨论睾酮使用的方式，有类似的共识声明，实际上有大量关于睾酮使用的数据，特别是在绝经后女性中，用于性欲低下或性欲低下。

And it's all been very positive in the sense there's been increased sexual desire, based on validated questionnaires, increased number of sexually satisfying events with testosterone use.

根据经过验证的调查问卷，性欲增加，睾丸激素的使用增加了性满足事件的数量，这一切都是非常积极的。

Now, the range of testosterone in women is about a tenth of the amount of testosterone a man needs.

现在，女性睾酮水平约为男性所需睾酮水平的十分之一。

Right?

正确的？

So testosterone cream is systemically absorbed wherever you apply it.

因此，无论您在哪里涂抹睾酮霜，它都会被全身吸收。

And so the way we generally recommend women to try this if they are having low libido, and we've ruled out other issues that may be psychologic —relationship, other issues that can affect libido, medications.

因此，我们通常建议女性在性欲低下时尝试这种方法，并且我们已经排除了其他可能是心理问题的问题——人际关系、其他可能影响性欲的问题、药物。

There's a lot of things, obviously, that go into that.

显然，这涉及到很多事情。

And we've checked their testosterone.

我们检查了他们的睾酮水平。

It appears to be low for physiologic levels for women, which, again, is one tenth of the male level, then we can actually prescribe off-label testosterone.

女性的生理水平似乎较低，而男性水平的十分之一，那么我们实际上可以开处方外睾酮。

And the guidelines or the consensus statements are not like true guidelines, but they recommend using transdermal testosterone.

这些指南或共识声明并不像真正的指南，但他们建议使用透皮睾酮。

So getting Androgel tubes from the pharmacy and putting a tenth of one tube on the back of the calf or the upper outer buttock, a hairless area, for absorption, that can improve desire overall.

因此，从药房购买 Androgel 管，将十分之一的管放在小腿后部或臀部上部外（无毛区域）以进行吸收，这可以提高整体欲望。

And then the other place we use testosterone is in women who have what we call vestibulodynia.

我们使用睾酮的另一个地方是患有前庭痛的女性。

So the vestibule is the area outside the vagina, which is very hormonally active.

所以前庭是阴道以外的区域，荷尔蒙非常活跃。

There's lots of androgen receptors there, and it can actually, when you have hormonal issues, meaning lower testosterone and estrogen in that area, it can cause pain.

那里有很多雄激素受体，实际上，当你有荷尔蒙问题时，这意味着该区域的睾酮和雌激素较低，它会引起疼痛。

And so actually applying a combined or compounded estrogen-testosterone cream to that area over time can reduce that pain and discomfort.

因此，随着时间的推移，在该区域使用联合或复合的雌激素-睾酮乳膏实际上可以减轻疼痛和不适。

So, as you know, testosterone receptors, or androgen receptors all over the body, very much in the genitals, very much in the brain, and they're very useful to...

所以，如你所知，睾酮受体或雄激素受体遍布全身，在生殖器中，在大脑中，它们非常有用......

a very useful place to treat women for those issues.

一个非常有用的地方来治疗妇女的这些问题。

Andrew Huberman: Thank you.

安德鲁·休伯曼：谢谢。

Kidney stones.

肾结石。

I hope to never have one.

我希望永远不会有一个。

Dr. Rena Malik: I hope you don't either.

Rena Malik 博士：我希望你也不要这样做。

Andrew Huberman: But people get them.

安德鲁·休伯曼：但是人们明白了。

How do you avoid getting them and how do you get rid of them?

如何避免获得它们以及如何摆脱它们？

So, kidney stones, very often they can be for a variety of different metabolic disorders.

因此，肾结石通常可能是由多种不同的代谢紊乱引起的。

Right.

正确的。

So it can be one, dehydration is a very common cause of it.

所以这可能是一个，脱水是一个非常常见的原因。

So dehydration combined with maybe a slight metabolic abnormality where you're creating more calcium or oxalate in your urine, can result in kidney stones.

因此，脱水加上轻微的代谢异常（在尿液中产生更多的钙或草酸盐）可能会导致肾结石。

And so how can you prevent them?

那么如何预防它们呢？

I mean, each person is individual.

我的意思是，每个人都是独立的。

If you get a kidney stone, typically we do what's called a 24-hour urine analysis plus some bloodwork to assess what is the metabolic abnormality.

如果您患有肾结石，我们通常会进行所谓的 24 小时尿液分析以及一些血液检查来评估代谢异常。

So we can target that either with diet or with medication.

因此，我们可以通过饮食或药物来瞄准这一点。

And so the kind of general recommendations for people who have kidney stones.

对于肾结石患者的一般建议也是如此。

One is increase your fluid intake to 2 to 3 liters.

一是将液体摄入量增加到 2 至 3 升。

Again, the same number I told you before; you want to decrease your oxalate intake.

还是我之前告诉过你的那个数字；您想减少草酸盐的摄入量。

Dr. Rena Malik: Now, if you Google oxalate, you're going to find a million things that you eat that have oxalate in them.

雷纳·马利克博士：现在，如果你用谷歌搜索草酸盐，你会发现你吃的一百万种东西都含有草酸盐。

But the big ones are spinach and rhubarb.

但最大的是菠菜和大黄。

We're seeing a lot of nuts, too, that are, you know, people eating a lot more nuts to get more protein.

我们也看到了很多坚果，你知道，人们吃更多的坚果来获取更多的蛋白质。

So cutting back, it's impossible to get rid of all of that in your diet.

因此，要减少饮食，不可能完全摆脱饮食中的所有这些。

But if you're having, like, a spinach salad every day, well, switch it to a different green.

但如果你每天都吃菠菜沙拉，那就换成不同的绿色蔬菜吧。

Right?

正确的？

Don't eat spinach every day.

不要每天都吃菠菜。

Also, you want to increase your citrate intake.

此外，您还想增加柠檬酸盐的摄入量。

That's an inhibitor of kidney stone formation.

这是肾结石形成的抑制剂。

So increasing fruits and things like that, to increase citrate vegetables as well.

因此，增加水果和类似的东西，也要增加柠檬酸盐蔬菜。

Actually, one easily accessible thing is Crystal Light.

事实上，一件容易获得的东西就是水晶灯。

It has a high citrate composition, so you can drink Crystal Light with that, two to three liters.

它含有很高的柠檬酸盐成分，因此您可以饮用两到三升的水晶灯。

And that can be helpful.

这会很有帮助。

You want to decrease your protein intake.

您想减少蛋白质摄入量。

So high levels of purines or purinergic meats, like red meats and things, can also put you at higher risk.

因此，高水平的嘌呤或嘌呤能肉类，如红肉等，也会使您面临更高的风险。

So these are kind of the general sort of preventative measures we talk about for kidney stones.

这些是我们谈论的肾结石的一般预防措施。

If you have a kidney stone, so a lot of times, people can have kidney stones in their kidneys, they're not creating any problems, they're tiny, we can observe them over time.

如果你有肾结石，很多时候，人们的肾脏里可能有肾结石，它们不会造成任何问题，它们很小，我们可以随着时间的推移观察它们。

If they start getting very large or they are starting to move into the ureters or the tubes that drain the kidney, oftentimes they're accompanied with pain.

如果它们开始变得很大或者开始进入输尿管或引流肾脏的管子，通常会伴有疼痛。

Quite a bit of pain, and it can be very uncomfortable.

相当大的疼痛，而且会非常不舒服。

In those cases if they're not having any infection symptoms, there's no signs of a urinary tract infection, there's no fevers, no chills, we can treat it conservatively with pain medication, and also there are medications like flomax, which are used for enlarged prostate as well, that actually relaxes the ureteral smooth muscle to allow the stone to pass a little bit better.

在这种情况下，如果他们没有任何感染症状，没有尿路感染的迹象，没有发烧，没有发冷，我们可以用止痛药保守治疗，也有像flomax这样的药物，它也用于前列腺肥大，实际上可以放松输尿管平滑肌，让结石更好地通过。

If you're having an infection, you got to get it treated right away.

如果您患有感染，则必须立即治疗。

You can get very sick very quickly.

您很快就会病得很重。

In fact, I've seen young, healthy patients, like, they're healthier than me, walk in the ER with a kidney stone, and within 24 hours, they're in the ICU because they're really sick because of a kidney stone.

事实上，我见过年轻、健康的病人，他们比我更健康，带着肾结石走进急诊室，24 小时内，他们就住进了 ICU，因为他们因为肾结石而病得很重。

Andrew Huberman: Fever, urinating, tea-colored urine, meaning blood in the urine, all of those are important warning signs that you ideally don't get to.

Andrew Huberman：发烧、排尿、茶色尿液（即尿中带血），所有这些都是重要的警告信号，最好不要出现。

Dr. Rena Malik: Yeah, blood in the urine, I mean, doesn't always mean infection.

雷纳·马利克医生：是的，我的意思是，尿中带血并不总是意味着感染。

It could just be irritation from the stone, but certainly fevers, chills, or you have a sign of an infection and the stone looks like it's blocking.

这可能只是石头引起的刺激，但肯定是发烧、发冷，或者有感染的迹象，而且石头看起来像是堵塞了。

So if you get imaging and you see what's called hydro nephrosis, or pressure behind the kidney, and you have these signs of infection, we don't want to wait because you can get sick pretty quickly.

因此，如果您进行影像检查并发现所谓的肾积水或肾后压力，并且您有这些感染迹象，我们不想等待，因为您很快就会生病。

And then to treat the kidney stones, there's three major options.

然后，要治疗肾结石，有三种主要选择。

One is shockwaves.

一是冲击波。

Another is ureteroscopy, where we go in with a camera and we have a small laser, we break it up into small pieces and---

另一种是输尿管镜检查，我们用相机和小型激光进行检查，将其分成小块，然后——

Andrew Huberman: Where is the camera inserted?

Andrew Huberman：相机插在哪里？

Through the urethra.

通过尿道。

Dr. Rena Malik: Correct.

雷纳·马利克博士：正确。

You're asleep under anesthesia, so you don't have to---

你在麻醉下睡着了，所以你不必——

Andrew Huberman: You saw that---

安德鲁·休伯曼：你看到了——

Dr. Rena Malik: Yeah, I saw----

Rena Malik 博士：是的，我看到了——

Andrew Huberman: You saw the wince.

安德鲁·休伯曼：你看到了畏缩。

Dr. Rena Malik: And then percutaneous nephrolithotomy, which is done if you have a large kidney stone or a very hard kidney stone that's up in the kidney, you can go in through the back with a small, like a small incision and with a specialized camera that goes in and uses ultrasonic lithotripsy to break up that stone and kind of suck it out that way.

Rena Malik 医生：然后是经皮肾镜取石术，如果您有很大的肾结石或肾脏中非常坚硬的肾结石，则可以进行这种手术，您可以通过背部进入一个小切口，例如一个小切口，然后使用专门的摄像头进入并使用超声波碎石术将结石打碎，然后以这种方式将其吸出。

Andrew Huberman: They're extremely helpful bits of information, or not even bits.

Andrew Huberman：它们是非常有用的信息，或者甚至不是一些信息。

This is enormous amount of useful information.

这是大量有用的信息。

I like to pivot, again, for sake of breadth.

再次，为了广度，我喜欢转向。

We can't go into extreme depth on everything, but appreciate your willingness to follow this carousel with me.

我们无法对所有内容都进行深入探讨，但感谢您愿意与我一起关注此轮播。

Oral contraception.

口服避孕药。

Previously on this podcast, I hosted a female physician guest who offered both sides of female oral contraception, discussed some of the benefits, discussed some of the risks.

之前在这个播客中，我接待了一位女医生嘉宾，她提供了女性口服避孕药的双方，讨论了一些好处，讨论了一些风险。

I made the decision to post clips about both on the internet, and wow, wow, wow, was I surprised, but also, frankly, a bit shocked.

我决定在互联网上发布有关两者的剪辑，哇，哇，哇，我很惊讶，但坦率地说，也有点震惊。

And then finally intrigued by how polarized the discussion is around female oral contraception and female contraception in general.

最后，围绕女性口服避孕药和一般女性避孕药的讨论是多么两极分化，这引起了人们的兴趣。

So, NuvaRing, Norplant, the pill, broad category of things there, but for sake of discussion, the pill, et cetera.

所以，NuvaRing、Norplant、药丸，等等，但为了讨论起见，药丸等等。

I mean it seemed that approximately 50% of responses, which seemed to come mainly from women, were of the, this stuff is terrible, it ruined my life, it ruins lives, it destroys you.

我的意思是，大约 50% 的回复（似乎主要来自女性）是这样的，这东西太糟糕了，它毁了我的生活，它毁了生活，它毁了你。

It has immense risk.

它具有巨大的风险。

And then the other half seemed to say, no, there's reduced risk of certain forms of cervical cancer.

然后另一半似乎说，不，某些形式的宫颈癌的风险降低了。

This has allowed me the sexual choices and lifestyle that I prefer without risk of pregnancy.

这使我能够选择自己喜欢的性选择和生活方式，而没有怀孕的风险。

I mean, it was astonishing to the point where I thought, wow, if only I could post both clips simultaneously.

我的意思是，这太令人惊讶了，我想，哇，如果我能同时发布两个剪辑就好了。

So obviously, I don't know what the answer is, but I do know that this is among the more polarizing topics available for discussion.

显然，我不知道答案是什么，但我确实知道这是可供讨论的更加两极分化的话题之一。

So what is the story, meaning, what are the data about oral contraception?

那么口服避孕药的故事、意义、数据有哪些呢？

Why so much controversy?

为何争议如此之大？

And what's the real deal here?

这里真正的情况是什么？

Dr. Rena Malik: Yes, so it is a very polarizing topic.

Rena Malik 博士：是的，所以这是一个非常两极分化的话题。

And there is abundance data, abundant data.

而且有丰富的数据，丰富的数据。

In fact, we even did a study, and again, this is not like high-quality evidence, but we looked at Reddit threads, and we looked at sexual dysfunction, specifically low libido, orgasmic difficulties.

事实上，我们甚至做了一项研究，再说一次，这不像高质量的证据，但我们查看了 Reddit 帖子，我们研究了性功能障碍，特别是性欲低下、性高潮困难。

And we read hundreds of threads and we did like a qualitative analysis to see---

我们阅读了数百条线索，我们确实希望进行定性分析——

Andrew Huberman: In females.

安德鲁·休伯曼：女性。

Dr. Rena Malik: ---in females, to see what are people talking about and problems with oral contraceptives and antidepressants leading to low libido.

Rena Malik 博士：——在女性中，了解人们在谈论什么以及口服避孕药和抗抑郁药导致性欲低下的问题。

And being very, as you describe, very like, this has ruined my life was very common.

正如你所描述的，这毁了我的生活，这很常见。

And so the theory is that taking oral contraceptives increases the amount of sex hormone-binding globulin, which binds testosterone and estrogen, and that actually makes testosterone less available, which is, as we've talked about, a very important hormone for desire.

因此，理论上来说，服用口服避孕药会增加性激素结合球蛋白的含量，这种球蛋白会结合睾酮和雌激素，这实际上会降低睾酮的利用率，而正如我们所讨论的，睾酮是一种对性欲非常重要的激素。

And so in some subset of people, they're seeing very significant consequences of taking oral contraceptives.

因此，在某些人群中，他们看到了服用口服避孕药的非常显着的后果。

Now, I think that we don't know which women are going to have this problem and we don't know how.

现在，我认为我们不知道哪些女性会遇到这个问题，也不知道如何解决。

It's probably a very small subset of people.

这可能是一小部分人。

But we do know that this does happen and that when you measure SHBG levels, they're up.

但我们确实知道这种情况确实会发生，并且当您测量性激素结合球蛋白 (SHBG) 水平时，它们会上升。

And that even after they stop the oral contraceptives, you'll see elevated SHBG levels from baseline.

即使他们停止服用口服避孕药后，您也会看到性激素结合球蛋白 (SHBG) 水平较基线有所升高。

Andrew Huberman: For how long?

安德鲁·休伯曼：持续多久？

Dr. Rena Malik: You know, for like, at least four months afterwards, you'll still see elevated SHBG levels.

Rena Malik 博士：您知道，至少四个月后，您仍然会看到 SHBG 水平升高。

So we don't know.

所以我们不知道。

Andrew Huberman: But not infinite.

Andrew Huberman：但不是无限的。

Dr. Rena Malik: We don't know.

Rena Malik 博士：我们不知道。

Andrew Huberman: Yeah, the endocrine system is weird because we assume everything is a short-term effect, but there's some plasticity in the system, especially because it's a neuroendocrine system.

安德鲁·胡伯曼：是的，内分泌系统很奇怪，因为我们假设一切都是短期效应，但该系统具有一定的可塑性，特别是因为它是一个神经内分泌系统。

Dr. Rena Malik: Exactly.

雷纳·马利克博士：没错。

Yeah.

是的。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Dr. Rena Malik: So I think, yeah, there's some neuroplasticity there that occurs as well.

Rena Malik 博士：所以我认为，是的，那里也存在一些神经可塑性。

And so we do see this.

我们确实看到了这一点。

And I think that the other side of it is, yeah, absolutely, oral contraceptives are amazing, right?

我认为另一方面是，是的，绝对，口服避孕药很棒，对吧？

They're helpful for sexual freedom, for preventing pregnancy, for a lot of things, and particularly other conditions too, like PCOS and other problems.

它们对性自由、预防怀孕等很多方面都有帮助，特别是对其他疾病，如多囊卵巢综合症和其他问题也有帮助。

Oral contraceptives are amazing and they've changed gynecology and management of these women in a very positive way.

口服避孕药非常棒，它们以非常积极的方式改变了妇科和这些女性的管理。

And so I think, yes, I do think that there is oral contraceptive-related sexual dysfunction.

所以我认为，是的，我确实认为存在与口服避孕药相关的性功能障碍。

Usually low dose estrogen sort of contraceptives are the culprit.

通常低剂量雌激素类避孕药是罪魁祸首。

But I think that again, the data, female sexual dysfunctional literature is just not as robust as male sexual dysfunction literature.

但我再次认为，从数据来看，女性性功能障碍文献并不像男性性功能障碍文献那样可靠。

Andrew Huberman: I saw a lot of comments about how oral contraception had led to depressive-like symptoms or just kind of ahedonia and apathy, not just lowered libido.

安德鲁·休伯曼：我看到很多关于口服避孕药如何导致抑郁样症状或只是一种快感和冷漠的评论，而不仅仅是性欲降低。

I can imagine how that would be the case through the elevated sex hormone-binding globulin, which is preventing testosterone, estrogen from being free, literally, and exerting their effects on not just the body but the brain.

我可以想象通过升高的性激素结合球蛋白会出现什么情况，它会阻止睾丸激素、雌激素的释放，从字面上看，它们不仅对身体而且对大脑产生影响。

But is there any evidence that oral contraception can disrupt neurotransmitters?

但有证据表明口服避孕药会破坏神经递质吗？

I'm not aware of any.

我不知道有什么。

Dr. Rena Malik: I don't think so.

Rena Malik 博士：我不这么认为。

Not to my knowledge.

据我所知。

Andrew Huberman: Okay, well, it sounds to me like oral contraception for women, because that's where we normally hear about it.

安德鲁·休伯曼：好吧，在我看来，这就像女性口服避孕药，因为我们通常听到的就是这种情况。

It sounds like there's a varied response and it's highly individual.

听起来反应各不相同，而且非常个性化。

I've certainly had partners that love the pill, or at least didn't seem to mind it.

我当然有喜欢这种药的伴侣，或者至少似乎不介意。

I've had some that hated it and no way tried that, never will, or just went with other forms of contraception or for whatever reason were not using contraception.

我有一些人讨厌它，但从未尝试过，永远不会，或者只是采用其他形式的避孕措施，或者出于某种原因没有使用避孕措施。

So it seems to me that there's a lot of variation out there.

所以在我看来，存在很多变化。

How does one explore that without risk of permanent damage?

如何在没有永久损坏风险的情况下探索这一点？

It sounds like truly permanent damage is unlikely.

听起来真正永久性的损害不太可能。

What are the other options?

还有哪些其他选择？

Is, the ring, copper IUD?

环是铜宫内节育器吗？

Dr. Rena Malik: So any sort of long-acting hormonal contraceptive we've seen, that's what we counsel patients on, is if they're having issues with oral contraceptives, even if they come in with pelvic pain and they're on oral contraceptives, I'll tell them, you know what, just stop.

雷纳·马利克博士：因此，我们所见过的任何一种长效激素避孕药，这就是我们向患者提供的建议，如果他们对口服避孕药有问题，即使他们患有骨盆疼痛并且正在服用口服避孕药，我会告诉他们，你知道吗，停止吧。

Because maybe the effect on the androgen receptors, or estrogen receptors is affecting the lubrication or other things, we're not sure.

因为也许对雄激素受体或雌激素受体的影响正在影响润滑或其他事物，我们不确定。

But why don't you stop it and go get a long-acting contraceptive method.

但你为什么不停止它并采取长效避孕方法呢？

Andrew Huberman: Like an IUD?

安德鲁·休伯曼：就像宫内节育器一样？

Dr. Rena Malik: Like an IUD.

Rena Malik 博士：就像宫内节育器一样。

Andrew Huberman: And are IUDs safe?

Andrew Huberman：宫内节育器安全吗？

And here we should probably say, okay, copper IUD is one form.

在这里我们可能应该说，好吧，铜宫内节育器是一种形式。

You want to mention a few of the other forms?

您想提及其他一些形式吗？

Dr. Rena Malik: So I don't prescribe IUDs, but generally speaking they're very safe.

Rena Malik 医生：所以我不开宫内节育器，但一般来说它们非常安全。

Of course there's risk with any sort of.

当然，任何形式都存在风险。

You know it's a procedure, you're inserting an IUD, so there's obviously some small risks associated with it, but it is safe and effective form of contraception.

您知道这是一个手术，您正在插入宫内节育器，因此显然存在一些与之相关的小风险，但它是安全有效的避孕形式。

Andrew Huberman: If people are wondering why the copper IUD is an effective form of contraception, copper is like the third rail for sperm, as I understand it.

Andrew Huberman：如果人们想知道为什么铜宫内节育器是一种有效的避孕形式，据我所知，铜就像精子的第三轨。

So much so that I was able to find some evidence for this in the medical textbooks, that in the old days, as I say, prostitutes who wanted to avoid pregnancy would put copper pennies in their vagina.

以至于我在医学教科书中找到了一些证据，正如我所说，在过去，想要避免怀孕的妓女会在阴道里放铜币。

Dr. Rena Malik: Really?

雷纳·马利克博士：真的吗？

Andrew Huberman: Now, I don't recommend that to anyone, and please, and I don't think it's a foolproof form of contraception, but there is evidence that that did happen.

安德鲁·休伯曼：现在，我不向任何人推荐这种做法，我不认为这是一种万无一失的避孕方式，但有证据表明这种情况确实发生过。

So, which is amazing.

所以，这太棒了。

That means that people somehow figured out the copper-sperm relationship, which isn't a good one for the sperm, and deduced from that a behavior.

这意味着人们以某种​​方式弄清楚了铜与精子的关系（这对精子来说不是一件好事），并从中推断出一种行为。

Dr. Rena Malik: Yeah, that's, that's---

Rena Malik 博士：是的，那是，那是——

Andrew Huberman: Rena's cringing.

安德鲁·休伯曼：瑞娜感到畏缩。

Dr. Rena Malik: Andrew Huberman: I am not suggesting people do that.

Rena Malik 博士：Andrew Huberman：我并不是建议人们这样做。

I think it's just an interesting medical factoid.

我认为这只是一个有趣的医学事实。

I can tell you want to move on from this topic, so we will.

我可以告诉你你想继续讨论这个话题，所以我们会的。

Before discussing prostate and anal sex, not stated next to one another for any particular reason, I want to talk about SSRIs.

在讨论前列腺和肛交之前（由于任何特定原因没有并列），我想先谈谈 SSRIs。

A lot of people over the last 20, 30 years have been prescribed selective serotonin reuptake inhibitors and other antidepressants that have disrupted their sexual function, or their sexual desire, seems in particular.

在过去的 20、30 年里，许多人服用了选择性血清素再摄取抑制剂和其他抗抑郁药物，这些药物似乎尤其扰乱了他们的性功能或性欲。

Do you see a lot of this in your clinic?

您在诊所看到很多这样的情况吗？

Do you hear about it?

你听说过吗？

What can people do about it?

人们能做些什么呢？

Oftentimes these sexual arousal or dysfunction issues associated with SSRIs and other medications make those medications prohibitive for people.

通常，与 SSRI 和其他药物相关的性唤起或功能障碍问题使人们对这些药物望而却步。

Dr. Rena Malik: So, you know, serotonin is kind of the anti to orgasm.

雷纳·马利克博士：所以，你知道，血清素是性高潮的抗药。

And so, in fact, we will use SSRIs off-label for people who are having premature ejaculation.

因此，事实上，我们将在标签外使用 SSRI 来治疗早泄患者。

So it delays ejaculation, and then there's also other sexual dysfunctions we see with it.

所以它会延迟射精，然后我们还会看到其他性功能障碍。

And it does happen, absolutely.

它确实发生了，绝对的。

It's dose dependent.

这是剂量依赖性的。

So in some cases, when someone comes in with SSRI-related dysfunction, if they're doing well, you can either try to reduce the dose or switch them to another antidepressant, for example, Wellbutrin, that does not have such severe effects on sexual function.

因此，在某些情况下，当某人患有 SSRI 相关功能障碍时，如果他们表现良好，您可以尝试减少剂量或改用另一种抗抑郁药，例如维布特林 (Wellbutrin)，这种药物不会对性功能产生如此严重的影响。

And so you can also use like Cialis and Viagra, like what we've talked about for erectile dysfunction as an addition if we can't change their medication management.

因此，如果我们无法改变他们的药物管理，您也可以使用西力士和伟哥等药物，就像我们谈到的治疗勃起功能障碍的药物一样。

Because you know, this gets a little bit complicated because we know erectile dysfunction and depression are very interrelated.

因为你知道，这变得有点复杂，因为我们知道勃起功能障碍和抑郁症密切相关。

Now, what's causing what?

现在，到底是什么原因造成的呢？

And where do we, maybe somebody went to see their doctor for depression, but was also having issue with erections, and now, if you fix the erections, do you help with the depression?

我们在哪里，也许有人去看医生治疗抑郁症，但也有勃起问题，现在，如果你修复勃起，你能帮助治疗抑郁症吗？

You know what I mean?

你知道我的意思？

Andrew Huberman: Males everywhere are shouting yes.

安德鲁·休伯曼：世界各地的男性都在喊“是”。

Dr. Rena Malik: So I think that there's a lot of discussion that has to be had there.

Rena Malik 博士：所以我认为必须进行很多讨论。

It's a lot easier to talk to your primary care doctor about depression than it is about your erections.

与您的初级保健医生谈论抑郁症比谈论您的勃起要容易得多。

And so I think it's important to really dig into that a little bit.

所以我认为真正深入研究这一点很重要。

But, yes, it is definitely a known thing.

但是，是的，这绝对是众所周知的事情。

We use it to our advantage when needed, and it can be helpful to switch medications or reduce the dose.

我们在需要时利用它来发挥我们的优势，并且它有助于更​​换药物或减少剂量。

Andrew Huberman: You mentioned earlier that trazodone can cause sustained erection.

Andrew Huberman：您之前提到曲唑酮可以引起持续勃起。

And is trazodone in the category of touching the serotonin transmission system?

曲唑酮属于接触血清素传输系统的范畴吗？

Dr. Rena Malik: I don't remember the mechanism, but interestingly, trazodone is also used for off-label, like as a third or fourth line for premature ejaculation as well.

Rena Malik 博士：我不记得其机制，但有趣的是，曲唑酮也用于标签外治疗，例如作为早泄的第三或第四线。

So, I don't remember the mechanism offhand.

所以，我不记得这个机制了。

Andrew Huberman: Let's talk about prostate and prostate health.

Andrew Huberman：我们来谈谈前列腺和前列腺健康。

Earlier, I queued up that there's a growing trend toward, I would say, more progressive male physicians — or physicians who treat males.

早些时候，我认为有一种日益增长的趋势，即更进步的男性医生——或者治疗男性的医生。

Excuse me.

打扰一下。

Dr. Rena Malik: Thanks for that.

Rena Malik 博士：谢谢。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Prescribing low dose 2.5 to 5 milligram Cialis, which is tadalafil, which may assist with erections.

处方低剂量 2.5 至 5 毫克西力士（他达拉非），可能有助于勃起。

But the rationale for this low dose, daily low dose is not centered around erections per se, it's really about prostate health.

但这种低剂量、每日低剂量的基本原理并不是围绕勃起本身，而是与前列腺健康有关。

Improving blood flow to the prostate, reducing prostitis, maybe even reducing the probability of prostate cancer.

改善前列腺的血液流动，减少前列腺炎，甚至可能降低患前列腺癌的可能性。

What other sorts of things are you encouraging men to think about when thinking about their prostate?

您还鼓励男性在考虑前列腺时考虑哪些其他事情？

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

So, before I forget, I want to mention that low-dose tadalafil is actually a treatment for erectile dysfunction.

所以，在我忘记之前，我想提一下，低剂量他达拉非实际上是一种治疗勃起功能障碍的药物。

In fact, it works quite well, particularly in men who are having a lot of psychogenic issues.

事实上，它的效果非常好，特别是对于有很多心理问题的男性。

One, because they don't have to remember to take a pill before sex, it's always on board.

第一，因为他们不必记得在性行为前吃药，所以药总是在船上。

And you're taking 5 milligrams every day and it has a 36 hours half-life, so you're kind of increasing those.

你每天服用 5 毫克，它的半衰期为 36 小时，所以你要增加剂量。

So it can actually work quite well and is a great option for erectile dysfunction.

所以它实际上可以很好地发挥作用，并且是治疗勃起功能障碍的绝佳选择。

So I do want to make that caveat.

所以我确实想提出这个警告。

In terms of prostate health, it has been shown to be effective for BPH, or enlarged prostate, and this is a very common condition.

就前列腺健康而言，它已被证明对治疗前列腺增生（BPH）或前列腺肥大有效，这是一种非常常见的病症。

In fact, if you look at autopsy studies, 80% of men at 80 have an enlarged prostate, like it's very, very common now.

事实上，如果你看一下尸检研究，就会发现 80% 的 80 岁男性患有前列腺肥大，就像现在非常非常普遍一样。

Does everyone get symptoms, and what's the long-term concerns of it and what can you do about it?

每个人都会出现症状吗？长期的担忧是什么？您能采取什么措施？

So, typically, as the prostate enlarges, it's right around the urethra.

因此，通常，当前列腺增大时，它就位于尿道周围。

It's a walnut-shaped gland sits underneath the bladder around the urethra, and it can narrow the urethra or the P-tube.

它是一个核桃形腺体，位于膀胱下方、尿道周围，可以使尿道或 P 管变窄。

And so over time, you can imagine, like, if you're, I always give this example, if you're sucking from a straw, right?

所以随着时间的推移，你可以想象，如果你是，我总是举这个例子，如果你用吸管吸奶，对吗？

You're drinking from a straw.

你用吸管喝水。

If you have a wide diameter straw, it's really easy to drink.

如果你有一根粗直径的吸管，喝起来真的很容易。

If your straw gets really narrow, like, say you take a coffee straw and you drink out of that, it's very difficult to drink.

如果你的吸管变得很窄，比如你拿一根咖啡吸管，然后用它喝水，那就很难喝了。

Very similarly, it can become very difficult to urinate if you have an enlarged prostate.

同样，如果前列腺肥大，排尿也会变得非常困难。

Now, what causes an enlarged prostate?

那么，前列腺肥大的原因是什么？

There's a whole host of factors.

有很多因素。

A lot of them are genetic.

其中很多都是遗传性的。

So if your father or your grandfather had a large prostate, you're probably more likely to have an enlarged prostate.

因此，如果您的父亲或祖父的前列腺较大，您可能更有可能患有前列腺肥大。

Do we know exactly how to prevent that?

我们确切知道如何防止这种情况发生吗？

Not exactly, but we know how to mediate the symptoms a little bit.

不完全是，但我们知道如何稍微缓解症状。

So the other symptoms you'll see before you have difficulty urinating is sometimes you'll see overactivity.

因此，在排尿困难之前，您会看到的其他症状是有时会出现过度活动。

So you'll see your bladder is responding to having to push hard against that narrow urethra to push urine out.

因此，您会看到膀胱正在对必须用力推动狭窄的尿道以将尿液排出的反应。

So it's having more urgency, like the sudden desire to go to the bathroom that you can't delay.

所以它有更多的紧迫感，就像你突然想去洗手间，不能拖延。

You're maybe going more frequently, and very often, you're going more often at night.

你可能会更频繁地去，而且很多时候，你会更频繁地在晚上去。

And so those are kind of the first signs people will see.

这些是人们首先看到的迹象。

And then over time, it may become more and more difficult to empty the bladder.

然后随着时间的推移，排空膀胱可能会变得越来越困难。

You might see some hesitancy, like, you're waiting for your stream to start, or it stops and starts, or you're just like, I can't empty.

您可能会看到一些犹豫，例如，您正在等待流开始，或者它停止并开始，或者您只是想，我不能清空。

It's not because it just drips or a very weak stream.

这并不是因为它只是滴水或非常微弱的水流。

And so those are kind of the things that can happen over a lifetime.

所以这些都是一生中可能发生的事情。

Now, what are some things that you can do to help?

现在，您可以做哪些事情来提供帮助？

Cialis helps relax the fiber, the smooth muscle of the prostate, so that it allows urine to pass more easily.

西力士有助于放松前列腺的纤维和平滑肌，从而使尿液更容易通过。

There's also other medications that you can treat very often, Flomax or other alpha blockers are helpful in that area.

还有其他您可以经常治疗的药物，Flomax 或其他 α 受体阻滞剂在该领域很有帮助。

In terms of things that you can do in general for bladder health, prostate health, there are certain things that are irritants to that area.

就您可以为膀胱健康、前列腺健康做的一般事情而言，有些事情会刺激该区域。

And so what I tell people, not everyone's affected the same way, so I don't want people to be like, oh, I got to stop all these delicious things I eat and drink, but certainly it can be useful to just pay attention.

所以我告诉人们，并不是每个人都受到同样的影响，所以我不希望人们说，哦，我必须停止吃和喝所有这些美味的东西，但当然，只要注意一下就会很有用。

So, like, if, say, you drink coffee every day and you find yourself running to the bathroom a lot.

所以，就像，如果你每天喝咖啡，你发现自己经常跑去洗手间。

If you limit your caffeine intake, you might see that you're not going to the bathroom quite as often because caffeine is a bladder irritant.

如果你限制咖啡因的摄入量，你可能会发现你不会经常去洗手间，因为咖啡因会刺激膀胱。

So that can be coffee, tea, chocolate, things of that nature that have caffeine in them; energy drinks — sometimes people forget they have caffeine in them.

可以是咖啡、茶、巧克力等含有咖啡因的东西；能量饮料——有时人们会忘记其中含有咖啡因。

And so limiting, that may improve your symptoms.

如此限制，可能会改善您的症状。

Alcohol also is a bladder irritant, and these have actually been studied in animal models.

酒精也会刺激膀胱，这些实际上已经在动物模型中进行了研究。

And you'll see that the bladder contracts more often when they're given these sorts of substances.

你会发现，当给予这些物质时，膀胱会更频繁地收缩。

And it's dose dependent.

而且它是剂量依赖性的。

And some people can actually habituate or get used to a certain dose of caffeine, so if you're drinking coffee every day, you may have less symptoms than someone who drinks it every once in a while.

有些人实际上可以习惯或习惯一定剂量的咖啡因，因此，如果您每天喝咖啡，您的症状可能会比偶尔喝咖啡的人少。

Other things can be sometimes carbonated beverages, spicy foods or acidic foods.

其他食物有时可能是碳酸饮料、辛辣食物或酸性食物。

Those sorts of things can also irritate the bladder lining.

这些东西也会刺激膀胱内壁。

So sometimes limiting those things may be helpful in those situations.

因此，有时限制这些事情在这些情况下可能会有所帮助。

Andrew Huberman: Thank you so much.

安德鲁·休伯曼：非常感谢。

That's very informative.

这是非常有用的。

Years ago, there was a discussion about bicycle seats causing damage to the prostate, maybe even sexual dysfunction.

几年前，有人讨论过自行车座椅会损害前列腺，甚至可能导致性功能障碍。

Is that still a thing?

那还是一件事吗？

I thought they put grooves into the seats, but I've also, in reading on the internet, I didn't do a deep dive on Reddit, but seems that women are reporting some bladder incontinence from excessive bicycle seat use, maybe even exercise bike.

我以为他们在座椅上加了凹槽，但我在网上阅读时也没有在 Reddit 上进行深入研究，但似乎有女性报告称，由于过度使用自行车座椅（甚至可能是健身车）而导致一些膀胱失禁。

It doesn't have to be road bike.

它不一定是公路自行车。

Dr. Rena Malik: Yeah, so this is a great point.

Rena Malik 博士：是的，这是一个很好的观点。

So cycling, if you think about it, right, you're sitting on your perineum, which is that space for men between the scrotum and the anus — for women, between the vagina and the anus.

所以，如果你想一想，骑自行车时，你会坐在会阴上，这对男性来说是阴囊和肛门之间的空间，对女性来说是阴道和肛门之间的空间。

And right there runs your pudendal artery and your pudendal nerve, which are again, responsible for blood flow and nerve function to the area.

阴部动脉和阴部神经就在那里运行，它们同样负责该区域的血流和神经功能。

So the most common things we see in people who are really high-volume cyclers, now, the studies have looked at, like, maybe they did a 350-kilometer race or they're biking three times a week for 60 minutes, but there's no consistency.

因此，我们在那些经常骑自行车的人身上看到的最常见的事情，现在，研究已经考察了，比如，他们可能参加了 350 公里的比赛，或者他们每周骑自行车 3 次，每次 60 分钟，但没有一致性。

But they're seeing pretty high rates of genital numbness.

但他们发现生殖器麻木的比例相当高。

So, like up to 50%.

所以，最多 50%。

And also in men, erectile dysfunction.

男性也会出现勃起功能障碍。

In women, you'll also see numbness, but because sensation is a big part of arousal, you'll also see kind of decreased lubrication, maybe decreased arousal as well in women.

在女性中，您也会看到麻木，但由于感觉是性唤起的重要组成部分，因此您还会看到润滑减少，也许女性的性唤起也会减少。

And so how can you prevent that?

那么如何防止这种情况发生呢？

The reason is because when you're sitting, particularly if you're leaning forward like competitive bikers do, or aero riding, you're putting pressure on the beak of the bicycle seat.

原因是因为当您坐着时，特别是当您像竞技自行车手或空气动力骑行者那样向前倾斜时，您会对自行车座椅的喙部施加压力。

And that's where most of the, your weight is not distributed evenly.

这就是大多数人的体重分布不均匀的地方。

So the goal is to take a bike seat that allows you to sit comfortably on your ischial tuberosities, and posture is a huge part of your pelvic floor.

因此，我们的目标是选择一个能让您舒适地坐在坐骨结节上的自行车座椅，而姿势是骨盆底的重要组成部分。

I know we didn't talk about that earlier, but sitting with good posture and not kind of slouching or leaning forward can actually really do wonders for your pelvic floor.

我知道我们之前没有讨论过这一点，但是以良好的姿势坐着，而不是无精打采或前倾，实际上确实可以为您的骨盆底带来奇迹。

So focusing on posture is helpful, but also when biking, posture is helpful.

因此，关注姿势很有帮助，而且骑自行车时，姿势也很有帮助。

So they've actually looked at this data and they found that people who aero ride, meaning lean forward, or people who use narrow bike seats, are more likely to have issues.

因此，他们实际上查看了这些数据，发现进行空气动力学骑行（即向前倾斜）的人或使用狭窄自行车座椅的人更有可能出现问题。

And so you want to get kind of a noseless seat and a wider seat.

所以你想要一个无鼻座椅和更宽的座椅。

The cutouts, actually, when they've looked at kind of mechanics of the cutouts, they'll see higher pressure around the opening.

事实上，当他们研究切口的机械结构时，他们会发现开口周围有更高的压力。

So it's actually not good to have a bike with a cutout, bike seat with a cutout, because they've seen, at least with some of the cutouts, that the pressure actually becomes higher on the area that's right around it.

因此，拥有一辆带有切口的自行车、带有切口的自行车座椅实际上并不好，因为他们已经看到，至少在某些切口的情况下，周围区域的压力实际上会变得更高。

Andrew Huberman: Very important point.

安德鲁·休伯曼：非常重要的一点。

I don't cycle.

我不骑自行车。

I don't like the exercise bike.

我不喜欢健身车。

I'll sometimes ride the assault bike, which has the big seat, for a few minutes.

有时我会骑几分钟突击自行车，它的座位很大。

Dr. Rena Malik: But I just want to add one thing, because I don't want to make people not cycle.

Rena Malik 博士：但我只想补充一件事，因为我不想让人们不骑自行车。

I think it's really valuable, cycling is a great aerobic exercise, has lots of benefit for cardiovascular health.

我觉得这真的很有价值，骑自行车是一项很好的有氧运动，对心血管健康有很多好处。

But there was actually another study that looked at people who were parts of sports clubs, so they were like swimmers, runners and cyclists, and they looked at rates of dysfunction and they found that actually the rate of erectile dysfunction was not different between runners, swimmers and cyclers.

但实际上还有另一项研究针对的是体育俱乐部成员，比如游泳运动员、跑步运动员和骑自行车运动员，他们研究了功能障碍的发生率，发现实际上跑步运动员、游泳运动员和骑自行车运动员的勃起功能障碍发生率没有差异。

So maybe because those other studies were just looking at cyclers, that maybe it's just the general rate of erectile dysfunction in that population at that point in time.

因此，也许因为其他研究只是针对骑自行车者，所以这可能只是该人群当时勃起功能障碍的总体发生率。

So the numbness is definitely an issue, the erectile dysfunction, maybe, maybe not.

所以麻木肯定是一个问题，勃起功能障碍也许是，也许不是。

Andrew Huberman: So I just have a couple of more questions for you, and by the way, you've been incredibly generous with your time and information here.

Andrew Huberman：我还有几个问题要问你，顺便说一句，你在这里花费了宝贵的时间并提供了信息。

Dr. Rena Malik: Thank you.

雷纳·马利克博士：谢谢。

Thank you.

谢谢。

Andrew Huberman: So I really appreciate it, as I'm sure our listeners do as well.

Andrew Huberman：所以我真的很感激，我相信我们的听众也一样。

Anal sex.

肛交。

You recently did a post describing the multiple reasons why women do or do not have anal sex.

您最近发表了一篇文章，描述了女性进行或不进行肛交的多种原因。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

Andrew Huberman: Very interesting post, very interesting study that you covered, and you explained it very clearly.

Andrew Huberman：非常有趣的帖子，您介绍的非常有趣的研究，并且您解释得非常清楚。

I'm guessing there are relatively few, but perhaps some other studies as well.

我猜相关研究相对较少，但也许还有一些其他研究。

About this.

关于这个。

Let's talk about anal sex, and maybe if you could just offer some of the key bullet points that you've learned from the literature and from your clinical practice.

让我们谈谈肛交，也许您可​​以提供一些您从文献和临床实践中学到的关键要点。

How frequent is it?

发生的频率如何？

With protection, without protection?

有防护，无防护？

How safe is it?

安全性如何？

What are the different reasons people do it?

人们这样做的不同原因是什么？

That might seem like a kind of a silly question, but it turns out when it comes to this topic, there are interesting data.

这似乎是一个愚蠢的问题，但事实证明，当涉及到这个话题时，有一些有趣的数据。

Educate us.

教育我们。

Dr. Rena Malik: So, anal sex.

Rena Malik 博士：那么，肛交。

Let's talk about it.

我们来谈谈吧。

Well, when you talk about anal sex, the reason people, it's become more and more common.

好吧，当你谈论肛交时，人们的原因，它变得越来越普遍。

Let's say, it's, more and more heterosexual couples are doing it.

可以说，越来越多的异性恋夫妇正在这样做。

We know that male homosexual couples are having anal sex.

我们知道男性同性恋伴侣会进行肛交。

And I think the one thing is that it's safe in terms of pregnancy.

我认为一件事是它在怀孕方面是安全的。

Right.

正确的。

You're not going to get pregnant from anal sex, which is one of the reasons people do engage in anal sex.

肛交不会怀孕，这是人们进行肛交的原因之一。

Andrew Huberman: Do you think that's the reason people are doing it more frequently?

Andrew Huberman：您认为这就是人们更频繁地这样做的原因吗？

Dr. Rena Malik: No, I think that's one of the reasons that people, one of the reasons people do.

雷纳·马利克博士：不，我认为这是人们这样做的原因之一，人们这样做的原因之一。

But in general, the issue with anal sex is that people forget to use protection, like a condom, for example, because sexually transmitted infections are actually more likely with anal sex than they are with vaginal penetrative intercourse.

但总的来说，肛交的问题在于人们忘记使用保护措施，例如避孕套，因为实际上肛交比阴道插入性交更容易感染性传播疾病。

Because the anal tissue is very thin and friable.

因为肛门组织非常薄且易碎。

So when you penetrate the anus, particularly if you have any trauma, you can have blood loss, and that blood loss can then easily, more easily transmit sexually transmitted infection.

因此，当您插入肛门时，特别是如果您有任何外伤，您可能会失血，而这种失血很容易、更容易传播性传播感染。

So it's really important to use a condom and use adequate lubrication.

因此，使用安全套并使用足够的润滑剂非常重要。

The anus does not make any of its endogenous lubrication, you have to use lubricant.

肛门不会对其进行任何内源性润滑，因此必须使用润滑剂。

The other interesting thing about anal sex is that the anus pH is different from the vaginal pH.

关于肛交的另一个有趣的事情是肛门的 pH 值与阴道的 pH 值不同。

So you want to use specific lubricants that are iso-osmolar to anal pH.

因此，您需要使用与肛门 pH 值等渗的特定润滑剂。

So you can actually look up anal lubricants.

所以你实际上可以查找肛门润滑剂。

And we could talk about lubricants, but generally there's water-based, silicone-based, oil-based lubricants.

我们可以谈论润滑剂，但一般有水基、硅基、油基润滑剂。

Water-based are the most easily accessible, silicone-based, are a little more slippery and last a little longer, and oil-based also last longer, but are not good for use with condoms.

水基的最容易接触，硅基的，更滑一点，持续时间更长一点，油基的也持续更长时间，但不适合与避孕套一起使用。

So definitely using lubricants and always kind of making sure to be in the context, of course, of being consensual, but also never force, always take your time.

因此，一定要使用润滑剂，并且始终确保在双方同意的情况下，但也不要强迫，总是慢慢来。

And those things are really important to avoid trauma because trauma can happen.

这些事情对于避免创伤非常重要，因为创伤可能会发生。

And usually it's not severe trauma.

通常这不是严重的创伤。

Right.

正确的。

It's not going to create long-lasting problems, but it is inconvenient, uncomfortable, and probably we're not seeing as much of it because they're not coming to the emergency room if they're having issues, unless it's really serious.

它不会造成长期的问题，但它很不方便、不舒服，而且我们可能不会看到那么多，因为如果他们遇到问题，除非真的很严重，否则他们不会来急诊室。

So I think it's really important, one, to prevent from sexually transmitted infections.

所以我认为第一，预防性传播感染非常重要。

Two, to be thoughtful and cautious.

二是要深思熟虑、谨慎行事。

And sometimes it requires some preparation.

有时需要一些准备。

If you're going to penetrate an anus, you're not going to start with a large girth item, you're going to start with something smaller and kind of work your way up.

如果你要刺入肛门，你不会从大的东西开始，你会从较小的东西开始，然后慢慢向上。

And then I think ultimately, why people have anal sex, so, as I mentioned earlier, the prostate is highly innervated and can be a source of pleasure, so some people enjoy that.

然后我想最终，为什么人们会进行肛交，所以，正如我之前提到的，前列腺受到高度神经支配，可以成为快乐的源泉，所以有些人喜欢肛交。

Particularly men may enjoy anal penetration.

尤其是男性可能会喜欢肛门插入。

Women as well may enjoy anal penetration because of the innervation around there, the pelvic floor.

由于盆底周围的神经支配，女性也可能喜欢肛门插入。

That's certainly reasonable to do so.

这样做当然是合理的。

As far as why people engage in anal sex.

至于人们为什么进行肛交。

So sometimes it's because, as I mentioned, they're trying to avoid vaginal penetration, either to avoid pregnancy or maybe menstruation or other reasons.

所以有时这是因为，正如我提到的，他们试图避免阴道插入，要么是为了避免怀孕，要么是为了月经或其他原因。

Sometimes it's because people want to do something special with their partner.

有时是因为人们想与伴侣一起做一些特别的事情。

Like, they feel like this is my special thing with this partner that I do with them.

就像，他们觉得这是我和这个合作伙伴一起做的特别的事情。

And so it may be something kind of like a gift or something like that.

所以它可能是某种礼物之类的东西。

Sometimes it's almost like they feel like they have to.

有时他们几乎觉得自己必须这样做。

And this particular study that I looked at, there's actually not a lot of studies on why people engage in anal sex.

我看过的这项特殊研究实际上并没有很多关于人们为什么进行肛交的研究。

And this particular study that I had talked about on my channel or on my Instagram was talking about why they specifically recruit drug users.

我在我的频道或 Instagram 上谈到的这项特殊研究正在讨论为什么他们专门招募吸毒者。

And so a lot of people had used drugs prior to engaging in anal sex.

因此，很多人在进行肛交之前都曾吸食过毒品。

And I think that that's not ideal.

我认为这并不理想。

You always want to be kind of in the right state of mind for consent and safety purposes.

出于同意和安全目的，您始终希望保持正确的心态。

And so those were kind of the common reasons.

这些是常见的原因。

Andrew Huberman: What about infection not related to sexually transmitted infection?

Andrew Huberman：与性传播感染无关的感染又如何呢？

My presumption is there is a higher risk with anal sex than there is with other vaginal intercourse, oral sex, et cetera.

我的推测是，肛交的风险比其他阴道性交、口交等的风险更高。

But is there evidence for that?

但有证据证明这一点吗？

Dr. Rena Malik: Not necessarily.

Rena Malik 博士：不一定。

It's more about sexually transmitted infections more than anything else.

它更多的是关于性传播感染而不是其他任何事情。

The rare things that people have kind of commented on, like anal incontinence temporarily or things like that, very rare.

人们评论的罕见事情，例如暂时肛门失禁或类似的事情，非常罕见。

Mostly it's just sexually transmitted infections because it's more easy to create bleeding through anal sex if you're not careful.

大多数情况下，这只是性传播感染，因为如果不小心的话，肛交更容易造成出血。

Andrew Huberman: And are people doing enemas before anal sex to prevent bacterial infection, or is that just like it's a kind of...

安德鲁·休伯曼：人们在肛交前进行灌肠是为了防止细菌感染，还是这就像一种......

Dr. Rena Malik: Some people are, some people are not.

Rena Malik 博士：有些人是，有些人不是。

I think people are making sure they're evacuated fully.

我认为人们正在确保他们完全疏散。

There's some media articles about what you should eat before to kind of keep your gut healthy and avoid kind of loose stools and things like that.

有一些媒体文章介绍了您之前应该吃什么来保持肠道健康并避免稀便之类的事情。

But generally speaking, there's lots of things you can look up to make it safe and healthy again.

但一般来说，您可以查找很多事情来使其再次安全和健康。

Andrew Huberman: I'm sure some people are listening to this and maybe they've turned it off already, and I think we can expect a varied response to this discussion, but it's happening out there.

安德鲁·胡伯曼：我确信有些人正在听这个，也许他们已经把它关掉了，我认为我们可以期待对这个讨论有不同的反应，但它正在发生。

Dr. Rena Malik: It's happening.

Rena Malik 博士：它正在发生。

Andrew Huberman: Apparently with an increasing frequency.

Andrew Huberman：显然频率越来越高。

Dr. Rena Malik: Yes.

雷纳·马利克博士：是的。

And I don't know if that's because of the increasing availability of pornography where it's visualized more, or if I don't really know why, but we do know that there's more going on in heterosexual couples than prior.

我不知道这是否是因为色情作品越来越多地被可视化，或者我真的不知道为什么，但我们确实知道异性恋夫妇中发生的事情比以前更多。

Andrew Huberman: As a final category of question, I was really interested in some of the posts you've done about herbs and supplements in the context of sexual desire and sexual function on this podcast.

安德鲁·胡伯曼（Andrew Huberman）：作为最后一类问题，我对您在这个播客上发表的有关性欲和性功能背景下的草药和补充剂的一些帖子非常感兴趣。

I always say, always, always always, we emphasize behavioral tools first, dos and don'ts, right, because those are the foundation of mental health, physical health and performance in all contexts.

我总是说，永远，永远永远，我们首先强调行为工具，该做和不该做，对吧，因为这些是所有情况下心理健康、身体健康和表现的基础。

There is of course a role for prescription drugs, sometimes.

当然，有时处方药也能发挥作用。

Oftentimes people can't do the things and avoid the certain things they want to because of depressive states, anxious states, et cetera, and prescription drugs can serve a role.

通常，由于抑郁状态、焦虑状态等，人们无法做他们想做的事情，也无法避免做他们想做的某些事情，而处方药可以起到一定的作用。

But I do believe the goal is always behaviors first.

但我确实相信目标始终是行为第一。

Then of course things like adequate sleep, nutrition, healthy social interaction, all of that stuff, exercise.

当然还有充足的睡眠、营养、健康的社交互动、所有这些东西、锻炼。

But we do often talk about supplements because they represent, I think, an important category of over-the-counter compounds that can play a role.

但我们确实经常谈论补充剂，因为我认为它们代表了可以发挥作用的一类重要的非处方化合物。

And I've talked before about Tongkat Ali, this Indonesian herb, I think it can be Malaysian as well.

我之前谈到过东革阿里，这种印度尼西亚草药，我认为它也可以是马来西亚的。

But this Indonesian herb is typically the one that I am aware works best for mild libido enhancement.

但据我所知，这种印度尼西亚草药通常是最适合轻度增强性欲的草药。

Sometimes, especially in the case of people taking SSRIs, it can enhance libido to override some of the challenges with SSRI-induced reduction in libido.

有时，尤其是服用 SSRI 的人，它可以增强性欲，克服 SSRI 引起的性欲下降的一些挑战。

And generally, even if people aren't under SSRIs, I hear from people who take Tongkat Ali and get libido increases.

一般来说，即使人们没有服用 SSRIs，我也听说服用东革阿里的人会增加性欲。

Also things like Maca root, which we don't really know how these things work exactly.

还有像玛卡根这样的东西，我们真的不知道这些东西到底是如何工作的。

Probably some freeing up of testosterone with Tongkat Ali, maybe some cortisol suppression as well, maybe some estrogen receptor modulation with Maca root, maybe some dopaminergic tone changes.

可能是东革阿里释放睾酮，可能还有皮质醇抑制，可能是玛卡根调节雌激素受体，可能是多巴胺能音调变化。

Shilajit, this ayurvedic herb, which there is at least one study that I think is done well that shows increases in FSH, follicle-stimulating hormone with Shilajit use.

喜来芝，一种阿育吠陀草药，至少有一项我认为做得很好的研究表明，使用喜来芝可以增加卵泡刺激素（FSH）的含量。

What are your thoughts on things like Tongkat Ali, Maca root?

您对东革阿里、玛卡根等东西有何看法？

Shilajit, how do you talk to your patients about this stuff?

Shilajit，你如何与你的病人谈论这些事情？

Dr. Rena Malik: Yeah, so I think that I see at least my patient population is still in the behavioral management place, right.

Rena Malik 博士：是的，所以我认为至少我的患者群体仍然处于行为管理阶段，对吧。

The biggest cause of sexual dysfunction, whether it's low testosterone, erectile dysfunction.

性功能障碍的最大原因，无论是睾酮水平低还是勃起功能障碍。

Sexual dysfunction is often comorbidities.

性功能障碍通常是合并症。

Right?

正确的？

So managing high blood pressure, managing diabetes with diet, which you talk about a lot, but the best studied diet is the Mediterranean diet, at least in the sexual dysfunction literature.

因此，通过饮食控制高血压、糖尿病，这些你经常谈论，但研究最好的饮食是地中海饮食，至少在性功能障碍文献中是这样。

Exercise, like, doing both cardiovascular aerobic exercise, but also doing resistance training, particularly of large muscle groups, and then really working on reducing blood pressure and preventing diabetes.

锻炼，比如，既进行心血管有氧运动，又进行阻力训练，特别是大肌肉群的训练，然后真正致力于降低血压和预防糖尿病。

And those things, I think are really key.

我认为这些事情非常关键。

And I know you talk about them a lot on this podcast, but I will tell you that when people are getting ready for, for example, we do a surgery for erectile dysfunction called penile prosthesis.

我知道你在这个播客上谈论了很多，但我会告诉你，例如，当人们准备好时，我们会进行一种称为阴茎假体的勃起功能障碍手术。

So this is like, end of the line, nothing's working, they can't get an erection at all.

所以这就像，最后，没有任何作用，他们根本无法勃起。

And they may have diabetes as a cause of it.

他们可能患有糖尿病。

And when we say you have to get your hemoglobin A1C below a certain level to do surgery, I cannot tell you how quickly these men change their behaviors.

当我们说你的糖化血红蛋白必须低于一定水平才能进行手术时，我无法告诉你这些人改变行为的速度有多快。

Andrew Huberman: For sake of erection.

Andrew Huberman：为了勃起。

Dr. Rena Malik: For sake of erections.

Rena Malik 博士：为了勃起。

So I think that really, if I can say one thing before you do supplements, which I don't have a problem with, I think that it's reasonable to try them.

所以我认为，如果我可以在服用补充剂之前说一件事，我对此没有意见，那么我认为尝试它们是合理的。

I would try one at a time to see what's working, so you're not taking a bunch of things and not knowing what exactly is working and realizing that they're not going to work immediately.

我会一次尝试一个，看看什么有效，这样你就不会拿一堆东西，不知道到底什么有效，并意识到它们不会立即起作用。

If you take something that works immediately, it's probably got a PDE5 inhibitor mixed in there.

如果您服用的药物立即起效，那么它可能混合了 PDE5 抑制剂。

And so it's going to kind of build over time, and you're going to see changes over time.

所以它会随着时间的推移而建立，并且随着时间的推移你会看到变化。

But I would say that the number one thing that I recommend for people is improving their diet, exercising, getting good sleep.

但我想说，我向人们推荐的第一件事是改善饮食、锻炼身体、获得良好的睡眠。

As you know, it boosts testosterone.

如您所知，它可以提高睾丸激素。

And even you mention this all the time about getting early morning light, but it's beneficial for testosterone as well, because you're helping release testosterone with the circadian biology.

即使你一直提到清晨的阳光，但这也对睾丸激素有益，因为你正在帮助通过昼夜节律生物学释放睾丸激素。

So I think that those things I can't stress enough, like, how valuable they are.

所以我认为这些事情我怎么强调都不为过，比如它们有多有价值。

And if you're smoking, quit smoking, it will kill your erection.

如果您吸烟，请戒烟，它会破坏您的勃起。

Andrew Huberman: And vaping.

安德鲁·休伯曼：还有电子烟。

Dr. Rena Malik: And vaping.

Rena Malik 博士：还有电子烟。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

Dr. Rena Malik: And then lastly, if you are developing true organic impotence, meaning that there's a biologic problem that's causing your sexual dysfunction, then it's really important to get your cardiovascular health assessed, because about 15% of men who develop erectile dysfunction seven years later will have a cardiovascular event.

Rena Malik 博士：最后，如果您正在出现真正的器质性阳痿，这意味着存在导致您性功能障碍的生物学问题，那么评估您的心血管健康状况非常重要，因为大约 15% 的男性在七年后出现勃起功能障碍时会发生心血管事件。

It is the canary in the coal mine, meaning that it's the sign that you may be developing cardiovascular problems or like endothelial dysfunction that's first presenting in the penis or in their sexual organs.

它是煤矿里的金丝雀，这意味着它是您可能出现心血管问题或首先出现在阴茎或性器官中的内皮功能障碍的迹象。

And this probably is the same for women, we just don't have the data yet.

这对于女性来说可能也是一样，只是我们还没有数据。

Andrew Huberman: I know a good number of women that take Tongkat Ali, in part, I think, on the recommendation, although I want to be clear, I never recommended it.

Andrew Huberman：我认识很多服用东革阿里的女性，我认为部分是根据推荐，虽然我想澄清，但我从未推荐过它。

It was an offer of something that people could try if they're doing everything else correctly and could assess with consulting your physician, of course.

这是一个提供的东西，如果人们正确地完成了其他所有事情，就可以尝试，当然，可以通过咨询你的医生进行评估。

And they too, some of them have reported improvements in libido and desire as well.

他们中的一些人也报告了性欲和欲望的改善。

Dr. Rena Malik: Well, that makes sense.

Rena Malik 博士：嗯，这是有道理的。

Andrew Huberman: Shilajit is less known about the distinguishing quality versus low quality sources of Shilajit is harder.

Andrew Huberman：喜来芝的质量鲜为人知，而低质量的喜来芝来源则更难区分。

Dosing is harder.

给药更困难。

It comes as this tar typically.

它通常以焦油的形式出现。

Maybe more science on Shilajit will come out in the next few years.

也许未来几年会有更多关于喜来芝的科学成果出现。

We could get behind it a bit more.

我们可以多支持一点。

Right now I'm sort of on the, yeah, maybe if you are an adventurer, you might try it, but it's not one that I normally throw to the top of the list.

现在我的想法是，是的，也许如果你是一名冒险家，你可能会尝试一下，但这不是我通常会放在列表顶部的。

Dr. Rena Malik: Yeah, I think that, like L-citrulline is pretty good.

Rena Malik 博士：是的，我认为 L-瓜氨酸就非常好。

Ashwagandha for stress reduction, which also has implications for sexual function.

Ashwagandha 用于减轻压力，这也对性功能有影响。

Tongkat Ali has reasonable data.

东革阿里有合理的数据。

I think there is reasonable data on these things, I think the website you talk about all the time, examine.com, is a great place to look at that.

我认为关于这些事情有合理的数据，我认为你一直谈论的网站，examine.com，是一个查看这些数据的好地方。

And like I said, I think it's reasonable.

正如我所说，我认为这是合理的。

They're smaller studies, there is bias in many studies, but there is effort done in this area, and there's never going to be really high-quality science.

这些研究规模较小，许多研究都存在偏见，但在这一领域付出了努力，但永远不会有真正高质量的科学。

No one's going to really fund that, I think.

我认为没有人会真正资助这个项目。

So I think our expectations need to be a little tempered when it comes to that stuff.

所以我认为，当涉及到这些东西时，我们的期望需要稍微缓和一些。

Andrew Huberman: Well, Rena, Dr. Malik, I want to thank you ever so much for this discussion today.

Andrew Huberman：嗯，Rena，Malik 博士，我非常感谢你们今天的讨论。

You provide us so much useful information and really have transcended the divide between the mysterious thing that everyone wants to know about sex and sexual health, genitals and genital health, prostate, urethra, UTIs, all these topics that many people are just afraid to raise and to confront directly.

您为我们提供了如此多有用的信息，确实超越了每个人都想知道的关于性和性健康、生殖器和生殖器健康、前列腺、尿道、尿路感染的神秘事物之间的鸿沟，所有这些话题都是很多人不敢提出和直接面对的。

And you've taught us so much about how to promote the health of this incredibly important system.

您教会了我们很多关于如何促进这个极其重要的系统健康的知识。

Dr. Rena Malik: Absolutely.

雷纳·马利克博士：当然。

Andrew Huberman: One thing we know for sure, either in vivo or in a dish, we're all here because a sperm and an egg.

Andrew Huberman：我们可以肯定地知道一件事，无论是在体内还是在培养皿中，我们都是因为精子和卵子而存在的。

And of course, there are other reasons why people engage in sexual activity that have nothing to do with reproduction, but surely it is core to our biology and our psychology and well-being.

当然，人们进行性活动还有其他与生殖无关的原因，但它无疑是我们生物学、心理学和幸福感的核心。

So thank you so much.

非常感谢。

And also thank you for the work you do day in and day out, week in and week out in your clinic, we will provide links to your clinic.

还要感谢您日复一日、周复一周在诊所所做的工作，我们将提供您诊所的链接。

People are interested in working with you directly as well as online.

人们有兴趣直接或在线与您合作。

That's how I initially found you.

这就是我最初找到你的方式。

And when I did, I was just absolutely delighted.

当我这样做时，我非常高兴。

I thought, finally there's somebody who's providing the kind of information that everybody wants in a thoughtful, logical, clear and respectful way.

我想，终于有人能以深思熟虑、合乎逻辑、清晰和尊重的方式提供每个人都想要的信息了。

So on behalf of all the listeners and viewers, and on behalf of myself, I just want to say thank you.

所以我谨代表所有听众和观众，并代表我自己，说声谢谢。

Thank you.

谢谢。

Thank you for what you do, and please keep going and please come back.

感谢您所做的一切，请继续前进，然后回来。

Dr. Rena Malik: Thank you so much.

雷纳·马利克博士：非常感谢。

And honestly, the work you do is phenomenal.

老实说，你所做的工作是非凡的。

It's an honor to be here.

很荣幸来到这里。

Thank you so much.

太感谢了。

Andrew Huberman: Thank you for joining me for today's discussion with Dr. Rena Malik, all about urology, pelvic floor, and sexual health.

Andrew Huberman：感谢您参加今天与 Rena Malik 博士的讨论，内容涉及泌尿学、盆底和性健康。

If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific, zero-cost way to support us.

这是支持我们的绝佳且零成本的方式。

In addition, please subscribe to the podcast on Spotify and Apple.

此外，请订阅 Spotify 和 Apple 上的播客。

And on both Spotify and Apple, you can leave us up to a five-star review.

在 Spotify 和 Apple 上，您都可以给我们五星级的评价。

If you have questions for me or comments about the podcast or guests that you'd like me to consider hosting on the Huberman Lab podcast, please put those in the comments section on YouTube.

如果您对我有疑问或对您希望我考虑在 Huberman Lab 播客上主持的播客或嘉宾有意见，请将这些意见放在 YouTube 的评论部分。

I do read all the comments.

我确实阅读了所有评论。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

Not on today's podcast, but on many previous episodes of the Huberman Lab podcast, we discuss supplements.

不是在今天的播客中，而是在 Huberman Lab 播客的许多先前剧集中，我们讨论了补充剂。

While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like improving sleep, hormone support and focus.

虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如改善睡眠、激素支持和注意力集中。

The Huberman Lab podcast has partnered with Momentous supplements.

Huberman Lab 播客与 Momentous 补充剂合作。

If you'd like to access the supplements discussed on the Huberman Lab podcast, you can go to Livemomentous, spelled O-U-S.

如果您想访问 Huberman Lab 播客上讨论的补充内容，您可以访问 Livemomentous（拼写为 O-U-S）。

So it's livemomentous.com/huberman, and you can also receive 20% off.

所以它是 livemomentous.com/huberman，您还可以获得 20% 的折扣。

Again, that's livemomentous, spelled O-U-S.com /huberman.

再说一遍，这很生动，拼写为 O-U-S.com /huberman。

If you haven't already subscribed to our Neural Network newsletter, our Neural Network newsletter is a completely zero-cost monthly newsletter that includes summaries of podcast episodes as well as protocols, that is, short PDFs, describing, for instance, tools to improve sleep, tools to improve neuroplasticity.

如果您还没有订阅我们的神经网络时事通讯，我们的神经网络时事通讯是完全零成本的每月时事通讯，其中包括播客剧集和协议的摘要，即简短的 PDF，描述了例如改善睡眠的工具、改善神经可塑性的工具。

We talk about deliberate cold exposure, fitness, various aspects of mental health, again, all completely zero-cost.

我们再次谈论刻意的寒冷暴露、健身、心理健康的各个方面，所有这些都是完全零成本的。

And to sign up, you simply go to hubermanlab.com, go over to the menu in the corner, scroll down to Newsletter, and provide your email.

要注册，您只需访问 hubermanlab.com，转到角落的菜单，向下滚动到新闻通讯，然后提供您的电子邮件。

We do not share your email with anybody.

我们不会与任何人分享您的电子邮件。

If you're not already following me on social media, I am Huberman Lab on all platforms.

如果您还没有在社交媒体上关注我，我是所有平台上的 Huberman Lab。

So that's Instagram, Twitter, Threads, LinkedIn, and Facebook.

这就是 Instagram、Twitter、Threads、LinkedIn 和 Facebook。

And at all of those places, I talk about science and science-related tools, some of which overlaps with the content of the Huberman podcast, but much of which is distinct from the content of the Huberman Lab podcast.

在所有这些地方，我谈论科学和与科学相关的工具，其中一些与胡伯曼播客的内容重叠，但其中大部分与胡伯曼实验室播客的内容不同。

Again, it's Huberman Lab on all social media platforms.

同样，所有社交媒体平台上都是 Huberman Lab。

Thank you once again for joining me for today's discussion with Dr. Rena Malik.

再次感谢您参加今天与 Rena Malik 博士的讨论。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。