Get Your Sex Life Back! What Everyone Gets Wrong About Sex, Libido & Erectile Dysfunction - Dr Khera

Here are the top 10 key takeaways from Dr. Mohit Khera's discussion on sexual health that could transform your understanding of intimacy, libido, and sexual wellness.

1. Sex span and its importance

Sex span refers to how long a person is able to engage in satisfying sexual activity throughout their life. Most people want their sex span to last as long as their lifespan. This differs from lifespan (how long you live) and healthspan (how long you live healthily).

Dr. Khera emphasizes that maintaining your sex span requires attention to four pillars: diet, exercise, sleep, and stress reduction. He believes no medication is stronger than these four lifestyle factors. Hormones, particularly testosterone, also play a crucial role in maintaining sex span for both men and women.

2. Sexual dysfunction is extremely common but rarely discussed

Sexual dysfunction affects a significant portion of the population. About 43-48% of women suffer from female sexual dysfunction, while 40% of men will experience erectile dysfunction by age 40. The percentages increase with age: 50% at 50, 60% at 60, and so on.

Despite its prevalence, sexual dysfunction remains stigmatized. Only 19% of women with sexual dysfunction seek therapy. Similarly, many men suffer in silence due to embarrassment. Dr. Khera points out that people readily acknowledge having conditions like hypertension but hesitate to admit sexual problems, despite excellent treatment options being available.

3. Erectile dysfunction can be an early warning sign of serious health issues

Erectile dysfunction (ED) often serves as the first indicator of other significant health problems. According to Dr. Khera, 15% of men who present with ED will have a heart attack or stroke within seven years. Studies show that ED typically precedes heart attacks by about 39 months on average.

This connection exists because of what Dr. Khera calls the "arterial diameter theory." The penile arteries (1-2mm) are smaller than coronary arteries (3-4mm), which are smaller than carotid arteries (6-7mm). Since smaller arteries get blocked first, ED often precedes cardiovascular events. About 20% of men with ED have some occlusion in their heart, making ED an important early warning sign.

4. Libido is affected by multiple factors beyond just attraction

Libido is influenced by numerous factors beyond simple attraction. Dr. Khera uses the mnemonic "PET" to describe hormonal influences: Prolactin, Estrogen, Thyroid, and Testosterone. When testosterone is low or prolactin is high, libido decreases in both men and women.

Neurotransmitters also play a significant role. Higher dopamine increases libido, while higher serotonin decreases it. This explains why antidepressants (which increase serotonin) often reduce libido. Additionally, lifestyle factors like fatigue and stress can significantly impact desire. Psychogenic factors, including relationship issues or anxiety about performance, can create vicious cycles that further diminish libido.

5. Obesity and unhealthy lifestyle significantly impact sexual function

The rising rates of obesity and diabetes correlate strongly with increasing sexual dysfunction. Fat cells contain aromatase, which converts testosterone to estrogen, lowering testosterone levels. They also secrete cortisol and leptin, which inhibit natural testosterone production.

Weight loss can dramatically improve testosterone levels. Losing 10% of body weight can increase testosterone by 85 nanograms per deciliter, while losing 15% can boost it by 250 ng/dL. This improvement in testosterone directly enhances sexual function, energy levels, and overall health. Dr. Khera notes that diabetics are four times more likely to have ED than any other population.

6. Testosterone is crucial for both men and women's sexual health

Contrary to common belief, testosterone is vital for both men's and women's sexual health. Women actually produce more testosterone than any other hormone in their bodies. When testosterone levels drop in women, libido typically decreases.

Despite its importance for women, there is no FDA-approved testosterone treatment for women in the United States. Doctors often prescribe testosterone formulations designed for men at about one-tenth the dose. Beyond sexual function, testosterone benefits include improved muscle mass, bone density, cognition, and reduced depression for both genders.

7. Treatment options for erectile dysfunction range from lifestyle changes to medical interventions

Dr. Khera describes multiple approaches to treating erectile dysfunction. Lifestyle interventions like following a Mediterranean diet, getting 7-8 hours of sleep, and exercising 160 minutes weekly can significantly improve erectile function without medication.

For medical treatments, daily Cialis (tadalafil) at 5mg is particularly effective for psychogenic ED. Unlike Viagra, which merely masks symptoms, daily Cialis can actually strengthen penile tissue and protect endothelial function. For cases where medications don't work, more advanced options include penile injections and surgically implanted penile prostheses, which have over 92% satisfaction rates.

8. The psychogenic component of sexual dysfunction creates vicious cycles

Sexual dysfunction often has a strong psychological component. One instance of erectile difficulty can create anxiety about future performance, which itself leads to more erectile problems. This creates a vicious cycle where anticipatory anxiety prevents normal function.

The same pattern affects libido. When men develop erectile dysfunction, they may avoid sexual encounters due to fear of failure or embarrassment. Their partners might interpret this avoidance as lack of attraction, creating relationship tension. Breaking these cycles often requires addressing both the physical and psychological aspects of sexual dysfunction.

9. Communication is essential for resolving sexual issues

Dr. Khera emphasizes that communication is the first and most important step in addressing sexual problems. Surprisingly, only 44% of men who develop erectile dysfunction tell their partners about it. Most simply start avoiding sex, which can be misinterpreted and damage relationships.

Open dialogue about sexual concerns is critical. Partners need to make time for these conversations and approach them without blame or embarrassment. Dr. Khera recommends sex therapy for couples struggling with communication about intimate issues. Addressing these problems openly can significantly improve not just sexual satisfaction but overall relationship quality.

10. Male testosterone levels have declined significantly in recent decades

Research shows a dramatic decline in male testosterone levels over the past few decades. In the 1970s, average testosterone levels for men between 18-40 were around 700 nanograms per deciliter. By 2015, these levels had dropped to the mid-400s, representing a decline of nearly 300 ng/dL.

This decline correlates with increasing rates of obesity, diabetes, and sedentary lifestyles. Lower testosterone affects not just sexual function but also fertility, as sperm production requires adequate testosterone. Dr. Khera views this trend as evidence that populations are becoming increasingly unhealthy, emphasizing the connection between overall health and sexual function.