Can Trouble Peeing Actually Ruin Your Sex Life?

Most men don't connect bladder and bathroom problems with their sexual health — but a major scientific review suggests they absolutely should.

This 2021 meta-analysis pulled together 24 studies involving nearly 24,000 men from countries including the U.S., Brazil, Japan, China, Turkey, and Nigeria. Researchers looked at how lower urinary tract symptoms (LUTS) — things like needing to pee urgently, going too often, weak stream, or waking up at night to urinate — relate to sexual problems in men.

Men with more severe urinary symptoms were over 3 times more likely to have sexual dysfunction than men with milder or no symptoms. And it wasn't just one area of sex life that suffered — erectile function, satisfaction during sex, and overall sexual satisfaction all took a significant hit. Interestingly, sexual desire was the one area not affected, meaning the want was still there, but the ability and enjoyment were not. The study also found this connection held true across all age groups, even men under 40. The link appears to be biological — both problems may share the same root causes, including reduced blood flow, nerve signaling issues, and even stress and anxiety.

The bottom line: Urinary symptoms aren't just a bathroom inconvenience. They may be quietly affecting your sex life too — and that's worth talking to your doctor about.

What Really Works for Menopause-Related Vaginal Symptoms — And What Doesn't?

After menopause, many women deal with painful or uncomfortable symptoms "down there" — dryness, pain during sex, itching, and bladder problems. This is called Genitourinary Syndrome of Menopause (GSM), and unlike hot flashes, these symptoms often get worse with age, not better.

In this study, researchers from the University of Minnesota reviewed nearly 12,000 studies and carefully analyzed 46 high-quality clinical trials to find out which treatments actually help.

What Works: Four treatments showed real improvement: vaginal estrogen, vaginal DHEA (Prasterone), oral ospemifene (a daily pill), and vaginal moisturizers. Notably, vaginal DHEA and ospemifene were more consistent than estrogen at reducing dryness and painful sex. Even hormone-free vaginal moisturizers helped with dryness — a good option for women who want to avoid hormones.

What Doesn't: Vaginal testosterone, vaginal oxytocin, oral DHEA, raloxifene, and bazedoxifene showed little to no benefit — and none are FDA-approved for GSM.

The Bottom Line is that serious side effects were rare across all treatments. However, most studies only lasted 12 weeks, and few included cancer survivors or older or non-white women — so we still have much to learn. GSM is common, treatable, and too often ignored. If these symptoms sound familiar, talk to your doctor. You don't have to just live with it.

This week, someone asked me, “Two weeks ago I could not achieve a ‘proper’ erection during inter course - the first time this has happened in 10 years. One week ago, I managed a firm erection but as I approached climax it subsided and I had to masturbate to achieve orgasm. I am 65, exercise regularly but have recently been under stress which has resulted in more alcohol consumption. What is going on? Is this related ?”. What you're experiencing is most likely a combination of psychological stress and lifestyle factors working against you — and yes, they are absolutely related. Stress alone can significantly disrupt the brain-body connection needed for a healthy erection, and alcohol use when it starts becoming more chronic and large amounts can also affect erectile function. Cutting back on alcohol, managing stress, and giving yourself some grace can make a real difference — but if this continues, please see a urologist, because there are very effective treatments available and you don't have to just live with this.

I love hearing from you, so if there’s a question you’ve been wanting to ask, just let me know. Who knows? Your question might be the one I dive into next!

Spring Promotion on My App 🌸

From April 28 through May 8, we’re offering 20% off The Better Sex App as part of a spring promotion. If you’ve been thinking about getting personalized, science-backed guidance for your sexual health, this is a great time to start. Inside, you’ll find tailored plans, daily lessons, and an AI coach trained on my clinical expertise—all designed to help you make real progress.

Check it out here: https://www.studio.com/rena.

I dove into a really important issue: why veterans face more sexual health problems than we usually talk about, and how it’s not just about age or fitness. "Veterans are significantly more likely to experience sexual dysfunction than civilians... there are specific documented biological and psychological mechanisms that are tied directly to military service."

Here are some quick takeaways:

If you or a loved one is struggling, please reach out for help and know you’re not alone. Taking action can make a huge difference in your quality of life. Check out the full episode if you want to learn more or share this with someone who might need to hear it!

This conversation with Dr. Rachel Rubin is all about women’s sexual health, the importance of pleasure, and why we ALL need better education around these topics. She really made it simple, saying: “Sex is supposed to be fun. It’s supposed to be joyful. It’s supposed to be adult playtime and playful.”

We covered a bunch of stuff, including why most anatomy books hide the full clitoris, how birth control can affect your hormones, and what actually changes in your body during menopause.

This episode is a must if you want real talk and actionable tips. So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “The “mysterious” clitoris needs to be demystified. Thank you. I’m sharing this with my wife.”.

Think your sex life has to decline after menopause? Think again. Check out my new Substack: Redefining Sexual Health After Menopause: Evidence-Based Insights on Hormones & Desire.

In this article, I share powerful insights on why sexual health doesn’t “expire” with age, how hormones and medical care actually play a role, and what most women are never told about desire, pain, and intimacy after menopause.