Finding the Clit and Breaking Barriers: Reclaiming Women's Sexual Health with Dr. Jessica Yih

Ep 624: Breaking down barriers to Women's Sexual Health with Dr. Jessica Yih, MD, a urologist aka drsexandsperm on social media who is an Assistant Professor at the Department of Urology, Director of Women's Sexual Health and Male Infertility at the University of California, Irvine. She shares all her insights about the clitoris, female sexuality, and the new direction medicine is taking in finally paying more attention to women's sexual organs, pleasure, anatomy, function, and illness. 

Summary: Discover the Hidden Power of the Clitoris and a Revolutionary Look at Women's Sexual Health

Join Dr. Jessica Yih (aka drsexandsperm on social media), a pioneering urologist, as she unveils groundbreaking insights about female sexual health and anatomy. Did you know the clitoris contains an astounding 10,000 nerve endings and is much larger than commonly believed? This eye-opening episode challenges traditional perspectives and breaks down barriers in women's sexual health education.

Dr. Yih shares her personal journey in the male-dominated field of urology and discusses how limited medical training on women's sexual health inspired her to become an advocate for change. The conversation explores crucial topics including:

- The complex anatomy and size of the clitoris
- Breaking down shame and cultural taboos
- Understanding sexual health across different life stages
- The impact of hormonal changes on sexual wellness

- Barriers in testosterone therapy for women and the potentially harmful impacts of the oral contraceptive pill in damaging a woman's ability to have pleasure with sex

This frank and informative discussion illuminates the importance of self-discovery and understanding your body without shame. Whether you're curious about your own anatomy or seeking to enhance your sexual wellbeing, this episode offers valuable insights that could transform your perspective on female sexuality.

Ready to revolutionize your understanding of women's sexual health? 

Timeline:

00:01:57 - Women's Sexual Health Awareness
00:05:21 - Understanding the Clitoris Anatomy
00:10:45 - Anatomy and Arousal
00:17:31 - Exploring Sensuality and Orgasms
00:21:16 - Understanding Sexual Health and Pleasure
00:23:22 - Impact of Aging on Sexuality
00:27:27 - Understanding Women's Hormonal Changes & Hormone Therapy Autonomy
00:35:06 - Hormone Therapy Benefits for Women
00:38:52 - Understanding Vestibule Pain and Testosterone
00:42:01 - Understanding Hormonal Vestibulodynia
00:44:46 - Impact of Oral Contraceptives on Health
00:47:35 - Testosterone Therapy and Patient Advocacy
00:52:55 - Advocating for Sexual Health Awareness
00:55:28 - Exploring Sexual Trauma Healing

Key Takeaways

Dr. Yih https://linktr.ee/drsexandsperm

• There is a significant lack of education about female anatomy, particularly the clitoris, which contributes to societal shame surrounding female sexuality.  
• Understanding one's body, including embracing self-exploration, is essential for enhancing pleasure and mental health, regardless of age.

Transcript

Transcript by Cleanvoice ai. Season 5, Episode 624: Finding the Clit and Breaking Barriers: Reclaiming Women's Sexual Health with Dr. Jessica Yih, MD, Urologist.

Copyright 2025 Pink Infinity Publishing LLC, All Rights Reserved. Questions? Please email ruanwillow@gmail.com

Please note there will be typos because this was not edited by a human.

00:00:02 SPEAKER_01
Hello, everyone. I'm super excited. I just get to talk to so many amazing people around the world. It's just amazing to me. And, you know, it's just a lot of people I end up finding on like social media or whatnot. This person actually found on Instagram and I just saw some of her posts and I was like, hey, she'd be great for my podcast. So I want to introduce everyone to Dr. Jessica E. She's an MD and she goes by also a doctor sex and sperm, which we need to find out what that means. And she's an assistant professor. at the Department of Urology, Director of Women, Sexual Health, and Male Infertility at University of California, Irvine. Welcome to the Oh Fuck Yeah with Rune Miller podcast. Tell us about you.

00:00:45 SPEAKER_00
Awesome. Well, thank you so much for the introduction and thanks for having me on. Yeah, so I am a board -certified urologist. went to medical school, did my urology residency. And then I did a fellowship. So fellowship is kind of the optional training after residency. And my fellowship was in men and women sexual health, as well as male infertility. So I was really lucky to be able to find this. You know, I think most people have kind of this misconception that urology is all about men. We just see penises all day. But I was really. lucky to find a mentor who specialized in women's sexual health because that had been something I'd been interested in and curious about for a long time. And I thought, I actually thought there was no way for me to be able to see those patients because I didn't know how to get training on it because it's really, it's so underserved population and we don't, we get minimal education in medical school and residency about it. I was super lucky. And then now I've been practicing for about five years. Initially, I mostly saw male sexual health patients as well as general urology. And now I'm transitioning my practice more to seeing a lot more women, seeing women's sexual health.

00:01:51 SPEAKER_01
don't, we get minimal

00:02:14 SPEAKER_00
seeing patients for their pelvic health. And this includes things like incontinence, overactive bladder, pelvic pain, vulvodynia, things like that. Also menopause.

00:02:26 SPEAKER_01
Yeah. And you know, it's so funny when you say that was one of my questions I was going to ask of you is like, in my brain, when I hear urology automatically, I think men. And then I'm like, wait a minute, women have that whole area down there too. We have, we have organs and yeah, it's very underserved. And I think. I feel like there's a little bit more of an upswing towards finally paying attention more. Yes. Right. You feel that as well. Yes. Because you probably see more of it even than I do. And I see it on social media, you know, or guests on the podcast. It's so underserved.

00:02:56 SPEAKER_00
Yeah. Yeah. It's really exciting time right now. Yeah. So I, you know, through medical school and we've done, we've done some studies looking at even current medical school training there, you get like one hour of like female. genital health at all. You get a little bit more on the obstetrics, gynecology side, like how babies happen and the reproductive cycle. But as far as genital and sexual health, it's really minimal. And so I actually didn't really learn anything even through medical school and residency until I found my mentor and did my fellowship. But my fellowship fellowship director, Dr. Erwin Goldstein, he has been treating women for sexual health issues for something like 15,

00:03:25 SPEAKER_01
as far

00:03:46 SPEAKER_00
been treating women for sexual health issues for something like 15, 20 years. And he has... you know,

00:03:52 SPEAKER_01
he has...

00:03:54 SPEAKER_00
know, trained a lot of fellows now. And there's like a handful of us who are really passionate about this subject. And then there's also other physicians, you know, there's internists, there's gynecologists. And a lot of people are paying more attention to it now. You know, there's a lot of media buzz around it. You know, Oprah had a segment on it. Halle Berry came out to talk about it. There's

00:04:16 SPEAKER_01
segment on it.

00:04:23 SPEAKER_00
There's that product goop from, I forget her name off the top of my head, but a lot of like media about it, about menopause and sexual health. So it's really exciting that we're, if we're feeling like there's finally some attention being brought to this subject.

00:04:42 SPEAKER_01
Right, right. Especially when a lot of, I feel a lot of fighting that, a lot of forces fighting that progression. And but, you know, it's like things like I do and you do. And, you know, we are coming at it from different directions. It's all about sexual health, sexual wellness, sexual being arousal. You know, and what I think is so disturbing is that, like, I went the majority of my life not even knowing the word clitoris, what it looked like, what it did. You know, like these we went like I went the majority part of my life not knowing part of my body. Like, that's crazy.

00:05:20 SPEAKER_00
Yeah, I think, you know, we're at a disadvantage because we can't see that part of our body, right? Unless we get out a mirror and really get in there and take a look. And even, you know, even if you're using a mirror, if you don't kind of get in there, you don't really see what's actually there. So, you know, I think the clitoris is one part of the body that's, you know, people don't know a lot about. Then also the vestibule, the vestibule of the vagina is another big part that, and these things are so important because they're so important to both sexual health as well as, you know, a lot of people have pain related to these areas. So it can in that way interfere with their sexual health because when you have pain, it doesn't feel good, obviously. Right.

00:06:04 SPEAKER_01
areas.

00:06:14 SPEAKER_01
It's a huge problem. So for people that really are kind of coming at this not understanding, will you talk a little bit about what the clitoris looks like? What does it do? How does it change in arousal? And I really like to kind of debunk this whole thing of people saying, oh, I can't find it. Our pleasure has become a cultural joke.

00:06:42 SPEAKER_00
Right. Yeah. Yeah. So, yeah, the clitoris is, you know, we have the part that's on the outside that you can see, which is it's at the top. So you have so from the outside and you have like the labia majora and then you have the labia minora. And then the labia minora actually meet at the top. And then, yeah, that's great. Yeah. And then the clitoris starts there. The clitoris, the part of the clitoris that you can see is at the top of where the labia minora. meat um pinching right like right where you're pinching there um and i think sometimes people say they can't see it because we do have skin that covers it so um you know unless you've had some surgery uh you know women are born with foreskin basically or the prepuce which covers

00:07:10 SPEAKER_02
And then the

00:07:24 SPEAKER_00
and i think sometimes people say they can't see it because we do have skin that covers it so um you know unless you've had some surgery uh you know women are born with foreskin basically or the prepuce which covers the head of the clitoris, the clitoris that you can see that nubbin. But you have the entire clitoris, which extends underneath the surface of the skin that goes around the vagina on both sides. And all of the entire clitoris can engorge. So it gorges and enlarges during arousal and sexual activity. So just like a penis, goes from flaccid to firm during sexual activity um the clitoris the entire clitoris that the small part that you can see as well as the um both sides the cruce on both sides um become engorged and you can feel that so people feel swollen they feel engorged they can feel the head of the clitoris being very firm um and so that um contributes to the increase in sensation, and it's also a reflection of someone's arousal.

00:08:44 SPEAKER_01
And this is obviously not to scale. This is very small compared to what it actually is. Talk about the size, because some people think that this is a tiny organ, and like you said, they think it's just what's on the outside. It's not tiny.

00:08:57 SPEAKER_00
Yeah, yeah, no, it's not. So the part that you can see is probably somewhere between maybe like... five to 10 millimeters, so maybe up to a centimeter, sometimes larger, even up to two or three centimeters of the clitoris that you can see. And then the part that goes around the side can be upwards of like five to 10 centimeters on both sides of the clitoris, yeah, of the vagina.

00:09:29 SPEAKER_01
So people think it's this tiny thing. And I always want to say, no, that's like the tip of the iceberg. And I know other people have used that analogy as well. And I think it's really hard for people to understand. Like, I think it's important to know what this looks like because it almost makes me be able to feel it better.

00:09:34 SPEAKER_00
that analogy

00:09:44 SPEAKER_01
Like I understand it better. I mean, I'm kind of a visual person too. So like,

00:09:44 SPEAKER_02
I understand

00:09:48 SPEAKER_01
I think that our entire, we've been done a disservice of our entire lives. And I'm so glad that that's changing, but we need to get the word out to people. And it's hard because people have it in their head that it's a certain thing than what it really is.

00:09:58 SPEAKER_00
need to get

00:10:05 SPEAKER_00
Yeah. And we're doing a lot more research about it as a field. So a few years ago, one of my co -fellows, actually, she did the same fellowship, Maria Yuloko, worked with a plastic surgeon, Blair Peters, and they did a study on looking at how many nerve endings there were going to the clitoris. And there's something like 10 ,000 nerve endings going from the clitoris.

00:10:27 SPEAKER_01
And there's something like 10

00:10:34 SPEAKER_00
And I think, you know, all this research that we're doing is really helping us understand more about the anatomy and the function of the clurus. So that's really cool.

00:10:46 SPEAKER_01
Yeah, it is because it's going to impact women's lives. It's going to impact their, you know, quality of life relationships.

00:10:47 SPEAKER_00
going to impact

00:10:52 SPEAKER_01
All of this is just going to make it so much more of a full life for so many women who have kind of often. women feel like that the sexuality sex isn't as much for them as it is for like a male partner person with a penis so I think that this is just wonderful that the medical community is really starting to look at it more because it just needs to be done we need to we need to switch this thinking you know that we have yeah yeah the other the other really exciting thing that I want to

00:11:17 SPEAKER_00
we have

00:11:20 SPEAKER_00
the other the other really exciting thing that I want to mention is that you know because we can't see it from the outside it can be a little bit difficult to study so one thing that people are also starting to look at is doing imaging of the clitoris so especially ultrasound imaging some people are doing MRI imaging but ultrasound imaging is a lot more accessible it's less expensive you just put on an ultrasound probe and you can see the inside the inside portion of the clitoris so there's

00:11:34 SPEAKER_01
so especially

00:11:43 SPEAKER_01
an ultrasound

00:11:44 SPEAKER_00
you can see the inside the inside portion of the clitoris so there's courses in america and in europe um teaching people how to um do an ultrasound of the clitoris and we don't actually really know what we're looking for yet uh you know because we haven't done it so it's kind of a learning process for everyone um just like when people started doing uh ultrasounds of the penis we're like okay we have to figure out like what's normal and what is abnormal um so we're kind of gathering all that information right now so it's really interesting that we're like actually part of ongoing science right now trying to figure out what we're looking at for the clitoris.

00:12:30 SPEAKER_01
Yeah, that's really true. And I think it's, you know, it's obviously not a difficult thing to do because we ultrasound, we've been ultrasounding organs inside the body for, you know, for a very long time. We've been able to see what's in there. So this should be done too. But what I think is interesting too, is people have postulated this, people I've talked to have postulated that the different sizes of the clit could impact a woman's sexuality and where they're aroused. Now, if you, this is probably like something nobody's really, studied yet, but like, does it always lay the same way? Does it lay in different parts? Does it arouse differently based on where it's laying? I suppose these are all things nobody knows yet, right?

00:13:08 SPEAKER_00
Yeah, that's really interesting, actually. You're right. I don't think anyone knows, because we haven't really done those studies yet, whether things change in different ways in different women. Yeah, I don't think we know that yet.

00:13:21 SPEAKER_01
know that yet. The person that brought it up to me, they thought, well, what if someone who likes more anal stimulation, maybe their clit extends that way more? And I'm like, I never really thought about such a thing. And, you know, it's not so different to think about how many different sizes of penises there are out there, that there would be different sizes of the clitoris as well. I mean, that just fits.

00:13:41 SPEAKER_00
just fits. Yeah, for sure. And I think, you know, even from person to person, I think everyone's anatomy, you know, we generally have the same parts, but everyone's anatomy is a little bit different. And that goes down to the microscopic level. Like we all have like a different network of nerves. And that's why. big reason why we're all so different and why arousal feels different for people. So some people, you know, have more clitoral arousal. Maybe they have more nerves around their clitoris. Some people have more vaginal arousal or even cervical arousal. Maybe some people have more anal arousal because that's where their nerves are more dense and they have more sensation around those areas. So I think that's that's just like kind of a individual, you know, our individual like anatomies and how we're all kind of different. And I think that's really cool, you know, because but that's something that we have to keep in mind that not everyone's the same. figure it out and, you know, work with each other on what feels good for you because, you know, that's not the same as what feels good for someone else.

00:14:29 SPEAKER_01
more sensation

00:15:03 SPEAKER_01
Right. Because I've also heard some people talk about whether the clit is more heavily hooded or not can impact what kind of pressure is stimulating to you. You know, like some people like stronger pressure. Some people like lighter pressure. Some people are like, whoa, you know, like that's way too much. I think that's really interesting. But I think it also points to the fact that a woman needs to learn her own body and communicate that. So for me, I for me, I always think people should, you know, play on their own, maybe with a bunch of different toys to try and learn their body. You know, they don't have to use toys, obviously. But if you don't know what you like, how can you communicate that? Right.

00:15:38 SPEAKER_00
Yeah. Yeah. I think that's really challenging. I think, you know, I. So there's a lot of misconceptions about toys, about self -pleasure. Right. So I think a lot of people are hesitant to touch themselves down there, like even literally touch themselves. Like, yeah, there's so much like it's dirty, like it's uncomfortable. And that goes back like I remember in high school, you know, we would be talking about things and people like, oh, I don't like masturbate. That's gross or something like that. And you're like.

00:15:57 SPEAKER_01
touch themselves.

00:16:12 SPEAKER_00
You know, so, you know, I think you mentioned some of that in your email, just like kind of this shame or this like oppression of our own sexuality because it's been talked about like, you know, from a cultural and social standpoint. So a lot of it is kind of breaking past those barriers to really kind of figure out what feels good.

00:16:38 SPEAKER_01
Yeah. And I was definitely one of those young people that was shamed. from my mom telling me I shouldn't be touching down there. And I was legit going to tell her I was excited that I found out that something felt good. And it really shut me down. And I know that this is our cultural roadblock that so many people face. And it's hard enough to learn your body, but then you throw in all this shame and stuff. And I felt really repressed and suppressed most of my life. So I kind of feel like I'm a little bit... behind or immature in my sexuality because I was shamed for so long. And I know other people feel this way because I talk to so many people and other people have felt shamed as well. And it's something we need to just break this cycle of thought in our cultures and just, it's just another body part, right? No different than feeling something soft on the wall and I'm petting my foam covered wall.

00:17:29 SPEAKER_00
No different

00:17:34 SPEAKER_01
covered wall. It's soft, it's touch. Why is it so different? The touch in our genitals, right? Like it's, it's, it's crazy to me.

00:17:37 SPEAKER_00
it so different?

00:17:42 SPEAKER_01
crazy to me.

00:17:43 SPEAKER_00
Yeah. Yeah. I think, you know, I think when we explore things like sensation, so like bringing in sensuality, maybe even kink and explore all these like different sensations that feel good and then bring that to our sexuality. Because it can be separate or it can be tied together and it could, you know, it could go both ways. And when they overlap and they work together, I think that really creates magic.

00:18:17 SPEAKER_01
Yeah, for sure. Now, one thing I want to ask, this is something that someone told me or I read or something, and I'm curious if you feel this is true. The reason that women can have multiple orgasms is because of all these different chambers that can fill with blood. And that means that we can fire off multiple. And I heard on a podcast once, and I don't know if this is true, that the female clitoral complex can circuit like well over 200 times, like in a short amount of time. I don't know if any of that's true. Interesting.

00:18:49 SPEAKER_00
Interesting. Yeah. Yeah. I think it's definitely also understudied.

00:18:50 SPEAKER_01
Yeah.

00:18:52 SPEAKER_00
think it's definitely also understudied. You know, what I know or what I've been taught is that so we have kind of the the the sexual cycle right so we have arousal um we have desire desire an arousal and then there's orgasm and then there's resolution and then there's a refractory period um and so um we think it's this refractory period is probably um partially anatomical or physiological and then also neurochemical so when we orgasm we have a big release of like oxytocin and dopamine um so these are neurotransmitters in our brain that make us feel good um and so there's probably some component of like if there's too much of a certain kind of neurotransmitter um it's prevents like some kind of further like increase in arousal to the point of orgasm like there's some um

00:19:59 SPEAKER_01
of orgasm

00:20:03 SPEAKER_00
something that kind of blocks it or like increases the threshold so that you can't have another orgasm. So we know that in men, that refractory period tends to be a lot longer. And for women, that can be much shorter. But it's also a learned skill, I think. So I've heard of men who have learned to have multiple orgasms.

00:20:15 SPEAKER_01
for women,

00:20:30 SPEAKER_00
And I think part of that, and that's the other piece, is that part of it is your pelvic muscles, actually. So a big part of orgasm is your pelvic muscle contraction. And so if you learn how to control your pelvic muscles... And that's part of learning how to have multiple orgasms is to create that pelvic muscle contraction in a way that builds up to that threshold of reaching orgasm more easily.

00:21:02 SPEAKER_01
That makes a lot of sense to me because I basically did that. I spent a lot of time by myself and I basically taught myself how to do it. I learned how to do it. It wasn't something that was intuitive ever. Right. Like I hadn't spent this time on it. I wouldn't have realized what I know. I wouldn't be attaining as many as I am in a short amount of time. And I just think it's really interesting that, first of all, that the female body can do that. That's crazy. Like that's mind blowing and amazing. Another crazy thing is all the different types of orgasms, like strong, body, small, you know, like just there's so many different types of those as well. So I think. If we don't spend time learning it, we're just doing ourselves a disservice. We're not living our life to the fullest. But I happen to believe that sexual health is a part of mental health and it's integral to who we are.

00:21:55 SPEAKER_00
Absolutely. Yeah.

00:21:57 SPEAKER_01
People shouldn't be missing out. You should be focusing on this.

00:22:00 SPEAKER_00
Yeah. You know, I think that you're absolutely right. So a lot of sexual pleasure, I think, is... building your sexual skills um so i think people have this misconception that um you know so firstly we're like shamed from touching and learning when we're younger right and then and then you're expected to like immediately get married um when you're like of the right age and have babies um but there's no like in between right so Learning your body and learning how to have good sex is really a skill that you need to build both with yourself and then hopefully with a partner if you want. And also learning how to communicate about it because that can be challenging as well.

00:22:56 SPEAKER_01
Yeah, with all that shame going on. And we get shame in multiple places. You know, I've talked to a lot of people, shame from religion, shame from family, culture. you know, just their own thought process. I can't do this. You know, they're self -limiting.

00:23:08 SPEAKER_00
-limiting.

00:23:09 SPEAKER_01
That's not going to happen for me. Why should I even bother?

00:23:11 SPEAKER_00
I even bother? Right? Yeah. Yeah. And I think the other thing that's hard about sexuality is that it can change over the course of your life. So, you know, and part of that, a big part of that is hormones. So when are in puberty, in adolescence, early, adulthood, our hormones are at an all time high, right? So especially testosterone levels. So I don't know if you know this, a lot of physicians actually don't know this, but women actually have more testosterone in their bodies than they have estrogen. So every single human in the world has more testosterone than estrogen, unless there's some medical condition. That is crazy.

00:23:51 SPEAKER_02
single human

00:23:59 SPEAKER_00
Yeah. So So for both men and women, libido is high when the testosterone is high. And so for a lot of younger people, minus all this shame and stuff, sexuality can come easier when they're younger because of hormones. But then as you get older and then you're hitting your 30s. This isn't true for everyone, but for most people, when they're hitting their late 30s and then into perimenopause, their 40s and menopause in the 50s, all of these hormones decline, especially testosterone and then estrogen has a steep decline in the early 50s or late 40s usually. So you can have vaginal pain that gets worse over time, low libido. Difficulty with arousal and orgasm because of the changes in hormones. So if something used to be easy, it doesn't mean it's going to be good forever. It might decline or get worse over time because of changing hormone levels.

00:24:59 SPEAKER_01
of the

00:25:14 SPEAKER_00
So that's another issue that comes up for a lot of people.

00:25:18 SPEAKER_01
Yeah, so that's why I feel like our culture was so different that people could learn this stuff when they're younger, when it is perhaps maybe easier because our hormones are at a different level. But not that you can't learn when you're older. Obviously, you still can. But I think you bring up a good point, too, that our sexuality changes as we age. There's a great gradient and a span. And if we're not open to all the changes... we're just kind of putting ourself in a spot where we can't grow or we can't experience and things can become more hollow. Like I feel like there's a lot of people out there that, especially women who feel like that midlife sex isn't for them. I always feel so sad because they're, they think they haven't really experienced what they needed to experience to not have that opinion.

00:26:07 SPEAKER_00
Yeah, yeah, for sure. I mean, I see I see a lot of patients exactly in that situation and like midlife perimenopause menopause. And, you know, it comes it's both a medical as well as a social issue. Right. So a lot of. Woman, if you have small children, you know, you have families, you have other priorities, and you just don't make as much time for your sexuality anymore because mostly you're taking care of your kids and you can't find time to have sex. And that along with the testosterone going down in the 30s. potentially like up to 25 % or more, so less testosterone than they do in their 20s. So it just kind of compounds. So if you have lower testosterone, low libido, and then you're prioritizing it less, and then it's just happening less, like you're not making the time. So then it just like kind of feeds into the cycle.

00:27:24 SPEAKER_01
I think it's really interesting, too, and I don't know if we'll ever get to this point where people are willing to be studied, but I see that there is a difference in how people react. Like some people get to their midlife and their libido increases. Right. Like what is a difference for them than the people where it is like getting killed and squashed? And so that's my one thought. My other thought is, OK, so a lot of these people are giving a lot of doctors are giving women estrogen and progesterone. for perimenopause and then i'm thinking well okay so that might be fixing something but if their testosterone is down why are they not also giving them testosterone yeah yeah so to your first point i think that's a your first point about sometimes we have we see people who really have increased sexuality later in life i think um that's really amazing to me when i hear that because that to me

00:28:01 SPEAKER_00
yeah so to your first point i think that's a your first point about sometimes we have we see people who really have increased sexuality later in life i think um that's really amazing to me when i hear that because that to me gives me a sense that like they've come into themselves so i hear that also is that like people are shedding kind of like um their misconceptions or like these old beliefs that they had about who they're supposed to be and as you get older then you you kind of become more yourself or become more free um to be whoever you want to be

00:28:34 SPEAKER_01
who they're

00:28:39 SPEAKER_00
more yourself or become more free um to be whoever you want to be and do whatever you want to do. Right. So like, you know, we can take the example of like the old, like the 90 year old lady who just says whatever she wants and does whatever she wants and dresses crazy. Her hair is crazy because she doesn't give a shit anymore. Right. Right. Exactly. I'm me. So I think that's,

00:28:49 SPEAKER_01
know, we

00:28:55 SPEAKER_01
and does whatever

00:29:02 SPEAKER_01
I'm me.

00:29:05 SPEAKER_00
think that's, that's really cool when I see that. To your second point about the testosterone, Not being prescribed for a woman. That's the yeah, that's a huge issue. So we're actively doing research on testosterone, as well as educating, trying to trying to educate all our medical students, residents and current physicians about the importance of testosterone for a woman. There's a lot of barriers, unfortunately. So testosterone is currently still a. scheduled substance which means it's like in the same cat in a similar category as narcotic medications and ritalin and stuff like that right yeah and and ritalin adderall so so it's like it's a controlled substance um so it's like tracked and people have i think some inherent fear about using testosterone for

00:29:46 SPEAKER_01
like in

00:29:52 SPEAKER_01
ritalin and stuff like that right yeah

00:29:53 SPEAKER_00
and and ritalin adderall so so it's like it's a controlled substance um so it's like tracked and people have i think some inherent fear about using testosterone for just that reason alone they're like oh what if i prescribe it and like um and i get like something's like i get tracked and my license gets like suspended or i don't know whatever people think right like not doing it right so that's one issue and then because it's a controlled substance doing research on it is really hard um okay it requires more

00:30:21 SPEAKER_02
like not

00:30:26 SPEAKER_00
it's a controlled substance doing research on it is really hard um okay it requires more

00:30:30 SPEAKER_02
okay it

00:30:36 SPEAKER_00
approval like more oversight and approval from the institutions so irbs as well as you know the institutions to get these research studies approved and i have i've known and i've heard of many people who've tried to do testosterone research and they cannot get their studies approved because their institutions come back and say Oh, testosterone isn't approved for a woman, isn't FDA approved for a woman, so we can't do this study. Because we don't know, it might hurt the woman, so we can't give it to them, we can't do this study. So it seems like, to me, like a systemic issue with hormones, especially in... In the treatment of women,

00:31:27 SPEAKER_00
the treatment of women, because we've had this issue with both estrogen, progesterone, and also testosterone in the treatment of women is that there's just this big fear around it. And it just doesn't get the same get the same privilege as other medications do.

00:31:50 SPEAKER_01
I think that part of that is probably gatekeeping because some people think it's not important. And, you know, people have this big thing in their head that men testosterone, women estrogen. And like you're saying, that's not even true. So we have this cultural thing going on, too. And then the other issue is I think that women get put up on a pedestal instead of being, you know, like, don't put us on a pedestal. This is hormones. I want to know that I have testosterone in my body already. All women do. Why is it? Why is it so taboo to then study it? It's already there. Yeah.

00:32:24 SPEAKER_00
So it's both a pedestal, but it's like, it's, it's also the opposite of the pedestal. I know what you would call that, but, oh, I, I know paternalistic paternalistic. Yeah. Yeah. Yeah. So, so the example that I always give is if you have a guy with say prostate cancer, there's been a lot of controversy about using testosterone when someone has prostate cancer.

00:32:36 SPEAKER_01
Yeah. Yeah. Yeah.

00:32:43 SPEAKER_00
you have a guy with say prostate cancer, there's been a lot of controversy about using testosterone when someone has prostate cancer. The guidelines and the general recommendation is that you have a conversation, right? You have a conversation with your patient about the risks and the benefits and what we know and what we don't know. And you let the patient make the decision. So we have a value.

00:33:16 SPEAKER_00
in the medical system where we have patient autonomy, right? That's one of the pillars of practicing medicine, patient autonomy. So men get to make their own decisions. But when we talk about a woman on hormones, I see all the time where, say, a patient with breast cancer, and we're talking about hormone therapy. She will tell me her oncologist will not let her. use hormones right so her oncologist didn't give her autonomy didn't give her a choice told her she is not allowed to use hormones so see this all the time so this is a huge issue where we're not giving women autonomy because we think we're doing the right thing for them i just and that just bothers me because so it's this attitude that's stopping

00:34:07 SPEAKER_01
just and that just bothers me because so it's this attitude that's stopping something that she needs or that could improve her life. Yeah. Yeah.

00:34:18 SPEAKER_00
Yeah. So it's a, it's a big issue where, you know, I think a lot of us are trying to educate on social media, you know, about kind of what are the real risks or, and the benefits of hormone therapy, estrogen, progesterone, testosterone. And we're trying to give this information to the people. to patients, to people, to everyone, so that people know that they have this option. And we're seeing that people are going to their doctors and presenting their doctors with this information. So it's kind of, we're going from top down and bottom up. So we're trying to go both ways to educate everyone.

00:35:03 SPEAKER_01
And it might sound cut out for a little bit. So I might've missed you talking on this. I'm not sure if you did or not, because I couldn't hear, but. So the whole thing with progesterone and estrogen and progesterone, I can't talk, and that being protective for women like towards osteoporosis and dementia, is that legit or is that like on social media as a fallacy as far as you know?

00:35:30 SPEAKER_00
No, yeah, there's a lot of research going on with hormone therapy. It used to be, so the misconception is that hormone therapy, especially estrogen, is linked to breast cancer. So that we could spend all day talking about the studies on that, but essentially that is not an accurate depiction of what the study actually showed.

00:35:51 SPEAKER_01
that,

00:35:59 SPEAKER_00
But it is. It does improve or does prevent and improve osteoporosis. Osteopenia can improve things like brain fog, dementia, reduce the risk of those things, reduce the risk of like... hip fractures with falls. So a lot of older women, they're at severe risk for osteoporosis and hip fractures. And that's a huge cause of mortality for older women, unfortunately. So hormone therapy, honestly, can be life -saving.

00:36:41 SPEAKER_01
Yeah. And my history is I actually... used to work as a nurse. So I know that from nursing school. Oh, yeah.

00:36:45 SPEAKER_00
school. Oh, yeah.

00:36:46 SPEAKER_01
Yeah. So, I mean, and that's when someone would break a hip, that could mean a death sentence for them, you know, like that could be the end for them.

00:36:54 SPEAKER_02
could be the

00:36:55 SPEAKER_01
them. But what I think is really crazy for someone like me, I have osteoporosis on both sides, my dad's side and my mom's side, and my dad had Alzheimer's. So like when I hear these kind of things, I think I'm, you know, I need to be on these things. The thing of it is people have a lot of fear, like you said, with the whole breast cancer thing. But if there's anything I can do to help prevent those things, I want to do it. And I've also heard people argue the things like, well, it's just a natural process. Why should I do that? Also, you know, like, why should I do anything? I feel fine. And someone brought up a good point I saw on social media is it's preventative. You feel fine because you don't have a problem yet.

00:37:31 SPEAKER_00
point I

00:37:36 SPEAKER_01
you don't have a problem yet.

00:37:38 SPEAKER_00
Yeah. And a lot of these things are they're silent until you have a big problem. Right. So a lot of a lot of medical issues like osteopenia, osteoporosis, you may not know until you have your fall and you break your hip unless you're getting screened and checked for those things. So, yeah, definitely really important from a kind of a holistic standpoint to to. to do all of those things to, to prevent, um, to prevent those kind of final problems, those like ultimate problems. Um, and, um, you know, there's a lot of lifestyle things that can be helpful as well. So, you know, it's not that we're like saying like hormone therapy is the cure -all, you know, but it's,

00:38:26 SPEAKER_01
know, but it's,

00:38:27 SPEAKER_00
it, it will make a significant difference. when you use it, especially with, you know, all of the other things that are recommended.

00:38:39 SPEAKER_01
And I think we should talk a little bit about pain. Like we haven't talked as much about pain, like pain during sex and how awful that is and how can that be fixed? Can you do anything? Because I think a lot of people, you know, if you have pain, you're not going to want to do that.

00:38:54 SPEAKER_00
Right. Yeah. Okay, so this is the other part of the body that is very poorly studied and very few people know that this exists. So the vestibule of the vagina is this area. So if you think about the labia minora, you have the labia minora, right? And then... You have your vaginal opening.

00:39:13 SPEAKER_01
have the

00:39:15 SPEAKER_00
have your vaginal opening. So you have your vaginal opening, the hymen, and then there's this tissue around the vaginal opening, around the hymen, right inside the labia minora. So people don't really think much of this tissue. So, you know, it just seems like it's there, but it's actually really important. So this is the equivalent or the homologue. of the in men of the urethra actually okay so embryologically um when we develop um we i'll start off kind of on on a single plane and then in men this tissue tubularizes so that becomes a tube to become the urethra. And then for a woman, it stays kind of this flat tissue. And the urethra is just the part that goes up into the bladder. So it's a tube there, but the rest of it doesn't tubularize. So this tissue is, we talked about testosterone already. This is testosterone sensitive tissue. So testosterone is really important for this tissue. And this is the area where most people have pain actually. So you can also have,

00:40:30 SPEAKER_02
can also have,

00:40:31 SPEAKER_00
like deep vaginal pain. And oftentimes that's related to like endometriosis. And so people have issues with that as well. So that's another version of people. But a lot of people have pain around just the vestibule, the opening of the vagina because issues related to having low testosterone.

00:40:53 SPEAKER_00
Yeah. And a lot of people have. actually have low bioavailable testosterone unbeknownst to them because they've been on the pill.

00:41:04 SPEAKER_01
on the

00:41:06 SPEAKER_00
So the pill,

00:41:06 SPEAKER_01
So the

00:41:08 SPEAKER_00
pill, you take the oral pill and it gets processed through your liver and your liver makes this compound called sex hormone binding globulin or SHBG. And SHBG binds up your testosterone and makes it unavailable to your tissue. So when you have high SHBG, you have less testosterone available to your body to do what it needs to do on the receptors. And when your vestibule has, you know, has all those testosterone receptors, there's not enough testosterone. So then it gets inflamed. And, and that's what causes pain is that you can have this. Yeah.

00:41:52 SPEAKER_01
this. Yeah.

00:41:53 SPEAKER_00
So that's called, Hormonally mediated vestibulodynia.

00:42:00 SPEAKER_00
Vestibulodynia. Dynia meaning pain.

00:42:03 SPEAKER_01
So the pain that they're having is completely due to lack of hormone being available. And they're because they're taking. Now, why isn't this medication like this medication should be stopped for women? This is really fucked up.

00:42:18 SPEAKER_00
is really fucked up. Yeah, so I mean, unfortunately, or fortunately, or unfortunately, I guess, you know, oral birth control has a lot of positives, right? It prevents pregnancy,

00:42:28 SPEAKER_01
right?

00:42:30 SPEAKER_00
especially, you know, for, you know, people who are underprivileged, you know, A teen pregnancy can be really devastating for someone's life, like, you know, as far as like outcomes in the future, like just how education and like continuing with school and things like that. So it can definitely be good, but it has, this is one major side effect that a lot of people don't. don't know, don't talk about, they develop pain and they're like, I don't know why this is happening. And a lot of physicians don't mention this because it doesn't seem relevant in the face of potentially having a unwanted pregnancy.

00:42:38 SPEAKER_01
teen pregnancy

00:42:50 SPEAKER_01
definitely be good,

00:43:09 SPEAKER_00
relevant in the face of potentially having a unwanted pregnancy.

00:43:16 SPEAKER_01
I can understand that, but this is a medication known to be harming women and it's not being fixed.

00:43:23 SPEAKER_01
We have a medication here that we know is actually hurting women. Yeah.

00:43:29 SPEAKER_00
Yeah. It's disturbing. Yeah. And it's not everyone. So it does depend a little bit on your genetics. So there was a study many years ago by Andrew Goldstein, a gynecologist who's also in this field. And they looked actually at the genetics and they were trying to figure out who was more susceptible to having this side effect from contraceptive medications. And so they were looking at. the dna actually and they found that in certain patients in certain people who had a certain dna like more repeats of a certain dna sequence they potentially had more pain pain side effects with contraceptive medications but i actually don't know of any further research that's come after that looking at

00:43:35 SPEAKER_01
bit on your

00:44:11 SPEAKER_00
pain side effects with contraceptive medications but i actually don't know of any further research that's come after that looking at you know, Hey, what can we do? Like, there's no, like, there's no test. Like I can't go out and order a test on a woman to see if she has those DNA segments and if we should try another medication instead of oral contraceptives. But yeah. So when I have someone who has pain likely due to oral contraceptives and it can be from years ago, you know, if when your SHBG goes up, it can stay elevated. for a long time or potentially even forever. So it can be if you've taken it 20 years ago or 10 years ago for like three months, you know, it can have a lasting effect on your liver. So, you know, we get people off of oral contraceptives. We use alternatives, you know,

00:44:55 SPEAKER_02
it can be

00:45:10 SPEAKER_00
know, lower dose contraceptives, progestin only contraceptives, the IUD. These are things that can have less negative side effects on testosterone levels, available testosterone levels in the body.

00:45:29 SPEAKER_01
Yeah, and I can see all those great benefits to birth control. In fact, I took it when I was younger. But here's where we could easily fix this is if people said when you went on it, hey, if you ever have pain with sex, think about that it actually could be this. Like it should be part of the teaching to be awareness. Maybe we can't go around testing everyone like you said. But it should be a part of the teaching. And at least you're aware of it. But I think there's probably a lot of doctors who maybe aren't. Right. Yeah. Yeah.

00:45:57 SPEAKER_00
Yeah. And I think it's it is part of this paternalistic mindset where people are like, it just doesn't matter. Right. Like sometimes. Yeah. Like they're like, it doesn't matter. We just don't want you to have children and nothing else matters right now.

00:46:04 SPEAKER_01
just doesn't matter.

00:46:11 SPEAKER_00
nothing else matters right now. And, you know. Patients are told like they don't have any other options. And, you know, sometimes they don't because maybe their insurance doesn't cover any other options or it's really expensive to get something else.

00:46:19 SPEAKER_01
know,

00:46:25 SPEAKER_01
really expensive

00:46:27 SPEAKER_00
So that's really challenging. Yeah.

00:46:30 SPEAKER_01
I was really shocked. I was in Target yesterday and the woman in front of me was buying oral contraceptive. And I thought, you can buy that at Target? No education at all?

00:46:42 SPEAKER_02
at all?

00:46:43 SPEAKER_01
I couldn't know. I didn't even know that that was a thing.

00:46:44 SPEAKER_00
couldn't know. I didn't even know that that was a thing. Wow.

00:46:48 SPEAKER_01
I couldn't believe it. It was this blue box. And I looked at it and it said oral contraceptive. And I was like, what? They can legit sell that? Yeah.

00:46:55 SPEAKER_00
legit sell

00:46:58 SPEAKER_00
Yeah. Again, pros and cons. You know, we do have people who need access to it who can't. And so this method of. having it over the counter can provide that for them. But it's challenging because people aren't educated about the side effects.

00:47:17 SPEAKER_01
effects. They have to read the whole package. And I can tell you, most people are not reading that whole insert.

00:47:22 SPEAKER_00
Yeah, most people are not, for sure. Yeah. Yeah.

00:47:23 SPEAKER_01
people are not,

00:47:28 SPEAKER_00
But yeah, so, you know, there are treatments, you know. You know, they're not always 100%, but putting someone on testosterone therapy, either locally, local, like topical testosterone to that area, to the vestibule. Sometimes even doing systemic testosterone therapy can be helpful. Sometimes we do surgery, so surgically removing that tissue. For some patients, it's not hormonally mediated. It's just something that they've always had. So that we think can be due to infections or inflammation. happen during infancy or something like that, because some people say they've always had pain, even from the first time they tried to use a tampon or something.

00:48:19 SPEAKER_01
from the first time they

00:48:22 SPEAKER_00
So we can surgically remove that tissue. That tends to help a lot as well for those patients.

00:48:31 SPEAKER_01
So those patients are allowed to get testosterone. It's not as regulated for they can get prescribed it.

00:48:38 SPEAKER_00
Well, to be totally honest, it's not difficult to prescribe it. You have to sign an extra thing when you send the prescription. Or if you send a paper prescription, you have to write your DEA number. So it's not actually difficult. It's more of, I think, for people, a mental barrier from an educational standpoint that they don't understand or they're afraid of it.

00:49:08 SPEAKER_01
That's what's so hard because, you know, we want to all be able to trust our doctor and we want to be able to trust what they're telling us. But when you hear things like that, I just don't have a whole lot of confidence. And I worry, you know, so many people out there that are just suffering when they don't need to be. I know it's something that slowly will permeate, but it's frustrating.

00:49:25 SPEAKER_00
it's something

00:49:29 SPEAKER_01
frustrating.

00:49:30 SPEAKER_00
Yeah. And, you know, I think that's true. of a lot of things in medicine is you know we're always trying to learn right the field um the whole medical field we're always trying to learn um and um we do have to do like cmes right continuing medical education to continue to learn more um but you know everyone has a different capacity for what they do so like you're you're Family doctor from, you know, middle of Ohio may not have this education and, you know, they weren't taught it in medical school and they don't have any access to to to this kind of education. So, you know, I wouldn't you know, it's it's hard to blame them. But, you know, as a patient or, you know, as a person seeking help. we need to have resources for that. So there's a few places online that you can go that are really helpful. So ISWISH, the International Society for the Study of Sexual Medicine, if you go online and look for ISSWSH, they have a lot of resources. They have a patient -oriented website. called prosayla p -r -o -s -a -y -l -a there's a lot of information on there there is a find a provider directory so these are people that are interested in sexual medicine they have some education about it they've been approved to be on the directory so we know that they know something you know we can't

00:50:44 SPEAKER_02
go online

00:51:01 SPEAKER_00
is a find a provider directory so these are people that are interested in sexual medicine they have some education about it they've been approved to be on the directory so we know that they know something you know we can't You know, can't fully vet everyone and what they don't or do or don't know, but, you know, they at least have some education.

00:51:23 SPEAKER_01
know, they at least

00:51:27 SPEAKER_00
And for menopause, there's also the Menopause Society. So the Menopause Society online, they also have a Finda provider directory. So these are places you can go to if you're not. getting the answers that you need from your doctor or someone's gatekeeping you or saying, you know, you can't have this or you can't have that, you know, to go online and like look for other resources for that.

00:52:00 SPEAKER_01
Yeah. And that's a big push for people. You also need to be an advocate for yourself and not just accept what you're told always. You still need to be an advocate for yourself and maybe do some of your own research. That's great to have those websites, too, so people can check that out. Yeah. Sometimes you need to do that so that you know the right questions, you know, what are the warning signs of maybe this isn't truth, you know?

00:52:23 SPEAKER_00
Yeah. Yeah. Yeah. And I think that's, you know, the beauty of social media is, you know, there's definitely downsides to social media, but it's, I think, really great place to get, it's good place to get bad information, but it's also a good place to get good information. Um, so there's some really great educators out there. Rachel Rubin, Kelly Kasperson. Yes. Um, um, you know, those are just a couple of the many, uh, great educators out there, um, talking about sexual health, um, and menopause health, hormone health, things like that.

00:53:02 SPEAKER_01
Yeah. Yeah. I've seen them on Instagram too. And we never asked you your, your Dr. Sexton sperm. Yeah. Skinny on that. Yeah,

00:53:11 SPEAKER_00
you know, a big part of our practice is male infertility. So that's where the sperm part is. And then, you know, sex, I see both men and women for sexual health. But yeah, I'm kind of small right now. I, you know, I think social media, like I said, is challenging. Yes, I'm working on finding my voice and growing. And, you know, I think the big the big thing that drives me is that people need this information, want this information, need this information. So, you know, it makes me a little bit nervous to be out there on the Internet, but I'm showing up for for you guys, for everyone who needs it.

00:54:00 SPEAKER_01
That's awesome. Well. Before we end, is there any topic we didn't touch on that you wanted to talk about or anything you wanted to say? And then also make sure you end with where everybody can find you.

00:54:12 SPEAKER_00
Yeah. So, yeah, I think to your point, I think that being your own advocate is really important. You know, keep looking for answers. You know, if there's something that you're struggling with, keep looking for answers. Don't give up. find the resources find the people that can support you and I think there's a lot of hope for women's sexual health you know we're getting much more attention now and I think there's a lot of great research coming out and I think we're only gonna get better from here so yeah and then my my Social media. So my Instagram, I'm on as Dr. Dr. Sex and Sperm. And then I do see patients at UC Irvine. So I'm in several locations throughout Orange County. So if someone's local to Orange County, I see new patients. And I'm also on a few other things like YouTube and not as active on the other things, but on YouTube, Twitter, I just started a sub stack. Oh, nice. I'm on a sub stack too.

00:55:28 SPEAKER_01
nice. I'm on a sub stack too.

00:55:30 SPEAKER_00
Yeah. So I have aspirations to write more. So I'm working on a book right now. My other passion is...

00:55:41 SPEAKER_00
sexual trauma healing. Oh, nice. So I'm working on a, on a short book on that right now that hopefully I'll finish and publish in the next few months. I'm just self -publishing, but that'll be available online.

00:55:55 SPEAKER_01
Yeah. That's a huge area that needs a lot of attention. Very much so. Yeah. Yeah. Wonderful. This was a wonderful discussion. Thank you so much for coming on and sharing all of that. helping people maybe learn a little bit more so that they can enjoy their lives better. I'm all about quality of life. And I do believe sexuality is a huge piece of that.

00:56:16 SPEAKER_00
Yeah. Thank you so much for having me on. You were wonderful. You're so kind. And thank you for having this podcast and educating you. It's really important. You're doing really important work.

00:56:24 SPEAKER_01
It's really important.

00:56:27 SPEAKER_01
It's really fun. But thank you so much for sharing and we'll be in touch. All right. Thank you. Thank you. Bye -bye.