You Are Not Broken

Changing Women’s Healthcare From Inside Medicine Dr. Sarah Cigna (She/Her) is an Assistant Professor of Obstetrics & Gynecology with The George Washington University. She is the current Director of the SAGA (Sexual Health and Gender Affirmation) Center and Director of the first Sexual Medicine Fellowship in the country for OBGYN physicians. She is active in the International Society for the Study of Women's Sexual Health (ISSWSH); she has served on the education committee for several years and will be taking over as the Education Chair this year. She is a Fellow of ISSWSH and runs a busy sexual medicine outpatient service, teaching medical students, residents, fellow clinicians and patients the wonders of sex medicine! She still enjoys birth work (delivering babies), and benign GYN surgery. She hopes to model the role of sexual medicine specialist in an academic setting for aspiring sex detectives.  Dr. Sarah Cigna, an expert in sexual medicine, discusses the importance of sexual health education, challenges in talking about sexual health, the need for comprehensive vulvar examinations, improving access to sexual medicine education, expanding sexual medicine fellowships, addressing side effects of birth control, individualized contraceptive options, improving pain control for IUD placement, and the misconception of testosterone as the desire hormone. The conversation explores the complexity of hormones and desire, emphasizing that there isn't just one hormone responsible for desire and that they all play together. The importance of individualized treatment and its impact on quality of life is discussed, highlighting the life-changing nature of sexual medicine. The significance of referrals and second opinions is emphasized, encouraging healthcare providers to seek help from specialists and patients to seek multiple perspectives. The need for expanding sexual medicine fellowships is addressed, calling for advanced learning opportunities for all healthcare professionals. Takeaways Sexual health education is crucial for healthcare providers to better serve their patients. Comprehensive vulvar examinations are essential for diagnosing and treating sexual health issues. Expanding sexual medicine fellowships can help train more clinicians in this specialized field. Individualized contraceptive options should be offered to patients based on their specific needs and preferences. Improving pain control options for IUD placement can make the procedure more comfortable for patients. Testosterone is not the sole hormone responsible for desire, and other factors, such as estrogen, play a significant role. Hormones and desire are complex, and there isn't just one hormone responsible for desire. Individualized treatment in sexual medicine can greatly improve quality of life. Referrals and second opinions are important in sexual medicine to ensure patients receive the best care. Expanding sexual medicine fellowships is crucial for advancing the field and providing evidence-based care. IG @drsarahcigna @gwsagacenter  NYC Sex Symposium www.theswell.com Check out details for my retreat: https://ascendretreats.com/ Listen to my Tedx Talk: Whywe need adult sex ed Take my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP, a private facebook group to discuss and my private accountability group for your health, hormones and life support! www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

242. Happy New Year's and the Nail in the Coffin of Hormones Causing Breast Cancer In this episode, Dr. Kelly Casperson shares updates on the podcast and announces the four-year anniversary. She discusses her plans for the future, including moving the podcast to a new category and manifesting success in the health and fitness industry. Dr. Casperson also announces a retreat and offers live group coaching sessions. She encourages listeners to sign up for the retreat and get a lifetime membership to her monthly membership program. Dr. Casperson answers a listener question about painful intercourse and provides recommendations for finding physicians and therapists specializing in menopause issues. Finally, she debunks the Women's Health Initiative study and emphasizes the safety and benefits of hormone replacement therapy.Takeaways Dr. Casperson is celebrating the four-year anniversary of the podcast and shares her plans for the future. She announces a retreat and offers live group coaching sessions for listeners. Dr. Casperson answers a listener question about painful intercourse and provides recommendations for finding specialized healthcare providers. She debunks the Women's Health Initiative study and emphasizes the safety and benefits of hormone replacement therapy. Bluming AZ, Hodis HN, Langer RD. 'Tis but a scratch: a critical review of the Women's Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause. 2023 Dec 1;30(12):1241-1245. doi: 10.1097/GME.0000000000002267. Epub 2023 Oct 18. PMID: 37847875 Check out details for my retreat: https://ascendretreats.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed   Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed   Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

243. UnF*ck Your Brain: Body Image, Desire and Coaching with Kara Loewentheil Kara Loewentheil, J.D., is a Master Certified Coach, host of the top-rated podcast UnF*ck Your Brain, and creator of the Clutch: A feminist mindset revolution. A graduate of Yale College and Harvard Law School, she did what every Ivy League feminist lawyer should do: Quit a prestigious academic career to become a life coach!  Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com Check out my retreat March 2024! https://ascendretreats.com/ In this conversation, Kelly Casperson interviews Kara Loewentheil about thoughtwork and its impact on desire and pleasure. They discuss the influence of society on women's thoughts and desires, the historical context of women's desire, and the concept of object of affirmation desire. They also explore body image and self-criticism, the importance of communication in relationships, and the process of changing thoughts and self-criticism. Overall, the conversation highlights the power of thoughtwork in transforming women's relationship with desire and pleasure. In this conversation, Kara Loewentheil discusses the impact of society's expectations on women and how thought work can help break free from sexist thinking. She emphasizes the transformational power of thought work and the importance of commitment and practice. Kara shares her personal experiences and how thought work has changed various aspects of her life. She also highlights the need to embrace the human experience and let go of the fantasy of constant improvement. The conversation concludes with an announcement about Kara's book, 'Take Back Your Brain.' Takeaways Society plays a significant role in shaping women's thoughts and desires. Women are often socialized to see themselves as objects of desire and believe that their desirability is dependent on others. Body image and self-criticism can negatively impact women's relationship with desire and pleasure. Communication is essential in fostering healthy and fulfilling sexual relationships. Changing thoughts and self-criticism is a gradual process that requires patience and self-compassion.   www.instagram.com/karalowentheil https://unfuckyourbrain.com/ Take Back Your Brain https://amzn.to/3RufcoX https://unfuckyourbrain.com/   Check out details for my retreat: https://ascendretreats.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

242. Modern Sex Challenges with Dr. Marianne Brandon Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com Check out my retreat March 2024! https://ascendretreats.com/ Dr. Marianne Brandon is a clinical psychologist and Diplomate in sex therapy.  Dr. Brandon is the author of “Monogamy: The Untold Story” and the ebook “Unlocking the Sexy in Surrender: Using the Neuroscience of Power to Recharge Your Sex Life”. She is co-author of the book “Reclaiming Desire: 4 Keys to Finding Your Lost Libido.”  Dr. Brandon makes cutting edge research on relationships and intimacy accessible for the general public — advice that the people are clearly starving for. Consider the stats:   Over 50% of marriages end in divorce    Over 40% of women and 30% of men report a sexual concern     20% of marriages are “sexless”     Over 20% of women report “marked distress” about their sexual relationships  Approximately 30% of spouses have had an affair Dr. Marion Brandon highlights the challenges of sex in society, the lack of comprehensive sex education, and the nuances of pornography. Dr. Brandon also explores the complexities of monogamy, the impact of AI and sex tech, and the role of power dynamics in relationships. She emphasizes the importance of treating couples, not just individuals, and the benefits of having a biopsychosocial perspective. The conversation explores the importance of hormone changes in midlife and the impact it has on sexual health. It highlights the lack of awareness and treatment of genital urinary syndrome, which can significantly affect relationship dynamics. The discussion also addresses the lack of knowledge among physicians regarding available treatments. The impact of intimate connection on overall well-being is emphasized, and Marianne Brandon's Psychology Today blog is recommended as a valuable resource. Comprehensive sex education is lacking, particularly in the digital age. Pornography can be a complex topic, with both positive and negative aspects. Monogamy can be challenging and requires effort, communication, and mindfulness. The rise of AI and sex tech presents both opportunities and concerns. Power dynamics can play a role in sexual relationships and can be explored in a healthy way. Understanding hormone changes and desire discrepancy is important in addressing sexual issues. Treating couples as a unit is crucial for addressing sexual concerns. Taking a biopsychosocial perspective can provide a more comprehensive understanding of sex and relationships. Midlife hormone changes can have a significant impact on sexual health and overall well-being. What to do when the man has a low libido. Genitourinary syndrome is often under-treated and can lead to changes in relationship dynamics. Physicians may lack knowledge about available treatments for sexual health issues. A satisfying intimate connection has a profound impact on relationships and overall life satisfaction. Marianne Brandon's Psychology Today blog is a valuable resource for information on sexual health. The testosterone conference for clinicians is an important event for learning about biopsychosocial and hormonal aspects of sexual health. She asks her clients about their best sex ever because I can learn a lot about them from this memory.    https://www.drbrandon.net/ https://www.psychologytoday.com/us/blog/the-future-intimacy twitter @drbrandon https://www.instagram.com/drmbrandon/   Harvard Testosterone Course https://hmstestosteronecourse.com/ Check out details for my retreat: https://ascendretreats.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

241. Myths and Truths - GSM and Pelvic Hormones Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com Check out my retreat March 2024! https://ascendretreats.com/ Myths about vaginal estrogen What is GSM - genitourinary syndrome of menopause? The original “use it or lose it” paper. Communication in adult sex ed is very important. Non-hormonal options for GSM We discuss vaginal DHEA My opinion about loading doses for vaginal estrogen Hacks to get cheaper vaginal estrogen – Cost Plus Drugs, Good Rx, Amazon Pharmacy Medication options for GSM and why I have a cream bias Access issues for vaginal estrogen When vaginal estrogen doesn’t work Why vaginal estrogen is a life long medicine Women post menopause have less estrogen in their bodies than men. Vaginal Estrogen is a preventative medicine. It’s role in preventing genitourinary syndrome of menopause. My opinion on the applicator for vaginal estrogen cream. How vaginal estrogen helps overactive bladder symptoms. When our understanding of estrogen is minimal, we don’t understand how it affects our overall health. Should we be treating the female partner when we give men Viagra? I discuss the gender bias in treating humans in medicine with aging issues. How can the medical community do better? The problem with the FDA black box warning on the vaginal estrogen product. Is it okay to put estrogen cream on the penis? How to help our kids and the next generation. https://uronurse.com/ Check out details for my retreat: https://ascendretreats.com https://marcella-hill.mystagingwebsite.com/wake-her-up-retreat/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

240. Sex After Cancer What are possible sexual issues after cancer? What are treatment options? How can we do better talking about it? Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com Dr. Laila Agrawal is a medical oncologist specializing in breast cancer in a community setting at Norton Cancer Institute in Louisville, KY.  She is a fellow of the International Society for the Study of Women’s Sexual Health and has a sexual health clinic for women with cancer.  How she went from oncology into sexual health after cancer? The importance of vaginal health after cancer treatment. Why does no one talk about breasts as sexual organs?  How does this affect the breast cancer conversation? We discuss options. Things to know about sexual health after cancer diagnosis: It is biopsychosocial The role of body image in impacting sexual health The role of prevention of sexual dysfunction after radiation – vaginal dilators. The ACOG statement supporting the safety of vaginal estrogen after cancer. We discuss different vaginal estrogen products and vaginal DHEA. The role of testosterone when you are on aromatase inhibitor after breast cancer. Use of non hormonal FDA approved products for low sexual desire.   Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed   Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed  Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership  https://www.instagram.com/drlailaagrawal/ @drlailaagrawal on X --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

Menopause in the Workplace and Estrogen After Breast Cancer Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment. Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com -       Female physicians want to back off work secondary tomenopause symptoms -       The huge financial burden and loss to the workforce because of untreated menopause -       One of the largest groups in poverty in America is women over age 80 -       I report on the Evernow survey of menopause in the workforce -       I discuss Avrum Bluming’s article in the May 2022 Cancer Journal – Estrogen After Breast Cancer – is it time? -       I discuss the progression of prostate cancer survivors being given testosterone over my career and how I think breast cancer will be headed this way too. -       The efficacy of estrogen in preventing hip fractures. -       The longevity benefit of taking estrogen The risk of pulmonary embolism with pregnancy, birth control and menopause hormone therapy  -       I discuss three paradigms coming in the future with hormones – hormones after breast cancer, hormones in women greater than 10 years post menopause, and hormones in perimenopause Evernow menopause in the workplace Dr. Avrum Bluming’s article Bluming, Avrum Zvi MD. Hormone Replacement Therapy After Breast Cancer: It Is Time. The Cancer Journal 28(3):p 183-190, 5/6 2022. | DOI: 10.1097/PPO.0000000000000595 Estrogen Matters Book Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

238. Testosterone: An Education  Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment. Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com Dr. Khera lives in Houston, TX practices at Baylor and has dedicated his clinical and research efforts to three main areas:  Men’s Health, sexual medicine, and hormone replacement therapy.   His basic science and clinic experiences have allowed him to thus far give over 250 lectures at scientific meetings throughout the world, publish over 120 articles in peer-reviewed journals, complete 15 book chapters, and edit and write two books, all in the field of sexual medicine and Men’s Health. Why is testosterone so interesting to Dr. Khera? Testosterone and prostate cancer – what do we know. Is a lowering Testosterone in men "natural"? and if it isn’t, what causes low testosterone in men? What do the new weight loss drugs do to testosterone levels and male fertility? We discuss the different ways you can give testosterone to women: topical, pellets and compounded injectable doses of testosterone for women: 50mg/ml and start at 0.1 mg injected a week. The benefits of testosterone for women besides low libido. The role of chronic pain and testosterone and pain meds. The mechanism of how your testosterone goes up when you lose body fat. The four pillars of health for natural testosterone production – diet, exercise, sleep, stress reduction Erectile dysfunction is a harbinger for heart attack and heart disease. “There is not a better barometer of a man’s overall health than his sexual health” – Dr. Khera The role of DHEA (a mild androgen made in the adrenals) in men and women. The link with Peyronies disease and Testosterone. And we discuss penile stretching devices. We discuss a 2013 Finkelstein article – they gave men testosterone and blocked its conversion to estrogen. So are we undertreating men by not addressing their estrogen? Dr. Khera was  part of the NEJM study that came out this summer looking at T in men with low T and high risk CV risk. The Traverse trial. Conclusions: In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was non-inferior to placebo with respect to the incidence of major adverse cardiac events.  Barriers to a testosterone prescription include that it is a regulated medication, a physician needs a DEA license to prescribe it – similar to a narcotic. Dr. Khera lends his opinion to safe prescribing of testosterone but thinks the DEA regulation is here to stay. He clarifies the number of men who suffer from hypogonadism and the number of men who are undergoing treatment for this condition? Testosterone levels are dropping because men are getting less healthy. Dr. Khera talks about measuring a baseline testosterone level in men as a marker of overall health and focus on lifestyle changes to naturally get this normal. 50% of men don’t talk to their doctor about their erectile dysfunction, and 44% of those men don’t talk to their partner about it. www.instagram.com/drmohitkhera Dr. Mohit and Dr. Morgentaler’s testosterone course ⁠NEJM article discussed: Gonadal Steroids and Body Composition, Strength, and Sexual Function⁠ ⁠Traverse Trial https://drmohitkhera.com/ Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

237. Libido/Desire Differences in Partners Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN  uberlube.com  Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment. Dr. Jennifer Vencill (she/her) is an assistant professor, board certified clinical health psychologist, and AASECT certified sex therapist at the Mayo Clinic in Rochester. Her research focuses on sexual health and health disparities in marginalized sexual and gender communities. Dr. Lauren Fogel Mersy (she/her) is a licensed psychologist and an AASECT certified sex therapist. She received her doctorate in clinical psychology and completed her postdoctoral training at the University of Minnesota’s Institute for Sexual and Gender Health. She has advanced training in Emotionally Focused Couple Therapy and Gottman Method Couple Therapy. She specializes in sexual health and relationships and owns her own private practice in Minnesota.  Why did they needed to write a book about desire? Desire discrepancy should be part of adult sex education "Your desire should match your partner" is a myth. Why do we want to blame someone or make someone be the problem in a relationship for having a low libido. The stereotype is that the low libido person is the female – but that is not always the case. We define responsive desire. Four requirements for responsive desire – consent, pleasure, focus, time When you have sex for your partner or fulfill a duty – if this is the default or only motivator for sex it can really affect your desire. Tips for getting out of this pattern. We talk about shame and sex. Your sexuality does not exist in a bubble. We suss out asexuality versus low desire. Asexuality is a self-identity label and a valid sexual orientation. What to do when not attracted to a partner anymore? Is attraction as fluid as desire is? We talk about “sexual destiny” beliefs versus sexual growth beliefs and how these can hurt and benefit our relationships.   Tips for the high libido partner. Reducing pressure on their partner and managing their rejection and disappointment reactions. Consider what you are longing for when you seek sexual connection or sexual frequency. Tips for “trying to conceive" low libido Is “desire discrepancy” in a relationship a deal breaker? Not usually. What to do when your partner stonewalls you or doesn’t want to work on the relationship.   Dr. Fogel Mersy Instagram, Facebook, and TikTok @drlaurenfogelmersy  Dr. Vencill www.instagram.com/drjennifervencill. Get their desire book onAmazon Desire: An Inclusive Guide to Navigating Libido Differences in Relationships.   Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed   Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed   Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dr. Sonya Ephraim, a urogynecologist and founder of Allure Pelvic Wellness, shares her insights on pelvic organ prolapse. She discusses the stigma surrounding this condition and emphasizes the importance of open conversations about women’s health. Topics include the risk factors for prolapse, especially post-menopause, effective treatments like pessaries, and the role of pelvic floor therapy. Dr. Ephraim also addresses common misconceptions about bladder prolapse and explores options for managing intimacy and body image during treatment.