EPISODE 38: midlife vj’s…Use 'Em Or Lose 'Em

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If you really have no sex drive, and there's no relationship issues and you're really trying Sometimes you actually do get some testosterone. So you would go to your doctor and say, I need to get laid. I'm not. How can you help me out?

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Hey, peeps, welcome to the flexible neurotic podcast. I'm your host, Dr. Sarah Milken. Yeah, you heard that right. I'm a real PhD doctor. Long, long ago, like last fucking year. I was sitting in the midlife funk wondering, was this it for me? That day, I realized I needed to get off my ass and start my midlife remix. I dusted off my PhD wipe the menopause, sweat off my forehead, grabbed my golden shovel and started digging deep to all my midlife pitches. It's not just luck, coffee and hormones that get you through your midlife remix. It's action steps. Let's do this.

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Hi, good peeps. This is the next episode of The flexible neurotic Podcast. I'm Dr. Sarah Milken, the flexible neurotic. Today I have another vagina expert gynecologist who you are going to love. We're adding another dimension to the midlife vagina remix. This guest is a board certified urologist with a subspecialty board certification in female pelvic medicine and reconstructive surgery and has over 20 years of experience taking care of women's most intimate needs. She's an Associate Professor of Urology in obstetrics and gynecology at Cedars Sinai Medical Center and as the Associate Program Director for the Cedars Sinai urology residents training program. Prior to joining Cedars Sinai, she served at the Memorial Sloan Kettering Cancer Center urology department, where she gained extensive experience in pelvic reconstruction following cancer treatment. Are you impressed yet? Now I sound like I'm like, Why do I really do all that?

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And we're all now.

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Amazing, and she's the co founder of blissart. An intimate lubricants company created and design for the woman who knows what you want, and elevating the female intimate experience. For today. She is our midlife sex orgasm and lubes Doctor slash coach. Her name is Dr. Karen i over. Hi, Karen. Hi, Sara, thanks so much for having me. I've been looking forward to this because if it's anything that I will talk about, much to the chagrin of my children, Regina. Oh my god, I'm so happy. My kids are at school today because my daughter's like she's 15 she's always like, are you doing like another vagina?

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He's like, everything relates to the vagina. And I'm like, What do you want me to do? It's kind of like a midlife thing. Actually, it's really funny. Now you are mentioning I now remember a story I think. I think it was Pamela Salzman actually, my son went to her house the first time I went to pick him up and I hadn't met her. So when I went to get him, I introduced myself. She said, Oh, so I hear your vagina doctor. I'm like, yeah.

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No, I like I added my thing by sums all like seven or eight. And I'm like, why don't you just tell her like, you know, I'm just a doctor is like, because you are a vagina, Doctor, I guess they mean, you got it, you know?

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You just got to call it what it is, you know, you know, I mean, they always say you shouldn't use like little pet names and stuff with your kids. And you should just call it what it is. But my daughter daughter's like, Why do you have to use that word like every day in every conversation? I'm here? No, it's interesting. You say that we literally we mean my colleagues and I just submitted a little research abstract about censorship of the word vagina. There is no other word. Like at least it is medical or scientific. The word is vagina. But yet we're so embarrassed to say we say the JJ we given nicknames, all this kind of stuff, which is so interesting. So even, you know, the Vagina Monologues without being advertised in New York Times, they could not print the giant. It's crazy, because I didn't I actually did an episode. I don't know if it will have come out before you or after you. But it's a woman who has a book called pussy yoga. And we talked about this word because Pussy is so triggering for people. How does How is it interpreted in your world?

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Um, I mean, nobody would really say that. If I use

Unknown Speaker  like your world, like when you're talking with your friends as a gynecologist, like, is it still super triggering?

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You know, I mean, you're asking like a biased audience here. I mean, I use like, a million times a day. So I mean, and also because I, it's been so censored, like I probably intentionally use it more than I need to like, I just feel like

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The more we call it something else, we reinforce this shame that goes along with vagina like, where it's such a taboo topic. We can't even call it by its real name. I know. Do you think penis is as disturbing to people as vagina or pussy?

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I don't I mean, but it's, you know, it's also like when the slides like when you call so I guess we use Dick a lot. Right? Right. Right. And but and yet, Duke doesn't seem to be.

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You know, it's a great question. And so back to her researching the word the censorship of the word vagina. I think it was an episode of Grey's Anatomy where they said penis like umpteen times and they never said vagina by its actual name. I think it was like the infertility episode or something is so interesting. And you know, I've been on TV interviewed a couple times and I remember going right before we went on, they said we can no you can't say the word vagina. I said, Well, what in the heck am I suppose so you have to say down there or a woman's part. So it's so interesting how we think we're so progressive, and we're still not unfortunately, I find that sexual health is like mental health. We like to say we understand it we're here to help you I talk about it but it still makes everybody not everybody but a lot of people on call a lot of people that for people like you who say the doing as much as I do.

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You know?

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Just normalize my own heart. Oh, my God, my kids are like who are you in? What the fuck is happening here?

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Okay, so I want everyone to get ready. We're gonna chat the orgasm gap, what it is why we care and how we can maximize sexual midlife mechanics and pleasure. Do the midlife pleasure toolbox, all of it. We're gonna dig deep with my golden shovel to get through getting in touch with our sexual health. Picking a lubricant and diving into midlife sex flirtation. Are you ready, Karen? I'm so ready. Golden should shovel ready? You have your perfect blow dry happening. You're looking good. You just described my whole life like the show.

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I feel to trust. Drop the mic. We're done. Yeah, we're done. Pink mic down. Here we go. Okay, so the intention of this episode is to talk about the importance in midlife, sex and pleasure. Why do we need to use our vaginas? Use it or lose it managing our own sexual health including sex hormones, pelvic floor strength, and ways in closing the orgasm gap. Sex is hard and embarrassing to talk about, like we just touch upon, especially for women in midlife. I mean, you and I are talking about vaginas all day long, apparently. And apparently everybody else doesn't. I was interesting when I did my first episode on vagina stuff with Dr. Sherry Ross, who I love. Women were like going crazy sending me DMS and messages like, oh my god, I'm so happy. You're talking about this. It's like I had this question. And wait, wait, you could put coconut oil in your vagina like, and it was like all these questions that women had, but they were too embarrassed to ask, like, Who are you going to ask like, you go to your doctor? I mean, you're a doctor, gynecologist, like, Do women really want to stop and talk about all the intricacies of their sex lives with you? I mean, I think in general women, like talk to them about, you know, with somebody, whether it's me or not, you know, so, since I do a lot of female pelvic reconstructive surgery, your sexual or a woman's sexual function is very important, right? Because I don't want to do anything that's going to impact that. So it is a natural conversation for me to have with a woman about that. And I think part of the star of that conversation is to normalize it. And you know, I still think it's cute, too. I've had patients who have been with me for years, and they'll preface a question with, well, I'm kind of embarrassed to ask, I'm like, Listen, honey, I have been your vagina so many times. Like if you can't ask me like, I don't know, I'm

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and but it's, it's true. Who do you ask? Because, you know, and I find this disappointing. I always like talking to my non doctor friends, because I get reminded about how, as doctors we forget, you know, we're we still need to make a connection. And my girlfriend said, you know, I went to the doctor the day and I had my pap smear. It just felt so transactional. Yeah, and that's and that's hard to have a conversation about your most intimate parts when you feel like you're just having a transaction Hey, I paid my copay to my vagina. I'm out of here. I know you're like in the stirrups and you have bills, but feels like this, like giant Q tip shoved into your vagina and not like metal thing and you're just like, ah, the last thing you want to do is be like, oh, when I'm in bed and my husband blah, blah, blah. It's just just to feel like the time and the place. Well, it's not and quite frankly as also my non doctor friends constantly remind me it's not like

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doctors get to the crop. So it's hard to talk to people about their sexuality if you're not comfortable with your own. Right. And so, you know, if anybody has walked away from this podcast today, you do have to be a little bit of squeaky wheel. So if you want to talk about it, you do have to bring it up. And it's not your doctor doesn't want to talk to you about it, but it's not necessarily top of mind for them either. And just like Sherry Ross, like she is, she's great. Women have to know there are certain doctors who are better equipped to discuss this with, especially, you know, doctors who are open to hormone replacement, different things, alternative ways of having orgasm, you know, and it's typically a gynecologist who specialized in, you know, either sexual dysfunction or, you know, urologist like myself who specialized in female pelvic medicine, because that's really what it's about. It's hard to see like your general doctor about something so specific. Yeah, I totally agree. I mean, I've been to probably three different gynecologist and my main gynecologist up through having my children was a man. And I adored him. But I mean, I don't remember really talking about my sex life that

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well, when you were young enough to still be having kids, your sex, I probably wasn't.

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I don't know. We just weren't talking about all that kind of stuff. But then I go to Sherry Ross, and she's like diving deep. I'm like, Okay, I have lunch yet.

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About this, like, I'm dying here. Oh, my gosh, this is hysterical. Okay, so I think that, like I read somewhere that some women see up to six gynecologists in midlife. What's the story with that? Like, why can we not find the answers that we're searching for?

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It? I think one issue is, you know, unfortunately, we have a little bit of attention to society. And because of that, I think that some and not just going to college is just some doctors not comfortable with hormones. And that's what we, you know, are seeking. I think also, as physicians, we are trained in very traditional medicine. And so things like bioidenticals and supplements are not a lot of our Forte's. And so if you haven't done your own research, or learn things from patients, you're also not comfortable talking about those things I have come to learn. And whether it's the internet or not, I have more interesting conversations with my patients now than I did say 10 years ago, I saw a cute cartoon where the patient's sitting across the desk from the physician. And you know, the I think the byline is like, I already did my research on Google. I'm just here for a second opinion.

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But I think it's great because they come with really well thought out questions. And together, we can find out, hey, maybe this is best for you. Or you know what, I don't necessarily think it I agree with you. But if you want to try that, I don't think it's gonna harm you. So that's fine. And these are not typically how we are trained in medical school to have conversations. So our more sophisticated patient these days, has to find. It's like matchmaking because like, if somebody asked me for a referral, I had to think about like, are they going to be a good match? Totally. Yeah, I feel like with the gynecologist I've been to I'm like, Oh, she doesn't really talk that much. She's not answering like 47 questions, she's only answering three. Or like you said, like, when you come in with, like, sort of non conventional medicine ideas that you've read about or seen. You just want a doctor to be like, yeah, they may not be like, Oh, my god, that's amazing. You should definitely do that. But like, you just want to know, like, is this gonna hurt me? Is there any downside in trying it and some doctors are not open to outside of that Western medicine box at all. And I have to say, if,

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if there had this conversation, say 10 or 15 years ago, and I was still first in practice, my responses are probably very different. And I have to give my patients a lot of credit for opening my eyes to things. So you know, we'll probably talk about the loop later, but the CD, right or like other supplements, like you don't learn about that kind of stuff. And it's really when patients come to you and ask you that it forces you to learn about those things that you can actually have a good conversation with patients. I mean, whether I'm the doctor or the patient, or in and whether it's medicine or any other industry, people who don't want to listen to my questions and my opinions, it's not right for me and you know, you're a smart chick who says vagina a lot like they're not gonna like click with someone who's not gonna have a same conversation with you. Believe me on that

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now with midlife women, why like we start kind of avoiding sex in general, not all of us, but I'm just going to sort of give a sweeping generalization and there seem to be a lot of reasons why women can be avoiding sex.

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in midlife, what it with what you see in the women you're talking to what are those main reasons?

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Well, you just open a hole like

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their sister, but I'm going to, I'm going to answer this as a physician and as a midlife. Okay. But let's be honest, number one, wanting to sleep is not the same as avoiding sex.

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So like, I mean, the thing is, we are juggling our kids. I mean, probably you and I, at this point in our life now, because our kids are older is the first time we're rested enough, we're actually thinking about sex again, totally. First of all, I think it's just a matter of, in many points in my life, given the option of sex or sleep, I'm going to choose sleep. I am exhausted, like, yeah, so that's one thing. The second thing is also when we're so busy, and I think women in general, we take care of other people, like, you're not feeling at the top of your game, and you're not going to gym on time, or like you haven't, you know, cleaned up the hair situation down. Things that are making you feel hot, and the reality is lasting about lingerie. It's like 1982 Oh, my God. Episode with the step for the new Stepford woman. And she was saying how, like her underwear was from Costco. Like, she had a pair from 15 years ago that were like Brisbane underwear. I mean, so it's like, it's like, you're set up for failure. I mean, the whole situation. And then, you know, we have like, media and all these things like that make us think like, Well, gee, you should just get in the mood. No, that's so what happens is like, all of a sudden, like a hot flash, it takes your body over his house, and like getting in the mood takes you over. It's really more situational, which is why like, we talk about vacation sex, it's like, I need to have time to relax, and nice dinner. I've actually like, grew myself from head to toe. Now I'm ready to get laid, you know, it's

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like, oh, like, sometimes after sex. I'm like, I really don't want to take a shower. But I feel kind of like, gross. And I don't think I'm able to sleep through the night just like feeling like dirty and gross. And I'm like, I'm not having sex. Because I don't even want a shower. And I went take a shower. I'm like, It's too much work. And like last night, like, we just moved to this new house. I don't even have a lock on my door. And then my daughter walks in at like 11 o'clock at night. And like, what are you doing in here? Like we're sleeping, but I'm like, I could have been doing something else. And she's like, I need cotton balls. I'm like, Are you joking? Like, what's happening here? You know? So it's like, even though my kids are teenagers, it's like, they're still in the house, of course. Well, and it's not like, so, you know, I live in a place where the houses are very close together. Right? And so there's something about having intentionally muffle yourself or, you know, it's just, like, totally let loose. You know what I'm saying? Like sex in the bathroom. Hurry up. And now I'm like, we don't have any window coverings. You know, it's like everything like everything. I mean, like everything. And my husband's like, sir, you come up with an excuse for everything. He's like, in college, you'd be like, I can't have sex right now. I'm thinking about graduate school. And he's like, What does graduate school have to do with having sex right now on a Thursday in college? I'm like, I don't know. My mind is somewhere else. You know, it's hard for them to like, because men don't really multitask a lot. Like yeah, we can have sex actually think about like when the laundry has to be put in everything else and like, which is probably also why and we'll talk about like his whole, like deficit orgasm for women, but it's just it's very different. So I do think it's important to specify, I don't know that women are always avoiding sex, versus it's just not convenient. Oh, it's not convenient. But I also think there are some issues like a lot of women in midlife or at least my friends and myself. It's like UTI land. Sure. And it's like oh, I have a UTI. My husband's like Do you have a UTI every fucking month? I'm like, yeah, pretty much. No, yeah, cuz we have sex once a month.

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To deal with UTIs and mid lifers, like, I mean, I am a pretty clean person hasn't I'm sure your hygiene has always been the same. It's not a hygiene issue. What's the deal with that? Is it estrogen? Is it like not showering after Yaks? No, no, come on. I mean, when we were younger, you can't have sex with each and every shower for like five days until I mean, the problem is, even if you're not menopausal, right, starting probably 35. A little bit older, we're very getting Peri menopausal, which is why it's much more difficult for a woman you know, who is closer to 40 to get pregnant, say someone in her early 30s. Those really subtle hormonal changes can actually affect our normal vaginal microbiome, which is a fancy word for saying we have a cesspool down there. We don't have as much good bacteria as we need to keep the bad bacteria in check. It just makes us more prone to infections. So how do we keep our mid life Mike? Is it microbiome and your microbiome? Yeah, okay. So how do you how does it midlife for keep there

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vagina vaginal microbiome in check, like, Are there three tips to the microbiome? Whatever? Sure. I mean, you know, unfortunately, there's not really a good vaginal probiotic. Okay. You know, because if you think about it, like if you take a probiotic by mouth, like when's the last time something you took in your mouth end up in your vagina that's not supposed to right? So the best probiotic, if you will, is avoiding antibiotics. So reflexively, every time a woman feels, you know, different down there. And I will accept the blame for my field, we throw antibiotics at you, which tends to propagate the problem, because that's not the underlying issues. So number one is don't always rush and take antibiotics. Second thing is, if a woman has already started to experience vaginal dryness, that is definitely an indicator that her vaginal estrogen level is lower. So you can actually take just a vaginal estrogen supplement or prescription to put inside the vagina to help with that. Or if you're fully menopausal, you might think about hormone replacement.

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And then the other thing is trying to avoid things that will make the vaginal pH abnormal. So believe it or not, our vaginas are actually pretty acidic, like those lactobacillus acidophilus actually made lactic acid. Like who knew we had some like acid.

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So it's really just maintaining that hormonal balance. And you know, there are some women who noticed that it's certain times the month the month, they're more prone. That's because our pH probably also varies a little bit with our cycle. I wish I paid attention that much, honestly, like, I wish I couldn't even give you a pattern, but it makes me think about pH like cleanser. You know how there's a lot of cleanse cleansers or vaginal intimate products that are like, this is pH balance for a woman? Is there validity to that and should be we be rinsing out our vaginas with a PH balance sort of soap. So generally, no, I mean, the vagina really is a self cleaning oven. They say that But Karen after you work out and you've been wearing leggings and having a swampy crotch vaginas do all day. Don't you want to put like a dab of soap in there? That's I mean that's external smells but yeah, right but you don't necessarily so that's why it's all semantics to so a vaginal cleanser when when technically a vaginal cleansers induce right? For the vagina goes inside. And most of us do not or should not do so moderate. Right? So the other cleansers, it's not really like vaginal pH because it's really external. Interestingly, most people don't really realize the external is not really your vagina that's like your labia what they should just be calling it like a female intimate washer or something. Yeah. And that pH. I mean, although it should be mild, the external is really more like regular skin is the inside of the vagina. It's more sensitive. Okay, so can we is it important to use a pH balance cleanser for the post workout, like vagina parts that are outside? I think it's probably more important. I think cleansing is probably the most important part. And I think cleansing listening is not irritating. I mean, I've had patients who they get a little crazy, and the more you wash also, it's just, it's not good for your skin, it gets too dry in here. So I mean, honestly, I think externally anything that is mild is probably I remember a doctor one saying you could even use like Satta fell or something. Yeah, it's nice and mild. It's a breadth of great cleanser. That's why dermatologist recommended a lot.

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Now, you say that women are not avoiding sex, but maybe you are.

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Yet to the few are or to generalize to.

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So UTIs are an issue, obviously. I mean, I guess personal body image is also an issue just because as we're getting older things may not be looking the same as they used to or feeling the same. So maybe perhaps you don't feel as like, Ooh, my spouse is gonna be interested in me, because now I've gained 15 pounds or whatever. Or maybe it's vice versa. Maybe you're on track to yourself, because

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they need 15 pounds. But you know what the great line is my turn on is the retainer.

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Yeah, he's like, I'm like you're wearing a retainer, and you're talking to me, and yes, I have known him since I was 13. But I don't see him as a 13 year old. So I'm like, can you please not talk to me with your retainer? And then he says to me, Oh, it's so much fucking better with your oily, weird retinae face. And I'm like, Okay, well.

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I'm like What is better or worse, the oily retina, a weirdo combo face or the retainer. I'm actually going to go to the dermatologist later get my like, peel on that. Like it looks like it looks like a baby to get done.

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And then like Cosmelan? Yes. Oh my gosh. It's the best one is with all complexion. You can't really use lasers. I know. That's the problem. We're gonna have to talk about that because I don't have a whole I got even though I'm not a dermatologist, I got a whole episode. Oh my god, I definitely need that for sure. But you know, even even though women have some body images, and I'm sure you've experienced the same thing, I feel like you bet to a certain age like 40 ish, whatever. And actually, you're like, you know what? That's me. Yeah. And I and I do think our confidence actually increases. So I would say by image for a woman with a steady partner is probably not an issue. Now, I do think it is really difficult for women who are newly single in our age group, because society makes us feel extremely insecure. Right? Single men our age who are successful are totally high. Single women are a true successful are intimidating, or, you know, they're competing with like women who are 30 years. They're a junior. And I've had several women come to me for vaginal tightening, and I go to exam that I'm like, your vagina is like, perfect. And it's because whoever they were with said they were to lose them like, Yeah, I think whoever you're with was too small.

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I love that that is so right. So some of the body image is probably falsely induced by people who have their own insecurities, quite frankly, it's funny, because I just did an Instagram post about the city about sex in the city and all those characters coming back, you know? Yeah. And it was interesting because it so many people are fired up about it, because I was talking about how on one hand, it's like Sarah, Jessica Parker and the other female co hosts, like they're aging, they have gray hair. This one has Botox, the other one doesn't, blah, blah, blah. And everyone's making a whole big stink about it. Yeah, we're all watching Yellowstone with Kevin Costner who I don't even know how old he is right now. But he somehow he's like, fucking hot smoking.

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On his ranch with his son dried face, you know, but it's like, it's interesting how we can view age so differently, and how a man can sort of get old and, you know, kind of enter his golden years, but women are sort of like put out to pasture. We're hEGGs we just become hags become better, we don't become better with age, we just get them heads.

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Is it true that up to 80% of women never experienced vaginal orgasm?

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Um, well, do you specifically mean that orgasm orgasm in general? No vaginal orgasm, because most most women can reach the clitoral type orgasm, but not the perpetration, right? Correct. That's probably that's probably true. exact statistic.

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Because the vagina doesn't have all the nerve endings like the clitoris does, like the concentration of urban nerve endings is like 1000 fold in the clitoris. I think also, a lot of women, you know, once you had a vaginal delivery, everything is really different down there, which is drives me crazy that we have, you know, one health class and like junior high, and then you're kind of sent out to figure the rest out, you know. And so I see, again, because of the nature of my practice of pelvic reconstruction, I see a lot of women who come who've had a baby. And things are just not the same down there. And she feels very alone and ashamed. And again, who does she talk to about this? And when I tell her, it's normal. And my favorite analogy is, if I took a golf ball and shoved it through your nose, you would not be surprised that things were not functioning the same. And yet, women are totally taken by surprise that their vagina is not the same as before having a baby and God forbid anybody tell her that beforehand? Right? Well, I mean, I had to see section. So I can't speak to, I guess my vagina shape changing from a birth canal delivery. But having C section scars is nope, not pretty either. It's sort of like, I don't know, if you're having a baby, you're having a baby gotta move on somewhere. Right, right. I mean, so again, I'm like, totally biased audience. So I'll probably be like, buoyed by all of this attrition thing, but like, I have three elective C sections because of what I do like I you know, I'm, I'm the type a control freak, you know, pelvic floor reconstructive surgeon who doesn't want to resolve at risk for these things.

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But it's interesting, too, like we tell women, they should have informed consent, but we actually don't offer women all of their delivery options unless there's an actual medical problem, where technically a woman can have elective C section, but we actually discourage them from doing

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that, in fact, the insurers discouraged the doctors in doing that by saying, well actually penalize you if you would see, like the national average of doing these actions, right? Well, I had my first C section, Jake, because his umbilical cord was too short.

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So and then so then you start once you have one C section, as you know, you're sort of like almost 100% having another one. And there was no way I was having more than two kids because oh my god.

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No, pregnancy and I are not a good luck. Let's just put it that. No pregnancy and it's it was a means to an end for me. I mean, honestly, people were like, Oh, you must have been such like a skinny pretty pregnant person. I'm like, actually, no, and they're like, We don't believe you and I send them a picture. They're like, Okay, you're right. Yeah, I was I was disgusting. I was literally half my body weight, like added on my I was the first of my sisters to get pregnant. And they didn't tell me to after the fact. They're like, yeah, when we saw you all decide we didn't want to have kids. Oh, I was like, it was not a pretty situation for me at all. And and then after my C section, somehow, I was like, 15 pounds heavier of water weight. Yeah. Here's the disappointing thing, right? So you're huge already. And then the baby comes out. And then you look down. You're like exactly the same, except now you're floppy.

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God, there's so many things and you're like, is this shit ever coming back together again? Oh, my God. But and you only have to wait another 20 years. We had this conversation.

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I know I have a friend who actually had her. What's it called? Again? Like Sonic clinic. Like when you have your clitoris like when you have everything trimmed so that it kind of looks back how you still plastic? Yeah, maybe it's that and I was like wait really? In Chico? Sarah, I had to it was like, all droopy and disgusting. And I felt like it was hanging out everywhere. And I was like, Oh, I guess mine is not that bad because I didn't have vaginal babies. Right? Well, some of the

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so the labia is actually analogous to the scrotum and a man. So hormonal changes will actually that's why like, when you look a little baby girls, it's kind of pink and small. And then you kind of get through puberty and adulthood. It gobbler. Yeah. So some of it is just hormonal changes, and people will have different responses. So some women will just have their labia growth more than others. And it's not necessarily related to delivery. Interesting. Okay, after keep a track of mine, I actually don't even want to see, you can just post me, you can post images over time on your Instagram, I don't even want to see.

32:40  

Okay, so let's talk about cables for a minute. Because I know that's like a big topic for a lot of people. Let's remind listeners what they are and tell me why they're important and who's doing them right and who's doing them wrong and why we care. So Kegel exercises, you know, will often tell women like pretending you're trying to stop yourself from your eating, I don't know about you, but like, I can't stop myself from pain. So an easy way to think about it is like try like I always tell patients, imagine you're at a cocktail party, you're trying to stop yourself from passing gas, right. So really subtle movement. And it should really feel like things are getting pulled up. So whether you're exercising the front or the back, also, we talked about the pelvic floor, like what the hell is that? Because our pelvic muscles literally aren't the whole bowl with just two openings, like vagina in the front, recommend the back. So whether you're squeezing the muscles in the front or the back, you are theoretically contracting your entire pelvic floor. So that keeps everything stronger. Okay, so as a pelvic floor specialist, what are we doing as mid lifers to keep our pelvic floor strong or to regain strength that we've lost?

33:50  

Well, so doing your Kegel exercises can help, you know, being you know, having sexual activity on a regular basis also exercise your pelvic floor. But as you've already discovered, like, you know, that's not happening all that often. Yeah, there are pelvic floor physical therapists who specialize in teaching, you know, women how to do these and monitoring them on a more objective basis, like in terms of their strength, but who really needs that, like, who are the candidates for that. So women who have loss of urine control or women whose organs are falling, you know, can benefit from doing the Kegel exercises, but, you know, it's like any exercise program, the longer you've been doing it, the better. So like, if you started picking up running when you are 40, you're probably never going to be as good as if you were doing it when you were 20. Right. And the the other problem with doing Kegel exercises, especially women who have had traumatic vaginal deliveries, the muscles actually are detached from where they're supposed to be inserted. And so you're exercising muscles sometimes that are not in the right place. So women get very frustrated saying, I've been so loyal with my cables, I'm not getting better. And so as you can see, I'm a

35:00  

Queen of analogies. So like if you tear your ACL in your game, you can exercise your quads all you want in the surrounding muscles. But you have to fix that ACL. So that's why I'm not saying surgery is the only answer. But I do feel like we give them an impression that Kalos and solve everything. And if they're not solving a problem, it must be because you're not doing them enough. But in reality, you can't strengthen every pelvic floor if the muscles have just been torn out of position. Yeah, and sometimes I think my mother, my mother in law had four children, vaginally, and she, at a certain point, her bladder was like, goodbye. Yeah, she you know what's behind, you

35:40  

know, she had it all put together and it was such an amazing gift. Because now it's like, okay, now I feel like I'm a functioning person. Not pulling your organs or hanging out your body.

35:52  

Now, what's the deal with this chair? The emsella? Chair, I don't even know how you spell it. Is it e? S? S E? LL? A? Yeah. Okay. What is it? What's the deal with that? So the background themselves here, and there has been other ones in the past, I think called the tonus. And what they do is it's electromagnetic stimulation, that just gets your muscles to contract more. So yeah, I've ever used a 10s unit in physical therapy. It's like you see all these celebrities now getting the M sculpt or the you put this thing on your stomach, and it does 50,000 setups for you. Right? Well, so it's like doing 50,000 vehicles for you, right? So you can just kind of sit there and like exercise your pelvic floor. So conceptually, it makes sense. But again, for the same women who tables wouldn't work, the Unseld chair might not, um, you know, and again, the reason I say theoretically is there isn't really a lot of long term data on it, but this falls under the category of certainly can't hurt you. Right? I try and put it hurt you. I don't I really don't see how. Okay, I mean, sitting on a chair, this vibrating. I mean, how could that not be?

37:02  

orgasm in the way?

37:06  

I need to keep your clothes on. So it's not like colleges, but they're like strip naked. And here's a paper robe and I hope you feel super sexy.

37:17  

About your sex life in your paper robe. Right.

37:22  

Okay. People like you talk about, like, their experiences. Because like, we think it's all like just fine. And you talk about this fear, like, oh, yeah, it's kind of ridiculous how I treat that patient. It's like this crunchy paper robe with your feet in these like, Hold weird stirrups and sometimes doctors will have like the shearling on, you know, but with my male OBGYN I, you know, I hadn't known him for 1000 years, and I'd be like, Oh, you're killing me. Like, oh, he'd be like, Sarah, you're making all these noises. I have patients in the hallway. And I'm like, Okay, I'll just explain it to them when I give out but this is not comfortable. Like, I don't want fingers on my ass. I don't want these shoved into my vagina. Yes, it hurts. Yes, it's annoying. No, but we've all got to do it.

38:16  

Now, let's talk about the orgasm gap. Okay, so Forbes Magazine stated that research found that a high percent of women said they always orgasm when they masturbate compared to only 6% during vaginal intercourse. Why is that? I know, we talked about that a little bit earlier. I mean, there's so many reasons. I mean, one is, it's just like, no one knows how to clean your house as well as you do. Right? Maybe though? All right, well, okay, maybe not a good example for you. But like, there are certain things that no one else is ever going to do. Yeah, as good as you write. And so probably and probably there are women who know how to pledge themselves much better than maybe they know how to express to their partner. I do think that there is hesitation to correct what your partner is doing for fear of insulting that person. Sure. And there's also a sense of, maybe if there is any, any, you know, women's orgasm is so multifactorial, right that like, let's say there's any relationship strains, there is no way you're gonna enjoy as much as by yourself. So there's so many reasons why, like I'll say to my husband, I'm like, You're being such a dick. Like, I don't even like want to talk to you. Why am I gonna have sex with you right now? Like, you're so grouchy and annoying, right? Right. Like I even like you. Why would I want

39:41  

he could like hate me and still have

39:44  

beer goggles. I mean, my God, but like, I think what's interesting is this idea that, like women are that women cannot know where those body parts you know where those little zones are.

40:00  

I'm one of them, too. I couldn't tell you exactly where it is and how to get there. But you can because you're a doctor. But don't you remember from that class we had in college? Oh, yeah, that one? No, there was

40:13  

a class and my daughter is in right now the horrific book. I'm like, oh my god, I think we do such a disservice to women by not preparing them, whether it's for pregnancy after pregnancy, how to have a good sex life, you know? So in that same article, I think is you sent it to me, right? A surprisingly high number of men and women don't know the terminology. Just like we go back to talking about a vaginal wash. No, sounds bad. And washes aren't really a vaginal wash. They are an external genital wash. That's all they are. One of my favorite things and I'm so I'll probably get fired for this. But I was doing the surgery one time, and I had a new surgical tech. And so I pointed the clitoris, I'm like, Hey, what's this? And of course, there's like no response. I'm like, that's what's wrong with.

41:02  

Me, here we are. And this is like, you know, right in front of you like and you still can't tell me what it is. Okay, so being a pelvic floor specialist, what do we not know about what's going on in there? And why are so many women not getting that spot vaginally?

41:18  

Because no one tells us or our partners what is right, there's all these like, Miss I mean, there's a G Spot, even that's still. Exactly that's still a hotly debated thing. I mean, and so people are like, probably trying really hard to find a spot when it's like, don't focus your efforts on something that we don't even know is there go back to the clitoris like do all we know work? So do we not know that there is a G spot like when you look into the vagina, like is there there's nothing you can see there? No, the G spa and theoretically as opposed to this kind of condensation of nerve endings, which would only be seen like by pathology, not by the naked eye.

41:58  

Yeah, and like the ones study where they talk about the G's, but I think it was like cadavers of like old people. And so you know, I mean, it's, but honestly, it's back to it doesn't matter whether there is one or not, if that's what feels good to you. Right? Then have your partner do that. But, you know, I think that we're not yet we still snicker about masturbation. Right? And like, it's like, where they say like, 99% of men masturbate the 1% who are lying about it? Yeah. What about but what about the women? Why is there like, we just don't talk about that. And like, if you masturbate, or if you enjoy sex, you must be some kind of a slut or something weird, like, women's sexuality is just now starting to be talked about in a normal way. Right? Because also, when you talk about women's sexuality, we think about oh, and not there's anything wrong with it. But like, you know, some dominatrix whose latex from head to toe? It's like, yeah, no, how about just the middle aged woman who, okay, fine. My life, my sex life has been on hold for 15 years, because I was raising my kids working my ass off. And now I finally have time at home with my husband. When I haven't done something for 15 years. Like, it's really hard to go back to yoga class and do the splits and you haven't been there a long time?

43:11  

Now, what is the deal with vibrators? Like why? Why should we care about them? Why should we use them? Can you become addicted to them? What's the story? You know, vibratory medicine for different conditions has actually been used for a long time. So actually, there's medical basis behind it besides just something feeling good. But what a vibrator potentially can do is increases pelvic blood flow, which is how a man gets an erection, which is how we get aroused how we make our normal vaginal lubrication, and how it actually makes any sexual feeling more intense, if you will. So if you're not sexually active on a regular basis, if you use a vibrator on a regular basis, it can help keep things healthy down there. So even if a woman never takes hormones, if she is sexually active on a regular basis, she probably won't get dry. She probably won't have him intercourse. But even if a woman who is taking hormone regular basis, though, Karen

44:14  

Well, probably level times a week, okay, a couple times a week. I mean, and I always use the analogy of yoga, right? It's so interesting how we totally disconnect our pelvis from the rest of our body, right? Like, if I didn't move my arm for a month, and I tried to it's not going to feel good. Yeah, if you only have sex once a month, you know, why are we surprised? And if it doesn't feel good first time around, that's interesting. And there are women who don't have sex for like years and have hormonal changes. And so if it hurts when she has sex, there's not really a lot of motivation to try it again. And so who no one really explains this to women. It's like okay, well, it's not also just as easy as no pun intended, like hot back in the saddle again.

45:01  

With vibrators I know some people are like, well, I don't want to use a vibrator because I'm going to get addicted to it. And then when I have sex with my husband, it's not going to feel the same. Like, what do you say to that?

45:12  

Well, you can be addicted to drugs, but it still feels the same when you do it.

45:21  

Nobody, I mean, like, if you have, like a battery operated machine

45:26  

that's delivering the certain, but then some people are like, but who cares? Like, probably should couple there's a there was a study that I read that was like, you know, couples who used a vibrator together during sex reported a lot of satisfaction from that. I mean, you can look at it in one of two ways. If somebody is using a vibrator a lot. That means they probably have a pretty good sex drive. Right? Which is, so how can that be detrimental? And you know, it's just, if you can orgasm both ways. Why does it matter of using your vibrator lot or not? But to your point? Yeah, if it's an issue, then just incorporate it into your sexual activity with your partner. I mean, it's it's so funny, too. I mentioned to you an email. We're doing a study on regular use of vibrators. Yeah, so improve overall, you know, sexual function, things like incontinence by increasing blood flow. And one of my male colleagues who said, hey, you know, does your wife want to participate? She gets a free vibrator this and that. And he said, My wife does use a vibrator. We all started laughing. I mean, I and I do think

46:29  

partners probably, again, get insulted thinking like, air partner needs a vibrator like, yeah, I would ask her if I was you.

46:41  

Now, let's talk about lubricant. Since you are the lubricant master, founder of blissart. Tell me about the song, tell me why you started it. And let's talk about the different kinds of lubricants. I'm definitely a lubricant user. Oh, good.

46:55  

So I'm literally after years of women asking like, Hey, I'm dry, what's a good lubricant? And, you know, this was several years ago, like, I didn't know any better, and I was, you know, not needing any then. So again, some of the things you know, is because you personally had to look yeah. So you just kind of recommended some of the kind of common names, you just pick a drugstore, and then lied, or I don't want I don't wanna like name. Yeah. But, um, but then the women come back and say, they actually felt more irritated afterwards. I'm like, really? So then I started looking at the ingredients and like, well, isn't the stuff that we're trying to push for not putting our cosmetics, you know, things like glycerin and parabens, and phthalates, all that stuff. So my co founder, who really was into natural beauty products, before they even saying that, hey, can you help me do this? And also, at the time, believe it or not, lubricants are considered medical devices. And they are supposed to be cleared by the FDA. But since it's not enforced, you don't have to, but because I was gonna put my name on this. I, you know, I said, Well, let's do the FDA clearance thing. Yeah, it was on your website. Yeah. And while this was going on, because it took a long time to get to the FDA, of course, CBD was really becoming more popular. And my co founder, unfortunately, her sister got really ill. And the only thing that helped her pain was CBD. So my co founder says, Well, if we're really trying to help women with pain, we should make a loop of CBD. And this goes back to oh my gosh, women's vaginas are going to get high, you know, because I didn't know anything about it. Yeah. So had to do some research for that. But I mean, CBD really is pretty amazing. I mean, it's like anti inflammatory analgesic, naturally antimicrobial, I mean, it's like the aspirin of like, you know, the supplement world. So that's how we ended up with two different loops. We have the waterbase FDA cleared one. And then of course, CBD is not approved for anything for the FDA. So that's why that one is not FDA cleared. So tell me about the two different is so there's a water based lubricant in general and there's an oil based Bearcat. Mm hmm. Who is a candidate for each and why would you pick one or the over the other. So if you use condoms, you really should be using a water based glue because oil will break down the condom which then defeats the purpose of having random, okay, or people who are really really sensitive water based tends to be more or less less irritating to them, you will so the waterbased really is for you know women who maybe don't need that maybe they lubricate some other but not enough they don't like an oily ceiling or they use condoms. repeated use of toys also is probably better with water base because it can break the toys down also, but most people probably throw their toys away after a while before their grubby anyway, so it's probably not that much of an issue. And then women who really have a lot of dryness or a lot of pain like CBD oil based one, I think is hands down, like the way to go and which one

50:00  

Is that on your website? The black, the one that's black colored is the one that CBD oil based. Okay, again, you're limited if you use condoms for that, right? So what are what have you found with the CBD component? So the CBD well, so it's not just CBD, and we had the really good fortune of working with a Chinese or biologist to mix in all of these Chinese or like Maka or any goat we know all these things that individually, maybe don't really do it, but when you mix together like more atio We'd

50:35  

How can you not put that ingredient your lube, right?

50:38  

That made just for you know,

50:42  

when we got this list of like potential treatments, I'm like, Yeah, we're putting that in. Wow, that's like such a score. But all of these

50:52  

herbs actually have natural vaso dilating effects mean they help increase blood flows, which increases arousal. So the CBD again, it's, it helps with pain, especially when you're prone to infections, because it's antimicrobial can help with that. And all of the other herbs ideally helped to increase arousal by increasing blood flow. In your lube research. Have you found that men are like, Oh my God, my girlfriend or my wife? Like she can't get what on her own? What's the deal with that?

51:21  

So some men do think it's because they're not getting turned on which to address that earlier? Yeah. Interestingly, I'd say close to 42% of our customers are male. Wow. Because if a woman is avoiding intercourse because of paying the dryness, you know, it might not be motivating enough for like your partner hand you like something that looks like a tuba toothpaste. But if they go the trouble of buying you a beautiful package product to show everyone who sees this, and then I will have it on my Instagram. So Karen sent me these they are amazing. I put them back in the boxes. You can see how beautiful they are. Okay, so what's this gold box? This gold? One is the water based one. And then the black one is the oil base whole CBD. Okay, so the black one that's oil base is called sea salt and Carmel. Right? So that one actually has like a little light just kind of and let's face it, things just don't smell and taste good down there. So it really helps that way.

52:22  

So you could use this for oral sex, both of them yeah. Is our DVD one because there is nothing toxic in any of them. You can actually spray the CBD lube in your mouth and you want to actually just also take advantage of the benefits of CBD just systemically. Wow, you were so kind of have to send these to me, I love them. And I put them back in the box. And I'm like, I actually what's funny is that my husband I think actually ordered another one on his own because Dr. Susan Yeah, because Dr. Suzanne Gilbert lens like, mentioned it and he like listened to the podcast and fucking bought it. He never buys anything. And I'm like

53:04  

we have we have live customers. That's so funny. You realize it's refillable, too. Oh, I didn't know that. Yeah, so the outer shell you can actually if you take off the Yep, just connected where the kind of square gold part is. Don't just try to work it out. Yeah, it's a model. Wow. Amazing. Oh, wait here. I'm getting it out here.

53:27  

Wow. Yeah. So I can just reorder just the refill. And so I can actually eat this right now. Uh huh. I'm kind of hungry. It's lunchtime.

53:37  

Status satisfied? Like just a movie for lunch? But no, but Carmel. Hmm. See? Salted Carmel. Okay, wait, how much are these? So the full size is 55. And a refill is 35. And how like, how many sticks? interludes Do you think one covers so it's about each one is about 400 sprays. People want that people it's so funny cuz classical. How long is last month? How long do

54:03  

you have sex? Because if you're only having sex once a year, it's been last year.

54:10  

I love it. Oh my gosh. Now let's talk about the sea salt lubricating product do you have that seems like an oxymoron sea salt lubricating. Explain that to me. And I want to say you know it's spicy salted caramel when we were looking at different flavors like my co founder I just couldn't do like the cherry lifers

54:33  

are like, I don't want my badge playing like watermelon. Literally Google like you know, top flavors or whatever. And because it's food grade flavor, it's not like fragrance. We also actually tested which ones tasted the venules don't want to overwhelming so it was really just that was the one that the jewel was like so that's what you got. Oh my God. Now this salt scrub. Like the thing that the salt that you put in the bathtub. What what sort of properties

55:00  

Does that have an IT and what are you sort of trying to alleviate or help or whatever? Well, so different salts have like kind of different properties, right? So like sometimes he was that was set like an Epsom salt bath. Yeah, right or like pink Himalayan different salts do have different kinds of healing properties, if you will, and they can't help to hydrate but the sea salt camera was just released. It's just really for flavor for the loop that was not necessarily like, yeah, this the salt itself, guests can do a little bit, but it's such a small percentage to give it a hint of flavor. But that's what's really for it's actually all the other ingredients that really make it what it is. So back to talk about like pH balance. It really is acidic like the vagina is supposed to be it contains lactic acid to hopefully make women less prone to infections that hyaluronic acid which is moisturizing just like us for our skin. It has l arginine, which is one thing that makes Viagra work. So that's why all of the ingredients in both loops were carefully chosen to enhance a woman's own lubrication or in some cases totally substitute a woman's own natural vegetation. I love that and they would be such a made like I said amazing holiday gifts for people because they're so gorgeous. Right? So when you get when your mom she's like with her vibrators

56:17  

like a gold vibrator. That's super pretty. Sarah, you outdid yourself this year with unique Christmas gifts.

56:24  

Like the Glissant stocking stuffer. Oh my god, I love it. I love it

56:35  

in terms of libido, and estrogen, all of these things, I mean, it's such a huge puzzle. I mean, we can't like just say, Oh, get this lube or get this vibrator. It's so many things. Yes. So from your sort of medical perspective, like, what are we doing? Like how do we fix all of this. So that's a great point, you do have to have a certain hormonal balance to have everything functioning correctly, right. And both men and women are libido is mainly driven by testosterone. So that's why taking estrogen alone doesn't guarantee that you're going to also maintain your libido. So that's why sometimes we're going to have to actually kind of venture out and have a doctor who is comfortable enough also prescribing testosterone. In addition, ironically, we don't even know the normal testosterone level. Yeah, and because, you know, it's typically a man's hormone. Um, but you know, if you have a doctor who was willing to bioidenticals during testosterone that way, you know, in DHEA, the supplementary is actually the precursor for testosterone. So if you just need a little bit, sometimes just taking a DHA supplement will do it. But if you really have no sex drive, and there's no relationship issues, and you're really trying, sometimes you actually do get some testosterone. Okay, so you would go to your doctor and say,

57:59  

I need to get laid. I'm not how can you help me out?

58:08  

Dying Oh my god. Okay, now that we have shoveled or shit for today, I hope you love chatting with Karen as much as I have. I've loved digging deep with you with our golden shovels on this podcast. If listeners want to find you, where can they find you. Um, you can go to our website which is blissart love calm. And also my Instagram feed is at Dr. Albert or you can also go to Atlas on love and please send direct messages. We love hearing questions and also just helps me to write blogs give me ideas about what people want to hear about. Okay, now you have to spell Glissant GLIs S A N T which means slippery in French. Ooh.

58:56  

spell your last name. E I L V er I over okay. See, it's not that easy. Okay, I want everyone to think about what should they can start doing today. One small step. I want to thank Karen for diving into midlife sexual pleasure and some of the ways we can rediscover pleasure and orgasm in the second half of life. Hence this podcast Dr. Karen Albert. Thanks so much.

59:27  

Hey, peeps, it's me again. I listened to this episode with Dr. Karen Oliver so I could summarize the golden nuggets for you to have actionable items to start using today. I know that when I listened to a long episode, I'm like, oh my god, I love that. But now I can't even fucking remember what the specifics were of the episode. This is why I come back and do a golden nugget summary. In this episode we discuss midlife sexual health a fucking huge topic for so many of us, and we begin to learn new tools to help understand the midlife change libido.

1:00:00  

Sexual Health the whole thing. Golden Nugget Number one, don't be embarrassed. Communication is key, especially with your gynecologist. I know it can feel awkward at first, but discussing the intricacies of your sex life can make all the difference. Dr. Karen explains that meeting with your doctor doesn't have to be so transactional. Talk to them, ask them questions don't just take off menopause is the answer for everything and you just have to stick it out. There are solutions Golden Nugget number to work with your vagina, not against it. During midlife, we might experience things we never have before. It can be difficult, but don't give up on your vagina. You're in charge of your vagina. Karen teaches us about how to navigate these new issues such as strengthening your pelvic floor, raising your estrogen levels, understanding your microbiome and so much more golden nugget number three, the orgasm gap. It's no surprise that it's not as easy for women to reach orgasm than it is for men and the stresses of midlife can make it even more difficult. Karen reminds us that a woman's orgasm is multifactorial and you have to look at your own personal factors in order to reach satisfaction. I mean look 70% of women cannot achieve orgasm through vaginal penetration and need clitoral stimulation. We have to do the work. Understanding your sexual health and talking to your partner are two factors that we can benefit from Golden Nugget number four, the wonders of lube. Dr. Karen teaches us about the different types of lubricants and why she started her own company Glissant. She explains how lubricants with natural herbs can benefit your body. She also dives deep into the soothing properties of CBD and lubricants. The gold is dripping off these nuggets, grab it use it, there are three things you can do first, subscribe to the podcast. Second is share it with some friends who would like midlife shit. And third, write an apple review send me a screenshot and I'll post it. I can post it anonymously or tag you you just let me know. And of course follow me at the flexible neurotic on Instagram Talk soon.