You Are Not Broken

I went to the 2023 American Urologic Association's National Conference. Here are some top takeaways and thoughts. So much on this week’s podcast! Low hormones in men and women — can increase risk for cardiovascular disease Women have a decreased risk of heart attack and stroke when started on hormones in the safety window of menopause (first 10 years) The Traverse study paper coming out in two months - can’t wait! Testosterone is not a gendered hormone All bones need testosterone Women in early menopause should be on hormones at least until natural age of menopause to decrease risk of cardiovascular disease, osteoporosis (NAMS guidelines and this indication has FDA approval). Equality in healthcare Three new oral testosterone pills on the market for men, not for women We need to focus on brains and bones health in women just as much as we do for men Treat women the same in healthcare Did you know the UK is requiring doctors to talk to their patients at age 50 about menopause? Amazing! If hormones are so dangerous, why don’t we stop estrogen in trans women after the age of 50 - a thought exercise on how we think about giving hormones to all bodies - Is staying on hormones during menopause gender affirming care? Oral DHEA supplements — what’s the deal? Bulkamid — urethral filler for stress incontinence ECoin training Prolapse repair in premenopausal women Should we offer it or no? Male infertility is associated with shorter life expectancy Marijuana affect sperm Using testosterone for maintenance of vaginal health Michael Pearlman balance scale of desire More about Addyi (filbanserin) Importance of elastin and collagen Very small percentage of women have cervical orgasms - but it matters. New technology that @mysteryvibe is releasing to help with period cramps --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

Feeling Broken In The Bedroom? What You Need To Know About Your Sexual Health - With Dr. Kelly Casperson This is an interview I did with Lesley McShane for her podcast “Redesigning Midlife” and it was just such a good interview I asked her if I could share it again.  1. Basics:  a. Menopause means it’s been one year and one day since your last period. b. The average age of menopause is around 51. and c. for ten years prior to menopause, women go through peri-menopause, where hormones are doing a reverse puberty. 2.  A lot of women stop or have pain during penetrative intercourse during this time due to a decrease in natural lubricant and collagen, but this can be easily treated. 3. Even if you don't have menopause symptoms, if you are over the age of approximately 51, you have gone through it. 4. The most sexually satisfied people aren’t young people, it is people in their 50s, 60s, 70s. 5. Great sex is not a passive thing. It’s an active process, just like someone that is physically fit. It has to be prioritized. 6. Use of lube increases your success of orgasm by 70-80%. Silicone based lube is best because you don’t absorb it like you do the water based. 7. There is no “how long” should I use Vaginal Estrogen cream. The use of it is like using sunscreen or wearing a seat belt. 8. You don’t need a “sex drive”. We do things because they are awesome.  If you aren’t having awesome sex, don’t wonder why you don’t desire it. 9. We feel entitled to a spontaneous sex drive that has been sold to us by media. And when we don’t achieve that, we end up feeling broken. 10. Putting something in the vagina only leads to female orgasm 30% of the time so special focus need to be paid to the female body. Your largest sex organ is your brain. 11. Don’t sit passively by waiting for spontaneous desire to happen. Get dressed up and go to the party even if you don’t think you want to. Chances are you’ll have a good time once you get there. 12. Control of stress and cortisol levels in our bodies will help us desire more intimacy. 13. If there is a desire mis-match in your relationship, normalize it by talking about it. 14. Communication with our partner about menopausal symptoms and what we are going through is important to our relationship. 15. Get educated on hormone replacement therapy as an option. When women start thinking about how they want to live as they get older and get educated, then they see how beneficial HRT could be for them. 16. Women between the age of 50-60 that are on hormone therapy live 3-4 years longer than women in the same age group not on hormone therapy. 17. For our young adult children that are starting their own sexual lives, the biggest thing they need to know from the start is about consent. 18. They need to be aware of is orgasmic equality. 19.We have to educate our girls that pleasure is for everybody.  Lesley McShane's podcast: https://podcasts.apple.com/us/podcast/redesigning-midlife-workout-motivation-over-50-weight/id1549596974 Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

Better Sex Through Mindfulness – Dr. Lori Brotto  Dr. Lori Brotto is a psychologist and Director, UBC Sexual Health Laboratory Canada Research Chair in Women’s Sexual Health Professor, Department of Obstetrics & Gynaecology, UBC Executive Director, Women’s Health Research Institute  “Sex is not just a deficiency in a hormone” – KJC Dr. Brotto tells us how she started her sex research career by studying rats. Do stressed out rats want sex? “Stress is antisexual” – Dr. Brotto “So many people don’t even know that they are stressed.” - KJC Dr. Casperson tells her story about finding mindfulness How Dr. Brotto discovered mindfulness for helping manage pain, anxiety, and desire Mindfulness During sex. How anxiety and depression affects our sexuality. And mindfulness can help! We talk about medications for low desire in women. Filbanserin specifically. Beliefs are key!  We discuss the role of beliefs on our sex life. Mindfulness helps us “see” our beliefs more. Anorgasmia – how common it is and what is the most common cause. How to suss out asexuality versus low desire.  Obligatory sex – how to navigate discrepant desire. The myth of penis and vagina sex and why it excludes so many people. Mindfulness for sexuality after prostate cancer. The role of communication with your partner. Do they even want your erect penis? https://www.loribrotto.com/ Better Sex Through Mindfulness https://amzn.to/42bchpj Better Sex Through Mindfulness Workbook: https://amzn.to/42abTYc https://www.instagram.com/drloribrotto/ https://www.cancersexnetwork.org/ https://www.drannekatz.com/   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

“The Cervix is Dumb” and I Disagree – April Live   Giovannetti O, Tomalty D, Gilmore S, Pattison A, Komisaruk B, Goldstein S, Hannan J, Goldstein I, Pukall C, Adams MA. The contribution of the cervix to sexual response: an online survey study. J Sex Med. 2023 Jan 14;20(1):49-56. doi: 10.1093/jsxmed/qdac010   Cochrane review on Cranberry for UTI https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001321.pub6/full   Kisspeptin is a protein that is essential for reproductive hormone secretion and fertility Male kisspeptin study https://pubmed.ncbi.nlm.nih.gov/36735255/   Sexual Tipping Point https://www.researchgate.net/publication/24001856_The_Sexual_Tipping_PointR_A_MindBody_Model_for_Sexual_Medicine   Oral versus Vaginal DHEA Vaginal DHEA is awesome – it is a prescription DHEA oral is a supplement – over the counter   - DHEA oral safety - lack of efficacy good enough reason to not take it?   Dehydroepiandrosterone replacement in women with adrenal insufficiency N Engl J Med 1999 Sep 30;341(14):1013-20.  doi: 10.1056/NEJM199909303411401. 50mg oral for 4 months – decreased HDL and total Cholesterol Conclusions: Dehydroepiandrosterone improves well-being and sexuality in women with adrenal insufficiency. Double-blind treatment of major depression with dehydroepiandrosterone Am J Psychiatry 1999 Apr;156(4):646-9. doi: 10.1176/ajp.156.4.646. Conclusions: These results suggest that DHEA treatment may have significant antidepressant effects in some patients with major depression. Further, larger-scale trials are warranted.   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

The Third time Dr. Haver is on my podcast! The role of sleep, diet, exercise and body image on sex is real. Dr. Haver’s story – she shares her journey of stress, grief and menopause and how “workout more and eat less” wasn’t working for her.   How female body composition changes in peri and menopause   Diets may change hot flashes   Can you measure inflammation?   Fatty liver – goes up in menopause – treatable with diet changes   Anti-inflammatory diet resource: arthritis.org   Supplements for peri/menopause -       Fiber, mag, vit D, omega 3 - - ? DIM ? DHEA   Role of continuous glucose monitors The loss of estrogen increases gut permeability – role of gut microbiome in bone heath –   Tiktok: drmaryclaire IG: https://www.instagram.com/thegalvestondiet Website: https://galvestondiet.com/   The Galveston Diet Book: https://amzn.to/433AsGZ   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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   Better Sex Through Lifestyle Changes – Diet, Sleep, Hormones, Exercise – The Galveston Lifestyle   Try not to eat like shit. The role of sleep, diet, exercise and body image on sex is real. Dr. Haver’s story – she shares her journey of stress, grief and menopause and how “workout more and eat less” wasn’t working for her.   How female body composition changes in peri and menopause   Diets may change hot flashes   Can you measure inflammation?   Fatty liver – goes up in menopause – treatable with diet changes   Anti-inflammatory diet resource: arthritis.org   Supplements for peri/menopause -       Fiber, mag, vit D, omega 3 - - ? DIM ? DHEA   Role of continuous glucose monitors The loss of estrogen increases gut permeability – role of gut microbiome in bone heath –   Tiktok: drmaryclaire IG: https://www.instagram.com/thegalvestondiet Website: https://galvestondiet.com/   The Galveston Diet Book: https://amzn.to/433AsGZ   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

Emergency Department Care of the Menopausal Female   Dr. Pam Dyne is a Professor of Clinical Emergency Medicine at UCLA David Geffen School of Medicine   Common things midlife women go to the ED for – irregular bleeding and prolapse Heart attacks present differently in women than in men. How to work up abnormal vaginal bleeding – questions to ask. Do ED docs know how to do a pelvic exam? Indications for a pelvic exam and optimal positioning Recurrent UTIs, and estrogen possibly 1st line rx so something to keep in mind Asymptomatic bacteruria - if doc says you have a UTI but you have no UTI sx, question whether abx indicated, pending the urine culture             - change in cognition in elderly human – don’t just treat for a UTI? Elder abuse – what is it – when to suspect it? Cardiac symptoms in perimenopause Heart attacks present differently in women than in men. “Sometimes a doctor’s job is to tell you what it isn’t” – workups that don’t show anything dangerous. How to use a tennis ball to do myofascial release for muscle pain The devastating effects of a hip fracture.   www.instagram.com/drpdyne Pelleton: singerpam   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

Increasing Penile Length, How Long Sex Lasts, and Urology YouTube Rockstar Rena Malik, MD    Dr. Malik is an associate professor of surgery in the Division of Urology and director of Female Pelvic Medicine and Reconstructive Surgery at the University of Maryland School of Medicine. She has published more than 60 peer-reviewed articles and book chapters.   She has 1.48 Million YouTube subscribers We go over her most popular videos – most of these questions are “am I normal” questions.   27M views – Scientifically proven ways to increase penile length Why are men so obsessed with penis size and do women care?   11M views – How long does sex last on average?   10 M views - What exactly is the G spot?   9.4 M views – Can you masturbate too much?   8.9 M views – Can you increase your semen volume?   5.8 M views – Can ejaculating more frequently reduce risk for prostate cancer?   5.7 M views – How to increase testosterone naturally   5.2 M views – Explaining the difference between showers and growers   4.3 M views – Does prostate massage have any health benefits?   3.5 M views – Does science support “no nut November”?   Dr. Malik's Youtube: https://www.youtube.com/channel/UCV66hp0qxx2Xq273N0bo7uQ https://www.instagram.com/renamalikmd https://www.tiktok.com/@renamalikmd   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

Here is the 2022 NAMS Hormone Therapy Position Statement! https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf 1) For women aged younger than sixty years or who are within ten years of menopause onset and have no contra indications the benefit risk ratio is favorable for treatment of bother some vasomotor symptoms and prevention of bone loss for women who initiate hormone therapy more than ten years from menopause onset. 2) We discuss safety 3) We discuss decreased mortality in women 50-60 in the WHI trial. 4) We discuss the absolute risk reduction for: all cause mortality, fracture, diabetes, and breast cancer in women aged younger than sixty years 5) Their statement on compounded and pelleted hormones 6) Vasomotor symptoms are assoicated with diminished sleep quality and reduced quality of life 7) Hormones for genitourinary syndrome of menopause 8) We discuss cognition and weight gain 9) The critical window or "healthy cell" hypothesis Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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

Joining me for the second time on the podcast is world renowned sex therapist, Dr. Marty Klein – Author and sex therapist to Silicon Valley. If you want our first episode together check out Episode 169 – where we discuss his book “His porn her pain” Today we are discussing his amazing book: “Sexual Intelligence: What we really want from sex and how to get it”. This book is 10 years old and still completely relevant. And he is still being interviewed about it!   What is sexual intelligence and why did it need to be written about?   “For a lot of people, sex is an opportunity to fail” – Dr. Marty Klein   How do you navigate when one partner wants something and the other doesn’t – oral during a period, PIV sex, kink?   What is your opinion about the “low desire” epidemic and the meds for low desire.   “Most people leave sex for when they are too tired to do anything else” – Dr. Marty Klein   “In a world that is filled with ice cream and Netflix….why would anyone want sex?” – Dr. Marty Klein   You say in the book PIV has symbolic meaning for hetero people – can you talk about why this limits us?   What to do when sex is boring?   What to do with a partner who won’t communicate about sex? Stonewalling?   26:13 Why Dr. Klein doesn’t like the term erectile dysfunction.   I’m not attracted to my partner any more – they gained weight or are getting older – any help?   Tips for desire discrepancy. Communication and more touch.   https://www.martyklein.com/ Dr. Klein’s book: His Porn, Her Pain  https://amzn.to/3IYvIsF Dr. Klein’s book: Sexual Intelligence https://amzn.to/3WLfYi0   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   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 And get on the wait list for the upcoming "adult sex education master class" --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message Learn more about your ad choices. Visit podcastchoices.com/adchoices

Motives between the Sheets: Understanding Obligation for Sex at Midlife and Associations with Sexual and Relationship Satisfaction Monika Georgieva et al. · https://doi.org/10.1080/00224499.2022.2076278 This study investigated reasons for sex at last sex, with a focus on obligation (an avoidance motivation) and doing something nice for a partner (an approach motivation), and their associations with sexual and relationship satisfaction, while controlling for marital duration, age, and sexual desire. We investigated these reasons among married, midlife Canadian women (n = 324), men (n = 275), and 25 non-binary/gender queer participants 40 to 59 years of age. Darling, Come Lay with Me or Talk with Me: Perceived Mattering and the Complementary Association between Sex and Communication within Marital Relationships Haeyoung Gideon Park et al https://doi.org/10.1080/00224499.2021.2018393 Kovacevic, K.*, Tu, E.*, Raposo, S.*, Rosen, N. O., & Muise, A. (2023). Is spontaneous sex ideal? Beliefs and perceptions of spontaneous and planned sex and satisfaction in romantic relationships. Journal of Sex Research. Not enough early breast cancer survivors on Vag E. – Dr. Menn - ------- Cold S, Cold F, Jensen MB, Cronin-Fenton D, Christiansen P, Ejlertsen B. Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study. J Natl Cancer Inst. 2022 Oct 6;114(10):1347-1354. doi: 10.1093/jnci/djac112. PMID: 35854422; PMCID: PMC9552278. Member question: On the topic of pain with penetrative sex, what can go awry during the healing process from vaginal surgery for hysterectomy and prolapse repairs that might contribute to this? Pelvic floor therapy, lubricants, moisturizers, estrogen and dialators are the armenatarium used but what happens when they are used long term but there is still pain upon insertion even a year out from surgery? NAMS practice Pearl on Testosterone https://www.menopause.org/docs/default-source/professional/practice-pearl-testosterone_.pdf Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK 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