Gyno Girl Presents: Sex, Drugs & Hormones

Menopause care is changing, and what you hear at your next appointment may change with it.

In this solo episode, I share what I took away from the Menopause Society meeting in San Diego.

There was a lot to be encouraged by, including new guidance from ACOG, the American College of Obstetricians and Gynecologists, and a health advisory from the American Heart Association on how reproductive life stages connect to heart health.

There were also mixed messages about hormone therapy that may have left some clinicians unsure what to take back to their patients.

I go through what has changed and what is still uncertain, and I share why I am encouraged about where menopause care is headed and what you can ask for at your next appointment.

What You’ll Learn

• What I took away from the Menopause Society meeting, including the mixed messages about hormone therapy.
• What ACOG’s new guidance says about hormone therapy for hot flashes and night sweats, and why timing matters.
• The non-hormonal options for women who cannot or choose not to take hormones.
• Why the American Heart Association advisory points to perimenopause as an important time for heart health, especially for South Asian women.
• What the new guidance does not cover, including sexual health.
• What to ask at your next appointment, and how tracking your symptoms can help.

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If you haven’t tuned in recently or this is your first time listening, I launched my book and have been on tour promoting it. One of the chapters getting the most engagement is Chapter 3, Sex and Culture for Brown Girls, so in this solo episode I read a portion of it. It looks at how sex was viewed in South Asia and other parts of the world before colonial rule, when sexual pleasure was written about openly in religious texts, medical books, and art, and how British colonial rule and Victorian ideals are part of that story. I also share how the launch has gone and how the book is organized.

What You’ll Learn

• How the book launch and tour have gone so far, and where I’m headed next.
• Why I chose the title Brown Girls Disease, and why culture is context, not a diagnosis.
• How the book is organized, from the foundations of anatomy and culture to the most common sexual health concerns and the conditions that complicate them.
• A reading from Chapter 3, Sex and Culture for Brown Girls.
• How history, religion, and colonialism shaped attitudes toward sex across South Asia and beyond.
• How long-term stress can wear on the body, and why it matters for health.

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Join me as I sit down with Dr. Natalie Crawford, a reproductive endocrinologist and the author of The Fertility Formula. We start with what women should understand about their bodies before they try to get pregnant, which includes knowing what is going on with their ovaries and hormones.

Natalie weighs in on one of the more recently discussed questions in fertility: should an IUD come out before you start building your family?

Natalie shares what she and other fertility doctors are seeing in women who have had a progesterone IUD for years, and why she suggests taking it out about six months before you start trying. We also talk about how far egg freezing has advanced and how much better the results have become.

Along the way, Natalie shares what an AMH test can tell you about your ovarian reserve and the timing of perimenopause, and how inflammation and lifestyle can influence your ovaries.

What You’ll Learn

• What to understand about your body, including your ovaries and hormones, before you try to get pregnant.
• The debate over taking out an IUD before you start trying.
• How far egg freezing has advanced, and what it can and can’t promise.
• What an AMH test can tell you about your ovarian reserve and the start of perimenopause, and why it isn’t a menopause test.
• Why symptoms can get written off as perimenopause.
• How infertility and earlier menopause show up for women of color.
• How to choose a fertility clinic, and when to get a second opinion.

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Menopause is biologically universal, but how women experience it, and whether they even have a word for it, depends a lot on where they live.

I talk with Dr. Yewande Banire, a family nurse practitioner who cares for patients in the United States and in Lagos, Nigeria, about what women's health looks like through an international lens. Yewande shares how her own years of heavy periods and fibroid pain, and being told it was just part of being a woman, led her into this work.

We talk about why women in Nigeria may not have a name for hot flashes or night sweats, how those symptoms can be mistaken for malaria or typhoid, and what limited access to hormone therapy looks like in practice.

We also get into the role a husband's permission can play, early ovarian insufficiency in women under 40, and what birth control pills can offer when hormone therapy isn't available. Yewande closes with a message for patients and for clinicians.

What You'll Learn

• Why perimenopause and menopause can feel like a "this is not a problem we have" in places where no one is talking about them.
• How symptoms like joint pain and night sweats get treated as other issues when menopause is the missing piece.
• What limited access to estrogen and progesterone means for women who can't easily get or afford them.
• How some cultures have stigma around age, and how a husband’s approval can shape whether women seek care for libido and vaginal dryness.
• What clinicians can do to meet patients where they are, and why it's okay to refer when you don't know.

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Seven years ago, I started keeping notes on patient stories I kept coming back to, including a woman who hadn't been able to have sex in seven years, and a 68-year-old cancer survivor who wanted her life back. Somewhere along the way, I ended up writing about myself too, including something I've never told you before. Those stories became my new book, Brown Girls' Disease?, out October 6th. The title comes from a term I once heard used in a hospital to dismiss South Asian women with vaginismus, and I'm reclaiming it. Culture, religion, and ethnicity do shape how we experience sex, but they're context, not a diagnosis, and this book is for anyone who's ever been dismissed, not just South Asian women.

Highlights:

• Why "Brown Girls' Disease" was originally a dismissive hospital term, and why I'm reclaiming it for a book meant for everyone.
• The patient stories behind the book.
• A personal story about my own experience with vaginismus that I've never shared publicly before.
• Why culture, religion, and shame shape how we experience sex, and why that context matters without becoming a diagnosis.

Book Tour Dates (as mentioned in this episode)

• October 6 — New York City (book pub day)
• October 8 — Chicago, IL (The Veronica Beard)
• October 15 — Charlotte, NC (hosted by Dr. Sasha Davenport)
• October 17 — Worcester, MA (UMass OBGYN Department 50th anniversary)
• October 18 — Menopalooza, Chicago, IL (with Midlife Upgrade
• October 20 — Los Angeles, CA (The Womb)
• October 21-24 — San Diego, CA (The Menopause Society annual meeting)
• October 25 — Cleveland, OH (bookstore event, plus a lunch and learn at the OBGYN/Sexual Medicine department the following day)
• October 28 — Oak Brook, IL (The Book Loft, book signing) ■
• November 11-15 — ISSWSH Fall Course
• December 10 — Palo Alto, CA

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Dr. Jim Pfaus is a behavioral neuroscientist who has spent decades watching rats have sex to understand what's happening in the brain during desire, arousal, and orgasm.

I talk with Jim about what that research can teach us about our own desire, and just how much of it comes down to the brain rather than any one hormone. We tend to assume females have little say in when sex happens, but Jim's research shows the opposite in female rats.

They have complete control over whether it happens at all.

He also shares a study on partner preference: when a male rat has to wait for one specific female instead of getting instant, easy access to her, he'll seek her out over other females afterward. When there's no wait, that preference never forms.

We also get into what dopamine and serotonin are doing during arousal and orgasm, why SSRIs can shut down desire and what can sometimes be adjusted, and the real relationship between testosterone and estrogen in both men's and women's bodies.

Jim also explains what might be happening in the brain when GLP-1 medications affect libido, the inverted U-shaped curve behind arousal and performance, how early experiences condition what turns us on for life, why pain responses in conditions like PGAD and vestibulodynia are so hard to fully unlearn, and what his research suggests about psychedelics and sexual connection.

What You'll Learn:

• Why sex is a behavior generated by the brain, not just a matter of hormone levels.
• What decades of studying rat sexual behavior reveal about desire and consent, including how female rats have complete control over whether sex happens.
• Why male rats only form a preference for a specific partner when she isn't simply available on demand, and what that suggests about waiting and anticipation.
• How dopamine drives attention and wanting, and why it drops sharply after orgasm.
• What serotonin does to desire and orgasm on SSRIs, and how dosing can sometimes be adjusted.
• The real relationship between testosterone and estrogen in both men's and women's bodies.
• What might be happening neurologically when GLP-1 medications affect libido.
• The inverted U-shaped curve, and why some people need more stimulation while others need less.
• How early sexual experiences can condition lifelong arousal patterns.
• Why pain responses like PGAD and vestibulodynia are so difficult to fully unlearn, even after the physical cause is treated.

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A lot of women notice their desire for sex fading over time and assume something is wrong with them, but there's often a real reason for it, and they're not the only ones going through it.

I sat down with Dr. Lori Brotto, one of the most recognized researchers in women's sexual health, to talk about why desire changes and what actually helps bring it back. We discuss the difference between spontaneous and responsive desire, how to tell low desire apart from asexuality, and how sensate focus works in sex therapy.

Lori also introduces eSense, her mindfulness and CBT based digital platform built to close the access gap for women who can't reach a sex therapist, and shares surprising research on how an AI-powered navigator stacks up against a human one.

What You'll Learn

• How to differentiate low desire (a treatable concern) from asexuality (a sexual orientation).
• What sensate focus actually is and how it's used in sex therapy.
• Why sexless relationships often start with avoiding non-sexual touch, not sex itself.
• What mindfulness and CBT do as treatments for low desire.
• The origin and design of eSense: a self-directed digital program modeled on real sex therapy sessions.
• The risks of unregulated AI (like general chatbots) in mental health contexts, and how eSense was trained differently.
• Access, translation, and the biopsychosocial barriers facing racialized and non-English-speaking women.
• Technoference: how technology disconnects us in daily life, and how it can also be used to rebuild presence.
• A live guided mindfulness exercise listeners can follow along with.

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We talk a lot about screening and treatment in the breast cancer space. What we do not talk about nearly enough is what happens after. What happens to a woman's fertility, her vagina, her relationships, her body image, her mental health, her cardiovascular health, and her sense of self when treatment ends and everyone expects her to simply be grateful to be alive.

Dr. Eleonora Teplinsky is a board certified medical oncologist specializing in breast and gynecologic cancers, head of breast and gynecologic medical oncology at Valley Health System, and author of the new book Beyond the Pink: Navigating Life, Health, and Breast Cancer. Her work has long focused on young women with cancer, sexual health, and survivorship. And this book is her answer to a question medicine has not been asking loudly enough: how do we help women not just survive but thrive?

We cover a lot of ground. Hormone therapy after breast cancer, including the nuanced conversations around hormone receptor positive versus negative disease, vaginal estrogen, testosterone, and Duavee. Bone health, body composition, sarcopenia, and the emerging data on GLP-1 medications and breast cancer recurrence risk. The difference between a local and distant recurrence and what ongoing screening actually looks like years after treatment.

We also discuss the racial disparities in breast cancer care that begin with clinical trial enrollment and run all the way through treatment decisions, drug access, and who gets believed when they report pain. The medical distrust that Black women carry into the oncology office for very good reason. And what it means to practice truly patient centered care when the healthcare system was not designed to make that easy.

Survivorship does not begin when treatment ends. It begins at diagnosis. And you are more than your breast cancer.

Highlights:

• Vaginal estrogen is safe for the vast majority of breast cancer survivors, including those on aromatase inhibitors.
• Testosterone may actually act as a tumor suppressor in hormone receptor positive breast cancer.
• GLP-1 medications show early signals toward lower breast cancer recurrence risk.
• Black women are underrepresented in clinical trials and undertreated in guideline-based therapies.
• Survivorship care starts at diagnosis, not when treatment ends.
• Bone density should be checked right after chemotherapy; weight-bearing exercise, calcium, vitamin D, and body composition monitoring are all part of survivorship care.
• Black women are underrepresented in clinical trials, undertreated in guideline-based therapies, and underbelieved when reporting symptoms; medical racism in breast cancer care is real and documented.

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Many of the women I see in my practice are dealing with gut issues that connect directly to their hormones, and this week I finally got to dig into all of it with someone who truly lives at that intersection.

Dr. Kumkum Patel is a board certified gastroenterologist who did a subfellowship in neurogastroenterology and motility and now runs her own private practice focused on IBS and the gut brain connection. Before she was a doctor she was a patient, and her personal journey through infertility, postpartum depression, and pelvic floor dysfunction as a first year fellow is what shaped everything about how she practices today.

We start with the gut brain connection, what the enteric nervous system actually is, why the gut is sometimes called the second brain, and how 70 to 80% of our happy hormones are made right there in the gut. From there we get into how stress, whether from childhood trauma, a stressful job, or the hormonal chaos of perimenopause, disrupts that entire system and shows up as bloating, constipation, diarrhea, and IBS.

We talk about the estrobiome, the specific gut bacteria responsible for regulating estrogen, and what happens when that balance is off. We cover why perimenopause causes constipation from three different directions at once, why leaky gut is a real phenomenon even if the wellness industry has run away with the term, and what actually works when it comes to treating IBS.

We also had a lot of fun with a rapid fire myth busting round at the end covering everything from gut cleanses to probiotics to how often you should actually be pooping.

This is the gut health conversation midlife women have been waiting for.

Highlights:

• 70 to 80% of your serotonin is made in your gut, not your brain.
• The gut is a self cleaning organ you do not need a cleanse.
• Perimenopause affects your gut from three directions at once.
• Normal bowel movements ranges from 3 times a day to 3 times a week
• Probiotics are all about knowing what strain is in them.
• Leaky gut is real, even if the wellness industry has run away with it.
• Childhood trauma can show up decades later as IBS or chronic constipation.

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Dr. Kudzai Dombo is a board certified OBGYN, educator, and one of the leading voices in elevating conversations around women of color and their healthcare journey.

We start with the SWAN study, a 25-year longitudinal multiracial, multi-ethnic cohort study that enrolled over 3,300 women between the ages of 42 and 52. It remains one of the most important sources of information we have on how menopause affects women differently across racial and ethnic groups. What it found is striking: Black women are more likely to experience worse vasomotor symptoms, their hot flashes last on average 10 years compared to 6.5 for white women, and they tend to enter menopause about 1.2 years earlier. Hispanic women also enter the menopausal transition earlier, with symptoms lasting on average about 9 years. These are not small differences.

We talk about why these disparities exist, including the concept of weathering, the chronic stress load carried by Black women navigating systemic racism that accelerates biological aging, and what allostatic load actually means in the body. We get into social determinants of health, what they are, how they shape who gets equitable care and who does not, and why implicit bias is not a character flaw but a phenomenon every clinician needs to examine continuously.

We also get personal. Dr. Dombo shares what it felt like to be on the other side of the system she works within, and we talk honestly about what patients can do when they feel dismissed, and what clinicians can do before they even walk into the room.

This is a conversation about science, equity, and advocacy. And it is one every woman and every clinician needs to hear.

Key Takeaways

• The SWAN study, established in 1996, followed over 3,300 women for 25 years and remains the most comprehensive source of data on racial and ethnic differences in the menopause experience.
• The SWAN study found that Black women slept on average 30 minutes less per night than white women, even though they were less likely to report sleep disturbances — a gap that has significant implications for cardiometabolic health.
• Weathering is the concept that chronic stress from navigating systemic racism accelerates biological aging in Black women, contributing to earlier and more severe menopause symptoms and higher cardiometabolic disease burden.
• Social determinants of health include economic stability, access to quality care, food environments, green spaces, and the chronic stress of racial discrimination — all of which shape health outcomes.
• Only 6.8 percent of US residents felt prepared to prescribe hormone therapy at graduation a statistic that explains a great deal about the care gap women experience.
• Hot flashes are not benign; the intensity and duration of vasomotor symptoms is linked to cardiovascular risk and brain health, which makes treating them a priority not a preference.

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South Asians represent about a quarter of the world's population but account for over 60 percent of the world's heart disease. The highest rates of diabetes and metabolic syndrome. And yet most women in the community have no idea this could be coming for them.

This week I spoke with Dr. Ambreen Mohamed, a cardiologist with a passion for improving cardiovascular health, particularly in South Asian communities. This is a conversation I have wanted to have for a long time, and it is personal. I lost my mother to a massive heart attack over a year ago, and like so many women in our community, her symptoms did not look like what we are taught to recognize.

We talk about why women's heart attack symptoms are so often dismissed, why the research was built on men for decades, and why what we call atypical is actually just different. We get into the genetics that make South Asians uniquely vulnerable, including lipoprotein A, APOB, insulin resistance, visceral fat distribution, and why someone can look healthy on the outside and have significant cardiovascular risk on the inside. We talk about the cultural pressures that make South Asian women put everyone else first, and how chronic stress compounds an already elevated risk.

We also cover what good prevention actually looks like. What to ask your doctor. What markers to check beyond a standard cholesterol panel. How pregnancy history, PMOS, preeclampsia, and early menopause all factor into cardiovascular risk assessment. And what is coming down the pipeline in cardiology that gives Dr. Mohamed genuine excitement.

This is not a doom and gloom conversation. It is an empowering one. Because knowing your risk is the first step to doing something about it.

South Asians make up about 25 percent of the world's population but account for over 60 percent of global heart disease, with the highest rates of diabetes and metabolic syndrome of any ethnicity.

What you'll learn:

• Women's heart attack symptoms are often dismissed because they can present differently from the classic Hollywood version, including fatigue, jaw pain, back pain, nausea, and indigestion rather than crushing chest pain.
• Microvascular disease, disease of the smaller coronary arteries, is more common in women and diabetics and can be missed entirely on standard imaging.
• The skinny fat phenomenon is real: visceral fat, the fat that wraps around organs deep in the body, increases cardiovascular risk even in people who appear slim.
• Early menopause is an independent risk factor for high blood pressure, and the estrogen drop during perimenopause and menopause accelerates cardiovascular risk.
• Sleep apnea is one of the most underdiagnosed contributors to high blood pressure and should be screened for before jumping to medication.
• The foundation of prevention is not supplements or peptides: it is sleep, movement, diet, stress management, and knowing your numbers.

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Have you ever left a doctor's appointment feeling like you were treated as a diagnosis rather than a person? Where the 15 minutes were up before you could even get to the real question?

Dr. Lucy McBride is a primary care physician, co-founder of the Ackerly McBride Group in Washington DC, and author of the new book Beyond the Prescription.

For over 25 years she has practiced what she calls evidence-based, relationship-centered medicine, and her weekly Substack newsletter Are You OK? now reaches over 41,000 readers.

This is not just a book about the medical system. It is about you. Lucy's argument is that self-awareness is a superpower, and that the most powerful thing you can bring to a doctor's appointment is a clear, honest understanding of your own story, your stressors, your history, and the narratives you tell yourself about what you deserve.

We talk about why medicine is very good at treating disease but less good at treating the person who has it. We get into the concept of the clinical gaze, what gets lost when a clinician reduces you to your labs or your organ system, and how communication on both sides of the exam table can transform the patient and doctor relationship. Lucy also walks through the patient personality types she writes about in the book, from the people pleaser to the optimizer to the internet warrior, and why recognizing which one you are is the first step to getting better care.

We also have a frank conversation about the parts of this that are hard. Health agency is not equally accessible to everyone. Implicit bias is real. Trust has been broken in many communities for very good reason. And putting the onus on the patient to be more empowered while the system remains broken is genuinely a big ask. Lucy does not shy away from any of that.

This is a must listen for patients who feel dismissed and for clinicians who want to do better.

What you will learn:

• Self-awareness is the birthplace of health agency: understanding your story, your stressors, your history, and the narratives you tell yourself about worthiness is the foundation of being a more empowered patient.
• Doctors want to care for whole people but the system does not give them the time or training to do it; pointing that out kindly rather than coming in adversarially can change the energy in the room.
• AI is most useful in healthcare as a question generator and vocabulary builder, not as a diagnostician.
• Trust has been broken in marginalized communities for very good reason; acknowledging that history is part of practicing better medicine.
• The best prescription a doctor can give is sometimes vocabulary: permission to ask the question you are embarrassed to ask and to not settle for less than someone who sees you as a whole person.

The biggest takeaway from this episode is: Trust but verify. Go into a new clinical relationship with openness and the benefit of the doubt rather than assuming the worst. And for clinicians: patients who come in with questions and articles are not trying to undermine you. They are doing the best they can in a system that has not served them. Meet them there.

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April Patterson was one of my earliest guests, and her first episode on persistent genital arousal disorder remains one of the most listened to episodes on this podcast.

April is a pelvic floor physical therapist who specializes in PGAD. She has also lived it. After spinal surgery addressed her original PGAD symptoms nearly a decade ago, new symptoms kept building.

Left lower quadrant pain, bladder pain, GI symptoms, clitoral changes, leg symptoms that did not match any nerve pathway. She was dismissed, she was told everything looked fine, and she kept pushing anyway. What they eventually found was pelvic venous disease. And it explained so much of what April dealing with.

In this episode:

• How PGAD and pelvic venous disease can overlap and mimic each other
• The symptoms that finally pointed to a vascular cause
• What the procedure involved and what they found
• How this is changing the way April approaches her own patients
• Why the vessels need to be part of the diagnostic conversation in pelvic pain

If you have been told everything looks normal and you are still in pain, please share this episode. These are the conversations that change the trajectory for women who have been searching for years.

After more than two decades as a board certified OBGYN and over a decade as a specialist in sexual medicine and menopause, I have come to believe that one of the biggest obstacles in women's healthcare is not the absence of treatments or research. It is dismissal.

This is not just something I see in my patients. I have lived it too. I share a story from my own birth experience that I have not talked about much publicly, and it changed how I think about what it means to navigate a system that was not built to listen to women. If it happened to me, someone who worked inside that system every day, I think about what it means for women who do not have the same access or the same voice.

That is also what led me to write Brown Girls' Disease. The women who struggle most in this system are almost always the ones who have been told the longest that nothing is wrong, and I wrote this book for them. We talk about what is in it, who it is for, and why the title means so much more than it might seem at first.

My mission has always been simple. I want women to feel seen, heard, and believed. This episode is about why that still matters so much.

Highlights:

• Dismissal is one of the biggest obstacles in women's healthcare today.
• Why siloed medicine means women fall through the cracks.
• The story behind the phrase brown girls' disease.
• Why naming a condition can be part of patients healing.
• The movement to end dismissal in women's health.

About the Book:

Brown Girls' Disease: A Guide to Sexual Health and Empowerment Through a South Asian Lens by Dr. Sameena Rahman is available forpre-order now on Amazon, releasing October 6th.

The book covers foundations of sexual health, the intersection of culture, religion, and colonization with sexual dysfunction, medical bias and implicit bias, trauma and mental health, and conditions including vaginismus, persistent genital arousal disorder, libido and arousal concerns, vulvodynia, perimenopause, menopause, and postpartum sexual health.

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Obesity may be the most misunderstood chronic disease in medicine. For decades we told people to eat less and move more, but the science says our weight is regulated by biology we don't control, in the same brain region that runs our reproductive cycles. Dr. Angela Fitch, past president of the Obesity Medicine Association and one of the country's leading experts in obesity medicine, joins me to separate what's real from what's myth in the world of GLP-1s.

Angela's fascination with metabolism started back in her chemical engineering days and carried her through residency, ten years of primary care, and eventually board certification in obesity medicine, where she's spent the past fifteen years building non-stigmatizing, comprehensive care for patients, including her current clinic, Knownwell.

We start with the question I hear constantly: why does obesity carry so much stigma when we treat it as a chronic disease like diabetes or hypertension? Angela traces it all the way back to Hippocrates prescribing treatment for "gluttony and sloth," through insurance systems that carved out obesity treatment as cosmetic, to the willpower myth that still shapes how patients are treated in exam rooms today.

The science behind why weight loss is so hard is more interesting than most people realize, and Angela is one of the few people in this field who can explain it without making you feel like you're being lectured.

We get into how these medications work, what they do in your brain, and why the conversation around them has become so loud. We also answer the questions that come up most frequently in my office and online, around muscle loss, microdosing, and whether compounded versions are safe, and Angela is refreshingly direct about all of it.

For the women in perimenopause and menopause who feel like their bodies stopped responding to everything that used to work, this episode puts language to what you're experiencing and gives you something real to bring to your next appointment.

Highlights:

• Obesity is a chronic disease, not a willpower problem.
• Why your body actively fights weight loss.
• What GLP-1s actually do and how they evolved.
• The truth about muscle loss on these medications.
• Compounded GLP-1s: what you need to know.
• Why access and coverage still fall short.

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At 25, Mathilde Olstad's life was on track: a new relationship, a finance degree nearly finished, a career about to launch. Then pain during sex appeared out of nowhere, Then pain during sex appeared out of nowhere, and it didn't go away. What followed was years of dismissal, dead ends, expensive alternative treatments, and being refused by seven gynecologists before she could access specialized care. Instead of staying silent, she turned her experience into The World's Tightest Community, a podcast reaching thousands of women living with vulvovaginal pain.

In this episode, Dr. Sameena Rahman sits down with Mathilde Olstad, creator and host of The World's Tightest Community, a podcast dedicated to vulvovaginal health, chronic pelvic pain, and breaking the silence around conditions like vulvodynia, vestibulodynia, and vaginismus.

Mathilde shares her story from the beginning: the sudden onset of burning vestibular pain at 25, a GP who told her everything looked fine, a year and a half of waiting, and the excruciating speculum exam where the shock on her providers' faces told her everything about how unprepared the system was for patients like her. She describes the desperate search that followed, from mainstream treatments to $1,500 herbal prescriptions, and the profound loneliness of never seeing anyone else who had walked this road.

The conversation goes global: why the latest research in vulvovaginal pain isn't crossing the Atlantic, what it took for Mathilde to access Norway's public vulvar clinic after seven gynecologists refused to take her on, and why so many complex pain patients become what clinicians call "heartsink patients." Dr. Rahman and Mathilde also dig into the visual language of these conditions, why "you are not alone" rings hollow when you can't see a single face, and how a Reddit community became the spark for a podcast that now reaches patients and clinicians around the world.

Mathilde shares her story from the beginning: the sudden onset of burning when having sex she went to her GP who told her everything looked fine, a year and a half of waiting, and the excruciating speculum exam where the shock on her providers' faces told her everything about how unprepared the system was for patients like her. She describes the desperate search that followed, from mainstream treatments to $1,500 herbal prescriptions, and the profound loneliness of never seeing anyone else who had walked this road.

Our conversation goes global: why the latest research in vulvovaginal pain isn't crossing the Atlantic, what it took for Mathilde to access Norway's public vulvar clinic, and why so many complex pain patients become what clinicians call "heartsink patients." We also dig into the visual language of these conditions, why "you are not alone" rings hollow when you can't see a single face, and how a Reddit community became the spark for a podcast that now reaches patients and clinicians around the world.

It takes courage to keep telling a story like this one. Every time a woman does, it reaches someone who thought she was the only one. If you know someone dealing with this, please share it!

I also want the clinicians listening to hear this with an open mind, not shame. So many of us were never taught about these conditions. But not having the answer is never a reason to make a patient feel like she's the problem. What she needs from us is empathy, curiosity, and honesty about what we don't know.

Highlights:

• Vulvovaginal pain conditions like vulvodynia, vestibulodynia, and vaginismus are common, with estimates ranging from 8 to 28 percent of women experiencing them in their lifetime, yet they remain under-researched and widely dismissed.
• Sudden-onset pain with sex is not "just anxiety" and should prompt a real diagnostic workup, including a vulvar exam, vestibular assessment, and pelvic floor evaluation.
• A diagnosis label like vulvodynia is only a starting point; without a differential assessment of drivers (hormonal, inflammatory, neuroproliferative, muscular), patients are left with trial and error.
• Pelvic floor involvement is nearly universal in vestibular pain, because anticipating pain leads to clenching and hypertonicity that outlasts the original trigger.
• The knowledge gap between North America and Europe in sexual medicine is real: patients abroad often can't access treatments, and some specialists are unfamiliar with current concepts in the field.
• Recovery is rarely one breakthrough; for Mathilde it was cumulative, including pelvic floor physical therapy, osteopathic work on diaphragm tension, and most recently pelvic floor Botox.
• Social media has forced real change in women's health, from IUD pain management to mainstream conversations about menopause, but vulvovaginal pain still lags behind.
• By the time a woman with these conditions reaches a new clinician, she has almost always been dismissed before; believing the pain is the first intervention.

Resources-

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Millions of women take SSRIs for anxiety and depression and many times no one tells about the sexual side effects, let alone that there's a solution. When it happened to a sex therapist and an OB-GYN themselves, they refused to accept "just add Wellbutrin" as the only answer. Dr. Laurie Mintz and Dr. Suzette Johnson join Dr. Rahman to share the deeply personal stories behind their new venture and why no woman should have to choose between her mental health and her sexual health.

What started as a friendship between "sisters from another mother" became a mission after both women personally experienced SSRI-induced orgasm dysfunction and discovered how well a compounded topical cream made with sildenafil and L-arginine worked for them. Now, in partnership with Mojo, they've launched something no one else is offering: the cream plus a short course covering the biological and psychological sides of orgasm dysfunction mindfulness, vibrators, erotica, and the science of why your body responds the way it does.

The conversation also dives deep into the orgasm gap: why women orgasm 22–33% less often than men in heterosexual encounters, what the research on bisexual women reveals about whose "fault" that really is (hint: it's not women's bodies), and the brand-new concept of the orgasm pursuit gap why women need to start actively pursuing their own pleasure without pressure.

This is midlife reinvention, medical advocacy, and orgasm equality all in one conversation.

Highlights:

• SSRIs are essential medication for many women but sexual side effects like muted or absent orgasm are real, common, and rarely disclosed at the time of prescribing.
• Most prescribers' only answer is "add Wellbutrin"—few know that a compounded topical cream (sildenafil + L-arginine) can restore blood flow, sensation, and orgasm for many women.
• New research identifies an orgasm pursuit gap heterosexual women largely don't pursue their own orgasm or expect their partners to.
• Pursuit is not pressure: women can actively seek the clitoral stimulation they need without turning orgasm into a performance demand.
• Sexuality does not expirewomen can and should stay sexually active at every age if they want to be.

Remember: I'm here to educate so you can advocate for yourself. This podcast is for education, not medical advice please see your own doctor or clinician for your individual care.

Please make sure to share this episode with women who would find it helpful. Most of this information is still new to many women and the more it gets shared the more women we are helping!

Get in Touch with Dr. Mintz & Dr. Johnson::

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One of the things that hasn't gotten a lot of attention in the menopause space is the gut. It's one of those symptoms that you may have not even thought was related to this stage in life. You may find that you have diarrhea, constipation, and less tolerance with certain foods. Or like my guest Cynthia Thurlow, one bout of food poisoning can turn your gut upside down and have lasting effects for years.

Cynthia is a nurse practitioner and metabolic health expert who explains why the gut matters in midlife and also gives us education on what is actually going on. How estrogen and progesterone directly impact your gut bacteria, motility, and inflammation. And while there are many modalities to treating it, some with good intentions moving from pharmaceutical drugs to vitamins isn't really giving the relief that many women are looking for.

We get into the gut-brain connection, why fiber might be causing bloating, and how to start with the basics to getting your gut health on a good path.

Highlights

• The gut microbiome contains 40 trillion bacteria, viruses, fungi, and protozoa. There are actually more cells in your microbiome than in your entire body.
• Most of the communication on the gut-brain axis goes from gut to brain, not the other way around. What happens in your gut directly affects your brain and mood.
• Ninety-five percent of patients don't eat enough protein. That's problem number one before worrying about fiber or any other intervention.
• Sitting down to eat and taking four to five deep breaths before meals shifts you out of sympathetic and into parasympathetic mode. This alone can improve digestion.
• There's a direct connection between gut microbiome health and vaginal microbiome health. They're not separate systems.
• Screening for adverse childhood events and trauma changes how you approach treatment because it rewires the autonomic nervous system and affects gut health.

If you're experiencing digestive changes during perimenopause or menopause, this episode is for you. Understanding your gut is the first step to feeling better. If you found this helpful, please subscribe so you don't miss future conversations about what real midlife health looks like.

Note: We experienced some audio technical difficulties during this recording. We've worked to enhance the sound quality as much as possible. Thank you for your patience and for listening.

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Perimenopause is typically attributed to the hallmark symptoms—hot flashes and irregular bleeding. But that represents only a fraction of the clinical picture. The reality encompasses a range of symptoms that often emerge gradually and go unrecognized as perimenopausal.

Dr. Amy Jean Voedisch is a gynecologist whose clinical approach mirrors mine. We practice evidence-based medicine through extended patient visits that allow for precision diagnosis and individualized treatment plans.

Sleep is one of the foundational pillars Amy emphasizes. It's become central to her practice, and addressing sleep disturbance often requires specialty consultation with a sleep medicine specialist.

We also discuss hormone therapy. While it can be an effective therapeutic tool, it's not a panacea and won't serve as a singular solution for all perimenopausal symptoms. This conversation is about what real perimenopause treatment looks like.

Episode Highlights

• The same symptoms may react different to treatment in each patient.
• Menopause education could have a larger role in medical school training.
• Birth control might be part of a patient's treatment plan, not just contraception.
• Reframing expectations about your body and grieving what you had before.
• The role of life circumstances and stress colliding with perimenopause.
• Understanding responsive desire in relationships.

If you're in your 40s and something feels off, this episode is for you. Perimenopause is something you just have to tolerate and there are doctors who care and want to help. Make sure to subscribe so you don't miss future conversations about what real women's health care looks like.

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Gen Z gets a bad rap for being lazy, but they're actually the most entrepreneurial generation we've ever had. Calle Foster, a leadership coach who spent 12 years in corporate learning and development, explains why that stereotype is costing you as a leader.

The real issue? It's how we're leading them. Gen Z was raised in a very different world than previous generations, and that context shaped how they show up at work. When leaders come at them with command and control, they shut down. They internalize it as their fault. They need guides, not controllers.

Calle talks about what Gen Z actually responds to: psychological safety, questions instead of orders, and understanding the why behind the work. She also addresses generational trauma—how silence about bodies, fertility, and mental health gets passed down through families and how we can break that cycle.

We also dig into how this applies to medicine and residency training, parenting Gen Z kids, and building teams where multiple generations actually respect each other instead of denigrating one another.

Highlights:

• Gen Z shuts down under command and control. Telling is yelling.
• Gen Z expects emotional availability from leaders because that's how they were parented by Gen X.
• Vulnerability from leaders creates safety for everyone on the team.
• Generational silence about bodies and fertility gets passed down.
• Gen Z has emotional language that's a strength, not a weakness.
• If women aren't building AI algorithms, we're automating bias into healthcare.

If you're a parent, a manager, or an attending working with Gen Z, this episode is for you. The way you lead and communicate shapes how the next generation shows up. My goal is to give you tools to understand your body, your hormones, your relationships—and how to build teams and families where people feel safe enough to actually speak.

If you've found this conversation helpful, please subscribe so you don't miss future episodes. And if you're in a leadership position, consider where you might shift from command and control to coaching.

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