Dr. Kelly Casperson on Midlife Sex, Revving Up Libido and the 411 on Menopause and HRT
Show Snapshot:
Is your sex life amazing? Or is it meh, painful or non-existent? If you want to reprioritize your sex life, tackle the effects of menopause on your body and intimate life, and make this the year of greater intimacy with your partner, please meet Dr. Kelly Casperson, a woman who believes that pleasure is not just a nice to have, but a vital aspect of wellness and health.
Dr. Casperson is a urologist, wife, mom, author, sex educator, and host of the top sexual wellness podcast “You Are Not Broken.” She joins me today to give us the 411 on midlife intimacy, sexual health, and the science of desire and to share ideas for making your sex life sing.
Show Links:
NYT Menopause Article from 2.2.23: Women Have Been Misled About Menopause
Quotable:
A man would not be allowed to suffer for years and years and or would not be willing to suffer would not be allowed to suffer. And so many women suffer with their with their sex lives.
Transcript:
Katie Fogarty 0:03
Welcome to A Certain Age, a show for women who are unafraid to age out loud. Beauties. Is your sex life amazing? Is it healthy and happy, pain-free, shame-free? Some of you may be nodding along thinking, “Yes, of course!” But odds are many of you are thinking, 'It's non-existent, episodic, just okay, amazing doesn't even come close."
Katie Fogarty 0:27
My guest today is a woman who believes your sex life can be amazing, that pleasure is not just a nice to ha but a vital aspect of wellness and health, and she has the tools and know-how to make your sex life sing. Dr. Kelly Casperson is a urologist, wife, mom, author, sex educator, and host of the top sexual wellness podcast called You Are Not Broken. She joins me today to give us the 411 on midlife intimacy, sexual health and the science of desire. If you want to reprioritize your sex life and make this the year you can finally say, 'Yes, my sex life is amazing!' Stick around, this show is for you. Welcome, Kelly.
Dr. Kelly Casperson 1:09
Thanks for having me. I'm very excited.
Katie Fogarty 1:12
We got to connect ages ago, when you were in New York, and you spoke at the Naomi Watts, New Pause Menopause Symposium. And when I heard you talk, I thought I really needed to have Kelly on the show. She's got such a frank, commonsense approach to some of the things that can frankly be kind of taboo. We are going to dive into midlife intimacy. We want to hear about what can get in the way of having an amazing sex life; how we can sort of fine-tune our own. But I would love to hear the backstory on how a urologist and a surgeon evolved into a sex and intimacy expert.
Dr. Kelly Casperson 1:52
Yeah, it's a good question. I didn't start out this way. So I was in private practice about seven years. And you know, The Seven Year Itch thing is true. Like you get, you get good at your job, you get a little bored, you start having the like, what am I doing with my life, and I actually had a life-changing patient come in, and she was crying. And the reason was low libido, sexless marriage. And it kind of brought me back to my training, which was all about penis, erections. Viagra, we thought the gynecologist were handling all the women. And I was also taught that women were complicated, and we might never understand them. And, like, in the midst of like, her crying and me being like that was I that's what I was told, is it actually true? Who's taking care of the people who are supposed to be sleeping with the people who were giving the Viagra to? Basically, I started reading everything I could, and going to conferences. And like, this little voice in my head was like, you've got to talk, you've got to talk. And it's like, you know, following your future self. Like if you've listened she's gonna call you forward, right? Yeah, of like, Why won't this voice shut up? Like, she just she was there and she was there for like, at least six months. I can't remember how long she was there. And she's like, you got to talk, you got to talk. And I was like, fine. I'll like I love podcasts. I'll start a podcast. And that was three years ago. Now, a million listens; I just hit so, and the voice got quiet once I started the podcast, so she was happy.
Katie Fogarty 3:20
That's so 1 million downloads is an incredible milestone. Congratulations. I know how hard it is to build an audience. And this is something that to be so proud of. But it's also in some ways speaks to this tsunami of need. Because if you've had a million downloads, there are a million people who tuned in to you to say, you know, I'm struggling. Why are so many women struggling with their sex lives?
Dr. Kelly Casperson 3:45
Yeah, yeah, that's right. And, you know, so and I actually got into menopause because of my, basically my Instagram followers, right, because they can talk to me a little bit more than podcast listeners can. But just kept asking like, Yeah, but since menopause, yeah, but since menopause. Yeah, well, you know, your sex life ends after menopause. And it was kind of the same thing of like, is that actually true? You know, let's go see. Let's go learn about that now. So I got NASM certified to be at menopause expert, and started realizing hormones actually aren't scary. We're just scared of them. And kind of merged from like sex into menopause. And now my, my podcast kind of goes back and forth between them. And in the New York Times article that came out February 1, about menopause and hormones and all of that they actually quoted a urologist who is a good friend of mine. So I'm like, Yeah, you're all just at the forefront because we're already comfortable talking about sex. We're already comfortable talking about hormones. And then we realize wait, but nobody's taking care of the women. And if they are, they're not treating the women like we treat the men because we get to see how we treat the men. And we don't let men age and suffer like we let women age and suffer. And so I think urologists are like in the driver's seat because we get view of all of this.
Katie Fogarty 5:01
You know, that New York Times article that you just referenced, I read, it's absolutely fascinating. I'm going to put it in the show notes because I think every listener should read it. And one of the things I flagged from that article was a quote about how there's a high cultural tolerance for women's suffering,' right?
Dr. Kelly Casperson 5:17
Like that's right. You know, a man would not be allowed to suffer for years and years and or would not be willing to suffer would not be allowed to suffer. And so many women suffer with their with their sex lives.
Katie Fogarty 5:32
What is the number one? I mean, there's probably a million things that you've heard and your practice but you mentioned that patient that was crying about low libido and a sexless marriage is low libido, one of the biggies? What are what are you hearing from your Instagram audience from your patients about their biggest pain points?
Dr. Kelly Casperson 5:51
Yeah, I think it's two things. I think one is low libido, which libido is absolutely fascinating, and I love talking about it, which is why I wrote a book because it's not libido. To understand libido, you need more than like a 15 second, Instagram reel, right? But like, we just think it should be like this high desire thing all the time, and you should just want sex all the time. And if you don't, then you shouldn't have sex. That's not actually how it works. So I'd say low libido is number one and number two would be genital urinary syndrome of menopause, which includes vulva, vaginal atrophy, dryness, tightness, tearing with sex, pain, with sex, decreased lubrication, decreased our arousal, decreased sensation, all due to hormone changes both estrogen and low testosterone in the vulva and the pelvis. So those would be number one and two would be desire. And that hormone changes in the pelvis that actually affects your quality of the sex you are having.
Katie Fogarty 6:42
Okay, so you just listed a buffet of things that none of us want. Dry vagina...it is like a smorgasbord of like, 'No, thank you!' I don't want any of those things. So, you know, I know from.. I'd love to tackle both of these areas, libido I've understood from other experts have come on the show is complicated. There's a lot of things that go into desire, maybe we can sort of start off with with libido and then talk about some of the physical changes that happened with with menopause and the change of hormones. So I've been on your, your website, I've seen that you've done podcasts on this, you've written blogs on the spontaneous versus receptive desire. Can you spell out for our listeners, what they are and and, you know, if we're not feeling awash in desire, and we're not tossing our partner into the bed, you know, why is that not a problem? And how can we maybe rev up our engines if we need to?
Dr. Kelly Casperson 6:42
Yeah. So desire, really. So as Freud who really called it, he kind of coined libido, which means, like an innate drive that we have. Kind of thinking of it like hunger or thirst, or even the drive to sleep, right, when we're exhausted. And the thing about sex drive is, it's not an innate drive, you're not going to die. If you don't have sex, the population might I mean, probably not. At this point, we're up to like 8 billion, but like, you're not gonna die, right? And so like for us to view sex drive, like a hunger or something where you're like, why shouldn't you have it? It's part of, it's like, lots of people don't... as we age as our hormones change. And as we get into long term relationships, defined by the brain, that's about six to 12 months. So people allow for 20 years, seven years, whatever it might be. Our novelty wears off that dopamine, right? And dopamine is actually released in the pursuit of something pleasurable. So I get a dopamine hit thinking about going to the refrigerator to get whatever the piece of cake leftover from the birthday.
Katie Fogarty 7:46
Me too.
Dr. Kelly Casperson 8:06
Yeah. And so that's when the dopamine is released. That's actually like, and so a couple of things...Number one, you don't need any desire to go have amazing, fantastic sex, right? Especially if you are like hung up on that meeting, that spontaneity. But you're like, "well, I kind of know all of his like moves, and like how he's gonna look and what he's gonna do." Like, the novelty has worn off. That's not a problem. Just go have great sex, and you have to have sex worth desiring. Right? I think so many people, and this is where I see, you know, like the male sex researchers, like they're, they're so hung up on getting women desire, and I'm like, You're assuming they're having great sex, right? And they're like, oh, yeah, we're assuming they're having great sex. And I'm like, don't assume that. So many women are having mediocre sex, like take it or leave it sex, like if I have an orgasm grea, if I don't no biggie. I'm just doing this to keep him happy sex of like, of course, you're not going to desire that. And then Rosemary Basson was a researcher who kind of said you know, for the female lived experience sometimes her desire happens during sex. Like oh, now I'm now I'm into it. Alright, let's go. Or her desire comes after sex of like, that was so awesome. I forgot how good that was. Can we do that again sometime soon? Will you remind me how good that was? Like her desire for the event happened after the event...
Katie Fogarty 10:10
That's fascinating.
Dr. Kelly Casperson 10:12
Isn't it interesting? Nnd like, for people to be like...what I see so much as people are like, well, I don't have sex because I don't desire it. It's almost like, it's not an essential ingredient. Right? Now it can be. Uou can get a new relationship. Not everybody wants to do that; then you're gonna get some novelty. You can increase your testosterone dose. Testosterone, of any hormone is associated with desire, way more than estrogen is. But some people don't want to do that. And some people's desire isn't associated. It's not directly correlated with testosterone level. But there's actually a lot of things in our lives that will decrease your desire for sex. And that's a busy life. I'm overscheduled. I have an undue burden of home life activities compared to my spouse. I'm not allowed to desire sex. I'm just the receptive one. I'm the one who always says yes, but I've never pursued it. Right? Like there's all these different pieces involved in libido. And so like, again, I can't share all of that in a 15-second soundbite. So it doesn't mean desire is not important, but I think it's not as important to a good sex life as people think it is. If you actually read the book, "Magnificent Sex," by Peggy Kleinplatz, I always bring this up when talking about desire, because she interviewed people who like, raise their hands to be like, "Hey, who would say they've got amazing sex?"And these people are like, I have amazing sex. And she's like, 'What's important?" And nobody mentioned desire, it's like, not in their top five.
Dr. Kelly Casperson 11:07
So what what would be mentioned then? I'm curious, it was just like....
Dr. Kelly Casperson 11:43
Communication.
Katie Fogarty 11:44
Okay.
Dr. Kelly Casperson 11:45
Comfort. With our bodies. Being willing to fail. Prioritizing time, set aside to have an active sex life.
Katie Fogarty 11:54
I love that. Okay, Kelly, we're heading into a quick break. But when we come back, I want to talk a little bit more about prioritizing time and prioritizing your sex life.
Katie Fogarty 12:03
[AD BREAK]
Katie Fogarty 12:20
Kelly, we're back. When we headed into the break, we talked about how to prioritize your sex life. That registered with me. Because what you shared is that we're not always awash in desire. And sometimes I think that if we believe the myth that we need to be to get going, then we just never get busy. And I love this notion of sort of prioritizing it and maybe getting ourselves as excited about being with our partner as we are wandering over the refrigerator and getting ice cream. Because that's what usually excites me. I kind of feel like this is this is a myth, it sounds like that, that you need to be awash in desire in order to have great sex. And one of the things I noticed about your book that I so appreciate, it is that you do a lot of myth-busting, which we do here. And one of the myths that that you shared in the book is that women, you know, quote, unquote, take longer to orgasm than men. And that that is a myth. That that is not true. So if women are as capable as being aroused as men are, why does this myth persist? And why is it important to debunk some myths in order to have a healthier sex life?
Dr. Kelly Casperson 14:27
Yeah, it's so important. I, you know, if you, stereotyping, we tend to do that we talk about sex. This doesn't apply to everybody, and not all bodies, but a lot of heterosexual couples have a very narrow view of what sex is. Sex starts when something goes in the vagina, sex ends when he ejaculates. Now, not always, but we're narrowing it down. That's called the heteronormative view of sex. And about 30% of women will orgasm by putting something in their vagina. Right? And it's actually might be more difficult to orgasm that way then versus direct clitoral stimulation. And so, add on top like, well, it's challenging to have an orgasm--it's hard, it doesn't always happen. It must be difficult. You know, it's just more different. Again, going back to my training, right? Like women are difficult, we don't have them understand. And it kind of just then the cognitive barrier to exploring like, oh my gosh, apparently I can orgasm in three minutes if I want to. And we want to figure out not that. Not that speed is better, but like, our bodies can inherently orgasm like penis owners can. But if we don't know that, we might just think like, oh, women just got the short straw. You know, if I get one, it's a bonus. But we don't prioritize it.
Katie Fogarty 15:36
Yeah, we settle. And it reminds me...
Dr. Kelly Casperson 15:38
We settle.
Katie Fogarty 15:38
I think it is such an important notion beyond even sex. Because when we fall prey to the myths around, you know, what it means to be a woman. Or what it means to be a woman who's getting older, and we believe these stories to be true, it gets in the way of possibility, right? You know, so if we believe that it's hard to orgasm as a woman, or we believe that, that it's something that takes a long time, we are potentially settling for less. Whereas your book clearly debunks this. When women are having direct clitoral stimulation, they can orgasm just as quickly as a guy. So if that's not happening, it's time to maybe assess what's going on in your sex life. So I thought that was such a fascinating myth to debunk. What are some other persistent myths that you hear from your patients, from your podcast listeners, that you think really gets in the way of a healthy happy sex life?
Dr. Kelly Casperson 16:39
Oh, that you need to say yes, every time your partner wants to have sex with you.
Katie Fogarty 16:43
Okay..
Dr. Kelly Casperson 16:43
I think that's incredibly disempowering.
Katie Fogarty 16:44
Yep.
Dr. Kelly Casperson 16:45
Because you don't have any agency over when your sex happens in your life. ecause you're just responding to somebody else's. And I think a lot of couples get into this of like, well, I don't want him to get grumpy. I don't want to blah, blah, blah. And we use sex as a tool to manipulate our partner's emotions. Instead of being like, when does this work? Well, for us as a couple, what do I need done to prioritize sex in my life? What do I need to ask for help with? Am I allowed to pursue sex with my partner? You know, what, what does? What does me asking for it look like? Is it safe for me to say no, to sex, and our relationships still preserved and intact? Like, that's what's so great about sex is like, it's just an avenue for personal growth. And I love when people get, they get to actually see their thoughts and realize beliefs are just thoughts you've thought long enough that you actually think they're facts. And another belief, just how benign does the belief like, "I just have low libido?"
Katie Fogarty 17:39
Right?
Dr. Kelly Casperson 17:39
Which kind of sounds like Oh, poor you like, you know, maybe a little victim-y. But like, if you believe that to be true, you're much less likely to be curious about it to challenge it to be like, maybe I don't, what if I didn't? What would me with with, you know, a great sex life look like? What would I have to change in my life to prioritize that? So it's like all this personal growth, you know, coaching, fun stuff that comes in when you start challenging those like little truth-y facts that aren't really. You've just labeled yourself or you've labeled your sex life. Or even the felt like sex have sex starts when he wants it. And when he puts the penis in the vagina. Then if he's got erectile dysfunction, or my vagina is dry, or you know, is sore, doesn't have estrogen in it or needs more lube, like the whole thing's broken. Instead of being like sex means communication. Sex means pleasure.
Katie Fogarty 18:29
Yep.
Dr. Kelly Casperson 18:30
Instead of this performance based, you know, exercise routine that we are involving another human with.
Katie Fogarty 18:36
Yeah. It's such an important reframe. And I actually wrote something that down that you said in your book, and you say, quote, a good sex life is up to you. And I thought to myself, This is good and bad news, right? Like, it's so funny, because like, on the one hand, yes, we do want to be in control of our destiny. And we do want to be able to feel like we have agency over our desire and our sex life. But on the other hand, you know, for being honest with ourselves, we need to put the work in, right? You know, we need to take ownership of our sex life;we have to take ownership over our body, and how we use it either for ourselves or in partnership with our partner. So if for somebody who's sitting here thinking, Okay, I know we've talked about libido, and I do want to talk about, you know, some of the what gets in the way painful sex drive, vagina, etc. But if you were to coach sort of broadly, our listeners, who might be sitting here sort of thinking to themselves, you know, God, I do really want a better sex life. I'm ready to take ownership over that. How would you recommend they get started?
Dr. Kelly Casperson 19:40
I just be curious. Be curious about it. Right? Like, and it's sometimes you just start with like, what do you what do you think you know about sex? Or what were you taught about sex? Right, even just uncovering like I was raised at sex was like dirty. Women who want it too much are whores or sluts, right? Like so you really like uncover all have this belief system that's become subconscious and drives your day to day, right? And then be like, what might I need to enjoy sex? Well, maybe I need to, like go away for a weekend with my partner or I don't have kids and I don't have household chores. And maybe I just need to, like, have an intensive, right? Just explore and be allowed to be curious. Not everybody can go away for the weekend. But lots of us can. Right? if you literally have to get your head out of your house. Right? And it adds novelty, which is which is always good for spontaneous desire.
Katie Fogarty 20:33
Yep, you share that I love also what you talk about in the book to talk about the concept of masturbation and, and that this is something that you have learned that not every woman is comfortable with, for a variety of reasons. There are cultural reasons or religious religious reasons, their you know, reasons of maybe like lack of experience or they haven't tried it yet. But you suggest reframing masturbation more as cultivation, which I thought was really interesting. And I would love it if you could sort of bring our listeners in and explain a little bit more about this concept of cultivation versus masturbation.
Dr. Kelly Casperson 21:10
Yeah, I think that, you know, if we think back to the sex ed said that we did get. It was female internal organs and reproduction, right? So we never got taught about the clitoris, let alone assuming that our possibly male partner who doesn't even own the organ knows anything about it. And so we really have to go back and be like, I didn't learn how to have pleasure. I don't think pleasure is mandated in any state sex ed. As of to date, consent is now mandated in like nine states, so we're getting a little bit better. But if we just never had the so I think so many people are like, Well, I just don't enjoy sex. That's like, what if you just aren't enjoying the sex that you're having?
Katie Fogarty 21:53
Yes, exactly.
Dr. Kelly Casperson 21:54
And you've never gotten curious about like, what feels good for you, let alone how to communicate to a partner about that. What do I need? I need lube. First, I need to focus on vulvar massage before I can just put something in my vagina so that my pelvis actually knows sexy times supposed to be happening. Right? We don't get taught about female arousal at all like erections are so black and white. Like they're so obvious, right? It unless you know what you're looking at. It is it's you and you can, but it is a lot more challenging. It's just not in your face of like, is a female pelvis actually ready for penetration? Or is it is it confused is like, is this just a tampon? I don't know. Did you want to be turned on right now? You haven't done a good job of it.
Katie Fogarty 22:33
Right.
Dr. Kelly Casperson 22:33
And then realizing like the role of vibrators, lube, erotica. Whether that's visual or reading it or listening to it. Things that get the brain in an aroused context, right? Like, it's not our fault that we didn't get any sex education. But it is our fault if we think the sex we're having is all that exists. Like there is like a rainbow of choices and you're having gray sex, right? Of like, it's up to you. Nobody's gonna nobody can come and be like, you know, what would really turn you on? Like, they're probably wrong. You're your own unique, you know, blueprint for this.
Katie Fogarty 23:11
Yeah. I love that distinction, that it's maybe we haven't been, we're not it's not just sex. That's, that's not going well, it's the sex maybe potentially, that we're having. And, you know, in fairness, you mentioned in the book too, that men are not given enough information. If we think women are ignorant about our own bodies, and our clitoris, like men are even...they know less sometimes. And if we are having heteronormative sex, which not everyone's having people are having sex with women, people are having sex with themselves, I mean, it's, there's a wide range of options. But if you were having sex with a male partner, you know, they too, don't necessarily know what what turns you on. And your book talks about ways of having those conversations and, you know, sort of educating yourself so you can help educate your partner. Why is that so key?
Dr. Kelly Casperson 24:00
Because men... if I was just interviewing my friend, she's got a million YouTube followers. She's a urologist too. And the Number One viewed video at 27 million views is ways to get the penis bigger.
Katie Fogarty 24:14
Ooooh. [laughs]l
Dr. Kelly Casperson 24:15
Like that's what that's what the steps gender stereotyping.
Katie Fogarty 24:18
Sure. [laughs]
Dr. Kelly Casperson 24:21
They think it's just bigger is better. Bigger is better. Faster is better. Harder is better. Like they're not even in the realm of like, what actually turns a woman on?
Katie Fogarty 24:29
Right.
Dr. Kelly Casperson 24:30
And you know, they've done research to be like, "Hey, women, how much how many of you are like happy with your partner's penis size?" And women are very happy with it. They're not over here wishing it was any bigger. Bigger is not better.
Katie Fogarty 24:43
Oh my god, I'm dying. [laughs]
Dr. Kelly Casperson 24:45
I use that to illustrate like, they don't know...
Katie Fogarty 24:50
You guys are in the wrong ballpark altogether.
Dr. Kelly Casperson 24:52
Yeah.
Katie Fogarty 24:52
That's hysterical!
Dr. Kelly Casperson 24:55
You know, I did a YouTube video with her and it's like..it's high up. We've got millions of views but It's not in the Top 10. And it's about how to please a woman. You know why women fake orgasms, stuff like that. But you're like, how to make it bigger and how to have more semen, higher volume I think is like Number Two. So like they're way off base...
Katie Fogarty 25:14
Oh my God...
Dr. Kelly Casperson 25:15
...on what's important for a woman sexually..
Katie Fogarty 25:17
This is hysterical! Somebody needs to write an article comparing these YouTube downloads. You know who's who's looking at what, and you can see sort of the mismatch that's going on with men and women in bed. So, I don't know if you've had a chance to see the very wonderful Emma Thompson movie Good Night Leo Grande, which I finally got around to watching. And I recommend it to anyone who's listening to the show. It's about Emma Thompson playing a widow who had never had an orgasm during her 37 years of marriage. And she hires a male sex worker to help her. We're not going to talk about hiring sex workers, that is beyond the scope of this. But you know, I was... the movie is so wonderful and loving. And the actors do such a stunning job with it with this very intimate material. And I adored this movie. Is that common? You know, is it common for women to spend many years into marriage and never have had an orgasm? Or was this sort of like a Hollywood thing? Does it really get that bad? What is your take...
Dr. Kelly Casperson 26:22
The last data I looked at is like 10% of women have not had an orgasm. And the sex-sperts think most bodies are capable of orgasm. And what that means is this isn't like a biologic, there's your pelvis is broken, that sort of thing. But it's--I haven't tried, I don't know how. We, again, we're gender stereotyping, but how we are socialized. We defer to the male as the default. And you know, we give our power away--he didn't give me an orgasm. He doesn't know it. He doesn't know how.
Katie Fogarty 26:55
Sure.
Dr. Kelly Casperson 26:56
Right? And we give a lot of our power away. Or we think like if I asked for that, that means he I'm going to make that mean that he didn't satisfy me enough with the penis. So we do not learn, again, this is the sex ed, we never got, how to communicate with our sexual partners.
Katie Fogarty 27:14
Yes, yeah.
Dr. Kelly Casperson 27:15
And then this is the same woman whose husband drags her to my clinic, and says there's something wrong with her because she's got low desire.
Katie Fogarty 27:22
Right.
Dr. Kelly Casperson 27:23
Same people. She's having the crappy sex to begin with?
Katie Fogarty 27:25
Of course! By the way, she's very busy...
Dr. Kelly Casperson 27:28
It's a chore.
Katie Fogarty 27:29
... right? Because modern life. And like what's happening, you know, in the sheets is not that great. So Kelly, a question for you. We talked about this a little bit at the beginning. You talked about the big issues. One's libido. And one is the smorgasbord buffet of just symptoms that nobody wants. Which many people have. Dry vagina, painful sex, you know, maybe UTIs, a whole a whole host of sort of pelvic issues. The very first show I ever recorde, my guest was Dr. Anita Sadaty, who is a gynecologist, and she said in her experience, the number one reason that people in her practice her client, why her patients suffer is because sex is painful. And whenever somebody says whatever patient says to her, like, I just don't desire sex anymore. She says, does it hurt? And the answer is yes. So I mean, the physical symptoms of what happens during perimenopause cannot be underestimated, you know, in terms of how it impacts your sex life. What do you recommend to patients who are suffering physically?
Dr. Kelly Casperson 28:36
See somebody who knows what they're talking about, which is kind of sometimes can be easier said than done?
Katie Fogarty 28:40
Yeah. So define that for us. What does that look like?
Dr. Kelly Casperson 28:44
A urologist who either specializes in sex med or sees a lot of female patients. BBecause we know how to examine vulvas very well. Gynecologist, ones who are more particular in menopause. Again, not all gynecologist know how to examine vulvas. Our medical education on menopause is so crappy, of course, referring back to The New York Times article from February 1st. But I would love to just say, Oh, go see a doctor.
Katie Fogarty 29:16
Right.
Dr. Kelly Casperson 29:16
You might, you might need to see two or three, or find an online clinic that can give you vaginal estrogen. And it's not the answer is not always just vaginal estrogen. You know, it can be tight pelvic floor muscles. You know, it can be other things. Maybe there's a yeast infection going on. Right? So somebody who can kind of analyze everything comprehensively. But by and large, we don't know because our menopause education is so crappy, we just I see over and over a woman's like, I didn't go through menopause.
Katie Fogarty 29:16
Sure, you did!
Dr. Kelly Casperson 29:20
I'm like, sure you did. No, I didn't! And I'm like, you're 63, by definition, you've been through menopause. What do you mean when you say you didn't go through menopause?Andr she says, "I didn't have a hot flash." And the hot flash caches are really what defines menopause for a lot of people, because our education, so crappy. But the point is, we don't realize that estrogen is actually useful for anything. And so it is incredibly useful for maintaining moisture, sensation, elasticity, lubrication, all of the things that are really important for sex.
Katie Fogarty 30:20
And so do you recommend that patients use vaginal estrogen? Or is this something that can be done this systemic estrogen? Are they different? And how so?
Dr. Kelly Casperson 30:31
Yeah, good question. So vaginal estrogen is local, it stays in the pelvis. It's a very low dose. It doesn't go into the bloodstream, you can, if you were to check your estradiol levels with a blood test, it would be negligibly elevated from vaginal estrogen. Very different than systemic hormone replacement therapy, which is full body. Usually delivered with a cream or a patch. And that is still incredibly low dose on magnitudes of order lower dose than what a birth control is.
Katie Fogarty 31:02
Sure.
Dr. Kelly Casperson 31:03
Right? So when people are so afraid of hormones, I'm like, you realize how much hormones we're talking about? We're talking about like, less than half of what a birth control pill is. Which people happily take for 30 years, right? And a lot of just regular systemic hormone replacement therapy isn't enough to deliver to the tissues in the pelvis what it might need. And again, you know, we're not, your pelvis is different than mine. Somebody might need more estrogen; somebody might need less. Like this one box--you just need this dose--well, no, humans are different, you know? You might need more; you might need less. So I see a lot of people who are on systemic estrogen and still need vulvar estrogen, because they're still having symptoms.
Katie Fogarty 31:44
Exactly. Okay. That's, that's good to know. So that, you know, find a doctor who's got menopause training. I believe you can find some of those on the NAMS website, right?
Dr. Kelly Casperson 31:55
Yeah.
Katie Fogarty 31:56
Where else would you direct people. I mean, I guess you could hit the Google and figure..
Dr. Kelly Casperson 32:00
Hit the Google. [laughs]. If we're specifically talking about pain with sex, I would start with a pelvic floor physical therapist. you can go to hermanandwallace.com. That's like a very well known pelvic floor educator, of pelvic floor physical therapists. Because your physical, your pelvic floor physical therapist is going to be able to be like, "Oh, you've got a tight hip. You've got to tight back. You've got a tight psoas muscle. All these affect pain with sex. But they're also tied into the people in the community who do give the vaginal estrogen. Who do know about, you know, pain with sex stuff. So like, if anybody was to go to my pelvic floor physical therapist, they know how to hook them up with me. So, that might be a different way of going about it. But it's pretty simple to find a physical therapist who specializes in pelvic floor and then use them as your go to for where can I get the hormones from?
Katie Fogarty 32:49
That's a fantastic piece of advice. I haven't heard that yet. And I've recorded 121 shows, you know, maybe people's first stop should be a pelvic floor therapist. I'm going to put all of that information you just shared in the show notes. And if you know if you are experiencing any of these symptoms, that's a great way to get started and great way to tap into the resources where you could learn what else you might use. Like a gynecologist or hormones, etc. Your book has so much phenomenal advice. I really want everyone to put it on their list, not I'm not normally very didactic. When I do this show everyone gets.. we're all grown-ups and everyone gets to make their own choices, but I really feel like this is a must-have bedside resource. There's so much great advice about owning your orgasms, strengthen your pelvic floor, you walk through all the different sex hormones and really lay out very clearly what they do you talk about erotica, how to initiate sex. You know, what happens when there's mismatched sexual desire and more. It's really a wonderful primer. We can't cover everything because we're kind of heading into our speed round. But I did want to close by asking you something that I asked a lot of my guests, you know, could you have written this book "You Are Not Broken," could you have launched this podcast, "You Are Not Broken?," when you were younger? Or did you take it into midlife to be able to have these conversations and have a voice on this particular topic?
Dr. Kelly Casperson 34:16
That's the best question ever. Nobody's ever asked me that. I love that. It happened when it needed to happen, when it happened. I wouldn't have known as much as I did; I wouldn't have had enough experience to kind of get upset at the status quo. I wouldn't have talked to enough people to realize this as a legitimate problem and not just like a "me problem" because I give out vaginal estrogen like 20 times a day in my clinic. And I think also the confidence, you know, like we go our whole lives with people being better experts than we are. And you just you get to the day, actually this is a good story for your podcast listeners. I hadn't done the podcast yet. And I was waiting for somebody to tell me I knew enough to start the podcast. And I'm like, "Well, this guy, this guy, could he maybe he'll let me know, I know enough. He should tell me I can start a podcast. Maybe this person will tell me that I know enough, and I should start a podcast." And I was getting out of the shower. And like, lightning struck my brain and it was like, "Nobody's coming. You're the expert. You are the one who needs to give yourself permission to do this." And by doing it now, now, I'm definitely the expert. Right? Like I already knew enough then. But like, once you do 200 podcasts and have a million downloads and like, write a book now you're like, oh, yeah, no, people, people don't know more than me. So you getyour confidence, because so many people are like, "Oh, I don't have the confidence." It's like the confidence comes by doing it.
Katie Fogarty 35:41
Yes, I agree. Yes.
Dr. Kelly Casperson 35:43
And that's the secret.
Katie Fogarty 35:45
I love that. Confidence comes from doing. 100%. And we get to midlife and we realize we have to give ourselves permission. You know, no one is coming to save us. We are saving ourselves. And if we want something done, we need to get an action. I could not agree more. I love love, love the way you sort of synthesized that. Thank you, Kelly. This is the perfect note to end on. We are moving into our speed round, which is a really fun high energy way to end the show. It's just one-to-two-word answers to kind of like a bada bing bada bang series of questions. So let's do this thing.
Dr. Kelly Casperson 36:21
Okay, let's do it.
Katie Fogarty 36:22
Writing "You Are Not Broken," was________.
Dr. Kelly Casperson 36:27
It's fun to be done writing a book.
Katie Fogarty 36:30
I love an honest answer. Okay, your brain is your biggest sex organ. Try this to get in the mood.
Dr. Kelly Casperson 36:39
Erotica.
Katie Fogarty 36:40
Every midlife woman needs this in their bedside drawer?
Dr. Kelly Casperson 36:45
Silicone or oil-based lube.
Katie Fogarty 36:47
Got it. Okay, great. More women should try this to jumpstart their sex life?
Dr. Kelly Casperson 36:51
Oh, man...
Katie Fogarty 36:54
So many answers, right? This is this is a good buffet!
Dr. Kelly Casperson 36:58
Communication. Asking for what you want. And one of the newfangled clitoral air pulse suction devices.
Katie Fogarty 37:04
Ooh, I love that. Okay. You mentioned one trusted book already. But what is a book or resource for women who really want to learn more about sexual wellness?
Dr. Kelly Casperson 37:15
My book?
Katie Fogarty 37:16
Yes. All right, that is 100% true, and it's going in the show notes.
Dr. Kelly Casperson 37:19
That's why I wrote it because I read all the other ones.
Katie Fogarty 37:24
Okay.
Dr. Kelly Casperson 37:24
And I was like, I was like...
Katie Fogarty 37:26
You're like,I can do better. I can do better.
Dr. Kelly Casperson 37:29
You got to make it light and funny. And fact, but not too sciency where you lose people.I really was like, I know what's out there and I and there can be a better one.You know what I mean?
Katie Fogarty 37:42
I've had women come on the show to say they've written books because what they were looking for didn't exist. And this is a phenomenal primer and everyone needs to own it. Okay, this trusted thinker on menopause and hormones needs to be on our radar.
Dr. Kelly Casperson 37:57
Heather Hirsch and Rachel Rubin.
Katie Fogarty 37:58
Perfect. Okay, finally, your one word answer to complete the sentence as I age I feel_______.
Dr. Kelly Casperson 38:06
Unstoppable.
Katie Fogarty 38:07
Love it. Love it. Love it. Love it. Thank you, Kelly. This was so fun and so informative. And I'm super inspired. I want to make sure our listeners know how to find you, your book your podcast and continue to get all of your great frank, straightforward thinking on creating an amazing sex life. Where should they go?
Dr. Kelly Casperson 38:28
The book is called "You Are Not Broken: Stop Should-ing All Over Your Sex Life." That's available on Amazon. I actually did the audiobook because podcasters have to do their own audiobooks. So if you want my voice, you can get that podcast anywhere you listen to podcasts, you are not broken. And then I'm most active on Instagram. I love that the Instagram community at @KellyCaspersonMD and my website's also kellycaspersonmd.com.
Katie Fogarty 38:50
Fantastic. That's all going in the shownotes.
Katie Fogarty 38:53
This wraps A Certain Age, a show for women who are aging without apology. Thank you for listening in and being a friend of the show. Before I say goodbye a quick favor. I would love a written review over on Apple Podcasts. Yes, the star ratings help, but written reviews really matter. You can share what you learned why you tune in mention a favorite guest talk about how the show makes you feel perhaps A Certain Age makes you feel happier, smarter, more inspired or simply like you're hanging out with some fun friends. Special thanks to Michael Mancini who composed and produced our theme music. See you next time, and until then aged boldly, beauties