Orgasm After Menopause: Vibrators, Testosterone & Solutions with Dr. Lauren Streicher (Pt. 2)

22:49Dr. Mary Claire Haver:Yeah. And the reason why is there's a comfort level with testosterone. When I explain to women that just like estrogen, this is something that is in their body naturally, that we are giving them a little boost of their testosterone to help with their libido. And that just sits better. It sits better. There is more of a comfort level with that. But when we look at how well testosterone works for libido specifically, it's about the same. It's about 50 % at best, again, because it's so multifactorial. A lot of talk about pellets. Don't get me started on pellets. I have an entire episode called The Problem with Pellets.

23:25Pellets.

23:25Dr. Mary Claire Haver:So, a lot of... The problem isn't actually the pellets. It's the pellet pusher. It's the pellet pushers. I'm like, I don't want to demonize a method of delivery to the human body. We have FDA-approved pellets for certain medications. Like, it's just a way to get medicine in your system. But the way it's marketed, the way that they teach... I even went and signed up to do a pellet. You're brave. No, just because I wanted to see, what are they teaching these clinicians? As you said, it's not the method of delivery. It's what's in the pellet. And they are these super physiologic, meaning much higher doses than every woman has ever made.

23:57Dr. Mary Claire Haver:I have yet to have a post pellet patient come to me. We check everyone's levels who was ever in a physiologic range. Sky high. Sky high. And, you know, we could go on and we could spend hours just talking about pellets. So let's cut to the chase and say that women should not use pellets because not only are they getting unnecessarily high levels of testosterone, But when we look at the side effects, aside from the cosmetic side effects, like losing your hair where you want it, getting hair where you don't want it, like all over your face, getting an enlargement of the clitoris, getting oily skin, getting pimples, we look at more serious side effects long term, such as a buildup in the lining of the uterus, increasing risks of uterine pre-cancer and even cancer.

24:37And we have very good data, which I talk about in my episode, and come again, about the increased number of hysterectomies in women on pellets because the levels are so high. Now, one of the things that's confusing for women is that the biggest sellers of pellets, of course, are women who have them, who tell all their friends how incredible they feel. And there's no question that a big bolus of testosterone is going to make you feel amazing. Huge, huge amounts of energy, feeling sexy, feeling alive, feeling productive. The problem is that's the initial feeling over time. People require higher and higher doses.

25:14The side effects get to be a huge problem. And it's not like you can just say, stop taking it. They sit there under the skin. For months. You cannot take them out. You have to wait for them to dissolve. And there have been some very serious problems. Women think they're FDA approved. There was a study that they were shocked to find out that they're a very expensive doctor.

25:34Dr. Mary Claire Haver:And a lot of women, it's all they're offered. They're not given the cornucopia of options. Correct. And why is that? There are a lot of doctors that are making a lot of money off of pallets. Because they're not FDA approved, it's a cash business. And along with the pallets, they're not only selling pallets, they're doing unnecessary blood work. They're doing these panels, the Dutch panel, a lot of things that are not only extremely, extremely expensive, cash only, but are not helpful in any way, not necessary in any way. I love when they tell you this is custom compounded just for you. They're giving everyone the same frigging pallet.

26:11But they're drawing your blood every 10 minutes and charging you for it to make you feel like you're special. And this is just for you. So what I say to people is if someone is pushing pellets, don't walk, run. Go to someone who is going to prescribe testosterone in a responsible way, in appropriate dosages. Do we watch levels? We do. When we prescribe estrogen, we don't because we generally don't need to. There are exceptions. But in general, we're not getting levels. Testosterone, you need to start with a baseline level because if your level's already high, I can tell you taking testosterone is not going to help.

26:47And in fact, you are more likely to get side effects. And then because they're compounded, that means that the levels of testosterone that you're getting may not be consistent. So it is always a good idea, at least in the beginning, until you're on a steady, stable dose to watch those levels to make sure that you're getting the right amount. And also, I just have to throw out there for people that rely on their voice professionally. Yeah. We're talking actors, voiceover artists, singers. You need to know that if you take testosterone, even in the normal physiologic low doses, that for some people, and we can't predict who that's going to be, there will be a change in your voice.

27:28It is not reversible. Yeah. It's not reversible. And already, and that's a whole other topic, is the impact of menopause on the voice because you have estrogen receptors, of course, in your voice box, which is why opera singers very often will use estrogen and why there is a change as women go through menopause.

27:45Dr. Mary Claire Haver:Lots of questions from our audience. One is, and this is also very curious to me, is the orgasm gap between males and females and between heterosexual couples and same-sex couples for women. All right. Orgasm gap. This is the realization that men are far more likely to have orgasms than women because, of course, they know how. They're able to have orgasms. And we see this orgasm gap starting very, very young, 20s, 30s, 40s. Well, I have good news for all the peri and postmenopausal women out there. The orgasm gap narrows as people get older because the guys are losing their ability to have. Now that we get better, they get worse.

28:25Exactly. We're not getting better, they get worse. But actually, in some ways, let's just talk about the woman who's not having difficulty with orgasm. If you look at a 20 or 30-year-old who has no clue where her clitoris is or what to do with it, most women, hopefully by the time they hit 50, do know where their clitoris is and do know what to do with it and are well aware that if they stimulate the clitoris either manually or orally or with a vibrator and they're not relying on a partner anymore or a partner because they know better, they're actually able to have an orgasm. So I know this sounds crazy and you don't expect me to say this necessarily and no one's really studied this, but the orgasm gap in my mind absolutely narrows for two reasons.

29:08One, women are better at knowing how to elicit orgasm, whether with a partner or on their own, and men are losing their ability to orgasm. So it's a level playing field.

29:18Dr. Mary Claire Haver:Well, and I feel that women are not willing to sacrifice their own pleasure anymore. You know? Absolutely. They're not just going to do it to do it. They're like, if I'm in, I'm in, you know, and we're going to do this until I also have an orgasm rather than just putting themselves second. They're really putting themselves first, I think, for their pleasure. One of my favorite books, and it's an old book, is Ian Kerner's book called She Comes First. And this is a book that's intended for men because men need this education to say, okay, dude, she comes first. take care of her orgasm first and then you can have your orgasm and this is very very important for people to acknowledge i mean talk let's talk about the men for a second well i'll tell you a funny story and i i when the first divorce happened in our friend group yeah i think that book went around the guys freaked yeah in our big giant friend group and i think the guy's kind of like uh and i think that book went around because i noticed a definite you know more attention to making sure that I was going to be okay.

30:21Dr. Mary Claire Haver:And there's sometimes I'm just like, it's fine. I, you know, I'm sick or I'm just not, you know, whatever. But, and I think it was born of that fear of that first divorce that happened. And like, what can I do to like, hang on to this relationship? So we were very appreciative of that book and my friend group. I think when I read the data, it's like 70 to 80 % of men will have an orgasm with intercourse and women, it's like more like 40 or 50 percent each time when you look at the raw numbers like that's how big the gap is but then we see now you're talking about young women young women correct correct but then again we do not have data on the orgasm yet that's one of the studies i want to do with kinsey i've been talking to him about that but we do not have data on the orgasm gap as you get into older folks do you think it bothers women that there's an orgasm gap because i see these like very you know politically slanted articles written about it yeah of like you know it's not fair and da da da Yeah, and most of my patients are okay.

31:16Are you talking about younger women or older women?

31:18Dr. Mary Claire Haver:Younger, yeah, really younger. When they're coming to me older, they're coming with a problem they need fix. Yeah. You know, they say it's okay. It's because culturally there's this expectation that men expect pleasure when they have sex, and women do not. Another wonderful book that addresses this is Girls and Sex. And it really talks about how young girls are not really educated in pleasure. Sex ed, we know, is all about how not to get pregnant or get an STI. It has nothing to do with pleasure. But the guys are not taught that. The guys are taught you should have pleasure. So that's part of the problem is that there isn't the expectation.

31:54So are they upset? I think the ones that expect pleasure are the ones who know how to have pleasure. So older women, different story.

32:03Dr. Mary Claire Haver:So we have an older patient who comes into your clinic and she says, I am struggling with orgasm. I used to have them. They're great. And I still want them. What's your first step? Walk me through. The first step is unless you're running a sexual medicine clinic, the likelihood of that happening is about zero. Let's be honest. How many of patients when you were doing general OBGYN walked in your door and said, hey, Dr. Haver, I can't have an orgasm. Will you help me? Maybe one in 20 years. Now, it was more common for them to complain about desire. Well, first of all, that's easier to spit out.

32:37And second of all, it is more common. It is more common. So when you talk about across the board, if you look at women between the ages of 18 and 100, most of them are not going to bring that up, even though 40 percent of women across the board have these issues with sexual problems. Doctors are not going to ask because they're not going to be able to help them. The only time that we have a flip in that script, of course, is if you're running a sexual medicine clinic because that's why they're there. So if a woman comes to a sexual medicine clinic and comes to see an expert and says, I'm not able to have an orgasm, what are we going to do?

33:13Well, number one, we are going to take a very detailed history. We need to know it all. And in fact, I have the history form in Come Again that I use for clinicians. So they don't even have to make it up. They can just use my history form because it goes through all of the things that might impact on the ability to have an orgasm. We're talking, you know, menopause symptoms. We're talking medications. We're talking diabetes, medical problems, surgery, radiation, chemotherapy. I mean, there's a very long list of things that we need to go through. And then depending on what their issue is, and it's never one thing, it's always multiple things, then we're going to set up a treatment plan.

33:47But the number one thing that we generally have to get rid of in almost every woman is pain. Pain, pain, pain. If someone says, I have no desire for sex, and if I do have sex, I don't have an orgasm, my next question is, well, when was the last time you had sex? Oh, it was a couple months ago. How'd it go? Well, it hurt like hell. Well, your vagina's not stupid. And if sex hurts like hell, it's going to tell your brain, don't go there. You're not going to get aroused. And if you don't get aroused, you're not going to have an orgasm. So until we fix painful sex, we've got nothing to talk about.

34:20So you've got to do that. You've got to look at the medications. You have to get rid of the menopause symptoms. If someone is flashing all day and all night, they're not going to be aroused. Keep in mind, and I keep circling back to this, in order to have an orgasm, you must have arousal. You must. That's your clitoris. That's your pelvis. That's your brain getting primed to trigger those nerve endings to do their job, right? Right. So almost every treatment I have is going to help arousal. Get rid of the symptoms. Get a decent night's sleep. Eliminate pain. Look at your drugs. Show someone the map to their clitoris.

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35:02Dr. Mary Claire Haver:I'm right here. Don't miss the return of Marvel Television's Daredevil Born Again. So what's next? We're going to take this city back. In an all-new season, now streaming only on Disney+. They're hunting us. It's time we started hunting them. I can work with them. This should be tons of fun. Marvel Television's Daredevil, Born Again, streaming only on Disney+. Eczema is unpredictable, but you can flare less with Epglyss, a once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking Epglyss achieved itch relief and clear or almost clear skin at 16 weeks.

35:44Dr. Mary Claire Haver:And most of those people maintain skin that's still more clear at one year with monthly dosing. Epglyss, LibriKizumab, LBKZ, a 250-milligram per 2-milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe.

36:12Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection.

36:22Dr. Mary Claire Haver:Ask your doctor about EBCLIS and visit ebglis.lily.com or call 1-800-LILY-RX or 1-800-545-5979. If we knew more about our sleep, what would we do differently? Would we go to bed at a consistent time or take steps to reduce interruptions to our sleep? With SleepScore, Apple Watch measures your bedtime consistency, interruptions, and sleep duration. Then, every morning it combines these factors into an easy-to-understand score from 1 to 100. So you'll know how to take the quality of your sleep from okay to very high. Know your sleep score with Apple Watch, iPhone 11 or later required. So is everyone going to be successful with having an orgasm?

37:04Dr. Mary Claire Haver:I would like to say yes, but that would not be honest. The answer is no, but that's okay. What's important is we need to rewrite the script. There's this idea that sex is not successful unless you have an orgasm, which is why, quite frankly, so many women fake it because they want them to stop trying already. It's, oh my God, please, I just want to go to sleep. And part of that script is that sex isn't over until you have an orgasm. Sex is over when you're ready for it to be over because you've been having pleasure. Stop having orgasm as the end game. There is a new normal very often for women to say, I don't need to have penis and vagina sex.

37:46I don't need to have an orgasm. If I am in a relationship, I need to have someone who is loving, who is kind, and who touches me in a way that's pleasurable. I was once on a, I think it was a Today Show or something, and I was on with a sex therapist. And we were asked the question, how often should people have sex? What's the right number? How many times a week? And the other person who was on this episode with me, I thought, gave such a beautiful answer. He said, the number of how often you have sex is unimportant. What's important is how often you are sexual, meaning that you touch someone, you kiss them, you speak to them in a way which is kind and loving and lets them know that you are attracted to them.

38:29That's great sex.

38:31Dr. Mary Claire Haver:What is a sexual medicine clinic and how would you find one? It's a really hard question. Who's a sexual medicine expert? It's not something that there is a fellowship in. The International Society of the Study of Women's Sexual Health, they do maintain a directory. I don't even know if I'm on that directory or not or if my clinic is. It's not complete. It's a starting place. I will tell you that for a peri - We'll put it in the show notes because people are going to be looking up stuff. For a peri - and post-menopause woman, for a lot of them, their starting place is going to be with a menopause expert.

38:58Because while all menopause experts are not experts in sexual medicine, and we've already established that you've got to get rid of the hot flashes. You've got to get rid of the menopause symptoms. You've got to treat your genital urinary syndrome. It's a decent place to start. Absolutely. And for a lot of women, that is going to be not only the best place to start, it may be all that they need. They may not need to go to that next level. But once they go see their menopause expert and get rid of all of those things, if they are still having trouble, then you may need to find a sex med expert.

39:29And some of the major medical centers have them. Most do not. I will say that. I'm at Northwestern. We have a sexual medicine center there that I founded. I'm no longer there. But I have excellent, excellent clinicians who are using all the protocols that I put into place when we open the center. And there are a number of places that do that. Interestingly, where you'll see it more than any place else is sometimes in oncology departments because we haven't talked about that. But certainly when we look at people who are having a great deal of difficulty with sexual function. It is young women, all women of all ages who are dealing with not just a cancer diagnosis, but chemotherapy, radiation, surgery.

40:10So that's a whole different world and very well recognized by a lot of the top oncology centers. University of Chicago has a wonderful, wonderful center for sexual function post-cancer. So that's another place to look.

40:24Dr. Mary Claire Haver:What is in the future for you. Where do you see this going? Do you feel like access to this kind of care is getting better? I do have hope. One of the reasons I have hope is I am the mentor for a medical student organization that is all about sex education. There's a wonderful, wonderful, now she's a resident, when she came to me when she was a first or second year medical student, Jennifer Ramon, I don't know if you've come across her. I think you brought her to a conference somewhere in Chicago. I brought her to a conference. Yes. And this is a young woman who said, wait a minute, wait a minute.

40:56How come we're not getting this education? And she is one of those people that puts words into action. And she put together a medical student consortium, which started in Chicago, but I encouraged her because it was during COVID. I said, you might as well get medical students from all over the country. So now we have medical students, hundreds and hundreds of medical students from all over the country that are part of this medical student consortium for education. We'll put the link in because if there are any students out there listening, They have to get involved. And we have events and we have lectures and we do all kinds of things.

41:29They're doing research. They're working with Rachel Rubin. She's another faculty mentor. And because it was COVID, one of the few advantages of COVID is that I said, hey, this is all virtual. Let's get the best of the best of the best. And we got like the top 15 sexual medicine doctors to get on board for their board of advisors. And these medical students are loving it. They are all over it. We bring them to conferences. We get them involved in research. And it gives me great hope in terms of what kind of fields are they going into? Because this is a discussion. They're medical students. Well, if I want to do this, what field should I pursue?

42:02And there are many routes to being a sexual medicine expert. You could be an OBGYN. You have to like doing surgery and other things if you do that. A lot of them go into psychiatry. The talkers, the ones that want to keep their clothes on and don't really want to do those exams of the clitoris. Internal medicine. Internal medicine. Family medicine. There's urology. There's a lot of ways for people to become sexual medicine experts if they're interested. So, yes, I do have hope because we have this very large group of students who are very excited about this.

42:31Dr. Mary Claire Haver:Wrap it up with come again, what it is, how to find it, who it's for. Come again is for everyone. It is for health care clinicians, meaning doctors, advanced practice nurses, anyone who's taking care of patients, not just gynecology, but in all aspects of medicine. and there's not one single medical specialty that doesn't need to know about this. Come Again is for women who at a high level want to understand what's going on, what's changing, and most important, what they can do about it. Come Again is for men who want to understand what's going on with the women in their lives. 30 episodes sounds like a lot, but I promise you it's entertaining.

43:10Some of them are short. Some of them are 10, 15 minutes. Some of them are longer. It started out as 50 or 60 episodes. And you do it in little bites, do little bites. And I throw in there a lot of history of this stuff, like we talked earlier about Princess Maria Bonaparte. I love that stuff. I would love to write a book about it. The history of all of it. So I throw a lot of fun stuff. It really is for everyone who has a curiosity about this. And even though it's skewed towards women who are appearing postmenopause, because let's face it, those are the women that are having the biggest challenge.

43:36It is really for all age groups because these are problems that can happen at any time in life. And the most important is I'm solution driven. and it's not enough to talk about the problem. Let's talk solutions.

43:48Dr. Mary Claire Haver:Well, it feels like, you know, menopause is having this renaissance and that it's this new topic, but you've been doing this work for 30? A long time. You know, whenever we talk about how menopause is having a moment, and that makes me a little crazy because I'm thinking it's not having a moment. I've been talking about menopause for 20, 30 years, but no one wanted to talk about it. And I used to do a ton of media, you know, Good Morning America and Today Show and on and on and all these shows. And I would always pitch to the producers let's talk about menopause and they'd be like no no we're not gonna no no give me another topic and now of course that's all they want to talk about and and i would like to think it's because you like the groundwork right well there's there's that but i would like to think that there's this interest in menopause because people are acknowledging that it is important and there is some of that a lot of it is we we know there's a lot of money to be made in menopause which is why people have to be careful with where they're getting their information um but i am glad that this somewhat taboo topic is now being talked about, not just in the doctor's office, but with your manicurist, with your friends, with your brother, you know, as it should be.

44:56That's as it should be. When women talk to their daughters about their first period, they should also be talking about their first half-lash.

45:03Dr. Mary Claire Haver:Yeah. In their last period. In their last period, yeah. I'm guessing you could retire if you wanted to. Well, officially I have because I'm not seeing patients anymore. But you're always working, Lauren. Somehow. Why? What keeps you going? My husband keeps saying to this, he said, wait, you've retired, but you're working harder than ever. What keeps me going? Why aren't you paused? Oh, gosh, I don't think. Are you unpaused? Well, no, I'm not unpaused. When people say, are you retired? And I'm like, no, I'm rewired. I'm now going on to the next thing to the next chapter because my passion has always been education.

45:36I mean, let's face it. I started off thinking I was going to be a journalist. I started off writing. I have five books. I have another one in the works. I've created this come again series. I have my podcast. Nothing gives me pleasure like getting out there and talking to people and making a difference. Because whenever someone says, why this? Why not something else? And I've always been driven to go towards what is no one else doing? What's the unmet need? No one else is talking about alternatives to hysterectomy. I'm going to be that person. No one's talking about menopause. I'm going to be that person.

46:10No one's talking about the inability to have an orgasm. I'm going to be that person. That's what keeps me going, to be the one who's out there talking about these things that are going to make a difference, that are really going to make a difference in someone's life. And what I also realized is I've always been in both worlds, the very academic worlds of lecturing to doctors and medical students, and I still do that. And then also in the consumer world, and they're equally important to me. And I would like to see those two worlds come together more because this is a conversation that needs to happen.

46:39And whenever I'm thinking, I just, I can't do this anymore. I'm overwhelmed. I have to stop. And then something will happen. A stranger will come up to me on the street. I had a stranger, I work on a treadmill desk and my treadmill desk broke. And I called the company. They tried to troubleshoot over the phone and they couldn't do it. And they said, let's talk to the owner of the company. The owner of the company gets on and he said, are you Lauren striker that wrote sex rx and i said yes i am he said your book saved my marriage i'm sending you a new treadmill desk and you just go stop it you're like okay and you're that okay this is why i do what i do because it makes a difference yeah we want to make a difference we want to make a

47:20Dr. Mary Claire Haver:difference and you make a difference it gets overwhelming i take a breath and then someone will say something i wrote or said or did made them find a doctor you know change their life for whatever. And I'm like, that's why I'm doing this. Like I told you at the beginning, this is for the ladies on the couches in Ohio, in middle America who don't have a sex med doctor, who don't have access, who don't know where to go or what to do and are feeling so alone. And for those women, what I want to tell them is that not only do we have solutions, but if you don't have a doctor, it's okay because I'm going to give you the roadmap.

47:50I'm going to give you the script of to go to the doctor that you do have. You may not have a choice, But you can go to the script. You can go to that doctor and you can say, Dr. Haver told me that it might help me to use a local vaginal estrogen. Will you prescribe one for me? Dr. Stryker said that if I use that estrogen on my clitoris, it might help with my orgasm. Will you prescribe it for me? They will. They will. They're not going to say no. Yeah. They will not say no.

48:17Dr. Mary Claire Haver:Well, thank you so much for coming on the podcast. It was an honor having you on today. Thank you for having me. It's been great fun. As a reminder to our audience, you can follow Dr. Stryker on Instagram at DrStryke, on Substack at drstryker.substack.com, and on her website at drstryker.com. She is also the host of Dr. Stryker's Inside Information podcast, and she has released a 30-episode audio series on sexual function called Come Again that is available for purchase through her website. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr.

48:52Dr. Mary Claire Haver:Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepawselife.com. My new upcoming book, The New Perimenopause, is available for pre-order on Amazon. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests.

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50:01Dr. Mary Claire Haver:...alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.