391. Say It Out Loud: PCOS Gets a New Name, PMDD Gets Real, and Your Ovaries Deserve Better

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1:05Welcome to You Are Not Broken, the podcast that challenges everything we've been taught about midlife, hormones, and sexuality. I'm Dr. Kelly Kasperson, board-certified urologist, author, and a leading voice in women's sexual and hormone health. Enjoy the show. Hey, everybody. Welcome back to the You Are Not Broken podcast. Today, we're going to have on my friend, Dr. Samina Rahman, who's a practicing gynecologist in the Chicagoland area. Welcome to the podcast. Woohoo! Thanks, Kel. So excited to be here. Dude, so we hung out last when I was on book tour last fall. We did an event and literally, it was a big event.

1:37Over like 100 people were there. And literally everybody I talked to was like, I'm Dr. Rahman's patient. I'm Dr. Rahman's patient. And like, they're all dialed in. And so I go up on stage and I'm giving my thing and I ask for a show of hands of like who's on testosterone in the room. Like it had to have been 60 or 70 % of the women in the room raise their hands. And I'm like, this is an educated, empowered group that's actually getting care. Yeah, no, that's true. Oh, thank you. I'm spreading the word as much as I can. It's funny because, you know, Mary Claire was on her tour last week and she came to Chicagoland and she said something, introduced me.

2:15And then she was like, at the end, you know, Christy Desapri and Samina Roman will answer your questions. And then she left out the back door. So we got this line of people that were... I was like, oh, this is... I wish I would have wrote my cards. You're like, yeah. Oh, God. Yeah, absolutely. I just came to support my friend and this happened. Totally. And tell the story of our event that we did in Chicago. We gave away my book in goodie bags. We already had it. And you were Ubering home. Tell that story because it's so good. Crazy. Okay. This lady that she picked me up on the Uber and she's like, oh, yeah, I come to this place because it was an event space.

2:50She goes, I pick up people here all the time. What was your event about? And I was like, oh, it was Menopalooza. We were talking about menopause. And she goes, what? And I said, well, you know, we talked about menopause. And then she goes, you know, I have, she's having hot flashes. She's had a hysterectomy. She, you know, is taking care of her kids and grandkids and all these things. And she's just exhausted. She said, I just have been trying to find a doctor to help me, but I don't have any answers. And I pulled out your book. I said, I got you the, I got you the menopause Bible here. you know she was like oh and that literally started crying she literally was in tears she was like as I gave her the menopause moment and I said it's my friend's book it has everything you need to know to get started I said I gave her my information I gave her like every menopause doctor that I knew that could maybe help her and she was in tears and she was like I prayed this morning I prayed on it I prayed that you know I could get some help because some people just and she was black and she never had gotten like access to care and people and she'd been dismissed before so just all the things were happening at once and she was like, you're like my angel.

3:53And I was like, yeah, me and Kelly. Incredible story. Do you think there's a, I think there's a reckoning coming. This is UK data. I haven't seen US data. Fill me in if we have it. Of all the women who get oophorectomies for non-surgical reasons in the UK, 5 % are put on hormone therapy. Crazy, actually. A hundred, just in contrast, 100 % of men who have their testicles removed. even for cancer are put on testosterone. 100%. Otherwise, it's medical malpractice. Yeah. And I'm sure it's half of that for like Black women who get hysterectomies and oophorectomies at higher rates, right? So like, it's pretty significant, I think.

4:31And I think that, yeah, there's a reckoning is happening, right? There's a reckoning coming. Like, are you kidding me? In 2026, we're still castrating. Like, there's a crazy word. There isn't actually a female word for castration because the word castration means removal of a male animal's testicles because like farming basically like animal husbandry is where the word castration came from and it is removal of male animals gonads there is not a besides oophorectomy there's not a female castration word i think people get super cringy when we say castration but we're like uh you come up with a different word then of what this is absolutely what do they it's spayed, right?

5:17Spayed and neutered? Yeah. I think, yeah. It's like a hysterectomy. Would you like us to call it castration or spayed? Either way, replace the hormones. You got spaded. You got sped. You got sped. So we sped you along. Sped you right into? Right into hypogonadal states. There was just a paper that came out in the British Menopause Journal looking at people on hormones. This is a massive database. I don't know if it was a UK databank, but it was massive database. And basically what they said is being on hormones doesn't decrease life expectancy, which is kind of basically saying like it is equal, right?

5:55But it was actually a teeny, it was only a teeny, teeny bit of life extension on it. But for early menopause, being on hormones gave you a 30 % survival increase, roughly. It was like somewhere between like 28 and 35 or something. 30 % survival increase. crazy i mean well we know this so it's a longevity issue actually for these women who have hysterectomy not hysterectomy ophrectomy less than age 40 45 they need those hormones they need full replacement they can't just get multiple yeah right right right multiple patches because the patches are designed for hormone menopause just to give you back enough to like help some things help some things but not fully replacement i mean full replacement we're going to watch your levels.

6:41We're going to see if we're getting to the levels we need, that kind of replacement. And that's just critical for your cardiovascular health, for your brain health, for your bone health, everything. And so the fact that so many women do not get offered it at the time of is just mind-blowing. They wake up with hot flashes. I thought she was like over 50. She had her period when she went in for her hysterectomy, woke up... So she wasn't menopausal, even though she was in her 50s. And woke up with hot flashes and the OB told her that she was just processing her anesthesia. And then she said, she said, I'm going to go to Casper said, and the OB was like, well, you know, she's going to give her hormones.

7:18And she's like, yeah, that's why I'm going. Let's talk about PMDD. How much PMDD do you see? Tell us what it is. A lot. Premenstrual dysphoric disorder. It is part of, I think, one of the maybe most misunderstood things. I think it's like a time of, you know, when we have our ebb and flow of our normal menstrual cycle. And as we're getting into the luteal phase, as our progesterone rises, some people have a susceptibility to those hormones that is unlike anyone else. I mean, a lot of us have PMS symptoms, right? We feel a little hungrier, we get bloated, we want chocolate, you know, we want so many, we might get a little angry, but it doesn't impact our quality of life.

7:58It's not impacting our relationships. And with people who have premenstrual dysphoric disorder, it really is a significant impact. It's like a clock set. Patients will say, oh my gosh, I know I'm about to get my period because I'm a raging bitch. No one can be around me. Or I'm so depressed. I'm crying all the time. And it is a true... They feel like it's a total Jekyll and Hyde. They totally feel Jekyll and Hyde the whole freaking month. And it's so debilitating. And I think it's just chalked up to like, okay, oh, you're hormonal. You're this, you're that. And it's so stigmatized anytime you talk about any of these mental health disorders that people don't get the attention they need.

8:34They get slapped on a pill. The pill makes them worse because some of the pills aren't helpful for that. And sometimes progesterone can help, but sometimes progesterone doesn't help. Progesterone meaning your natural progesterone that your ovaries make. So sometimes that can help, but that doesn't always help. And it seems to be that the ovulation is the trigger. So as you age and you don't ovulate, then you don't get PMDD. I feel like during menopause, I feel like I see a lot more worsening PMDD, but it might be because of the all over erratic nature of what's happening. Tammy Rowan has taught me a lot about like progesterone sensitivities and how she's always talked about it as PMDD as a progesterone sensitivity.

9:14Although she and Jeff Kisner did a recent, you know, ish-wish webinar where he was actually talking about it more at the GABA receptor level. Like it's not necessarily the progesterone, but it's the interaction with the GABA receptor. So, you know, I didn't get to hear all of it, but that was like more, more about what it was about. And so the reason that's that medications like Yaz or the Drisperin type or progesterone seems to be beneficial and is FDA approved for that indication is because it's not considered, it's almost like not a true progesterone, you know, it's a aldactone analog. So it works at the receptors, but it doesn't act like progesterone otherwise.

9:54And so I think that there's something... Because some people get put on other pills and they're crumbling downwards, like they don't do well. That's the one that's been probably the most tested and for people have done the best on is the Yaz family, which may or may not include Nextellus because it is Drosperinone. And then I think the way it impacts... I think we have to be clear about the fact that estrogens impact how we interact with serotonin, right? And so I think that you know, that modulation, that neuromodulation that happens. That's why a lot of people do luteal phase SSRIs and they do well, they really do well with them.

10:31And so I think, you know, we don't have all the answers. This is women's health. It's really trial and error is the too long to read of like, it's real, but it's trial and error to see if your body, what your body responds to. It might be a SSRI for a week out of the month. It might be a birth control pill with a specific progestin in it. it might be progesterone. I had somebody who's successful on Duovie. Yes. And I think that similar philosophy is that you're not on an actual progesterone. You have a sensitivity to it. So if taking more progesterone makes you worse, the Duovie helps because it's benzodiazepine, which is a selective estrogen receptor modulator.

11:11So it's not working the same way for those listening. This podcast is sponsored by Explore Worldwide. One of the themes that keeps coming up in my conversations is that it's okay to want more. More joy, more connection, a better experience. And thanks to our sponsor, Explore Worldwide, you can get so much more when you travel. All of Explore's adventures are 100 % human-made. Their tour leaders have actually stayed at that family-run guest house that isn't even online. They've eaten at the neighborhood restaurant the locals love and know the trail you'd never find on your own. Your vacation should feel uniquely yours, not like it was generated from the same prompt everyone else entered.

11:51That's the difference a human touch makes. Explore Worldwide's trips are created by real destination experts and led by tour leaders who actually know the places they recommend. They handle everything so you can relax, stay curious, and experience something genuinely memorable. This is your time. Demand more. Visit exploreworldwide.com and don't just travel, explore. This podcast is sponsored by Jones Road. I like to take care of my skin, but I don't like the whole cover-up makeup routine. I like things fast and fresh. So when I found Jones Road Beauty's Miracle Balm, it genuinely fit the bill for my lifestyle and skin.

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13:08Modern day makeup that's clean, strategic, and multifunctional for effortless routines. For a limited time, our listeners are getting a free full-size mascara on their first purchase when they use code Y-A-N-B at checkout. Just head to jonesroadbeauty.com and use code Y-A-N-B at checkout. After you purchase, they will ask you where you heard about them. Please support our show and tell them that our show sent you. And so I think that that might be an option. So some people actually, like for extreme cases, people have, you know, even done like a medical castration where they're like taking like a Lupron kind of thing and then giving back what be instead.

13:49And so that used to be something that I considered, you know, like, I mean, that has to be really extreme cases. These patients are almost asking for a hysterectomy because they're so miserable and they failed so many things. They failed acupuncture, they failed, you know, anything that we would consider them try and then you know you can do something like a lupron which will give you a medical kind of frustration and i literally wanted to bring it up because literally this morning somebody was having a patient and that patient was 35 bad pmdd and their first option was hysterectomy oophorectomy and i was like i'm not sure that's first line therapy i think that's i think that's we've tried everything else and this is all we have left and then you do give back and i'm like especially you got to make sure you're going to have give hormones back if you take the ovaries away it's not just the hormones that are causing the pmdd there's something about the ovulation i just remember this from the from the ish wish advanced hormone course if i'm remembering it properly yes yeah absolutely so it's the hormones and this interaction you know with all of our receptors in our brains you know with the GABA receptors and and you know your serotonin everything i think that it's this modulation that happens with estrogen and your progestins that we don't probably have a full understanding of but but it's real and there's options to try it's awful i mean literally people feel jackal and hyde they feel like they're two people in once they can't keep relationships it's really so unpleasant i mean they're not feeling like myself the nflm of perimenopause and menopause like it's real right again it's something else where people are like, I don't know.

15:24Does Samina feel like Samina today? Can't test it. Like you have to believe her. You have to believe her. You have to believe her. That's the secret sauce of it. Let's talk about the late breaking news of we've just, we, the Lancet. Who just renamed PCOS? Who has the power to rename stuff? Do we just have to publish a paper and rename things? I mean, that's how genital urinary syndrome of menopause happened. That's how musculoskeletal syndrome of menopause happened. Bonda Wright just wrote a paper and said, here it is. So some people have now renamed, apparently it's official enough, PCOS. Yeah.

15:55And I think it was a long time coming. I remember filling out this survey when they asked maybe a year ago, they're like, what kind of, these are the different kinds of names that we would consider. It started in Australia, actually. And I feel like there was what, 57 different groups, like 1400 people, something, something crazy. They just published it in the Lancet article. Today's May 12th. which i guess that's pretty fast only one year so why did they feel like a read so pcos polycystic ovarian syndrome is getting renamed why did they feel like that was necessary and what has it been renamed to well let's talk about pcos is polycystic ovarian syndrome if you think about the name you sound like you just have a bunch of cysts on your ovaries and what does that mean right the cysts and the ovaries are the problem when that's the name and that is not the case you can have cysts You don't always have cysts enderobus.

16:46It is a metabolic, hormonal and endocrine metabolic syndrome, really. And so what they've named it is polyendocrine metabolic ovarian syndrome. So PMM, ovarian syndrome. So they kept that in there. So the ovary was maybe still the culprit. I thought they were going to take ovary out because men can get PCOS or whatever the new abbreviation is. Some metabolic dysfunction, similar to it, right? Yeah, that's interesting. So for the women, I guess, they'll still call it polyendocrine metabolic ovarian syndrome. So PMOS. And so that aspect is so crucial because number one, the stigma around PCOS is huge, right?

17:24You always think, oh, I don't have PCOS. I'm not obese. I'm not hairy. I'm not this. Because that was the classic sort of phenotype that we were taught back in the day, right? That this is a PCOS. If your ultrasound doesn't show cysts, they rule it out, even though that's not a defining characteristic. Right. And so it's traditionally you have to have, they have the broader criteria. You have to have two out of three of these. And these are symptoms, right? So you have to have either an elevated testosterone on blood work, DHEA or testosterone, or clinical symptoms of elevated testosterone. So that would be hair loss.

18:00It would be hair growth, hirsutism, or be acne. So you could have any of that, and that would count one in that category. You could have an irregular cycle. And it's usually oligomenorrhea where you skip cycles, a 40-day cycle, a 50-day cycle. You may only menstruate once or twice a year. So this anovulatory cycles was another characteristic. And then the third was ovaries that looked polycystic. So you have like these cysts that just kind of look, they used to call it a chain of pearls. Like it just looked like a chain of pearls around. or you can also use anti-malarian hormone levels. So the AMH level, which is made by those cysts, it tends to be two to three times elevated in PCOS patients.

18:42And so that was the criteria. You have to have two out of three of those. And so if you have two out of three of those, you met the criteria and then you can get treatment. And what would the treatment be? It would be depending on what you're trying to treat. But we know these patients have infertility issues. We know they have menstrual issues and we know they phenotypically might have like some issues with their aesthetics and how they feel about themselves. But the big picture that was missing was this cardiometabolic inflection issue that was coming up, right? Like this is a point where patients have higher cardiometabolic risks, higher heart disease, they have more chances of having diabetes and pregnancy, like all of these risk factors that weren't being addressed.

19:19And so years go by, you get told by one person you have PCOS, you get told by the other person you don't. There's not a cure for cardiometabolic sort dysfunction here. So it is something you can control. And I think that's very important to remember. But as a syndrome, we don't know that we can cure this at this point. So what you're looking at is lifestyle modifications. You're looking at trying to obviously lose weight, but also reduce visceral fat formation. So sometimes that's why we used to use metformin to increase your insulin sensitivity. And then you treat the other things, right? You can't go through life without a cycle, without doing it on purpose, right?

19:56Some of us try to stop our cycle. But if you go one, two, three years, not menstruating regular, not having at least four cycles a year, and you have PCOS, you can get this hyperplasia of the lining of the years. And this is actually when we see young patients get endometrial cancer, is are those that have PCOS. So those things have to be treated. Fertility can be treated. And then like the feelings around the mental health distress that comes with it, depression. It's an inflammatory condition. We think there's probably... I started to talk to Tanya Dempsey. She always says that's how she came to understand mast cells was her understanding of PCOS.

20:30So there's probably some level of that mast cell stuff happening with PCOS as well. But the change was real. Yep. Anything FDA approved for PCOS or is everything off-label? And just to clarify for people, that doesn't mean things don't work. It just means it hasn't gone through an FDA process. But is there something FDA approved for PCOS or this new name? No. Metformin usually can get covered for PCOS. I don't know that it has a PCOS indication. For a while, back in the day when I would have patients on metformin and they were failing, this was pre-pandemic, I would give them Ozembic and their insurance would cover it because they failed metformin.

21:08But there's not an indication for it on the label. But the GLP-1s, because of how they help insulin resistance, visceral fat changes, do seem to be promising for PCOS. A sweet spot, yeah. There are studies on it. They have better fertility outcomes. They have better cardiovascular parameters, all the things. And so, you know, so if you treat some of these things, your cycle will then regulate on its own. You can maybe restore some of your fertility concerns and maybe you won't have as many skin concerns and hair loss and the T would come down too. What happens to PCOS with menopause? Because the ovarian function decreases significantly.

21:47what happens with pclf what what are the 58 year olds with a history of pcls doing it depends on whether they're treating their pcls were they on like some sort of you know birth control pill hormones that were regulating their cycles you know were they on top of their cardiometabolic metabolic game and in getting the lifestyle modifications they needed those patients are you know sliding into it a little bit easier than patients who weren't their metabolic changes are worse. I think their weight gain is worse. Their cardiovascular profile is worse. I mean, so that's why it's really important to identify it early as a risk factor for all of these things.

22:20And so I think also that's why changing the name was so important because it was always considered a guide-only issue. But when you think about it as a systemic issue, the internists are sending them to the guides, the guides don't. I didn't get trained in it. And for my understanding, The amount of people with undiagnosed PCOS, there are not enough gynecologists on this planet. Yeah. They say 170 million women have PCOS around the world, one in eight globally, one in four South Asians. So, I mean, it's not a small number. And I think, because it's an inflammatory condition, it really is a full-on, based on all the insulin resistance, all the inflammatory cytokines.

22:59We see it a lot of times hand-in-hand with endometriosis. I can't tell you how many patients I have that have both. Yes. And you can be thin and have PCOS. Especially for, you know, South Asian, I think they tend to have a lot more patients. Ruby Jelani, who's on Instagram a lot, always talks about the fact that she was this thin person who had fertility problems and it wasn't because she was anorectically, you know, her anorexia was because she had PCOS. And so, you know, she had all this skyline hormones and everything like that. I'm always very protective of the testosterone discussion, right and it irritates me how people think pcos is a testosterone first problem of like oh everything's because of the high testosterone instead of the testosterone goes high because the ovaries are dysfunctional because of the metabolic underlying problem the inflammatory stuff right yeah exactly and i think that's the understanding is you know you have to know that the ovaries make androgens and so if the ovaries are malfunctioning they're gonna make a lot of cysts and they're going to make a lot of injuries.

24:00Yeah. I think that's important for people to understand. What do you think is going to change because the name's changed? Do you think like, hopefully now primary care endocrinology, like it's going to become more of an internal medicine? I do. I do. I think more family practice, more internal medicine will embrace this. I think maybe people will work on more preventative things, right? Like, oh, you have PCOS, we need to get on top of your cardiomyel and malic health. You know, I don't think that a lot of people emphasize the fact that this is a huge risk factor for so many things down the line.

24:29And if you don't change your lifestyle and eat with intention and get all the medications that will help your insulin resistance, you're going to be that person that has an early heart attack and all the diabetes that comes with it and all the things. So I think it's going to be early prevention, early action, and hopefully less times for diagnosis. We're not going to go years and years before diagnosis comes. Right. Keto diet or low, low sugar, low processed sugar, low processed carbs that tends to move the needle on the, the disorder formerly known as PCOS. We should have a symbol for it. Right.

25:12But medicine changes, you know, like medicine changes all the time. We, we used to call it the senile vagina for Christ's sake in the 1980s. And then vaginal atrophy, which I still think is not a bad thing when discussing the vagina, but it doesn't describe all of GSM. But like, we're constantly renaming things. I mean, it was called Stein-Levendon. The PCOS was called Stein-Levendon syndrome for a while, but for the two people that probably made it. Yeah. I didn't know that. Yeah. That's interesting. I learned today from a sex therapist, we don't call them private parts anymore. We call them personal parts.

25:43Oh, I think. Because at some point, you might want to share your private parts with somebody else and then then they're not private and try to like undo the myth of the shame of private. Now we call them personal parts. And I'm like, okay. I'm like, I don't hate the renaming when it's done like thoughtfully with intention. Anything else you want to talk about with PCOS or should we move on? No, I think that, you know, it's just something I feel like should be treated early and that people should be aware of it. We shouldn't be ashamed of it and stigma around. Don't be dismissed. If people dismiss you, get a second opinion if you can.

26:14I know that's hard. you got a book coming out brown girl's disease where'd that name come from it's very intriguing what's what's happening in over here so um i'm taking this phrase back because i start with the story of you know when i was a resident this is post 9-11 you know a lot of south asian women like 40 have uh like significant pelvic floor dysfunction or vaginismus wait hold on 40 yeah if you look at like the all india data yeah it's like significant actually like if you look at global data and just for anybody who needs the help including myself south asian is that anything south of china it's india pakistan nepal um i'm gonna miss some so india pakistan nepal bangladesh miyanmar burma the country formerly known as burma right i'm gonna have to look at because Yeah, this is very bad.

27:07The South Asian not knowing all this stuff. No, it's okay. But to me, I'm like, I can't assume that I know all of it. So we should, we gotta know what we're talking about. Oh, Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Wait, before we talk about your book, we have to talk about what you and I did. Golly, three years ago now. I was literally in the airport and I got a message on Instagram that somebody in Pakistan needed vaginal estrogen. Oh, yeah. Do you remember that? Before we got the estrogen box warning off at the FDA level, we got somebody in Pakistan on vaginal estrogen.

27:43So please correct me, but it's very hard to get vaginal estrogen in a lot of countries, including the United States now, but that's a different problem. And if it hurts to have sex, you don't want to have sex. And if you don't have sex, it's grounds for divorce. And if you get divorced culturally, you're not allowed access to your children. Did I get that correct? We're like, who cares about a little vaginal dryness? Well, it's actually catapults into a very big effing deal. This podcast is sponsored by Addy. Let's stop pretending low libido isn't a big deal. If it's bothering you, it's worth paying attention to.

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31:01And so I think, you know, that's something that's not usually discussed as much, but I feel like, and that's kind of what that, that lady said to us, right. That she was having all these concerns about not being able to stay in her marriage uh yeah and then we ended up getting her vaginal estrogen we find people we found people the underground railroad of an international vaginal estrogen yeah so but there's a lot more talk of it now so i think that's a good thing yeah remember that was our like baby advocacy not literal baby but like our intro to advocacy was like we got to get some vaginal estrogen into Pakistan and we did it I mean I did not complete the journey myself no but we did we did it yeah the women's networks are amazing yes absolutely okay so go go back to brown girls disease okay and so I um so South Asian women and a lot of women some conservative backgrounds do have this like involuntary contraction of the pelvic floor because of all the sex negativity they grew up around and so I did my residency in University of Massachusetts which Worcester, that whole area in the Boston and greater area has a decent number of South Asians.

32:11And so I went into this room with my attending. I was an intern. She saw a South Asian woman who was like vaginismus, tried to do an exam. She was like, she jumped to the top of the table. The attending was really pissed off. She was really mad that she couldn't tolerate the exam. She walked out and she looked at me and she's like, what's the deal with your people? They act like they've never had anything in their vagina. That's what she told me. And I was like, what? the fuck is going on? Who says that? What world am I in the Northeast? I grew up in the South. I was like, wait, this is not the South.

32:43They would just say, bless her heart. But like, here, you're just telling me to my face, like, what's the deal with your people? And I was like, and so I would see this kind of like, you know, interaction play out many times throughout my residency to the point where I talked to other South Asian OBGYNs about it. And there, one of them was like, you know, they call that brown girl's disease in my hospital. Oh, another girl, brown girls disease like watch out and i was like really and she was like yeah and i was like that's crazy i guess that's i could see and so it was a derogatory term that was kind of thrown at women like a diagnosis that you just throw at someone because that's what you assume without actually understanding who they are what their history is you know she could have vestibulodynia from hormonal mediated problems and you're just calling it she got her right but you're looking at her and you're making your own assumptions and you're calling it brown girls so that's what i called it I took the term back.

33:32You know how people take and they re-empower themselves? I love that. Like so. So I took it back and I'm like, you know what? Brown girl's disease. I love it. When's the book come out and where can people find this? Hopefully October 6th and it'll be on, you know, Amazon and many bookstores. I'm going to plan a tour. I'm in the middle of figuring that out right now. So sleep now. You know how people like give you advice when you're going to have a baby? They're like, sleep now, make peanut butter and jelly sandwiches and put them in your freezer. Yeah. I mean, it's kind of like birthing a baby, right?

34:04Yeah, the book tours are for real. I look at my picture. Then you look back and you're like, oh, God. That was a lot. That was a lot. I mean, you have so many people just to help in the Chicago area. You could just do book events for days and just cover Chicago. Chicago. Yeah, I've had a number of people reach out. So I'll probably do a couple in Chicago. And then probably just cities that I know people. I lived in LA for a while or the Bay Area, but North Carolina, I just, you know, I grew up there. Some of those places, you know. So fun. Yeah. I like it. I mean, your book really does cover, and I think it's going to be a great resource for all of the different possibilities of what can be going on in the pelvis, from lichen sclerosis to vaginismus to vulvodynia.

34:49They are all different. And when people just say I have pain with sex, it can be a lot of things. Pelvic floor dysfunction, low hormones. Yeah. But one thing that I always say, I like to take problems away from people. Like if you have pain with sex and low desire, you just have pain with sex. You don't desire painful things. Yes, exactly. I mean, you are so well versed in the menopause world, in perimenopause, in the complexities of birth control and in ish-wish, women's sexual health, women's sexual dysfunction. It's a big topic, all of that stuff. Yeah, it is. I cover a lot of it. I mean, I think it's pretty readable.

35:28I think that like, you know, I wanted to make sure I cover like a span of all types of sexual dysfunction because we have books that cover just sexual pain and, you know, certain other things. But, and I want to make sure I was like bringing in the, you know, biopsychosocial, but a lot of people don't talk about the psychosocial enough, you know, so I want to make sure to bring in the cultural elements and how sex is viewed in different cultures and how that plays into, you know, people's sexual dysfunction and their ability to access care. I talked a lot about medical bias and implicit bias in medicine and the medical gaslighting that we have.

36:02I always say if you can get the same treatment plan from a bartender at last call, then you're not receiving medical advice. You're receiving bias. That's good. I mean, especially like you're being legitimately serious. People are like, just have another drink of alcohol. And you're like, I don't even drink. why is this a good idea share with us about the muslim culture and what you see as kind of common themes either as far as the sex education that people got or issues with medical care and access can you enlighten us yeah for sure basically no education we got nothing we're starting from no i i actually did a study with this group called heart women women and girls it's a nonprofit in Chicago, but it's a national nonprofit who they do a lot of sexual education within the Muslim communities.

36:53And they do a lot for sexual assault victims and people who have religious and spiritual abuse. And so we did this study in 2020. We have surveyed like 700 people, Muslim women, most of them turn out to be heterosexual, like, you know, high income women that were able to answer these surveys. But again, something similar happened where it was like 40 % of women had experienced sexual pain at some point, more than half of them decided not to seek help because they didn't think something was available or they thought they would get dismissed or they thought painful sex was normal because that's kind of what you're told over time.

37:30And so I think that there is this underlying current of normalizing sexual pain that we don't talk about sex. We don't talk about menstruation. We don't talk... It's like Bruno. You don't talk about Bruno. You don't talk about sex you don't it's all under the bruno account we'll just call it bruno from now on yeah yeah no that's clever you could definitely do something you should do an instagram reel on that anyways well i think you know a lot there's a lot of hope in the hope meaning uh not good for you like i just hope it gets better i just hope it goes away yeah that's right exactly and so and sometimes people just push through and they'll get through and they'll be like okay now i have my kid and you know there's a lot of unconsummated relationships and marriages and when i go to issm the international sexual medicine society meetings there was two years ago it was in dubai so it was in conjunction with the middle eastern sexual medicine society meeting so ish wish had a thing there and it was all over every other thing was unconsummated marriages erectile dysfunction from unconsummated marriages vaginismus unconsummated marriages and even though we don't use the term vaginismus as frequently because we have like genital pelvic penetration disorders that are a big umbrella you know it's still the most common thing that is discussed when it comes to sexual problems in the Middle East in South Asia and all of these countries and so there was just tons of like how do we respond you know a lot of people are using vaginal Botox in the Middle East and in Turkey Turkey's one of the big countries that has a lot of data on it and so I think that, again, this underlying sort of shame and stigma associated with anything women's health and PARPs related, you know, is really intense and intense to the point where even the clinicians, the doctors, they don't want to learn about it.

39:13They don't want to talk about it. And we know from our ISHWISH data that if the clinician, the doctor's not going to bring it up, then the patient's less likely to bring it up, right? And so you're much more likely to get the answers if you're bringing it up yourself. And so that's not happening and you're having nobody teaching it. And so I've actually tried to go into like different places in the Muslim communities. I used to have a flyer, you know, our big celebrations are called Eid, E-I-D. And so I'd be like, Eid Mubarak, which means Happy Eid. Have you consummated your marriage? And I would leave these flyers in like the mosques.

39:43This is like early 2014, 2015, like my early stages of building my practice. And like people would just throw them away. Like, oh my gosh, I can't believe she's talking now i know we're talking about it like because that's the context you know that didn't bring much traction i'm like fucking i'm gonna write a book if people want to read it they can you know like i mean i think books are so good because people can read it in the privacy of their own home and you know nobody knows you're reading it and it just creates such a more educated consumer i guess of health care of like oh i know that there's words for this and i know it's not me and just me being ultimately shameful of like, no, no, bodies respond in different ways.

40:24And sometimes we need help and hope is not an FDA approved treatment for anything. I think it's true. I mean, they say, you know, like when they, when we talk about building a terminology for something, I have patients that have persistent general arousal disorder and they come to me suffering all their lives. And they said, you know, before I read your website, I did not know there was a term for it. I just thought I was like this freak who always felt aroused and whatever, you know, like just terrible things about themselves. And, you know, I think the psychiatrists call it affect labeling where you immediately have a reduction in your nervous system when you know there's a name associated with it.

40:59And so I think even just the power of the name was so impressive, you know, when I see people talking about it, talking about the vestibule, like this is, you know, such an important piece of tissue that inhibits people from having sex. And so, so many patients are like, oh my God, so that was the reason. Like this piece of anatomy right here, it's like it, you know? So I think, I think the fact that we need to say the right names, we need to talk about things in the correct way. And that will continue to de-stigmatize things. And actually in the book, I talk about when I went to see Barbie for the first time in the movie.

41:30And I took my, that then four-year-old and my 11-year-old. And there's that scene where Barbie goes, well, she's on Malibu and she's skating and she goes, well, we don't have a vagina and he doesn't have a penis. And then my four-year-old looks up to me very loud like any four-year-old would do but mommy we have vaginas don't we and the woman literally came to me at the end of the movie and was like did your daughter say vagina in the middle of the day i'm like yeah she certainly did i was like we're high-fiving over here and she's like really pissed off she's like clutching her pearls mad that like i told i had my daughter say vagina that's not how we change the world man i mean that's the thing is people wanting to not talk about it, you assume that means everything's fine.

42:13Yeah. Or the troubles aren't real. There's so much that happens by not talking about it that it's like, why don't we try 100 years of talking about it and see what happens. And see what happens. Can we move the needle then? Yeah. Let's give it 100 years. Let's see what happens in like three generations and see if we can make it. Well, thank you so much for coming on. I absolutely appreciate it. This is Flew By. Crown Girl, look for your tour. You do a great Instagram. So tell us where we can find that. Yeah, I'm gynogirl on Instagram. And I have a podcast Kelly's been on at GynoGirl Presents Sex, Drugs, and Hormones.

42:49And then I try to do a little bit on YouTube too. So yeah, now I'm in Chicago. I feel like you're one of the OGs and I feel like you're just getting started. So try, you know, it's hard. You know, it's hard. I mean, I have three kids, you know, it's like kids and then you have a practice, which is a fourth kid. And then you have, you know, a spouse, which is a fifth kid. And then if you have parents, like... Right. And don't forget to take care of yourself. Yes, exactly. Which is always... Make those peanut butter and jelly sandwiches, put them in the freezer. I never did that, but I remember that advice being like, okay, don't forget to intake fiber when you're on your book tour.

43:25Awesome, my love. Dr. Rahman and I text nearly every single day for people who don't know. So I will be talking to you soon. And thank you for coming on the podcast. Thank you. I appreciate it, Kel. All right. Well, do all the great stuff that you're doing. I'm super excited about stuff we talked about offline. Thank you. Talk soon. All right. Take care. If you found this episode funny, helpful, insightful, please take a moment to follow, rate, and share the You Are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people. And thank you.

44:00For courses, books, and my monthly membership and the Kasperson Clinic information, visit kellykaspersonmd.com. This podcast and all content from Dr. Kelly Kasperson is intended for educational and informational purposes only, and this is not a substitute for individual medical, coaching, or psychological advice, diagnosis, or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you are not broken.