You Are Not Broken

236 – Prolapse – Surgical and Non-Surgical Options

This podcast is sponsored by Femselect

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Dr. Sonya Ephraim, MD, FACOG, FPMRS, is a urogynecologist and the founder of Allure Pelvic Wellness and Aesthetic Gynecology in Deer Park, Illinois, outside of Chicago. She talks about how she decided to go back to do a fellowship in female pelvic medicine.

In this episode, we talk a lot about prolapse and touch on-

· What is pelvic organ prolapse?

· Why prolapse needs a rebranding – so much shame

· Risk factors for prolapse

· What are the signs and symptoms?

· Our tips for treating constipation

· Prolapse risk goes up after menopause – we discuss the likely role of hormones and decreased muscle strength.

· The impact of prolapse on those suffering

· Why we hate calling it “bladder prolapse”

· How the bladder can be affected by vaginal prolapse and what may and may not improve

· How do we know if we have prolapse

· How do we know if we should treat prolapse

· Risk of de novo stress urinary incontinence when prolapse is fixed, either with pessary or surgery

· What is a pessary and what are the risks of a pessary.

· Can you be sexually active with prolapse?

· The role of pelvic floor physical therapy and prolapse.

· Surgical treatment options:

o One size does not fit all.

o Obliterative surgery – colpocliesis

o Hysteropexy vs. hysterectomy

o Minimally invasive options – suture or mesh based (sacrocolpopexy) procedures

o New treatment options (EnPlace) benefits and data

o The cervix as a sexual organ for some people and the consideration of cervix/uterine preservation in prolapse surgery.

· Modern prolapse repair is safe, effective and recovery is not too stressful for most women.

· Post surgery instructions and rehab – vaginal estrogen and pelvic floor physical therapy

· The risk of recurrent prolapse

· When to consider adding a sling to your prolapse procedure

· Just because someone or something said you have prolapse, doesn’t mean you need surgery

Instagram.com/allurebydrsonya

https://allurepelvicwellness.com/

#EnPlace, #PelvicOrganProlapse, #WomensHealth #PelvicHealth

My previous Prolapse episodes

21 – pelvic organ prolapse master class

138 – February Live – Hormones, prolapse, pelvic floor PT and more

161 – “I Just need to put something in my vagina”, Prolapse, and how PT helps

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

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Menopause Society President – Dr. Lisa Larkin

This episode is sponsored by Solv Wellness. To get Via, moisturizer for her, visitvia4her.comfor 30% off your first purchase. Discount automatically applied at checkout.

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Dr. Larkin Trained at Yale and the University of Chicago, Dr. Lisa Larkin is a women’s health internist, menopause, sexual medicine, and medical breast expert and a women’s health physician and consumer educator who has been practicing in both academics and private practice for over 30 years. She is Founder and CEO of Ms.Medicine, a national health care organization dedicated to advancing women’s health on a broader scale and Founder and CEO of Concierge Medicine of Cincinnati, an Internal Medicine and Women’s Health practice where she continues to practice clinically. Dr. Larkin is the President of the Menopause Society.

Why did NAMS (North American Menopause Society) rebrand to Menopause Society?

“We can’t pigeon hole women’s health into the Ob/Gyns” – Dr. Casperson

“Women’s health doesn’t belong to any one specialty” – Dr. Larkin

Dr. Larkin shares her story about not being trained in menopause and her career journey and how she understands the WHI study.

We talk about fezolinetant (Veozah) – the new non-hormonal medication for hot flashes.

One of Dr. Larkin’s favorite thing to talk about is breast cancer risk assessment and prevention so we discuss this.

We define dense breasts.

Why alcohol just doesn’t make sense in midlife

Dr. Larkin shares her personal journey with menopause symptoms and sexual dysfunction. And shares non-hormonal options. And what you can do without seeing your doctor.

The role of confidence in midlife - lack of confidence in what to do and how Menopause Society/her clinic/my podcast can help - and what we see when women get confident and educated in midlife.

What excites Dr. Larkin about menopause and the women’s health space

https://www.menopause.org/

https://www.instagram.com/drlarkin/

https://www.mymsmedicine.com/dr-lisa-larkin

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

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Dr. Sonia Wright interviews me on genitourinary syndrome of menopause - AKA: The Senile Vagina and The Super Penis

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Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment.

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The history of getting to the name “genitourinary syndrome of menopause”

GSM happens not just in menopause

The labia goes away after menopause unless hormones are supplies

Recurrent urinary tract infections are in the top 10 reasons women go to the doctor

Why you get more urinary tract infections after menopause

When we treat erectile dysfunction are we treating the partner?

We talk about sex ed for adults and what I would put in a curriculum.

The role of vaginal estrogen

Where to get cheap vaginal estrogen

ACOG statement on vaginal estrogen after breast cancer

“estrogen is not trying to kill you”

The FDA black box warning on vaginal estrogen is wrong

Can I just use lube?

Issues with sensitive skin when starting vaginal estrogen

Why I don’t use a loading dose with vaginal estrogen

When to consider adding testosterone to your vulva or DHEA to your vagina

How to talk to your health care provider about genitourinary syndrome of menopause and ask to try a prescription product.

Vaginal estrogen can help overactive bladder and urge leakage

The myth of needing to finish your periods prior to starting vaginal estrogen

https://soniawrightmd.com/

https://www.instagram.com/drsoniawright

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes.

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Booty Play and Butt Stuff

I am back with Jenn Mason! Check out our older episodes on toys and more #45, #49 and #52

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Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment.

Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com

The more people are empowered in their sexuality, hopefully this will decrease the bad things.

What is booty play and let’s define what it is and what the body parts are.

How do people get started with butt stuff?

No one gets extra points for going up in size with booty play.

Tips for starting to explore.

Consent and doing stuff because my partner wants me to.

The importance of communication.

Is booty play guaranteed pain?

Pain is a sign to slow down or stop.

How to people prepare for receptive booty play.

How messy is booty play in real life?

Lube lube lube

Is it okay to ejaculate in the rectum?

Rules for booty play

Do you need to use condoms?

What anuses are supposed to look like.

Is there a lube that is specific for booty play?

Anal play safety

Does booty play make me gay?

How to talk to your health care provider about anal sex.

If someone wants anal sex does that mean he is weird?

Can receptive anal play mess up my body?

Does the penis have to be a certain type of hard for penetrative play?

Why does this not go well sometimes?

“No one gets a trophy for getting a penis into a butt” – Jenn Mason

https://winkwinkboutique.com/

https://instagram.com/winkwinkboutique

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes.

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I am back with Jenn Mason! Check out our older episodes with Jenn on toys and more #45, #49 and #52 Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Go to Addyi.com and use code NOTBROKEN for a $10 telemedicine appointment. Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com What are intimate lubricants and why are they important? When do most people get introduced to lubes? Types of lube Myths about lubes How to incorporate lube into your life How to talk about lube Risks with lubes Novelty lubes What’s coming down the pipeline with lubes Do lubes have expiration dates? Lubes versus intimate moisturizers – an educated difference. A discussion about “natural” and “botanical” and “organic” lubes https://winkwinkboutique.com/ https://instagram.com/winkwinkboutique Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK Listen to my Tedx Talk: Why we need adult sex ed Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message

“Low Libido is Not a Problem to Me” - Caffyn Jesse

Caffyn Jesse is a queer elder, sacred intimate, teacher and writer who revels in the power and pleasures of the erotic. They are a renowned teacher of sex, intimacy and healing trauma with pleasure.

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Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com

She tells us how she went through her journey at age 40 and found her erotic energy

"You are not broken" is the name and theme of my podcast – She tells us how her work relates to this?

In your book, “Science for Sexual Happiness” she says – “Can you imagine a way of being sexual that is energized and playful, passionate and flowing? “ - I think for so many people it is a hell no.

How they would work with pain with penetrative sex.

How they would work with low libido.

We have so much experience consenting to things we don’t really want” – Caffyn Jesse

Tips for being stuck in a sexual rut?

How can erotic massage change our experience of sex?

In your book “Intimacy Educator: teaching through touch” – you have a whole chapter on touching a vulva owner. Tips.

How they deal with erectile dysfunction

What do you do on your retreats?

Science for Sexual Happiness by Caffyn Jesse

Intimacy Educator: Teaching Through Touch by Caffyn Jesse

https://ecstaticbelonging.com/

https://www.facebook.com/caffynjesse/

https://www.instagram.com/caffynjesse/

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes.

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Normalizing Sex - Talking With a Sacred Intimate Practitioner

How did he choose this career path – or did it choose him? From the military to tech to surrogate partner.

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What is the difference between Surrogate Partner Therapy and Sexological Bodywork?

His approach uses the theory that sexual energy manifests in your body, not your mind – tips for people to access and be comfortable with their body.

Tips for communicating.

He discusses what a sacred intimate is.

How he works with trauma.

His definition of sex. The top reason men and women seek out his work.

How do people stay intimately connected when life gets busy?

So many disempowered people – where do you start?

What is consensual non-monogamy and what does he wish people knew about it?

What he wishes doctors and therapists knew about his job?

www.instagram.com/comingcloserwithandre www.coming-closer.com

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes.

www.kellycaspersonmd.com/membership

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Sex Med Advocate and ISSWSH President - Sue Goldstein

Sue Goldstein is an AASECT certified sexuality educator and certified clinical research coordinator. She serves as clinical research manager and program coordinator for San Diego Sexual Medicine

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She is current president of ISSWSH (International Society for the Study of Women’s Sexual Health)

Her story of your career in sexual education and sex med.

Pain associated with oral contraceptives.

There should never be pain with sexual activity.

We pick apart “doing menopause naturally”

We discuss PGAD Persistent Genital Arousal Disorder and the role of education for people and providers. Language matters.

We talk about menopause and pain with sex after menopause.

Is low sex drive the “tip of the iceberg” for testosterone?

We discuss testosterone, SHBG and bioavailable testosterone and explain how this works.

What is a vajay-jay? The importance of using correct words for our anatomy.

Why we love ISSWSH.

Why Sue hates the concept that “women are complicated”

The combo platter of aging PIV intimacy – we need to approach both partners to address the issues.

Sue shares her experience with HSDD

We discuss the issue with delayed ejaculation.

“The educated woman is the empowered woman” – Sue Goldstein

https://www.isswsh.org/

ISSWSH’s Education website https://www.prosayla.com/

Book about vulvas: Petals by Nick Karras

Sue’s Book: When Sex Isn’t Good https://amzn.to/3OKyMMk

Did you get my “You Are Not Broken” Book Yet? https://amzn.to/3p18DfK

Listen to my Tedx Talk: Why we need adult sex ed

Join my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed

Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes.

www.kellycaspersonmd.com/membership

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GOAT - Dr. Irwin Goldstein He is the director of San Diego Sexual Medicine. Dr. Goldstein has had a long career providing medical help to those with sexual problems, having been involved with sexual dysfunction research since the late 1970′s. Dr Goldstein’s interests include regenerative therapies for men and women, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women. He has authored more than 360 publications in the field of sexual dysfunction, with 20 consecutive years of funding by the National Institutes of Health Thanks to our sponsor Sprout Pharmaceuticals addyi.com/notbroken Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com You are a urologist. I am a urologist. You are a pioneer and yet I don’t even remember hearing about you during residency training. How do urologists not know who Irwin Goldstein is? He started out in men’s sexual health. Dr. Goldstein tells us his story. Dr. Goldstein published the original paper on Sildenafil (Viagra) – and 90% of the phone calls after were women asking for help for them. He created ISSWSH. https://www.isswsh.org/ He was in the room when the term vulvovaginal atrophy was changed to genitourinary syndrome of menopause (GSM). Thoughts on DHEA vaginally. Women and Sildenafil – oral versus topical and his thoughts on arousal. Orgasm guidelines are coming!! The role of dapoxetine (Priligy) for inability to orgasm – you can’t get this in the USA Other drugs for orgasm The role of testosterone for orgasm issues Sexual side effects of birth control pills Depression side effects of birth control pills Testosterone in women! It is a thing! Estradiol in men – needed for bones and erections. We wrap up with discussing hard flaccid. A hypogastric nerve dysfunction. Any advice for me, for other physicians, for the women and their partners? --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message

Mojo and Empowerment with Deborah Kagan Thanks to our sponsor Uber Lube 10% off, Code NOTBROKEN uberlube.com Deborah Kagan helps women conquer self-doubt and indecision to step into their full power, love who they are and live a turned ON life. She tells us her inspiration and her story. How do we get women to thinking differently? Our bodies are energy and the concept of male and female energy. The four pillars of Deborah’s teaching about MOJO. What is Mojo and how is it different from libido? How do you know if you are disconnected from your body? We discuss masculine and feminine energy. We discuss our thoughts about the Barbie movie. Feeling feelings and using anger for us. We discuss your intuition, your gut intuition and where your mojo lives. We discuss pain and the role of Western medicine and the role of our energy and listening to our body and our relationship with our body. The Real Undressed Podcast: https://podcasts.apple.com/us/podcast/the-real-undressed-with-deborah-kagan/id1494643770 Order Undressed Now Find her on https://www.facebook.com/mojorecoveryspecialist Instagram (@deborahkagan) Twitter (@deborahkagan) Pinterest (/deborahkagan) and LinkedIn (/in/deborahkagan). And for all things mojolicious, check out www.deborah-kagan.com/blog --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message