SEX

In this episode I interview sexual health specialist Becky Lynn, MD. 
We discuss Low Libido, Painful Sex, Orgasm, Masturbation, Sex Toys and much MUCH more!

Transcript

spk_0:   0:00
Hey, guys, welcome to another episode of four vaginas only. In this special episode I interview Becky Lin, who is a physician that specializes in sexual health. We will be discussing low libido, painful sex, orgasm and masturbation, sex toys, UT eyes and much, much more in this episode. But first, let's set the mood and cue the music theme. Hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. All right, Doctor Celestine here, your host of four vaginas only. Like I stated in this episode, we're gonna be interviewing Dr Becky Lynn. She's an obstetrician gynecologist that practices out of Missouri, but she specializes in sexual medicine. Sexual health. So this episode is amazing. Thank you so much, Becky, for letting me interview you for four vaginas on Lee. We touch on some great topics that I know a lot of women out there want to hear about. Want to hear the answers to? I also ask a few questions directly from my four vaginas on Lee listeners, You can get some of the answers to that. The tough topics. And, I mean, they shouldn't really be tough. You know, these should be commonplace topics that we talk about as women as females, because it's our body, and we should understand every single aspect of it. Sex is not shameful. And talking about your vagina shouldn't be shameful either. So let's jump right into it where I will let Becky introduce herself to you guys. Tell me about yourself. How did you become specialized in sexual health? How does that happen?

spk_1:   1:55
Um, sort of by accident. So, you know, I did my training at a big medical center, Barnes Jewish hospital here in ST Louis. And, um, nobody asked me about sex like they, you know, we took care of, ah, population that, you know, worked three jobs. I had a lot of babies. Had you no more issues, sort of lower socioeconomic status. Nobody ever asked me about sexual problems. And then I went to a community hospital when I finished residency, and all of a sudden everybody was saying, you know, what do I do? I have low libido, and I had no answer. I know, I know I certainly didn't learn that in residency or anything. So I ended up getting a card in the mail about a conference that was happening in Chicago, and I went to the conference and I learned so much and I went back to my little community hospital and I had an answer for things. But I wasn't an expert. And then ultimately I went to the University of Missouri in Colombia and, um at a faculty meeting. Our euro gynecologist was talking thio somehow that the topic of sex came up and he's like, You know, I really just want to operate. I don't wanna discuss libido. I don't want to deal with painful sex And I said, I'm happy to do that. And then after that, all of my partners were referring the special problems. So I figured I might as well just learned this and become an expert. And I found this wish, which is the International Society for the Study of Women's Sexual Health. It's a fantastic organization, so I started there. Then I ended up doing a precept er ship with Dr Michael Kretschmann in California, and I just learned so much, and ultimately, after that I ended up taking a course to become a sexual counselor in Florida. So I have that certification also. And then I've just gotten really involved in this, wishing I go to the meetings and I go to other meetings and I've done research and I really have become the expert in sexual health. And also, I do a lot of menopause a lot, a lot of menopause, because there isn't overlap, not completely, but quite an overlap. So I do a lot of that, too. So that's how it fell into my lap. I know my kids asked me How did you become a sex doctor? I tried to Yeah, playing that talking about sex should not be shameful, but it is part of who we are. We wouldn't be here if we weren't having sex. And I just, you know, sort of try and frame it. And this is just a part of life and part of, ah, happy, healthy relationship. And, you know, I used the real words not the obviously, you know, nothing shameful in saying vagina. They're used to it.

spk_0:   4:41
One of my first questions for you, like you even kind of touched on in your kind of intro to yourself just now was about low libido, because I think that's the number. One question I get all age groups. So whether it's young women or menopausal women, everybody has issue. Or a question, at least about have a libido, not feeling as they want to have sex is often as their partner does, and you know, and that they feel like things have changed over time, too. And a lot of our training tells us so. You know, sometimes it's tough in the relationship. Sometimes you need counseling, but sometimes it's not that at all. I'm saying priority of the time. It's not that

spk_1:   5:17
Robbie, right? That's so true. And I think libido is so complex. It is, you know, one of the most comp plaques, although it's all kind of complex, but one of more complex issues that I deal with. And, you know, I really try to take the time to drill down into, you know, psycho social things that could be affecting libido but also medical issues that could be affecting libido. So, you know, I always ask about the relationship I asked about chronic diseases, depression, anxiety, poor body image, What did your parents teach you about? Faxes It shameful, You know, um and then look at their medicine. So SS arise. Think of how many women are on the antidepressants like Prozac, Zoloft, Celexa, back in effect, libido. And then sometimes people just have low libido on. You know, when it's when it's low libido that lasts a certain amount of time, it's not dependent on you know. It's not like your partner. The not a nice person like that is just low libido. It's called hypoactive sexual Desire Disorder. And in that they've shown on, like, you know, brain imaging, that there's a difference in the brains of women who have HST d or low libido or hypoactive sexual desire disorder compared to women who don't. And so there are medicines for that Now. Luckily, um, it's super super common, and so many things play into it that as a physician, I feel like I really need to take the time to get all the questions answered before I just throw a medicine at somebody. I think that's the wrong answer.

spk_0:   6:53
Yeah, that makes sense, doesn't it? I think in general of medicine, that's what kind of makes sense as a whole.

spk_1:   6:58
Yeah, and medicines. I prescribed them all the time, but I also addressed the other things in the relationship in their lives. The family

spk_0:   7:08
do you think are some of the most common causes?

spk_1:   7:11
Well, you know, lobbied. So a couple things libido naturally goes down with age and in long term relationships. So you know they've done studies. The 1st 18 months of any relationship are your partner can do no wrong. It's the honeymoon phase, you know, lovey dovey. And then, you know, when you've been together longer than that, the novelty wears off and, you know, libido changes the bet, and then we also have to keep in mind a couple things. So men in general, not all men and not all women fit thes. But men in general have higher libido than women. They have much more testosterone than women do. Women tend to have less libido and fewer spontaneous sexual thoughts throughout the day, and a question that I get often as well. You know, where a woman comes in and says I have low libido, but I almost think it's better to frame it as you just don't have the same libido as your partner because you know what is low, what is normal. And people often ask me that, too. You know how What is normal libido? How often am I supposed to be having sex? There is no normal. Everybody's different. And I also forgot to mention that low libido in and of itself isn't a problem. It's only a problem when you are distressed by it, you know, because it was just a low libido and it's not bothering you. You don't have to do anything about it, but so it's more of like a desire discrepancy than you know. When you're in a relationship like that, then, oh, it's just completely low. Everything that's important is that women tend to have a more responsive desire, as opposed to spontaneous sex drive. Men are in general, much more likely to have spontaneous sex drive more sexual thoughts throughout the day, and women may not be thinking about sex. But if they get a cue from their partner, whether the you know something sexual or it's you know, he took out the trash or something and I'm being Heteronormative here, you know, I don't mean to exclude anybody but like you're you know, if you're getting what you need emotionally in a relationship, you're more likely to have that responsive drive. So, you know, that's another thing that I hear in my practice all the time. Women say, Well, my, you know, my partner says I never initiate and he says, Well, you must not love me if you don't have sex with me And she says, But I do love you. I'm just not thinking about it. So you know that that definitely plays a role in the last thing. Sorry, I could talk for hours on this. All right is many times, you know, women in general, as you know, you have kids or you work or you work and have Children. You get in bed at 10 o'clock at night and you're exhausted. That's not the best time to try and have sex. And so and men in general sometimes like to get in bed and they use sex to wind down. Not everybody, but so it's, you know, I tell my couples, you know, schedule, sex, pick a time, make it Saturday morning or Sunday afternoon, not 11 o'clock at night, when a lot of, you know, when you could be really tired. So, um, you know, I think a lot of how I manage low libido is just education About what? You know what to expect, but not to excess fact how things tend to work. And I think education does a world of good.

spk_0:   10:37
Yeah. Yeah, definitely. My two other questions just about low libido was just because I had a lot of patients coming in talking to you about those two medications are either being up to the bathroom and then also the Addy. If that's even how you pronounce it, I'm not even sure, but Yeah, a lot of people come in asking about that because they're all on TV all over the Internet. So how often do you actually use them? Do you think that it works?

spk_1:   11:02
Yeah. So there's actually three medicines now available, though, but only two are FDA approved. So the two that are FDA approved our bi Li si and Addie and, um and both of them are for their FDA approved for premenopausal women with hypoactive sexual desire disorder. So when I talk to patients about low libido, if I if I think they're good candidates for Addie. Then I will mention it, go through the risks, the benefits, the side effects. And I really think that ad he helps a lot. But But you have to if there's anything else contributing, and even the best of relationships can have communication problems, Um, you know, you've got to fix those other things, but also, it's not going to make you incredibly horny. It is not going to make you the initiator. But what I hear my patients say is that makes them a little bit more receptive, more spontaneous sexual thoughts throughout the day. And they like being on it. So I really do think it's about managing expectations. If you tell somebody you're gonna take this drug and all of a sudden you're gonna have sex all the time, that is not That is not what it does. But you know what it has been shown in in pivotal clinical trials to improve desire. And it I had a lot of negative press when it first came out because the FDA had an alcohol restriction on it, right? Yes, yeah, and which they've changed by the way they took that away. And now they changed the labeling. And you just want to avoid taking your Addie within two hours of drinking. And for eight hours at I don't drink for eight hours after, um, you take your Audi So So that's adding then there is by Li si and this was just, um, FDA approved total win for women. Ah, and just going back to Addie for one second out of you take every night because it makes you drowsy. Um, by Lee c is for use in premenopausal women on an as needed basis. So this is sort of like Viagra and that you only use it when the time is right. And so when it's also been shown in clinical trials, Thio improve desire. Um and it just started like I just prescribed some of it within the last month. So I haven't heard back from my patients about how they felt, But I'm really excited to hear back and see how it's working. And the last one you mentioned was testosterone. So testosterone is not FDA approved for low sex drive in women. Well, but there is a lot of data on testosterone, mostly in a patch form that shows that it improves libido in postmenopausal women. So there's not a lot of data that testosterone does anything in premenopausal women. So I rarely ever used it in premenopausal women. Unless they're like in the peri menopausal like where you know, I suspected it's low. I'll try in the right upper end of normal. But really, there is a lot of data on testosterone, um, and postmenopausal women. But it's not FDA approved because the thief FDA says there's not enough long term safety data. But just the last couple months, there was an international out consensus statement that was released by, you know, saw that, Yes. Yeah, And the idea is, you know, in the right circumstances with, you know, informed decision making with your patient, you can choose to you testosterone. And the goal is to get the testosterone not in a super physiologic range, but to put it in normal pre menopausal physiologic range. So that's what I shoot for when I do testosterone. Okay?

spk_0:   15:13
Yeah. I mean, it's good. I'm glad that there's so many options out there, even new ones being developed, which is great. I didn't even know about that. Most recent one

spk_1:   15:19
meeting Yup. I'm really excited for it. Yeah,

spk_0:   15:23
I wanted to talk a little bit about painful sex, and I think that's the second most common thing that I hear in the office. Probably. I think it's actually number one. I feel like painful sex. Number one. That's low libido comes in at number two in my office, at least. Yeah, so I wanted to hear from you. What are some common causes and some treatment? I know it could go on forever and ever because I notice many, many different causes, but just like the waiting, because the most common

spk_1:   15:49
right, So So I would agree with you. I think in my practice, it's like 40% low libido, 40% painful sex and then 20% all sorts of other things. Yeah, but the painful sex, I would say, is divided into, um, post menopausal and peri menopausal vaginal dryness, vaginal atrophy. And then, in that population, I see many, many post menopausal women just, you know, painful sex because there's no estrogen around and so the vagina doesn't stretch, it loses its elasticity. And within that population they're huge number of breath cancer patients and survivors that where if they had any estrogen. Now it's being blocked, which is fantastic if you're trying to prevent breast cancer from coming back. But it wreaks havoc on the vagina and they develop painful sex and it can be incredibly distressing. You know, hear your breath, cancer patient or now you're survivor and nobody ever tell view. All of a sudden sex is gonna be painful, and you may not know that it's related to your treatment. So there's there's that group of people that's a that's probably 50% of my painful sex patient out OK, and then the other half is probably, um, you know, vaginal business, pelvic floor muscles Fathom Bull Virginia and the pelvic pain syndromes. So people have got like endometriosis. I see usually anxiety and depression. You know, we'll turn up the amplifier on pain. So we we have a pelvic pain center where I work on DSO. I worked really closely with them on, you know, for those patients, because that's usually pretty complex pain syndrome. And if you only treat the vogue, our pain and you don't treat the bladder pain and the vulvar pains not going to get better, and if you only treat the pelvic floor muscles spasm, but you don't treat the bulb mania. You know, it's just like you need to treat all aspects of that sort of pain to make somebody feel better.

spk_0:   17:48
Yeah, definitely. It could be multifactorial. Yes, the sure How do you diagnose, um, muscles fast on pelvic core muscle spasm?

spk_1:   17:57
Yeah. So, um, what I do is I put two fingers on the vagina, uh, five and seven. And those are your elevator muscles and I prem. And sometimes, like, if you start doing this in your office when you see pelvic pain patients, you will You'll see that? Oh, my gosh. Some people are, I usually say, press on them and say, Does this hurt? Is this way after well during sex, and sometimes they will jump off the table. And you're like, Oh, pelvic floor. Then I also press on either side of the bladder. You get the operator muscle that way. Um, so that's that's how I make that diagnosis. So you can use that some those muscles and they flinch or they're in pain. Or you can feel the tension once you put fingers in the vagina.

spk_0:   18:44
Yeah, I just want to put that out there because I feel like sometimes I do that exam on some my patients, and they're even wondering if I'm making it out. They never heard of that before. They've never had a doctor really do that.

spk_1:   18:54
Write the exam that you do for pelvic pain or for orgasm problems is much different than a routine gynecologic exam. And you, any times when when patients have pain, you just you just can't do a speculum you're not going to because I'm not going to give me so much information. You know I can, and I don't want to make the patient terribly uncomfortable. You know, sometimes you get from the history, you know. Oh, this is what's going on. You don't need to put a speculum in

spk_0:   19:25
it, so I'm just switching gears a little bit again, talking about you're talking about orgasm and things like that. So I was just wondering if you a lot of women, you know, they say they can't orgasm with their partner. A lot of them are shy about masturbation, but when have you had any tips on women that you a little bit more sexually reserved in that area or can't orgasm.

spk_1:   19:50
And so one thing that I think is important for women to know, and I don't feel like our education system does a very good job. Any of this is that not all women can orgasm from vaginal penetration. Some people don't like up to 70% in some studies cannot have an orgasm from vaginal penetration, but the majority of women can have an orgasm from clitoral stimulation. And I definitely see women come in and they say, Well, you know, I can't orgasm and I always want to clarify with them which type that is because some women can have a clitoral orgasm just fine. But they think there's something wrong with them because they don't have a vaginal orgasm. And if you look in the movies, everyone you know you watch. Men and women have orgasm from penetration, both at the same time all the time. It's not a way which

spk_0:   20:43
is insane. That's not realistic,

spk_1:   20:46
realistic. It is a room taking thing. And you know it is hard because for people who feel guilt, so you feel guilty about masturbation or their religion told them not to do it. You know, I AM patients who say notes. It's against my religion. I just can't do that. There are a couple things that I recommend to help somebody reached orgasm. And 1st 1 thing that's really important is that in post menopausal women, when they have vaginal atrophy and lack of hormones, I hear time and time again they say, Oh my gosh, it takes so much work to reach orgasm And when I get there, it's like Wasn't so great or they can't at all. And, uh, I like you, so you have to prime the pump. You have to give them the vaginal hormones back. And vaginal hormones do not have an increased risk of blood clots, heart attack, breast cancer, stroke, even though it says that on the package insert because of that all D'oh! Right, So that's That's because the FDA has mandated any estrogen product to have the same label. But we know that the resident of low dose vaginal hormone as much are much different than you know, swallowing a pill or hormone. Yes, exactly. So I always feel like, you know, the car isn't gonna go if you don't put gas in it. And so the vaginal left. That's the gas or vaginal D a ta, which is in Toronto. So works really, really well too.

spk_0:   22:15
No, I've never used that.

spk_1:   22:17
Oh, yeah? Yeah, that's a very good one. So, um, that one. And in Vecsey, Um, and I used greens sometimes, but I find they're more expensive, but I find that intro PSA in Vecsey and creams do a better job. Um uh, yeah, and then, 01 more thing about orgasm. The other thing is that there is a website called OMG. Yes. Have you heard of this one? No, I don't think so. Yeah. OMG guest. And basically, it's a site where women are talking about the orgasms and they videotaped them masturbating. And it's designed, not pornography. It's designed to help women improve their orgasm. But where I use it in my practice is, um, to have women go to that site and figure out different techniques that might help them reach orgasm war if their partner doesn't really know, You know, different things to try and let many couples have trouble communicating their needs and wants. It's kind of a good thing that they can watch together and be, Oh, let's try that. Oh, and there's so much. There's two seasons of it, and there's so many different, different things that they show you how to. D'oh! It's not always, like, harder and faster. That isn't all right. So, um so, yeah, so that's That's a good Web site and a good resource also. Yeah,

spk_0:   23:45
right. I've never heard that because I'm usually, like I try to be a school word as possible. Like in terms of technology forward and eat our patients that are forward. So this is a great one to put in my toolbox as well. So thanks for that. Sure. Eso Speaking of masturbating, Ah, lot of people. I put out a few questions. My four vaginas only group and I have a couple for you. And one of the ones that came up was how to properly use sex toys and care for sex toys.

spk_1:   24:16
Young. So, um, you know a couple things. You basically want to clean them with warm, soapy water. Um, some sex toys, like the company will ask you to buy their own cleaning solution. Nine entering person The time warm, soapy water Let it dry is, you know, the best way to go. Um, you don't want thio like put a sex toy in the rectum and then in the vagina. You know, move all those coliform bacteria into the vagina. You don't want to do that. You can always use a condom on a sex toy if you need to. Um, And if you are in a lesbian relationship you don't want to share tonight, um, you you really want each partner to have their own toys, Just so you're not sort of intermingling bacteria. Yeah.

spk_0:   25:09
And I know I think a lot of people don't understand that which is great and put out here, especially on the podcast. So Ah, a second question that I got waas that one of my followers followers said that she's been with the same man for 12 years, but now they want to have sex with other people. And is that normal?

spk_1:   25:28
Right. So Okay, so there's really not any normal. But there are people who want to do that. And, you know, we see polyamorous relationships where it's a discussion between the two partners, and if they both come to an agreement that they both want to do that, I don't think abnormal. It's just a decision that the two of them make. Where it becomes a problem is if one person wants other partners in, the other one doesn't. But, I mean, there's a whole polyamorous community, so I wouldn't say it's abnormal. It's normal. It's just different,

spk_0:   26:04
right? I think that's a huge singer put out there. Mostly, I mean, there's nothing really that I could think of that has to do with sex. That is, that I would classify as abnormal. It's just whatever you're comfortable with,

spk_1:   26:16
right? I mean and granted, there are things sexual that you know are illegal and wrong. Yes, right, Yes. But But in general, yeah. I mean, people have fetishes and be right. You know, I sort of feel like, you know, you're not hurting anybody else. Who cares what you like Sexually, everybody's different. It's all just who we are,

spk_0:   26:38
right? That's in the same way that I feel. So my last question for you from one of my followers was talking about urinary tract infections and they wanted to know, is there correct? Are correct way to prevent UT ice after sex, but I hear a lot of you know, cranberry juice peeing after you have sex. What is the official consensus on this

spk_1:   26:56
being after you have sex? For sure. And if you are a post menopausal woman, vaginal estrogen really helps decrease bladder infections or UT eyes. And I sometimes see post menopausal women who keep getting bladder infections, and they keep getting treated with antibiotics over and over again. Or somebody says, like, if it's sex related, somebody says, we'll just take a back drum on antibiotic after you have sex every time. But that breeds resistance. So then, you know the bacteria won't respond to those antibiotics when really all they need is a vaginal estrogen, and that'll that'll lower their risk of getting bladder infections in the first place. Yeah, I

spk_0:   27:39
have a lot of postmenopausal women that I packed, too. They come to me after being on antibiotics, like three or four days of with their PCP. Yeah, and I'm like, Wait, hold up, back up. This is probably not the real cost.

spk_1:   27:51
Oh, they just needed a vaginal estrogen. Actually, I feel like vaginal estrogen or D a ta, which isn't. Arosa is the fountain of usually Dyna. Low risk.

spk_0:   28:04
Yeah, that's great. I want that. Um, what do you think about a Zo and those products that are over the counter that a lot of people use?

spk_1:   28:12
Um whoa. I over the counter products. I don't really know all of the data on them. I mean, you have todo over the counter products with a grain of salt because they're not regulated by the FDA. I want everybody to know that over the counter s Yeah, they're not regulated by the FDA, and they can have whatever they wanted him. Um, I have read some things about cranberry and that cranberry juice and drinking cranberry really does help prevent ut eyes. Um, you know, but and I think that the, you know, the, um well, the Zoe's and the things that help prevent pain. That's fine, you know? Yeah. You have burning when you pee and you can't reach your doctor's office. You're so miserably uncomfortable. All of those five rhythms of the of the world are totally fine.

spk_0:   29:02
Yeah, I just have a lot of patients coming to me, and they use a Zo, um or I guess, drink cranberry juice, like every time they have sex, and some of them say it works. I'm going to say it doesn't. I mean, I just feel it's very individualized. If it works, it works great, right? You know, it's not that we have to talk about something else, right? Yeah, yeah, yeah, But that's it. I mean, my very last question is when for anybody out there that's listening, when do you think someone should see someone like you a sex health specialist?

spk_1:   29:30
So if they have a sexual disparage sexual problem and they are distressed by it, then they can ask the regular O b g. Brian. But if they don't get an answer that they feel is what they need, then they should search out a sexual medicine specialist. Yeah. Um, yeah, because because many times I hear Pete Oh, well, they just told me this Or drink a glass of wine to help my libido. That's never the right answer. Oh, no. You know the answer you think you were looking for, Then search for a sexual medicine expert and and I have a lot of, um I have social media sites where I post interesting articles about sexuality, about menopause. What's new in the field. What's going on? So

spk_0:   30:17
the bomb was working. They find you on there?

spk_1:   30:19
Yeah. So I I do. I do have a youtube channel. If you search Dr Becky Lin, please subscribe and share. And then my diagram is Becky Lynn M D. That's B E c k Y a white and N M D. My Facebook is women's sex health, MD. And then my Twitter is at Becky Kalen So great. Yeah, I go. It's part of my mission to educate women about sexuality and so we can empower them to lead a happy, healthy sex lives.

spk_0:   30:57
And I feel like in this day and age, social media is playing a huge role in that. And like I was saying with vaginas only, there's a lot of misinformation out there. Yeah, I love having not only myself, but people coming onto my podcast, talking to other positions and posting that to where people can get riel. Information for riel, doctor and docile media is so prevalent, you know, we might as well put out good information.

spk_1:   31:20
Absolutely. And you know, and it's hard for people to know what's good information. What's not good information that I think when it comes from an O b g y n a sexual medicine expert. They can feel pretty comfortable that it's good. Accurate information.

spk_0:   31:34
Exactly. Agreed. Agreed. Agreed. Thank you so much for a doom. It's according with me. I really appreciate it. My pleasure. How awesome is she? Thank you so much, Becky, for doing this podcast episode with me. She told you where to find her on YouTube, Instagram, etcetera. And she has a new website coming out as well. And thank you to all of you guys for listening to four vaginas only. And keeping up with me and four vaginas on Lee on our instagram page Facebook and our website www dot for vaginas only dot com. How many times can you say vaginas? Right? It's never enough. Alright, guys, I'll catch you on the next episode. But by