Permission for Pleasure
A podcast to educate and equip women with the information and confidence they need to express, experience and enjoy their sexuality. Cindy Scharkey RN, BSN, brings her 35+ years of experience as a healthcare professional to open the doors to healthy conversations about sex. This is a community where you can listen and learn to give yourself permission for pleasure. Visit www.cindyscharkey.com for educational blogs and newsletter.
Permission for Pleasure
Do You Ever Think Your Sex Life Is Broken?
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Have you ever felt broken when it comes to your sex life? Urologist and sex expert Kelly Casperson, MD joins me to talk about her book You’re Not Broken: Stop “Should-ing” All Over Your Sex Life. We discuss what bad sex looks like, why sometimes ‘good enough’ sex is fantastic and how self-cultivation enhances your sexual health. I also asked Dr. Casperson her top tips for preventing UTIs (find them at 27:53).
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More on these topics
Book review: The Body is Not an Apology
Learning to Listen to Your Body
Date Your Body
Why don’t I want sex as much as my partner (Desire styles)
Guide to lube
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How we think about ourselves matters greatly. What's so fascinating is women are like they want to fight for their brokenness. Like they want to really tell me how they indeed are broken. And I'm like, what's the upside, you guys?
SPEAKER_01Hello everyone, and welcome to Permission for Pleasure. I'm delighted to have you listening today. I'm Cindy Sharkey, your host. And today I'm talking with Dr. Kelly Kasperson, a urologist, sex expert, and author of You're Not Broken. Stop shoulding all over your sex life. Kelly and I discuss things like what women are holding on to in the area of shoulds. What are they shouldding all over their sex life? And reasons to have good enough sex. Also, what bad sex looks like. One of the ways we define bad sex is not using lube. You know I'm a big fan of lube, and this episode is sponsored by Uber lube, my favorite silicone lube. You'll hear us talk about it in this discussion, but did you know that 80% of women say having an orgasm is easier when they use lube? Eighty percent? Uber lube is smooth and silky, it stays where you put it, never gummy or sticky. Look for the link in the show notes to try it with my discount. Right now I'm reading Sam Keane's book Passionate Life, and this sentence stopped me. Listen to what it says. What we should desire creeps silently inside us and replaces what we really desire. Let's jump in now, friends. I'll introduce you to Dr. Casperson and we'll start our discussion about why we want to stop shooting all over our sex lives. Dr. Casperson, welcome to Permission for Pleasure.
SPEAKER_00Thanks for having me.
SPEAKER_01Thrilled to have you on. I would love for you to introduce yourself and tell people about your work in the world.
SPEAKER_00I'd love to. I'm Kelly Kasperson. I'm a board-certified urologist. I practice urology in Washington State. And about three years ago, I started a podcast for sex ed for adults, basically, for women specifically. And through that, um, I wrote a book, and through that I got interested in menopause because hormones matter, and and all my people kept asking me about it. So, really, my platform now, and as much as the other thing is Instagram doesn't let me talk about sex very much. They don't like it when I say Volva.
SPEAKER_01No, they don't.
SPEAKER_00So I tend to be a little more hormone midlife on Instagram than the podcast, just because you can say whatever you want on your own podcast. 100%.
SPEAKER_01And your book is called You Are Not Broken. Stop shooting all over your sex life.
SPEAKER_00That's right. So many shoulds.
SPEAKER_01So many shoulds. I love that because you know, this idea of being broken is just pervasive with women that I meet with and speak to. And thus that brokenness has them shooting all over their sex lives.
SPEAKER_00That's right. How we think about ourselves matters greatly, right? We we might not think that. What's so fascinating is women are like, they want to fight for their brokenness. Like they want to really tell me how they indeed are broken. And I'm like, what's the upside, you guys? Like, what is the upside of telling your body it's broken? Literally, no, none. And we have so much science and data now of like your body's listening to you. And if you don't love it, and you don't want the best for it, and you're you're not looking to try to help it, like it knows that. So, like, literally, there's no upside in thinking you're broken. But women, though, they want to, they want to fight for that right.
SPEAKER_01That's an interesting way to put it. And I wonder if the mantras around that are so ingrained, Kelly, that you know, it's just really hard to change the narrative for ourselves.
SPEAKER_00Yeah, I read this amazing book, The Body Is Not an Apology. Sonia Renee Taylor. I'm looking at, I have to look at my bookshelf.
SPEAKER_01Oh, I have a book review on that book. I'll link to it in the show notes, listeners.
SPEAKER_00It was the first, it's like, you know, even in what you were saying of like how it perpetuates, of like, oh, I know we all do struggle with body image, of like normalizing that instead of she's like, I don't want to get you to neutral. I want to get you to freaking radical love. And it was the first time where it was like, what are we doing accepting the fact that everybody has poor body image or accepting the fact that everybody feels broken? Why don't we Sonia Renee Taylor this thing and be like, no, I'm gonna get you to neutral. I'm gonna move you past neutral. We are lucky to be alive, we're lucky to be upright, and every day is a bonus and a gift.
SPEAKER_01Yes. I also want to just reference listeners, the episode with Hillary McBride, all about this topic and her book, Wisdom of Your Body, another really good resource along with Sonia, about relearning how we want to think about and accept and embrace our bodies and live in them. So let's pivot a little bit and talk about well, some of those shoulds that you you really go through in the book, what we're talking about here. Let's just share a few of those, what those look like and are that you hear often.
SPEAKER_00Yeah, so many should. You shouldn't want sex too much, but you should want it a certain amount. There should be a certain amount of sex that you do desire. You should only like a certain type of sex, you should like the same type of sex all the time your entire life and never vary. You shouldn't fantasize you shouldn't use lube. You should always be wet on demand. The penis should always work. You should always have an orgasm when something goes in your vagina. All the things. So many shoulds. Mm-hmm.
SPEAKER_01And you also touch on, you know, I should have sex with my partner because they want it and need it, even if I don't want it.
SPEAKER_00Oh, yeah. Duty sex. People come in and they're they're having duty sex, and then they also feel like their low desire is like a separate issue or something. And I'm like, Well, you're having sex for somebody else. It's not for you. Like, of course, you don't desire that. It's a job description at that point. It's always nice to ask people questions like, are you having sex worth desiring? And if you're not, well, let's not wonder too much where the desire is.
SPEAKER_01Yes.
SPEAKER_00And it's interesting because a lot of people think desire needs to happen first. You know, the linear Kinsey model or Masters and Johnson model of first there's desire. And I always say, like, well, of course, if you were going to a lab in the Midwest in the 1950s to have people watch you have sex, like desire was kind of implied, right? So, like, their linear models just don't explain modern day long-term relationships, especially of women who are different than men, right? And so desire can come during, desire can come after, or desire doesn't need to be there at all. Just go have some great sex.
SPEAKER_01Yes. I don't hesitate to mention it every episode because people really don't have education around the different ways that desire can happen. And so when when we think that spontaneous desire and what we see in media and films and what have you is the only way, we think we're broken again, which is not the truth. And you're right, there's just a whole gamut of ways we can experience desire. And you mentioned long-term relationships, which I meant one. So it's always important for me to mention that as we age and get into longer term in a relationship, that desire turns from more spontaneous to more responsive desire. And that's a normal way to be.
SPEAKER_00Yep. And that happens around six to 12 months, by the way, according to brain researchers.
SPEAKER_01Okay, tell me a little more about that.
SPEAKER_00Well, that's when our the dopamine of like newness, curiousness, I don't know what's fully gonna happen, the excitement of new novelty wears off. Right. And it gets more into like, we're in long-term relationships for other reasons, not because they're new and exciting, right? But if we think what love is, and if we think what sex is, is a new, exciting kind of out of our control drive, then what do we do with these long-term relationships where we're not getting that, right? We really need to reframe like, I mean, I want to be in this relationship, but uh, these old ideas of what desire is, what this new love feels, it's really it's it's close to addiction in the brain of like the amount of dopamine that new love will give a brain. It's totally normal for the brain to be like, I got this now, I understand. And that's like six to twelve months.
SPEAKER_01Did you hear that, listeners? That new relationship energy only lasts so long.
SPEAKER_00You always hear the people that like, you know, they move from one relationship to another, they think they fall out of love. And it's like, are you truly falling out of love or are you you're chasing the high? Hmm. Right? Because the high does not last. No, you can argue that some people they have the high last, right? There are some people who are like, oh man, I I I'm as hot for him now as I was when I first met him. Those people exist. They're creating that, they're hanging on to those beliefs, they're working on that part of their relationship. They're not letting all the mundane, boring, maybe negative things cloud their judgment of what my desire for this person is. So you can have it if you want it. Or you can be like, well, no, but I I want to be in this relationship. I want to have great sex. I'm not gonna sit around waiting for desire to happen.
SPEAKER_01Let's not sit around waiting for desire to happen. There you have it. Love that. You know, you quoted Barry McCarthy as saying good sex adds 15 to 20 percent additional value to a relationship. Bad or non-existent sex drains it by an estimated 50 to 70 percent. And when sex provokes conflict, it takes on an inordinately powerful role destabilizing the relationship. Boy, that stopped me when I read it. It's staggering. I mean, 50 to 70 percent of a drain on your relationship when sex is bad or non-existent.
SPEAKER_00I just saw somebody, it's like she's like, we don't fight about anything except for sex, and it's a problem, right? Like it's a big if you think, you know, what are the top two reasons that divorces happen?
SPEAKER_01Money, sex, money and sex, and it's hard.
SPEAKER_00Like, I've actually looked on the internet for this data and it I can't find it. It kind of comes around in a roundabout way of like I can't actually find that because we're not asking people getting divorced, like, why are you getting divorced? But a lot of times, like the intimacy and connection is gone. And the other thing is our very narrow view of what sex is, right? Of like the sex is when a penis goes in the vagina in a heterosexual relationship, and it's like there's intimacy and closeness and touching and connectedness that all also goes away if that goes away, but it doesn't have to. It's just that we haven't expanded our view of how to be close to each other without doing that one action, which is incredibly limiting because when the vulva and vagina have a problem or the penis has a problem, if you don't know how to otherwise stay connected, you've got a problem.
SPEAKER_01A hundred percent. And I would say as people age, like if I do workshops with like just 50s and overs, this is what I'm trying to emphasize with the women there is that if you broaden your idea of what sex is and you allow it to be much, much more, that will serve you in your aging as our bodies change and we sometimes have to make adjustments or things don't work the way they did when we were 25 or 30. And people have a hard time doing that when their framework for sex is just one thing, like you mentioned.
SPEAKER_00Yeah, well, I mean, our sex education is so bad, right? And going back to like what kind of desire are we supposed to have, we don't know because we didn't get any sex education, and then we have the movies, right? Or the internet. And it's like they do a very bad job. They're very like penis and vagina, heteronormative, spontaneous desire. So that's all we're fed. We don't understand that the concept of sexuality and connectedness is so much bigger. Mm-hmm.
SPEAKER_01Non-real, right? Let's get real about the bad sex because you list these out. I mean, I wasn't laughing because I but I was like, wow, some of your language is so right on, Kelly. I love it. How do you define bad sex? Right off the bat, I think of painful sex. You called it white knuckling sex.
SPEAKER_00Yeah. You're doing it to make your partner happy, right? Or because you think it should. Or you think if you have painful sex enough, it'll stop being painful, which actually that's not how pain works. You're basically like reinforcing the pain of like, see, I told you it was gonna hurt again. Yep, there it is again. I'll prove it to you. Pain, duty sex, sex for somebody else. And you know, we use orgasm as a marker of pleasure. Orgasm isn't the only marker, or there's plenty of people who have not don't have consistent orgasms, they still love sex. But if you're having sex and only one person is having the majority of the orgasms, you're like, is this equal pleasure? You know, is this fair? Is it equitable? I can't remember what else I said for bad sex, but those would be the three off the top of my head.
SPEAKER_01I love those because they're so true, but you termed it one common medical cause. And I literally started cheering. I wrote it in all caps. Premature penetration.
SPEAKER_00Oh yeah, that's bad sex.
SPEAKER_01Bad sex is premature penetration and lack of lube. Okay, friends, you know I am the lube fairy, and you know I love uber lube, so let's talk about this idea that our lubrication just happens on demand. You know, 80% of women you quoted said that they have an orgasm easier when they use lube.
SPEAKER_00Yeah, and it's cheap. It's great. It's so easy. But again, we did not get sex ed. We got a disease and pregnancy prevention plan, if we were lucky, right? But it's just lack of knowledge. It's all any of this is like the vagina can be self-lubricating, but the clitoris is not, the penis is not, the vulva is a little bit if you go in a little bit when you get close to the vagina. We have all these organs required for pleasure that don't self-lubricate, right? And then you've got maybe medication side effects or aging or low estrogen that affects the vagina's ability to lubricate, and or you're just starting sex by putting something in the vagina and not arousing the pelvis. The pelvis, it might be this might be a tampon. It has no idea that this is supposed to be a sexy time. You have not given it a heads up of what your intent is. So you're like, oh, it hurts. And you're like, well, nobody got taught that the vagina lengthens, elongates, and tilts with arousal, making room for accommodating something, right? So if you just start sex by putting something hard in the vagina, number one, it's gonna be way more uncomfortable. Number two, there's not gonna be lubrication. But again, this is the sex education that we did not get it. They're not showing you this on in Hollywood. We just don't know these things, and then we feel broken.
SPEAKER_01Yes. I do really stress this point about not putting something in the vagina into the vagina is wanting it.
SPEAKER_00Yeah. And if you don't know what a vagina wanting it is, that means you've never been properly aroused. That was a strong statement. I don't know if I can be a hundred percent strong on that statement, but when your vagina wants something in it, you're gonna know because you're pretty darn aroused at that point.
SPEAKER_01Right. Not enough arousal is one of the things on the bad sex list, is women, especially not understanding their own arousal, not being able to recognize their own arousal, you know, not being able to do the things that brings them the most arousal or understanding their own body enough to be able to communicate that with the partner.
SPEAKER_00100%. Well, what do we call women who like sex too much? We call them bad names. So now you're telling me I should figure out how my body gets aroused and maybe do that. I'm an active participant in that. But I was just taught that a woman who likes sex too much is bad, right? Like we literally have, we're running up against brick walls. Another thing that we don't learn is like our brain can be aroused and our pelvis can be aroused. And you can have one without the other. We can have wetness down there and you're not cognitively into sex, or you're like super into sex, but you're still pretty dry. That is, we got two different arousal centers. And what is our role in activating that arousal? I'd say it's everything because you're the human having the sex, right? It's not our partner's job. They can participate. But like, what's our role in calming our nervous system and getting out of that sympathetic fight and flight stress response because we just got home from work and then we put the kids to bed and then we packed lunches, and now somebody wants to have sex with me. What are you gonna do to get into a state if you want to? You don't have to. But certainly learning to transition to a place where arousal can happen is a power move. Give me 10 minutes. I'm gonna go do some yoga. Maybe I'll take a bath, maybe I'll go read some erotica, maybe I'll go get an external vibrator with some lube and just go warm up my pelvis first. All acceptable. And it all leads to much better sex.
SPEAKER_01You're speaking my language there, Dr. Kasperson. Just to keep giving women permission for that kind of transition time that we need to engage our minds and get settled into our bodies and really allow ourselves to pay attention to arousal and good feelings and pleasure. And you also mentioned, you know, this idea that is so pervasive that our partner is gonna give us an orgasm.
SPEAKER_00Oh yeah.
SPEAKER_01I just I really don't agree with that. I I feel like if women could embrace their own sexuality separate from a partner, they have their own sexuality, a partner has their sexuality, and then they have their sexuality together.
SPEAKER_00100%. The relationship has its sexuality, right? And people are like, especially the low desire person gets and there's always a low desire person, just because you can't ever be perfectly matched, right? You're not twins. Just like somebody likes pizza more, somebody likes playing pickleball more, whatever. There's this is an unnormal thing that happens in relationships, is one person likes something more than another person. You might like horror movies, I don't like them so much. But what's right for the relationship, right? Do all orgasms have to be partnered in the relationship? No. And it's not the low desire person's job to rise to the high desire person's level. That creates more discord than a lot of things that I see of like, what's good for the relationship? What's enough to stay connected? What's enough to stay, we like our sexual life together. What's that? Not, well, we can only be down that the low desire. We can only be up at the high desire. Like, what does the relationship need where we know we're connected, we know we're good. It might not be as much as this, and this person might be like, I gotta get, I gotta show up to the party and figure out how to like this a little bit more. What's good for the relationship? Might be one way of thinking about it. Beautiful.
SPEAKER_01Because that get it over sex or just having sex to have it off the checklist is not going to spur your desire nor pleasure.
SPEAKER_00That's right. And I think, you know, Barry McCarthy says it so beautifully is the concept of good enough sex. Like this does not have to be mind-blowing, multi-orgasmic, so good for everybody all the time. It doesn't, that's not a goal. Perfection can never be achieved, especially in the realm of sex, right? But if it's good enough, it's sustainable, the relationship's happy, yeah. Sometimes you won't have an orgasm. Sometimes you'll want to just be close, but like it doesn't need to be about you. You just want to be there with your partner while they get some pleasure. It's all fine. This concept of good enough sex is fantastic.
SPEAKER_01I love how you speak to that. I hadn't heard it put quite that way until I read it in your book and Barry McCarthy's your quotes from him, but then how you fleshed it out in the the reasons good enough sex is great, right? Let's talk about that. That intimacy, like you said, is the ultimate focus. That pleasure is as important as function.
SPEAKER_00Yeah. And I think people, we do this, especially we're so visual now with social media and everything, of like we are constantly comparing ourselves to what they're doing. How much sex are they doing? How much sex should we have? And it's like, it's not about anybody else, right? Like there's no there. And that's the whole thing of like who you become as you're becoming somebody who's confident in the bedroom, who you're becoming when you're sexually confident. You know, like it's like the ultimate personal growth too. So it's like, do it for the personal growth. Like who you become when you realize these are difficult conversations, but you're not afraid to have them. You're not afraid for it to be awkward. You're not afraid to speak up for how you're feeling. Like all that personal growth that comes with achieving a good a good enough sex life is like, that's good stuff, people. It'll trickle over to like your job, it'll trickle over to the way you communicate about other hard things. Like who you become is super fun.
SPEAKER_01Yes, I agree with that. And also recognizing that we talked a little bit about long-term relationships, but whether you're in a long, long-term relationship or not, the quality of your sex is gonna vary. You talked about this, you know, day to day. Sometimes it's gonna be mind-blowing, sometimes it's gonna be mediocre. Sometimes it's gonna be just sort of okay. Sometimes it's gonna be kind of a flop, right? That's a normal sex life. I think people are so skewed by what they see, like we talked about, that they think it's gonna always be this one way. And then when it's not, again, something's broken.
SPEAKER_00I use a lot of exercise metaphors. It's helpful to explain it in a non-sex concept of like all of your workouts are not that freaking best workout of your life. But you want to be somebody who works out. Sometimes you're tired. Sometimes you had a lot of stress going on. Sometimes you ate a big meal. Right? Like they're not all great, but you showed up. You're doing enough exercise to be consistent in your life and to be the person who has fitness as a priority. Staying in the game, not being perfect.
SPEAKER_01And I do like your words around uh self-touching and self-pleasuring as part of this journey that you're talking about, about making your best self and that that will just permeate all the areas of your life. So I'm gonna circle back to it because I think it's so important. You call it self-cultivation. Yep. Tell me more about why you term it that way because I am on board.
SPEAKER_00Well, I didn't invent that term, so I can't won't take credit, but I can't remember where I got it from. It's I've read so many sex books at this point. Just the word masturbation so loaded that like I just like to not use it. But I think the other thing is like giving your power away to your partner to be the only person who can touch you down there and to be the person who knows how to touch you best is at when you look at it that way, it's actually a little ridiculous to think like, why would that make any sense? Right? Really, like again, going back to the beginning of the podcast of like this is your body. It might not be perfect, you can freaking love it anyways. Let's start by practicing, right? How do you expect your partner to give you the best love ever if you don't know how to do it yourself? How do you communicate that? How do you know if they're they're supposed to go faster or slower or harder or deeper or soft? Like, how do you know? You don't know. You have the hardware, you literally have it 24 hours a day, and you're like not even using it. You just don't have as much information.
SPEAKER_01You don't have as much information, and you can't communicate that information. And even going back further than that, I just taught a couple parent groups this week, and so it's on my mind because I was telling the parents that you know, your daughters, the first person to touch their clitoris should not be someone else.
SPEAKER_00That's right.
SPEAKER_01If they don't know where their clitoris is and they've never touched their clitoris, this is poor education. They need to understand their own body, not have someone else telling them and showing them, or maybe not even knowing or not telling them and showing them. I just have a real thing around this issue for for girls and as they're growing up having education around their own bodies and being entitled to have a freedom and encouragement to touch their own bodies and look at their own bodies and see them for exactly how they are. It's so important.
SPEAKER_00Well, it's so important and to realize like the person who's gonna, whoever they're gonna start hooking up with, is also young, also inexperienced, and also might not even go for the clitoris. So you're setting her up with such a bad education of what sex is and and how a woman's supposed to feel and how a woman's supposed to enjoy it. Our society, like I I struggle to say vulva and clitoris on Instagram. Like these are taboo words, they violate terms and conditions. To me, this is like it's insane that I we can't say these body part names. How do you how are you supposed to communicate to your doctor what's wrong if you can't talk about these body parts? So many women I see, I they're like, what's where is it? Down there. Where down there? I don't know, down there. Like they don't have the words, and it's like this is all just empowerment communication skills.
SPEAKER_01For sure. Let's talk about your sexual etiquette here for ideal version of a sexual etiquette, you called it. Which we've already been touching on, but let's narrow it down. Number one, which we just talked about, know the clitoris, know the penis, and use lube.
SPEAKER_00Definitely use lube.
SPEAKER_01Number two, the woman comes first without a penis in her vagina, then the man can put his penis in with consent.
SPEAKER_00100%. 20 to 30 percent of women achieve orgasm by putting a penis in their vagina. I mean, this all sex education we didn't get, right? And we're all feeling so broken about it. Now, the majority of women who do have an orgasm with penis in the vagina are simultaneously stimulating the clitoris, whether that's with a hand or with a toy, right? Or the angle, the angle's right, so you're getting some friction there. That's fair enough. And if she has an orgasm first, that means she's gonna have good arousal. So her pelvis has been warned that a penis is gonna come in. All good things. And the other thing, again, which I see happen a lot, this is not how it has to be, but again, it's a stereotype, is when a man has an orgasm, he's kind of over sex. Now we can educate people to be like, you can't just be, she still needs to, you know, let's step it up, right? Whether they've been trained or their the way their oxytocin makes their brain now, now I'm hungry, I don't want to have sex. But like, if that's what happens to your partner once they have an orgasm, then you you should get yours first.
SPEAKER_01Yeah. And he can orgasm in general once, but she can orgasm more than once.
SPEAKER_00If she wants to.
SPEAKER_01If she wants to, and if it's enjoyable. But I have to just insert that there, and that's one of yours. Your last one is everyone's satisfied and happy, they talk about it and tell each other what worked well and what changes they want to try in the future. Yeah.
SPEAKER_00That's the problem, is we don't get taught how to talk about sex, and then something goes wrong in your sex life. So you never had the skills to communicate, and now something's wrong. And so it's like communicate when it's good. Like that was so great. I forgot how great that is. Thank you for reminding me how great that was. You know what I really like? I like when we use that pillow. I really like when I'm able to like do some yoga first and clean my mind out. Just talking about what's good, then now you're gonna have some skills and it's gonna not get good at some point. Like there's gonna be stress and surgery or a baby or menopause or erectile dysfunction. Like, our sexuality is fluid and it changes. So it's like having the skills of when it's good is gonna set you up for when the road has a little bump in it.
SPEAKER_01And the road will have some bumps in it. That's just life. We're gonna pivot a little bit, Kelly, because as soon as people saw you were a urologist and a well-respected one, they came in hot with the questions about UTIs, urinary tract infections. So many women struggle with this. And I know this is a big pivot, but this is important because so many people in the community ask for your advice and just your tips or what to do about preventing UTIs and help with recurrent UTIs. So I wonder if you might speak to that.
SPEAKER_00Yeah. Big problem, very common. I always say the only person who's never gonna get a UTI is a dead person. We put the pleasure in the plumbing through the sewer systems down there. Like, you know, it's everything's close. Our microbiome is incredibly important. One big change with that is whenever you have a low estrogen state, that could be with birth control, that could be with breastfeeding, that could be with menopause, that can be with perimenopause, your pH of your vagina changes because the lactobacillus dry off. When your pH changes, E. coli love it more. So our vagina actually acts as a barrier between the rectum and the bladder. Very important organ. The vagina is not just to put stuff in and to have babies come out of. It actually helps decrease our risk of UTI because of its healthy microbiome. All that's to say, if you have any of those low estrogen states supplementing with vaginal estrogen cream, it's a prescription. It's incredibly safe. The FDA warning on it is wrong. So a lot of people, they'll they'll get a prescription, then they'll read the packaging and they'll freak out because the packaging literally says probable dementia. Like I would freak out too. We know it's wrong. Vaginal estrogen is incredibly useful. In the postmenopause women, it decreases risk of UTI by 68%. Why is it not decrease it by 100%? Because you're still alive and only dead people don't get UTIs. The other thing is uh repeat antibiotic use, kills your microbiome. You're at your highest risk of another UTI right after you took antibiotics. So vaginal estrogen, frequent urination, don't hold your pea, treat your constipation, be very well hydrated, urinate frequently. Dilution's the solution to pollution.
SPEAKER_01Wait, repeat that. Repeat that.
SPEAKER_00Dilution's the solution to pollution. So as far as supplements, we don't have a lot of data. It's hard to do research on supplements because they're not regulated by the FDA. But there is some data to show that, like a high-quality cranberry made of the skins. So Theracran or Allura are two brands that are high-quality cranberry. D-Manos is a great supplement, helps E. coli not stick to the lining of the bladder. Those are two non-prescription options. There's not a lot of data on, you know, don't take baths. I don't think there's anything to any of that. Sex can be a trigger for some people. You can take an antibiotic just to neutralize the load during sex, drink lots of water, pee afterwards, use lube. I think even microtrauma with sex increases your risk of UTI. And there's a lot of things that hurt that feel like a UTI that aren't actually bacterial in nature. You don't know the difference because this pain feels like pain, feels like pain. The only way to know is to get a urine culture and to start saying, like, it's never growing out bacteria. Maybe there's an issue going on that's causing pain that isn't a UTI. Tell me more. Well, menopause is one of them, right? Burning with peeing is a menopause, menopause, menopause. They think it's, they're like, but the antibiotics don't really help. And like my urine cultures are always negative. Great. Let's stop drugging your body with antibiotics because this is not bacterial in nature. And then chronic pain conditions, vulvar conditions, there's lots of stuff that hurts that isn't made by bacteria, so we can stop taking antibiotics for them. And pain after sex. I have pain a day after sex. Not always a UTI. That can be a pelvic fluorosm, right? I go to the gym and I'm sore the day after the gym. That's muscle soreness. So you can see a physical therapist if that tends to be what you think is a UTI, but the cultures are negative. So interesting topic, very common. Nobody can ever make you have zero, but you can improve your situation. I think there's something to a clean diet. I think there's something to not drinking alcohol, getting sleep, having a strong body. The more frail you are, the more at risk you are for UTIs. So healthy diet, healthy body. So your immune system can just fight these off a little bit better.
SPEAKER_01Yeah, so helpful. And the other piece that another listener wrote in, which is this is what I hear so often, is I struggle with the fear, anxiety, and pain surrounding it all. Definitely, it's making my desire for intimacy incredibly different, is I'm always afraid of the next infection.
SPEAKER_00Yep, 100%. So what are you doing to prevent it, right? So many people are they're afraid of getting it, but they're doing nothing to prevent it. Are you on the vaginal estrogen? Are you using lube? Are you trying sex in a different way, right? What do we need to do? Do we need to not put something in your vagina for a while until you get your microbiome back? Do you need to see a pelvic floor physical therapist because you're having pain? We can sit around being fearful, or we can decide to be proactive work on prevention. Okay. It's funny, women will come back and they'll be like, but what do I do when it happens again? I'm like, why don't we talk about how to prevent it and or decrease it? Right. Again, we can never make it zero. I can't make you never have a UTI again. But we can try different things to get your confidence up that like it's gonna go okay sometimes.
SPEAKER_01Mm-hmm. Great advice on that. Thanks for speaking to that. You're doing so much, Kelly, on menopause right now on your platform. People have no education about sex and then they have no education about their bodies and changes as they age. I would love to hear from you like the top two or three things, the questions that you get the most often and that you're continually educating about menopause.
SPEAKER_00Estrogen doesn't cause breast cancer. Alcohol does cause breast cancer. We're scared of the wrong things, right? Number one killer of women in in this country and the world is heart disease. Hormones decrease your risk of heart disease. Also, just a lot of myths about that. Oh, another one. Um, well, is taking hormones natural? That's a big thing right now. This myth of natural. This like myth that if it's not natural, it's then it's unethical and you shouldn't do it. I love busting that myth because you're wearing shoes, you've got walls, you've got probably have heat or air conditioning, you probably floss or brush your teeth. None of it's natural. So maybe menopause is natural, which again you can argue, well, but before 100 years ago, not many people live past 50. Average life expectancy between 30 and 50 for thousands and thousands of years. One can even argue, is menopause natural? Is living 30 years past your ovaries' ability to produce estrogen actually natural? Some may argue no, it's not. Does that mean we should die sooner? Right? Like the myth of natural is so ridiculous when you start digging into it. So, okay, let's argue that it is natural. Does that mean we shouldn't treat it? Lots of things are natural, and medicine wants to relieve suffering, help you improve your quality of life, right? Why is menopause so unique? I would argue it's not. And I was gonna say, well, men have low get low testosterone when they age. Do we not give them testosterone because we say it's not natural?
SPEAKER_01Yes, that's the truth.
SPEAKER_00No, we give them testosterone. So we have a great gender bias in low hormones. And I just ask we should all be treated equally.
SPEAKER_01If you had one or two things that you wish every listener could hear, kind of your mantras, Kelly, what would they be?
SPEAKER_00You're in control of your life. You're not living anybody else's life, you're living your life. And once you realize you're in the driver's seat and you realize almost anything's possible for you, it gives you a like a security and a confidence. Once you have such firm understanding that you have a compass and it's you and your life, all the other vibrations of the world, they just bounce off so much easier.
SPEAKER_01Good advice.
SPEAKER_00So many women, they're like, I don't know, let's see what they're doing. Let's go ask those five people what they think. We spend all of this time figuring out how to live somebody else's life. And you end up missing yours. Don't miss yours. Don't miss a man. It's good. It can be so good.
SPEAKER_01Kelly, tell people how they can find you and your book, your work in the world, all the things.
SPEAKER_00Yeah, the book's on Amazon, You Are Not Broken. Stop shooting all over your sex life. Instagram, if you're on it, Kelly Kasperson MD. And then the podcast is You Are Not Broken. That's on Apple Spotify wherever you want to listen to podcasts. Websites KellyCaspersonMD.com. Hey, I've got a TED Talk coming out in a couple weeks.
SPEAKER_01Wonderful. Kelly is dispelling Miss day in and day out on her platform. I encourage you to check her out and all the education she is providing. And as she's learning, she's providing more. I love it. I love it for all of us. Before we wrap up with asking Kelly her delight, I want to thank Uber Lube for sponsoring this episode. As you've heard Kelly and I say, it's all about the lube. Use lube, more lube. It's all about the lube. So check out the link in the show notes for your discount on Uberloop. And Kelly, on this show, we like to ask people to share something that delights them day to day because we want to be paying attention to pleasure in our day-to-day lives. Do you have something that you could share that just brings you delight?
SPEAKER_00My daughter's hands. I love them.
SPEAKER_01Tell me more.
SPEAKER_00Well, they're so little. They're so little and they're so like transiently little, too, right? So like every time I see them, I'm like, this is the last day they're gonna be this size. Glad I appreciated them today.
SPEAKER_01Beautiful. Thanks for sharing that.
SPEAKER_00Thanks for asking.
SPEAKER_01And thanks so much for being with us and sharing your expertise, your joy, your enthusiasm. We're cheering you on.
SPEAKER_00Thank you. My pleasure.
SPEAKER_01And friends, let's focus on what we really desire and stop shooting all over our sex lives because that will help us give ourselves permission for pleasure.
