Shadow Me Next!

From Bedside To Bedrock: Why Sexual Health Is Healthcare | Dr. Stephanie Zwonitzer, DNP

• Ashley Love • Season 1 • Episode 51

Share episode

Want a front-row seat to the human side of sexual health and urology? We sit down with Dr. Stephanie “Dr. Z” Zwonitzer, a urology and sexual health nurse practitioner, to explore how candor, education, and empathy turn the most awkward appointments into moments of relief and real progress. From the first conversation to the follow-up high five, Dr. Z shows how evidence-based care—and a little humor—can rebuild confidence, intimacy, and connection.

We trace her path from ICU nurse to doctor of nursing practice and unpack the decision to move from carrying out orders to understanding the why behind them. Along the way, we widen the lens on what urology actually covers: erectile dysfunction, premature ejaculation, low testosterone, prostate care and BPH, overactive bladder, recurrent UTIs, Peyronie’s disease, pelvic pain, and the genitourinary syndrome of menopause. Dr. Z explains how she tailors treatment across ages and goals, collaborating with surgeons on implants and reconstructive options while championing lifestyle, relationship dynamics, and mental health as part of the plan.

You’ll hear pragmatic strategies for making vulnerable topics feel safe, managing time in a high-volume clinic without losing the human touch, and navigating patient research from Google to AI with respect and clarity. We talk wins that matter—finishing a hike without scouting for bathrooms, restoring erections after years of frustration, and replacing shame with knowledge. Plus, a student-focused segment on tough interview questions and why owning mistakes builds trust and resilience.

If you care about sexual wellness, urology, and whole-person care, this conversation delivers practical insights and a refreshing dose of honesty. Subscribe, share with a friend who needs it, and leave a review to tell us what sexual health myth you want us to tackle next.

To learn more about Dr. Z: 

Podcast: Between the Sheets

Website: betweenthesheetswithdrz.com

Instagram: @betweenthesheetswithdrz

Virtual shadowing is an important tool to use when planning your medical career. At Shadow Me Next! we want to provide you with the resources you need to find your role in healthcare and secure your place in medicine.

Check out our pre-health resources. Great for pre-med, pre-PA, pre-nursing, pre-therapy students or anyone else with an upcoming interview!
Mock Interviews: shadowmenext.com/mock-interviews
Personal Statement Review: shadowmenext.com/personal-statement
Free Downloads: shadowmenext.com/free-downloads

Want to be a guest on Shadow Me Next!? Send Ashley Love a message on PodMatch, here: https://www.podmatch.com/hostdetailpreview/175073392605879105bc831fc

Ashley :

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor, and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face, and what drives them in their careers. It's access you want and stories you need. Whether you're a pre-health student or simply curious about the healthcare field, I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations. So make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped. And follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests. Today on Shadow Me Next, I'm talking with someone who brings so much honesty, humor, and heart into an area of medicine most people are terrified to talk about. Sexual health and urology. Dr. Stephanie Zwanitzer is a urology and sexual health nurse practitioner. I love the moment she describes realizing she wanted to know the why behind her decisions, not just carry them out. That feeling led her to transition from nurse to nurse practitioner. We get into all of it. How she helps patients navigate incredibly vulnerable conversations, how she makes the most embarrassing appointment of someone's life feel safe and even light, and how much joy she gets from restoring confidence, intimacy, and connection in her patients' lives. And we talk about the reality of practicing in a field where every single day looks different, emotionally, clinically, and personally. This is a thoughtful, fun, and very real conversation about what it means to treat the whole person and why sexual health is healthcare. Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. This is Shadow Me Next with Dr. Stephanie Zwanitzer. Dr. Z, thank you so much for joining us on Shadow Me Next today. I cannot wait for our conversation. It's going to be a blast.

Dr. Stephanie Zwonitzer:

Thank you so much for having me. I'm excited to be here.

Ashley :

So, Dr. Z, you are a urology and sexual health nurse practitioner. Um, you have your doctorate of nursing practice. I would love to hear about your journey in medicine, primarily because nurse practitioners, you guys have such a fantastic route to medicine. It's also different for each of you. So if you wouldn't mind, give us a little bit of your journey.

Dr. Stephanie Zwonitzer:

Yeah, absolutely. So, way back in eighth grade, I job shadowed a nurse midwife and fell in love with nursing and decided that was going to be my career. And I stuck with it. So, right out of high school, I got my bachelor's in nursing and uh graduated from the University of Nebraska Medical Center in Omaha, Nebraska. And it was a great experience. They're a fabulous, fabulous hospital system with all kinds of different ways that they do medicine, transplants, and everything else. So it was such a great learning experience and a great environment because they have so many different types of students there that everybody is in teaching mode. And so it doesn't matter if you follow a patient to the CT room or you're in the exam room with them or whatever, everybody's in teaching mode. So it was a great experience. And I worked as a cardiac ICU nurse for a while, stayed home with my kids when they were little for about two years, and then went back to work. I did um med surge floor and then eventually geriatrics. And a couple years into the geriatrics, I was like, you know, I'm really starting to like get frustrated that I don't get to make more of the decisions. I call the docs and I'm like, hey, you know, room 12's blood pressure is high. And they're like, okay, go ahead and adjust their amlodipine. I'm like, all right. And then, hey, room 14, their blood pressure is high. And they're like, okay, go ahead and increase their lacinopril. And I was like angry that I didn't know why this room got their amlodipine and this room got their lacinopril, and why can't I make these decisions? And that's when I realized, like, all right, I need to go back to school and practice at a higher level. So I went to the University of South Alabama and I got my both my master's and my doctorate from there. So at the end of my master's, it was like a five-year program. So at the end of my master's, which was the first three years, um, I was able to start practicing as a nurse practitioner. And then I finished my doctorate while working as a nurse practitioner. So that was really cool because I got to do my doctoral project where I was working as a nurse practitioner. So it really was meaningful to me rather than doing your research project at somebody else's office for their patients. It was, these were my patients that I was affecting. So it was really cool that way. Um, and then I worked as a primary care in subacute, so um skilled nursing facilities. So I worked for the hospital. This is kind of cool. I worked for the hospital that I had worked as as a nurse, and then I worked in the skilled facilities, but I was still owned by the hospital. So I was trying to prevent those 30-day readmissions and things like that and really not only help the hospital give better care, but help my patients do better and get back home out of these rehab facilities. Um, so it was really interesting and I learned a lot. Plus, for my first job, it was like kind of cool because I still got to do some blood, I still got to do some IV antibiotics and things that I was used to doing as a floor nurse, but now I'm the one ordering them, but I still got kind of like some of that in-between care. And then I did pain management for a little while, and that was really interesting. Um, but the way that my company was doing um pain management was heavy on opioids. And I just felt like I was kind of contributing to the epidemic and not really being able to help people get off. And so I left there and I ended up in urology, which I just took on a whim. I didn't know I was gonna love urology. And I had friends in the field who were like, oh my God, with your personality, you're gonna love it. Just give it a chance. And so I did, and it is absolutely where I belong. It is fun, it is interesting. Every patient is different, even if they have the same issues. Um, and then I get to do the sexual medicine side of things, which is super fun. And I don't know how you feel about this, but I feel like everyone gets to have sex and they should be having good sex. Like I've saved marriages because of what I help them with in their clinic. It's so cool.

Ashley :

There's a lot to unpack there, and I cannot wait to touch on a couple of those things. But first, I want to go back to something that you said and working in GYN. I giggle because I think I know what they mean. When somebody said, with your personality, you're gonna do really well in urology. And we're both laughing because it it really does take a special person to walk into the room of a complete stranger and say, All right, drop your pants. I'm gonna look at the most private of parts of your body. And we're actually we're gonna have a good time with it, right?

Dr. Stephanie Zwonitzer:

I mean, that's that's really and you like you have to figure out how to have that bedside manner and that joking, but not offensively joking. And there's this fine line between being really comfortable with your patients and being like too comfortable or or creepy with your patients. And so, yeah, it really takes a special person. And I, one of my favorite compliments I get is when I have one of my male patients come in who is embarrassed and feeling bad about talking about his lack of erections or his lack of sexual desire. And I'm just like walk in and I'm like, all right, so your dick's not working right. Like, let's talk about it. And he's just like, phew, okay, you're right. We can talk about this. Thank you for making it easier for me. It's like, you're welcome. I love that is my favorite compliment that I can get when I make it comfortable for one of my guys.

Ashley :

And you know, I love that. And that it's it's something that even in dermatology, you can imagine. In dermatology, which is where I work as a PA, um, it's skin, believe it or not, your penis and your vagina, it is covered in skin, which is definitely still fair game for us. And um, because I worked in GYN previously, I tell people it's like my old stomping grounds. Like, I like bring it on. I love it. Let's take a look. Um, and and that's that is that's the highest honor that I can when somebody says, Ash, thank you for making that like it was not only comfortable. I actually that was really fun. Thanks, you know. Yeah, and that's great because not only number one, they feel like they have literally been seen and their problems have been addressed. But a lot of times we're we're providing an education for them, which we're gonna talk all about, um, especially with your podcast between between the sheets, you know, it there especially in women's health, and I'm sure in men's uh urology and men's sexual health as well, you really you don't know what you don't know as a patient, right? And and that's true for for women of all generations and for men of all generations right now, which you are addressing in a million different ways. Let's step back real quick. And I wanted to talk to you a little bit about when you made that decision as a nurse, when you realized, hey, I want to not just be giving these meds to these patients, I want to know the why behind that. If you could, for maybe for our students that are kind of considering this, put yourself, and I'm sure you know people that are on the opposite end of that. Who who is who is thinking, okay, I'm really comfortable in nursing right now. That is not what I want to do. This is what I want to be. What does it look like for that, for that healthcare provider?

Dr. Stephanie Zwonitzer:

Yeah, great question. I think really it's it's this internal desire to do more and to not be surface level. And I'm not saying that nurses are surface level, nurses do a hell of a lot. I mean, I I learned so much as a nurse, I took really good care of my patients as a nurse. But when there's this internal desire that what you're doing just isn't quite enough for you, that's when it's like, okay, what more can I do? And maybe it is being a nurse practitioner, and maybe it's doing research, or maybe it's getting your masters to go teach. But there's just this thing inside of you that says, I need to go to that next level. I'm not there right now. And that's what it was for me. It was every day having to call the docs and get the permission to do something, get the order to do it. And I'm like, but I just want to know why. And I want to be the one calling the shots. I see what they need, and I want to know why I am choosing one medication over another. And then I just want to do it for that patient. I don't want to have to call and ask anymore. And I think that's a big deciding factor in whether or not you go back to school. Absolutely. It also has to fit with your lifestyle, right? I mean, when I went back to school, I waited until both my kids were in school. So I went back when my son was in kindergarten because as a nurse, I was working full time. So I was doing my 312s and I was doing grad school. But then on the days where they were in school and I was not at the hospital working, I could do all my homework. I could do my clinical rotations and things like that. So it worked with my lifestyle at the time too, which made a big difference.

Ashley :

And you mentioned the fact that you took a little bit of time off, even too, and your kids are really young. And I, it's just there is for a lot of people, that extreme flexibility is so important. And like you said, the fact that you've worked in multiple areas of medicine too and kind of stumbled into this incredible passion that you've have right now with urology and sexual health. Um, it's very, very cool. Okay, let's talk about a day in your life because right now, you know, we've heard about what kind of led you to where you're at. Um, I would really love to hear what does it mean to be a urology and sexual health nurse practitioner? Do you see men? Do you see women? Do you see both? Is it a men's clinic, a women's clinic? How does that look? What does that look like?

Dr. Stephanie Zwonitzer:

Yeah, great question. So, in my particular practice, I see both men and women. Um, it depends on your office and different things that you do and also the docs that you work with. So, you know, there is still a lot of surgery in urology. And man, urology covers a lot, which I did not even realize. Working on the floor as a nurse, like you called urology when you couldn't get a foley in. You called urology for bladder cancer. Like, really minimally, did you call urology? So when I got into it and I was like, we do testosterone, we we treat prostate cancer, we don't send that to oncology. Like, there's so much that urology does. And so it really depends on where you work and what your office specializes in. But my life, I do, I have two docs that do penile implants for erectile dysfunction, who do surgeries for peronis, who do um different reconstructive type surgeries. And then I also work with a urogynecologist. So she's doing vaginal reconstruction, prolapses, different things like that. So I get a lot of sex med, which is really fun for me, and I love it. Um, and because I love it, every doctor in my office, even the general urologist that I don't always work hand in hand with, they send me their ED patients and things like that because it's my specialty and I do have that rapport with patients. But I also see overactive bladder patients, I see recurrent UTIs, I see BPH, um, I see prostate cancer guys who are stable. We have a nurse practitioner who specializes in advanced prostate cancer. So anybody whose PSAs are changing or their treatment's not working for them, I send them to her. But I'll see the guys who are like in remission, we're just checking their PSAs, that kind of stuff. Um, low testosterone, um, vaginal issues like uh vaginis, pain with sex, um, the genito-urinary syndrome of menopause, which everyone needs to learn about. Please learn about. Um, it's so important. And so, yeah, I see a variety. I see from um age 18 till death, um, my oldest patient I ever had was 105. And she just walked herself into the clinic, you know. I mean, so I see a really big variety. In urology in general, you're gonna see a big variety, but it's it's a great field.

Ashley :

Oh, I love how varied it is. And I would imagine you have patients who come in uh very worried, very anxious, very nervous about their medical problem. And then um, you have other patients who might be just really excited and anticipatory about the conversations you are gonna have about another issue, maybe a performance issue that they might be having. How I mean, is it an emotional day? Is it like high highs and low lows, or is it usually pretty steady for you?

Dr. Stephanie Zwonitzer:

Yeah, I mean, it can be. Um, when I did more prostate cancer, it was a little bit more emotional because you're diagnosing, you're telling somebody their biopsy is positive, things like that. My day-to-day now is pretty stable. I would say I have more highs than lows because I get so many patients that I gave them a new medication for their OAB, and holy cow, they went on a hike and didn't have to piss in the woods. You know, like it's so exciting. Or I gave a guy, you know, we talked about ED, we got him on a good treatment, he comes back and he's like high five and me, like, yes, I got to have sex and I lasted until climax. This was so exciting, you know. Um, a guy with premature ejaculation, we get him on the treatment plan and all of a sudden he can last five minutes instead of one. I mean, it's just so what I do is a lot more highs than lows currently. Um, but it does depend on which part of urology you practice.

Ashley :

Absolutely. Dr. Z, what is what's two questions? What's the most common condition that you treat? Maybe men and then women. And then two, what's your what's your favorite? What what just gives you the most satisfaction?

Dr. Stephanie Zwonitzer:

Yeah. So um for men, BPH, large prostates, peeing issues, um, peeing issues from their large prostate. For women, it's either overactive bladder or recurrent UTIs, and a lot of times they're hand in hand. Um, I would say what gives me the most joy is my erection patients. Um, when they come in and they've tried Viagra and Cialis and they're like, I don't know what to do. I don't know what my problem is. I don't, and we can sit there and talk through the psychological aspect of it, the relationship aspect of it. We can try different combinations of medicine, we can talk about injections or prostheses, depending on where they're at in their journey. And it's giving them hope that they didn't have coming in. And for a lot of them, they have lost relationships, they have lost self-esteem, things like that. So to give them that back and then to have them come back for their follow-up and high-five me and be like giving me hugs because they're so excited they had an erection and they haven't had an erection in five years, like they're so excited and so appreciative. Those are my favorite.

Ashley :

That's incredible. How long are your visits? How I mean, do you have a standard amount of time? I would imagine some of these conversations are really long.

Dr. Stephanie Zwonitzer:

They can be. Um, so our practice as a whole requires APPs, both PAs and NPs, to see um 20 patients a day. So the schedule is set up for 21. That way, you know, if you have some no-shows or whatever. I I've been doing it long enough. Um, and our bonuses are RVU structured for students. That means the more you see, the higher you bill, the more you get paid. I see 30 patients a day. Oh my god. So my appointment, yes, my appointments are 15 minutes, but some of them are five minutes and some of them are 30. So you kind of balance out throughout the day. So your guy who comes in with BPH and he's very stable and he's on his Flowmax and he's super happy. We talk about how the grandkids are, how life's been for the last year in a couple of minutes, and then he's out the door. And then my erection guy comes in and we spend 20 minutes talking or 25 minutes. So it does balance out throughout the day, but I see four patients an hour every at 15-minute intervals.

Ashley :

That's incredible. You are superwoman. You are a superwoman. Have you ever encountered a situation where, because I think we're getting this a lot in medicine, especially now that patients are coming in so well informed. And I just actually made a post about this. Patients, patients are doing really excellent research. You know, patients used to say, well, I doctor Googled it, and it was kind of a laughing matter, a joke. Nowadays, patients say that I take them very seriously because they, if they're doing their research, it's probably pretty good research. Um, so that being said, do you have patients coming in that are looking for a certain treatment? You mentioned Viagra and Cialis, and there are obviously reasons not to use those in certain patients. Do you have patients coming in looking for something and you have to kind of give them bad news and say, well, no, that's not what we're gonna do. How do you approach that? Do you ever get some, do you ever get anger coming back to your body?

Dr. Stephanie Zwonitzer:

Absolutely. I would say the biggest time that I get that is with my low testosterone guys. When I can't give them because they're actually not low testosterone, they need to get their diet and their sleep and their other things in line, but their tea is actually okay. They don't like that answer. Um, women who come in and they've already tried Mirbetric, they've already tried Gem Tessa for their overactive bladder, and you're like, all right, well, procedures are your next option. Nope, I want another medication. So yeah, I definitely get that. Um, and with Chat GPT and all the AI stuff too, it's gotten even worse. Yeah. Um, which sometimes for the better and sometimes not so good because chat GPT is not always accurate. So be careful when you're using that for student papers. But so um, but yeah, I think the way that I generally approach it is I appreciate that you did your research. I appreciate what you learned. Clinically, what I see is this. And in your specific case, I see this plan working better. So let's try my plan. And if it doesn't work over the next six weeks, whatever, um, you know, then we can kind of try and renegotiate and see where things are at. But, you know, based on your blood work, your symptoms, your whatever, I don't necessarily agree that that would be the best treatment for you. I'd really like you to try this one. Are you open to that? Some of them are, and some of them are absolutely not. I want what I've said I want. And you're like, all right, try it. Like it's not gonna do what you want it to do. I'm gonna prove to you that it's not gonna do what you want it to do. As long as it's not harmful, sometimes I let them try what they want and just to prove to them that it's not gonna work.

Ashley :

Well, I think it's number one, it shows that you were listening. Yeah, for sure. And then it, you know, hopefully they'll come back and they'll discuss with you again and say, hey, listen, Dr. Z, um, it didn't work. They won't say you're right.

Dr. Stephanie Zwonitzer:

They'll say it didn't work. And oh no, they would never say I'm right.

Ashley :

Oh, it's so true. You know, we've spoken to students a couple of times, specifically, yes, don't use Chat GPT on your papers. If you do, make sure you're using a reputable resource to confirm the information. Absolutely. Um, but there is a segment on the show for students, and let's talk to that as well. It's called Quality Questions, and it is where we discuss an interview question, perhaps, that you've had in the past that was super duper memorable. And this is a great way for our pre-health students, or really anybody, looking towards an interview in the future to kind of practice some of these um things that you very well might hear when you're sitting in front of a complete stranger who is evaluating your entire life. So, do you have one of these quality questions? Keep in mind that there's more interview prep, such as mock interviews and personal statement review, over on shadowme next.com. There you'll find amazing resources to help you as you prepare to answer your own quality questions.

Dr. Stephanie Zwonitzer:

I do. So I remember, and it kind of threw me off because I wasn't expecting it. You expect the like, what are your um best qualities, your least qualities, you know, things like that. But what they asked was, when is a time that you made a mistake with a patient and what did you do about it? Because we all do. You are going to make a mistake with a patient. And admitting that, first of all, sucks. Admitting it in an interview? Are you kidding me? So, like, I really sat there and I was like, all right, well, this one time I gave, you know, a milliliter when I should have given a half a milliliter or whatever. I don't remember exactly what my example was, but I gave too much of a medication. Um, I went straight to my charge nurse. You know, it was back when I was a nurse. Um, I went straight to my charge nurse and you know, told them we called the pharmacy, we asked what to do, we documented everything, whatever. And the patient turned out to be fine and everything was good. But that is such a hard question to answer, especially on the spot when you're like, what do you mean? I'm supposed to talk my best. I'm supposed to be on my best behavior right now. I'm in an interview and they're like, hey, when did you screw up? And you're like, oh, well, but just know we all have screwed up. Like, we have all made a mistake. Pray that your mistake didn't do harm to a patient, but we've all made mistakes. You've written the wrong order, you entered the wrong med, you gave the wrong something, you've done something, and that's okay. We all have. We just unfortunately work in a career where we could have like some really bad outcomes if we make mistakes versus you know dropping the mail off at the wrong house.

Ashley :

That's a really great quality question. Oh my gosh. I mean, it's it's a terrible one. I would not want that one. That sounds awful.

Dr. Stephanie Zwonitzer:

No, I remember just being completely shocked. Like, how dare you ask me something like that? I would never make a mistake. You're in an interview. You don't want to admit that you make mistakes.

Ashley :

No, no, absolutely not. Absolutely not. Dr. Z, you have this fantastic podcast. It is called Between the Sheets. And I would really love just for you to tell us quickly what this podcast is about. Because um, coming from you, I can't wait to hear it. I I love this podcast so much. It is so much fun.

Dr. Stephanie Zwonitzer:

So, Between the Sheets came from me loving sexual medicine. And at work, I still have to practice general urology because that's what I do. And I wanted this outlet to be able to explore sexual medicine more, to get quality education out there because it's lacking, and to kind of start to strip away the shame and tabooness of talking about sex. So we cover everything from basic anatomy to the kinkiest stuff. I had an episode on fisting. Okay. So, like everything in between um sexuality, couples, singles, everything. And I have some amazing guests on there who provide a wealth of knowledge and it's so much fun.

Ashley :

It is so needed. It is so needed. And I'm sure this probably came about because in clinic, you were answering questions that you did not even realize were questions. It goes back to what we were talking about about how patients don't realize what they don't know. Uh, people, we as humans, as sexual beings, yeah, don't realize what we don't know. Ah, so we lost Dr. Z right there at the end of our conversation. The joys of recording across states and Wi-Fi. But honestly, I think that's a pretty fitting end to this episode because what she shared with us today was real, unpolished, and exactly what so many people need to hear about sexual health and urology. Before we wrap up, I want to make sure you know where to find more about Dr. Z because she is doing such important education in this space. She hosts the podcast Between the Sheets, where she breaks down everything you were too embarrassed to ask, from anatomy to desire to ED to pain with sex to some of the kinkier topics she hinted at today. And she does it in a way that's approachable, evidence-informed, and genuinely fun. You can also visit her website, Between the Sheets, with Dr. Z, that's DRZ.com, and follow her on social media for bite-sized education, honest conversations, and the kind of sexual health content I wish every patient had access to. I'll link all of her information in the show notes below. Dr. Z, if you're listening back, thank you for bringing so much clarity, humor, and humanity to a part of medicine that so many people are afraid to talk about. Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode, or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday. As always, if you have any questions, let me know on Facebook or Instagram. Access you want, stories you need, you're always invited to Shadow Me Next.

Head Shot

Ashley Love

Host