What Your Gynaecologist Was Never Taught About Your Body

— Dr. Kelly Casperson sitting down with Dr. Andrew Goldstein, one of the world's leading specialists in vulvovaginal disorders and female sexual medicine. They cover vulvodynia, lichen sclerosis, cervical health, arousal disorders, and the emerging treatments that are finally starting to change what care looks like for women who have been dismissed, misdiagnosed, or simply never told what was actually going on

🤩 You Are Not Broken Podcast

https://podcasts.apple.com/us/podcast/you-are-not-broken/id1495710329?i=1000770401294

Transcript

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Middle that's called an honey or nobody's falls. Women open midlife. Just do a day.

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Comment sing along. Hello my friends, and welcome back to Not Your Mother's Midlife. I'm your host, Joanna, and today we're going somewhere that medicine has been slow to go to. A real detailed, no-glossing over conversation about vulva and vaginal health, or vaginal health, depends where you are in the world. I'm sharing they're both the same things, right? No matter what part of the world you live in and what accent you have. Vagina is a vagina. I'm sharing an episode from You Are Not Broken Podcast again. I've shared many from there because it's fantastic. Dr. Kelly Kasperson sits down with Dr. Andrew Goldstein. He is a board-certified OBGYN and one of the world's leading specialists in vulva vaginal disorders and female sexual medicine. He has published over a hundred peer-reviewed articles on conditions that the rest of medicine has largely looked away from. The last part matters because the conditions he has spent his career on, vulvardynea, lichen or lychen, sclerosis, arousal disorders, vulva pain are not rare. They are common. And maybe we have not heard those words before, but apparently they are very common. And they have been chronically underfunded, undertreated, and misunderstood. Not because the patients aren't suffering, but because women's pain has historically not been taken seriously enough to fund the research that would lead to answers. We have just been left in the dust, ladies. This conversation covers a lot of ground. Let me walk you through the parts that I think matter the most. They open with cervical health, specifically cervical innovation and its role in sexual pleasure. This is something that barely gets mentioned in medical school, which tells you something about how narrowly cervical health has been framed. The cervix has a nerve supply that is relevant to sexual sensation, and procedures like LEAP, LWP, or L L E T Z, Aussie, which are used to remove abnormal cervical cells as part of a cervical cancer prevention, can affect that nerve supply as well as urinary function. And Dr. Goldstein talks about surgical techniques now being developed specifically to preserve those nerves during treatment. This is new. And the fact that it took this long to be a research priority, frankly, that's a problem, but you know, none of us are surprised. On HPV vaccination, he is direct. The impact on cervical cancer rates globally has been significant and the data is strong. He also covers efforts in resource-poor countries to expand cervical cancer prevention, which gives the conversation a wider frame than just what's available in a private clinic in New York City. Then they get into vulva anatomy, which sounds like it should be basic, but Dr. Goldstein makes the point that misconceptions about female anatomy are carried not just by patients, but by providers. The anatomy is more complex than most people are taught, and that gap in understanding has real consequences for how conditions get diagnosed and treated. Vulvadynia is a signific I've never heard that word before, so it's it's hard for me to pronounce it. Vulvadinea, I'm be out front, I've never heard that word before, um, so it's I don't know if I'm pronouncing it correctly, but it is a significant part of this episode. It's chronic vulva pain with no visible cause, and it affects up to 8% of women by the age of 40. That's a lot, because there's nothing to see on examination. It has historically been dismissed or simply attributed to psychological causes. Is it Goldstein or Goldstein? I don't know. I'd say Dr. Goldstein has been actively working to change that, including through Evolva Dianea Research Summit, whose findings come out in early 2026. The summit brought together both researchers and patients to rank the most promising treatment directions, and that combination of expert and patient input in itself is very notable and very exciting. Marcells are immune cells involved in allergic responses. The research on what's actually driving vulvadinea is moving fast. Two of the most interesting areas mast cells and pelvic floor muscle dysfunction. Mar cells are immune cells involved in allergic responses, and there's growing evidence they play a role in the nerve hypersensitivity seen in vulvardinia. Neuroproliferation and overgrowth of the nerve fibers in the affected tissue is another finding that's been consistently shown in the research. Emerging treatments discussed include topical ketotiffin, an antihistamine that targets mast cells' activity, as well as localized nerve targeting approaches and novel chemical injections for pain relief. A botulant toxin, like Botox, for pelvic pain is headed into clinical trials. No cures yet, but a field that is finally moving. Lycan sclerosis gets significant attention. It's an autoimmune inflammatory skin condition that primarily affects the vulva and perianal area. Untreated, it causes scarring, affects sexual function, and carries a 5 to 7% risk of malignant transformation, meaning it can progress to cancer. And yet it is routinely missed by gynecologists, urologists, and GPs, largely because most providers receive very little training in vulva skin conditions during their residency. The first line of treatment is still ultrapotent topical cordosteroids. This helps but have long-term limitations. What Dr. Goldstein is excited about are JACSTAT, that's J-A-K-S-T-A-T, pathway inhibitors, a class of drugs already used in other autoimmune conditions that are showing real promise for lichen sclerosis. And in the pipeline is stratabarrier cream, which is currently in clinical trials at his centers. Now on to arousal disorders. Topical sildenethyl for women. Sildeneth is the active ingredient in Viagra. And while it works very differently in women than men, there is a mechanism. It increases blood flow to the genital tissues, which support arousal and sensation. The reason it hasn't simply been repurposed for women is partly regulatory and partly about drug delivery. The formulation of topical cream affects how much the active ingredient actually gets absorbed, and Dr. Goldstein goes into the science behind this. The thread running throughout the whole episode is advocacy. Dr. Goldstein is direct about the relationship between research funding and clinical progress. Conditions that don't receive funding don't generate the trials, the data, the approvals, or the insurance coverage that make treatments accessible. And the conditions he works on have been chronically underfunded because they affect women and because they involve anatomy and experiences that medicine has been uncomfortable talking about for years. If you have ever dealt with vulva pain, painful sex, lichen sclerosis, symptoms, or arousal difficulties, or if you have a daughter, a friend, a mother, this episode is worth your time. I'll link it in the show notes. Thank you for listening. And if you enjoyed this episode, please share it with a friend. Share it on your socials. You never know who might actually need to hear this. And drop your thoughts or ideas for future episodes. I'd love to hear from you. Subscribe to this podcast and go over and subscribe to my YouTube channel. There's lots of fun videos over there, and you'll never miss an episode. And until next week, I'm Joanna, and this is Not Your Mother's Midlife. And until next week, I'm Joanna, and this is Not Your Mother's Midlife. Bye bye.