Ep 35: Let's Talk About Sex with Dr. Shieva Ghofrany

Holly, Lacey, Keira and Whitney invited Dr. Shieva Ghofrany, M.D. OBGYN, into the widow's circle to discuss all things sex and sexual health! Getting back on the horse, so to speak, is scary after having a long-term relationship! We took your questions to an expert! Everything from sexually transmitted infections (STI), to how to make sex more enjoyable, Hormone Replacement Therapy (now called Menopausal Hormone Treatment), Ozempic, latest grooming trends and much more! Nothing is off limits with Dr. Shieva Ghofrany! @drshievag.

https://www.tribecalledv.com

This episode is brought to you by Roger Brooks and his team at Strategic Investment Management. As an Austin-based fiduciary financial advisory firm, Roger and his team bring decades of experience and empathy to help people regain financial control through life's ups and downs so you can move forward with confidence. www.strategicim.com. 512-341-9898

This episode is also brought to you by Meredith Schlosser, real estate agent for the Los Angeles area and beyond! If you are looking to buy or a sell a home in the LA area or need a referral for an expert agent around the world, Meredith should be your first call.

www.MeredithSchlosser.com

Episode Transcript

(00:00):
Grief is messy and I'm no maid. This is every widow thing.
This episode is brought to you in part by Meredith Schlosser,
expert real estate agent in the Los Angeles area.
And whether you're looking to sell or buy or want a great
recommendation for agents all over the world, she's got you.
Today's episode is brought to you by Roger Brooks and his team

(00:23):
at Strategic Investment Management.
As an Austin based Fiduciary financial advisory firm, Rodger
and his team bring decades of experience and empathy to help
people regain financial control through life's ups and downs so
you can move forward with confidence.
Welcome to every widow thing. I'm so excited about our guest

(00:44):
today I'd like to welcome Shiva Gofrani.
She is an OBGYN for over 25 years, you guys, so she knows
her shit. And she's also the Co founder of
Tribe Called V It's a virtual platform that speaks openly and
honestly about Women's Health. She's a tireless advocate for
women, but really for people andhas a wealth of knowledge, so

(01:06):
we're so excited for her to be here today.
The reason we asked her is because we want to talk about
sex and sex health and she knowseverything and there is no topic
that is taboo for her. So thank you so much Shiva for
being here. Honey, thank you.
First of all, thank you for the intro.
And I I love that we're going totalk about this.

(01:27):
And I would say it applies certainly for people who are
embarking on sex again after having been widowed, but also
people who are just post menopausal or perimenopausal and
haven't been in the game for a while because marriage, all of
it. So it all it applies to.
Exactly. This episode is literally for
anyone that has has been out of the game for a little while and

(01:49):
even like you said pre menopausal, menopausal because
our bodies are changing and we don't really know what's going
on and there's a ton of information out there, but it's
different than the information we got 10 years ago.
You know Holly and I, we've beenwith our guys since we were 19.
So when we were all of a sudden pushed back into the game at in

(02:13):
our 40s, that's a very differentenvironment.
So we're going to start with Holly.
We asked our audience actually for questions.
So we're going to be addressing some of the questions that they
have, some of the questions thatwe have and we're going to start
it off with Holly. Well, OK, so I decided to start
dating five years after my husband died and that it was,

(02:37):
you know, we'd been together 28 years.
And so I'm like, hey, I'm going to date and everybody's all
excited for me and they're like,well, be careful of the STD's,
STI's, herpes, blah, blah, blah.And I was like, I just want to
go on a date. This is one thing that I love
about you and your Instagram. You address it a lot and try to

(02:58):
normalize it. So let's talk about the St.
Is it used to be STD? I know I was like St.
DS St. is. So tell me why not sex?
'Cause it's not. It's not a disease.
It's not. It's not a disease.
Disease sounds so judgy and like, Oh my God, like it's
something terrible. Whereas what I always try to say

(03:19):
about STI sexually transmitted infections is it's just a part
of having sex. You have to accept that there
are certain ones you can almost always avoid by doing certain
things, and there are certain ones that you cannot 100% avoid.
And you have to accept that risk.
Or if that's too big a risk to accept, then you have to
abstain, which most people don'twant to do.
And I hate to say that everyone has herpes, because not everyone

(03:41):
has it, but a huge portion of ushave had it, have it, don't
realize we have it, And if we can normalize it and more
importantly, destigmatize it, then people will learn about it.
They won't freak out. I actually have said millions of
times, I think if people learn more about it and didn't freak
out, we'd probably prevent more herpes because they would learn

(04:01):
about it and they'd learn the strategies as to how to decrease
it because they wouldn't be so embarrassed about it.
They could talk about it more openly.
And that like 80s and 90s, therereally was this campaign herpes
is forever, Which as I say to people all the time, technically
speaking, is true. Once you've been exposed to it,
you have it. But like.
Chicken pox is forever. And we don't stay on chicken
boxes forever, so it sounds so ominous.

(04:21):
Area when we say herpes is forever.
So that's unnecessary, right? Because the implication of that
would be you want to try to avoid it because it's forever.
But the honest answer is you cannot 100% avoid herpes no
matter what. Because even if you use condoms,
dental dam took medication to suppress it and had your partner
take medication to suppress it, you still theoretically could

(04:42):
get exposed to the virus becauseso many of us carry it without
knowing it and we shed it. We say it sheds
asymptomatically, meaning without an obvious cold sore on
your mouth or on your genitals. So that's why you can't 100%
avoid it. You don't you'll you'll drive
yourself crazy by thinking you can.
So then by ominously saying likeit's forever, it's useless.
Guess the only thing that I would tweak if I could and I try

(05:03):
to teach my patients this is instead of saying like I have
herpes, which again sounds like this, I wish we could all just
change our vernacular and say, oh, I carry the herpes virus
because many of us carry the herpes virus and we would know
it if we all got tested. But you guys might know this or
you might not. The current guidelines by the
CDC do not recommend screening for herpes.

(05:27):
So when you go to your doctor and say I want full STI
screening, if they're just sticking with the guidelines,
they'll test for HIV, hepatitis,syphilis.
They will not test for herpes. They'll also test for gonorrhea
and chlamydia and probably something called trichomonas.
But herpes is not part of the screening unless you come in
symptomatic or asking for the test.

(05:48):
It's not standard. I have many feelings about that.
I actually think that in order to destigmatize it, we should
just kind of routinely screen everybody, anyone who's actually
having sex, oral or otherwise, right?
And then we'd all know. And then we could destigmatize
it and we could kind of say, like, oh, I've been exposed.
I haven't been exposed. Oh, if I haven't been exposed,
here are the things I could do to decrease my chances.

(06:09):
I've been exposed, but I never get outbreaks, so my my
likelihood of shedding it asymptomatically might be less.
But it might not. So let's talk about that.
It would just be a conversation like it should be right now.
So let me ask you this, what is,in your experience, is herpes
the most common? Most common.
The most common is actually HPV,the one that causes warts or

(06:34):
abnormal pap smears is the most common because really, really
90% of us carry it, carry it. I don't want to say have it
because again, that sounds so stigmatic.
So. Question about that if you have
an irregular PAP that means HPV correct?
Like when someone almost. Always there is a small
percentage of the time than an irregular Pap smear is from, not
from HPV, but the vast majority of time, like over 90% of that

(06:57):
it is from HPV. And the vast majority of us who
have had HPV or currently have it, whether or not we know it
will never have cervical cancer,oral cancer for, or anal cancer,
which is the cancers that can cause.
That said, most of us, if we have had sex even once with one
partner, with a condom or a dental dam, we'll get exposed to

(07:20):
HPV because it lives on the skinvery easily in our genital area
and in our mouth and in our anus.
And so that's why I say to patients, like if you tell me
you want to avoid herpes and HPV, I'm going to tell you not
to have sex. But that's, that's the only
answer. But then we can actually get a
little bit fancier and say, OK, use condoms when you can,
recognizing that you can still get either virus even with

(07:41):
condoms. Talk to your partners about
whether or not they know they'vebeen exposed.
Again, now we're getting into more details which are, Whitney,
you had said, don't you know youhave HSV herpes if you had a
blood test and the answer is yes.
But all you know from the blood test for herpes is that you've
been exposed at some point and that you have antibodies.

(08:03):
You can't tell when you've been exposed or who exposed you
unless you've been routinely testing like every six to 12
months and then you could time it.
But like just today, at age I'm 54.
If all of a sudden today I decide I'm just going to go cold
test myself for herpes. And I've never been tested
before, and I show up with antibodies against the one or

(08:24):
two strains of herpes that we test for, which is herpes, one
that usually causes cold sores or herpes 2 that usually causes
genital ulcers. If I test positive for both of
those, I don't know, did I get it from the first guy I had sex
with when I was 18 years old or the most recent person I had sex
with, Which is my husband, right?
And if I got it from my husband,who I've been with now for 25
years, did he give it to me during our marriage or prior?

(08:47):
There's no way to know. So even herpes testing is
confusing when it's positive because there are some false
positives. And because it's only telling
you've been exposed, it's not telling you timing again unless
you're going regularly, in whichcase you see certain changes in
the antibodies show up. Does that make sense?
It's like with COVID, right? Like you guys got tested for

(09:07):
COVID. Let's say you've never had COVID
before, and you got COVID testing right now for
antibodies. You might all show up with
antibodies unrelated to the vaccine, but you wouldn't know
when you had COVID. I'm going to offer you all
ladies who are embarking on sexual activity.
Try not to use those terms with yourselves, because then you're
further swearing yourself or your partners, right?

(09:27):
It shouldn't be a scare. It should be.
I know, I get it. I always joke like I get that no
one wants it. I don't want it either, but I
don't want it to be a scare. I think it's how we were brought
up. I think it's that that kind of
pain when we were younger, you know, we don't feel dirty from
having the chicken pox, but we feel dirty with having herpes,
which by the way, you can get from drinking after somebody.

(09:51):
It doesn't have to be sexual to get herpes, right?
It's just a different and so nowit's all mixed up.
It's mixed up. And this is a common thing,
like, I have been tested, right?Because I wanted to know and I
wanted to, like, prove to my patients.
They're like, I'm like everybodyelse.
And I tested positive for HSV 1,which is the oral, oral cold
sore virus herpes, right? I was negative for HSV 2, which

(10:11):
is just dumb luck because it's not like I didn't have sex
before. Right now what I tell people is
this. I don't know if I got even the
oral one from my mother, my, my best two friends, or my husband.
They've all had cold sores. I'm lucky.
I've never had a cold sore, but I carry the virus.
If I gave someone oral sex, I could give them the virus on

(10:33):
their genitals, even though it'soral cold sore virus herpes.
I might not know it because I'm not shedding any virus.
And then they end up with genital herpes from the oral
virus strain, and now they're freaking out and think there's
something terrible when in reality it was all very
innocent. Right.
So again, common. Well, so then for people out

(10:54):
there that are like just embarking on intimacy for the
first time in a very long time, what are the, what advice do you
give them in this scenario? And then we still need to talk
about HPV or or or in any of thethe scenario, Yeah, yeah.
OK, so let's see. You came to me and you you all
said OK, guess what? I I want to start having sex

(11:17):
with someone. I I don't actually use the word
intimate just because I don't know why I don't.
Because you're a doctor. You like medical term
intercourse. Intercourse.
Like, I don't know. Intimacy sounds so beautiful,
but it also was like, sounds subtler.
I'm gonna start having sex. What should I do?
I would say, first and foremost,right now, let's get you tested,
which in my practice would be HIV, hepatitis, B&C, and

(11:42):
syphilis for sure. Those are blood tests, gonorrhea
and chlamydia, which can be a genital swab or a urine test.
And then I would also talk to you about herpes.
And I would say, do you want to get tested or not?
It's not the standard. But here are the reasons why I
think you should, though you might not want to because
sometimes the knowledge does freak you out.

(12:03):
And if you're not equipped to deal with that yet, then let's
table it. And according to guidelines, you
don't have to test for it. So we would talk about all those
things, right? You might notice I didn't say
HPV in that because there is no direct test for HPV other than
having your Pap smear. And with the Pap smear nowadays
we test for HPV, but it doesn't tell us when you were exposed.

(12:26):
It doesn't exactly tell us what strains you have specifically.
It might, but it's not the standard of care and you can
have a negative test right now and there's still potentially
low level of HPV in in your cervix or a previous history of
HPV that is already cleared. So HPV is not part of the the
routines free, but those other ones I mentioned are.

(12:47):
So those ones are the ones I would test for and I would tell
you to do it So you have a baseline so that you know like
do you carry any of these you didn't know about.
Let's know what your status is and let's talk about it like
calmly but warmly but in a way that is not going to freak you
out or scare you, right. The second thing I would say to
you is you are all of my generation Ish, right?
We're all in our, I'm assuming you guys are like 40s to 50s.

(13:09):
So we did not get vaccinated forHPV.
And do you guys know this that the guidelines now support
getting vaccinated for the HPV virus that many of our children
are getting vaccinated for starting at around age 11 for
boys and girls, but now they've extended it past age 26 to age
46. So I would tell you to also get

(13:30):
vaccinated for HPV. Even.
But what if you already have it?It doesn't work then.
Great question. No, it can work because just
like with the COVID vaccine, when we got vaccinated for
COVID, if we got vaccinated, it wasn't necessarily only one
strain, it wasn't just Delta, itwas also Omicron, for example,
right. So when we have HPV, like I said

(13:51):
before, we don't know exactly which strains we have, and
there's actually probably hundreds of strains, but we've
defined dozens of strains. The vaccine covers 9 strains.
So even though like in my case, I know I had HPD 'cause I was
22, I 22, yeah, 22, I had warts,I had an abnormal Pap smear, I
know I have HPDI don't exactly know all the strains.
So I could get vaccinated against the current 9 strains

(14:13):
that we can vaccinate against sothat I could prevent future
exposure to HPD. Now I missed the, I missed that
deadline, but our listeners haven't.
Right. And here's what I will say and
don't quote me on it for your doctors, but you could quote me
on it. Technically speaking, the
guidelines only mean that it's FDA cleared for that purpose or

(14:35):
FDA approved for that age group and therefore insurance should
cover it. You could elect to talk to your
doctor and say, I know I'm the class age 46, but can I still do
the vaccine And there's no harm in doing it.
And the truth is, the biggest reason I would tell you all to
do it is really not to prevent cervical cancer.
Because if you go routinely for your Pap smear and get it done
every one to five years, which is the current guidelines,

(14:56):
you're likely not going to get cervical cancer or certainly not
advanced cervical cancer. But all of us are at risk for
head and neck cancer and that's on the rise because we can't
screen for it the same way. So I really would tell you all
if you are going to go have sex with someone new who likely does
not know his or her status with HPV, please consider getting

(15:16):
vaccinated. And anyone out there listening,
please, please please if there'sever a reason to vaccinate your
kids like I would, I in a hot 2nd would want every kid to be
back. Yeah, I have all of mine.
I've done all three of mine. OK, So this is interesting
because Lacey, you brought up HPV and you were you were
talking about the the, the throat cancer?

(15:37):
Yeah, that's that seems to be onthe right.
Michael Douglas, the actor. And I think there's another
actor that came out and said theone.
Val Kilmer is another one. And so that was, yeah.
So I was wondering. So it's on the rise.
Absolutely. So that and.
We so we know that's. From HPV and oral sex, that is

(15:57):
how you got that particular throat cancer.
And you can keep passing it backand forth between if you're with
a partner, even if once cleared,you can keep passing it back and
forth till I mean. So it's interesting that you say
you could get the vaccine. I mean HPV, it's a fascinating
thing. HPV has a virus is like we could
do, we could do three episodes on just HPVHPV is a fascinating

(16:19):
virus because we don't, we say that many of us get exposed and
then we probably clear it and it's the persistence of the
virus that worries us. But the truth is, as OBGY NS, a
lot of us anecdotally will tell you, like I've had patients who
literally haven't had sex in 20 years, like nuns who had had
intercourse once and now we're nuns not having any sex and all
of a sudden their Pap smear showed up with HPV.

(16:40):
So that was not new exposure. That was a virus, that.
So we. Think at low levels and then.
Those nuns, you got to watch outfor those nuns.
That's crazy. I would go, So what do you do?
Because we talk, you know, you are very much about, you know,

(17:01):
being proactive and not being what's the word, yeah, but it
starts with API. Say be proactive and are being
paranoid. Yes, thank you.
I mean, I'm just going to be frank here.
Oral sex is a part of the is a part of the relationship a lot
of the times. And now I'm like scared to
death. So what do you do?

(17:24):
No, seriously, what do you do? I don't want cancer.
Because the man can't. Be tested correct?
You. Know this is my this is my
ubiquitous example every single time.
And if you really think about it, I will guarantee you that if
you're being rational, it will resonate.
And I want you to keep going back to it every single day.
I'm. I'm pretty sure all of us are
getting into a car, right? And every single day we don't

(17:47):
know it. But we have been create, we have
been taught this mental model that you're going to get into a
car, but you're not going to be drunk, you're not going to text,
you're going to wear a seat belt, you probably have airbags.
You have to get to work, you have to get to your podcast, you
have to get to your friends at the bar, You have to do all the
things you want to do. And therefore you're not going
to say, I don't want to get to acar, 'cause I don't want to get
in a car accident, right, you'regoing to save yourself.

(18:09):
I'm probably not going to die because I've taken all these
measures. You're not even saying it
consciously. It's so mentally modeled into
your behavior. You're taking measures.
You're being as cautious as you can, and you are accepting the
small risk of either a Fender Bender or the even smaller risk
of a catastrophic illness. I mean a fiery crash, right?
You're doing that. We're all doing it.
Yeah, Kara actually was in one. And and this is one of the

(18:32):
things that happens, yeah, this is one of the things that we
learned from another guest that we had on recently, where you
can be fearful after you lose your spouse unexpectedly, which
we all did. It can create fear and wanting
to control every little thing inyour life.
But one of our guests, Tiffany from Rebuilding Joy, said, which

(18:53):
is so true, we did everything right and he still died.
So you can't live in that fear. You, you take all the
precautions that you can and yougo live your life.
Yeah, So you're right. And so you take, we do it every
day. And the car is the best example
I can give of of us taking a measured risk every single day
that actually, I mean some people do die, but the odds are

(19:15):
small. So when it comes to oral sex or
sex, you have to just kind of pragmatically look at it like
that, Like I would like to embark on a sex life.
I know there are certain risks. What are the things I can do to
minimize my risk? I can get vaccinated.
Whether or not I want to stick with the guidelines of only
being in my 40s or not. I can make sure that I have a
conversation with my partner about do you know if you've been
exposed or not? Do you know if you had genital

(19:37):
warts? You know if your your past
partner had abnormal Pap smears?And even then, by the way, all
it is, is knowledge. It's not prevention.
We don't have prevention yet outside of the vaccine.
And then you accept that there can be some exposure, but it's
worth the risk because you are, well, I'm not going to.
Say unless you want to be a nun and not have any, no.
Even the nuns. Then you want to have a nun if

(19:57):
you never even the nuns. And then the secondary part is
also recognizing, like, OK, so then don't be paranoid.
But if all of a sudden, let's just talk about like, your
throat, your voice changes in, your throat gets raspier, you
start to notice that it hurts when you swallow.
You start to notice that you feel something.
Don't freak out and be paranoid and think you have cancer

(20:17):
because you probably don't go toyour doctor and or an ear nose,
throat doctor to look in your throat.
I remember years ago my voice was raspy and I was like I went
to my ENT and I was like I know it, I know it.
There's warts on my in my vocal cords and I've got HPV there,
don't I? And she was like chill out
sister. You are fine.
She's like you have some polyps because you talk a lot and drink
coffee, but again. I'm on my.

(20:40):
Way, right. So, so, so I don't want any of
you or anyone listening to thinkor even say, but now I'm so
scared. I want you to think, oh, now I
have knowledge. Now I know how I can prevent it,
that I can't 100% prevent it andthat I'm going to be proactive
just like I do every day with mycar, right.

(21:00):
I want you to keep going back tothat example because you do it.
You've already been taught, but no one said to you when you were
16 and getting your license, by the way.
Well, actually my mother did. But my your parents might.
I think you could die in a fierycrash every minute, right?
They would have scared the shit out of us.
Right, exactly. No.
Every mother, I think, does I. Just remember that it like
drivers Ed, there was that scarymovie they would play.

(21:23):
Yeah, yeah, it was just. Crash over, crash over crash and
you're. Like, Oh my God.
But there's a lot that's not in our control.
So what you're saying is you become knowledgeable, you
prevent as much as you can and then you go and you live your
life, which is a great message for widows and widowers and
anyone that's had lost. Because after something

(21:43):
traumatic like that, you can be very fearful and and that is not
the way you want to live. All right.
So wow, we could, we could keep talking about this, but we've
got some other questions that wewant to get to so.
OK, wait, but I have two things that I want to say.
Yes, one is just a bad joke. So when we said like, OK, what
would you say if you came to me and I would say, OK, let's talk

(22:03):
about your STD STI panel, let's talk about contraception and and
then ideally you meet someone new.
This is like my pie in the sky future world.
Everyone kind of shows up with their like, hey, you know, I
like Rose. You like vodka.
Here's my STD screen. Let me see yours So that we can,
like, match like, oh, look, we've both been exposed to both

(22:24):
herpes. Therefore we're not going to
give it back and forth to each other.
Check. That one's off the list.
Oh, it turns out I had HPV. You did not.
Or you don't know if you did because you're a man and you
don't get tested for it. We're going to use condoms for a
while until we decide that it's worth the risk of not using
condoms and then move on. Or I had chlamydia, but my
chlamydia now is negative and I was treated with antibiotics,

(22:46):
right? So you can kind of go through
that checklist together in a in a non emotional, non judgmental,
non stigmatized way because you're just trying to figure out
like what level of concern do I need to bring to the table here.
It's important to have those conversations with some.
I don't know why. It's like finances.
Why? At a certain point, if you're
going to have sex with someone, doesn't it make sense that you

(23:07):
should be able to talk about money, not politics?
But you can talk about money andyou could talk about sex.
And. Talk about as long as you do it
the way you do it, which is in anon judgmental way but in a
mature way. And we're still in this weirdly,
very Mystic society. We're like everything.
We're hyper sexualized, but we're like, oh, let's not talk
about sex. Even though, like every other
thing on hip hop Instagram musicvideos is about sex.

(23:30):
But it's not really about sex, right?
It's really messed up. So you would say to someone,
like if we're talking to our audience of widow and widowers
or even, you know, we have some people who are divorced, solo
parents, whatever it is, and they're ready to get back out
there. The first thing they should do
is go and get tested themselves so that when they have a partner
they can say I've been tested, this is what what we're working

(23:53):
with. And really, I feel like you
should have that conversation asif you've been on a couple of
dates and you think this is whatyou want and you you want to go
a little further. Then you have that conversation
of, hey, I've been tested, I'd like for you to be tested.
And then you both show your tests.
It's like a test reveal and thenyou take your clothes off.

(24:15):
And that's so hard because like you, you know you want to do.
Go ahead, Sorry, I was going to say.
You want to get that taken care of before you're in the moment,
especially if you've been out ofthe game for a minute and you're
getting carried away. And it takes a few days.
You've had a couple drinks and it's like it's on.
Hey guys, Whitney here and I'm about to share some information

(24:38):
with you that can make a very stressful situation super, super
easy. Talking about buying or selling
a home, I have the perfect realtor for you.
Her name is Meredith Slauser. She's a real estate agent based
out of LA, but she has teams allover the world.
So if you're not in the LA area,you can still give Meredith a
call and she can put you in the hands of an expert.

(25:00):
Here's the deal, all right? You want to work with someone
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Can we shift gears? Yeah.

(26:25):
Well, yeah. Yeah, we've got, yeah.
I'm dying to ask you so much because I follow you and you're,
you've got, you've run the gamutwith all these topics.
Whitney said something one time and it cracked me up because
it's so true. We've all lost our husbands in
our 40s. And so you're getting back out
there and and you remember I didn't get married till later in

(26:45):
life, but I was 36 when when I met him.
So I married at 37, almost 37. Well, I looked a whole lot
better than and things were a little higher, a little, you
know, and now you've had babies.And so my 19 is, she says my 19
year old butt. He doesn't know my 19 year old
butt. So that said a lot of us are

(27:05):
trying to do things to look a little better, get our hair done
and and the one thing, Ozempic, all the other drugs that are
doing the same thing that Ozempic does.
And I have a lot of friends thatare on it.
I have been very fearful of it because I had an uncle who died
of this heart issue from Finn. Finn.
That's been my fear of trying it, even though it would be

(27:26):
nice, because as you know, not that you've experienced it, I
don't know. But menopause, you can gain
weight. Like I'm bigger now than I've
ever. Been so it's frustrating you
guys are you guys are good because you're 1-2 questions
brings up like 10 things so I think I'm.
Sure, I could do it too. Yeah.
Asking for a friend. I say very publicly and very

(27:49):
openly that I had weight loss surgery when I was 40.
So I am leaner now at 54 than I was from 30 to 40, but that's
only because of weight loss surgery and Ozempic.
So I get it. Second, I would say this.
I laugh when I think of us as women, that we're like, Oh my
God, my butt. My butt when I was 19 was not
that great anyway. But like, my butt wasn't what it
was when I was 19. Like, how many guys out there
have, like, the fucking ABS theyhad when they were?

(28:10):
So they're farther on us. Though.
Than we are on them, I think. We are so critical of.
Ourselves. I get it.
Right. But OK, so let's tease the part.
Fen. Fen.
Which, by the way, of course, I tried that in the 80s too,
'cause I tried all the things 'cause I had such disordered
eating as like a girl in the 70sand 80s who had to diet all the
time. That was a miraculous appetite

(28:33):
suppressant. It was two different medications
Phentermine and Fen Fen Laxamine.
I forgot the one that was taken off the market because
Phentermine is still on the market.
The 2nd Fen of Fen Fen was what caused pulmonary hypertension
which is very rare side effect but it happened and but again a
rare side effect where still a bunch of people died.
Enough people that it was taken off the market.

(28:53):
And because of the pulmonary hypertension meaning high blood
pressure in your lung system which is very dangerous, it
affects your heart. It is dreadfully dangerous.
The difference is the mechanism that that worked was suppressing
your appetite by essentially changing parts of your vascular
system is the best way I can describe it because I'm not an
endocrinologist or a or a pulmonologist.

(29:15):
But this is a totally different mechanism like this is working
on something different in your hormone system.
As I say a lot and I said this about the about COVID vaccine,
I'll say it about Ozempic when people are like, Are you sure
it's safe? My answer is this.
I'm not sure anything is 100% safe.
Just like the car, right? I am sure that net, net, net for
me right now at 54, having had ovarian cancer, I know that if I

(29:39):
continue to gain weight as a menopausal woman with a history
of cancer, I know the risks thatthat was going to increase for
me because I was going to have high blood pressure, my
cholesterol is going to go up. I know what that would have
done. So it's worth me taking the
small chance that there's going to be something that comes out
in the next 10 to 20 years. That's not true for everyone.

(30:00):
And like, I can't see all well because you all look small, but
you all look so lean and healthythat I don't think any of you
probably need Ozempic. With the data we have right now,
there might be data in the future, pretty near future, when
we have enough people on it for long enough because we've
actually been studying it for several years or iterations of
it, where we know that even those of us who, let's say

(30:22):
needed five to 10 lbs could safely go on small doses of it.
I don't think we're there yet. So I wouldn't tell everyone in
the world who needs 5 to 10 lbs of weight loss in perimenopause
or menopause to go on it, because I just don't know the
side effects long term. But for someone like me, with my
history of weight and with my risks, to me it's worth that

(30:42):
small risk that. Right.
It's really personal. Well, if you have diverticula or
diverticulitis, it can be much more risky to take something
like that. And I was like, huh, I didn't
quite understand the reason. About that one connection, she
might be saying, which is not a direct it's not like
diverticulitis is a reason not to take it.
But what it does is slows down your GI tract, it slows the

(31:04):
emptying of your stomach, so it makes you feel full faster.
But it also because of that for some people the side effect is
that they're everything gets sluggish in their GI tract and
they can get constipated and youmight know this that if you have
diverticulosis you don't want toget constipated because that can
trigger. Diverticulitis.
OK, we don't have a lot of time left and we still want to talk
some sex questions and one of them is about as you get older,

(31:29):
sex may not be as enjoyable. And I know you know this isn't
I'm I'm throwing it to Kira, butit's because.
It's because. We have a button.
Is because we have. No idea why I'm in charge of
talking about HRT. Right.
And that's why I'm throwing it to here because we're going to
talk about hormone replacement therapy, which now is called
what? What's it?

(31:50):
Called on HG menopause hormone therapy, right?
Menopause. Hormone therapy?
I didn't. Know it had changed.
But yeah, when you. Were saying Ozempic helps with
like lowering cholesterol and things like that.
I was told that, you know, estradiol would do some of the
things like helping, you know, with heart health.
And so maybe you could just talkabout, because I know there's
also fear around breast cancer and hormone replacement and you

(32:14):
know, bioidentical versus whatever the other one is non
and not bioidentical. I don't really know.
So let's dive. Into that, ladies, ladies, this
is a big topic. I love talking about this
because I talk. About it all, this is my.
Favorite one, I will talk fast because there's so much to cover
and we can cover it all in our last couple.
This is like a whole another episode.
But in a nutshell, in 2002 therewas a study that came out, the

(32:38):
WHI study that scared the out ofeveryone because it went on the
news and basically said being onhormone replacement, which is
what we called it back then, will increase your risk of
breast cancer. And therefore, literally, women
were taken off their hormones overnight.
Right. And that's an important
historical piece of data to knowbecause it literally made it
into the mainstream media. Women got scared.

(32:58):
Doctors got scared. They took everyone off.
So that was what under can't do.Math 2002.
How many years ago? 20.
Two years ago. Flash forward in the last three
to five years, we have such gooddata on different formulations
slightly of the hormones we usedin that study.
But we also looked back at that study and recognized the study

(33:18):
was misinterpreted and very poorly interpreted.
So in fact, people who were on estrogen only, meaning if it had
a hysterectomy, they don't need to take estrogen and
progesterone, they only need estrogen.
Those women actually had a lowerrisk of breast cancer, lower
risk than the background risk, right.
People who were on estrogen and progesterone together had a

(33:39):
slightly higher risk. Slightly, like it went up
instead of about 10:00-ish percent and maybe went up to
12:00-ish percent. Like, not a lot of women were
getting breast cancer, but they were getting breast cancer
because, as I always joked, cancer has a really good PR that
scared the shit out of everyone.So everyone decided that breast
cancer was the only thing to prevent, therefore take everyone
off their hormones. Which meant all those women

(34:01):
missed out on the opportunity tohave the hormones to not only
help with hot flashes, night sweats, horrible headaches when
your estrogen levels are low, but also improved bone density,
which is so important because many more of us will die from a
fracture in our hip or spine than from breast cancer.
We missed out on the opportunityto have what you're alluding to,

(34:23):
the protection of our heart and our brain, right.
And so that study really caused a lot of harm because of the way
it was designed and because of the way it was interpreted.
We were using synthetic hormones, which is in contrast
to bioidentical. So when you heard of Premarin,
for example, that like, my mom took three.
Years. Still does it 84 So Premarin was

(34:44):
a synthetic hormone, actually wasn't really synthetic, 'cause
it's from horse's urine, but we saw synthetic.
I'm glad she doesn't flash forward to now.
We have tons of data. We have a lot of very good
supportive evidence that the bioidentical hormones that we
prescribed, which are hormones that very closely mimic the ones

(35:05):
that are in our system already, we prescribe them as regular
doctors. We prescribe them from the
regular pharmacy And that's in contrast to bioidentical
hormones that are from compounding pharmacies, which
are not FDA approved formulations.
They're not covered as far as insurance.
So that's the distinction like Suzanne Summers used to talk

(35:26):
about bioidenticals that were compounded.
What most of us, as OBGYN's are talking about is bioidenticals
from the regular pharmacy. Because that's insurance that's
covered by insurance, not because it's bad insurance.
And supported by data. OK.
But so let's go forward to. OK.
Now we talk about bioidentical formulations that absolutely for

(35:48):
sure we know from all the data help your bones to prevent
osteoporosis. That alone is a game changer for
us for our life. We don't like to think about it,
right. The five of us here are like,
oh, we're not thinking about ourbones, but we should be because
the work we're doing now with weight training, with things
like estrogen can really affect our bones later.
And we do not want to die of a hip fracture or a or a vertebral
fracture. So it definitely helps our bones

(36:09):
and it can decrease, for example, colon cancer risk, plus
it helps all your symptoms. We think from pretty good data
that it can also decrease dementia risk and cardiovascular
risk. But that is a little bit harder
to stake our claim 1000% becausethere's some refuting data.
So we're still working on it. But again, it probably will help
those things and it can help with hot flashes, night sweats,

(36:31):
maybe libido. Progesterone in the bioidentical
form absolutely can help your sleep, which you might know is
totally disordered when we're menopausal.
How? Does it?
Have sex, Shiva? Here's the most important part.
Let's assume anyone listening oryou guys are like, OK, that
sounds great, but it's a lot of information.
And I'm not ready to to take menopausal hormone therapy,
meaning the systemic stuff that's going to make me feel

(36:53):
better and prevent these things.But my vagina hurts and my vulva
hurts when I've sex because it'sless elastic than before.
And all I feel DRY that's that'ssomething that I wanted, right?
Not DRY, it's less elastic. Yes, yeah.
I love when people listen. Because it's really not about
the dryness, it's about that that you're not.

(37:14):
It's not, it's not a lot there. The elasticity is gone.
So you're not able to, I mean, take in?
See, I've never heard of that until you like recently that
accommodate accommodate. Because if I just if I just say
to you guys like, oh it's dry, then the answer is if it's dry.
Use Lube use. Lube.

(37:35):
Which how many times have we heard that just using Lube
doesn't often help? Because, again, it's not DRY,
it's inelastic. You want it to be more like
don't just want it to be slippery, right?
Something. DRY.
I'm sorry. You're just in front of me.
I'm not looking at you for any reason.
Right. We.
Want it? Elastic, right so.
I don't want to accommodate our partner.

(37:57):
She's just doing this. I don't see the partner.
Let her talk. Let her talk.
Yeah. So we want to make sure that we
are more elastic for them, but more so for us because it's more
enjoyable. It won't hurt less.
Chance of a urinary tract infection.
People get UTI S from less elasticity in their vagina and
vulva. So if any of you do anything

(38:17):
with hormones, there's a long conversation you have to have
with your doctor about whether or not you want to use systemic
hormones. But there's not a long
conversation that you need to have with vaginal or vulvar
estrogen, unfortunately. I should caveat there are still
long conversations cause a lot of doctors won't talk about it.
But they should. But is that a topical thing or
like a OK? It's a topical meaning.
It's an you. Either it's a cream or a vaginal

(38:40):
Suppository or a tablet or a ring and you put it into your
vagina. And if you use the cream, you
also rub it outside on the vulvais.
That in addition to the the hormone or menopause replace
that's in addition to is what you're saying.
That's separate from yes, meaning because let's say you
use hormone replacement or menopause, hormone therapy.
That's systemic, but it's not getting to your vulva in your

(39:01):
vagina. So even people who are on
hormone replacement often need something vaginal or vulvar
interesting. Many people who can't or don't
want to take hormone replacementstill can safely use vaginal or
vulvar estrogen. You have to get that from a
doctor. You have to get that from a
doctor or someone who prescribesit.

(39:23):
It should be over the counter, but it's not.
But you have to use it regularly.
It's not a lubricant. We're like, oh.
It's not a hey, I'm going to have a hot date tonight.
I'm going to put this ring in. So you do it like every day?
Is it like an everyday thing? You do it well, it depends If
it's the If it's the cream, you use it twice a week.
If it's a ring, it stays in all the time.
If it's this other Suppository. So it depends on the brand and

(39:44):
the formulation. It's either every day or twice a
week. This is how I liken it.
Like when you we every day we dosome different things.
I do like 10 different things totry to get my skin to be
elastic. But then at night if I'm going
to go out, I might add like an extra zhujing.
Like, you know, something that makes it look oily, right?
So that extra Zhuj is your lubricant you might still need
to use. Or a vaginal moisturizer you

(40:06):
might want to use, but your everyday or a couple of times a
week more regular is what you doto make your skin more elastic.
That would be like on your skin.I'm assuming you all are using
retinol and vitamin C because those are both really good for
your skin. Those are the things you use all
the time to make it better. And then just when you're having
some, like when you're about to go out at night, you use
something extra. So it's like, and that is

(40:28):
something that is sad to many ofus that that answer has not
gotten to you guys broad enough that everybody would have access
to this. So if someone has had breast
cancer because a friend of mine has and sex is very
uncomfortable for her, so would you recommend this product for
her? Yeah, that one, most definitely.

(40:48):
Over and I am deeply sad that women who have had breast cancer
are consistently scared away from vaginal estrogens because
we've had this data for years. This is not something new.
This is not information that should have been gate kept.
We have had decades of information that vaginal
estrogens were safe. Now we're talking about it more.
But for decades, like I would. I gave it to all my breast

(41:10):
cancer patients, but I told themthat I needed the blessing of
their oncologist just to cover my ass.
And most of the time I could getthe blessing of their
oncologist. Really good.
News being told that and they'reactually their vaginas involve
us hurt even more because many of them are on the anti
estrogen, the estrogen blocking medications like Lamoxiform.
Oh so it's a shame, like, oh, we're saving you from breast

(41:31):
cancer, but now we're basically like making you feel old and
decrepit, like you don't need tolive any other part of your life
for the rest of your life. It's very unfair.
All right. Well, let me ask you this then.
So then really what I guess I I wanted to clarify is if you are
having sex and it is painful, Lube is not enough.
You need to get one of these products that is not over the

(41:53):
counter. You have to talk to your doctor
about it, but some sort of vaginal estrogen because Lube is
not going to create the environment down there that
you're hoping for. If you're having pain during sex
and you've been on prolonged birth control pills or you're
nursing or you are peri or post menopausal, which are all low
estrogen states, and assuming it's not like pelvic pain in

(42:15):
your pelvis, it's actually just pain in the external part when
you're having sex, then please go see your doctor and talk
about vaginal estrogen or vaginal DHEAS, which is a
version of it. But yes, get one of those
hormones because that will be really impactful and help you in
addition to a vaginal moisturizer and a lubricant.
Does it melt with all UT is too?I'm prone to UT is it prevents?

(42:38):
UT is absolutely. Oh my God.
That's now inelastic. You will get UTI potentially,
and this prevents that as well. I did.
There was one thing that severalwomen in our audience were
asking about that we wanted to address before you go, and that
is about grooming. You see a lot of vaginas in

(43:00):
vulvas. And we're just curious, like for
people who maybe were with someone since the 80s and now
it's 2024, like what's happeningout there?
What are the trends? A great question, Okay.
Do you know this? That, first of all, let's just
review the inside is the vagina,the outside.

(43:22):
The. Only thing you need to clean is
the external. Just our, you know, when when we
take a shower, by the way, we need to clean, as I joke like
our pits and our parts, right, our armpits.
Because of bacteria and hair, they tend to smell and then our
external genitalia, meaning our vulva, but we don't need to wash
anything else with soap. You don't need soap on the rest
of your body by the way. The rest of your skin, even you

(43:43):
can leave the rest of your skin without soap because the rest of
your skin doesn't actually sweat.
If you want to do it, you can't,but you don't need to the
external vulva. Theoretically you only need to
use water, but I understand thatmany of us feel a little bit
better if we also use some kind of gentle soap.
So I would advocate I am not paid by Dove.
I do say Dove should pay me. The only thing I would advocate

(44:04):
for in any form of soap so far, unless someone comes out with a
better one, is just bar of Dove that is moisturizing only on the
external. Do not put it in your vagina,
but only on the external. The reason I say bar the bar is
cheaper, it's less landfill, better for the environment and
you don't need to buy like all these special body washes or

(44:25):
external like what? If there's just shampoo up here,
shampoo down there, like, what about that?
Well, shampoo might be a little too harsh for the external skin
down there, so I wouldn't try it.
That's what the grooming looks like it has.
To be for a friend I. Mean it's 80s grooming?
Then you might need some shampoo.
Now grooming, I would like to say it's a little bit up to

(44:48):
personal preference and it is like I don't think anyone should
be shamed for wanting to be groomed or not wanting to be
groomed. But I do think objectively what
I've seen and there's no. Fate.
That's what I want to know. What's out there right now?
Do you think that that unfortunately a lot of young
people are fully groomed, meaning bald, bald, bald, which
I fully get why that like seems like?
It would feel comfortable. Right.

(45:10):
Like I joked that when I went through chemo and I was bald as
a bat and I had not a hair on me, it was like, oh, that sucks.
I don't have eyebrows or eyelashes, but oh, it felt so
nice to just be, like, completely.
Clean. Well, and let's be honest, it's
just sex is nicer. It's just like it's just like a
small but not path. Well, but it's not.
But it's not because you think it's going to be smooth, but
skin rubbing against skin is going to get friction.

(45:32):
So now they can it hurt more. So think about your your little
hair follicles actually have oilglands, so they're secreting a
little bit of oil, which is good.
So what I saw a lot when I was seeing all these gynecology
patients in the office was the people who are completely bald,
especially who are wearing thongs a lot especially who are
like spinning a lot their parenting.
And like that area in between your, you know, the taint

(45:55):
between your vagina and your butt that would get so irritated
because everything was boiled bald.
They had no, like, none of theirown lubrication from the little
oil glands and the chafing and itching and not even itching.
But the chafing was causing it to get really like thickened and
uncomfortable. So they'd come see me and I
would be like, are you going to tell me that you're having
itching there? And they would say, how did you
know? Well, I can see it, I could see

(46:16):
that over time. So I would advise not to fully
groom, not to go completely bald.
I would advise to trim as much as you need so that you can
comfortably wear your underwear or your bathing suit that you
feel comfortable with. I would at least leave like a
little, you know, the landing strip of the patch or whatever
we want to call it. Because I do think at least on
your labia you need a little bitof hair to secrete some oil.

(46:38):
So I think that is what's that. That's interesting.
There's no proof, but it makes sense that we need some of it.
And again, the best reason I cansupport it is that the hair
follicles have some oil glands that are going to help lubricate
a little bit. All right.
OK. Good information, by the way.
We didn't even talk about and that's a whole other topic.
But I hope you all know your anatomy and know what gives you

(47:00):
pleasures that you know how to instruct other people.
I had some questions about vibrators next time by.
The way the answer is yes about it, about that.
Yes, yes, yes. But can you get desensitized if
you use them? Yeah, I think, you know, this is
what I say. Some of my young patients are
like, I can't even have without a vibrator, They say and and I
get that right. Because it's just so much more

(47:21):
effective and more efficient than anything someone can do for
us, right? And well, so I do think it's,
it's appropriate to, like use one and sometimes use it during
sex because you might need to. But also to recognize that maybe
you need to purposely on your own, masturbate just with your
hands, or make sure that he or she is giving you oral sex

(47:42):
without a vibrator so that you can still have it reach that
threshold without it having to be something really people
can't. Some people, they say they they
just aren't able to no matter what.
And then the answer is, OK, thenalways use a vibrator, right?
Do you know people who are like on Prozac Lecture Pro?
That can really make it harder to have, so that's.
Which a lot of people with loss they're they're having to have

(48:03):
that. Well, I have a question.
How do you what is the correct pronunciation of CLITORIS?
Clitoris. Clitoris.
OK, not clitoris. Don't you remember that Seinfeld
episode about Dolores? Yeah, I.
Don't. That's hilarious.
OK? I was like, no, dude, it's, it's

(48:24):
clitoris. It's clitoris.
And he's like I have always and.We used to just say the clitoris
was like that little nubbin, right?
But do you all know that the whole thing underneath it
because? That's the tip of the iceberg,
right? Yeah.
It goes all the way down the labia and like up into the
vagina. And that's new.
Like, we didn't learn that 25 years ago in medical school.
So the nerve endings go down your labia and then back into

(48:46):
your vagina where like they kindof talked about the G spot, that
whole top wall of your vagina underneath your bladder that
also has nerve fibers. That whole thing is clitoral
nerve fibers. It's not just a little nerve.
So it shouldn't be that hard to hit then.
Why can't they find it? Why can't?
It should not be that hard. And they still don't know what

(49:07):
to do with the big guts, right? Well, that's why.
Like you said, and this is a really hard, I think it's an
uncomfortable conversation for people but you.
Don't need to talk. You just need to show.
It's like make sure not saying somewhere we.
Could bring you. I just say don't, don't don't
call it anything. Just get to know it.

(49:28):
Yeah. Yes.
Oh man. We could talk to you for hours
and hours. Shiva, thank you so much.
Thank you Tell everyone because this is what's so great about
you. You give all of this information
freely on Instagram. Share your your two Instagram
accounts. I love getting to talk about it,
'cause I love hearing from you all.

(49:49):
Yes, like I always say, it's notlike selfless.
Oh my God. It's like very mutually
beneficial, 'cause I feel good that, like, this is the one
thing I know a lot about and I can and I I joke like because
I've been through like HPV and ovarian cancer and endometriosis
and, you know, miscarriages and all of it.
I can, I can like, empathize because I know our psyche.
And so so anyway, everyone can find me on Instagram at Doctor

(50:12):
Shiva G, which if you notice when it's all together, it's VAG
badge that just worked out my name.
And then my online platform withJenny, my business partner, is
Tribe Called V like Vulva or vagina tribecalledv.com.
And right now we have a pregnancy class and a
perimenopause class. But in the near future, we will

(50:33):
have a much bigger assortment ofall the videos about everything
we talked about. HPV, herpes, endometriosis,
PCOS, contraception, cancer, perimenopause, menopause, all
the stuff. Yeah, it's a it's a lot of great
information and it's easy to listen to.
As you can tell she was so greatat communicating and she's fun
and interesting and and gets theknowledge or the information out

(50:56):
there. So I encourage everyone to go
and follow. You won't regret it and you
could spend hours and you'll be so smart at dinner parties and
in the bedroom and. In the bedroom, you'll instruct.
And thank. You thank you so much.
Eva, we love you. We appreciate.
It. Bye, bye.