January 7, 2025 • 38 mins
Discover the transformative power of understanding perimenopause and menopause with our insightful guest, Dr. Sadaf Lodhi, an OBGYN and intimacy coach. We promise you'll gain a deeper appreciation for the impact these stages have on women's sexual health, covering everything from the onset of symptoms like brain fog and hot flashes to the systemic factors that influence the journey for different ethnicities. Dr. Lodhi shares wisdom from her coaching practice and her own podcast, highlighting the importance of self-advocacy and the growing movement for better treatment options.
New book out "Dare I Say It: Everything I Wish I'd known about Menopause" by Naomi Watts...highly recommend it! https://amzn.to/3WXc6NF
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Straight from the Source's Mouth
.
Speaker 2 (00:02):
Podcast Frank talk about sex and dating.
Hello, Tamara here, Welcome tothe show.
Today's guest is Dr Sadaf Lodi,OBGYN and intimacy coach, and
we'll be talking about theeffects perimenopause and
menopause can have on your sexlife, her coaching practice and
her own podcast.
Thanks for joining me, Dr Sadaf.
Speaker 1 (00:23):
Thanks so much for having me on.
I really appreciate your time.
Speaker 2 (00:27):
Yeah, I think this is a great topic.
Obviously, as I read somewhere,half the population goes
through this at some point, soit's good to know on both sides
for the women and the men likethe differences that can happen.
Speaker 1 (00:38):
Yeah.
So I think that you know.
What's important to realize isthat perimenopause can start way
before menopause.
So menopause for the majorityof people here in the US, for
women, is at the age of around52.
Of course, it can happen eitherbefore or after, but that's
kind of the mean age.
(00:59):
And what's important to realizeis that perimenopause is a time
before menopause.
So, and this is the time wheresometimes women's period can
become irregular, they can startto notice some brain fog, they
can have some heart palpitations, maybe even some arrhythmias,
they can have joint pain, theycan have dry eyes.
(01:21):
There's so many symptoms thatcome about with perimenopause
and what's important to realizeis that sometimes these and of
course the most common ones thatare hot flashes and night
sweats, and that's what a lot ofwomen will complain about
around this time.
What's important to realize isthat sometimes, even after the
menses completely stop, thesesymptoms don't always go away
(01:41):
and sometimes it can get evenworse, for example, like the
joint pain can get even worse,and we'll talk a little bit
about these things.
But what's important to realizeis that different ethnicities
go through menopause fordifferent lengths of time.
So, for example, there is astudy that was done.
It's called the SWAN study andit was a multicenter study and
(02:02):
it looked at women through midmidlife and what they noted was
that Caucasian women tended togo through perimenopause for
about seven years before theyhad a cessation of their menses.
So when you have no period fora whole year, then you're
considered in menopause.
If you go, you know, like 11months with no period and all of
(02:23):
a sudden the 12th month youhave a period, then you're not
in menopause.
Yet it's when you go a wholeyear without a period.
Like I said, caucasian womenaround 7.2 years, african
American women they say about 10years, and Hispanic women 8.9
years, and East Asian women.
So, for example, japanese womengo through perimenopause for
(02:44):
about five years and they thinkthat perhaps, you know, african
American women and Hispanicwomen tend to go through
perimenopause for the longestperiod of time and they think
perhaps that could be due tosystemic racism that then
affects their DNA, which causestheir telomeres to get shorter,
(03:05):
which makes them more at riskfor certain diseases and also
for going through perimenopausefor a longer period of time.
So you know, that's reallyimportant, because if we're
saying that the mean age forsomebody to go through menopause
is 52, and we, you know, and ifyou're looking at a Caucasian
woman, we say that she goesthrough perimenopause for seven
(03:25):
years, then we're saying thatperimenopause could start as
early as the age of 45.
And that's important to knowbecause if you start having hot
flashes and night sweats andmood swings and all this stuff,
and you go to your provider andyou tell them, hey, I'm having
all these symptoms, I think Imay be in perimenopause, you
know, don't accept it if theysay you know you're too young,
(03:45):
because that's not the case.
You know, and I think a lot ofwomen have these, all these
symptoms that they can't explainand they don't know what's
going on.
And they, you know, there'sactually a term that's been
coined for this is called notfeeling like myself.
And you know, a lot of womenfeel like that.
And what's important is thatonce you know about all these
things, then you can advocatefor yourself and you can say
(04:08):
well, you know what.
I know that you think I may betoo young to be going through
this, but that's not the case.
I have heard, you know, in thispodcast.
You know that I can be goingthrough perimenopause for a long
period of time.
I really want you to take alisten to me and really listen
to my symptoms and listen towhat I'm experiencing so that
(04:28):
you can best help me.
Right and I think that's reallythe most important thing is
knowing about what thesesymptoms are, how long they can
last, and then you can go andadvocate for yourself.
Speaker 2 (04:38):
Yeah, and I definitely.
I know lots of people that arehaving those symptoms and and I
know it's becoming more of athing now.
I know Oprah has talked aboutmenopause and more and more
people are getting educated, butit's maybe not the medical
establishment as much.
Speaker 1 (04:51):
Yeah, yeah, and I think it's, you know, it's
really important because I agreewith you.
I think that menopause is nowreally having a moment right now
, and I think what's happeningis that women are no longer
standing for the status quo.
You know, we're not acceptingthe fact that this is just
something that happens and wehave to deal with it and it's
going to, you know, happen forthe rest of our lives.
(05:12):
I think that people are reallywanting treatment and they
really want physicians andproviders that will listen to
them, that will, you know, helpthem and not dismiss their
symptoms, and I think thatthat's really what's happening
and I applaud it.
You know, I think it's reallyimportant.
I think, also, there's beenrecent advocacy on how employers
(05:33):
can support their employeesduring this time, and you know
what are some modifications theycan make in their offices so
that they can better supportwomen going through
perimenopause, menopause, and Ithink this is super important.
Speaker 2 (05:46):
Yeah, definitely.
And then also we are going totalk about how it affects your
sex life.
But I wanted to ask first areyou a fan of hormone replacement
and like which?
Like we talk about sex with orwithout hormone replacement?
Maybe Absolutely.
Speaker 1 (06:00):
Absolutely so.
I, you know.
So, just so your listeners know, I am, I am a board certified
OBGYN.
I'm also a menopause societycertified practitioner as well
as a sex coach, and I am what'scalled an Ishwish fellow,
meaning like I'm a fellow of theInternational Society for the
Study of Women's Sexual Health.
So sexual health is near anddear to my heart and I just
(06:22):
think that it's because, youknow, one, sexual health is part
of health and, two, we justdon't talk about it enough.
There's a lot of stigma,there's a lot of, I guess, shame
or, you know, people just feelreally uncomfortable talking
about it.
But I, what I want people toknow and understand, and your
listeners understand, that it isa part of your health and it's
(06:42):
really, really important that ifyou're experiencing some type
of sexual dysfunction, that yougo and approach your doctor or
whoever provider, whoever thatyou see that you're having this
dysfunction, and that you allowenough time.
You know, unfortunately ourhealth care system is really
broken and so we have about 15minutes to go talk to our doctor
, right, like your doctor istrying to see like 40 patients
(07:04):
in a day.
And so now here you are, you'recoming in, you're saying you
know I'm having pain with sex.
Your doctor has 15 minutes todeal with that.
Unfortunately, a topic likethat takes like about an hour.
It is not something that can beresolved or even, you know,
fully examined in 15 minutes.
So you know when you, if you'rehaving an issue like that, I
(07:24):
really want you to make surethat you have enough time
allotted in your appointment,you know, and just ask whoever
you schedule with to ask them ifyou can get a half hour
appointment, because you knowit's going to take a little bit.
So you talked about you knowwhat are some.
Am I a fan of hormones?
Absolutely A hundred percent.
Hormones are something that wehave naturally in our bodies,
(07:46):
right and around the time ofmenopause.
That's when our estrogens stopmaking hormones.
So that's when you know we nolonger are making estrogen or
progesterone.
It goes pretty much, you know,down to zero almost, and if not
to zero.
And what's really important isthat when we have that steep
decline of estrogen in ourbodies, you know we are at risk
(08:10):
for cardiovascular disease,we're at risk for osteoporosis.
We have vasomotor symptoms likehot flashes, night sweats, mood
swings.
We have the genitourinarysyndrome of menopause, which
we're going to get to now,because you know that was kind
of the question that you hadabout how menopause and
premenopause can affect your sexlife, and that is a super
important question and I reallyapplaud you for asking that,
(08:31):
because that's something thatpeople really feel embarrassed
talking about and they reallyshouldn't, because, again, sex,
sexual health, is a part of ourhealth and you know, for most,
for a lot of women, they want tocontinue to be sexually active
long into their 80s, 90s,however old you know that
they're able to be.
And just because you're inmenopause doesn't mean that all
(08:52):
of a sudden now you have tobecome, you know, abstinent.
That's not it, you, it's reallyup to you.
It's a decision that you makeand you decide what happens.
So, in terms of what happens toour bodies when we are going
through perimenopause, menopause, and how does that affect our
sex life?
So during this time, what wenotice is, when we have this
decline of estrogen, we seechanges in our vulva, in the
(09:14):
vagina, in our bladder health,okay, and what I want your
listeners to know and you mightbe surprised, but I'm not
surprised anymore that sometimeswomen come to me they're not
really sure how many holes theyhave.
So we just to kind of clarifythat.
We have three holes we have aurethra where we pee from, we
have a vagina, and that's youknow where the baby comes from
(09:38):
through really that tunnel, thatvagina, and we have the rectum
where we poop from.
So just, I just want to kind ofget that out of the way.
So what happens is that duringthis time, as the estrogen
declines, we see changes in notonly the microbiome of the
vagina, where the pH goes up,making us more susceptible to
(09:58):
bacterial infections, but alsowhat we notice is that the
tissue becomes thinner, andthat's really important because,
as that and it's because of theestrogen, because the estrogen
goes down estrogen isresponsible for so many things
it's responsible for elasticityin our skin, it's responsible
for the collagen, it isresponsible for the blood flow,
(10:21):
it increases blood flow, theblood flow, it increases blood
flow.
And so when that estrogen goesdown in our vulva, in our vagina
, that tissue becomes thinnerand we have decreased blood flow
in that area.
When we have decreased bloodflow, we have decreased
lubrication.
We can have problems witharousal, we can have pain with
(10:42):
sex.
Okay, and that's the biggestthing is that people come in
with because they're having painwith sex.
Why are they having pain withsex?
They're having pain with sexbecause one that tissue is
thinner and so there's morefriction, there's decreased
lubrication, so that increasesthe friction right that your
body, your cells are makingdecreased lubrication.
That tissue is becoming thinnerso it's more prone to, you know
(11:05):
, tearing.
It's not stretchy as much as itused to be, again, making it
uncomfortable and possiblypotentially tearing.
You know you can have decreasedarousal because you're having
pain, right.
Anything that causes painyou're not going to want.
So you know, for women, as theyget older, if they're
(11:26):
experiencing pain with sexthey're not going to want it,
and that was, I think, the keything to remember.
So if you're having pain withsex, you need to go and see your
provider and let them know.
Especially if you're in thisperimenopause, menopausal time,
you need to let them know sothey can help you out.
So some of the treatments thatwe offer to women that are going
through this and also I didn'tmention that you can have issues
(11:48):
with your bladder, you can haveoveractive bladder.
Again, there are receptors ofestrogen on that bladder and so
you know, some women during thistime feel like they have, they
have this urgency where theyhave to go to the bathroom.
They have to go right away.
If they don't go, they'reafraid they're going to.
You know, pee their pants right.
Because of that overactivebladder.
You also have recurrent UTIsbecause that urethra starts to
(12:10):
get bigger and if you saw amenopausal woman, if you saw her
vulva, you would notice thatthe opening of that vagina has
become smaller but her urethrahas, which she pees from,
actually gets bigger and makingher more prone to have bladder
infections.
That's why women in likenursing homes, those poor ladies
(12:30):
that are not able to get up andurinate and take care of
themselves, you know they sitthere and they can get these
recurrent bladder infectionsthat can then eventually go
undiagnosed and lead to sepsisand even death, because you, you
know we're not picking up onthese bladder infections that
these poor women are sufferingthrough.
So that's why it is super,super important that during this
(12:51):
time when you are inperimenopause, menopause, and if
you're having pain with sex,that you go and you get
evaluated and you get treated.
So let's talk a little bit aboutthe treatments that we have for
women during this time.
We have, you can do, lubricants, but I will tell you lubricant
is not going to solve theproblem right.
What a lubricant does is it'sgreat for sex and there's tons
(13:14):
of lubricants.
There's, you know like.
You can have oil-basedlubricants, you can have
water-based lubricants, you canhave silicone-based lubricants.
I think the silicone-basedlubricants are probably the best
.
They based lubricants.
I think the silicone basedlubricants are probably the best
(13:34):
.
They last the longest and theydon't dry out and they don't,
you know, you can use.
They last a long time and theydon't cause any type of like
fungal infection or anythinglike that.
So I think that that's why Ireally like those silicone
lubricants and they're fantastic.
But a lubricant is only going toget rid of the pain with sex,
right, it decreases friction.
So, although lubricants aregreat and you know women during
this time may be having a hardertime making lubrication on
(13:55):
their own those lubricants aregreat for that.
However, they are not takingcare of the problem, right.
They're not going to help withthat elasticity.
They're not going to helpincreasing that collagen.
They're not going to increasewith that lubrication.
They're not going to help withthe bladder health that we're
talking about, you know.
You, what women need during thistime is vaginal estrogen.
That vaginal estrogen does notgo throughout the whole body.
(14:19):
It only is in the vagina.
It stays there.
It's very low dose and it isreally important, and what that
vaginal estrogen will do isit'll help with all of those
issues, right.
So with that, it'll help toplump up that tissue.
It's going to increase bloodflow to that tissue, it's going
to increase lubrication, it'sgoing to help with that
(14:40):
overactive bladder, it's goingto help prevent recurrent UTIs.
It's going to do all of thatand it's going to maintain your
vulvar health and that is thebiggest thing.
So, even if women are notsexually active, it doesn't
really matter.
The point is, is that you wantto really really maintain your
vulva.
Some women also usemoisturizers, and moisturizers
(15:01):
are fantastic.
It's kind of like you know howyou have a moisturizer for your
face, you have a moisturizer foryour vagina and what that does
is it increases the watercontent in those cells to make
it more plump.
The one that's used the most ina lot of these moisturizers is
called hyaluronic acid, and it'sgreat for that.
(15:21):
But again, it's not going tohelp with the bladder health,
right, it's just going to plumpup that tissue a little bit, but
it's not going to do all of thethings that vaginal estrogen
will do.
Speaker 2 (15:33):
Do you have a preference on bioidenticals or
is whatever?
As long as it's vaginal cream,that all of them work fine.
Speaker 1 (15:44):
Yeah, so you know what?
Okay, so when we talk aboutbioidenticals, what we're
talking about are hormones thatare similar to what our body
makes, right?
So we don't actually reallyneed to go to a compounding
pharmacy, unless it's somethingvery specific.
The FDA has approved vaginalestrogen and it's called
estradiol cream.
It's Not that expensive.
It's going to be way lessexpensive than a compounding
(16:05):
pharmacy and you don't reallyneed to go to a compounding
pharmacy.
This vaginal estrogen is FDAapproved.
We know it's safe and you canjust ask your prescriber to
prescribe it to you.
You can typically get it fromthe pharmacy for like $10, like
a copay, you know and or you cango to Mark Cuban's pharmacy
that he has it's GoodRx, and youcan get the vaginal estrogen
(16:29):
very cheap as well.
So you don't really need to goto a compounding pharmacy for
this.
You will get the FDA-approvedmedication and it's fantastic.
All you need is vaginalestradiol, and that is estradiol
is the most common form ofestrogen in our bodies and it is
completely safe and the amountof vaginal estrogen that you use
(16:53):
is super small.
So what you, if you were to usethe cream right the way that you
would use it is, you would putit comes with the applicator.
I tell patients not to use theapplicator.
It becomes a little bitdifficult and I think that it's
plastic and it may beuncomfortable.
Whatever.
People can just use theirfinger and I have them put the
cream on up to the second lineof their finger.
(17:14):
I have them put it on insideand outside, so inside of the
vagina, outside on the vulva,and they rub it in and they do
that every single night for twoweeks at night and then after
that it's twice a week for therest of your life and you never
stop using it because you wantto always maintain that vulvar
(17:35):
health, because it's going tohelp you with recurrent bladder
infections.
It's going to help you decreasethat painful sex.
It's going to increaselubrication.
It has so many great benefits,even women, that there are
studies out that show that evenwomen that have had breast
cancer can use vaginal estrogen.
Even women that have a historyof blood clots can use vaginal
estrogen because it's local, itstays there, it doesn't go
(17:57):
throughout the whole body.
If you're worried aboutestrogen, you're worried about
hormones, it's going to staywhere you put it, especially the
cream, and even there's there'stablets, there's a ring,
there's different formulations,there's a suppository, so if you
don't want to do the cream, youfeel like it's messy.
There are other ways to getthat vaginal estrogen in.
Speaker 2 (18:14):
Okay, yeah, that was the question I was going to ask
about breast cancer, becausethere's a study which a lot of
people say was a failed study,saying that you know, there's a
lot of concern about breastcancer by doing hormone
replacement, there's a lot ofconcern about breast cancer by
doing hormone replacement, andfrom what I've heard that that's
not necessarily accurate.
But now that you're saying thevaginal cream especially is not
going to affect anything likethat, so it's not there.
Speaker 1 (18:34):
Yeah, yeah, vaginal estrogen.
I don't know about that studythat you're talking about with
hormones and breast cancer.
I'm not too familiar with that.
But you know, definitely,before you take any type of
hormones, I would, you know,speak to your hematologist,
speak to your oncologist to makesure that they feel that it's
safe for you.
You know, one of thecontradictions to taking
(18:56):
hormones is an active cancer,right, so you never want to do
anything that's going to makeyour health worse.
But vaginal estrogen is really,really safe and really safe and
it's not going to harm you,it's not going to go all over
your body.
If you're worried about that,okay, awesome.
Speaker 2 (19:13):
Yeah, I mean that's obviously great information,
because I know someone that wascomplaining about painful sex
and I didn't know to tell herabout the cream.
So now I know.
Speaker 1 (19:22):
Yeah, absolutely.
That cream is fantastic andit's so helpful and it really
does change women's lives, youknow.
I mean when they're not havingthat chronic irritation, when
they're not having that painwith sex, when they're not
dealing with all of those things.
It's really a game changer.
In fact, I'll tell you, youknow, I had a dermatologist
friend and I was talking to herand she was really afraid to
(19:44):
take vaginal estrogen herselfbecause she had a blood clotting
disorder and she's like no, no,no, I don't want to take it.
But you know, and I kept tryingto make her understand and then
I said okay, you know what, I'mjust going to prescribe this for
you and you take it if you wantto take it.
So I prescribed it for her, shetook it, she did that and she
does the moisturizers.
And she said it was a gamechanger for her.
(20:05):
And she said she's now going totell all of her patients to
take vaginal estrogen and do amoisturizer every day, because
the vaginal estrogen once you dothe maintenance dose is just
twice a week.
So if you still feel like alittle bit of irritation or
something like that, you can dothe moisturizers in between to
get that irritation to go away,and just so that everything in
(20:29):
that area feels better.
Speaker 2 (20:31):
Yeah, and you said it's a game changer for women
and men as well, obviously,because if their spouse is not
wanting to or their partner isnot wanting to have sex because
it's painful and they haven'ttalked about it, then now the
problem is solved for bothparties.
Speaker 1 (20:44):
That's a very good point you make, actually, and I
do want to talk about that alittle bit.
So, you know, I was talking toanother friend of mine and they
were telling me that theirfriends are actually now having
extramarital affairs as theirwives are menopausal because,
(21:04):
you know, their wives no longerwant to have sex because they're
having pain and they don't knowwhat's going on and their
doctors aren't helping them andnobody's listening to them, and
so they've given up that part oftheir life.
And, you know, although theystill want to be sexual, they
don't know how to havenon-painful penetrative sex,
although, as we know, you know,there's different forms of sex
and you can definitely findpleasure in other ways.
However, you know, for them andtheir partner, they wanted to
(21:28):
have penetrated sex and it wasso painful.
So now they're you knowpartners are having these
extramarital affairs and youknow what could have really
helped that relationship.
Of course, I'm sure you knowthey're going out and having
extramarital affairs.
There's probably lots of issuesin that relationship to begin
with, but you know, one of thethings you know that was part of
(21:48):
the problem was the fact thatthey could no longer have sex
without pain, right, and so,like you said, you know it does
save marriages and relationships, so it's really important.
Speaker 2 (21:58):
Yeah, and I was going to say too, some, some women
have even okayed it becausethey're like I don't want to
have sex, it hurts.
You go ahead and have it withsomeone else, just I don't want
to have sex, it hurts.
Go ahead and have it withsomeone else, just I don't want
to hear about it or whatever.
Whatever agreement they make,but yeah, they just knew they
could not have it be painful,right, all right, you're
absolutely right.
And is this the kind of stuffsince you do?
(22:20):
Coach on?
Speaker 1 (22:21):
this.
Is this the kind of stuff thatcomes up I would imagine for
your coaching.
Yeah, I mean honestly, are fromwomen that have had a lot of
sex negativity.
They feel that sex is wrong,dirty, shameful.
I just had a woman yesterdaythat I talked to about coaching
and she has a really bad,traumatic relationship with her
(22:44):
own body.
She know she had all theseprocedures done, she just
doesn't like herself, shedoesn't like her body and so she
doesn't really enjoy otherpeople touching her body because
she has a very bad relationshipwith her own body.
And so, you know, we are tryingto move from that sex
negativity that she holds withinherself to sex negativity that
(23:05):
she holds within herself, to, ifnot, sex positivity, to a place
of sex neutrality, which I feelis really important, because
you know it's hard to make that180 degree shift.
But if you can at least slowlywork your way where you're able
to change your mindset a littlebit and get to a place of
neutrality, then I feel that youcan at least be open to sexual
(23:27):
stimuli, right, Be open to sometype of sexual advances, and not
be so, you know, feel sorepulsed by the idea.
Speaker 2 (23:37):
Yeah, and just knowing that men are just happy
that you're there, like you knowthey.
They just think so much lessabout it.
You know, they're just so andit's easier said than done to
like.
Speaker 1 (23:47):
Yeah, absolutely Absolutely.
And you know, I think what'simportant to realize is that
there's so much you know.
So what we say in sexualmedicine is that the brain is
the biggest sexual organ, and Iremember the first time I heard
that I was like what you know,that like kind of blew my mind.
But it's absolutely true, right, it's.
It's because whatever ourthoughts are, whatever is going
through our head, is going toaffect our feelings, and
(24:11):
whatever feelings we have willaffect the actions that we take,
right?
So if we are thinking that sexis wrong, it's shameful, it's
dirty, or that I don't like mybody, I don't like the way it
looks, this, and that thefeeling that we're going to have
is that maybe, perhaps one ofshame, one of guilt, you know.
And so the actions that we'regoing to have are those of like,
perhaps, turning our partneraway, turning, you know, not
(24:33):
really allowing ourselves toexperience pleasure, not really,
you know, enjoying what we'reable to enjoy because of the
thoughts and all these, you know, all this chatter going on in
our brain.
And I think that that's reallyimportant to understand.
One, that the brain is thebiggest sexual organ.
And two, I think one of themost empowering things that I
can leave your listeners with isthat we are, we are able to
(24:57):
choose our thoughts, and I thinkthat that again was one of
those.
You know statements that I waslike wow, really blown away with
because we can choose.
You know statements that I waslike wow, really blown away with
because we can choose.
You know, sometimes, I think,people, you know, we go
throughout our day, we have allthese thoughts that come and go,
whatever, and we just thinkthat, oh, you know, they just
happen, they.
You know we have no controlover them.
But when we realize that we canchoose our thoughts, right then
(25:22):
you're getting to like the rootcause, like if I can choose to
be happy, if I can choose tofind joy, then I can really
change the feeling that I'mhaving and that will result in a
change of action that I cantake.
Speaker 2 (25:36):
No, I totally agree.
I just did that this morning.
I was talking negatively tomyself and then I caught myself
immediately and was like no,you're just doing this, you know
, I like did the completeopposite and spun it into a more
positive way 100 percent andthat you know that takes time.
Speaker 1 (25:50):
One, it takes knowledge to realize that that
is happening, right.
Two, it's the other knowledgeis realizing that we have that
option and that we can chooseour thoughts.
And three is acting on it Right.
So I think what really helpspeople is having positive
affirmations that we say everyday.
Right, so we can choose to saywhatever we want to ourselves,
(26:11):
right, we can choose to say I ama great speaker, I am a great
coach, I'm a great clinician,I'm a great doctor, I'm whatever
.
Whatever we want to say, wechoose that.
And so when we decide that weare the masters of our own fate,
when we are the masters of ourown thoughts, it's a game
changer, right, we can.
And just like what you did, yousaw, you know, you reflected on
(26:34):
whatever the thoughts you werehaving and you immediately
changed it.
And I think that's so importantand that can start with
affirmations in the morning,right, and those affirmations
are always.
They start with I am and then Iam whatever.
Right.
So instead of you know and Ialso heard of this one time is
that you know we have worry,right, we worry about everything
(26:55):
and that's you know.
It gives people anxiety becausethey're always worrying about
the future is that we can havepositive worry instead.
You know, like what if you knowthings work out?
What if this is the best thingthat ever happened to me?
What if this is, you know,going to be so helpful in my
career, in my relationship,whatever, when we really sit
down and think about the thingsthat we can do just by changing
(27:17):
our mindset.
Speaker 2 (27:18):
Yeah, I wanted to share one more quick example.
So my example is I was recentlytold well, I was told I had
ADHD.
A while back I never thoughtanything of it, but then I
realized I was impulsive.
But then I changed impulsivityto I make I make good decisions
with velocity, because that isreally what I do.
Yeah, decisions with velocity.
Speaker 1 (27:40):
I love that, I love that and I think that's
fantastic, and it doesn't haveto be something that's wrong
with you.
It could be your superpower,right.
It could be something thathelps you to accelerate in your
career, in your relationship, inwhatever way right, as long as
you're not hurting yourself orothers.
It's absolutely, it can bedefinitely a benefit to you and
(28:01):
those around you.
So I don't think that, you know, it's not always that there's
something wrong with us, right,and I think that if we're able
to reframe those thoughts, thenwe would feel better about
ourselves.
Speaker 2 (28:13):
Yeah, exactly, all right.
So I would say, if you want totalk either more about your
coaching or we can talk aboutyour podcast, or how to reach
you, like kind of all of them.
In whatever way you want to doit.
Speaker 1 (28:24):
Absolutely.
I appreciate that.
So, you know, my coachingreally focuses on moving forward
in your relationship, whetherit's with yourself, a
relationship with yourself, orwhether it's a relationship in a
couple, so a partner, your,your husband, whatever you know,
your marriage, whatever it is,and it's all about moving
forward.
So coaching is, you know, it'snot therapy and that's what I
(28:47):
want people to understand.
It's not, like you know, I'm atherapist.
I'm not, I'm a physician, I'm aclinician, but I'm also a coach
and you know if there are somethings.
So the difference of therapyand coaching is that, like for
therapy, you know, we deal withthings.
Therapists will deal withthings, perhaps in somebody's
past to unpack it, and all ofthose things.
(29:07):
So it's a little bit about, youknow, going back into your
childhood and things like that.
Coaching is all about movingforward.
Like you know, here I am atthis place in my life how do I
move forward in my relationship,how do I move forward in my
career, how do I write?
So that's what that coaching isabout.
They're not consultants,they're coaches, and that's what
(29:30):
I do.
I really help women moveforward in their relationships
so that they can experiencepleasure, and it's about
removing emotional and physicalbarriers so that women can
experience pleasure.
And that's really what I do andthat's because I'm a
gynecologist, so I can assessthem anatomically.
But also we talk a lot aboutmindset and about the thoughts
that happen and you know whatare they thinking and how can we
reframe that.
So it's a little bit of likecognitive behavioral therapy
(29:52):
that I do, and so that's whythat's really important.
So that's about my coaching andit really helps women that say,
for example, have vaginismus.
So vaginismus is where themuscles around the vagina will
tighten up in anticipation ofany type of penetration.
And so you know and these womenhave a really tough time with
(30:12):
you know, whether it's aphysical exam, whether it's
inserting a tampon, whether it'swith penile vaginal intercourse
, with any one of those things,women really kind of those
muscles just tighten up, right,because there's that fear that
they have that it's going to bepainful, it's going to hurt or
perhaps that it's wrong.
I shouldn't be doing this.
Whatever you know, whatever thethought is, it automatically
(30:33):
turns on those muscles, so thenthey become so tight.
So for somebody that has that,I think that that is like a
perfect example where you wouldneed a sex coach, a sex med doc.
A sex med doc to really assesswhat's going on anatomically,
and also either sex therapist orsex coach to kind of help you
move forward.
And then pelvic floor therapistthat would work with dilators
(30:56):
and help you and teach you waysto relax those muscles so that
they wouldn't clench up.
So that's like an example ofwhere sex coaching really works
in well with you know, adiagnosis of, say, vaginismus.
You know my podcast is all aboutrelationships.
It's about, well, the reasonwhy I do it.
(31:16):
So I'll tell you why I do it.
I do it to empower and educatewomen or men or anyone, anyone
that wants to listen.
It's not for a specific subsetof people.
I know it's called the Muslimsex podcast.
It's not specific to Muslims,it's just a provocative title
that gets people to pause andthink, oh, what's this?
But it's really about how dodifferent conditions impact a
(31:38):
relationship.
I talk about libido.
I talk about orgasm.
I talk about arousal.
I talk about painful sex.
I talk about menopause.
I talk about you know I'mactually in my third season of
the podcast and we've talkedabout so many different topics
in there.
I have a lot of times I'll havedifferent clinicians on that'll
talk about how.
You know, those things thatthey specialize in affect a
(31:59):
relationship.
So, for example, I had apsychiatrist on that came in and
talked about anxiety anddepression in a relationship.
I had a GI doctor come in andshe talked about how, if a
patient had a colostomy back,how would that affect a
relationship?
How would that affect intimacy?
You know, I had sex therapistscome on and they've talked about
mindfulness in a relationship.
(32:20):
I've had another sex therapistcome on.
She talked about somethingcalled sensate focus.
That is a great modality to usein somebody that's experienced
trauma or abuse or somebodythat's never had sex before.
And how do they start thatrelationship?
How do they start that physicalintimacy in that relationship?
And so I've had on a wholebunch of great, fantastic guests
(32:41):
, and so that's kind of what wetalk about.
And it's a global podcast.
You know, outside of theWestern world I have a lot of
people in the Middle East andPakistan, india, wherever all
over the world that listen tothat podcast and that really
enjoy it.
So that's why I do that.
And so how can people work withme?
Well, people can either reachme on I'm on Facebook at Dr
(33:06):
Sudef OBGYN.
I'm on YouTube at Dr SudefIntimacy Health.
I have an official office, apractice, a brick and mortar
(33:26):
that is located in WestchesterCounty, new York, and I am
currently open and accepting newpatients, and you can go onto
my website at wwwfemmehealthcomand you can get information
about the practice.
You can schedule a meet andgreet with me.
(33:48):
You can even call the officeand schedule your appointment
and book one today.
So, yeah, those are all thedifferent ways.
I'm actually hosting a retreat.
I just finished a retreat inseptember and it was you may
really like this tamra.
This Tamara is was focused onperimenopause, menopause and
sexual health and nutrition.
I co hosted it with a friend ofmine who is another
(34:09):
gynecologist and but she was adietician before she became a
gynecologist and so she focusedthat.
We do lectures every day, nomore than an hour and a half.
That's a max.
You know they're usually forlike an hour.
We did it every day so thatpeople could get information
about perimenopause, menopause,sexual health.
Those were my lectures.
She would do lectures onnutrition and then, when the
(34:30):
days that she would do herlectures, we would do them right
before.
We did a cooking class.
So we did two cooking classes.
This was the retreat happened.
It lasted a week.
It was in Morocco.
We started every day with yogaand meditation and it was so
phenomenal it was the first yearwe did it and we had such
amazing reviews.
Everyone loved it.
But I think it's because wecreated an environment right at
(34:51):
the onset of one ofvulnerability and one where
people could be honest withtheir feelings and about what
they were going through.
And I think, because we createdthat environment early on,
people felt like they couldreally be open and honest about
what was going on in their livesand what they wanted to work on
and things like that.
And everyone left there feelingreally full and we all became
(35:15):
really good friends and it wasall about creating a community.
And I really think that women,when they're going through these
huge transitions in their lives, such as perimenopause,
menopause they really need acommunity because you know, in
that community you don't feellike you're alone.
You feel like you know I'm withthis tribe of women that are
(35:38):
going through similar things andyou know we can lean on each
other, we can ask questions and,that being said, I actually
have a Facebook group it'scalled it might be menopause
support group by Dr Silla Flodythat people can join, and it's
on Facebook, so you know it's a.
It's a private group, though,and and people ask questions on
there.
You know people are concernedabout brain fog.
They're concerned about new andnew onset anxiety and
(36:00):
depression.
They're concerned about weightgain that they have in menopause
, perimenopause and how tomitigate that.
You know lots of greatquestions that people pose and
you know we come together and weanswer those questions, so
really fantastic.
Speaker 2 (36:14):
Okay, yeah, the retreat does sound awesome.
Is there a final closingcomment?
You wanted to kind of leave.
Speaker 1 (36:22):
Yeah, I'd love to say , you know, what I want people
that are listening to yourpodcast to realize is that
there's always hope.
And you know, I think sometimes, when we're going through
something that seems reallyawful, you know, we may feel
like there's no hope.
So I want women to know thatthere's always hope.
There's always something thatwe can do.
And if we don't know, you knowwe'll at least try to find
(36:43):
something that we can do.
For whatever it is that you'regoing through whether it's
sexual dysfunction, whether it'syour perimenopause, menopause
or, you know, sex coaching ormindset or something like that I
want you to know that there isalways hope and to make sure
that you seek out a healthcareprovider that can help you.
And if you find somebody thatdoesn't listen to you or is
dismissive of your symptoms,then you need to find somebody
(37:06):
else that will listen to you.
You can go on the menopauseorgwebsite to find a menopause
society certified practitioner,and you can go on the
international society for thestudy of women's sexual health
org website to find a sexualhealth fellow that can help you
out.
Speaker 2 (37:22):
Yeah, and I was going to say I'd also recommend, come
as you are, that book.
Yeah, she talked about thebrain stuff too.
Speaker 1 (37:31):
Like you said, I love her.
I love her.
And she's the one that said andI quote this all the time is
that to want sex is to have sexworth wanting.
So you know you're not going towant something that doesn't
bring you pleasure, that ispainful, where you're not
feeling like you're hurt oryou're being seen.
You know you're going to wantto be in a relationship that you
(37:51):
feel heartening, but also whereyou're experiencing pleasure
and you're not having pain.
Speaker 2 (37:56):
Yeah, yeah, definitely, and I have lots of
episodes about the differencesbetween men and women and the
that kind of stuff, so that's awhole nother topic.
But I agree, Like all right.
Well, thank you very much forbeing on.
It was a lot of greatinformation.
I was gonna say, if you lovethis episode, be sure to tell
your friends about it and rateit as well.
Speaker 1 (38:14):
And thank you so much for having me on, Tamara.
I really appreciate your timeand your audience's time and um,
and I hope they all have agreat day.
But thank you so much forhaving me on.
Welcome to the Straight from the Source's Mouth
.
Speaker 2 (00:02):
Podcast Frank talk about sex and dating.
Hello, Tamara here, Welcome tothe show.
Today's guest is Dr Sadaf Lodi,OBGYN and intimacy coach, and
we'll be talking about theeffects perimenopause and
menopause can have on your sexlife, her coaching practice and
her own podcast.
Thanks for joining me, Dr Sadaf.
Speaker 1 (00:23):
Thanks so much for having me on.
I really appreciate your time.
Speaker 2 (00:27):
Yeah, I think this is a great topic.
Obviously, as I read somewhere,half the population goes
through this at some point, soit's good to know on both sides
for the women and the men likethe differences that can happen.
Speaker 1 (00:38):
Yeah.
So I think that you know.
What's important to realize isthat perimenopause can start way
before menopause.
So menopause for the majorityof people here in the US, for
women, is at the age of around52.
Of course, it can happen eitherbefore or after, but that's
kind of the mean age.
(00:59):
And what's important to realizeis that perimenopause is a time
before menopause.
So, and this is the time wheresometimes women's period can
become irregular, they can startto notice some brain fog, they
can have some heart palpitations, maybe even some arrhythmias,
they can have joint pain, theycan have dry eyes.
(01:21):
There's so many symptoms thatcome about with perimenopause
and what's important to realizeis that sometimes these and of
course the most common ones thatare hot flashes and night
sweats, and that's what a lot ofwomen will complain about
around this time.
What's important to realize isthat sometimes, even after the
menses completely stop, thesesymptoms don't always go away
(01:41):
and sometimes it can get evenworse, for example, like the
joint pain can get even worse,and we'll talk a little bit
about these things.
But what's important to realizeis that different ethnicities
go through menopause fordifferent lengths of time.
So, for example, there is astudy that was done.
It's called the SWAN study andit was a multicenter study and
(02:02):
it looked at women through midmidlife and what they noted was
that Caucasian women tended togo through perimenopause for
about seven years before theyhad a cessation of their menses.
So when you have no period fora whole year, then you're
considered in menopause.
If you go, you know, like 11months with no period and all of
(02:23):
a sudden the 12th month youhave a period, then you're not
in menopause.
Yet it's when you go a wholeyear without a period.
Like I said, caucasian womenaround 7.2 years, african
American women they say about 10years, and Hispanic women 8.9
years, and East Asian women.
So, for example, japanese womengo through perimenopause for
(02:44):
about five years and they thinkthat perhaps, you know, african
American women and Hispanicwomen tend to go through
perimenopause for the longestperiod of time and they think
perhaps that could be due tosystemic racism that then
affects their DNA, which causestheir telomeres to get shorter,
(03:05):
which makes them more at riskfor certain diseases and also
for going through perimenopausefor a longer period of time.
So you know, that's reallyimportant, because if we're
saying that the mean age forsomebody to go through menopause
is 52, and we, you know, and ifyou're looking at a Caucasian
woman, we say that she goesthrough perimenopause for seven
(03:25):
years, then we're saying thatperimenopause could start as
early as the age of 45.
And that's important to knowbecause if you start having hot
flashes and night sweats andmood swings and all this stuff,
and you go to your provider andyou tell them, hey, I'm having
all these symptoms, I think Imay be in perimenopause, you
know, don't accept it if theysay you know you're too young,
(03:45):
because that's not the case.
You know, and I think a lot ofwomen have these, all these
symptoms that they can't explainand they don't know what's
going on.
And they, you know, there'sactually a term that's been
coined for this is called notfeeling like myself.
And you know, a lot of womenfeel like that.
And what's important is thatonce you know about all these
things, then you can advocatefor yourself and you can say
(04:08):
well, you know what.
I know that you think I may betoo young to be going through
this, but that's not the case.
I have heard, you know, in thispodcast.
You know that I can be goingthrough perimenopause for a long
period of time.
I really want you to take alisten to me and really listen
to my symptoms and listen towhat I'm experiencing so that
(04:28):
you can best help me.
Right and I think that's reallythe most important thing is
knowing about what thesesymptoms are, how long they can
last, and then you can go andadvocate for yourself.
Speaker 2 (04:38):
Yeah, and I definitely.
I know lots of people that arehaving those symptoms and and I
know it's becoming more of athing now.
I know Oprah has talked aboutmenopause and more and more
people are getting educated, butit's maybe not the medical
establishment as much.
Speaker 1 (04:51):
Yeah, yeah, and I think it's, you know, it's
really important because I agreewith you.
I think that menopause is nowreally having a moment right now
, and I think what's happeningis that women are no longer
standing for the status quo.
You know, we're not acceptingthe fact that this is just
something that happens and wehave to deal with it and it's
going to, you know, happen forthe rest of our lives.
(05:12):
I think that people are reallywanting treatment and they
really want physicians andproviders that will listen to
them, that will, you know, helpthem and not dismiss their
symptoms, and I think thatthat's really what's happening
and I applaud it.
You know, I think it's reallyimportant.
I think, also, there's beenrecent advocacy on how employers
(05:33):
can support their employeesduring this time, and you know
what are some modifications theycan make in their offices so
that they can better supportwomen going through
perimenopause, menopause, and Ithink this is super important.
Speaker 2 (05:46):
Yeah, definitely.
And then also we are going totalk about how it affects your
sex life.
But I wanted to ask first areyou a fan of hormone replacement
and like which?
Like we talk about sex with orwithout hormone replacement?
Maybe Absolutely.
Speaker 1 (06:00):
Absolutely so.
I, you know.
So, just so your listeners know, I am, I am a board certified
OBGYN.
I'm also a menopause societycertified practitioner as well
as a sex coach, and I am what'scalled an Ishwish fellow,
meaning like I'm a fellow of theInternational Society for the
Study of Women's Sexual Health.
So sexual health is near anddear to my heart and I just
(06:22):
think that it's because, youknow, one, sexual health is part
of health and, two, we justdon't talk about it enough.
There's a lot of stigma,there's a lot of, I guess, shame
or, you know, people just feelreally uncomfortable talking
about it.
But I, what I want people toknow and understand, and your
listeners understand, that it isa part of your health and it's
(06:42):
really, really important that ifyou're experiencing some type
of sexual dysfunction, that yougo and approach your doctor or
whoever provider, whoever thatyou see that you're having this
dysfunction, and that you allowenough time.
You know, unfortunately ourhealth care system is really
broken and so we have about 15minutes to go talk to our doctor
, right, like your doctor istrying to see like 40 patients
(07:04):
in a day.
And so now here you are, you'recoming in, you're saying you
know I'm having pain with sex.
Your doctor has 15 minutes todeal with that.
Unfortunately, a topic likethat takes like about an hour.
It is not something that can beresolved or even, you know,
fully examined in 15 minutes.
So you know when you, if you'rehaving an issue like that, I
(07:24):
really want you to make surethat you have enough time
allotted in your appointment,you know, and just ask whoever
you schedule with to ask them ifyou can get a half hour
appointment, because you knowit's going to take a little bit.
So you talked about you knowwhat are some.
Am I a fan of hormones?
Absolutely A hundred percent.
Hormones are something that wehave naturally in our bodies,
(07:46):
right and around the time ofmenopause.
That's when our estrogens stopmaking hormones.
So that's when you know we nolonger are making estrogen or
progesterone.
It goes pretty much, you know,down to zero almost, and if not
to zero.
And what's really important isthat when we have that steep
decline of estrogen in ourbodies, you know we are at risk
(08:10):
for cardiovascular disease,we're at risk for osteoporosis.
We have vasomotor symptoms likehot flashes, night sweats, mood
swings.
We have the genitourinarysyndrome of menopause, which
we're going to get to now,because you know that was kind
of the question that you hadabout how menopause and
premenopause can affect your sexlife, and that is a super
important question and I reallyapplaud you for asking that,
(08:31):
because that's something thatpeople really feel embarrassed
talking about and they reallyshouldn't, because, again, sex,
sexual health, is a part of ourhealth and you know, for most,
for a lot of women, they want tocontinue to be sexually active
long into their 80s, 90s,however old you know that
they're able to be.
And just because you're inmenopause doesn't mean that all
(08:52):
of a sudden now you have tobecome, you know, abstinent.
That's not it, you, it's reallyup to you.
It's a decision that you makeand you decide what happens.
So, in terms of what happens toour bodies when we are going
through perimenopause, menopause, and how does that affect our
sex life?
So during this time, what wenotice is, when we have this
decline of estrogen, we seechanges in our vulva, in the
(09:14):
vagina, in our bladder health,okay, and what I want your
listeners to know and you mightbe surprised, but I'm not
surprised anymore that sometimeswomen come to me they're not
really sure how many holes theyhave.
So we just to kind of clarifythat.
We have three holes we have aurethra where we pee from, we
have a vagina, and that's youknow where the baby comes from
(09:38):
through really that tunnel, thatvagina, and we have the rectum
where we poop from.
So just, I just want to kind ofget that out of the way.
So what happens is that duringthis time, as the estrogen
declines, we see changes in notonly the microbiome of the
vagina, where the pH goes up,making us more susceptible to
(09:58):
bacterial infections, but alsowhat we notice is that the
tissue becomes thinner, andthat's really important because,
as that and it's because of theestrogen, because the estrogen
goes down estrogen isresponsible for so many things
it's responsible for elasticityin our skin, it's responsible
for the collagen, it isresponsible for the blood flow,
(10:21):
it increases blood flow, theblood flow, it increases blood
flow.
And so when that estrogen goesdown in our vulva, in our vagina
, that tissue becomes thinnerand we have decreased blood flow
in that area.
When we have decreased bloodflow, we have decreased
lubrication.
We can have problems witharousal, we can have pain with
(10:42):
sex.
Okay, and that's the biggestthing is that people come in
with because they're having painwith sex.
Why are they having pain withsex?
They're having pain with sexbecause one that tissue is
thinner and so there's morefriction, there's decreased
lubrication, so that increasesthe friction right that your
body, your cells are makingdecreased lubrication.
That tissue is becoming thinnerso it's more prone to, you know
(11:05):
, tearing.
It's not stretchy as much as itused to be, again, making it
uncomfortable and possiblypotentially tearing.
You know you can have decreasedarousal because you're having
pain, right.
Anything that causes painyou're not going to want.
So you know, for women, as theyget older, if they're
(11:26):
experiencing pain with sexthey're not going to want it,
and that was, I think, the keything to remember.
So if you're having pain withsex, you need to go and see your
provider and let them know.
Especially if you're in thisperimenopause, menopausal time,
you need to let them know sothey can help you out.
So some of the treatments thatwe offer to women that are going
through this and also I didn'tmention that you can have issues
(11:48):
with your bladder, you can haveoveractive bladder.
Again, there are receptors ofestrogen on that bladder and so
you know, some women during thistime feel like they have, they
have this urgency where theyhave to go to the bathroom.
They have to go right away.
If they don't go, they'reafraid they're going to.
You know, pee their pants right.
Because of that overactivebladder.
You also have recurrent UTIsbecause that urethra starts to
(12:10):
get bigger and if you saw amenopausal woman, if you saw her
vulva, you would notice thatthe opening of that vagina has
become smaller but her urethrahas, which she pees from,
actually gets bigger and makingher more prone to have bladder
infections.
That's why women in likenursing homes, those poor ladies
(12:30):
that are not able to get up andurinate and take care of
themselves, you know they sitthere and they can get these
recurrent bladder infectionsthat can then eventually go
undiagnosed and lead to sepsisand even death, because you, you
know we're not picking up onthese bladder infections that
these poor women are sufferingthrough.
So that's why it is super,super important that during this
(12:51):
time when you are inperimenopause, menopause, and if
you're having pain with sex,that you go and you get
evaluated and you get treated.
So let's talk a little bit aboutthe treatments that we have for
women during this time.
We have, you can do, lubricants, but I will tell you lubricant
is not going to solve theproblem right.
What a lubricant does is it'sgreat for sex and there's tons
(13:14):
of lubricants.
There's, you know like.
You can have oil-basedlubricants, you can have
water-based lubricants, you canhave silicone-based lubricants.
I think the silicone-basedlubricants are probably the best
.
They based lubricants.
I think the silicone basedlubricants are probably the best
(13:34):
.
They last the longest and theydon't dry out and they don't,
you know, you can use.
They last a long time and theydon't cause any type of like
fungal infection or anythinglike that.
So I think that that's why Ireally like those silicone
lubricants and they're fantastic.
But a lubricant is only going toget rid of the pain with sex,
right, it decreases friction.
So, although lubricants aregreat and you know women during
this time may be having a hardertime making lubrication on
(13:55):
their own those lubricants aregreat for that.
However, they are not takingcare of the problem, right.
They're not going to help withthat elasticity.
They're not going to helpincreasing that collagen.
They're not going to increasewith that lubrication.
They're not going to help withthe bladder health that we're
talking about, you know.
You, what women need during thistime is vaginal estrogen.
That vaginal estrogen does notgo throughout the whole body.
(14:19):
It only is in the vagina.
It stays there.
It's very low dose and it isreally important, and what that
vaginal estrogen will do isit'll help with all of those
issues, right.
So with that, it'll help toplump up that tissue.
It's going to increase bloodflow to that tissue, it's going
to increase lubrication, it'sgoing to help with that
(14:40):
overactive bladder, it's goingto help prevent recurrent UTIs.
It's going to do all of thatand it's going to maintain your
vulvar health and that is thebiggest thing.
So, even if women are notsexually active, it doesn't
really matter.
The point is, is that you wantto really really maintain your
vulva.
Some women also usemoisturizers, and moisturizers
(15:01):
are fantastic.
It's kind of like you know howyou have a moisturizer for your
face, you have a moisturizer foryour vagina and what that does
is it increases the watercontent in those cells to make
it more plump.
The one that's used the most ina lot of these moisturizers is
called hyaluronic acid, and it'sgreat for that.
(15:21):
But again, it's not going tohelp with the bladder health,
right, it's just going to plumpup that tissue a little bit, but
it's not going to do all of thethings that vaginal estrogen
will do.
Speaker 2 (15:33):
Do you have a preference on bioidenticals or
is whatever?
As long as it's vaginal cream,that all of them work fine.
Speaker 1 (15:44):
Yeah, so you know what?
Okay, so when we talk aboutbioidenticals, what we're
talking about are hormones thatare similar to what our body
makes, right?
So we don't actually reallyneed to go to a compounding
pharmacy, unless it's somethingvery specific.
The FDA has approved vaginalestrogen and it's called
estradiol cream.
It's Not that expensive.
It's going to be way lessexpensive than a compounding
(16:05):
pharmacy and you don't reallyneed to go to a compounding
pharmacy.
This vaginal estrogen is FDAapproved.
We know it's safe and you canjust ask your prescriber to
prescribe it to you.
You can typically get it fromthe pharmacy for like $10, like
a copay, you know and or you cango to Mark Cuban's pharmacy
that he has it's GoodRx, and youcan get the vaginal estrogen
(16:29):
very cheap as well.
So you don't really need to goto a compounding pharmacy for
this.
You will get the FDA-approvedmedication and it's fantastic.
All you need is vaginalestradiol, and that is estradiol
is the most common form ofestrogen in our bodies and it is
completely safe and the amountof vaginal estrogen that you use
(16:53):
is super small.
So what you, if you were to usethe cream right the way that you
would use it is, you would putit comes with the applicator.
I tell patients not to use theapplicator.
It becomes a little bitdifficult and I think that it's
plastic and it may beuncomfortable.
Whatever.
People can just use theirfinger and I have them put the
cream on up to the second lineof their finger.
(17:14):
I have them put it on insideand outside, so inside of the
vagina, outside on the vulva,and they rub it in and they do
that every single night for twoweeks at night and then after
that it's twice a week for therest of your life and you never
stop using it because you wantto always maintain that vulvar
(17:35):
health, because it's going tohelp you with recurrent bladder
infections.
It's going to help you decreasethat painful sex.
It's going to increaselubrication.
It has so many great benefits,even women, that there are
studies out that show that evenwomen that have had breast
cancer can use vaginal estrogen.
Even women that have a historyof blood clots can use vaginal
estrogen because it's local, itstays there, it doesn't go
(17:57):
throughout the whole body.
If you're worried aboutestrogen, you're worried about
hormones, it's going to staywhere you put it, especially the
cream, and even there's there'stablets, there's a ring,
there's different formulations,there's a suppository, so if you
don't want to do the cream, youfeel like it's messy.
There are other ways to getthat vaginal estrogen in.
Speaker 2 (18:14):
Okay, yeah, that was the question I was going to ask
about breast cancer, becausethere's a study which a lot of
people say was a failed study,saying that you know, there's a
lot of concern about breastcancer by doing hormone
replacement, there's a lot ofconcern about breast cancer by
doing hormone replacement, andfrom what I've heard that that's
not necessarily accurate.
But now that you're saying thevaginal cream especially is not
going to affect anything likethat, so it's not there.
Speaker 1 (18:34):
Yeah, yeah, vaginal estrogen.
I don't know about that studythat you're talking about with
hormones and breast cancer.
I'm not too familiar with that.
But you know, definitely,before you take any type of
hormones, I would, you know,speak to your hematologist,
speak to your oncologist to makesure that they feel that it's
safe for you.
You know, one of thecontradictions to taking
(18:56):
hormones is an active cancer,right, so you never want to do
anything that's going to makeyour health worse.
But vaginal estrogen is really,really safe and really safe and
it's not going to harm you,it's not going to go all over
your body.
If you're worried about that,okay, awesome.
Speaker 2 (19:13):
Yeah, I mean that's obviously great information,
because I know someone that wascomplaining about painful sex
and I didn't know to tell herabout the cream.
So now I know.
Speaker 1 (19:22):
Yeah, absolutely.
That cream is fantastic andit's so helpful and it really
does change women's lives, youknow.
I mean when they're not havingthat chronic irritation, when
they're not having that painwith sex, when they're not
dealing with all of those things.
It's really a game changer.
In fact, I'll tell you, youknow, I had a dermatologist
friend and I was talking to herand she was really afraid to
(19:44):
take vaginal estrogen herselfbecause she had a blood clotting
disorder and she's like no, no,no, I don't want to take it.
But you know, and I kept tryingto make her understand and then
I said okay, you know what, I'mjust going to prescribe this for
you and you take it if you wantto take it.
So I prescribed it for her, shetook it, she did that and she
does the moisturizers.
And she said it was a gamechanger for her.
(20:05):
And she said she's now going totell all of her patients to
take vaginal estrogen and do amoisturizer every day, because
the vaginal estrogen once you dothe maintenance dose is just
twice a week.
So if you still feel like alittle bit of irritation or
something like that, you can dothe moisturizers in between to
get that irritation to go away,and just so that everything in
(20:29):
that area feels better.
Speaker 2 (20:31):
Yeah, and you said it's a game changer for women
and men as well, obviously,because if their spouse is not
wanting to or their partner isnot wanting to have sex because
it's painful and they haven'ttalked about it, then now the
problem is solved for bothparties.
Speaker 1 (20:44):
That's a very good point you make, actually, and I
do want to talk about that alittle bit.
So, you know, I was talking toanother friend of mine and they
were telling me that theirfriends are actually now having
extramarital affairs as theirwives are menopausal because,
(21:04):
you know, their wives no longerwant to have sex because they're
having pain and they don't knowwhat's going on and their
doctors aren't helping them andnobody's listening to them, and
so they've given up that part oftheir life.
And, you know, although theystill want to be sexual, they
don't know how to havenon-painful penetrative sex,
although, as we know, you know,there's different forms of sex
and you can definitely findpleasure in other ways.
However, you know, for them andtheir partner, they wanted to
(21:28):
have penetrated sex and it wasso painful.
So now they're you knowpartners are having these
extramarital affairs and youknow what could have really
helped that relationship.
Of course, I'm sure you knowthey're going out and having
extramarital affairs.
There's probably lots of issuesin that relationship to begin
with, but you know, one of thethings you know that was part of
(21:48):
the problem was the fact thatthey could no longer have sex
without pain, right, and so,like you said, you know it does
save marriages and relationships, so it's really important.
Speaker 2 (21:58):
Yeah, and I was going to say too, some, some women
have even okayed it becausethey're like I don't want to
have sex, it hurts.
You go ahead and have it withsomeone else, just I don't want
to have sex, it hurts.
Go ahead and have it withsomeone else, just I don't want
to hear about it or whatever.
Whatever agreement they make,but yeah, they just knew they
could not have it be painful,right, all right, you're
absolutely right.
And is this the kind of stuffsince you do?
(22:20):
Coach on?
Speaker 1 (22:21):
this.
Is this the kind of stuff thatcomes up I would imagine for
your coaching.
Yeah, I mean honestly, are fromwomen that have had a lot of
sex negativity.
They feel that sex is wrong,dirty, shameful.
I just had a woman yesterdaythat I talked to about coaching
and she has a really bad,traumatic relationship with her
(22:44):
own body.
She know she had all theseprocedures done, she just
doesn't like herself, shedoesn't like her body and so she
doesn't really enjoy otherpeople touching her body because
she has a very bad relationshipwith her own body.
And so, you know, we are tryingto move from that sex
negativity that she holds withinherself to sex negativity that
(23:05):
she holds within herself, to, ifnot, sex positivity, to a place
of sex neutrality, which I feelis really important, because
you know it's hard to make that180 degree shift.
But if you can at least slowlywork your way where you're able
to change your mindset a littlebit and get to a place of
neutrality, then I feel that youcan at least be open to sexual
(23:27):
stimuli, right, Be open to sometype of sexual advances, and not
be so, you know, feel sorepulsed by the idea.
Speaker 2 (23:37):
Yeah, and just knowing that men are just happy
that you're there, like you knowthey.
They just think so much lessabout it.
You know, they're just so andit's easier said than done to
like.
Speaker 1 (23:47):
Yeah, absolutely Absolutely.
And you know, I think what'simportant to realize is that
there's so much you know.
So what we say in sexualmedicine is that the brain is
the biggest sexual organ, and Iremember the first time I heard
that I was like what you know,that like kind of blew my mind.
But it's absolutely true, right, it's.
It's because whatever ourthoughts are, whatever is going
through our head, is going toaffect our feelings, and
(24:11):
whatever feelings we have willaffect the actions that we take,
right?
So if we are thinking that sexis wrong, it's shameful, it's
dirty, or that I don't like mybody, I don't like the way it
looks, this, and that thefeeling that we're going to have
is that maybe, perhaps one ofshame, one of guilt, you know.
And so the actions that we'regoing to have are those of like,
perhaps, turning our partneraway, turning, you know, not
(24:33):
really allowing ourselves toexperience pleasure, not really,
you know, enjoying what we'reable to enjoy because of the
thoughts and all these, you know, all this chatter going on in
our brain.
And I think that that's reallyimportant to understand.
One, that the brain is thebiggest sexual organ.
And two, I think one of themost empowering things that I
can leave your listeners with isthat we are, we are able to
(24:57):
choose our thoughts, and I thinkthat that again was one of
those.
You know statements that I waslike wow, really blown away with
because we can choose.
You know statements that I waslike wow, really blown away with
because we can choose.
You know, sometimes, I think,people, you know, we go
throughout our day, we have allthese thoughts that come and go,
whatever, and we just thinkthat, oh, you know, they just
happen, they.
You know we have no controlover them.
But when we realize that we canchoose our thoughts, right then
(25:22):
you're getting to like the rootcause, like if I can choose to
be happy, if I can choose tofind joy, then I can really
change the feeling that I'mhaving and that will result in a
change of action that I cantake.
Speaker 2 (25:36):
No, I totally agree.
I just did that this morning.
I was talking negatively tomyself and then I caught myself
immediately and was like no,you're just doing this, you know
, I like did the completeopposite and spun it into a more
positive way 100 percent andthat you know that takes time.
Speaker 1 (25:50):
One, it takes knowledge to realize that that
is happening, right.
Two, it's the other knowledgeis realizing that we have that
option and that we can chooseour thoughts.
And three is acting on it Right.
So I think what really helpspeople is having positive
affirmations that we say everyday.
Right, so we can choose to saywhatever we want to ourselves,
(26:11):
right, we can choose to say I ama great speaker, I am a great
coach, I'm a great clinician,I'm a great doctor, I'm whatever
.
Whatever we want to say, wechoose that.
And so when we decide that weare the masters of our own fate,
when we are the masters of ourown thoughts, it's a game
changer, right, we can.
And just like what you did, yousaw, you know, you reflected on
(26:34):
whatever the thoughts you werehaving and you immediately
changed it.
And I think that's so importantand that can start with
affirmations in the morning,right, and those affirmations
are always.
They start with I am and then Iam whatever.
Right.
So instead of you know and Ialso heard of this one time is
that you know we have worry,right, we worry about everything
(26:55):
and that's you know.
It gives people anxiety becausethey're always worrying about
the future is that we can havepositive worry instead.
You know, like what if you knowthings work out?
What if this is the best thingthat ever happened to me?
What if this is, you know,going to be so helpful in my
career, in my relationship,whatever, when we really sit
down and think about the thingsthat we can do just by changing
(27:17):
our mindset.
Speaker 2 (27:18):
Yeah, I wanted to share one more quick example.
So my example is I was recentlytold well, I was told I had
ADHD.
A while back I never thoughtanything of it, but then I
realized I was impulsive.
But then I changed impulsivityto I make I make good decisions
with velocity, because that isreally what I do.
Yeah, decisions with velocity.
Speaker 1 (27:40):
I love that, I love that and I think that's
fantastic, and it doesn't haveto be something that's wrong
with you.
It could be your superpower,right.
It could be something thathelps you to accelerate in your
career, in your relationship, inwhatever way right, as long as
you're not hurting yourself orothers.
It's absolutely, it can bedefinitely a benefit to you and
(28:01):
those around you.
So I don't think that, you know, it's not always that there's
something wrong with us, right,and I think that if we're able
to reframe those thoughts, thenwe would feel better about
ourselves.
Speaker 2 (28:13):
Yeah, exactly, all right.
So I would say, if you want totalk either more about your
coaching or we can talk aboutyour podcast, or how to reach
you, like kind of all of them.
In whatever way you want to doit.
Speaker 1 (28:24):
Absolutely.
I appreciate that.
So, you know, my coachingreally focuses on moving forward
in your relationship, whetherit's with yourself, a
relationship with yourself, orwhether it's a relationship in a
couple, so a partner, your,your husband, whatever you know,
your marriage, whatever it is,and it's all about moving
forward.
So coaching is, you know, it'snot therapy and that's what I
(28:47):
want people to understand.
It's not, like you know, I'm atherapist.
I'm not, I'm a physician, I'm aclinician, but I'm also a coach
and you know if there are somethings.
So the difference of therapyand coaching is that, like for
therapy, you know, we deal withthings.
Therapists will deal withthings, perhaps in somebody's
past to unpack it, and all ofthose things.
(29:07):
So it's a little bit about, youknow, going back into your
childhood and things like that.
Coaching is all about movingforward.
Like you know, here I am atthis place in my life how do I
move forward in my relationship,how do I move forward in my
career, how do I write?
So that's what that coaching isabout.
They're not consultants,they're coaches, and that's what
(29:30):
I do.
I really help women moveforward in their relationships
so that they can experiencepleasure, and it's about
removing emotional and physicalbarriers so that women can
experience pleasure.
And that's really what I do andthat's because I'm a
gynecologist, so I can assessthem anatomically.
But also we talk a lot aboutmindset and about the thoughts
that happen and you know whatare they thinking and how can we
reframe that.
So it's a little bit of likecognitive behavioral therapy
(29:52):
that I do, and so that's whythat's really important.
So that's about my coaching andit really helps women that say,
for example, have vaginismus.
So vaginismus is where themuscles around the vagina will
tighten up in anticipation ofany type of penetration.
And so you know and these womenhave a really tough time with
(30:12):
you know, whether it's aphysical exam, whether it's
inserting a tampon, whether it'swith penile vaginal intercourse
, with any one of those things,women really kind of those
muscles just tighten up, right,because there's that fear that
they have that it's going to bepainful, it's going to hurt or
perhaps that it's wrong.
I shouldn't be doing this.
Whatever you know, whatever thethought is, it automatically
(30:33):
turns on those muscles, so thenthey become so tight.
So for somebody that has that,I think that that is like a
perfect example where you wouldneed a sex coach, a sex med doc.
A sex med doc to really assesswhat's going on anatomically,
and also either sex therapist orsex coach to kind of help you
move forward.
And then pelvic floor therapistthat would work with dilators
(30:56):
and help you and teach you waysto relax those muscles so that
they wouldn't clench up.
So that's like an example ofwhere sex coaching really works
in well with you know, adiagnosis of, say, vaginismus.
You know my podcast is all aboutrelationships.
It's about, well, the reasonwhy I do it.
(31:16):
So I'll tell you why I do it.
I do it to empower and educatewomen or men or anyone, anyone
that wants to listen.
It's not for a specific subsetof people.
I know it's called the Muslimsex podcast.
It's not specific to Muslims,it's just a provocative title
that gets people to pause andthink, oh, what's this?
But it's really about how dodifferent conditions impact a
(31:38):
relationship.
I talk about libido.
I talk about orgasm.
I talk about arousal.
I talk about painful sex.
I talk about menopause.
I talk about you know I'mactually in my third season of
the podcast and we've talkedabout so many different topics
in there.
I have a lot of times I'll havedifferent clinicians on that'll
talk about how.
You know, those things thatthey specialize in affect a
(31:59):
relationship.
So, for example, I had apsychiatrist on that came in and
talked about anxiety anddepression in a relationship.
I had a GI doctor come in andshe talked about how, if a
patient had a colostomy back,how would that affect a
relationship?
How would that affect intimacy?
You know, I had sex therapistscome on and they've talked about
mindfulness in a relationship.
(32:20):
I've had another sex therapistcome on.
She talked about somethingcalled sensate focus.
That is a great modality to usein somebody that's experienced
trauma or abuse or somebodythat's never had sex before.
And how do they start thatrelationship?
How do they start that physicalintimacy in that relationship?
And so I've had on a wholebunch of great, fantastic guests
(32:41):
, and so that's kind of what wetalk about.
And it's a global podcast.
You know, outside of theWestern world I have a lot of
people in the Middle East andPakistan, india, wherever all
over the world that listen tothat podcast and that really
enjoy it.
So that's why I do that.
And so how can people work withme?
Well, people can either reachme on I'm on Facebook at Dr
(33:06):
Sudef OBGYN.
I'm on YouTube at Dr SudefIntimacy Health.
I have an official office, apractice, a brick and mortar
(33:26):
that is located in WestchesterCounty, new York, and I am
currently open and accepting newpatients, and you can go onto
my website at wwwfemmehealthcomand you can get information
about the practice.
You can schedule a meet andgreet with me.
(33:48):
You can even call the officeand schedule your appointment
and book one today.
So, yeah, those are all thedifferent ways.
I'm actually hosting a retreat.
I just finished a retreat inseptember and it was you may
really like this tamra.
This Tamara is was focused onperimenopause, menopause and
sexual health and nutrition.
I co hosted it with a friend ofmine who is another
(34:09):
gynecologist and but she was adietician before she became a
gynecologist and so she focusedthat.
We do lectures every day, nomore than an hour and a half.
That's a max.
You know they're usually forlike an hour.
We did it every day so thatpeople could get information
about perimenopause, menopause,sexual health.
Those were my lectures.
She would do lectures onnutrition and then, when the
(34:30):
days that she would do herlectures, we would do them right
before.
We did a cooking class.
So we did two cooking classes.
This was the retreat happened.
It lasted a week.
It was in Morocco.
We started every day with yogaand meditation and it was so
phenomenal it was the first yearwe did it and we had such
amazing reviews.
Everyone loved it.
But I think it's because wecreated an environment right at
(34:51):
the onset of one ofvulnerability and one where
people could be honest withtheir feelings and about what
they were going through.
And I think, because we createdthat environment early on,
people felt like they couldreally be open and honest about
what was going on in their livesand what they wanted to work on
and things like that.
And everyone left there feelingreally full and we all became
(35:15):
really good friends and it wasall about creating a community.
And I really think that women,when they're going through these
huge transitions in their lives, such as perimenopause,
menopause they really need acommunity because you know, in
that community you don't feellike you're alone.
You feel like you know I'm withthis tribe of women that are
(35:38):
going through similar things andyou know we can lean on each
other, we can ask questions and,that being said, I actually
have a Facebook group it'scalled it might be menopause
support group by Dr Silla Flodythat people can join, and it's
on Facebook, so you know it's a.
It's a private group, though,and and people ask questions on
there.
You know people are concernedabout brain fog.
They're concerned about new andnew onset anxiety and
(36:00):
depression.
They're concerned about weightgain that they have in menopause
, perimenopause and how tomitigate that.
You know lots of greatquestions that people pose and
you know we come together and weanswer those questions, so
really fantastic.
Speaker 2 (36:14):
Okay, yeah, the retreat does sound awesome.
Is there a final closingcomment?
You wanted to kind of leave.
Speaker 1 (36:22):
Yeah, I'd love to say , you know, what I want people
that are listening to yourpodcast to realize is that
there's always hope.
And you know, I think sometimes, when we're going through
something that seems reallyawful, you know, we may feel
like there's no hope.
So I want women to know thatthere's always hope.
There's always something thatwe can do.
And if we don't know, you knowwe'll at least try to find
(36:43):
something that we can do.
For whatever it is that you'regoing through whether it's
sexual dysfunction, whether it'syour perimenopause, menopause
or, you know, sex coaching ormindset or something like that I
want you to know that there isalways hope and to make sure
that you seek out a healthcareprovider that can help you.
And if you find somebody thatdoesn't listen to you or is
dismissive of your symptoms,then you need to find somebody
(37:06):
else that will listen to you.
You can go on the menopauseorgwebsite to find a menopause
society certified practitioner,and you can go on the
international society for thestudy of women's sexual health
org website to find a sexualhealth fellow that can help you
out.
Speaker 2 (37:22):
Yeah, and I was going to say I'd also recommend, come
as you are, that book.
Yeah, she talked about thebrain stuff too.
Speaker 1 (37:31):
Like you said, I love her.
I love her.
And she's the one that said andI quote this all the time is
that to want sex is to have sexworth wanting.
So you know you're not going towant something that doesn't
bring you pleasure, that ispainful, where you're not
feeling like you're hurt oryou're being seen.
You know you're going to wantto be in a relationship that you
(37:51):
feel heartening, but also whereyou're experiencing pleasure
and you're not having pain.
Speaker 2 (37:56):
Yeah, yeah, definitely, and I have lots of
episodes about the differencesbetween men and women and the
that kind of stuff, so that's awhole nother topic.
But I agree, Like all right.
Well, thank you very much forbeing on.
It was a lot of greatinformation.
I was gonna say, if you lovethis episode, be sure to tell
your friends about it and rateit as well.
Speaker 1 (38:14):
And thank you so much for having me on, Tamara.
I really appreciate your timeand your audience's time and um,
and I hope they all have agreat day.
But thank you so much forhaving me on.
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If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.