Today on the Body Pod, we are rerunning doctor Kelly Casperson's episode which is all about vaginal health and pleasure.

Now, Kelly is not only an incredible physician, but she is also one of my favorite menopausal specialists in the space.

She is funny, she is vibrant, and this episode will not only educate you, but keep you in stitches most of the time.

Enjoy this episode with doctor Kelly Casperson.

Hi.

Everyone, my name is Haley and this is Laura and welcome to the body Pod.

Today on the Body Pod, we have a super special treat interviewing urologist doctor Kelly Casperson.

If you are not familiar with her, you need to be.

She is the ted X speaker for why we need adult sex education.

It is fabulous, it is short, and it packs a punch, so you will want to watch that if you haven't.

She's also the podcaster for You Are Not Broken, as well as the author of a book that's launching this fall that is the redo of her original book, You Are Not Broken.

You can now pre sell that on Amazon.

This podcast is spicy and it will tap into every emotion that you have.

Let's get into the show, all right, Welcome back to the Body Pod.

Everyone.

We are so excited we have doctor Kelly Casperson here.

We've already done her intro, so we are so excited to just get into all of these questions that we have and any questions that you have sent in for us.

So welcome doctor Casperson.

Thanks for having having me.

Okay, first of all, we were just saying this offline, but you are so funny.

And I when I was watching your Ted Talk, I'm like, this person.

I need to live next door to Kelly because.

The same we're like, why is she not our best friend?

Yes?

Thank you?

Where do you guys live?

Maybe we're close, maybe we don't even know what older.

I'm in Park City.

I lived in Denver for six years.

See missed opportunity.

Well where are you now?

You're in Washington.

I'm in Washington State now.

Oh yeah, yeah, Well that's great to Denver for the first time last spring and I was like, you, guys, hasn't always been this brown?

And they're like yeah, and I'm like, I forgot I forgot right.

And it's funny because every time I drive out of state and you're just like you're leaving colorful Colorado.

I'm like, no, the fuck who came up with that tagline?

They needed they need to do.

So my first date with my husband was in Boulder.

Oh I love that.

So it's special.

There's two kids because of Boulder, Colorado.

I'll have you no, yeah, I love it.

Well, okay, so Doctor Casperson, here we go.

Let's talk about Well, first of all, your Ted Talk, because I just was blown away.

I've watched it multiple times.

And I'm always like, nobody ever talks about the Ted Talk.

Oh my gosh.

That was the first thing we wanted to talk about.

Yeah, talking about that Ted Talk.

Why we need adult sex ed I mean, we just had a sex therapist on and she was like, adults need to be you know, they need to be teaching their kids about sex ed better.

And then I'm like, we don't even know if we're.

Talking about teach them what what Hollywood taught you?

Like it's a disaster.

Yeah, so can we talk about that?

For anyone who hasn't, well, first of all, you need to go watch it right now.

But if you haven't, I.

Watched the Ted Talk.

If you type in Ted ex Caspersus and it'll on Google or it'll pop up or on YouTube, it'll anyways it pops up.

Yeah.

I love that.

It's by like twelve minute.

Baby.

You know, you spend like a half a year working on a TED Talk, so I'm super glad I did it.

The Ted Talk started out so I like, I really started out diving into female sexual health.

And so the TED Talk started out with female It was like going to be female education.

And because women have way less orgasms than men do, and it's not because their body can't do it.

Lesbians have same amount of orgasms as men do.

You literally put a penis in the room and a woman's orgasms go down.

They did an amazing bisexuality study looking at that, which is just like sweet research.

But so it started out female sex ed and then I was like, yeah, no, well the other fifty percent aren't any better on this, right, So the TED Talk really did open up to all adults and being like, you won't think you're so broken if you just get some basic information.

Yeah.

Yeah, OK.

I love when you say in the podcast, when you ask the question are you completely confident in the bedroom and do you talk to your partner about it?

I just thought that was such a profound question.

Because I all of a sudden, I found myself asking myself like, well am I I feel like I am, but then it's like, well am I too?

And I think it's such a good question.

Right, And then if you're not, be like, oh my god, I've probably lived my whole life this way, yeah, or what got me?

What got me?

Not what happened right, like if I was, which I would say is the more unique one.

I think.

I think we fumble around in secrecy as teenagers learn something good, bad, neutral from that first experience, and then we just take that forward.

Yeah yeah, yeah, well I have to tell you I this is these are the exact words that I've spoken forever.

Was like, I don't know, maybe I'm just broken exact words.

I'm just like I don't know what to say.

And so this was really enlightening.

But that's what makes so easy to name my podcast, because like when I started talking to women about sex, like that's what they just kept saying.

I'm broken, I'm broken, I'm broken, I'm broken, and I'm like, well, actually, most women don't have an orgasm from putting something in their vagina, Like you're not broken, you just don't know that fact right, and then like another woman if she had never had an orgasm, and I'm like, well, ten percent of women have never had an orgasm, so it's not, as I am, isn't it wild?

And like the sex researchers say, it's not because it's it's rare, that it's actually because it's a body problem.

It's really And then you know, going back to the ted talk of like sex is biopsychosocial.

It's not just our bodies, it's not just our hormones.

It is you know, the religion and beliefs your parents gave you and your first experience and dude, the power differentials and heterosexual relationships.

I'm telling you, nobody talks about this and it profoundly affects people sex lives.

Oh my gosh.

Okay, let's dig into that a little bit, the biopsychosocial because I'd love that.

And I'm sure a lot of women are like, Okay, that sounds cool, but let's let's dig into it.

Probably like this sounds really complicated, because that's how I thought, like, I'm like, that is a long word.

So and I actually like I hated that word because I'm like, I think it sounds super clinical.

It sounds like somebody knows something that you don't know, Like do you have to go to a to like grad school to figure out what biopsychosocial means?

And as I was writing the Ted talk, Ted talks, you know, they're kind of formulaic, like three important points blah blah blah, right for a Ted talk, And I was like, oh crap, bio psycho social.

It makes sense, and it lends itself to a nice Ted talk because then you can break down all the pieces.

But basically the word just means that, like everything's affected by what's around you and how you were raised and your body, right, which you could also say like are eating styles and choices are biopsychosocial?

You know, it's like what does your body tolerate?

What foods did you grow up with?

What does society tell you about the foods?

Right?

Like seeing is biopsychosocial.

So once you kind of break it down and be like, oh, right, yeah, that's just like humans don't exist in a bubble.

Your sexuality doesn't exist in a bubble.

It's influenced, whether it's probably not consciously influenced, but you have been watching Hollywood movies.

Your whole life.

You have been influenced about sex roles, gender roles, who initiates how fast people orgasm?

You know that the glitterist is non existent?

Right, Like you have been influenced by that, because like what other good sex and do we have in the United States?

The data says our sex and now is worse than it was in the nineties.

Oh come on, I know.

Why though, because of everything that's online that got political.

It kind of got political.

So like, but to me, I'm like, you know, I'm a I'm a victim of the ninety sex education.

But I'm like, dude, you know when I think of the female body parts that I was taught, like, well, I think of like what was on the screen, it was uterous and ovaries.

That's the female.

That's like, although important body parts, not responsible for pleasure.

Yeah, oh so what Okay, this is going off topic of where I was gonna go, But how do you think the kids growing up now with the porn industry, let alone Hollywood but that are just like coming into this and they're just like, oh, this is going to be the sexual experience.

This is amazing.

Yeah, and then they're like, uh no.

So there's a profound disappointment between reality, their reality and what they've been watching.

So, I mean poor used to be like so rare.

You had to like go over to your friend's house, sneak into their dad's claw find the magazines that were in the brown paper bag, like legit, because that was like my first experience with like male gay porn in seventh grade at my friend's house.

So like it was like very hard to access.

Now it's I mean, it's in your it's in your pocket all the time, right, So, like porn has profoundly influenced people's perception of not only what women want, but how men are supposed to perform.

And so now that you know, talking to my friends who do the sex set in colleges and stuff and the health just the health centers, guys coming in thinking their bodies are perfund profoundly broken because they don't last two hours, or they think they you know, ejaculated too soon, or and then they're coming in super confused because they're like, I don't think the women are liking what we're what we're doing because what we're watching, right, So it's a profound disconnect.

And part of sex education is that a lot of audio visual is performative.

And this is a movie.

I love the analogy.

This is not mine, but it's like learning to drive by watching the Fast and the Furious franchise.

Yes, that's such a good end, like not reality, but we know that right.

We don't know that with sex egg because we never got a good sex head to be like, oh, these people are faking it.

Yeah, oh so true.

So do you see more male or female clients or is it just pretty much a mix?

I see you about seventy percent female, but I mean I still see a lot of guys.

Well, it's been very interesting because I really deep dove into caring about the female now in the like the last five years.

Is when a guy comes in for a rectile dysfunction and you know, viaguer prescription whatever, you know, we talk about their health because again, penises are biopsychosocial.

Like if the heart health that you have is not good, the penis doesn't function, right, we'd never talk about a rectile dysfunction.

But so they're coming in for that, we're talking about their heart, like you know all these things, and I'm like, what's your plan with this?

I thought these guys would have a plan, like profoundly interesting that like nine out of ten are like, I don't know.

I was just gonna, you know, go home and maybe have sex with my wife.

And I'm like, okay, so you haven't had sex in five years?

Does she know you're here?

Does she consent to you coming home with a super dick?

Like?

Have you had this conversation?

And they're like, ten times out of ten they're like, no, haven't had this conversation, which is which is enlightening.

I'm like, dude, people don't talk about their sex lives.

They've lived together for decades and do not talk about their sex life.

I gotta tell you, things get so much better when you start talking about it.

And nobody's died so far.

I've never read a report of somebody dying from talking to their partner about sex.

That's so true.

It's the lack of communication.

But speaking of the ED, that was a statistic that you shared I think on Instagram that forty percent of me.

Yeah, those a lot of were Oh was that on the TED talk forty percent of men?

Oh yeah, forty percent of men by the age of forty have a rectile dysfunction.

Is that correct?

Yeah?

At least a little bit.

Which that's what But to me, I'm like, if I was a man, I would want to know that because I love how you talk about the shaming and the shoulting, because I think I would feel that as a man, because obviously we have as women our own set of shame and shooting.

But that's a pretty powerful piece of information.

Yeah, I mean, I think it really normalizes that our bodies age.

I think it normalizes that, like what you choose to do with your health, whether it be drinking smoking, by the way, drinkings horrific for erections, but yeah, exercise, but like that is profound.

Like, you know, I've got guys in their eighties who have perfectly fine erections.

It does not I mean, everybody's going to have problems, but I think it's you know, when women enter perimenopause menopause and we start needing lubrication, by the way, we should just start lubrication at like age eighteen.

But lubrication, vaginal estrogen, all the things is like normalizing it of like, dude, guys have changes in their bodies too, right, Like none of us are immune from the powers of aging, and it's okay to do something about it and get it treated.

Okay, I'm so happy because I always feel like we get the shit the babies, menopause, men can go after like younger girl, like we're aging up every I mean, it's literally like I didn't even think that that many men had to struggle with it, and of course they're not as comfortable talking about it.

No.

Yeah, I just read this one study about like the actual amount of a rectile dysfunction compared to like how many people actually go to the doctor about it, right, And Viger's over the counter in a lot of kundry, so like in a lot of countries, guys don't have to go And now we have all these online pharmacies, so we're really opening access to people, kind of reducing the challenge that it is to go see a doctor.

But it's super common for them.

And you know, the directions guys really tie erections to the definition of manlihood, the definition of a man that you're fully capable, that you can you know.

But again, going back to the sex ed, like good sex ed will tell you it's okay to lose an erection in the middle of sexual activity.

It's normal and it happens, and it doesn't mean you're broken, but guys don't know that.

And then they watch the movies and these guys are like obviously enhanced many times and taking perform performance enhancing medications, right, so they don't know that.

And just like, erections are not reliable, but good sex ed will will teach you that, and people don't know that, so they just feel profoundly broke can ashamed less like a man.

Uh, you know.

And the more anxious and stressed you are about your erection, the more you're gonna not sustain an erection because when the body's stressed, erections are like now's not the time he's stressed, right, so it actually can compound and make it worse.

Oh, that performance anxiety, I'm sure totally.

Yeah.

I have to say the the vaginal dryness, which you had the best podcast on that, the menopause symptom no one talks about.

I mean, come on, so let's move on to the vaginal dryness and calling it the When you said the volva vaginal atrophy, I'm like, nobody wants that.

No, it gets worse, my friend, in the eighties it was called the senile vagina.

Stop it stop right, Well, so it keeps at least it keeps kind of getting better.

I don't know, but yeah, because you're really nobody likes vaginal atrophy, so we call it GSM or genital urinary syndrome of menopause, right, which is a mouthful, but it's a better term.

And I'm like, well, nobody liked Bobbo vaginal atrophy.

That was an improvement just from senile vagina.

So bad terrible.

I was actually I was pulling The reason I know this is I was pulling up that my guy at the medical library was helping me.

I was pulling up an old study.

Actually had to like take it off of a shelf and xerox it for me, and it was the study from which the user er lose it myth comes from, because I'm like, where does this come from?

Let's go back and dig and find the thing that like everybody kind of cites and in it they talk about senile vaginas and I was like, whoa, that was a gem I hadn't planned on discovering.

God.

Yeah, but getting back to like it, people don't know, like you got it.

It goes back to education again, like people think menopause is a hot flesh menopause is not a hot flesh and menopauseist is when you can no longer get pregnant, But it's not that's not what it is.

Those are just like signs and consequences of what it is.

And what it is is a profound hormone change another way of saying that is a profound enrochronology change, right, Like you are outliving your ovaries, which is a whole nother podcast of Like if you outlive your eyes, you get glasses, If you outlive your hips, you get a hip replacement.

If you outlive your teeth, you get teeth.

Why are we so afraid of replacing what our ovaries are?

We're outliving, right, But so with that, your hormones go down, including testosterone, and the pelvis is profoundly active and lovely and healthy because of your hormones.

So when your hormones go down, your labia can disappear.

Inner labia disappears.

Nobody knows that you can get more recurrent urinary tract infections, pain with sex, more yeast infections, more burning when you pee getting up at nightmare to pee frequency urgency.

All of those things are under the umbrella of genital urinary syndrome of menopause or GSM, and explains that both the genitals and the urinary system change because of menopause.

Now two more things and then I'll stop talking.

This can happen before your periods are done, because your hormones start fluctuating before your peers.

So people are like, my doctor said I was too young because I was forty two.

Like, no, your estrogen can go low.

Certainly, your testosterone is low often by that age, and you can I saw a woman shoes in her mid forties profound vaginal atrophy.

And what this means is you can't penetrate.

Tampons are painful, it burns when you pee.

This is not just sex.

For the people who think sex is extra, I would say it's an important quality of life piece.

But can happen certainly before menopause, and for a lot of people, it happens eight years after menopause.

So they come into my office and they're like, but menopause was years ago, and I'm like, well, yeah, but you still have low hormones and now it's caught up to you and that departarment.

But because we don't have any education about what menopause is people disconnect that what's going on in their pelvis is because of a change in hormones.

So is the best way to correct that or help is through hormones.

One hundred percent.

Now, the medical the medical literature will say try non hormonal treatments first.

What that means is lubricants and moisturizers.

Lubricants and moisturizers are band aids.

They make skin feel better, but it doesn't actually like you could you can put on glasses or you can just print everything in twenty point font Right, you're like, well, glasses actually like just make it all all better?

Right.

I think this is my opinion after being being into this for a while, is I think vaginal estrogen what other people call it local estrogen or pelvic estrogen.

If you're on Instagram, you don't want to save a jack too much because they'll kick you off, and it's true, So I call it pelvic or local estrogen.

Okay, that's just like skincare.

It's skincare for down there.

And I think at a certain age women should just because what do you want to do?

Do you want to come in to see me once your labia are gone?

You don't want to have sex anymore, and you're on your fourth urinary traction fection.

Perfectly reasonable if you want to wait for that.

Or you could be like, how can I just like have good skincare so I don't have that happen.

Oh, it's like, gosh, do you.

Want to come in once your face is skin down sinscreen?

I am it.

I'm up skincare for the badge.

I'm usided, dude.

Skincare is like a twenty six billion dollar industry.

Like women care profoundly about their skincare, and this is just vulvar vaginal bladder.

It's generally urinary skincare very safe, incredibly safe, so safe, it's over the counter in multiple cut, so safe that breast cancer survivors can take it, so safe that breast cancer patients who are currently treating their breast cancer can take it.

Vaginal estrogen just is in the pelvis.

It won't prevent your bones, right, it won't prevent usteoporosis, It won't protect your brain, it won't protect your heart, like all the amazing things that systemic estrogen will do.

Right, all it does is help GSM.

And my argument is it should be a preventative medicine, like H fifty five, pick a number, like, here's your mammogram, here's your colonoscopy, here's your vaginal estrogen.

Okay, you need to be everyone's dog.

Found.

Don't ask me about anybody's ear problems.

I cannot help.

Yeah, well, okay, so I'm gonna I always like throw myself under the bus on every podcast.

I'm like, well, here's my problem.

I know both of us are like dragging our.

Our podcast just created for the for the host, like help themselves.

I mean, come on, that's what we're all doing.

So okay, the overactive bladder, I did not know that was a symptom of perimenopause.

And let me tell you, I've gone to the urologist and I he had me on the anti what are the called the anticol energics.

Those are nasty drugs.

Yes, by the way, I'm so annoyed.

I was on it for like three years, and then my new urrolis because this guy like bounced.

He was like, oh no, you can't be on that, like you don't go on that long term.

And I had no idea.

So now I'm like, well, why am I peeing all the time?

Freaking vaginal estrogen.

What's wrong with your urologists.

I'm allowed to say that because I'm a urologist, Yes, exactly.

And I'm also allowed to say that because I was literally in Denver, Colorado last spring, looking at how brown it was, telling the Rocky Mountain Neurologic Society that vaginal estrogen is equivalent to anti cool energics.

Like, we literally have that published data.

The problem with that data is it's hiding in the menopause drone and urologists besides me don't read that.

But I was literally in Denver last year telling the Colorado urologists that vaginal estrogen is equivalent to the nasty medications they put you on.

My he's fired, he's he is.

I have an amazing urologist, and you're boulder.

Who's a female that you can go see.

Her name is doctor Carolyn Phronsia.

Go see her.

She's amazing.

Oh I'm seeing her as soon as I get off this call.

This is.

Help me, help you.

So overactive bladder and incontinent incontinence.

Means bladder leakage.

Okay, that's what I wanted to know the difference.

So so many women always complain about if they sneeze, if they jog, they're running, they're you know anything that your he just comes out.

What.

Yeah, let's talk about that because that's super important and very common.

So leaking, when you cough, sneeze, laugh, trampoline, double under exercise.

Right, it's called stress in continence.

People think that means it's because you're stressed.

It's not because you're stressed.

Stress means a force.

So it's a force on the bladder, force on the pelvis.

Right, So running, jumping, coughing, sneezing, all of that will push urine out of the pelvis.

Happens with aging, decrease, collagen decrease, hormones decrease, muscle strength.

Also, putting any sort of baby through a vagina once or multiple times can increase.

So there's many reasons that it happens.

Baginal estrogen may or may not help.

Doesn't help everybody with that.

I've seen some women on systemic testosterone get helped with that.

I'm not saying that's why we should use systemic tstosterone.

It's another podcast episode, but sometimes systemic hormones do help.

Pelvic floor physical therapy can help greatly.

They're awesome and the traditional surgery was a sling.

It's called a midirethral sling.

It's been around for twenty years, done plenty of them.

It's a great surgery, but I'm giving you a three percent risk of mesh complications for your life because I'm putting a permanent piece of mesh in there.

I will now offer you the best new things in slice bread, which I went in very skeptical and cynical because I'm not the youngest urologist anymore.

It's called bulkamid b U l K M I D.

You know how women get fillers for their face, yes, to make their cheeks and their lips more full.

It's filler for your urethra.

Oh my gosh.

And it decreases strength and continents by like fifty to eighty percent.

It's a three minute procedure.

There's no downtime.

I'm like a walking billboard.

It's like you can exercise the next day, you can have sex the next If you have a sling, you can't have put anything in your vagina for six weeks and you can't exercise Like Downtime's a big deal for busy women.

Bulkamid no downtime, just the day you're having the procedure, I have you pee before you leave my surgery center because I want to make sure you're not haven't blocked, and it's not permanent like a meshling is.

But the benefit is you don't have any risks of things being permanent in your body.

And so you just call me and you just tell me when it wears off, and we give you more insurance covers it.

This is no brainer it's a no brainer.

Nobody knows about Bulkaman yet.

It's been in Europe for over seven years.

It's been in America for about two to three years.

I went, I'm telling you, believe me.

I went in cynical and like, slings are pretty awesome.

Why am I gonna do something that's not maybe doesn't let like I went in fit with a scientist mind.

I'm like, I don't know about this.

If women tell me they don't like it, I'm not gonna do it.

Like that's how I went in, And now I'm like, these are the happiest freakin' women.

They like bring me house plants as thank you gifts.

One woman came in with no underwear on to just to show me she can wear no underwear elk.

She has like a love it, like these are happy women because it's like it's hardly a surgery.

I give you a little ivy a aesesia because if you're going to put a needle in myurethra, I'd like a little ivan asesia, like no breathing tube, no incisions, no stitches, like this is filler for your urethra, for stress and contents and insurance covers it.

I can't take it.

And I feel like women don't care about going and getting something done again because they're used to getting the botox or getting you know, you go and get your teeth cleaned.

How often?

I don't know.

I just feel like that's I agree.

When I was starting to do this procedure, I had a woman come back at a year.

She's like, yeah, more off, And I'm like, let listen, let me ask you.

Would you rather come back and see me once a year for this or would you rather me give you a sling?

Right yeah?

And she's like this once a year, hands down, keep the mesh out of my body.

And I'm like, the women are speaking, man, they know what they want.

We've got options, they know they want the bulkamen.

It's like very rare that I see a woman and do a sling.

Now, it's usually like do a balkamid if it's what if it didn't meet your expectations, let's do it again.

So you get two bulkamids before you've bought yourself a sling.

And I've probably done two hundred to two hundred and fifty bulcamed in the last like two and a half years, and I've put slings in four of those people.

It's a great, oh.

Come, this is amazing.

And so it doesn't always come down to like not having a strong pelvic floor.

Not always.

No, the the control of urine is actually quite complicated, right, So it's like the integrity of your urethra, how you integrity of the urethra, collagen and hormones.

Right, Estrogen really helps the mucosa, the collagen, the blood blood just keeps things plump.

So it does an atrophy.

So estrogen hormones also the descent of the urethra where it rides underneath your pubic bone.

It can get pushed down a little bit by having a baby age all that stuff, and then the muscles of the pelvic floor.

So it's not just you know, I agree with the pelvic floor.

Physical therapists try it.

It's not invasive, they can help.

It makes a world a difference.

But if it.

Helped everybody, I would be out of a job in that department.

And I'm telling you, I'm not Yeah.

Do you do vaginal reconstruction surgery Yeah, for prolabse yeah, yeah, or just anything woman I don't do.

I cringe.

I get very I'm very I'm a protective person.

I get very protective of my women, and I get very cringy anytime people are like tightening rejuvenation, Like those words mean nothing, and you're playing on the insecurities of women because they don't know if their vulva and vagina's normal.

And like, I think there's a huge market for preying on women's insecurities about their genitals.

So I do nothing like that.

Yeah.

For me, it's like, dude, I had a baby, I haven't bet on my hormones, the tennis balls falling out, and I can't exercise.

I'm like, fix it if you want to fix it.

Absolutely, So I do a lot of pelvic surgeries, a lot of vaginal surgeries.

But anybody who's got a website about rejuvenation and tightening.

What the fuck is tightening?

Okay, well we so we To me, I'm like you people come to see me because sex is painful, because it's too tight because they don't have estrogen.

So to me, I'm like anybody who's branding vaginal tightening is I don't know a predator.

Okay, well we read how you said there are three things that you should never do, and I have done two of them.

R the vaginal kitness and the overactive bladder, which I've done that.

So I guess that.

Anticke a energics for overactive bad.

Yeah.

So between Haley and I we have covered them all, but her and I both have done pr P in the dress.

You please tell us why we shouldn't do either of them.

Listen, if women want to spend their women can spend their money however they want to spend their money, Like, I'm not here to tell people not to.

They can dazzle their armpits for as much as I care.

But where I have a problem is when women are sold something, yes for something for something that doesn't either solve their problem, right yep.

That's my big issue of like, you know, take sexual desire.

For example, sexual desire is quite complicated.

It's biopsychosocial.

There's a great TED talk on it.

But it's like desires complex, right, Like it's your relationship, it's how you view your body image, it's your hormones, it's how good the sex is to begin with, Like, desires really complex.

And when a woman is sold like come get these proprietary injections to improve disease desire.

I know that's bullshit because it will not affect everybody's desire because desires complex.

Yeah right, and by the way, it's thousands of dollars.

Insurance doesn't cover it, and you have to keep doing it if it does work.

Yeah, so believe it.

For a woman who's like it were great, it's like, okay, well just wait for it, Like it's just have you budgeted for this plan?

Right?

Like totally.

I always joke like women shouldn't have to re mortgage their house to take care of their health.

No.

Yeah, that's such a good point though about the desire.

It is like we're missing that point.

And in your TED talk, I feel like one of the most important things you said too is your biggest sex organ is your brain and it's isn't that what you said?

Did?

I?

I want to repeat it correctly, and I just think, how you're exactly right.

Totally.

I mean if I think if I think my body's a disaster, it's failed me.

I'm worried about leaking.

I'm checking in on my thighs all the time.

Like, my experience of my sexual life is going to be very different than if I came in being like this is what I'm showing up with today and let's try to have a good time, which is even different than fuck, yeah, look at me.

Yeah, this is awesome.

I am hot, okay, right, because I think we're always trying to get to neutral.

Yeah, And it's like, what if we were profoundly radical and tried to get to freakin' awesome.

There's a book on that there, book called.

This is our best podcast already.

There's for people who are interested in at work to get like, there's this book called The Body is Not an Apology.

I think Sonya Renee Taylor, if I'm getting it right, it's like over on my bookshelf.

But she's like, why the hell are we striving for neutral?

So good?

And it's like as soon as she says, You're like, oh right, we've put the bar real low.

Yeah yeah, well, okay, this is like since I'm sharing everything, Like when I see these things advertised, You're right, Like I go down and book and I'm like, I don't know if if I'm normal, Like how do you know?

Because your body parts have been banned on the internet, Like the only body parts we see are photoshopped or video shopped or surgically augmented.

It's very hard for people to go and to see if they if like how does my chin compare?

Like you can go see a whole bunch of different chints, right, yeah, but like it's profoundly important to know that people sit within the Bell curve and if they don't that, you know, we can do something about it.

And even if you don't sit within the Bell curve, you can have an amazing sex life anyways, if it's not, you know, a broken thing.

I saw this woman, older woman.

She came in with her I think he was her husband.

We're doing a pelvic exam for like I don't even remember what it was for.

And she was like, I'm so sorry, I'm so sorry, I'm so ashamed, and I'm like, oh, you know, tell me about that.

And she's like my earlier husband, like before, the before husband had told her that she had a profoundly abnormal labia in volva, and I think it was a little more derogatory of a term.

I made it medical, but like derogatory term about how horrific her external genitalia were.

And I was like, listen, I'm gonna do you a favor.

I look at like fifteen volvas a day.

I have a lot of volva knowledge in my brain.

I'm just gonna tell you where you are on the bell curve.

Yeah.

She's like okay, Like I wanted to keep it like super neutral.

I'm like, I'm just going to tell you how average you are.

It did her exam and I'm like, you're like so average, you're unforgettable.

Like I can't actually remember her vulva now right, I'm like, you're just like average, normal bell curve, nothing remarkable.

And her husband looked at her and he's like, see, honey, I told you.

And I'm like, you get to release this asshole from your brain now.

But again, going back to sex ed, like she took that one guy's advice.

He wasn't he how many involvements.

Had that guy looked at right and taken him as what her body was.

That is so sad.

Anyways, I don't remember the point of that story, but like women are hiding in shame because they don't know if they're normal or not.

That's yes, that's the point.

Well, all of you know, we're at this age where when we are with our friends we're talking, we end up talking about all of these different things.

And a lot of my friends have said that they feel like their vagina has aged, like it's not looking the same and they and sometimes functioning the same, and they do want it to function like it did, but also look young.

And I never even thought about that until I started having conversations about it, and I'm at an older age.

But what do you think is the best advice for people that feel that way?

Yeah?

So, I mean again, this whole thing is biopsychosocial, right, Yeah, it's like, why do you want to change your body part?

Oh?

Because society told you youngers better?

Okay, interesting, so there might not actually be anything wrong with the body part you're just coming to And by the way, we wear clothes, like ninety nine percent of the time, like Society's literally not like I understand the face so much more because it's your billboard, right, But it's like, dude, literally, maybe a couple of people are looking at your volva and ideally they're having a hell of a good time with it and not trying to judge your like your anatomical age by it.

Yeah.

Right, But that's why I love these conversations, because like you just take somebody's concern and you just freaking blow it out of the water by being like, is anybody asking how old you are?

And you're like, hold on, let me check my volva.

Yeah, And what's funny is all, yeah, we'll save Well did your husband seeming like are there any complaints?

It's like no, he'd be all over it every day.

Yeah.

So I'm like, okay, this is my advice.

Number One, nothing prevents us from aging except for death.

Yeah, so true, you like nothing is stopping the clock.

And do you spend spend your whole life wishing you were a different age or your body look different at the on your deathbed, you kind of wish you didn't do that, Like, enjoy the time you had, right.

Number two, save your money, go get yourself some phenomenal good hormone healthcare because our I would agree, our volvas do change with age.

We lose volume, we lose elasticity, and a twenty dollars bottle of vaginal estrogen does a world of difference, and we should be putting it on our clitterists.

We should put putting it on our labia minora.

And that six o'clock entrance to the vagina is nasty.

It gets tight, and that's the first part that starts hurting when people start complaining of dryness or pain with sex.

So when I see people being like get tighter, I'm like, dude, just give it.

Give yourself five years with no hormones and you'll be tight to the point that you hate sex.

So like, I don't think that tightness should be a branding thing at all.

It makes no sense to me.

If you want to work on tightness, like get a good pelvic floor physical therapist, get your muscles toned right.

Yeah, so pelvic floor physical therapy and then vaginal estrogen.

But don't remortgage the house or brain, like go out to dinner or go on vacation.

With the amount of money that people are taking from women praying on their insecurity that their vulva doesn't look twenty like your partner doesn't care.

They probably just want more sex.

Yeah, what are we try?

But when all you see online is like the plastic surgery images of this is how I can change a volva, you start thinking that's necessary.

It is completely not necessary to a great sex life.

So true, Well spend your money on.

Good vibrators, for sure.

That's what I thought you were going to say.

When you said hormut it on hormone.

I was like, we're having the vibrate vibrary conversation.

Wow, we invest in some good vibrators, Like a twenty dollars vibrator is kind of a piece of crap.

Yeah, in my opinion, this is this is the best.

Okay, the pelvic floor physical therapist.

I went because I had a lot of issues with my my last my third child birth.

I didn't know that entelled and when I went in there, I was like, well.

That was spir is personal and for people, I want to address that right because I see a lot of women say I don't want to go because I'm worried about an internal exam stuff like that, and I'm like, you need to communicate that to them.

You need to tell them you're boues, whether you've had a history of trauma.

You don't have to tell the details.

But I fully respect if a woman is not ready to get naked and have some fingers in her for, you know, checking out her hip joint on the first date, I get it.

Yeah.

And physical therapists can do a lot without going inside of you.

They're very talented people.

They're better than doctors are at assessing pelvic floor muscles and inside the vagina is the way to do that.

But they can do a lot without doing that, and you can also get to know them.

Is this a good fit?

Are we aligned in what the plan is?

Do I feel good showing up here right?

Like you don't have to rush into the internal exam, but you got to communicate it.

You can't be like, well here I go and then be like I wish I didn't I wish we didn't do that.

Like address that, bring that up on the front end, is would be my advice.

That's good advice.

Oh, I just didn't know what I was getting into.

I mean, like, the lady was amazing, but I was just like she's like, okay, so this is what's happening.

I was like, ah, well, I thought I was coming in here for a hamstring something.

Where are we going with this?

You learned a lot.

But with I mean, they're incredibly talented.

There is like not a pelvic floor physical therapist that I haven't liked yet.

They're invaluable people.

I mean, it's so silly our healthcare system, right, Like I'm a surgeon.

People come to me first of all not wanting surgery, and then I'm like, you know, I'm a surgeon and They're like no, I didn't know that.

And I'm like, okay, well Google.

But but I'm like, you can go to physical therapy first.

The surgeon doesn't have to be your first stop, right, And so many good pelvic floor physical therapists will tell you though.

They'll be like, go see a doctor, get on vaginal estrogen, like they know the importance of hormones in pelvic health.

So we're all it's all just kind of like a mutual love fest that like we love them, they love us because we all do a different part to help help a woman.

So besides the estrogen, what is another essential hormone that you feel like is really helpful for women?

Testosterone and progosta.

Yeah, so there's three.

I mean, there's three hormones that we can buy, right, like that, we have pharmacies that we've created our bodies.

Well, I mean besides the other hormones of like insulin, thyroid, you know all tho sick.

But we're talking like perimenopause menopause hormones.

And to call these sex hormones is a complete misnomer, Like, yes, our gonads make most of them, but like they work in your brain, they work in your heart, they help with insulin resistance.

Like the fact that we've labeled them sex hormones is actually like a dismissal of their importance.

They're vitally important for our entire body.

But again we didn't get taught that.

But so there we have many hormones within the like there's many types of estrogen.

There's several types of androgens, like all of these different things.

But we have three that like money can buy, money can buy testosterone, progesterone, estrogen.

Our ovaries make testosterone which then gets converted into estrogen.

So it's actually wrong to say ovaries make estrogen because you're missing out.

You're missing out the fact that like we actually have more testosterone in our bodies than estrogen because we make testosterone to make some estrogen, which is I didn't even get taught that in medical school.

Like it's insulting how little we know about our bodies.

But so to me, in perimenopause and menopause, those are the three options on the table, and I think they're all important and they all do different things.

And if you see somebody for hormones and they don't talk about all three of those things, then I wouldn't say they're comprehensive if they're only would.

I like put this on Instagram the other day and like, if your only option for a woman is a pellet of one type, you're a one trick pony.

You're not actually a hormone expert.

I loved when you said that.

Oh, I loved when you said the pharmacists or assholes quote.

I was like, yeah, so let's talk about that.

The testosterone and the lack of you know how hard it is to get from it.

It's embarrassing.

And the reason why it's embarrassing is because I know, I trust and I believe that in the future it's going to be better.

Like I know that I know there is a world where we have good access to this, and so I'm like, oh my god, I'm part of the generation where it's embarrassing, but like we have to help get it there.

Right.

So ovaries make testosterone.

All people have testosterone.

Men just have more of it, right, Like people need to know that because otherwise I come in looking like this crazy person who's like testosterone for women, and they're like what right, So you got to like go back to the education first.

But the FDA has about twenty different products for testosterone for men.

We have ero for women.

The FDA has said we want five more years of safety data for testosterone for women, more safety data than we have for men.

The additional problem, because of the Olympic doping scandals of the seventies and eighties, our legislature got a little pissed that people were doping, so they put in the FED a federal act that all of these synthetic androgens are now banned substances, and on that list was one naturally occurring hormone called testosterone.

People do not overdose testosterone like they do not do it.

They might become they might have gros some more hair and get angry, like there's side effects, but like too much disosterone doesn't kill a person.

But it's on this list of banned subst stances, including fentanyl and oxycodone.

What that does is it prevents access because now we've labeled it as unsafe instead of something your body naturally makes.

Right, So we've got two problems.

We do not have a female dosed product approved by the FDA.

That means insurance won't cover it, and you have to dose it appropriately and it's actually difficult to do.

The other problem is now it's on the DEA list.

Your name goes on a register of being somebody who has a controlled substance it legit.

Yeah, California has its own list because they wanted today want to know everybody who's taken oxycodone and fentanyl and ope tiestosterones on that list, and you have to see a doctor every six months for your prescription instead of every year because it's on that list.

And it also carries the stigma of doctors being like that's unsafe.

That's a steroid.

Of like, course it's a steroid, so but so it's cholesterol, like something being a steroid means nothing.

So yeah, we've got a lot, a lot of barriers to testosterone.

But let me tell you, there is nothing like testosterone appropriately dosed in a woman made midlife where she comes back to see me and she says, I'm back.

Oh, I just got the chills.

I feel more like myself.

And I'm like, at the end of the day, if my job as a doctor isn't to make you feel more like yourself, what are we doing?

You know?

Like, there is something profoundly better about women when they are on testosterone.

They come back and they're like, I can think faster, I'm quicker, I have more energy, I can recover better from the gym more.

I just had a woman She's like, I'm more interested in the world.

Again, You're never going to get an FDA approval for something that makes you more interested in the world, right, Like, it's these these stories that come back.

The other bullshit about testosterone for women is that the main global consensus it is for low desire.

Why is the only legitimate reason for you to be on a hormone for you to sleep with somebody else?

Good point, Well, messed up.

It's so messed up.

I didn't even think about that.

Like my male brother pointed that out to me.

He's like, Kelly, isn't it kind of weird that, like the only reason for women to take testosterone is to like sleep with dudes?

And I'm like, yes, bro, Yes, yes, bro, thanks for putting that out to me.

Gosh, and I don't want to be on any anyone's list, any government.

Get as you are if you take testosterone.

Or like America's most wanted.

It makes it sound like you're doing something dangerous.

And so in a woman's body, the testosterone she has in her twenties is about forty to fifty percent higher than the testosterone she has in her forties.

Wow, testosterone starts going down much early.

We kind of think of menopause as like and on Tuesday, the ovaries stopped and then everything fell off a cliff.

Right, That's not how it works for testosterone.

It's a very much slower decline, but it starts earlier.

But you're still gonna make some testosterone even after the periods are done.

Right, So testosterone is kind of like slow but early, but can you can keep getting making some estrogen is like in perimenopause, it's like up down up down, super up, way down up down here's the period.

Now you're not going to have one for a while.

So estrogen is like spastic, right, and then progesterone can kind of it's kind of doing its own thing.

Nobody's really paid it.

It's like the it's like the step brother that like doesn't doesn't come out of its room.

Much like, we haven't really looked at progesterone very much.

So, but progesteron is profoundly important for mood and sleep.

We just we just I think we need more research, especially in perimenopause.

But so to say for a woman who's still she's perimenopause, she still has her periods, maybe her energy is low, maybe her sexual desire is low.

To me, I'm like, I'm checking that woman's testosterone way before I'm telling her to go get PRP and her clitterists or lasers or you know anything else.

Is like, there's things happening in your body, let's optimize them.

And by the way, it's predamn cheap.

So but mean it all comes back to education.

The more we know, the less we're gonna fall victim to people who just want to make money off of us.

Yeah, okay, so with testosterone, when it's low for certain women.

I just had a conversation about this this week.

That can affect your ability to grow muscle.

Yes, so I have some clients.

I mean I only work with people forty plus and most of them are in their fifties and their post metapuzzle and when they again, different conversation.

But when they come and they're like, well, I don't want to get bulky, and I'm like, do you know how you are?

Like try?

I'm like, do you know how many women that like, we'll talk to them when they're passed out on the floor just because they're trying to main pin their muscle that they have.

Dude, And the role of muscle and longevity, the role of muscle and insulin resistance, the role of muscle in bone health, the role of muscle in preventing falls.

Like I'm telling you, if you want to do anything to help out your seventy two year old future self, lift the weights.

Please preaching to the choir, but it's like, dude, muscles are so important.

Yeah.

I just saw a lady, she's sixty, she just came back four months.

So sometimes taking disasterone, especially when it's appropriately dosed, and we can go into that, but she's about four months in.

She's like, I'm noticing now my lean body mass, right, but in appropriately does hormones like it's gonna get you there slowly, not like four months is slow?

Right, she spent she spent ten years without the damn stuff.

Yeah, but you know, to be like, yeah, I think all tastostone's important and wound healing.

Right, Orthopedic is looking like the orthopedic world is looking.

They did a study where they gave dudes super high to stosterone, like way more than standard replacement before hip replacements, and they actually did better.

No way, it's a little unorthodox, but like people are, you know, I think we are under because of the stigma and all the other things that we're calling these things sex hormones.

We're under researching the role of hormones in healing and lean body mass.

Certainly we know how important it is for bone protection and in women, your bone loss starts before your period's end.

I was like, oh, that happens after your periods end.

It's like no, no, no, this starts before because remember, the hormones are already doing their thing before the period stop.

It's profoundly important.

I am I am, I'm getting blood work done, oversation, I'm giving you a standing ovation.

I don't want it to end.

I'm super sensitive in your time, in our hours.

But holy like my brain is just running with all of these conversations that I mean, I love what you're doing, Kelly.

I love how I love your personality number one.

I mean that alone outside of all of the education and knowledge that you're sharing, but like it's just on the opposite side to wrap up, like, I see women all the time that are just like shamed about weight or the fact that they don't have as much lean body mass and all of these things, and I'm just like, why are we making our lives miserable when it's just hard?

I mean, and a lot of that comes from biopsychosocial and it's just it makes me so sad when women are just like kind of told that after midlife, like well, why do you care that much about your body or about your sex or about you know anything.

It's just it's very disheartening.

And you know, I thought about this.

These are things I think about a lot, so you know, we're like, oh, society tells women all these things.

Ah, and it's like we just lay down and fucking accept that.

And it's like, no, no, you get to decide.

You control the narrative.

You tell people how to treat you, You tell people what women are like at this age.

Like there's I'm so sick of this, like laying down and taking it attitude of like do you not realize your power?

We have immense power, freaking use it.

Yes, aimen to that.

And I think the older we get, the better we get.

I don't think it's oh.

My god, yeah, I mean just look, you know, I'm so inspired by the thing of like, you know, Martha Stewart.

Stewart didn't make her first million, and I'm making this up because I haven't looked recently, but like women kick it in the gear in mid life.

Yeah, for any woman to be like, oh.

They told me that this is just blah blah blah, it's like, no, no, no, this is when you can kick it into gear.

If that's what you want to do.

You don't have to do that, right.

But it's like, you write the narrative because we have the immense privilege of living long and we've never lived this long before on a global scale, we are literally making it up.

What aging looks like, all this is just a big grand experiment for the next generation, right, We're trying to help help out our kids.

So what you are doing, I think it's like an amazing.

Moment right now in mid life for women.

And I'm like so happy to be part of the conversation.

Yes, that is the perfect way to end really quick.

Can people see you online?

Do you do telehealth or are you ful?

It's a good question.

So I practice in Washington State.

I currently only have a Washington state license.

So what that means is you must be the bullshit of the world, right, Like, do you think healthcare is any different in North Carolina than Washington State.

No, But state regulations don't blame the doctors for this, is what I'm saying.

State regulations say that the person has to be in the state where the doctor is licensed, which makes again arcane state rules.

But I'm already booked out for months and months and months taking care of Washingtonians.

So I'm like, I have no incentive to get other state licenses because I'm like, I had I got nine million people in this state, fifty percent of them are female.

Right, But so the point is I take care of Washington state people or people who fly in right now.

I have no problem with you flying in, but.

Oh I'm flying in.

I'm gonna get on.

Your note to me.

I'm like, I like, you're in Boulder, you have resources.

I will get you the people.

Yeah, okay, doctor Krollen phronsiac.

You will say, you know me, I will help with her, take taking care of you.

We will get all the women, all the balkamed in Boulder in Colorado, and it'll.

Be will help other people done.

I'm done, all right.

So your Instagram is that the best place for people to get a hold of you or follow you?

So either in Instagram because I love it, but it gets a little busy on there, you know, so you can always send me an email info at Kellycasperson MD dot com.

That's through my website, which is Kellycasperson MD dot com.

My baby of babies is the podcast.

You Are Not Broken.

I love it.

That's the long form, right because like you have to hear these things a couple of times to like understand hormones and like the pelvis and how it works.

So I love a lot, Like podcasting is my favorite thing.

So You're Not Broken?

And then the book is being re released September tenth, so it's for pre sale on Amazon right now.

If you didn't get the book before, it's now taken down and re releasing September tenth, which is you are not broken, stop shooting all over your sex life.

Okay, we're we're coming back on in September when you're slammed exactly nine million.

Everyone has like nine million Instagram lives.

Oh, I'm already pre booking, so we want to pre book you now because this is amazing and we're making everyone by the book.

I'm going to pre buy the pre sell right now on Amazon because I just think you're fabulous and we are so grateful for your time and for everything that you're doing to serve women.

So thank you so much for that, and we look forward to your book launch.

Yeah, thank you, thank you.

Thank you guys so much for having me.

Thanks for listening everyone.

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