Episode 396: Hope Is Not a Strategy — Dr. Marty Klein on Communication, Masculinity, and What Makes Sex SatisfyingWhat if the biggest obstacle in your sex life isn’t your body? What if it’s your expectations?This week I sit down with sex therapist Dr. Marty Klein for a wide-ranging conversation about communication, intimacy, and what actually happens in a sex therapist’s office. We start with ego. When it drives the conversation, we listen to respond instead of to understand, and then we wonder why we feel disconnected. Marty also shares what he sees in his Silicon Valley practice, where a culture built on optimization and problem-solving shapes how people approach intimacy. We talk about people turning to AI for relationship advice. It’s convenient, and it might simplify things. But it can’t replace the depth of a real human connection, and it may just tell your ego what it wants to hear.Then we get into sexual function. Expectations play a huge role in erectile dysfunction, and good therapy starts by asking a simple question: what do you actually want? Marty explains why defining a “satisfying sexual event” matters so much, especially for older adults looking for intimacy. His blunt reminder: hope alone is not a treatment plan.We also take on modern masculinity. We talk about the manosphere, the anger many young men are carrying, and why anger is not an effective way to attract a partner. Many young men feel isolated and are struggling with the social skills dating requires. Early wounds to masculinity can shape a man’s confidence for decades, and Marty explains why men often have a harder time recovering from them than women. We close with trauma, relaxation, and the body. Relaxation matters more than intensity. Sex is an idea as much as a physical act. And you can have a full, rich life without being defined by what happened to you.In this episode, we talk about:How ego undermines communication, and the habit of listening to respond instead of to understandActive listening, open-ended questions, and validating feelingsHow Silicon Valley’s culture shapes the way people approach intimacyAI as a relationship advisor: what it offers, and what it can’t replaceWhat sex therapists actually do, and why they help with non-sexual relationship problems tooThe role of expectations in erectile dysfunctionWhy defining a “satisfying sexual event” is central to sex therapyThe unique challenges older adults face in finding intimacyWhy therapy should focus on what clients want to achieve, and why hope alone is not a strategyWhy understanding the context of sexual dysfunction is essentialThe manosphere, and why anger doesn’t attract partnersIsolation and the social skills deficit many young men face in datingThe long-lasting effects of early wounds to masculinityHow trauma affects identity and recoveryReconnecting with your body for a more fulfilling sex lifeWhy relaxation matters more than intensitySex as an idea, not just a physical actBuilding a fulfilling life after traumahttps://www.instagram.com/doctormartykleinhttps://www.youtube.com/c/DrMartyKlein1As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Vibrator 101: Everything You Wanted to Know, But Were Too Embarrassed to AskUse code "notbroken20" at elixirplay.com for 20% offDr. Kelly Casperson explores vibrator basics through anatomy, blood flow, arousal, and pleasure. She discusses why sex education often misses important information about women’s bodies, reviews research on vibrator use, demonstrates different toy styles, and answers audience questions about squirting, pain, prolapse, and beginner-friendly options.The conversation emphasizes education over shame: understanding the clitoris, allowing time for arousal, and seeing vibrators as one possible tool for sexual wellbeing—not a replacement for a partner or a one-size-fits-all solution.Key topicsHow blood flow relates to genital arousal and sexual functionThe clitoris, the primary organ of orgasm for most women, and how it relates to the vaginaHow desire can be responsive and emerge during or after arousalWhy arousal matters before penetration, particularly when pain or low hormones are involvedThe G spot as a sensitive area associated with clitoral anatomyWater-based, silicone-based, and oil-based lubricantsResearch on vibrator use and sexual function, satisfaction, and pelvic healthKelly’s HEAL framework: hormones, education, arousal and vibration, and lube and moisturizersDifferent vibrator styles and considerations when choosing oneMyths about numbness, replacing partners, or becoming “addicted” to vibratorsAudience questions about squirting, prolapse, clitoral hood fusion, pain after orgasm, and antidepressantsAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Episode 394 – Dr. Susan MacDonald on Testicular Pain, Pelvic Floor Dysfunction, and Rebuilding Life After Stage 4 Breast CancerNormal scan. Normal labs. Still in pain. Now what?Dr. Casperson is joined by fellow urologist Dr. Susan MacDonald for a conversation that starts with male pelvic pain and ends somewhere much more personal. They discuss why men with testicular pain are so often dismissed, how chronic pain gets mislabeled, and why pelvic floor dysfunction and referred pain get missed again and again.Then Dr. MacDonald shares her own story. She was diagnosed with de novo stage 4 bilateral breast cancer after missing her own early symptoms, and she describes what it's like to go from surgeon to patient. She talks openly about fatigue, grief, hormonal changes, and the career pivot she never chose. She also explains why she now wants to help patients move beyond survival mode toward resilience and joy.In this episode:How Dr. MacDonald found urology by accident (Grand Rounds, free pizza, and the realization that it's a surgical specialty)Why male reconstruction and urethroplasty won her overWhat urethral strictures are, and why tissue from inside the cheek is used to repair themHow common testicular and pelvic pain is. She estimates about 5% of urology consults.Why chronic pain is harder to treat than a kidney stone, and why normal imaging doesn't mean the pain isn't realThe harm of forcing a diagnosis, and patients carrying "heavy bricks in a backpack" of labelsThinking through a differential diagnosis out loud, with the patient as a partnerPlacebo effects, and why antibiotics can seem to help even when infection isn't the causePelvic floor dysfunction as the missing center of the Venn diagram, and the value of working with pelvic floor physical therapistsHer stage 4 breast cancer diagnosis, and how surgeons are trained to ignore their own bodiesLiving through treatment: fatigue, insomnia, arthritis, hormonal changes, and griefWhy leaving full-time academic surgery was forced, not voluntary, and her pivot into video education and speakingSex after cancer, and why the messaging for men and women is so differentTart cherry juice and hot flashesDr. MacDonald Linked InAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Casperson is joined by Dr. Rebbecca Hertel, DO, MSCP, for a candid conversation about getting stronger through perimenopause and beyond. They talk about how hormonal shifts change training, recovery, and body composition. They also cover why bone health deserves your attention now, and how to read research and lab results with a critical eye.Along the way, Dr. Hertel explains what osteopathic medicine actually is. She also shares why your pain might not be coming from where you feel it. The two dig into protein, GLP-1s, testosterone, and hormone therapy, and why finding a clinician who listens matters as much as any prescription.In this episode:What osteopathic medicine and osteopathic manipulative treatment (OMT) involveWhy pain can show up somewhere other than its sourceHow perimenopause affects muscle, recovery, sleep, and body compositionWhy gaining muscle in midlife takes longer, and why it's still worth itBone health, fracture prevention, and the case for resistance trainingProtein, hydration, and fueling your body during weight lossGLP-1 medications and strategies to help preserve muscleHormone approaches in perimenopause and postmenopauseWhy hormone therapy is not contraceptionTestosterone: symptoms, side effects, and how to think about lab resultsHealth span, independence, and prevention across the lifespanHormone stigma and the need for better education at puberty, postpartum, and midlifeDr. Hertel's IGDr Hertel's WebsiteAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Episode 392 – When in Menopause: Advocacy, Policy, and the Power of Speaking UpWho gets to be a menopause advocate? You do. You probably already are.Dr. Casperson sits down with Jennifer Weiss-Wolf, a lawyer, women's leadership leader at NYU Law, and author of When in Menopause: A User's Manual and Citizen's Guide. Jennifer helped drive the fast, bipartisan wins in period policy. Now she's applying those lessons to menopause, and she's honest about why this one is harder.They cover where the policy wins are coming from, what still blocks progress, and why workplace perks miss the point. They also talk about why the real work is bigger than any one issue. If you're a clinician, an advocate, or just someone who wants to make change without a big platform, this one is for you.In this episode:How Jennifer moved from menstruation policy to menopause around 2020. It started with a friend's question about the policy landscape, not with her own symptoms.Advocacy as a choose-your-own-adventure. Legislative language, storytelling, and community-building all count.What period policy taught her about state-level wins and working across the aisle.Why menopause reform is more complicated than it looks. Decades of neglected science and deeply interconnected issues make it hard. She describes the field as organic rather than fractured.Language, stigma, and culture. How do you change policy when people still can't say "vagina" in public or on social media?Why most workplace accommodations fall short. Many are too small, too generic, or built on a weak understanding of menopause. Protections also have to come before anyone asks employees to disclose.The legal gap. The U.S. has no clear anti-discrimination protection for menopause. The ADA, pregnancy protections, and age-discrimination law help in some cases, but they leave holes.What actually moves the needle: access, research funding, clinician education and training, and reimbursement reform. Business leaders should fund these upstream fixes instead of offering superficial perks.Clinicians already have a platform. Patient visits, office materials, and staff handouts all spread accurate information, and small repeated messages add up.Community is the engine. Jennifer's examples include gyms, book clubs, schools, libraries, and PTAs. Midlife women are an underestimated political and social force.Jennifer's IGJennifer's New BookAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Sameena Rahman on menopause, PMDD, PCOS, and why naming things mattersThis week I sat down with practicing gynecologist Dr. Sameena Rahman to talk about some of the most misunderstood areas in women's health: hormone replacement after oophorectomy, PMDD, and the recent renaming of PCOS. We move fast from clinical nuance to culture, stigma, and medical bias, and you'll walk away with plenty of practical takeaways whether you're a patient or a clinician.Sameena also shares the story behind her book, Brown Girls Disease, and why she's reclaiming language around pain, shame, and access to care.In this episode, we talk about:Why women who have their ovaries removed need full hormone replacement, not just a low-dose patchThe difference between menopause management and medical neglect after hysterectomy or oophorectomyThe evidence that early menopause plus hormone therapy can have major survival benefitsWhat PMDD is, how it differs from typical PMS, and why it can feel like "Jekyll and Hyde" every monthWhy PMDD may be more about hormone sensitivity and brain receptor interactions than progesterone alonePMDD treatment options, including SSRIs, specific birth control formulations, progesterone, and in extreme cases medical suppressionWhy the old label PCOS creates stigma and hides the cardiometabolic risk behind the syndromeThe new name, polyendocrine metabolic ovarian syndrome, and why I think the rename could finally bring primary care and internal medicine into the conversationHow PCOS affects fertility, diabetes risk, heart health, weight gain, and endometrial cancer riskHow pelvic pain, vaginismus, and sexual dysfunction are shaped by culture, religion, and medical biasWhy Sameena chose the title Brown Girls Disease as a way of reclaiming a term that had been used dismissivelyHow language changes care, from saying "vagina" out loud to replacing shame-based terms with clearer onesNaming things matters. You are not broken.Dr. Rahman's IGAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care.If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead.What We CoverWhat vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the bodyWhy so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulvaHow symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSMWhy numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worseBarrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdownHow overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketingWaxing, microtrauma, and hair as a protective barrierGSM, recurrent UTIs, and why vaginal estrogen is still so underprescribedLate diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealthNotable Quotes"My five year old can say vulva.""I really like talking about uncomfortable things and making comfortable people uncomfortable.""Just do what brings you joy."About Dr. Melissa MauskarDr. Melissa Mauskar is an Associate Professor of Dermatology and of Obstetrics and Gynecology at UT Southwestern Medical Center, where she's the founder and Director of the Vulvar Health Program — a tertiary referral center for gynecologists, dermatologists, and primary care physicians across Texas and the nation. She's a Fellow of the International Society for the Study of Vulvovaginal Diseases (ISSVD), founding president of the Vulvar Dermatoses Research Consortium, and serves on the board of the Women's Dermatologic Society. Learn more at utswmed.org/doctors/melissa-mauskar.As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I walk through the basics of vaginal estrogen and vaginal DHEA for genitourinary syndrome of menopause, recurrent UTIs, painful sex, urinary urgency, and vulvar tissue changes. I also answer audience questions throughout, covering safety after breast cancer, use alongside systemic HRT, dosing, formulations, and what to do when symptoms don't improve.This one's for clinicians and the general public alike, the focus is correcting misinformation, improving access, and helping people understand that low hormones can affect the pelvis long before or long after menopause.What We CoverWhat genitourinary syndrome of menopause (GSM) actually means, and why it replaced older terms like vaginal atrophyThe full range of GSM symptoms — urinary urgency, recurrent UTIs, bladder leakage, pain with sex, dryness, tissue thinning — as one unifying hormone-related syndromeWhy GSM is so common (roughly 50–90% of women at or after menopause) and can start in perimenopause, during breastfeeding, on oral birth control, or after cancer treatmentData showing vaginal estrogen can reduce recurrent UTIs by about 50%, plus a large database study linking vaginal estrogen use to lower hospitalization, ICU admission, and sepsis-related death in women with recurrent UTIsWhy "too old for vaginal estrogen" is a myth, and why age alone is never a reason to deny itSafety after breast cancer — why the evidence supports vaginal estrogen for many survivors, and why "zombie myths" keep resurfacing anywayThe difference between systemic and local hormone therapy, and why some people need bothCreams vs. tablets vs. rings vs. vaginal DHEA — and why DHEA can be especially useful for reversing established atrophy (it converts to both estrogen and testosterone)Practical stuff: burning, discharge, application technique, dosing frequency, and when it's time for a pelvic exam instead of another productUsing vaginal estrogen alongside clobetasol for lichen sclerosus, and alongside systemic estrogen or testosterone when appropriateNotable Quotes"The third pillar of academia is to communicate the research, to communicate the knowledge to the general population.""There is not an age your driver's license tells you if you're too young or too old for vaginal estrogen.""If atrophy happens because of low hormones and you add hormones back, you can reverse atrophy."Key FrameworksGSM as the unifying diagnosis for urinary, sexual, and vulvovaginal symptomsLocal hormone therapy vs. systemic hormone therapyPrevention vs. symptom treatment"Zombie myths" — outdated beliefs that keep resurfacing despite the evidenceWant to join me live for these? Get on my email list so you don't miss the next one.As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I talk with Dr. Lexx about how to have honest conversations about sex with kids, why sexual shame still shapes adult relationships, and how to think more clearly about desire, consent, and pleasure. We dig into misinformation around sex education, sex as a form of power, and what healthy support can look like from educators, counselors, and therapists.What We CoverSex-positive parenting and how to talk to kids about bodies and boundariesWhy sexuality education in the U.S. is more restricted than people think — and why "medically accurate" isn't a givenThe real difference between sex educators, sex counselors, and sex therapistsHow midlife, menopause, and shifting desire reshape relationshipsPractical ways to rebuild intimacy and connection when the spark fadesKey FrameworksPersonal parts — Language that reduces shame and emphasizes ownership over the body.Unwanted touch / secret touch — Clearer safety language than "good touch, bad touch."Sexuality as a whole-life concept — Not just intercourse, but identity, embodiment, relationships, and power.Compersion — Feeling happy for a partner's pleasure or joy, even if it isn't personally relevant.Sensate focus — Purposeful nonsexual touch used to rebuild connection and learn what feels good.Consent first — The baseline for everything, including fantasy, touch, and negotiation.About Dr. LexxDr. Lexx (Lexx, The Sex Doc) is a sex therapist, educator, and speaker whose work centers healing, pleasure, and connection — with a particular focus on Black, Brown, and queer communities often left out of traditional therapy spaces. Learn more at lexxsexdoc.com.https://lexxsexdoc.com/Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode 387, I sit down with Dr. Lucy McBride to talk about the widening gap between the traditional medical system and the wellness industry, and how patients can find solid ground in between. Lucy makes the case for evidence-based advice, realistic expectations, and actually engaging with your healthcare system instead of trying to DIY your way to health.What We CoverThe gap between the medical system and the wellness industryWhy evidence-based health advice matters more than everThe risks of wellness products and influencers overpromising certaintyHow patients can better engage with (not opt out of) the healthcare systemSupplements, vitamins, and gadgets — what's worth your money and what isn'tThe wellness industry often overpromises certainty and results it can't back up.Living in the "middle ground" means engaging with the healthcare system effectively rather than avoiding it.Dr. McBride's book, Beyond the Prescription, is a practical guide for navigating health choices.About Dr. Lucy McBrideDr. Lucy McBride is a practicing internist and the author of Beyond the Prescription: How to Contextualize Your Health and Break Free from a Lifetime of Fatigue, Anxiety, and Stress. Grab her book here: Beyond the Prescriptionhttps://www.lucymcbride.com/https://www.instagram.com/drlucymcbride/SubstackAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.