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BETTER! Muscle, Metabolism, Meals, & Mindset in (Peri) Menopause with Dr. Stephanie Estima
Why Sexual Health Is Actually a Life-or-Death Issue with Dr. Juliana Hauser
01:15:03
Dr. Juliana Hauser reveals why sexual agency is the ultimate form of self-knowledge—and how ignoring your sexual health can have life-or-death consequences. From understanding your anatomy to navigating menopause, this conversation reframes sexuality as a vital sign of wellness, not a luxury. Learn the nine pillars of holistic sexuality and why knowing your "yucks and yums" changes everything. Watch the full episode at https://youtu.be/LAFDFOPsWeQ
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- [00:00]
Dr. Juliana Hauser
If you are breathing, you're sexual. So you don't actually have to put it on your to do list, which is a wonderful thing. You are sexual by nature of being human. It's one of the few things that we all have in common. We are all sexual beings just by birthright. Like, you know, when do you ever get a standing ovation for your vulva when it's not in a sexual act?
- [00:21]
Dr. Stephanie Estima
It should be a rite of passage.
- [00:23]
Dr. Juliana Hauser
It really should be. Because it's pretty amazing, to be honest. Like, you have to look at your anatomy. Like you would talk about kissing. People will have one story, and mine is ninth grade in. In the movie theater. And I'm not going to say his name because he's a nice person, but he basically licked my face.
- [00:40]
Dr. Stephanie Estima
Yeah.
- [00:40]
Dr. Juliana Hauser
And you know, it's just.
- [00:42]
Dr. Stephanie Estima
That's mine too.
- [00:42]
Dr. Juliana Hauser
Yeah. For women, a word that I use and I'm tentative with how I use it, but I would say we have a very delicate. And delicate doesn't mean fragile, but sophisticated maybe. Sophisticated, yeah. I like that word too elegant. Whatever right word. Feels that it's not bad.
- [01:02]
Dr. Stephanie Estima
God. Wow. I'm very rarely shocked and speechless, and I'm a little speechless right now. That is unbelievable. Hello, my friends. Welcome back to another episode of better with Dr. Stephanie. It's me, your host, Dr. Stephanie Estima. And in today's episode, we are going to discover how your sexuality can literally be a case of. Of life or death and why you need to pay attention to it. My guest today is Dr. Juliana Hauser. She is a licensed marriage and family therapist. She holds a bachelor's degree from Center College, master's degree from Auburn university, and a PhD from the esteemed College of William and Mary. And today we are talking all about sexuality and holistic sexuality. So we're not just talking about sexual acts. Right. We are talking about what it means to be a sensual being. How that through line puts, pervades other areas and other verticals of your life. We talk about how our sexuality changes from our 20s, our 30s, and some of the physiological changes in our 40s and 50s, and how that informs our sexuality. We talk about arousal, desire, gosh, pleasure. We talk about why sexuality is very male centric in terms of what. Even when we think about sex, what. What are we thinking about? Right. We're thinking about, you know, P in the V. Right. So if you're listening in the car with young children, this is not the episode to listen in front of them. You might want to save this for your afternoon walk or Another time when little ears are not listening. But this is really going to help reframe potentially through different filters other than religion and culture and the names that we've been told, if we enjoy or don't enjoy sex, what that means for us as sexual beings on this planet. So please enjoy my conversation with Juliana Hauser. If you've been following me for a while, you know that I am always looking for evidence based ways to support longevity, especially during perimenopause, menopause and beyond. When we experience shifts in energy recovery and resilience, this is when it really starts to show up. One of the most fascinating compounds I've been exploring lately is spermidine. Terrible name, I know, but hang on. When we're younger, our bodies produce most of the spermidine that we need internally through our gut, microbiome and our cells. But as we age, that production declines and we become much more reliant on dietary sources. Spermidine is part of a family of compounds called polyamines and it' one of the most important roles in your body for activating autophagy. That is your body's cellular renewal and recycling system. But what's really exciting is that it also supports mitophagy, which is the process of cleaning out and clearing out damaged and old and slow mitochondria, making way for healthier, faster and more efficient ones. And since your mitochondria are responsible for producing energy in every single cell, this is going to have a direct impact on how you feel every day. So your stamina and even that underlying fatigue that so many women often experience and complain about in midlife. This is where Primidine from Oxford Healthspan really stands out. It delivers food derived polyamines. So you're not just getting an isolated spermidine, you're getting it from the same form that naturally occurs in whole foods. And it also comes with complementary polyamines that work together to support these longevity pathways. Spermidine has been associated with lots of benefits, ranging from cognitive support and heart health to hormone balance and even visible changes like stronger hair, skin and nails. For me, one of the most noticeable shifts is the sustained energy and cellular vitality that I experience. It has become foundational in my daily routine. If you'd like to have these benefits and try it for yourself, you can head over to Oxford healthspan.com Dr. Stephanie, that's my name and use code Dr. Stephanie and you're going to get 20% off your order. That's Oxford healthspan.com doctorstephani and use code-R S T E P H A N I E. All right, and we're live. Dr. Juliana Hauser, I am thrilled to have you on the Better Podcast. Welcome to the show.
- [05:19]
Dr. Juliana Hauser
It's so great to see you again.
- [05:21]
Dr. Stephanie Estima
It is so great to see you again. We are here now, and we are talking about your book, a New Position on Sex. And I have had the pleasure of spending some time with you in real life, which is, you know, luxury these days. You're such an interesting person, and you really walk the walk. You're so accepting, and you talk about very difficult subject matter in a way that's accessible for a lot of people. And this is what I'm really hoping with this conversation where we can talk about sexuality, arousal, desire, the stuff that changes as we grow older, and what is required for us to have a holistic view of our sexuality. So with that, I want to start by talking about this idea that women already have a lot on their to do list. So, you know, they listen to my podcast and they hear me saying, you gotta strength train, you gotta do mob, you gotta do mobility work. You know, you gotta do cardio, you gotta do zone one, zone two. You gotta polarize your training. And so it's like, all right, that I put that on my. On my list. And now we're having this conversation where you are going to, I think, talk about why we need to prioritize our sexuality and our sensuality and why this is a vital sign. And I think that there is a possibility to misconstrue that for women saying, oh, gosh darn it, there's just. Now there's just another thing on my to do list. I gotta. Now I gotta be sexual, right? Yes. So tell us. Tell us why. Being in touch with our. Maybe our sensuality, sexuality, if we needed to define those terms, we can do that as well. Why that is a vital sign and why that is a key component to living well, aging well, and feeling good in our bodies.
- [06:59]
Dr. Juliana Hauser
And it's probably the biggest hurdle that I face in the work that I do is helping convince people that the sexuality, and particularly holistic sexuality, isn't a luxury, it's a necessity, because that is not what we're taught. We are taught that it has a purpose and a place, and it's for certain kinds of people at certain times in our life. And. And it's. It is something that is not of benefit beyond a few minutes, and that's just not accurate. And I'll give. There's a couple of a couple of different places in which our sexual health really matters and why I think it is pivotal and in our well being, our overall health and well being and particularly our mental health. So one of which is we have the science that shows that if you are participating in sex acts and you have pleasure associated with it, that you have a flooding of hormones. And those hormones are very good for us. And, and that if you are having sexual connection that feels connected to you, it doesn't have to be love connection, it can just be like feeling wanted connection. But if you are having connection through sharing your body with one or more people, that the benefit of connection to your mental health and to your positioning in the world makes a very big difference. It's very highly beneficial to have that. The trifecta is when you are sexually active with somebody or with people who are seeing you and valuing you and wanting you and, and that feels soulful to people. That's doesn't have to, that's not the gold standard that hasn't happened all the time or it doesn't have to be with every sexual interaction that you have. But finding those three things can make a very big difference in your mental health and your overall physical health too. There's lots of studies about the physical benefits beyond the hormonal flesh that there's just, there's cardio as an aspect for it. It is something that is helping with your tissues, your sexual tissues, your reproductive organs, that if you're using it, that that is a benefit when you're not using it, that there could be problems that arise from it. So that also is, it's, it's not a dormant organ. And treating it as something that needs to be used like other muscles and other organs is something that, that you're wanting to consider as a part of your whole overall physical functioning. And then there's the other aspect. And this is where I spend a lot of my time and where I came into my work as somebody who is an expert in sexuality because I started off as a kindergarten teacher. And it's such a, you know, a very interesting switch to go from a kindergarten teacher to somebody who is a sex therap therapist and sex expert. But as I transitioned into therapy world from teaching, I realized that whether I was working with individuals or couples that in some way some type of their sexuality was a part of our conversations or needed to be a part of the conversation. And there are some countries that have done a good job with sex education, but the majority of countries do not. And so not Knowing even just the basics of a lot of who we are as sexual beings is a problem. Not knowing how beneficial physically it is to us and for our mental health, but also not knowing why putting time into who you are as a sexual being is a big problem. And my answer to that is who we are as a sexual being. And by the way, when you're saying about our, you know, our sexual. If you are breathing, you're sexual, so you don't actually have to put it on your to do list, which is a wonderful thing. You are sexual by nature of being human. It's one of the few things that we all have in common. We are all sexual beings just by birthright, and we don't have to do anything about it. What we, what we have to do, what our responsibility on top of that is to figure out who we are as a sexual being and the details of who we are as a sexual being. And again, we're not giving a lot of space or guidance in how to do that. And we have, and a lot of problems happen in relationships and in our mental health and in our societies when we don't know who we are as sexual beings and we don't have space to figure out who we are as a sexual being. But it's, it's an area that the, the phrase that I use is it's the final frontier of self development. If you want to know who you are, just the, the soul of who you are, know who you are as a sexual being. And for some, that is a huge leap. You're like, what are you talking about? And, and it's because when we hear the word sexual or our sexuality, we think two things. Having sex with other people, like sex acts and like what we're doing with our body and with whom we're doing it. And that's just a very antiquated view of who we are as a sexual being. And, and in understanding that, we realize that in looking at like the nine pillars, if you examine all nine pillars, then by the end of it, even through a sexuality lens, you know yourself differently. Sexuality is hard to have space for. We don't have a lot of education with it. There's a lot of emotions attached to it. There is politics attached to it. There's a lot of cultural implications of it. There's a lot of negativity associated with it. There's a lot of rules associated with sexuality. It is just a mess in a lot of ways. So if you can figure out who you are and get answers to your sexuality, with all of that mess happening, then you've done the work to know who you are. It just so happens to be with the. With the lens of sexuality. But the byproduct is, you know, who you are. So what's interesting to me is like, when I work with somebody about figuring out who they are as a sexual being, so much of their world changes from the beginning to end. And I've often thought that I should have pictures of someone looks like as we are starting it at the beginning to the end, because there's just an awakening that happens. And my goal is never to make somebody, somebody who want, who has to have sex acts in their lives to be a sexual being or to know who they are. It is about having choice and having sexual agency. That's the gold standard. That's what we want, is knowing who you are on your terms as a sexual being, not on anyone else's.
- [12:55]
Dr. Stephanie Estima
I think that there's maybe more than a handful of women who are going to listen to this and they're going to hear you say who you are at your core. Like the crux of your soul is, you know, that is analogous to being, you know, you know, your sexual being. And I think that there's like age, you know, there's a filter of age and you know, the generation that we grew up in culture. I think you mentioned politics, religion, also, I would say the male centric view of sexuality, like you mentioned it very quickly. And I actually want to come back to this, like this penetrative sex, right? It's like it just. Sex just lasts a few minutes. And that's just like, you know, pardon the crassness, but that's why he's just like pumping away like a jackrabbit. And then it's when he's done, you know, sex is done.
- [13:34]
Dr. Juliana Hauser
Right, right, right.
- [13:35]
Dr. Stephanie Estima
And then there's also, like, women who enjoy sex are called every possible terrible name that you could ever imagine. I won't repeat any of them here. But, you know, we all hear the word slut, shaming, like all that kind of stuff.
- [13:47]
Dr. Juliana Hauser
Equally negative words. If you don sex right, you're just. There's no way. There's no. There's no happy medium that is like, you have the perfect kind of sex. You're the person kind of sexual being. You're always wrong to somebody.
- [13:59]
Dr. Stephanie Estima
Yeah. So how do. Okay, so help us get over the lenses that we're looking through, be it age and generational, religion, culture, you know, the way that we've been taught, you know, you Said that sex education, we don't get a lot of it. Like, my sex education in school was like, here's the banana. Here's how you put the condom on the banana. You know, here's a woman bleeds, you know, here's the menstrual cycle, here's the two graphs. Estrogen, progesterone, like that was like, it, it wasn't anything about sexuality, it wasn't anything other than male centric, you know, penetration. So maybe talk to us about if there are women who are listening here that are like, you know, I don't need, like this is not important. Like, how can we get them to see potentially beyond some of the filters that they might be looking at that term and just the entire idea by.
- [14:50]
Dr. Juliana Hauser
So I'm going to give it a personal example. And, and I, and I start with, I get it. I, I didn't understand it either. I didn't understand the importance of knowing who I am as a sexual being beyond it improving my sex life. And, and how I was defining a good sex life was, as you said, it was very male centered. It was what everyone else was telling me or particularly the media or maybe what I saw in the news or like a movie, a movie. It was never something that I sat there and thought, what do I want? What do I, like, what do I not want to do anymore? What, what, what are my options? I never ever asked that question, nor did I have anyone in my life asking whether it was a sexual partner or friends of mine. It just wasn't a part of it. And at one point, in between getting my master's, my PhD, I moved to LA and acted. And I had an acting coach. We were in a class and she was a ball buster. I mean, she was tough. And one of the kind of rules was like, you just never say no to her. And if she asks something, you just gutterly answer it. If you hesitate, it's bad. And we had been working together for quite some time and there was a view of trust. And she went around the circle. I was the second one to go. And she asked what would be the worst scene for you to have to act out? And somebody went, and I think they said, murder. And I was like, oh, I knew. I knew immediately it was how I had to seduce somebody. If I had to seduce somebody, that was the worst scene that you could give me. Then the next person looked at me and they're like, like killing a child. And then like, and then the next person went and everyone was looking at me and they're like, you know, incest or. And, you know, whatever. It was all these big things. And mine was the outlier.
- [16:31]
Dr. Stephanie Estima
That was your big thing? That was your big thing?
- [16:33]
Dr. Juliana Hauser
That was a big thing. I didn't even think twice about it. It didn't feel vulnerable to say, because we're just so used to answ, honestly, until everyone else was like, what the. And. And so I knew it. I knew she was going to come to me. She was like, all right, Juliana, then you need to go over and seduce Price. And I. I did it. I tried it. I was horrible. I knew I was horrible at it. She's like, price, do you. You know, do you feel turned on? He's like, not at all. And. And she had me go back to the circle, and she pulled somebody else who you would inherently say that you could feel that she was in touch with who she was as a sexual being and had a lot of sensuality to her as well. And she seduced him in, like, two minutes. And she's like, bryce, what do you think? And he's like, I can't even speak words. And, you know, it was. Everyone laughed. And she looked at me, she's like, fix that shit, Julian. Like, fix it. And I remember thinking at that time, fix what? Like, what is it that I'm fixing?
- [17:28]
Dr. Stephanie Estima
Yeah.
- [17:29]
Dr. Juliana Hauser
And that question. And then, you know, a bit after that, I went back and left LA and went back and get my. I got my doctorate. And in my doctorate, that was lingering. And I was already married and had a child by then and was in my 30s. And I didn't under. I knew the question. I didn't understand how to answer it, and again, still didn't know what it was. And so I started doing it. And in the US you do. There's only one state that requires that you have a class of sexuality to be a therapist, which is horrific. And so I didn't have a lot of education personally, and I didn't have a lot of education professionally, so I started seeking it out, and I started asking. And what I realized as I started asking people, like, I started asking people, do you feel sexually fulfilled? Do you feel happy with who you are as a sexual being? And. And the ones that answered, I would say why or what it was. And I started finding themes, which is ultimately what became the nine pillars of sexuality. But what I saw was there was an absolute link between somebody who was describing being fulfilled in their sexual life and who they were as a sexual being and other areas of their life being fulfilled and peaceful. There was just an absolute link to it. So at first, because I had a very rudimentary view of what sexuality was just being sex acts, I was like, oh, they're having good sex. Oh, they're having lots of orgasms, or they have a good partner, you know, they're good in bed, or whatever any of those words mean. And, and it didn't take long to realize that had nothing to do with it. The, the common thread was not if you were sexually active or what kind of sex you are having, even what kind of partner you were having. It was, were you in touch with making choices about what you were doing, who you were, and all the other things outside of sex acts, like sensuality? Were you somebody that knew this is a yes to my touch? I love this kind of touch, or I don't. Did you have the proactive stance of asking yourself those questions? And again, going through the nine pillars, were you somebody that took the time to sit with yourself and instead of being influenced by everybody else, which is what most of us have as in our sexuality, as opposed to other areas, I think there's a difference in it. Those were the people that describe themselves being fulfilled as a sexual being and in their relationships. And that felt profound to me. And as I posed this through my education, when I was looking at this as a therapist and I started asking people, I realized that even just having, like, people were hungry to talk about it. And I would say when I asked women, they were hungry to answer the questions, and it. Even if they felt uncomfortable or it was awkward, it didn't take long for them to just want to share everything, the good and the bad. And I would say men were desperate to talk. And I'm not sure men would have identified with that word, but that was my experience and felt a lot less skilled, a lot less safe. They didn't have a lot of words that they didn't feel comfortable. They didn't know what was okay, what felt bad. And that has particularly grown in the past 20 years of men feeling. For men who have an ethical stance on how. How their gender is, is behaving, they are nervous about getting sexuality wrong more than anything and saying the wrong thing. So they're talking less and they're. They're practicing less than that. And, and I realized for those who have, who identify as having, you know, a different gender identity or sexual orientation that wasn't heterosexual, some of my questions and some of the way I was asking it, if they were already through that process of embracing what they knew about themselves, and, and, and feeling happy with who they were. My questions weren't nearly as interesting. They weren't nearly as hard because they had already done the work in coming out or in finding out who they were in their, in their gender identity, which both are a part of who you are as a holistic sexual being. It was the same process. And so I really started looking at the coming out process. I started looking at what does it mean to examine who you are. And it was all about asking your asking questions, all about saying, this is on my terms, who I am. And when you do that, the details don't matter. It's the process of asking it. And that changed a lot for me.
- [21:44]
Dr. Stephanie Estima
So it's really about, I mean, I'm going to make a little joke here and it's probably going to be inappropriate, but it's like we all kind of have to come out, we all sort of have to come out of the closet, right?
- [21:53]
Dr. Juliana Hauser
We do.
- [21:54]
Dr. Stephanie Estima
We all have to figure out what it is that we like. And I think that the, the first question is, I mean, you were just touching on this is just exploring and just asking yourself, like, what is it that I actually like? Is there a certain, like you said, a certain touch or a certain type of music, a certain environment, you know, et cetera, et cetera, and just looking and starting to create this roadmap of who it is that you are.
- [22:23]
Dr. Juliana Hauser
Absolutely.
- [22:25]
Dr. Stephanie Estima
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- [25:36]
Dr. Juliana Hauser
When I knew I had the nine pillars and I started working at the order of it, at first I was like, ooh, I need to pick like an easy one to be the first one or I'm going to lose people. And so I put sensuality first. And then I realized, oh, it's not the easy one. In fact, none of them are easy.
- [25:50]
Dr. Stephanie Estima
Yeah.
- [25:50]
Dr. Juliana Hauser
And I actually had a lot of people cry when I would not and they would say, you're the first one that's ever asked me do I like this, do I want to be doing this? And there are lots of tears. And then realizing that isn't just in their sex life that's in a lot of their lives. And then a lot of, especially when I was working with, with women saying like, wow, how come I, I've never done this? And asked myself this and that. Again, that awareness is the first thing. And then gaining the skill of asking and, and then learning how to live. The answer is a skill that translates to all areas of your life. And if you could do it within sexuality, you can do it in all areas of your life. And that is the transformation. So it's. I love great sex. I'm all about having great sex and, and orgasms and all the wonderful things. But what I'm most about and what is the most transformative is sexual agency and learning the skill of agency within who you are as a sexual being. Which begins with ask those questions. And, and I, I kept sensuality first because just like being, we're all sexual, we all have senses. We may not have all five, we may not have full access to all five, but we all have our senses. And so it's a common starting ground. And it is, it's, in some ways it is less confrontational to be asking, do you like this kind of feel on your skin versus do you like doggy style? It's just as just an easier entry point for a lot of people. And also because it's so specific to you, it is also harder because there's no performative nature to it like you can if you're doing partner sex. It is not male centric, even if you're a male. It's not about gender, it's about you. And there are a lot of people that don't learn the skill of even just listening to their body and not just asking it, but like listening. So I'll ask the question and we'll get through the experience of never being asked it before and not knowing the answer. Now we have to think, so what is your body telling you? And so you start building a mind body connection, which is pivotal in our health in general, but particularly in our mental health. It's like, what is our body cueing us? And for some people that begins with your work. And for some people it's, it's mine. And it's asking like, how do you listen to your body? And for some people that is a very easy skill. They come by it naturally. For others it is a very hard road to understand how, how your body tells you yuck or yum.
- [28:21]
Dr. Stephanie Estima
Okay, so this is, this is great. I think I, I love this idea around when you are, this idea of self agency when you start asking yourself, what are your yucks? What are your yums? I want to maybe double click here, because I do. As you were talking, I was thinking about this idea because it is so individualized, because it's. You have this unique blueprint of what makes you a sexual and essential being that is unique. I think that there can be a little bit of like, is this okay? Like, am I okay? In the same way that when you were in that circle with your acting, you know, classmates, you were like, oh, turning someone on, or, you know, that was your big thing, and everyone was like, what? You know, so. So I think that there can be a little bit of that where it's like, oh, but I really like. I like it when he or she does this. I like this environment. I like this kind of touch. I like this kind of, you know, is that okay? And I think that that goes maybe even a little further. And I would actually like to parse this with, like, anatomy, because one of the big things that I hear a lot from women when I even broach the subject is so many women don't even know what they. What they like when they are touching themselves. Like, they're. They don't. They don't know what their anatomy looks like, first of all. So nobody takes a hand mirror. Nobody knows, you know, the right labia is bigger than the left lab, and the inner lips are a little bit. Nobody know. Like, they don't want to look, they don't want to see, they don't want to, you know, and then. And then on top of that, they don't even know what they like. So if you don't know what you like when you are touching yourself, let's say, how are you going to be able to explore that in the context of, you know, one or more people?
- [30:00]
Dr. Juliana Hauser
I want. I want to go back and say that a lot of the questions are like, is this normal? Is this okay, what does this say about me, that I like this or don't like this? What are you going to think about me? What am I going to think about myself? There's so much shame associated with who we are as sexual beings. And. And I'd say that the underlying question that I get asked the most is some version of. So I figured this out, like, what do you think? Like, how bad is it? Right? Like, what are people gonna think about it? And my answer always is, oh, there'll be a hundred people lining up for this with you. Or there'll be a hundred people are like, absolutely no. Just like, you like you will. There will always be people that have commonalities. It's just we so rarely. We don't say, hi, my name is Juliana and I like pegging men. It's just not. I would. I wish we could introduce ourselves like that.
- [30:53]
Dr. Stephanie Estima
And, and it would be put in your Instagram bio. You have to put it in.
- [30:57]
Dr. Juliana Hauser
Yeah, I'll have a whole lot of direct messages happening. But it's, it's. We don't, we don't have the verbiage, we don't have the permission. And since we're not educated very well in this and we really. It's. It's genetic lottery, it's positional and it's relational about how much you are exposed to what quote is normal, which I don't like the word at all. And, and what it says about you. And, and almost like people look at their sexual fantasies or what their. What arouses or interests them. Like it's a Warshaw text that it's like it tells you something about you. And sometimes it does, but sometimes it doesn't. And, and people are very afraid of that because it's such a secretive aspect of, of who we are going to your question. I don't. Do you want to say anything about that?
- [31:41]
Dr. Stephanie Estima
No. I love it. I love it, I love it. I love. You're on this tangent. I'm like, oh, this is such good stuff. Yeah.
- [31:46]
Dr. Juliana Hauser
And so thinking about, you know, that how do we share with anybody else what we like unless we know it on our own body through our own exploration. One caveat I have to. That is I. I would talk in. In great length about how much I'm a proponent for. For self touch and self pleasure. But I also think it, it's. There's nothing wrong with learning about what you like through other people. What is important is that you have the communication skills and you have the ability to be vulnerable and risk taking. And there are some things that you don't know if you're gonna like it unless you have someone to do it with. There's just some things that aren't. Aren't solo oriented. But to your point is we have to be comfortable with all parts of our sexuality, which includes our anatomy. And it is fascinating to me. There's actually, if you know the show Orange is the New Black, there's this great scene where one of the women is showing the other woman the difference between where her urethra opening was and where her vaginal canal opening was. They didn't use those words. That's like where you pee out of and where your period comes out of. And a bunch of them were like, there's a difference. And, and then she like spread it open. She's like, this is it, this is it. And it was very revolutionary when, when the scene came out and, and I loved that it was being shown. And, and what was fascinating afterwards was there are so many women saying, wait, I thought my clitoris was where I peed out of. And I didn't, I've never even even seen my urethral opening. Didn't even, never have heard that word before. And I never looked at it. And maybe you could see it on an anatomy. And so I used to do this thing when I was, did workshops out of my house and I'd have people put a piece of paper and a book on their head and then I would have them do a drawing and it was always absurd because you can't see it. And then I'd have everyone present their vulva and they're always awful looking and, and not in the right spots because you can't orient yourself. And, and I would say this, this is what we're taught. This is how we're taught. This is how, this is how disjointed it is. And so let's just not worry about what we don't know and let's just all talk about it. And it's one thing to learn on a 2D model. Like we're just looking at a piece of paper and it's just a generic anatomy. It's. And we already know that it's very wrong that there's so much variety to it. It's another to learn it on your own. And so I love it when particularly we're talking with women, if women will go to whoever their provider is, OB or midwife or whomever, and say, go through my anatomy with me, me. And, and I want you to show me, have a mirror and have them show you where everything is because it is quite different. And I was probably 10 years into my career in sexuality when I, I got to meet my, my mentor, Betty Dotson. And if, if, if people don't know who she is, I want you to look her up. And she is absolutely an incredible woman. She has passed away. She passed away at 91 is several, several years ago. And she did something, she had a course called Body Sex that she came up with and she did for, since the 70s and, and she was just, just such a revolutionary person. And if you know the movie Fried Green Tomatoes, there's A scene of them getting mirrors out. That's really based on the work that she would do. She, she was the woman who was saying, get your mirrors out. And, and I probably can't say the words and look at that. And. And so I was able to go meet her for the first time in her, her apartment in New York City and do a two day naked workshop. I write about it in the book. And, and I knew when I was gonna, when I talked about it that there would be a lot of people like, what are you talking about? That you're gonna go. And of course you would do it because you're someone in the sex world. Well, I went because I wanted to meet Betty. She is the pioneer in, in my field. And that was just my thrill. I did not think through until I was getting in the elevator to go upstairs that I was gonna have to get naked with people for two days. And I all of a sudden became not Dr. Juliana. I was all. I was just Juliana. And I was scared to death about it. And I, it was, it changed my life to experience this, to push myself in that way. And when after a series of things, one of the things you do at the end, at the, at the first day is you do a genital show and tell. And she would say, because she, she liked to, to, to be controversial and to shock people, she would say, who wants to see an 80 year old vulva? That's not the word she used, but vulva. And we were all like, I want to see it. It. And, and so she said we were all naked to begin with and at this point we were pretty comfortable being naked. And she just spread her legs and she went through her anatomy with us. And she had asymmetrical inner labia. And she talked about what that looked like. We got to see it. She talked about her aging. She showed us gray pubic hair. She talked about the difference of the color. And no one had ever talked to me ever about how a vulva aged. It was. And I was 10 years into my career and I hadn't even thought about that. That. And then everyone does their own genital show and tell. And I, and I felt like I was back into that acting class again. I was like, oh. And I thought I would be like spreading my legs and be like, let's do it. But when it came to my turn, I had to work to open my legs because I, I walked into that body sex feeling really good about my body and particularly about my vulva. And I'd been complimented a lot So I was like, yeah, I got this. But I was maybe like the fifth to go. And the people before me, I thought, had beautiful vulvas. And I was. Was like, I don't think mine's going to be as good. I don't know. I don't know. I don't remember what my vulva looks like anymore. And. And as she walked through my anatomy with me, I had to really work through just. Even the body image of my genitals. And. And that was unexpected to me and was very confronting in a lot of ways. And. And the way that they do it is everyone claps. And so we joke like, you know, when do you ever get a standing ovation for your vulva? When it. When it's not in a sexual act.
- [37:29]
Dr. Stephanie Estima
It should be a rite of passage.
- [37:30]
Dr. Juliana Hauser
It really, really should be. Because it's pretty amazing, to be honest, when it's just, you know, to be supportive and wonderful. And she always liked to. She. The way that she would describe your vulva would be in architectural terms, because she was actually an artist. And so she. She looked at the artistry of revolva, and then she'd have you name your vulva. But all of that was. Was really important to my own growth. And I know it's not something that a lot of people are going to want to do, although I think it should be mandatory that we all go through this because it's so healthy. But what was really beyond that, the most tangible takeaway, was how since we got to see so many real genitals and not porn and not anatomy book, but I got to see women's. And if you. If you. If you're not interacting with women's vulvas sexually, you aren't going to see many because it's very hard. Even if you're around women naked, it's very hard to see all of that as opposed to penises. So we. We really got to see it live. The differences and. And the, you know, how amazing women would talk about what they liked about their vulva, what they didn't like about it. And that was very enlightening and normalizing. And then we got to see. And this is something that I had never been taught was that there was a. There is a big variety, not just about labia, but about the positioning and size of your urethral opening to your vaginal canal, also to your clitoral glands. I never knew that. In every anatomy, it's always this. Always position, always. It's always, yeah. And that. And it's Not. And that is, that's important. It's important to know that for different sex acts, for your sexual health, that alone, understanding your own ratio is different. And, and it's, it's also important in how you're looking at your vulva to know the difference of when things are healthy and when things are not. And if you aren't okay with touching yourself, if you don't look at yourself and it doesn't have to be in a daily basis, but you, you need to have it be something that you, you, you can track and not just have a partner be the one tracking, but you're tracking. This is a difference that I need to have checked out. And, and also I think in the aging process we have so much discrimination in about aging and being older. I do think a lot of women in particular, but men as well grow an increasing shame as if they felt great about their body and their genitals at a certain age. As they age, when it's changing, we haven't taught how to value those changes and to normalize that and celebrate them. And so I see an increase with aging of, of the loss and, and the change. And, and I think that makes a really big difference too.
- [40:03]
Dr. Stephanie Estima
God, that's so good. And the other thing I would love to add in here is when you are seeing some of these different normal variants, we'll say, and I'll maybe I'll actually, before I even say this, I'll pre frame this by saying any type of plastic surgery that makes you feel better, like you do you. Right? But I think that there is. I remember seeing a doctor online and I was very upset by the post. I mean I was initially very upset and I was trying to ask myself like, what about this post really upset me? He was saying, oh, I had this patient today and we did this. I don't know the technical term, but he basically injected a filler into her labia to puff them up and then he simultaneously did the lips on her face. So he made a joke about, oh, and she got like two lips. You know, the two lips on her body were, were fixed today. And it was really. I was very upset by it. One, I felt very bad for the patient who was treated by someone who could make a joke about his patient's anatomy. I think that was, that was one of them. But I think that there's also this like perseveration of like, oh my, my, like my labia on the ones. No, they maybe they feel deflated or maybe they've become defatted or like the inner labia now on the right is bigger, or it always has been the versus the left. So I need to fix that. So I think that there's sometimes predatory practices where we see labioplasty, we see all of these different cosmetic procedures done to the vulva, you know, at, at large. And we don't really know what the impact is on their sexual. Like, there's a lot of nerve endings there, so we don't even know how that might even affect her sexuality, her feeling post surgery. So those are my really, truly honest thoughts. Thoughts as a woman, you cannot heal until your body feels safe. And I think that most women have accepted that. Feeling slightly anxious, slightly wired, slightly on edge all the time is just part of our lived experience. And that's normal. Well, my friend, it is not. This is a classic fried nervous system that has had to endure and endure and endure and has not been given, given the signal of safety that you can relax in a very long time. And the problem is most of us try to fix that by doing more. So we will do more workouts, we will put in more supplements in our routine. We will try to have more discipline. But your nervous system doesn't respond just to effort. It responds to safety. And this is why I love and recommend Apollo for women like us. It is a wearable that uses gentle vibrations to tell your body that you're safe. And when your body believes you, when your body believes that you are safe, you can finally shift out of that chronic stress loop and you're gonna start to enjoy better sleep, better recovery, clearer thinking. This is the layer that most people miss. We all want the diet and the workout, but the nervous system unlocks it is the key key. So if you want to try it, head over to ApolloNeuro.com forward/better, and you're going to get 99 off of the Apollo with smart vibes. AI, tell me what you think about that.
- [43:16]
Dr. Juliana Hauser
Yeah, well, I agree with you. I mean, like, my, my caveat is if you have put purpose and intention behind the thought process and the decision feels right for you.
- [43:25]
Dr. Stephanie Estima
Yes.
- [43:25]
Dr. Juliana Hauser
Then I'm. Then I'm supportive of whatever it is.
- [43:27]
Dr. Stephanie Estima
Yes.
- [43:28]
Dr. Juliana Hauser
But I also think that again, just like a therapist rarely have a sexuality class, medical students often do not as well, even, even if you're a GYN or even if you're a plastic surgeon that's going to be working on vulvas. The. If you go back and see their education, they had a little bit of anatomy, but they didn't have anything about sexuality or about how to speak about how this is positioned and what this means and all of that. And so it's, you know, we're all at a disadvantage of making really great informed decisions about this. And some of this, especially when you're doing cosmetic surgery on your genital, it's not reversible. And some of it can't be predictable too, because there are some who, when we're talking about the labioplasty that we're speaking about changing the size, particularly of your inner lips, and usually it's a reduction. And there are some people who describe feeling numb and that they no longer can feel any pleasure at all. And it almost feels like, like they've had a clitorectomy, that they, that their nerve endings are gone, even though it was just their labia lips. Others that they report that they're not having much of a change of their pleasure either. So there, there's a variance in it. It, but it's not risk free. And, and I do think it could be like anything, there's, there can be a very slippery slope. And to me, the important question is why and what is it doing? Because there are some people who have labioplasties because their lips are large and they're like horseback riding and they get irritated or they're a bike rider and it's too much for them that, that's a different thing. And, and, and I'm not even saying it's a negative if you're doing it for appearance and you feel better because you feel shamed. Because it's amazing to me the story of that. All it takes is one person making a sound that you interpret as someone saying something negative, thinking negative about your vulva, how it tastes, how it smells, how it looks. And it stays with a woman for 60 years and that's what has defined her. And so I understand wanting to take control of that in a certain way, but I feel troubled that where I think that leads to mostly is that there is an ideal. And that goes back to the rules that are associated with sexuality, which is there's always a right and a wrong. And typically somebody who's pointing the finger of saying that's wrong is, is somebody who is, has a, a pretty narrow view. And that it is. There's not a continuum of, of options. And that feels very scary to me, whether it's something that you're looking at or, or putting rules upon it. And, and I'm, and we are not taught a lot about our anatomy. And frankly, it's just really, in the past 10 years that we've learned about the female anatomy and learning about our clitoral system in any kind of advanced way. And so we really don't know the implication of it. So I hear what you're saying, and I double down on that with you.
- [46:11]
Dr. Stephanie Estima
I love how you frame that as well. So I think that if you've done. If you've opted for the surgery with intention and you are understanding, like it's an informed consent. You understand the risks. You understand. And you feel great afterward. Like, I am. Like I am your biggest cheerleader, where I think I was. And maybe I didn't communicate this well, so maybe I'll restate it is when I. When it. When it feels like, oh, there's something wrong with me because I don't look like the porn star or I don't look like that. So I. Whatever that ideal is. So I have to fix myself because somehow I'm broken. There's something wrong with me because my laby on the left or whatever is bigger than the one on the right.
- [46:47]
Dr. Juliana Hauser
Right, Right. Yeah. And I think it's just like, you have to look at your anatomy. Like you would talk about kissing. There are some people. Like. One of. One of my favorite, like, talks that I do is. Is about kissing. And I ask people to think of the worst kiss they've ever had. And if you've had multiple kisses, most people will have one story. And there's often a similar face. And you could go right back to it. Mine is 9th grade in. In the movie theater. And I'm not going to say his name because he's a nice person, but he basically licked my face. Face.
- [47:15]
Dr. Stephanie Estima
Yeah.
- [47:15]
Dr. Juliana Hauser
And, you know, it's just.
- [47:16]
Dr. Stephanie Estima
Oh, that's mine too.
- [47:17]
Dr. Juliana Hauser
Yeah. Don't lick faces.
- [47:20]
Dr. Stephanie Estima
Don't lick faces.
- [47:22]
Dr. Juliana Hauser
Especially at that age. Sometimes people like it, but. But. And then I'll think. But I'll tell you there's somebody out there who can't wait to have their face licked and that their number one kissing story is somebody who's doing that. Did I have another story of someone that just, like, jammed their tongue down my throat and I was like, oh, my. Like, just the world, I'm gonna choke on your tongue.
- [47:40]
Dr. Stephanie Estima
Right, Right.
- [47:41]
Dr. Juliana Hauser
But then I've had people say that that's the best thing ever. It's the same thing with our genitals. That to one person, if someone has inner lips that are longer than the others, that's their ideal. That is just juicy and fabulous. And someone else are like, oh, I prefer the look of it being the opposite of the inner lips being smaller. Whatever it is, there's such a variety that. That is what I think you're speaking about is if it needs to. It needs to be answered from you.
- [48:09]
Dr. Stephanie Estima
Yes.
- [48:09]
Dr. Juliana Hauser
And it needs to be how you're feeling about, not what you think others are saying or what the ideal is. There's trends. There's trends in sexuality too, and they change. And some things, when you are doing it medically, you can't reverse back. And it always makes me feel sad when someone has, through anatomy, lost the ability to experience pleasure. And that happens with multiple kinds of surgery, not just labioplasty.
- [48:32]
Dr. Stephanie Estima
Let's talk a little bit about pleasure, because I know that there are women listening. Like, I know she's talking English. I know what pleasure means, but I don't know exactly what is pleasurable. Obviously, there's many things that can be pleasurable. Like, my cappuccino in the morning is pleasurable to me. But we're gonna talk about this maybe in the lens of sexual. The difference between arousal, something that people get aroused by, and desire. Because this word desire, we use it now. I mean, we see this HSDD now. Hyposexual Dysmorphic Disorder. This is the one and only at the time of this recording anyway, you know, justification for testosterone therapy for women. And I think that there's a huge opportunity for women to understand the difference between what arousal is in the context of pleasure and desire. Can you speak to that?
- [49:22]
Dr. Juliana Hauser
Yes. And like most answers, I'm giving a caveat at first, which is because we don't have a lot of spaces to speak about sexuality. When we do, there is often a bridge you have to make of are we talking about the same thing? And it can be really difficult to. Like what? Again, like, if I was to say the. Describe the color blue, you may have a certain blue that goes to your mind. I also have a blue, but we have different blues. But they're both blue. And who's right or wrong in that? And how do I understand your blue versus my blue? And so that is the background to the answer about what's the difference between arousal and desire and pleasure? Is it's difficult to know if we're talking about the same thing because it's really difficult to explain it. So how do you explain what's pleasurable to you? The way that I siphon it down. Down is that it's a yuck or a yam and it's your. And there's a guttural reaction to it, that it's a yes, it's a no, it's a yuck or it's a yama. And that's how I define pleasure. When we're looking at arousal and desire, it gets a little trickier and it, and it, it coexists with science. And I started to. Desire is a different pillar from pleasure and the holistic sexuality pillars. And I use the word desire instead of libido because a lot of people have a negative reaction to libido and of, of all things within holistic sexuality, libido absolutely has a right and a wrong that we've been taught. And we use words like high libido, low libido or high desire, low desire. And, and we are positioning ourselves to compare. And, and, and there seems to be this standard that means that you have the right kind of libido or desire. And, and that's just, that's a problem. So I use desire because I like looking at your relationship to desire instead of your level of desire and, and backing that to arousal there. For some it's very similar and, and it's hard to distinguish in your body because your body is still trying to learn how to communicate to you. I'm feeling aroused and I'm feeling desire. And so for some of the way they describe it, it's the same thing. Scientifically it's viewed as something different. And we know that you can feel aroused but not feel desire. And you can feel desire and not feel aroused. And the way that I explain it to, to my clients or when I'm doing workshops is I say arousal is. We're going to focus more on the science of it and what's happening to your anatomy and desire. We're going to think about more the psychology, the mental health aspect of it and the presentation of what you are interested in. And for some that's like yep, I get it, that makes sense. And for others it's still like what are you talking about in this? And we are particularly not taught what happens to our body when it's in an aroused aroused state. And that is such a shame because any is fascinating for, for all genitals. It's just really, really interesting for women. A word that I use and I'm tentative with how I use it but I would say we have a very delicate and delicate doesn't mean fragile. It, it means that, that it has almost like if we were like a Rolex that just the, the inner workings of it are fine tuned and I'm not saying that the penis arousal system isn't. But it just has a little bit. Has a of lot less that can then can go wrong and less that has to go work together for it to go right. And so I use the word delicate. There are other people who wouldn't like that word, but I.
- [53:08]
Dr. Stephanie Estima
Sophisticated maybe.
- [53:09]
Dr. Juliana Hauser
Sophisticated, yeah. I like that word too. Elegant. Whatever. Right word. Feels that it's not bad. But we. We have to protect it. And part of protecting it is understanding it to start of understanding your arousals, understanding your anatomy and how it is all built to conspire for pleasure and arousal and knowing that knowing your anatomy and knowing how it works together. My favorite book is called the Clitoral Truth by Rebecca Chalker. It is an old book and it is a classic and it is. It's just. I haven't found anything better that if you really want to understand the clitoral system is to read her book. And she does such a beautiful job of teaching you anatomy and teaching you how it brings pleasure and how if you stack it together, how it just really exponentially changes that for you. And that I think really makes a difference in understanding your arousal and understanding particularly. So you need to have a baseline of anatomy, a baseline of pleasure in anatomy. And you need to understand like the arousal cycle. It's called the excitation cycle in our. In our. In my field. But it's the arousal cycle. And so you know the basics of that and then you need to learn your own because there's variants from that. And. And the arousal cycle that is used. The excitation cycle that is used as. As the gold standard is not great. In.
- [54:30]
Dr. Stephanie Estima
I was gonna say I kind of hate it, but. Yeah, I wanted you to say it.
- [54:34]
Dr. Juliana Hauser
Yeah, I really. I really hate it.
- [54:36]
Dr. Stephanie Estima
Okay, good. Okay. Thank God.
- [54:37]
Dr. Juliana Hauser
Yeah. And it's not. It's not great science studies on it. It's very hard to have scientifically sound studies for the female anatomy. So all. There's just a lot that's wrong about it. It. But I. Even visually, I don't even love to look at it visually. I think it. I think it positions orgasm as. As the goal is the big deal. And I think it makes you feel like arousal is like this uphill climb that's just er. And then you, you know, you get to the plateau and then like oh, fireworks. And then it resolves itself. And I. I think there's something to it, but I don't think that's how everyone works. And. And I think if you. If that's how you think it should work and yours doesn't work that way way then you don't learn how to work with your own body and you it is, it's similar like if we were just to look at the sleep cycle and I'm not an expert in sleep, but I know that that's not how everyone's works and that we don't have to all reach this one standard. What you have to do is optimize it yourself. And so I think that's what's important about learning about arousal. Learn the basics and then learn the specifics with you and learn your arousal system changes in your lifespan. It ages, it changes, it changes in relationships, it changes how you're doing. And so what can work for you in one aspect may not work. And it doesn't mean you're broken or anything's wrong. It just means things have changed and you just have to work with that.
- [55:59]
Dr. Stephanie Estima
And how do things change? I think it's important to highlight perimenopausal and menopausal women because we see this really dramatic change in our hormones, which are of course crucial to our genitals and our reproductive life and system. So talk to us about how that changes just so we know what to expect. I think that any clinician worth their salt is able to predict your future for you so that when you get there, you don't misinterpret what's happening. So talk to us about what's happening.
- [56:28]
Dr. Juliana Hauser
Agreed.
- [56:29]
Dr. Stephanie Estima
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- [58:28]
Dr. Juliana Hauser
So if we're, if we're going to use the word elegant, because I like the word that you use, if we have an elegant system, then it is going to be something that is responsive to any kind of change. And to me I say that safety is the number one aphrodisiac and it is the number one link to arousal. And that is emotional safety, physical safety, relational safety, and safety that you provide for yourself. And so if your safety is tweaked, leaked, and anyway, our elegant and delicate system is going to interact with it. And I would, I would look at it as not as broken but as a warning system. And, and I, I think we have a very great warning system that something feels awry. What we're not, what we don't have a lot of is how to decipher the warning and what are our options of what can change. And some of that is in the aging process. So I'll use another personal example. I like risk taking first so that other people would do it as well. So about a year and a half ago when we were filming this, I had a hysterectomy and I went into my hysterectomy going, how much do you care about my sexual health? And you know, I want to, I want to preserve my, my sexual pleasure. Very like, I want to know, how much are you going to care about that? I want to be able to orgasm after this. And there are other more important things than that, like to the physicians. But the physician that I chose had the best answer and didn't hesitate. And so I was like, okay, I Feel like she's got it, she understands. And that we're going to work together and we're not only going to talk about my fibroids, we're going to talk about my sexual pleasure and making choices that are going to protect it as well. I went into, you know, we were. We were. Actually, I met you a couple months after that. That's when we were down at Vonda's conference. And so, you know, we're in the circles, we're in these conversations and perimenopause and menopause. And so I felt very informed going into that also went into it knowing my body very well and feeling very comfortable with who I am as a sexual being and feeling very informed with my pleasure, arousal, desire cycles and knew that it could change. And I made the decision for my own. That made sense for me to go on hormonal replacement therapy. And I did not expect it to be a drastic change of how I experienced pleasure. And it was. And I felt like, I quote, did everything right. And yet it still changed. What helped, like all the work that I'd done previously for my sexual agency, what it helped me do, is to not freak out. It also helped me to not accept that that's how it has to be. It may be, but it. I didn't have to accept. I knew that there are options and I knew how to stand up for myself. And I knew I'd been practicing saying the hard conversations that, that I maybe previously, like, seducing someone was really hard for me back in my 30s. If I hadn't been doing work like that, it would have made it hard for me to say, hey, how much do you care about me orgasming after this surgery? And, and I'm grateful that I was. Had done the work to feel comfortable with that, because when it came to a screeching halt, it was. I was like, okay, it's just something I have to. To face and deal with and found a practitioner. I used somebody else, but I had a surgeon who did the surgery, and then I had somebody who was in charge of my hormone replacement therapy in my care afterwards. And she also had a beautiful answer to it. And she really looked at this and like, this is. And she was. She's like, ooh, let's look at this like a puzzle puzzle. And instead of it being gloom and doom or minimizing it, she was like, yeah, let's figure it out. And it may. It may take a while, but we're going to figure it out. And we did. And it felt so Wonderful to have a practitioner who genuinely was like, I hope you are orgasming. I want you, if that's what you want, like, that's great. I want you to feel good about this. And then I, I find it just like with so many topics within sexuality, women just start talking about it, we aren't sharing it. And, and so it can feel very scary if you're like, wait a second. Because a lot of women like I, I, it takes so much more to orgasm. Or what I hear very often is like, I just no longer have any interest. There is no desire, there's nothing to tap into and, and it disappeared overnight and nothing is working. And, and if you don't understand that, that is not for every, it doesn't happen to everybody, but it can happen to you. You can freeze in response to it or again, just feel like that's what, that's part of aging is you lose that. And I also feel fortunate that Betty, going back to my mentor, she was, you know, 91. I'm not sure how true it was at 90 and 91, but I know it was in her 80s that she was like, I have a vibrant sex life. It is not the same kind of sex that I was having, you know, when I was 60 or when I was 50, when I was 40. But my, I'm, I'm sexting. She would always say she was sexting some 26 year old in her 80s and, and, and she, she made it so achievable. And she also showed us that it's, that her sexuality wasn't lesser than, it was different. And, and she was somebody who had a lot of sexual agency and she had a lot of experiences. So she went into her 80s feeling like she had experienced what she wanted to experience, but she also was like, I'm, I'm going to be, I won't, I don't get to, I'm not going to be erased. My, who I am as a sexual being doesn't get erased because I'm getting older and I work with a lot of clients who are in their 70s and 80s and some want to be sexually active and, and they are, and things are not even much of a problem at all. Others, they're, they're not interested in it and they're at peace with that. And others are like, it's not where I want it to be. Can you help me? And I, I think that's the, the road that we need to be on. And I, I just was interviewed for a study yesterday and she was asking about the aging process. And she asked me if we used models, either like a drawing or a 3D model of an aged vulva. And I sat there, I was like, nope, nope, we don't. I can't think of one company that provides that. I could think of Betty. And that's pretty much all I think about. I think it's the only 80 year old vulva that I've seen and, and it's indelible in my brain because it's the only one. And I think if not that, I'm saying that we have to again and like, you know, drop our drawers and show everybody. But I also feel it's part of my responsibility is one, to learn for myself, but it's also for me to teach others and to say to my peers, to my clients, to, to those who are coming up behind me, as you said earlier, which is like, you have to know what to expect so that you can prepare for it. And you know, one of the things that I think is, is really great in, in our field is that it used to be called vaginal atrophy. What a horrible word.
- [65:09]
Dr. Stephanie Estima
Terrible.
- [65:10]
Dr. Juliana Hauser
Yeah, yeah, it's just the worst. And I remember a friend of mine called me, she's like, I just heard this word called vaginal atrophy. And then I googled it and she's like, Juliana, I'm in a spiral about this. And, and I, and it was, she couldn't believe that no one had told her that her outer lips could change in plumpness. And, and she felt she was newly divorced and starting to date again. And she's like, I don't want to, I want to say I'm sorry if, if you'd had a photo, if I had a photo shoot for my 20s, this is what you could have gotten. But you know, like here with my
- [65:47]
Dr. Stephanie Estima
20 year old vulva picture.
- [65:49]
Dr. Juliana Hauser
Yeah, that's right.
- [65:50]
Dr. Stephanie Estima
Yeah.
- [65:50]
Dr. Juliana Hauser
And she's like, and don't even try to tell me to love my bulbar. I don't. And so we're not even going to have that discussion. And, and it was, was I, I thought it was a very healthy discussion. And, and what I said to her was like, I'm just glad you're talking about it. Yeah, that, that's the first step in this. And, and wouldn't have been nice if you hadn't been so surprised. And, and then gratefully since that conversation that, you know, the name has changed. We don't use vaginal atrophy anymore, thank goodness. But I, I, I think your question, your point about like what do we know what's ahead is, is crucial. And, and I want to give an example that I think ties in what we're saying now and goes with the first question that you gave which is why is sexuality important? The last piece of that answer is that it truly could become something that is life or death for you. And so I'm going to backtrack that that the statistic is that women died most of sepsis from a UTI in a nursing home than any other thing thing. And, and partly it's because that generation wasn't giving hormonal placement therapy. We know that. But I add to that that is also a very not educated sex educated population. And, and I have seen what happens. So if you, if we go back to not being properly sex educated we aren't being taught to touch ourselves, to look at ourselves. And, and we have decades of that being the case. Maybe add in some lover had a weird face and you made you interpreted that they thought you smelled bad. So now you like really don't wanna have anything to do with it down there. And, and you then get to perimenopause and menopause and things are wreaking havoc for you and you start having UTIs all of a sudden and you were taught U2 eyes were from having dirty sex. And so you don't understand how you're getting UTIs if you've ever had UTI. It's miserable and horrible and you can't ignore it it because you feel so terrible. So then you have to go to the doctor and you feel shame because you think because of your lack of education, because of the world doesn't teach us the right thing that you need to explain. I'm not having dirty sex and I don't have poor hygiene. I don't know why I'm having UTIs all of a sudden and you feel embarrassed by that and our medical community hadn't caught up and this is, I'm using it a different. You know, before the last few years the medical community wasn't teaching us because they weren't being taught that we needed to have vaginal estrogen cream and that would make a very big difference. And it. So now we're. So now I move it to now and again the stacking effect of all the negative of all the way that our world doesn't support us and who we are as sexual beings. And you are faced with multiple UTIs in menopause and you don't know how to ask the doctor where am I supposed to put it. Or if they say your urethra opening or your bachelor. You know, you know, you just put it on your lips and. And you don't even know what your urethra opening is or how to find it. And so you just, like, are in the dark, just, like, guessing. So you're really not even putting it where you're supposed to because you don't want to spend a lot of time there. You don't know what yours looks like. And then you're not getting results from the vaginal cream. And you don't believe it. You don't believe, like, that it's this miracle cream that's going to change your UTIs. Or you feel like it's gross. It feels nasty to touch yourself or to have cream on it, and. And so you end up suffering and accepting it. Which women in so many areas of our lives, we learn just to suck it up from our period pain to, you know, all the other things that women go through through. We suck it up one more time, just, like, have to deal with UTIs and we don't advocate for ourselves. And then we. We get to a nursing home and we can't. We don't have the. We have dementia issues or we have other issues and no one's paying attention to it, and we have UTIs and we die from sepsis. It may sound like a very long journey to that, but it is. I could give you a hundred examples of how not. Not prioritizing who you are as a sexual being and our culture and not prioritizing robust sexual health and in our wellness viewpoint and in our own wellness plans as well as our own sex education, the catastrophic effects. And I'm not even. I haven't even talked about sexual violence or knowing that the studies show that sex and money are the reason. There's just so much that sexuality is pervasive, yet we partition it off as one little aspect and one part of our lives, and it is an absolute mistake.
- [70:15]
Dr. Stephanie Estima
God. Wow. So well said. Yeah. I mean, I don't even know. I'm very rarely shocked and speechless, and I'm a little speechless right now. That is unbelievable. And I think I've heard you also talk about this idea that, you know, in the same way that we look at heart rate and respiratory rate and all of these sort of. Of baseline metrics for health, that we would also look at our sexual health as one of those vital signs in the last couple of minutes that I have you here, what would be if we. If someone were to, I mean, Obviously we're going to pick up the book A New Position on Sex. We're going to read through these. We've talked about some of the pillars that you've talked about. There you go. A New Position on Sex. So wellness. And we talked about pleasure, desire. We've talked about some sexual acts and interest. If we were to define, if we were to put, I don't know if we can. But if we were to put numbers behind, if you were to say, okay, the vital sign, your sexual, like this is how we're going to measure your vitality through your sexuality, what would be some of the metrics that we might be looking at?
- [71:19]
Dr. Juliana Hauser
I would say how much your body talks to you and how much you listen is one of those indicators. Another is the value of your connections. And I, I know again, because you have to just, you have to unlearn what you were taught about the word sex and sexuality. But if you were to embrace holistic sexuality, you'll see that connection, whether it's through sexual, sexual connection or through connections through relationships, how you're feeling about the quality of your connections is another way of indicating of how in touch you are with, with who you are. And again, it may feel like a, a lip, a big leap. But if you, if you read the book, you'll understand how I get to the point of why connection is one of the last pillars and to me one of the most important ones. Friends. And, and it's to me, it's where sexuality and mental health and my, in my work really overlaps. And, and I, I will, I say that people can live a long time in pain, they can't live a long time without connection. And purpose can be part of that. But connection in general and for some people who, who they are and their connection with themselves is one of the most important aspects of, of themselves. And it doesn't mean that is just about looking at your genitals as a way to connect or just about self pleasure as a way to connect with yourself. It is. Are you tuning in to your yeses and no's on a small scale and on a big scale? And are you somebody that can also do that for anyone that you're interacting with? So I, I teach agency as a skill and it's not a pillar. It's threaded throughout all of the nine pillars. But I think if you are someone who has agency, you listen to your body, you ask yourself questions with purpose and intention, you, you have, you make decisions for yourself and you are somebody that provides that space for somebody Else inside and outside of sexual connection. It's. It's not easy to do that inside of sexual connection. A lot of times if you are partnered with somebody, you, no matter what the gender is, people will say they acquiesce to their partner or they let their partner be in charge or they want their partner to be in charge. Charge. And. And they're not showing up for themselves or they're not even aware they're not showing up for themselves. And so if you are able to make decisions with sexual agency, I think it's the ultimate litmus test of you being in touch with who you are as a sexual being. And your answers are fluid and ever changing. And interact with yourself. So it's not one stop. What. What you may. What may be a yes to you at 20 is a no for you at 42.
- [73:50]
Dr. Stephanie Estima
Right.
- [73:50]
Dr. Juliana Hauser
What was a no for you at 30 is a hell yes for you at 70. Like all of that. And so you can't ask yourself once. You have to keep asking yourself and keep building the skill of agency. And all it takes is one relationship, one sexual interaction where somebody did not bring in your agency or didn't know what they wanted and, and didn't provide that mutual self reflection. It. It. It changes a lot for you because when you do experience it, you. You. That's what you only want. You only want to be with a partner or to be sexually connected when you can really show up for yourself or the person is saying it because. And the way that I say it is you can't really trust somebody's no if you don't hear their yes. And you can't accept a yes if you don't know how to hear their no. And, and you have to be somebody first who knows your yeses and nos. And then you have to be somebody who is safe enough for people to give you their yeses and nos. And I think that's the gold star of where you are in a holistic sexuality.
- [74:51]
Dr. Stephanie Estima
Juliana, this is fantastic. This is as I suspected it might be. This was a fantastic conversation. And I know this is gonna give people so much permission and the beginnings, those inklings of agency that we've been talking about, to start exploring who we are, what we like, what makes us tick. And so a new position on Sex is the book. Highly recommend. Everybody getting it. Where can we find you outside of the book? Where can we find you on the interwebs, the Internets, all the places. Yeah.
- [75:22]
Dr. Juliana Hauser
On all social media platforms as Dr. Dash, Juliana Houser.
- [75:25]
Dr. Stephanie Estima
Great. We'll have all that in the show notes as well. Juliana, thank you again.
- [75:29]
Dr. Juliana Hauser
Thank you so much.
- [75:29]
Dr. Stephanie Estima
This has been fantastic.
- [75:31]
Dr. Juliana Hauser
Great. Thank you for having me on.
- [75:34]
Dr. Stephanie Estima
Hey, friends, welcome to the afterparty where we talk all things good, bad, and ugly about the episode. Man, this was such a great conversation. I think that if you are this far into the episode, you know, vaginal estrogen can be, you know, life or death situation, but really how you relate to your own body. I was literally speechless when she said that. I was like, oh, my God, I have. I wanted to cry because I can just imagine the woman who, you know, maybe she grew up in the. Whatever it is, the 30s, the 40s, the 50s, has a certain. Certain look or certain opinion about her genitalia. Maybe she thinks it's gross or it's nasty or she doesn't have even just the anatomical know how in terms of how to apply it. So she is so embarrassed. She goes to the doctor. She's like, I. I promise you, I'm not gross, but I am having this issue, you know, fills a prescription, and then because she's so repulsed by herself, doesn't fill it. I just want to cry. I want to cry because I know that there are so many women, maybe that even listen to the show show that. That might feel like that about their anatomy and their genitalia. And, I mean, it's part of why. It's part of why the podcast is here so that we can have some of these, you know, we'll say edge. Edge conversations that are a little, you know, edgy and that sort of push us to reflect on ourselves. So really, really enjoyed Juliana. She is, honestly, I am so impressed by her because when you sort of look at her, her. She has all the things, you know, she's graduated from prestigious college. She has, you know, the. She has all, like, thousands and thousands of hours of clinical practice. And then she sort of drops, you know, off, you know, casually in our conversations, like, oh, and I went to a naked seminar, and I had to show everybody my vulva, which is, you know, for many people, far beyond their comfort zone and something they will never do. But it is very, very impressive that she can be both very analytical and, you know, scientifically oriented and accepting and also doing the work. I thought that it was, as she was talking about the example when she was in acting class and the teacher was asking everybody, like, in circle, like, what's the most mortifying or, like, the worst thing that you could ever imagine that her worst thing would be to seduce someone. The thought that I Had when she was talking is like, oh, you know, like, you're in the right line of work. You know, like, sometimes I feel like the work finds you. You don't find the work. Like, you don't just get up and be like, you know what I'm going to be. I'm going to be a sexual. I'm going to be a sex therapist. You know, she was a kindergarten teacher and I think moving, like, kind of following what she was meant to do. Like, she's meant to do this work. So I had that. I wanted to share that with you. I didn't share it with her, but I thought. I thought that that was like, yeah, she's in the right line of work. Like, she found the right line of work there. So loved all of that. I think that the other thing that I really enjoyed was this idea of sort of going. Just being curious about what your, you know, she called it yums and yucks and yums. So what are your yucks and yums? What are the things that, you know, if you're a sensual being, maybe you don't have all of your senses, let's say, but maybe you have your sense of touch and your sense of taste and your sense of smell, and maybe you use. And your. Your vision. Maybe you use those things to explore what are some of the things that turn you on. I really like that because I think that a lot of women that I've spoken to, at least over, you know, many, many years, is that we are so afraid of being aroused for all the words that come along with it. And I didn't use any of the words on the. On the recording officially, but it's like, you know, I mean, you know, I don't even need to say the words like, you know, the words that I'm talking about. Right, right. It's like, oh, there's the walk of shame. All it's like, and we slut shame. And we call them every single thing in the book. And. And the reverse is also true. Like Juliana pointed out, it's like. And if you don't want to be sexual, you are called frigid. You're called, you know, all. All these different names which are horrible. And so I think the. I really like this idea of, like, self exploration. And there's no wrong answer. Like, that's kind of the beautiful thing, too. So my type A personality leaning, you know, my mechanistic leanings, let's say, of my personality always wants to know, like, am I getting an A on this? Like, am I like, do I get a gold star on my chart? Am I getting, like an A plus? Am I your favorite student? So that's what else it means. Like, you can take the girl out of school, but you can't take school out of the girl. So I always am thinking along those lines. And I suspect if you listen to the show and, you know, you feel a connection with me, that you're probably similar. And so what I really find freeing is that, that there's no wrong. Like, there's no wrong answer. It's like, that's just who you are and that's just, you know, that's just what. That's just your blueprint. So I really love that there's a certain freedom for me in that. So really, really enjoy that. And I also really like the talk about aging vulva. So I noticed she was talking about her mentor, Betty Dotson, and how she's like, I have a prototype. Like, I know what an 80 year old, you know, vulva looks like, but most of us don't. I do think that it is interesting to take into consideration how sexuality changes how we are, you know, how what we liked when we were 20 maybe changes when we're 40. Or what we said yes to when we were 20 maybe is a no in our 40s or 50s. And what we said no to in our 30s is now like a hell yes in our 50s. I really, really loved that. So to continue asking questions because you and I are not the same people that we once were when we were 20 and 30. Like, gosh, I was an idiot when I was 20. And I will say that, you know, in the best possible way. Right? Like, I was a really, really curious, motivated, maybe misled young girl. And I just, I mean, I have a lot of love for, for that girl because, you know, she's still with me in many ways. But what worked for her, let's say, sexually, doesn't necessarily work for me now as a woman in my 40s. So really, really love that. I think that she. I have this suspicion that you could go to her with absolutely anything and she wouldn't even bat an eyelash. She would just like, like, yep, seen this a hundred thousand times before. Totally common. And this is how we're gonna fix it. Like, she kind of reminds me for those Canadians that are listening, whoever watched Su Sue Johansson, she's very, like, matter of fact, like, here it is. And she does it with, you know, with compassion. So there's my, there's my little Canadiana reference for you. There okay, so I hope that you enjoyed this, this episode. I hope that this was something for you to maybe reflect on, on with yourself. Maybe you want to listen to it with your partner, what comes up. I think conversationally, this would be very interesting as well. She said something in the show, actually, that I really liked, which was like, sometimes you got to, like, experience something with someone else to kind of know if you like it. So I, I was like, oh, yeah, of course. Like, there's so many things that I would have never been able to do myself that I've had the, you know, opportunity to do with other people that, that was able for me to make a call, yes or no. So I loved that. So maybe this is a call conversation for you and a partner or partners, and see what lands, what doesn't. So let us know what you thought about it. Spotify, Apple, podcasts, all the places. And until next time, I bid you au and we'll see you then. All right. All right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only, and the advice recommendations we discuss do not replace medicine, chiropractic, or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor, and these conversations are meant for educational purposes only.