Urology is for Everyone! Breaking Down Sex, Surgery, and Stereotypes with Dr.Milhouse MD

Summary

Podcast Summary: Cate & Ty Break It Down

Episode: Urology is for Everyone! Breaking Down Sex, Surgery, and Stereotypes with Dr. Milhouse MD
Date: January 14, 2026
Host: PodcastOne
Guests: Dr. Fenwa Milhouse, MD (Urologist)
Hosts: Catelynn and Tyler Baltierra

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Overview

This engaging episode dives into the world of urology, busting myths about the field, exploring the intersections of sex, surgery, and gender, and discussing disparities, sexual health, and hormone replacement. Cate and Ty—reality TV mainstays best known for MTV’s "Teen Mom"—host Dr. Milhouse (“your favorite urologist”), who champions sex positivity and inclusivity in medicine. Together, they destigmatize urology, unpack common misconceptions, address representation, and deliver candid, often humorous, advice about sexual health and the medical journeys of men and women alike.

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Main Discussion Points & Insights

1. Dr. Milhouse’s TV Experience and Urology on Screen

• Dr. Milhouse recounts the journey creating a TV special about her urology practice:
  • Only one episode aired, despite nearly a million viewers and great feedback ([01:07]–[02:51]).
  • Changing TV landscape and network pivots have made "doctor shows" less common.
• Cate shares her own urology experience:
  • Details her surprise at needing a urologist while pregnant, and how common it is for women to assume urology is only for men.

2. What Does a Urologist Do—And Who Do They Help?

• Dr. Milhouse clarifies urology vs. gynecology:
  • "Gynecologists are specialists of vulva vaginal owners… urologists are specialists of the male reproductive system… but urology is truly for everyone." ([05:52])
    • Urologists handle urinary tract issues for all people.
    • Women’s urological needs often overlooked or misrouted to gynecologists.
  • “We are glorified plumbers… if there's something wrong with the part of your body that produces and excretes urine, you're coming to see us.” ([06:32])
• Representation in urology:
  • Only about 9% of urologists are women; Black women make up ~1% of the field. Representation is slowly improving ([08:41]).

3. Healthcare Disparities and Representation

• Health disparities are stark:
  • Black men are twice as likely to be diagnosed with, and die from, prostate cancer; yet are least likely to be screened ([10:14]).
• Barriers:
  • “It’s partly lack of access… you go to a part of the city that is primarily Black, like the access to specialties is very different from more well-to-do, predominantly white areas, which is so wrong.” ([10:54]–[11:21])
• Dr. Milhouse’s Background:
  • Born in Nigeria, raised in Texas, now practicing in Chicago.

4. Sex Positivity, Shame, and Sexual Health Struggles

• ED on the rise for young men?
  • More young men are seeking help for erectile dysfunction, possibly due to reduced stigma and increased information ([18:29]).
  • “Gen Zers are more informed, not as ashamed to talk about their health, and they seek health treatment…So I think part of it is just these younger people that used to 20 years ago just kind of suffer in silence, are like, no, I can go get this treated.” ([18:43])
• Role of porn, anxiety, and trauma in sexual health:
  • Early porn exposure and compulsive consumption can impact sexual function, but porn itself is not inherently a risk factor; how it's used matters ([21:41]).
  • Dr. Milhouse calls for parents to directly address porn and sex with kids: “Your kids are getting porn sent to them… you have to talk to your kids about porn and why it’s meant for adults…” ([25:29])
• Female sexual pleasure:
  • Most women (about 86%) need clitoral stimulation to orgasm—penetrative (vaginal) orgasm alone is rare (14%) ([30:32]).
  • “The clitoris needs to be your main focus… in the beginning, in the middle, and at the end. She comes first, ideally.” ([33:20])

5. Communication and Deconstructing Shame

• Open communication in relationships:
  • Cate and Ty champion candid, age-appropriate sex education for their daughters ([26:26]).
  • Dialogue about sexual pain and anatomy breaks taboos.
• Performance pressure:
  • Both men and women experience sexual anxiety, but manifestations differ. For men, it’s often erectile or performance anxiety; for women, it’s arousal or orgasmic dysfunction ([28:19]).
  • Normalize awkwardness and unmysterious realities of sex:
    • “Real life is, like, kind of awkward. Somebody might fart… or, oh wait, I gotta pee…” ([24:31])

6. Surgery, Treatment, and Common Procedures

• Range of urological surgery:
  • High variability based on subspecialty (kidney stones, cancer, sexual medicine, reconstructive, pediatric, etc.) ([16:04]).
  • For women, fixing leaky bladders is common; for men, erectile dysfunction surgery (penile prosthesis) is notable.
  • “We can get a stiff dick. Don’t you worry, fellas. Because of this implant.” (Dr. Milhouse, [17:50])
• Penile enhancement and cosmetic urology:
  • Emerging trends: fillers and surgical sleeve implants ([56:54]).
• New tech:
  • Devices to control overactive bladder via a small implant in the ankle ([55:42]).

7. Debunking Myths & Notable Facts

• Does cervix stimulation hurt?
  • Absolutely:
    • Dr. Milhouse: “Don’t touch my cervix. I want to wear a t-shirt—don’t touch it!” ([38:14])
    • Individual preferences vary, but pain is not ‘normal’: “If sex hurts routinely for you, it’s not normal…You’re supposed to enjoy it.” ([41:50])
• Vagina and penis size:
  • Average erect penis: ~5.1–5.2 in.
  • Average unaroused vaginal depth: 3–4 in, but doubles with arousal ([63:45]).
• Labia changes post-menopause:
  • Labia minora shrink due to decreased estrogen:
    • “One of the telltale signs of menopausal changes…labia will be miniature or gone.” ([60:23])

8. Hormone Replacement Therapy (HRT) – Clearing Confusion

• Strong advocacy for HRT for menopause/perimenopause:
  • Symptoms that can be improved: hot flashes, night sweats, mood swings, vaginal dryness, recurrent UTIs, sleep problems ([45:26]).
  • “If men went through menopause, we’d have a solution yesterday.” ([42:55])
  • HRT’s reputation damaged by a 2002 study; modern evidence shows risk is low and timing matters ([44:29]-[47:49]).
  • Start early for best protection (especially heart health):
    • “HRT started in perimenopause, or early menopause, actually decreases your risk of heart problems.” ([48:03])

9. Women’s Anatomy and Societal Shame

• Many women are embarrassed to ask about (or aren’t taught) their own anatomy. Dr. Milhouse stresses it’s a societal issue, not personal failing ([58:26]).
• Need for better medical education and prioritization of female pleasure and anatomy in research and medicine.

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Notable Quotes & Timestamps

• “Urology is for everyone!” – Dr. Milhouse ([05:40])
• “The clitoris needs to be your main focus…” – Dr. Milhouse ([33:20])
• “If sex hurts routinely for you, it’s not normal. You’re supposed to enjoy it.” – Dr. Milhouse ([41:50])
• “If men went through menopause, we’d have a solution yesterday.” – Dr. Milhouse ([42:55])
• “Real life is, like, kind of awkward. Somebody might fart...” – Dr. Milhouse ([24:31])
• “One of the most common disparities is black men are two times likely to get diagnosed with prostate cancer… and least likely to get screened.” – Dr. Milhouse ([10:14])
• “HRT started in perimenopause, or early menopause, actually decreases your risk of heart problems. There’s an advantage.” – Dr. Milhouse ([48:03])

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Key Timestamps for Major Segments

• [01:07]–[02:51]: Dr. Milhouse’s TV experience
• [03:47]: Cate’s personal urology story
• [05:52]: Urology vs. Gynecology explained
• [08:41]: Diversity stats in urology
• [10:14]: Racial disparities in prostate cancer
• [13:41]: Dr. Milhouse’s path to becoming a urologist
• [17:13]: Common urological surgeries for men and women
• [18:25]: Erectile dysfunction, young men and performance anxiety
• [21:41]: Porn, sex education, and impact on sexual function
• [30:32]: Clitoral vs. vaginal orgasm statistics
• [38:14]: The pain of cervix stimulation—debunking social myths
• [41:50]: Painful sex & when to see a doctor
• [44:29]–[48:03]: HRT misconceptions and modern best practices
• [55:41]: Tech innovations in urology
• [56:54]: Male enhancement/cosmetic urology
• [60:23]: Labia changes after menopause
• [63:45]: Average genital sizes

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Tone & Style

Conversational, playful, and candid—filled with humor, real-talk, and accessible explanations ("glorified plumbers" for urologists, “We can get a stiff dick,” “Don’t touch my cervix!”). The episode is rooted in body-positivity and inclusivity.

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Further Information

• Dr. Milhouse:

  • Instagram: @DoctorMilhouse
  • YouTube: Down There Urology
  • TikTok: “Your Favorite Urologist”
  • Practice: Down There Urology, Chicago

• Call to Action:

  • Cate & Ty urge listeners to advocate for medical shows about urology, follow Dr. Milhouse, and maintain candid conversations about sex and health.

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Takeaways

• Urology is relevant to all genders.
• Women and people with vulvas often have urological issues—don’t overlook this!
• Communication, knowledge of anatomy, and destigmatization are key to better sexual health.
• HRT is safer than many think; seek early, individualized advice.
• Medical representation and research still need more diversity and focus on women and minorities.
• Embrace awkwardness and honesty—because everyone deserves healthy, happy sexuality.

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This summary covers the key medical, personal, and social themes discussed, with ample quotes, context, and timestamps for deeper exploration.

Transcript

[Kate]

So, you guys, welcome back to another episode of Kate and Ty. Break it Down. We're super excited to have with.

[Ty]

We have a Doctor down below, Dr. Milhouse in the house.

[Kate]

Yeah, I love it.

[Ty]

We're so excited. Thank you for joining us.

[Dr. Milhouse]

Thank you for having me. I could not believe you reached out to me. And I can't believe I am still, like, amazed that you guys follow me and listen to me and take note of what I'm doing. I just feel honored because I adore you both and have been a fan of you all since your journey began on public tv.

[Kate]

Oh, thank you.

[Dr. Milhouse]

Yeah, thank you. And I love what you're doing here.

[Kate]

That's. I mean, that's where I first saw you, was your show. Yeah. So we. I did watch your show. Yes, I did. I enjoyed it very much. So do you know, is that. Is it coming back? I've only seen the one season, child.

[Dr. Milhouse]

It's not even a season, honey. It is. It is a one episode, one hit wonder.

[Kate]

Yeah, it was. Sure. I'm like, so did they not pick it up? I thought it was very interesting. And I feel like it's a lot of things that people should know about.

[Ty]

Because no one knows the TV world unless you're in it. And so you know how that goes.

[Dr. Milhouse]

Now you. Now I do.

[Ty]

Yeah.

[Dr. Milhouse]

My God, now I do. I mean, that one episode was so many months in the making and took a lot of brave humans to put themselves on front street. I mean, the humans you saw on that one episode, they were real, they were suffering, they trusted me, you know, random Doctor that they literally just met to do what I did. And the operations you see are obviously real. I loved the episode. I loved it. I loved the portrayal of how it was. I think it portrayed me and my personality to a T. And I really thought it taught a ton for the audience. I mean, got tons of good feedback. Tons of good feedback. It was like almost a million viewers.

[Kate]

Wow.

[Dr. Milhouse]

It was great. And all. On all metrics, it should have been picked up. Yeah, on all metrics, it should have been picked up. But timing was bad. So. Right. Like, things have changed in the TV world and landscape with the strikes, which I support and this, that and the other. And I don't know, I don't think. No, I'm not under contract anymore. PLC basically pivoted and they are not investing like they once did in Doctor shows. That's why if you pay attention to tlc, you don't see the Doctor shows like you used to.

[Kate]

Right. Because I noticed, like, like Dr. Pimple Popper moved over to lifetime.

[Dr. Milhouse]

To lifetime.

[Kate]

Right. I wonder why, though, Because I thought it was very. Yeah, I love that kind of stuff, and I think it's very. It's interesting to me. And like you said, a lot of people don't know a lot about urology and, like, doctors and urology and stuff. Like, I had to go see a urologist when I was, like, pregnant because I had weird things going on. And, like, for me, like, you know, it's like. I don't think. I think it's, like a. A branch of, like, in the doctor world that people don't really know or, like, talk about a lot. And so even for me, like, going into it, I was like, oh, my gosh. Like, this is so weird. We automatically think that, like, a urologist is just for men, when, in fact, it's not. And I found myself there thinking it was hormonal things, and come to find out, it was something completely different. And I ended up having to have, like, a surgery to myself. And so what you do? I had a. I had a. A periorethral cyst.

[Dr. Milhouse]

Oh, yeah?

[Kate]

Yeah. And.

[Dr. Milhouse]

And I thought it was, like, hormonal surgery to yourself.

[Kate]

Huh?

[Dr. Milhouse]

What surgery did you do to yourself?

[Kate]

Well, no, like, the urologist did.

[Dr. Milhouse]

Okay, I thought I heard you did. I was like, did you try to bust your own.

[Kate]

No, no, no, no. It was way too painful. But I was like. I was pregnant thinking, like, it was, like, hormonal, you know? And I went in there, and he was like, no, like, you have to have a surgery, and we don't want to do it when you're pregnant.

[Ty]

That was crazy.

[Kate]

It was just a crazy experience. But.

[Dr. Milhouse]

But we can safely. Like, did you get it done pregnant? Because it can be safe?

[Kate]

Yeah, because, like, I. I asked for that. I was like, well, is it possible? And he did. He did mention about, like, how it was, but he didn't feel comfortable. Like. Like, full comfortable, like, fully sedating me or whatever, like, putting me under. So I ended up opting for when, after she was born. And it was the craziest experience of my life. But. But I think it just goes back to, like, a lot. I don't think it's talked about a lot, and I think a lot of people do think that urologists are just for men. And it's like, no, that's not accurate at all.

[Dr. Milhouse]

Absolutely. You said it all. You said it all, Caitlin. I mean, no one knows what we do. Y'. All, the public that you don't know, Even our Own colleagues in medicine don't quite know the extent of what we do. And I didn't know what a urologist was until I got to medical school, and then I had to Google it, and I was like, oh, this seems like a male gynecologist. You know, that's like, the first thing that I think people comes to people's head. And as a woman, especially as a black woman, I was like, well, you know, I can't see where I fit into this, you know, so check that off. And then it wasn't until I met a black woman urologist, and I was like, whoa, how is a woman of color in urology? And like, oh, no, there's a whole. Urology is for everyone. I love saying that. Urology is for everyone.

[Ty]

Well, I think people get it confused, like urology and then gynecology and then, you know what I mean? They get it like, so what is, like, the main. Like, what's the main difference of people listening who don't know? What is the main difference?

[Dr. Milhouse]

Okay, so gynecologists are specialist of vulva vaginal owners, okay? So they technically will not see men or penis owners, okay? They see people who own a vulva, vagina, uterus, or ovaries. All right, on the flip side, urologists are specialists of the male reproductive system. So we're the specialists that people with. With penises go when they have problems with their penis, that people with prostates, that people with men who have infertility, testicle problems, all of that. So that's where we got the male gynecologist rap, okay? Which is very true. On. But urology Euro, that is the study of the urinary tract. We are the specialists. We're the plumbers. I like to tell people we're the glorified plumbers. All right? If there is a something wrong, blockage, anatomic mass or cyst or tumor or something in the part of your body that produces and excretes urine, it's coming. You're coming to see us. Okay, so that's anything from kidney masses, kidney stones, kidney malformations. Your ureter, which is the tube that connects your kidney to your bladder, things that happen there. Your bladder, bladder issues, urinary leakage issues. We see recurrent UTI issues. Your urethra, you had a peri. Urethral cyst. Okay? That is a urologist who actually does that, even though it's. You're like, it's in my vagina.

[Kate]

Right, right.

[Dr. Milhouse]

You're like, but wait, why is it not going To a gynecologist, it is usually a urologist who does that because it's next to the urethra. Because our urinary tract, our lower urinary tract, involves women or people who own a vagina and vulva. There's a whole part of urology that is dedicated to women or vulva vaginal owners. So this is why we are uniquely positioned, because we actually can see anybody, no matter what's between your legs, who makes urine. And we are really good experts at genitals, whether it's the male genital or the female genital.

[Ty]

That's interesting, because I remember when Kate first went to the urologist, she was like, oh, no, it's a guy. She's like, dang it. Like, she was hoping for a female.

[Kate]

Yeah, well, because like you said, I mean, my first instinct was I went to my. My gynecologist, and she was like, I can't help you with this. And I'm like, what do you mean you can't help me with this? You know, and she's a female. Right. I'm like, what? And she's like, you have to go see a urologist. I'm like. And then. Yeah, so, yeah, that's the. That's the first thing I did.

[Ty]

So I feel like. Is urologist. I mean, women have to be pretty rare, I guess, in this field, because I remember.

[Kate]

Are they not?

[Ty]

Yeah, I was curious.

[Dr. Milhouse]

Yeah. So it's getting better. But I think the latest statistic is 9% of urologists are women. That used to be worse. We do see, like, women coming in the pipelines. I was just at a meeting in Chicago. I live in Chicago, and there is this group called the Chicago Urologic Society meeting. It's been around for, like, over 100 years. It's like, one of the oldest urology societies. And that room used to look like white men. Okay. Used to look like straight up man club. Okay. And it's great to see because one of our speakers, I'm the vice president of the society as a black woman, but one of the speakers said, I was a resident here 25 years ago in this room was, like, filled with men. And now I'm looking, and it's like 50% women. So we have women that are. Are entering urology residency. And so you will continue to see that number go up as it should. Yeah. We obviously need better representation, not only gender, but race and ethnicity and background. We need more black and Latino urologist. And so somebody like me as a black woman in urology is A unicorn. Like, really about 1% of the urology workforce.

[Ty]

Now, do you. Now do you find that there's specific. Is there any differences with certain, like. Like, higher risks for black people or Latino people? Like, is there, like, versus white people, like, in this field?

[Dr. Milhouse]

Yeah, yeah. I mean, the reality is there are disparities when it comes to marginalized communities in almost every subspecialty that you can think of. And urology is certainly not spared. One of the most common disparities is black men are two times likely to get diagnosed with prostate cancer to die of prostate cancer. And unfortunately, black men are the least likely to get screened for prostate cancer.

[Kate]

So why do you think that is?

[Dr. Milhouse]

Risk is the least likely to get.

[Kate]

Screened, and why do you think they're not getting screened?

[Dr. Milhouse]

Oh, Caitlyn, that's a whole nother podcast, baby.

[Ty]

That's a whole nother episode. That's part two.

[Kate]

Yeah, yeah. Cause I'm like, wow, power. Yeah.

[Dr. Milhouse]

I mean, it's partly lack of access. Oh, my goodness. I mean, again, you live. You guys are near Detroit, so you can understand, like, you go to a part of the city that is primarily black. Like, the acts, like grocery stores, a clinic, access to specialties is very different from, like, the. Like, more well, to do quote unquote, a predominantly white, which is so wrong.

[Kate]

Like, how are we still here?

[Dr. Milhouse]

Yes, yes. Chicago's the same way. Chicago. When I moved to Chicago, I was like, whoa, it is so different if you're on the south or west side of the city versus if you're on the north side. Like, you have everything you could want on the north side. And on the south side, it's like, yeah, we can't even get a functioning park for our kids. So again, this could be another hour.

[Ty]

Now. Were you born and raised in Chicago?

[Dr. Milhouse]

No, I wasn't. I was born in Nigeria and have been in the United States since. Since I before. I don't even remember being born in Nigeria since I was, like, 2. And then we settled when I was about 7, 8 years old to Texas. So I grew up in Texas and came to Chicago for residency at University of Chicago in 2008. And that was supposed to be like, okay, I'll do my residency and then go someplace else. And then I met my husband and stayed.

[Ty]

Oh, wow. Okay.

[Kate]

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[Dr. Milhouse]

Yeah, so I absolutely, positively did not think that I would be a urologist. Like I said, I didn't even know what it was when somebody said the word had to look it up. And I immediately crossed it off my list. Urologist is not only a medical doctor, we are surgeons. Okay, your urologist did your surgery, right? And so urologists are surgeons. And so even the thought of me being a surgeon, I was like, no way I can be a surgeon. I'm clumsy, I'm a little like goofy. I'm, you know, a woman, I'm black. Like, there's like what I saw of surgeries. Surgeons were like, they're very, they're very like strict and no nonsense, very smart, you know, and, you know, just wasn't like who I saw myself as at all. So what where I thought, I thought I dabbled in dermatology. I remember I was like, I'm going to do dermatology. They seem to like, love, you know, have lots of free time. And then I did a rotation at derm clinic and I was so bored.

[Ty]

Like, screw the skin.

[Dr. Milhouse]

I was like, this is boring. No, I can't do it. Then I thought I did think gynecology. I actually was very much thinking gynecology because, you know, again, As a woman, woman's health naturally appealed to me. I was, I think, more into the gyne part than the ob part because I've. I didn't really inherently think, oh, I want to bring babies into the world. But I was like, okay, cool. That's really an honor to do, you know, in medicine. To bring babies into the world is, like, probably the biggest honor to. Yeah, yeah, in medicine. So I thought about that for a while and ultimately found my calling in urology. Once I actually saw what urologist did, I was like, oh, no, this is where I'm at. And actually, I can see myself being a surgeon now because these people are cool as shit. Like, yeah.

[Ty]

Yeah. So I was gonna ask what is, like, for people who don't know? Like, I don't think people. A lot. A lot of people understand that urologists do a lot of surgeries and a lot of procedures. Like, so it's like, what is the most common procedure that you see with men and women in your place?

[Dr. Milhouse]

Okay, so this answer may be different. Different depending on what urologist you speak to. Because even within urology, there are what we call subspecialties.

[Ty]

Okay, what do you mean? Like, what does that mean?

[Dr. Milhouse]

Yeah, yeah. So there are urology specialists that just deal with kidney stones. So the most common thing they're doing are kidney stone surgeries. There are urology specialists that just deal with male infertility, so they're doing that. They're urology specialists that deal with bladder leakage and other problems that are predominant maybe in female and females. Okay. There are urologists who do cancer. Like, they're cancer urologists, so they're taking out prostate cancer, kidney cancer, testicle cancer, penile cancer. They're urologists who do reconstruction. So they might be somebody who does a lot of gender affirming surgery. Okay. And other reconstruction. So there's tons of subspecies pediatric urologists who just do a. Kids. All right, so to answer your question, general urology, I mean, for me, my practice is heavy, heavy sexual medicine, heavy on female urology, heavy on hormones. Okay. So at this current moment, like, one of the most common surgeries that I might do is fix a leaky bladder. Okay.

[Ty]

Okay.

[Dr. Milhouse]

And we do that with slings. And. And that's for. And that's predominantly going to be women, just because women are more likely to have leaky bladders. One of the most common surgeries that I do in men might be to surgical treatment for erectile dysfunction called a penile prosthesis, which is where we actually implant a device that Gets a firm penis for a man who can't get an erection any other way.

[Ty]

It's an implant.

[Kate]

So you don't have to take a pill no more. No little pill anymore.

[Dr. Milhouse]

Yeah, well, these are people who. Pills don't work. They tried pills that doesn't work. Injections don't work.

[Kate]

Yeah.

[Dr. Milhouse]

You know, that sort of stuff. Yep. And, yeah, it's an implant. It's a very highly successful implant with a very high patient satisfaction rate. And we can. This. I basically tell virtually any man, I'm like, we can get a stiff dick. Okay.

[Ty]

Don't you worry, fellas.

[Dr. Milhouse]

We could get a stiff one. And this is why. Because of this implant.

[Ty]

Now what? Okay, so it's interesting because I read somewhere, I can't remember where, maybe a year ago, where it was, they were talking about how erectile dysfunction is on the rise. Are you seeing that at all, like, in younger men? Like, than that, you know, than usual?

[Dr. Milhouse]

Absolutely. Seen that.

[Ty]

And that is so weird to me. How.

[Dr. Milhouse]

What do you.

[Ty]

How are we. How are we getting here? How's this happening?

[Dr. Milhouse]

Well, okay, so, Tyler, it could be. Maybe it's not on the rise, but maybe younger men, this generation, y'. All. I mean. Wait, are y' all millennials or are you guys.

[Kate]

Yeah, you're millennials. Yeah.

[Dr. Milhouse]

Okay. Okay. You're like, young millennials or. No, you're mid millennials.

[Ty]

I was born 92, so I'm an old millennial.

[Dr. Milhouse]

So what am I talking about? I'm an old millennial. Yeah. Okay. So anyway, so, Jen, what is it? Gen Z after that? Yeah, Gen Zers are, like, more informed. They are not as ashamed to talk about their health, and they seek health treatment. And so are millennials probably, too. And so I think part of it is just these younger people that used to 20 years ago just kind of suffer in silence, are like, no, I can go get this treated. I mean, we have. There's, like, millions of doctors on social media, on the Internet. So people know that things can be done in ways that they probably didn't know existed before. So it could be just. Again, more people are seeking care. There could also be the factor of, like, how we do sex today. And what am I talking about? I think in my practice, I see a lot of young men under 40 with ED. In fact, most of my men with erectile dysfunction, my practice, are young. Wow.

[Ty]

Wow.

[Dr. Milhouse]

And what I have observed is that there is a lot of anxiety and performance anxiety and stress around sexual activity.

[Ty]

Interesting. So that. That feels like more like a. Like a. Like A. Almost like porn or they're too. You know, because how are you getting. How does. So.

[Kate]

But that was actually one of my questions about, like, if you thought that, like, anxieties or past traumas can play a role in sex. And it sounds like it can.

[Dr. Milhouse]

Hundred percent. One hundred percent you. Okay, so, yes, anxiety traumas. I mean, obviously trauma can play a role in every facet of our lives. Sex obviously included anxiety over being a performance. I feel like there's a whole lot of, like, showiness about sex and like, oh, is he gonna last this long? And I. I do feel like we put a lot of pressure on men. Like, are you. Are you wrong and hard and lasting long and doing these. Can you make me orgasm? And this and that. And I have a whole thing about. I have a whole thing about women saying, can he make me orgasm? Like, no, Boo. Can you make yourself orgasm and tell him what you like?

[Kate]

Right.

[Dr. Milhouse]

Making another woman do something. Another person do something for us. Another human. But anyway, there's that. I think so. Porn. I am. This is a. This is like a great. Probably a question. How does porn play into this? And the truth is, science is kind of conflicting. As somebody who's very sex positive. Kink positive. And I'm going to say it like, not. I'm not anti. I'm for erotica. Let's just say, like. Yeah, okay. Used well.

[Ty]

Right, right, right. Healthy porn. It's all good. We're good with it. Yeah, Yeah.

[Dr. Milhouse]

I don't think porn. We don't believe that porn independently is a risk factor for erectile dysfunction. Okay. We do believe there are certain porn behaviors that do increase the risk for erectile dysfunction. So early. Early exposure to porn. I mean, boys who are exposed to porn, like, 10, 11 years old. Yes. There's probably a higher risk of sexual dysfunction. Okay. Again, I'm an old millennial. We had. You had to buy porn at a Blockbuster Video. Okay. It was in a magazine.

[Kate]

You had to put it as a vhs. You had to put in the tv.

[Dr. Milhouse]

So when I was that young, like, it wasn't on the. On the interwebs. There was no interwebs. Also, if you have a porn addiction, okay. If you have a problem, I like to say I asked my patients, what is your relationship to porn? And they're like, what does that mean? I was like, wow, tell me about it. And then I asked them, like, do you ever feel guilty? Do you ever feel, like, compulsive? Do you feel like. You know what I'm saying? Like, is it like you Know your go to stress reliever all the time or, you know, stuff like that. So.

[Ty]

Yeah, and that's kind of what I meant as far as, like, healthy or non healthy, like, there. I. I'm pro porn too. Like, hey, as long as it's not affecting you and your mental health and you're obviously your sex life, then go for it. You know what I mean? But I think there is a. Probably a line, obviously, where it's like, it can become impulsive.

[Dr. Milhouse]

Yeah.

[Ty]

Kind of an issue, like. So that makes sense.

[Dr. Milhouse]

Absolutely, absolutely. So I. I'll see patients who say I can't get erect because I don't have the same stimuli that I have been conditioned to because they've been watching, like, really hardcore porn since they were 13 and they watch it all the time. And so now they need, like, really a lot of, like, their brain, their dopamine connections and their arousal connections have been, like, associated with, like, really hardcore imagery. You see what I'm saying?

[Ty]

It's almost like the adult man got hijacked by this.

[Dr. Milhouse]

Yes.

[Ty]

Almost on. Because honestly, like, I. I feel like that. I feel bad for the generation that, like, I didn't.

[Kate]

We didn't have the younger.

[Ty]

Yes. Like, we didn't have that access in our pocket. So I don't even know what I. I just feel bad for him because I couldn't imagine having that much access, being so young and what that would do to your. You know, you growing up, going through puberty and developing your own sexual identity. Like, that's a whole.

[Kate]

Well, then I think it also. But then. And then also, too, I think it also can, you know, make young men and. And women feel like, you know, they have to act a certain way or do things a certain way or. It's not real. When some porn that we watch is not real, it's not real.

[Ty]

You know, production, you know, lights and cameras and. Yeah. I mean, like.

[Dr. Milhouse]

Yeah.

[Ty]

I wish. I wish people would understand that. That it's not real life. You know what I mean?

[Kate]

Correct.

[Dr. Milhouse]

Real life is, like, kind of awkward. Somebody might fart.

[Kate]

Yeah, right, right, right, right, right.

[Ty]

Exactly. You know.

[Dr. Milhouse]

Oh, wait, I gotta pee. Like.

[Ty]

Yeah, yeah.

[Dr. Milhouse]

Real life, it's like, there's awkward moments, and if for you, you're like, you know, already anxious, and then this awkward moment leads to, like, losing an erection or doing that, then. Because all you've known is, like, this curated idea of what sexual encounters are with humans. Like that you speak to something, Tyler, which is. Our kids are. Are very much exposed and have all this Access, which is not like always good. And what that means is we have to be really communicate as parents, you know, that this is. We can't hide and think, okay, if I don't say anything right, Tommy and even Susie aren't going to see porn. You're. You're big. Your kids are getting porn sent to you. You don't even have to. They don't have to Google porn. It's getting sent to them inad certainly.

[Kate]

Right.

[Dr. Milhouse]

Okay. If they're on any social media type whatevers. So you have to talk to your kids about porn and why it is meant for adults and how to use it, you know, well, and you know, teach them that sex is not taboo.

[Kate]

I was gonna say. And I think, yeah, I think also, you know, I mean, I feel like with us being on the show for 16 years and stuff and our daughters getting older, like they've seen us, you know, people have seen us talk to our children about sexual sex at an age appropriate level. And there's been some people that give us some flack, but I feel like there's also been a lot of support. And I think minetized thing is, is like if you started at a young, at a younger age where it's appropriate and you do it in an age appropriate way, you know, then it's always going to be normal to talk about it with your parents, you know, And I feel like that's important too. Like we should be talking about sex. We should be talking about, you know, my 11 year old says like, you know, when if I ever have the thought about it, I'm coming to you so that way I could be protected. And that's been years of like.

[Ty]

Yeah, she started out very young and she asked a question and we were like, right. I let her curiosity kind of drive it, you know.

[Kate]

Yeah, she was like five and she was obsessed with horses and she was like, played this game where you had to like get two horses together to get a baby.

[Ty]

Shout out to that horse game. Because it.

[Dr. Milhouse]

Yeah.

[Kate]

Yeah. And she was the one who was like, well, how does this happen? And she's like, oh, were they mating? And me and tower like, yes, they're meeting. And it started off with mating and then, you know, she just progress. It's super, I think it's super important. And I guess I never really t thought about like talking to her about porn and I think that is very smart.

[Ty]

Remember I told you, I, I told you earlier that I was like, you know, I think it's important to just let her know that this is, like you said, it's meant for. It's entertainment for one. It's pro. It's, you know, produced. It's not real. And it's meant for entertainment for grown adults, you know, with a way more developed brain than you have right now. So I, I feel like, with that being said, like, I, I, and I like you, you know, talk about performance anxiety for men, but I also feel like there's, it's also for women because if we're, if they're watching and they think they have to act like this, make these noises, be this aggressive or not be that aggressive or be this, whatever, you know, or they might feel.

[Kate]

Weirded outlet that, you know, how come I can't have an orgasm? Vaginal.

[Ty]

They think it sounds wrong with them, you know, or something. So, yeah, it's important to talk to them.

[Kate]

Kate and Ty Break it down is brought to you by Progressive Insurance. Do you ever think about switching insurance companies to see if you could save some cash? Progressive makes it easy. Just drop in some details about yourself and see if you're eligible to save money when you bundle your home and auto policies. The process only takes minutes and it could mean hundreds more in your pocket. Visit progressive.com after this episode to see if you could save Progressive Casualty Insurance Company and affiliates. Potential savings will vary. Not available in all states.

[Dr. Milhouse]

You're absolutely right, Tyler and Caitlin. There's performance anxiety, man. There's anxiety with sex manifesting as performance anxiety. Erections. For men, I feel like for women, anxiety manifest as arousal and orgasm dysfunction. Okay. Because for us to engage in most. Well, let me put a caveat here. Obviously we are mostly talking about heteronormative sexual encounters. Sex can be a lot of things and I hate that sex in the world has come to like penis in vagina. Yeah, Sex is a lot of stuff. So anyway, but for the sake of the, you know what we're talking about for penis and vagina, heteronormative sex. The vulva vaginal owner doesn't have to have a clitoral erection to engage in penetration. Right. We're not the ones, you know, we're the ones being penetrated. So if you are a woman who's anxious about, do I look weird? Is my vagina look strange? Oh, my God, I saw this porn. And d. Am I wet enough? Am I, you know, this and that. Am I going to squirt? Everybody wants to squirt. It's like a cool trick.

[Kate]

I know, right?

[Ty]

1.

[Dr. Milhouse]

It's one way that people orgasm. It's Absolutely legit. But it's not the only way that we orgasm. And so I'm constantly telling women, like, why don't you stop and smell the roses? Like, you're like the kid in the backseat, like, are we there yet? Are we there yet? Are we there yet? And you're missing out on all the beauty happening around you. You're like, am I going to get an orgasm? I'm going to get an orgasm. And you're missing out on the touching, the licking, the sensation, the smell, the whatever, the sights. Enjoy the ride. And I promise you, when you take your mind off or take orgasm off the table, take that off, that pressure off the table, that you're more likely to get to orgasm that way than when it is like, I must achieve this milestone or else.

[Ty]

Yeah, like, enjoy the ride. Don't. Don't. Don't worry about. The destination is enjoy the ride. Because I feel like it's a big misconception that, you know, all women can orgasm vaginally. And it's like, that's not. That's not the case. I guess it's a very low percentage. I want to ask you, like, what is the. Do you know the percentage?

[Dr. Milhouse]

Yes.

[Ty]

What is the percentage? So everyone knows.

[Dr. Milhouse]

Okay, so the percentage. I'll tell you the percentage of women. The default orgasm for vulva vaginal owner, a woman is the clitoris. And it's. About 86% of women need clitoral stimulation to orgasm. That is the norm.

[Ty]

Yeah.

[Dr. Milhouse]

So about maybe 14% of women can orgasm purely vaginally. Purely. Okay. That doesn't mean women can't have vaginal sex with clitoral stimulation simultaneously and have a beautiful orgasm. Doesn't mean that vaginal penetration doesn't feel good. But pure vaginal without clitoral stimulation. 14%. And furthermore. 14%. 1. Furthermore, a lot of vaginal orgasm is the G. What we call the G spot. Okay. The G spot is really a zone in the upper wall of the vagina. Okay. Where's my vagina pillow? I don't know if this is. Yeah, this is. Yeah, absolutely.

[Ty]

There's the vulva pillow.

[Dr. Milhouse]

Good for you, Tyler. I called it a vaginal pillow. It's really a vulva pillow.

[Ty]

You are. No, I was actually.

[Kate]

I was gonna say he's way smarter about the vulva than I am.

[Ty]

I'm just a nerd, and I read. No, he is stuff. And I. It's funny because Kate was like. I was like, you know, you have five different zone. Like, five different.

[Kate]

Oh, I asked him things about she was like. All the time.

[Ty]

I was like, you have a majora. You have a minora. You got a. You got the. Is a wishbone shape. There's all this thing.

[Kate]

Yeah.

[Ty]

Got a hood.

[Dr. Milhouse]

You could teach us. That is what I was getting at. The clitoris that we see is just a little bit the. It's a wishbone, and there's. There's, like, legs that are underneath that, like, wrap around the upper wall of the vagina. And so we believe that that G spot, G zone is actually part of the interior of the clitoris that people are getting stimulated. So even then, the clitoris is involved. Okay.

[Ty]

Yeah. Yeah. Which I think a lot of people get. They get confused on it because they're. And especially, like I said with. With girls having that kind of anxiety of like, what's wrong with me? Why isn't it happening? And then obviously, that could even leak over to the guy thinking, oh, my God, what's wrong with me? Why can't I give her one like this? And so I just think it's like. But 14. That's way crazy.

[Kate]

That's way lower than I thought it was.

[Ty]

Yeah. I'm like, you're a minority, right? At that point. Like, holy. That's crazy.

[Dr. Milhouse]

You are a minority.

[Kate]

So a man should not feel discouraged if a woman needs clitoral stimulation to have an orgasm, because it's completely normal.

[Ty]

I think. I think bring. Bring all. You know, how many toys are out there now that are. We. Listen, we have an arsenal. We have an arsenal nowadays, you know what I'm saying?

[Kate]

There's lots of things out now.

[Ty]

There's people designing toys specifically for this thing. Like, go shopping together.

[Kate]

Shop together.

[Dr. Milhouse]

Shop together, yes. So not only should the man not feel bad, the man needs to reprioritize the clitoris. Like, the two things I tell men, you know, that are having sex with women. I was like, the clitoris needs to be your main focus in the beginning, in the middle, and in the end. Okay. Throughout. Okay. Number two, she comes first. Ideally.

[Kate]

Love that.

[Ty]

I always thought I have a 2 to 1 ratio. That's my 2 to 1. Listen, for every one I get, you got to have at least two. It's how it works. A two to one, two to one. That should be the standard. Gold standard, at least.

[Dr. Milhouse]

I'm happy for you. But I feel bad for you, too, because you're. Because you're like, I got mine. We're good. We're good. And he's like, no.

[Ty]

Two to one. Two to one.

[Dr. Milhouse]

I love it. No that's great because you, you know, we take longer to orgasm. There was a study and it showed that the average time to orgasm for a woman was 13 and a half minutes. Okay, that's going to matter. We take longer. We can orgasm back to back. Like we can orgasm. Keep it going, right? A man, okay, now with a penis on average takes like five minutes to, to orgasm. Okay. Once vaginal penetration begins, they looked at like intravaginal time. Five minutes in the vagina before it orgasmed, that average was five minutes. And once a man ejaculates, there's a refractory period before that penis can penetrate again. When you're young, that refractory period might be a few minutes. Cool, I'm back. But that is that it's when you're young, when you get to be. I'm a 43 year old woman. Men my age, that refractory period is probably you the rest of the day.

[Ty]

We'll try to.

[Kate]

Tomorrow.

[Dr. Milhouse]

Yeah, yeah, try tomorrow. Exactly.

[Ty]

That's interesting though, because I feel like. Yeah, I mean, that's like. I mean, I'm kind of shocked by.

[Kate]

The five minutes compared to 13. Like, yeah, she definitely better. That's what. And these guys are. Some of these guys out here be lazy.

[Ty]

You know, it's funny because I always tell her, I'm like, I'm like, listen, you're the priority. Because I have the easiest organ. You know, I was made this way. I nothing's. I don't need anything. You know, it's very easy for me. It's so, it's. I always like, you know, obviously I think women should be prioritized in that way because it's not my fault that you got 13 minutes versus the five. I think five is really. Holy shit. I mean, is there a way to like make that longer? Because that seems super short. Yeah. What the fuck? Five minutes.

[Dr. Milhouse]

Five minutes in the vagina. That's, you know, five whole minutes is like. I mean, it's short, but it's like a lot of time if you like actually count the seconds. But anyway, true. To make it longer, how do you make it longer? You can masturbate before you have sex. So that's because.

[Kate]

But hopefully your refraction time is not long. Right?

[Dr. Milhouse]

Well, exactly right. Like maybe let's say you're going on a date, hot date in the evening. You like maybe masturbated like, you know, in the afternoon. You see what I'm saying?

[Ty]

Yeah.

[Dr. Milhouse]

Because then you might have a higher threshold to orgasm because you've already.

[Kate]

Right.

[Dr. Milhouse]

Rode that wave and so the next wave. Usually if you can get your, assuming you can get your erection back right then that it takes longer to get past that, that next orgasm that quickly. So that's a like a behavioral trick you can do. And there you can, there are numbing sprays and delay sprays. They've got like all sorts of over the counter sprays you can spray your penis with essentially like numbing spray.

[Kate]

Put lidocaine on it.

[Dr. Milhouse]

Like lidocaine. Yeah. And I mean it will obviously like it'll take away some sensation. So it's not, it might be a double edged sword in some cases. Although the delay sprays are getting better where they're not totally numbing but it could be like, where it's like, okay, great, I'm not ejaculating but I'm also not enjoying it like I used to. Right.

[Ty]

Well then I'd be worried about the girl. What if the girl gets. Absorbs the lidocaine? Yeah. Then shit.

[Dr. Milhouse]

A good, that's a great point. A good spray doesn't hopefully cross into the, the vagina. So yes, that can happen though. So look for that like, look for that messaging if you're going to buy one, like does it transfer to the partner?

[Kate]

So I think Tyler actually on his card he has a really good question about the.

[Dr. Milhouse]

Oh God, yes.

[Ty]

Okay. So can the cervix feel pain?

[Dr. Milhouse]

Oh yes. Yeah.

[Kate]

Thank you.

[Ty]

Thank you God. Yes, Dr. Milhous, I have literally I, I'm gonna say I'm gonna slap myself. I see another male doctor go on and say that there's no.

[Kate]

Yeah, we've seen some and there's like men in the comments and stuff saying.

[Ty]

That I'm like, this is mind blowing because.

[Kate]

Don't touch it. Yeah, I'm gonna punch you.

[Ty]

I will kick you in the face.

[Kate]

Yeah, literally I'll kick you.

[Dr. Milhouse]

Don't touch my surface. I wanna, I want to wear T shirts. Like don't touch.

[Ty]

Yeah. And that's why when I told her that she was like, that's crazy because I think and in. And that's important to talk about because men need to be careful if, if you, you know, you can't just go in there and be wild because she's gonna punch you in the face.

[Kate]

Oh, I'll kick you in the face.

[Ty]

So yeah.

[Dr. Milhouse]

Yes. A you need to make sure she is sufficiently aroused. Okay. Because a non aroused vagina, the cervix is so close to your opening. Because did you know when we are aroused our vagina like grows it Grows.

[Ty]

It grows backwards. Guys go forward. Girls grow backwards.

[Dr. Milhouse]

And we. Yeah, it, like, gets. It gets deeper. It gets deeper. So that's why there might be times you're like, dang, she's really taking it, but that's because she's really aroused. You know what I'm saying? Other times you like, other times it's like, I don't know if you experience this, Caitlin, but, like, sometimes I'm having sex with my husband. I'm like, okay. Like, yeah, I'm not fully aroused, so you have to be gentle because I can feel you hit my cervix.

[Kate]

Like, oh, there's been a few times.

[Dr. Milhouse]

Like, yeah, I'm like, dang, she's really. I'm taking it deep because I'm fully aroused. You see what I'm saying?

[Ty]

But I feel like it's almost like. But even for guys, like, you can't go. Sometimes you just can't go all the way in. It's fine. It's. It's gotta chill out, you know, Calm down. Because I mean well.

[Kate]

And people have heard me say on this podcast before, I mean, I don't know, I could hit in the face.

[Ty]

Don't cry.

[Kate]

But, like, we. Me and him have had conversations before about, like, when I see women's comments, and they're like, yeah, right. I love it when they pound my service. I'm like, a liar. They're just trying to perform. Perform. It's performative. You're a liar.

[Dr. Milhouse]

I don't believe it.

[Kate]

But who knows? Somebody might like that pain. But in my mind, I'm like, you're a liar.

[Dr. Milhouse]

There are a few people who do like it. Caitlyn.

[Kate]

That is not crazy to me.

[Dr. Milhouse]

I'm usually not. I'm not. Yeah, they are a few. I have had a patient who directly told me I was doing surgery to fix her, like, uterus that had fallen, and she was like, Dr. Milhouse, I like my cervix touched. Like, I like my cervix touched during sex. So I don't want. She was like, I don't want a hysterectomy, because I'm gonna lose that. You know? And so I modified the plan, which I'm so glad she was able to articulate that. But also, I also tell patients that too. But there certainly are physicians who will just offer da, da, da, da, da. And not talk to patients about that. But anyway, that goes to your point that there are a few patients who do like, indeed like the service, being touched.

[Kate]

Don't touch mine. Do not Touch it.

[Ty]

I don't feel like getting punched today.

[Kate]

So that crap hurts. The best. Best way I can describe as for me is it feels like a. Like a contraction. Like a labor congestion. Like, oh, no.

[Ty]

And it does. It's a really quick mood ruiner. Like, I feel like garbage. I'm so sorry. I'm just like, oh. You know, it's like, oh, it doesn't. It's nothing worse than that. But like I said, I think women have to be vocal about it. Men have to be careful with what they're working with and make sure they're not, you know, being wild, being tuned with your partner.

[Dr. Milhouse]

If they're looking like they're in pain and it's not, like, the fun type of pain. Like, yeah, I'm bdsm. But, like, they're in pain. Like, back off. You're so right. That when it's painful like that it's deep in your. Like, on your pelvis, and it hurts like hell. And it doesn't go away, like, just because the stimulation stops. Like, there's.

[Ty]

Yeah. Because. Yeah. She said, like, the next day. I'm like, this is why. I mean, it's. It's like a little.

[Kate]

And I think that's what. That also goes back to, like, communication.

[Ty]

Yeah. Yeah.

[Kate]

For, like, having a healthy sex life is huge. You have to communicate.

[Dr. Milhouse]

Correct.

[Ty]

Yeah.

[Dr. Milhouse]

The other thing I want to say really quick is that if sex hurts. Because I feel like I need to say this.

[Kate]

Yeah.

[Dr. Milhouse]

If sex hurts routinely for you, it's not normal. I don't want us to. Normal. Like, we talked about, like, modifying behavior. But also, if sex, even with modified behavior like this or whatever hurts for you, that's not normal. You're not supposed to endure penetration. You know, it's not supposed to. You're supposed to enjoy it. Okay, then that needs to be addressed.

[Kate]

No. Very.

[Ty]

Yeah, that makes sense. You don't. You shouldn't have to endure it. That's crazy. Enjoy it. That's. Yeah. Because now when you talk about hormones, too. Because I thought. I'm trying to listen. My mom is, you know, menopause, whatever. I've been trying to talk to her for years to go do some hrt, and she's like, I feel like. I don't know if it's her generation, but she listen to me. So I'm like, can you please explain?

[Kate]

But then she's just, like, struggling because you don't go and do it.

[Ty]

And I'm like, mom, there's things out there now. But I'm trying To I want any woman listening, I want them to know, when do you get HRT perimenopause? Before, like, when is the best time to start that?

[Dr. Milhouse]

Love it. Okay. I do a lot of hrt. And for those that may be like, what is hrt? HRT is hormone replacement therapy is what it stands for, but it specifically usually refers to like estrogen based hormone replacement with or without progesterone. Okay. And the, and estrogen is the main hormone that declines and drops off the cliff when you go through menopause. Okay. And we have long, you know, for the last 20 years, been conditioned and for the last 20 years been conditioned to think that, well, it's just something we have to endure. And there's a lot of symptoms and a lot of suffering that occurs that doesn't have to occur. And I will say, if men went through menopause, like, we'd have a solution yesterday. It would be like, you will give me my hormones, God damn it. And I'm not leaving the office until you write me the prescription. Okay. Period, point blank. But. And back in the day, so there's a generation of women who had plethora of hormone therapy. And hormone therapy was thought to be like the holy grail. And we in 2000 got like, it just got stone cold, like no hormones for women because of a study that was very well designed. The WHI Women's Health Initiative study. Very well designed study. But the results were conclude. The, the, the, the conclusions made were made off fear and not off like real logic. Okay. So the conclusions made was like HRT causes cancer.

[Ty]

Whoa.

[Dr. Milhouse]

And HRT might cause heart problems and dementia. And the reality is, is that there were, there was one arm of women that were randomized to estrogen and progesterone and they had like one. The absolute like risk of hormone of breast cancer was like, like one. I don't remember the extra percent, but the 1%, it was very low. Very low. You had the other arm that was randomized to estrogen only that had no uterus. And they. And the people who got HRT in that group actually had a lower risk of breast cancer.

[Ty]

Oh, wow.

[Dr. Milhouse]

They don't. Wow. They don't tell you that. So it wasn't about the estrogen, it's about the combination. Okay, so who gets hrt? So if you are a woman who is obviously not had a period for at least a year, you are considered post menopause. That's the definition.

[Ty]

Okay.

[Dr. Milhouse]

If you have gotten. If your last period was over a year ago, you have now crossed over, post menopause. Okay? And if you're suffering from symptoms like hot flashes, night sweats, brain fog, mood changes. Oh, gosh, sometimes it's like dry skin and itchiness, and there's sexual complaints. Vaginal dryness, itching, recurrent UTIs, poor sleep. Sleep is a big one. Like, sleep interruptions, like, could go down the list. Then you are likely, could be a candidate of hrt. There are very few people who absolutely cannot get hrt. Okay. If you have breast cancer or have had breast cancer, then potentially you can't get it. I say potentially because if you've had it, you might actually be able to still get it, believe it or not. But if you actively are getting treated for breast cancer, you probably are not somebody who should get hrt. That's. That is about it. The way we do. HRT can be safe for people who have had blood clots, can be safe for people who. Who even smoke. It can be safe for even older menopause. Now, this perimenopause group. That's a big word right now. What is that? That's the group of women that are about 10 years before they hit menopause. Remember, menopause is when you haven't had a period in a year. So those 10 years leading up is perimenopause. The thing is, we. You don't know when you're not gonna have your period for a year. So anticipate. We. We. It's a clinical diagnosis. It's like most women go through menopause at age 51. So that means that women in their 40s, you can kind of assume that they're in perimenopause just by.

[Kate]

I feel like I'm there.

[Dr. Milhouse]

Yeah. And even as late is. Even as early as late 30s. Okay. And so you can offer them HRT, too. Why not? HRT is. Is. No dip Is. Well, it's not. No different. But birth control, right and HRT are like, right in the same realm. Like you're giving a woman birth control. Birth control is actually higher amounts of synthetic hormones where HRT might be more. Lower amounts of. More bioidentical, meaning closer to what your body already does. Hormones. I don't know why we're afraid of getting hormones when we'll give a woman birth control till they're 51, and then suddenly no hormones for you.

[Ty]

And that's why I was trying to tell my mom, because I feel like she had kind of that same reaction, was like, well, hormones. I'm like, mom, if you do it not like it's. You're not. It's not too early. Like you can still. Yeah. Help yourself.

[Dr. Milhouse]

Better. Yeah, Mom. The earlier the better. There's an advantage.

[Kate]

I was gonna say, because we have a friend of ours who. She's probably. How old is she?

[Ty]

She's. She's probably in her mid-40s. Yeah. Probably early 50s maybe.

[Kate]

But. And I would say, like our friend, she's been, what, she's been doing hormone replacement for a while and now it's like, she's like, now I just have to put on a. Let's, like a lotion every day. And she's like. And.

[Ty]

And she has no symptoms. She's like. I mean, you wouldn't be able to tell her age. I mean, it's. It's amazing. Which is. I'm trying to say, like, it's. It's like not too late for you go in there and see if you're a candidate for hrt. Because it could literally change your whole life.

[Dr. Milhouse]

Yes. So there is an advantage to starting sooner than later. HRT in perimenopause, started in perimenopause or early menopause actually decreases your risk of heart problems. There's an advantage.

[Ty]

Wow.

[Dr. Milhouse]

I mean, it's a clear advantage. Okay.

[Ty]

Amongst the.

[Dr. Milhouse]

Helping you with your symptoms, but there's a clear advantage. HRT started 10 years or more after menopause. That heart protection goes away. Okay. So there might. Yes. So that's where we get into this ten year thing. And so there might be a neutral or increased risk of heart. Cardiovascular. Things with HRT started later. That doesn't mean you can't do it. Okay. Things have to be weighed with risk and benefit. Like that's what we do in medicine. You say, listen, your life sucks, you're suffering from this, this and this. What's your risk? Okay. If you have a healthy 68 year old woman who's like, miserable. Okay. You don't deprive her of HRT simply because, well, you missed the mark.

[Ty]

Yeah.

[Dr. Milhouse]

And now you're, you know, you're. You can't do hrt. You have to make it individualized, weigh the risk and benefits. Some people will hear this and decide it's not for them. And that is fine too. It doesn't have to be. If you, if you determine it's not for you, that's great. But too many women, like your mom probably were just told simply, yeah, no, it's bad, no, now, yeah, you can just live with it. It's normal. Their. Their symptoms were, were Dismissed. And they were gaslit and they were just told hormones are bad. And not given a thorough conversation with real.

[Kate]

Remember the stories you used to tell me about your Aunt Dawn? She was like literally going like mentally crazy.

[Ty]

I mean. Yeah, it wasn't. She was. It was wild. She was vacuuming at like one in the morning. It was great.

[Kate]

She couldn't sleep.

[Ty]

I kept thinking, I'm like, man, it just sucks because I feel like the stigma with HRT is still around. I can see it. And I'm like, why is this still happening? When there's solutions, there's. There's things that can make your life better.

[Kate]

And he tells me all the time, he's like, no. He's like, you will be going to see a doctor.

[Ty]

Well, you will, you know, at least be.

[Kate]

And I agree with him. But he's like, no, I'm serious. But he always, you know, he shares with me the benefits.

[Ty]

I don't want it to be, you know, late. Right. Then I don't want to watch you suffer when you don't have to suffer. And there's things out there and yeah, like it's, it's like, I don't know why HRT is so scary.

[Kate]

Well, and I feel like too, I think that leads me into a question that popped in my mind. Like for women, do you like, is it normal for you to follow like your mom's kind of like pre menopausal schedules or your grandma's or is like every woman different? Because I feel like I look at my mom and my mom, I would say like hit menopause. Like no period or everything. Like late for like early, like late 40s.

[Dr. Milhouse]

Yeah, you are probably. I mean there's, it's not, it's not completely direct, but there is some influence on your, on your mom's journey, on yours. Like when you start your, when you start menses or your period. Yeah, right. And when you. Then when you enter menopause. Absolutely, absolutely. So you can look to your mom and be like, okay, yeah. Oh yeah. No, I don't think that.

[Kate]

Right. Yeah. Because I always thought, I always wondered about that. I'm like, huh, well, if my mom, you know, late 40s, no more period. I'm like, well, maybe, maybe that'll be me, you know? And so that's why I wonder because I'm like, sometimes I do have. I get like hot flashes and stuff sometimes. Like, I swear to God, like, I'll tell Tyler. I'm like, I am dying. And he's like, it's freezing in here. And I'm like, I'm dying.

[Ty]

And that's what I was like. That's why, that's why I mentioned. I'm like, well, listen, like, it's never too early to just talk about hrt, you know, you never know what's going to happen, especially if. Since her mom happened to her so early.

[Kate]

So I just didn't know if there was a connection with like, family members or if just, you know, everybody is just different. No matter if your mom, you know, your mom had it early or not.

[Dr. Milhouse]

Yeah, no, that can increase. That can. Absolutely. If your mom went through menopause a little bit earlier than the average, then you are probably more likely to enter menopause.

[Ty]

Yeah.

[Kate]

Okay.

[Ty]

Yeah.

[Dr. Milhouse]

And you are. How old are you?

[Kate]

33.

[Dr. Milhouse]

33. So, yeah. I mean, again, having said the big epiphany, like, birth control and HRT are like, on the same spectrum. There's no. If you were a patient of mine, you're like, yeah, should I. Can I start hrt like, yeah, hell yeah. I can put you on is whatever hormones. I mean, that you. Not whatever hormones. But I can absolutely feel no qualms about putting you on. On these hormones if it helps.

[Kate]

Interesting.

[Ty]

Okay.

[Dr. Milhouse]

Yeah, yeah.

[Ty]

Because I feel like, yeah, people get. I'm like, man, I'm seeing so much fear mongering almost around. I'm like, this is so stupid. Like, it's like, especially when it's.

[Kate]

And it's typically for men doctors, too.

[Ty]

I know that. I guess that's my big thing.

[Kate]

Older men doctors.

[Ty]

That's why I was so excited to talk to you. I'm like, I need to talk to a female like this. I'm so sick of seeing these dudes up here, like, talking about. It's like, dude, you don't have one of these. You don't have a vulva. So stop. Like, I don't know what you're talking about.

[Kate]

Right.

[Dr. Milhouse]

Yeah.

[Ty]

But yeah, I had.

[Dr. Milhouse]

In fairness, I do have some male colleagues that are really.

[Kate]

Oh, I bet.

[Ty]

Oh, yeah, I know. Yeah, of course.

[Dr. Milhouse]

Yes. But yes, I, you know, their medicine is. Medicine is rigid.

[Ty]

Yeah.

[Dr. Milhouse]

You know, when we get a thing. And again, the thing in 2002 was HRT is bad, man. If they dig in, you know, and despite mountains of evidence coming out since then that have, like, shown like, listen, what have we done? We, like, we went too crazy here. It took what, 25 year. What is it to her? It's 2020. It took 24 years. 23 years. 23 years. So 20, 22,002 is when the study came out last year is when the FDA took the black box warning off just last year. Holy. See, I mean, it literally just happened. Months of words. When I say last year, I mean, we're talking months ago.

[Ty]

Wow, that's crazy. That's why misinformation, it can have a damaging effect for a long time. Like, it's really important that we get all the information right? Because. Dang, man, that's. Yeah, that's crazy.

[Dr. Milhouse]

It's affected a whole generation of women.

[Ty]

Yeah. Oh, God.

[Kate]

That's probably why your mom is a. I'm like, not doing.

[Ty]

It's okay. It's just hrt. It's fine.

[Kate]

And that's why her reaction was like, what hormones? And it's like, yes, mom, hormones. You know, like, what I wanted to know.

[Ty]

Like, we have some, like, fan questions and stuff that we. Yeah, yeah.

[Kate]

That we at least, you know, what do it. Are there, or you know, what new treatments or technology and urology excite you the most?

[Dr. Milhouse]

Wow, this is very cool. I am excited about. Well, in medicine, I'm excited about how we're using AI to help with the administrative burden or like, the. The burnout. Okay. Not to help with, like, patient care per se, but like, to help with the burnout, which is a huge problem in our health care system.

[Ty]

Yeah.

[Dr. Milhouse]

But in urology, specifically, technology, there's new technology coming out regarding how we treat overactive bladder. So overactive bladder is super common. That's when you really gotta go. Gotta go really bad, frequently, urgently. You might pee your pants unintendedly. And there's new technology where we can implant a simple, small device in the ankle, believe it or not, in the ankle, and that can help people achieve bladder control. And so there's lots of new, like, products and devices that are coming out there. There is new ways that we have adopted to treat common conditions like prostate cancer to help with outcomes. There are. I. I am kind of very niche in that. I am in this cosmetic urology portion too. I do a lot of male enhancement, simply put, making penises bigger. And so I love that urology is embracing that. And we're looking into kind of ways to do that safely.

[Ty]

You put an implant in there.

[Dr. Milhouse]

There are. There are surgical. There's. Well, there's many options, but like, the top two. The top being fillers. Putting fillers.

[Ty]

Oh, okay.

[Dr. Milhouse]

And then another option is like a sleeve implant that is put surgically in the penis.

[Ty]

Wow, that's.

[Kate]

That is crazy.

[Ty]

Crazy.

[Kate]

Another question I had is, like, what's the question patients are most embarrassed to ask but really shouldn't be.

[Ty]

Oh, God.

[Dr. Milhouse]

I feel like they're embarrassed to ask everything. The question that patients are most embarrassed to ask. Anything around sex.

[Ty]

Yeah.

[Dr. Milhouse]

Anything around ejaculation, they are embarrassed to ask. I will say my patients. My patients who have a vulva are embarrassed to ask about their anatomy because they. They are ashamed that they don't know it. So I had a patient who was, like, honest with me. Like, I'm embarrassed, like, where do we pee out of? You know what I'm saying?

[Ty]

Wow.

[Dr. Milhouse]

I mean, these are grown adults, and so. And I. And I kind of tell patients, especially my vulva owners, like, it's a. You are a product of our society. And our society has allowed us women to look at a part of our body with, like, not to look at it, but to, like, think that a part of our body is, like a mystery. We are not encouraged to. We're not taught about it.

[Kate]

Right.

[Dr. Milhouse]

You're not encouraged to look at it and to explore it in any kind of way. So some of us have never seen our own vagina. I saw a woman who was, like, in her 60s. She was like, I've never looked at it in a mirror. And so we so don't feel bad, basically. Like.

[Kate]

Right.

[Dr. Milhouse]

You know?

[Ty]

Yeah. Because honestly, that's. That's crazy to think about that, you know, Like. Like, it's kind of what brings it me back to when I thought about. I was like. And I was telling her, like, you know, there's. You have all these different zones and these different things. And she was like. She was like, I have a what, like, inner lips, all this stuff?

[Kate]

Yeah, no, it was very educational.

[Ty]

And it was one of those things where it's like. And it made me think about, well, how crazy is it that men have none of these issues? We know about all of our parts, so why is it that we are not prioritizing women in studies? We're not. You know what I mean? Like, we're.

[Dr. Milhouse]

Why.

[Ty]

What is it about medicine that we're not. Obviously, we're doing something wrong or else.

[Kate]

And I think it's getting better, thankfully, because, like you said, like, we are seeing more women and, you know, black women, Latino women, which is so awesome to see, becoming doctors, urologists, all the things. Like, it's freaking awesome. We obviously need more women in there because we are a priority too. And I. And I do feel like that's getting better. I feel like I am seeing younger, you know, doctors and all different types of field Fields that are females. And that's awesome to see.

[Ty]

Yeah.

[Dr. Milhouse]

We need more. I will tell you something. If, if I lined up a hundred doctors, random specialties, most of them couldn't name all the parts of this.

[Ty]

Wow. And they have medical. That's. That's why. But that goes that like you said, that's a society. Like women are getting shame, but it's really not their. It' society that we have not prioritized women in studies. We haven't prioritized them in pleasure studies, we haven't prioritized them in a lot of things. So. Which is like we need to, you know, get our together, you know? Come on. Yeah. Okay. Another question. Yeah. That I thought was really crazy. Does. Does the labia majora shrink after menopause?

[Dr. Milhouse]

It does.

[Ty]

Oh, God, it's wild. So wait, you, you, you, you don't have a. The majora is kind of smaller pre puberty and then you get, they get larger during puberty and then they go away like shrink. That's crazy.

[Dr. Milhouse]

So your inner lips, or labia minora is the official term, are very, very hormone dependent. Okay. And particularly estrogen dependent. And so before puberty, estrogen is low. So your daughter's estrogen levels are, you know, maybe not the 11 year old, but certainly the younger ones, they're pretty low. And if you are a parent to a little girl, you know that you don't really notice like a labia minora. Right. Okay. Now as we get when we get through puberty, that's when they, you know, kind of grow and blossom and they not only do that, but they get melanated. Okay. So you might notice that your labia darken too with puberty. Okay. When we get. Go through menopause, that is the other low estrogen state. So before puberty we're low. After menopause we're low. And so one of the signs of like menopausal changes in the, in the vagina, what we call gsm, it's got a term called gsm. Genital urinary syndrome. And menopause. One of the telltale signs is these labia will be, will be miniature or gone.

[Kate]

Wow.

[Dr. Milhouse]

Okay. And.

[Kate]

Well, I can't wait for that day.

[Ty]

That. Yeah, that is interesting. Okay.

[Dr. Milhouse]

This is why vaginal estrogen, if I will die and my tombstone will say vaginal estrogen saves lives. Okay? In my world, perfect world, Dr. Milhouse ruled the world. Vaginal estrogen would be preventative medicine like in. At the age of 40, period, you turn 40, here's your vaginal estrogen, you're using it for life. Okay. And one of the many benefits is that might salvage your labia minora. But let's say you don't care about your. Like, it's going to keep your whop. Whopping. It increases natural lubrication, which declines when you get into perimenopause and beyond. That was one of the first things that I experienced. Like, when I turned 40, my vagina was like, yeah, we're like, officially in perimenopause, let me tell you. And it was like, we're pumping the brakes.

[Ty]

Yeah.

[Dr. Milhouse]

I. I rebuke you dryness so much, so I put myself on vaginal estrogen exponent, like, expeditiously. So vaginal estrogen improves lubrication. Us. It improves vaginal elasticity so that you get aroused. Okay. It improves pain with penetration or prevents pain with penetration. It decreases your risk of UTIs that go up.

[Ty]

Wow.

[Dr. Milhouse]

It. It's the essential oil for your coochie.

[Ty]

I can't believe it's not. It should be common. It should be common practice. Then it should be like, yeah, standard.

[Dr. Milhouse]

Like, it should be over the counter.

[Kate]

Right. You just go buy it, you know?

[Ty]

Yeah.

[Kate]

Seriously. Seriously.

[Ty]

Okay, another question. Average size of both genitalia. So average size of penis. Average size of vaginal canal.

[Dr. Milhouse]

Oh, my goodness. Okay, so the average erect size of a penis is, like, length is, I think, 5.1, 5.2 inches.

[Ty]

Oh, wow.

[Dr. Milhouse]

Yep. That's erect. That is erect. Okay. Average. I did a thing about this. Let me find this. There is an average vaginal size. I did a whole. And again, the vaginal size changes with arousal. So when they did these studies, some of the studies, they were done aroused and some of them were done not aroused. So in one study, the unaroused vaginal depth. And we talk about vaginal size. We're talking about the depth, the unaroused. Okay. Vaginal depth was just under 4 inches.

[Kate]

Oh, wow.

[Dr. Milhouse]

With a range of about 2 to 5 inches. There was another study that looked at the MRIs unaroused, and they found that.

[Ty]

What?

[Dr. Milhouse]

That study found that the average unaroused size was again, around like, three and a half inches. Okay. Now when you're aroused, that number probably doubles.

[Kate]

Oh, wow.

[Ty]

Got it. Okay.

[Dr. Milhouse]

The vagina. Yes. Yep.

[Ty]

So, yeah, I think it's interesting because I think people don't know that the canal gets longer.

[Dr. Milhouse]

Yeah, it gets longer and it gets wider. So the MRI study found that, like, the average width of the widest part of the vagina, the widest part of our vagina is like in the middle, if you will. So the narrowest part is at the opening. There's also a narrow part way up at the top. But in the middle, the widest part, unaroused, was 1.3 inches.

[Ty]

Okay.

[Dr. Milhouse]

But that can get extremely wide with arousal. We know it gets wide because we birth babies.

[Ty]

Yeah.

[Kate]

I'm like, we don't want it wide.

[Dr. Milhouse]

We want it wider when we're aroused. We don't want it nice and tight. Like, that stuff is not fun. It's not cultural gaping. We don't want it gaping, but we don't want it. Okay.

[Kate]

Yeah, that goes back to the cultural. We're like, no, we don't want it wide.

[Dr. Milhouse]

But I told. I tell men who like, oh, she feels wide. I'm like, she probably aroused.

[Ty]

Yeah. That actually is a good. It's a good sign. It actually means she's. She's feeling great.

[Kate]

Yeah. You're doing your job. You know, Calm down.

[Dr. Milhouse]

Well, it's an ocean. Just enjoy.

[Ty]

Yeah. Go swimming. Go to take a dip.

[Kate]

I know this, and this has been fun. I feel like we could talk. We definitely have to do a part two in person. We're gonna figure something out that works for both of us. I just want to say thank you for taking the time to come and talk to us and answer some questions from people and ourselves.

[Ty]

Yeah.

[Kate]

And if people don't know where to find you, where can they find you?

[Dr. Milhouse]

You can find me on Instagram @Doctor Milhouse. And that is Millhouse with one L M I l H O U U S e. You can find me on YouTube at. Down there urology. If you don't remember either of those, just put in Instagram or YouTube your favorite urologist. And you can do that on Tick tock too, if you just remember one thing. Just remember I'm your favorite urologist. And you will find me in Chicago. It's called down there urology. If you're in the Chicago area and you need a urologist, you've got some coochie or penis problems or whatever problems, hormone problems, come and find me. I'd love to see you.

[Kate]

And then also too, if people don't know, they can watch your episode too. On tlc. Yeah, on the. On tlc, we're gonna do a little thing. We're gonna.

[Ty]

We're gonna write TLC and say, get your together and green light this thing. Damn thing. We need this.

[Kate]

Or you gotta go to a lifetime or something. Something's going on. What the heck, right? Yes.

[Dr. Milhouse]

Somebody Somebody needs to see this.

[Kate]

No, it was so intriguing. It was so Dr. Milhous put her on TV. Seriously. And it needs to be talked about more. So it's like, come on, what are they doing? You know? Jeez.

[Dr. Milhouse]

Agreed.

[Kate]

But so thank you so much. It was such a joy to meet you.

[Dr. Milhouse]

This was so much fun for me. Thank you so much. I'm so glad you hit me up in the dms and I will drive to Detroit anytime. Let's make it happen.

[Ty]

Awesome.

[Kate]

Thank you. Yeah, we can. We can plan it so that way we can to figure out child care.

[Ty]

Yeah. Yeah. No flu that time.

[Kate]

Yeah.

[Dr. Milhouse]

Let's do it when it's warm.

[Ty]

There we go. Yes.

[Kate]

Downtown Detroit. Good food, good times, you know? Yes, absolutely. We love Chicago too, though. I think it's a beautiful city.

[Dr. Milhouse]

So if you're ever in.

[Kate]

I will. We will.

[Dr. Milhouse]

We will.

[Kate]

For sure. You guys please make sure go check out Dr. Milhous. Also, please make sure to like and subscribe. Also leave a comment. And don't forget to follow our Patreon page where you guys can catch video episodes everywhere. You can listen for years.

[Ty]

Thank you. Should have kept to myself. Nothing's off limits. Yes, I'm talking about the time I lost my phone mid flight instead. Still haven't truly emotionally recovered from that. There might be too many sound effects. I've been told to chill. Will I unclear, but if you've ever laid awake at night cringing at something you said five years ago, congratulations, you found your people. Intrusive Thoughts with Adam Rippon is available now wherever you get your podcasts.