266. Health Tech - Revolutionizing Vulvar Health with Dr. Uloko

Summary

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Podcast Summary

Episode Overview

Podcast: You Are Not Broken
Host: Dr. Kelly Casperson, MD
Guest: Dr. Maria Uloko
Episode: 266. Health Tech - Revolutionizing Vulvar Health with Dr. Uloko
Date: May 26, 2024

Theme:
This episode dives into the revolution happening in vulvar health, focusing on Dr. Uloko's experiences as a urologist, her pivot to health tech, and her development of vulva AI—a tool aiming to democratize, destigmatize, and modernize care for people with vulvas. It critically examines persistent gender disparities in sexual health medicine, the erosion of the doctor-patient relationship, barriers within the U.S. healthcare system, and how technology can contribute to more equitable care.

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Key Discussion Points & Insights

1. Dr. Uloko’s Path to Urology and Sexual Medicine

• Representation and Passion (04:00–07:50):
  • Dr. Uloko describes her unexpected journey into urology, influenced by her love for “dirty jokes” and serendipitous encounters with inspiring female surgeons.
  • Quotes experiences of adversity and bias in medical training, emphasizing the necessity of representation:
    • “I had a medical school adviser who told me I could never be a surgeon because I was 'not serious enough’... So he told me I couldn't, so then I said, I bet. And so then I did it.” (05:48, Dr. Uloko)
  • Her ultimate passion was ignited by the encouragement of Dr. Erwin Goldstein to pursue women's sexual health.
• Discovery of Sex Medicine:
  • The realization that comprehensive sexual health required a greater focus on vulvar conditions and that mainstream medical training fails to adequately address these conditions, despite their prevalence.
  • “We’re really bad at recurrent UTIs. And turns out a lot of these vulvar conditions mimic UTIs ...it just felt like finally my training was complete." (07:30, Dr. Uloko)

2. Gender Inequity and Sexual Health

• Persistent Gaps in Treatment and Training (08:23–09:50):
  • Both doctors discuss how women’s sexual health is neglected in clinical training and practice.
    • "A lot of this work is equality, equity, policy, advocacy… this affects everybody. And it’s real. The boots on the ground are real bad.” (08:53, Dr. Casperson)
  • Dr. Uloko highlights how the clinical guidelines and attention to quality of life post-interventions in male sexual health are not paralleled in gynecology for women.
    • “In urology, after treating prostate cancer, we have clinical guidelines for erectile dysfunction and incontinence… In gynecology, it’s about babies and cancer, never quality of life.” (25:14, Dr. Uloko)

3. Erosion of the Doctor-Patient Relationship

• Pressures of Modern Medicine (11:50–13:08):

  • Both speakers lament the dissolution of the “precious, holy, sacred” doctor-patient relationship due to insurance, time constraints, and burnout.
    • “This relationship is dying… It’s a 10 minute appointment, your insurance tells you you can’t have the meds your doctor recommends, and your doctor leaves because they hate their job.” (12:21, Dr. Casperson)

• Burnout and systemic failures (16:57–19:55):

  • First-hand stories highlight overwhelming patient volumes, lack of institutional support, and health tolls on providers.
    • “[Institutions say], 'Why aren’t you just doing this on your own with no help, blindfolded, like 10, you know, all the things,’ it’s just not a sustainable system or model.” (19:27, Dr. Uloko)

4. The Case for Health Tech in Women’s Sexual Health

• The Tech Pivot (22:37–24:27):

  • Dr. Uloko explains that health tech, particularly AI, could bridge gaps in knowledge and care that traditional systems fail to fill. However, she urges that physicians must play central roles to ensure these innovations are grounded in real clinical experience.
    • “My worry is that as we’re building that bridge without physicians in the conversation, there’s going to be a lot of solutions that don’t actually work for patients.” (24:14, Dr. Uloko)

• Introduction to Vulva AI (24:39–32:14):

  • Vulva AI is designed to democratize accurate, evidence-based information about vulvar health, help identify reliable diagnoses, and empower patients to be their own advocates.
    • “I want to get that wealth of knowledge, take this brain, take the clinical experience that patients have with me, and give it directly to the patients in a very tangible, easy to digest way to educate themselves.” (30:01, Dr. Uloko)
  • Addresses the misleading and often outright wrong information on the internet, emphasizing the need for accessible, evidence-based, personalized education.

5. The Power of Patient Advocacy

• The Need for Data and Demand (33:16–36:13):
  • To make a lasting impact, Dr. Uloko stresses building a mass movement: “I want to create a vulva revolution… It’s not going to be one person. I cannot change the system. It’s going to be thousands, millions of us collectively educating ourselves, empowering ourselves, and holding the system accountable.” (34:05, Dr. Uloko)

6. Testosterone in Women: Myths and Barriers

• Guideline Defiance (36:38–41:41):

  • Dr. Casperson brings up the recent American College of Physicians conference instructing not to prescribe testosterone to women.
    • “Slides from the American College of Physicians conference… 10,000 doctors were just told: Do NOT give testosterone to women in America.” (37:37, Dr. Casperson)
  • Dr. Uloko underlines the damaging disconnect between data and policy, pointing out there are international guidelines supporting testosterone therapy when appropriately prescribed:
    • “What does it matter if we’re doing research if the physicians aren’t even looking at the research… That is why I created vulva AI.” (39:31, Dr. Uloko)
    • “There’s a lot of feelings versus facts in women’s health, which drives me crazy. And so I want to arm every patient with facts so that they can combat people’s feelings.” (35:36, Dr. Uloko)

• The Role of Education (42:27–44:12):

  • Both agree that science communication and empowerment are critical, not medical gatekeeping.
    • “You only know a subject as well as you can teach someone… We’re not doing a good job in healthcare with this mentality that we are the only gatekeepers to education and knowledge…” (42:41, Dr. Uloko)

7. The New Model: Advocacy, Education, and Tech Combined

• Multi-Modal Empowerment (44:12–46:29):
  • The hosts conclude by recognizing the power of social media, podcasts, and tech for expanding reach, and the necessity for ongoing advocacy:
    • “You might not be able to see me in clinic, but because I can meet you where you’re at… I can make a change in your life.” (44:27, Dr. Uloko)
    • “This legit takes hours… But I wouldn’t give it up. My life is so much better for having done this work.” (45:49, Dr. Casperson)

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Notable Quotes & Memorable Moments

• On Representation:

  • “I am someone that lives off of spite... So he told me I couldn't [be a surgeon], so then I said, I bet.” (05:52, Dr. Uloko)

• On Burnout:

  • “I can either continue to work in a system that does not care about my well-being... or I can leave.” (17:32, Dr. Uloko)

• On Health Tech’s Necessity:

  • “Tech is going to be the bridge between healthcare now and getting to the people, but we should not let tech happen without us.” (23:24, Dr. Uloko)

• On Patient Data:

  • “We have Oura rings to track all the other things. Why can’t we track our treatment success, our diagnostic success, all these things?” (30:46, Dr. Uloko)

• On Barriers to Testosterone for Women:

  • “Despite national and international guidelines around this topic... Slides from American College of Physicians just told 10,000 doctors: do not give testosterone to women in America.” (37:37, Dr. Casperson)

• On the Power of Education:

  • “There’s a lot of feelings versus facts in women’s health, which drives me crazy. And so I want to arm every patient with facts so they can combat people’s feelings.” (35:36, Dr. Uloko)

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Important Timestamps

• [00:47] – Dr. Uloko’s Background and Defining Research on Clitoral Nerves
• [02:17] – Why Urology? Representation and Challenges
• [09:18] – The Intersection of Hormones, Sexual Health, and Advocacy
• [11:50] – Erosion of the Doctor-Patient Relationship
• [17:32] – Burnout and Leaving Academic Medicine
• [22:37] – Why Tech Is the Bridge and the Need for Physician Involvement
• [24:39] – Introduction to Vulva AI
• [30:46] – The Role of Data and Personalized Tracking in Women's Health
• [36:38] – Barriers to Testosterone Therapy and the Importance of Accurate Guidelines
• [44:27] – The Impact of Advocacy Platforms and the Importance of Accessible Education

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Conclusion

This episode is a passionate, insightful conversation highlighting the urgency of reforming women’s sexual health—through physician advocacy, equitable policy, and especially through the potential of technology to educate and empower patients. Both Dr. Casperson and Dr. Uloko deliver truth bombs on the reality of modern medicine, the gendered disparities in care, and the need for collective action and reliable resources like vulva AI. Their humor, candor, and commitment foreground a movement that is gaining momentum: the “vulva revolution” in health.

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Transcript

[A]

Foreign. Welcome to the you are not broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show, friends. I am back with my favorite people. Female urologists on my podcast are my favorite people. I have Dr. Maria Uloko today with me. Thank you. Thank you so much for coming.

[B]

Thank you so much for having me.

[A]

Efd, you just passed your urology oral board, so congratulations.

[B]

Thank you. Thank you.

[A]

That feels rite of passage.

[B]

Huge rite of passage for all people.

[A]

You guys. It takes years and years and years and years to become a doctor slash surgeon, in case you didn't know. Takes a very long time.

[B]

Lots of time. I.

[A]

Lots of time passes like Maria, how. But it's time. Take the oral boards. Okay, so you're a urologist who specializes in comprehensive sexual health, which includes the medical and surgical management of sexual health for all genders, which is a powerhouse move. This ranges from menopause management to complex erectile dysfunction. You're considered a leader in chronic pelvic pain and vulvar conditions. You're an international award winning researcher with a focus in vulvar health, which we're going to talk about. And big deal. What year? 2022 or 2023. The research in defining how many nerves are in the human clitoris.

[B]

Yes. When did that paper come out official? It was first presented in 2022 and then officially published in 2023.

[A]

Awesome. With your friend, Dr. Blair Peters, who's in the plastic surgery world. So my book to talk about me for a hot second. But this comes back to you. So my book got bought by Hachette and it's gonna be republished in September. And they're like, do you wanna change anything? And I'm like, I need to change one thing. And in it it had said that we didn't know how many nerves were in the clitoris. Cause I had written it before you published your paper. So that was the one piece of data and new research study that I put in the book.

[B]

Thank you, thank you, thank you so much. I love that I can contribute to science in a way and then also contribute to updates in your book.

[A]

I know, it's so awesome. How did you guys. Well, let's back up for a hot second. Why urology? Why sex medicine?

[B]

Okay, so why urology? That's a question that I get asked a lot, especially when I walk into a room and they're like, you're not an old man. Why are you my doctor?

[A]

You should just Fuck with them and be like, I am.

[B]

Wait, what you mean I'm not? So the story is serendipity, and then also it speaks to why representation matters. So I got into medical school at 17. I did a six year program right out of high school. And, you know, I was already that kid that, like, kind of loved dirty jokes and everyone knew that was me. And so when I got in, all my friends from high school were like, you're going to become a urologist. And I was like, dick jokes? Hell yeah. Not knowing anything about urology, not even knowing that. Like, I was so I was such a clueless high schooler. Like, I don't come from a physician family, and then I'm an immigrant myself. And so I'm going through the process and I'm realizing that, oh, surgery, that's very definitive. Like, I like seeing a problem and then fixing it. And so when I took my surgery rotation, it was one of the most miserable experiences of my life. All the surgeons were miserable, except for one, Dr. Christy Gooden, who was a transplant surgeon. That really instilled in me this idea of, find something that when you wake up every single day, you are so excited about. And I was like, girl, this ain't it. Like, every day on surgery, all the residents were miserable. The attendings were mean, and I was like, maybe surgery isn't for me, but I'd already signed up for a Women in surgery conference in San Francisco. And I went. And the only person that I really, really resonated with was a female urologist. Dr. Hadley Wood was a reconstructive surgeon at Cleveland Clinic. And that was the first time I one, ever saw a female urologist. And then two, like, she was so well dressed, so nice, so funny, so personable. I was like, I want to be you when I grow up. And that's literally how I became a urologist. And I took a rotation. Loved it. And then I just kept taking more rotations and I was like, okay, this is it. Then it also helped that I am someone that lives off of spite. So in medical school, I had a medical school appointed advisor who was this old staunchy man that said some really awful things to me. Like when I told him I was class president for the second time, he was like, you know, they're giving leadership to positions to women of color over white men. And I was like, oh, oh, okay. Like, and this is a man with power. This is my during my annual review. And like, what am I supposed to say about that? Like, yeah, sure, this is the same Person that also told me that I could never be a surgeon because I am not seeing serious enough. And I'm like, what does that mean? I'm very serious. I just told you. I'm class president for the second time. Like, come on. So he told me I couldn't. So then I said, I bet. And so then I did it. Got into the field and realized, like, okay, maybe it just never fit the pattern of, like, seeing Dr. Gooden. Like, seeing Dr. Chrissy Gooden being. Waking up in the middle of the night, watching her be so excited to be able to transplant these patients at 2 or 3 o' clock in the morning. Like, just so high octane energy, like, all the things. And so I was like, I don't have that same passion for general urology. And I was getting a little nervous, especially when it came time to, like, decide whether to be fellowship trained or just go into clinical practice. And I realized, like, the thing that I love the most was sexual health. I've always been interested in that. And then I met Erwin Goldstein, who is such a champion for women. And I, when I met him at this traveling fellowship award that I got, he was the person that was like, you, you're a woman. You are into sexual health. How about also learning about women's sexual health? And I didn't even know that was a thing. Didn't know that was something available to urologists. And also I was living in Minnesota for five years, and I was like, san Diego? Say less.

[A]

Did you do. Did you do Mayo or did you

[B]

do U of M for U of M? And I was just so cold.

[A]

You did U of M for residency? How do I not even know this? I'm from Duluth.

[B]

Oh. Oh, my gosh, No.

[A]

I went to med school there.

[B]

Ah, yes. It's freezing. Freezing.

[A]

Terrifying. How do people even have sex in that state?

[B]

It's so cold. It's so cold. That's why I had to go to San Diego to learn about it. And so once I was there, I then fell in love. I finally understood what Dr. Gooden was saying. I was like, oh, my God. I eat, breathe, sleep, sleep this. Like, it was so fun to learn about, learn even more about male sexual health and go deeper, deeper, deeper. Super nerdy stuff. But now I was exposing all of these. This huge gap in my training that I'd never even noticed was the female vulvar sexual health part of things, and seeing how it related to urology. And I was like, wait a second. We're really bad at recurrent UTIs. And turns out a lot of these vulvar conditions mimic UTIs and. Whoa, whoa, whoa. It was like. It just felt like finally my training was complete. And also, all the people that are in this world and in this space are super fun. There's just some brevity. There's a lot of seriousness. Obviously, we take our jobs very seriously, but it's also. It's sex. No one is dying. That's a lie. Some people do die from these things. But in terms of you can just give so much joy and life and breath and all the things through our work, which just makes me so happy.

[A]

Yeah. My story really parallels you. Number one, Goldstein, he came up to my practice to do an intra rosa talk, which is a DHEA for the vulva, which is an amazing product for people who don't know. I met him and he's like, you're the future of female sexual health. And I'm like, yeah, whatever. Blah, blah, blah, blah, blah. Right? And, like, the more that that is becoming a true statement, the more it just makes me want to cry of, like, when he chooses you. He sees it.

[B]

Yeah, no, it's. He, like, sees into the future in, like, the weirdest way as possible.

[A]

Yeah. I love it. For me, it's the hormones that, like, eat, sleep, eat, sleep. Like, I am. I am literally reading more journal articles now than I ever have in my life. And I was a voracious reader in residency. Like, I always won the award for that, whatever that test you have to take every year and stuff like that. Like, I was not a schlumpy resident by any means, and now I'm like, I cannot get enough of female hormones. And I think, you know, I see this in you and I see this in me. Is a lot of this work is equality, equity, policy, advocacy. Like, it is this amazing piece of the world where you're like, this affects everybody. And it's real. The boots on the ground is real bad as far as what the current standard of care is.

[B]

Yes, yes, this. It's also why I love it, because we get. I think once you. With great power comes great, great responsibility. And I think having this knowledge about hormones, sexual health, menopause to vulvar pain, to like, it just means that I am a more complete doctor and physician able and a better scientist even. I mean, Dr. Goldstein really taught in me. Stay curious. You know, someone's telling you a symptom that you're. You've never heard of before. It's not. Doesn't necessarily fit the pattern. Get curious about that. And explore that deeper. They might be shell, they might be showing you something. And that's just this fun ability to explore. But then also the policy and the advocacy side. I created one of the first boulevard health centers in the United States run by a urologist. And everyone told me, like, this is going to be really hard in a health care system with insurance and all those things. Like, I really wanted to be able to prove that you could do this work in insurance, not just essentially taking what we did in Goldstein's clinic and then essentially reconfiguring it into an insurance model. And that was tough and also made me really hyper aware of all of the policy changes that need to happen. And without being able to see that no matter what degree of patient education and front facing education that we do, there's still going to be barriers when they leave our conversations that I would have never been aware of. I would have been like, yeah, we did a great job. Look at the high five. We were engaging and fun and we taught. And then on the back end, and we were just talking about this beforehand of like, cool. We are teaching all these people these awesome things and telling them to advocate for themselves. And then they're like, oh, but what doctor do they go to? Good luck finding someone. And so I think the work that we're all doing that we're just. All the urologists that I know just screaming into the void. It's so monumental because I think we're really shining a light to a system that's just been operating in the light of day. Right. Like, we're all just seeing it now. We're all waking up to it and being like, wait a second. This is how we're accessing healthcare. This is how healthcare is delivered to 50% of the population. This is wild because it's so different from how we trained and access care for our predominantly male patients.

[A]

Yeah. One of the things I think I'm getting more into or realizing more right now is the fraying, the degradation of the precious, holy, sacred doctor patient relationship.

[B]

Ooh, right.

[A]

I'm like, there's something there. We're gonna do something with this. But, like, just culturally, what that relationship was and how it was revered, how it was protected, how it was very unique amongst any relationships you have.

[B]

Right.

[A]

Like, you go to an expert, you take off your clothes, you tell them things, you don't tell them. Like a very unique, I would say, for lack of a better word, holy. Sorry, if not everybody likes that word. But it's like 10 minute doctor appointment. Your Insurance telling you you can't actually have the medication that your doctor thought was best for you. Your doctor moving away because they actually hated their job. And doctors don't stay in jobs very much anymore. Like this relationship is dying.

[B]

Yeah.

[A]

And it's like that just keeps coming back to me more and more of like it's very, you know, you'll hear it from patients. Like they'll be like, I've got my doctor of 20 years. Like you will hear people speak of this relationship with a level of preciousness that I know a lot of other people don't have.

[B]

Yeah, yeah, no, I think I can speak to that from a physician, like almost advocacy side of. You commented or you spoke on this several weeks ago about how healthcare is now being driven by insurance and payers. And because of that it took this beautiful practice of this art of medicine, the skill of medicine into this capitalist. You were just a cog in the wheel. You are just a body for these people to see. 10 minute visits. This health care model is not helping to make people's quality of life better, better and it's, I don't even necessarily know if it's making their disease free lives better. And doctors are just there as the middlemen trying to keep things afloat, trying to just work within a system that is not catering to what they need to be able to give and deliver the best care. And that's why doctors are leaving. Right? We are, we are being taxed and forced. Like I think about it like I was when they plugged me into my institution. I now was the, I had a really strong referral base. But the thing is, it was one of those things where everyone was like, oh, do we even need that? Do we even need women's sexual health or vulvar sexual health? I was like, yeah. And they're like, fine, we'll try it. Tried it. I had no, I, by the time I left, I had a year and a half waiting list. I was seeing 30 patients a day, whether it's menopause, chronic pelvic pain, all the things. And I was just like, this is not sustainable. And when I would try to advocate for on my behalf because ultimately if I feel supported, I can support my patients better. I was always kind of gaslit into being like, oh, in a couple of years we'll be able to get you this, that and the other. And it's like I don't necessarily know what metrics I have to be meeting for you all to deem this work worthy for, for you all to deem that I shouldn't be like, burning myself out to be able to see all these patients, answer all their inbox questions, sit with them through their most traumatic experiences because all the other providers in the healthcare system have dismissed them and I would not have any clinical support. This feels a little ridiculous. And it almost felt like, how dare you ask for help? How dare you do these things? And you know, this is the system that doctors are currently facing. And I can understand why they're leaving, why they're fleeing, especially since I pivoted into tech and I see like, tech is made for their employees to be comfortable. They try to do things that make their employees comfortable. And versus like, in the hospital system, there's this. As a prior director of several parts of my institution, I got to see when people asked for things, and I feel like most, not most, but for the most part, they were asking for very reasonable things like clinical support to be able to do their jobs better and to take care of patients better. And institutions are saying, no, you can handle it, just suffer through it. And this is a story I think so many physicians share. And this is the story that so many patients don't know about. And from their standpoint, they're just seeing their doctors leaving. Like, why would you leave me? I need you. And it's like, I can't do my work well within the system. And so I think a lot of doctors are fleeing the system to figure out a better way to make this happen. Because right now this insurance model doesn't care about patients and it doesn't care about doctors. And everyone is suffering except for the CEOs.

[A]

Yeah, absolutely. I think you and I are very, very aligned on that. And I kind of had my like, aha moment. Just very, very recently, I saw like 30 people in one day with one staff. Like, there's just not enough humans. Right? And I'm like, I'm like, oh, I'm not my best self. And I'm at the point in my life where it's no longer okay for me to not be, try to be my best self. Right. And so it was like this collision of like, I no longer consent to me having to struggle so hard that the best me doesn't come out anymore.

[B]

Yes, yes. That was my awakening. That was what led me to leave academic medicine in the way that I had to. Just because it was like, I can either continue to work in a system that does not care about my well being. Like, I got, I was so chronically stressed because I was chronically Traveling like teaching and running a clinic, being a director of my own clinic and then being a director of DEI and like teaching and like mentoring and doing all these things that I. There was a of part point in time where I was at a conference almost every other weekend and then I would go back to my job because again I'm like, I want to teach and train doctors so that people are stopped suffering and this, that and the other. And my body shut down. Like there was a point where I had Covid rsv, the flu, Covid, all within a four month period. And the second round of COVID when I called in sick because I was like, I had a fever of 100 and something was on my deathbed. They were like, hey, can you see patients remotely? I was like, what more do you all want from me? You guys just want to kill me. Just weekend it burning me. That's fine. Because at this point this is wild. And it got to the point where I was just like, I can't do this in this way because what needs to happen is that the system needs to hire or train another either physician or mid level, not mid level but advanced practice provider to able to do this work. But instead they're like, well we just have her, so let's just keep piling things on. And it's not like I didn't advocate or ask or show the numbers. It was still just like, yeah, in two years, in two years we can get you the help that you need. And I'm like, I'm pulling numbers that a lot of people would, could never imagine. So I need, I need support. And to then be told, like to then be made, made to feel bad about the fact that you need support. Like why aren't you just doing this on your own with no help, blindfolded, like 10, you know, all the things, it's just like this is, this is not sustainable. It's just not a sustainable system or model.

[A]

I think it's a nice analogy to tech because you're like, tech is very highly trained, smart people that they want to keep, right? Because they know that, they know that like in a market they can go somewhere else. Especially since the FTC just struck down non compete.

[B]

Yes, that's huge.

[A]

So that's big. So to me I'm like, physicians are no different. They're highly trained, there's a massive shortage and, and they're actually treated like shit at work.

[B]

Truly, Truly. And it's, it's so, it's, it's such a sad thing because you know And I think every person that's working in a hospital system now is like really feeling the brunt of this. But I strongly agree with that statement of. I think my, my pivot out of purely clinical and academia and into the tech space was seeing my tech friends like, or I would like complain about something.

[A]

Why are you so happ.

[B]

Like I would complain about an issue or like just be like, ugh, let me tell you about something that happened. And they're like, well why isn't that X, Y and Z happened? And I was like, well that's.

[A]

Oh, we don't have the X's.

[B]

Yeah, like we're not a really solutions oriented system where I sweep it under the rug and make you feel bad about needing support type of system. Like you can't run a hospital lien like you just can't. Also from a business standpoint, hospitals will always be in business. Like, there's like, it doesn't make any sense. Like if we're truly talking about supply and demand, the demand will always be there. But when the supply is dwindling, which every study is showing we are having, we are about to be seeing a healthcare crisis and a healthcare shortage. And when you're not even adjusting or adjusting your, the way that you're operating to meet that supply and demand, this is an ineffective business.

[A]

It's, it's just that, yeah, I, well I keep seeing, I keep seeing, you know, from the people who create the trained people of like, we need to, we need to train more people. And I'm like, no, they're going to quit. Do you get, you can't just trade more people and put them in a miserable system. How about keep the, you know, like, you know, we were talking about it takes so long to make a well trained nurse, to make a well trained scrub tech, to make a well trained surgeon, to make a well trained nurse manager. Right? Like it takes a long time and we're losing these very talented people to the system. I don't want anybody to think like, oh, the poor doctors are complaining. Like, no, we speak for all the people in healthcare.

[B]

It's happening. And the unfortunate thing is that the people that are affected by this most are the patients. And, and I always think it's important to have these conversations to say like, hey, we're trying our best. We're trying our best within a system that is not humane. It's not humane. And we are undervalued as healthcare workers, all of us. Like every, like that's the unfortunate thing. Everyone within a hospital system. If you were to not everyone, but like, if you were to poll a couple of people, you would see there are some real issues systemically and it's how do we solve for that. And this is why I think tech is going to be the bridge between healthcare now and getting to the people. But this is also why I believe that we should not let tech happen, health tech happen without us. Like, we have to be in those rooms, we have to be in those spaces. Because a lot of these people that are making the decisions where dollars allocated in tech, where what new company is coming out, they have never worked in a hospital one day in their life. And it shows and like what they're investing in and how things will actually work. It shows. And I think it's so important that physicians are in these conversations, are in these spaces, because right now the system is on fire and tech is that bridge to getting to patient care. It is not a perfect bridge. And my worry is that as we are building that bridge without physicians in the conversation, without physicians leading in this space, there's going to be a lot of solutions that are made that don't actually work for patients.

[A]

Yeah, totally. So how did you get into it? Tell us about the vulva AI Executive Summary. I love it. Like all of the things, where are you now? What's exciting you about tech and what are you creating?

[B]

Yeah, so what is exciting me about tech is the democratization of healthcare, especially when it comes to women's health. One of the superpowers of being trained in all genders in sexual health is also. It kind of makes you a. It has given me an ability to see how men and women have a very gendered access to healthcare and healthcare delivery.

[A]

That's why urologists are the superpowers. Gynecologists don't see it. They don't see that women are treated differently, but the urologists do. Yeah.

[B]

And it's like glaringly very obvious once you see it. Cause we, I mean, prior to meeting Goldstein, I was like, oh, well, the level of care and the level of funding and resource and research and innovation obviously is happening in all specialties because they're well funded and well resourced. As urologists, we very much have privilege. We are a well funded industry and that funding helps to create our innovation and our drive and also our clinical guidelines. Someone that's now board certified. When I was going and reviewing the guidelines, I was like, wow, we do a really good job of having a very holistic approach to disease states. Right. So like, let's Take prostate cancer. We treat your prostate cancer. Take out your prostate. Oh, no. Now you have erectile dysfunction and urinary leakage. We've got guidelines for that and we've got ways to treat it and make sure that your quality of life is there. And that is across the board. We, like, every single urologist that you go to that's board certified should know how to do this. So when a person is coming with erectile dysfunction, they're not being told, oh, well, I don't believe you. Or is it just your partner?

[A]

Or, why aren't you just happy that we cured you from prostate cancer?

[B]

Exactly. Right? Yes, exactly.

[A]

Why aren't you just grateful?

[B]

Yes. Did you die, though? Is that it? Is the phrasing that I feel like it's like, it's not obviously said to them, but it's the practice. Is that right? And if you look back at the history of gynecology, it's never once been a practice. Go back to the Mary James Marion Sim. It was never about quality of life. It was just about babies and then cancer and then not much weight in actually what is the quality of life. And so being on that side of things and then being an advocate and, like, speaking and teaching, I just kept seeing, like, okay, cool, Now I've gotten women riled up. I've gotten them riled up to know that they should be advocating in the doctor's office for themselves. Like, yeah, I want to go get my menopause treated. And also I was like, but where do you go? Who are you going to? I don't know. Like, and also, where are you going to go for resources? Like, because not every single person has access to the guidelines and has access to the latest research or even knows how to interpret that for themselves. And so I kept seeing, again, where we're at the problem and then the problem, the actual what is actually happening in health care and then how it's affecting patients. And also someone. As a chronic pelvic pain specialist, my patients needed so much support. Not because they're needy. Like, I actually think chronic pelvic pain is one of my. They're my favorite people to treat. Highly motivated, all the things. But I would have to spend so much time debunking all the myths, then teaching them about their bodies, and then we could actually get to work. But the thing is that years and years and years of maltreatment or mistreatment, misdiagnosis led to such a much more complex problem.

[A]

Yeah, yeah, you've got a traumatized human in front of you now?

[B]

Yeah, every single one. And I was just like. Or my favorite was the person that had never seen a doctor before. They were just like, yeah, this started not too long ago. And I was like, ugh, yes. I don't have to unpack all of this trauma and then reteach you the right thing and re engage with you in a way. And I was just seeing how just unsupported all these people were. And like, there's only like, I think ishwish has like three or four hundred doctors and sexual health from their registry. There might be more, I don't. That are registered, but the last time I looked and I'm realizing that there's like 3 billion vulvas in the world and it's like, okay, do they all come?

[A]

Doesn't matter.

[B]

Yeah, the math wasn't mathing. I was like, okay, well, amazing. Now you're somewhat educated. Now you're empowered, but you're not educated. So that was the thing, is that there was a lot of empowerment happening, but not enough very detailed, specific to you types of education. And a lot of my research has also shown that a lot of the things like chronic UTIs, recurrent UTIs, chronic pelvic pain, vulva, vaginal infections, overactive bladder, a lot of these symptoms actually originate from the vulva, not from the bladder. This, that and the other. And so focusing on vulvar health actually can prevent all these other things. And so it's just like, I have this wealth of knowledge, and we all have this wealth of knowledge. And I was like, how can I get that wealth of knowledge? Like, take this brain, take the clinical experience that patients have with me, and give it directly to the patients in a very tangible, easy to digest way to educate themselves so that they can then go to their doctor, their doctor that's supposed to know how to do this already and advocate for themselves and be like, hey, I think I might have this condition. I read. And here's the evidence that shows that this is how you get it diagnosed. I would like these tests and I would like. And this is the method to treatment and to actually have patients be able to track their treatment so that they can figure out how they're doing. Right? Like, we have oura rings to track all the other things. Why can't we track our treatment success, our diagnostic success, all these things? Because this is what my, especially my Gen Z millennial patients, they want all that data. They want to know how their symptoms are doing, what's going on with their bodies and they couldn't find it. Like if you go on Google, most of what's in sexual health, bovar health, all of this stuff is wrong.

[A]

And so, dude, when you start realizing the Internet's wrong, that's when you've truly woken up. Right? Like I was like, Google has the definition of testosterone wrong.

[B]

Yes.

[A]

Oh, we're in, we're in trouble. Yes.

[B]

Like these patients are going to Reddit, they're going to Facebook to get help and care. And I'm like, this isn't normal. Especially because these disease states are, are very common. Chronic pelvic pain, 1 in 4 people, chronic UTIs and chronic pelvic pain. 85 million women a year suffer this. Vulva owners, women like all the things, this is costing the healthcare industry $85 billion. And instead of us restructuring our education system and our training system actually include vulvar health, we're just telling our patients, you're crazy. Oh, you're those symptoms.

[A]

And let's try a different antibiotic.

[B]

Let's try a different antibiotic. And I was like, okay, so I'm teaching all these, I'm trying to train all these doctors, I'm trying to like, we're trying to talk to acog, AMA about like, hey, what about we like restructure how we're training and how we're teaching and all these things and they're all kind of like, eh, whatever. And so I was like, you know what, I'm just going to build something that's going to go straight to patients. I cannot be in every single doctor's visit with you, but how can I be able to give you all the information, essentially the roadmap to get your own diagnosis, to be the most trusted source for your sexual health care. And in a perfect world I want to build the Women's health Google where you're actually getting evidence based correct care right in your pocket. So the idea was to utilize AI and tech to help people with chronic UTIs, recurrent vaginal infections, chronic pelvic pain, overactive bladder symptoms, and interstitial cystitis or painful bladder symptoms. Get cheaper, faster, more accurate diagnosis.

[A]

Love it. Where are you with it? Where can people go for that? To like see the. Are you in beta testing? Like where are you with everything?

[B]

So we're in beta testing. I finished the UCLA health accelerator, Health equity accelerator. I'm in the LA plug accelerator now and we're beta testing and I'm opening my Pre seed round May 1st. So if anyone is, and this is the thing too, that I Always like, to tell people is like, I need women to buy into this. Like, not just from a, like, monetary standpoint, but from a. Not even buy into. Buy into the idea that the healthcare system doesn't have your back. We. It doesn't even have your front, honestly. No. But, like, I think a lot of people are like, yeah, Maria, she'll fix it. And I'm like, no, no, no, no. I need buy in. Like, this is something that. This is a. Ultimately, what I want to create is something I'm calling a vulva revolution. I want to empower women and people with vulvas to understand that they are their biggest healthcare advocates. And they. They also. They have so much power. It's actually wild how much power patients have, but they don't know they have that. And there's like, actual legal words and terms and this, that and the other and ways to do that. They don't know that. And I want to be able to teach them those things. And this is. I want to create a movement. I want women and people with vulvas to start saying, I deserve better care, period. I deserve better care, period. And it's going to. It's not going to be one person. I am one person. I cannot change the system. It's actually going to be like the doctors are. We're advocating. I mean, like, you got this podcast, you got this platform, you are doing so much education and work, and we're advocating for change and policy and reform all these things. 7, 10, 15, 20 of us is not going to do as much as thousands, millions of us collectively educating ourselves, empowering ourselves and holding the healthcare system accountable. Because the amount of patient stories that I heard of, like, they told me I was crazy, they told me nothing was wrong with me, they stopped me on my medications. If these people had had some resource or some guide to say that's not even by the guidelines, that's not even by the book, they would have had such a better quality of life, way less suffering, all of these things. And those stories broke my heart. It's like if you had just known what was the correct thing and what was the right thing instead of whatever that physician felt into that day. There's a lot of feelings versus facts in women's health, which drives me crazy. And so I want to arm every patient with facts so that they can combat people's feelings. Because it's wild. It's so sad.

[A]

I love it. I love it. Before we wrap up, I want to talk about one more thing. There's so many Things to talk for those who are listening. I have been trying to get her on my podcast for, like, four. Four freaking years.

[B]

I've been busy, girl.

[A]

You were like, literally my longest pursuit.

[B]

I'm here. No, it's been. The last four years have been a whirlwind of research and all the things. And starting a clinic and doing the thing.

[A]

I've been trying to get her on for, like, four years and talk about all the things. And like, we're already out of time. But just so you know, it's a big deal that she's on here today. You wrote a paper about testosterone in women with Dr. Rubin. The clinical management of Testosterone Replacement Therapy in Postmenopausal Women with Hypoactive Sexual Desire Disorder. A review. It's all. It's free on your website, by the way, if you guys go and I'll post that in the show notes. But. So I just got sent the slides from the American College of Physicians conference that just happened in Boston on testosterone. It's in the slides. It says, do not give testosterone to women in America. Do not give testosterone to women in. In America. So you, as the person who wrote a paper on how to do it, how to give testosterone to women in America, please discuss this travesty. By the way, American College of. American College of Physicians, huge internal medicine membership. About 10,000 people were at this conference. 10,000 doctors were at this conference, and they were just told, do not give testosterone to women in America.

[B]

This is why vulva AI has to exist, right? Because now those 10,000 doctors are going to go out because there's this weird thing where we're just like, whatever, Women's health. Just, sure, whatever. Someone will fill me in. Someone will fill me in on the gaps. So that doctor is now. Most likely. That person looking at those slides is not going to be like, I wonder if that's correct. They're just gonna be like, obviously that's the right thing. Despite having international national guidelines around this topic. This very goddamn topic. Right? Like, it's not just urologists that endorses, not the sexual medicine specialists that endorses, like the National Society of Endocrinology, like, all of these big. I think it was nine. Like, international governing agencies have sanctioned this, have said, this is safe one, done safely, and this is how to do it. This is what drives me crazy, is that I talk about how research is advocacy. That's why I do a lot of research. That's why I do the things. What does it matter if we're doing research if the physicians aren't even looking at the research and then they're going to go and go talk to that patient that is gaining weight, that is losing muscle mass, that is increasing the risk of osteoporosis and fractures. That is like feels tired, feels fatigued, feels less sexual. It's affecting their quality of life, it's affecting their relationships. They have low self esteem now because of the weight gain. They're going to go tell that person, no, you don't deserve testosterone. It's too dangerous. And that person, because they don't have a resource or a guide, are just going to say, I guess that's it. And then internalize that essentially wrong information and say, well, that's it. And then move about their way. That is why I created both AI because the amount of people that are just the amount of physicians that are propagating and telling patients truly wrong clinical information about their bodies and preventing them from getting treatment and care, it's too many. It's too many. It's happening too much. Now. Someone using vulva AI is like, actually this clinical guideline says that it's safe and this is how we do it. Tell me why you said this, because that's not what is the standard of care now. And that person is going to. I tell my patients, you actually are going to educate other doctors in this field more than you know. And so I teach them anatomy, I teach them physio. Like, you think you're going to a doctor's visit, but you're actually getting a. What's the word? A full lecture. Like you're getting a full on lecture. And I was very specific on why I lectured patients because I was like, listen, I could give you a little blurb about why this works and why it won't work and blah, blah, blah, and we could be on our merry way. But I think it is in my power I have to educate you in order to protect you from other doctors. Because what we're doing here is for the most part, we're going by a guideline or expert opinion. And you're going to go to your doctor and they're going to be like, oh, hormones, that's scary. Ask them why. Ask them who told them. It's scary. Ask them have they read anything since 2001? And they'll be like, no, but this is who's teaching and training or not teaching. This is who is training our next generation and also taking care of patients, right? And it's like, oof. Yeah. So I'm not surprised that. That happens. And also, it also speaks to the importance of what I'm building and what I'm trying to prevent in healthcare. Because that's some bullshit. I know.

[A]

It's all. It's awful. I was fired up in the surgeon's lounge for sure.

[B]

It's like they said it with their whole chest, too. Just loud and wrong. They're loud. That's wild. But also not surprised. I am not surprised.

[A]

Yeah. At the end of the day, this is my belief. Women are smart. Humans are smart. They might not have gone to medical school. They might not know how to navigate the medical system. Lord knows it's hard enough for you and me to navigate the complex medical system, but they are smart. You give them the information, they can make decisions. Yes. And that's my whole point. Platform is like, I'm going to give you the info. You decide if you want to try hormones or not. I'm here to support you.

[B]

Yes, yes, yes, yes. I think this whole paternalism of physicians are the smartest people and only we can potentially, like, figure out medical knowledge. It's like, it's bullshit. Like, we can give people our. Our job is science communication. You only know a subject as well as you can teach someone. So if you're not able to teach someone a concept for them to then make their own decisions for what works best for their bodies, their life, their beliefs, their culture, their quality of life, you're not a good teacher. Like, you're not doing a good job. We're not doing a good job in healthcare with this mentality of, like, we are the only gatekeepers to education and knowledge, and you have to come through us to get your healthcare information. That's why there's so much misinformation out there, because we are holed up in our ivory tower. And that's where, like, I don't know, like, all these snake charmers can come in and just be like, yeah, you know what works great? I don't even. I can't even think of a bad. Make it up. Yeah. Like, you know what works Great day old coffee grounds. Yeah. Yeah. And putting them directly into your eyeballs and it's like, ugh. And until doctors are in this conversation, that's who people are going to trust.

[A]

I think that to add to my chapter of the eroding doctor patient relationship, though, is like, you've got 10 minutes because that doctor's got 30 more people. They're tired, they're burnt out. You're just a. I can say this because this is. I Get this, this is my job, right. Of, like, you want to take time with me. That's taking away from the 25 other people who are behind you, I'll have you know. And furthermore, the influencers on social media, you are more bonded with them because you see them every single day.

[B]

Yes. Yeah, Right.

[A]

Like, you are more bonded with those snake oil salespeople than you are with your doctor because of how much time you spend with them. So, yeah, the system is not working in anybody's favor right now.

[B]

No. And, you know, but I'm so grateful for platforms like this. Of it's been so funny in this, like, non medical sphere, like, pivot that I've done. Of how many women, when we get started talking about menopause and femtech and all the things and menopause comes up, like, Kelly Casperson, I'm like, oh, I know her. And like fangirl, like, just. Absolutely. And then they tell me about, like, how you empowered them to advocate for themselves or this and that and the other and how they've been telling other friends. And I'm like, yeah. Like, that is why we are physician advocates. That is why we speak up. That's why we bust our ass to do this work. Because you might not be able to see me in clinic, but because I'm able to meet you where you're at and educate you in a way that's easy and tangible for you, I can make a change in your life. What our forefathers could have never done that. Right. And it's like, why do we continue to uphold this traditional model that's clearly not working? And why not think outside the box and like, you've done that in this platform and it's really awesome. It's amazing.

[A]

Thank you. I mean, you're right. It takes a lot of work. And I think, you know, people, when people see that and they reflect it back to me, I'm like, yeah, but I love it and it's fine. But like, no, this legit takes hours. You guys, like, so much work. It is work. But, like, I wouldn't give it up. I wouldn't change. I wouldn't go back to before I started. Like, my life is so much better for having done this work that it's definitely the choice that the universe picked for me. And I'm on the ride. And I'm so glad you pivoted. I'm so glad you got healthy and got out of a system. And I love that you. Four years into this freaking podcast, we finally got together.

[B]

We did it. We did it. We did it.

[A]

Awesome. Okay, I'll put everything in the show notes and thank you so much for coming on.

[B]

Thank you for having me.

[A]

Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the masterclass for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.

[B]

Queen Carvania stood haloed by the morning. An army hung on her every word.

[A]

My champions, I have sold my chariot on Carvana. Twas a lovely suv, an inexplicably queenly offer. They're even coming to the castle to collect it. Tonight we feast. An offer you can feast on. Sell your car today on Carvana. Pick up fees may apply.