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Dr. Kelly Casperson
Welcome to the you are not broken podcast. I'm your host, Dr. Kelly Casperson, a.
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Board certified urologist, thought leader, and conversation.
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Starter on midlife living, hormones and sexuality. Enjoy the show.
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Hey, everybody. Welcome to the you're not broken podcast. What if your low libido isn't a problem, but rather a message? What if healing trauma doesn't mean reliving it, but finally releasing it? And what if sex in midlife could be better, not over? And what about if therapy wasn't about fixing you, but about finding you? So today I have an amazing sex therapist who is an expert in the not so small niche of perimenopause and menopause. Dr. Rachel Boyle. Thank you for coming. For the people who are seeing this and not just listening on the podcast, I have to describe, we just pulled up to like interview and we're both wearing striped collared shirts and it's hilarious.
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Dr. Rachel Boyle
Yeah, we did it.
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Dr. Kelly Casperson
Welcome. I said you're a doctor. Am I wrong? I don't know. Correct me. What have you done? What should I call you?
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Dr. Rachel Boyle
Okay, so you just call me Rachel. So I have a master's degree in marriage and family therapy, so that doesn't equal PhD. But what I have done since then is I'm trained and certified in emdr. Polyvagal theory, parts and memory theory. Those are all trauma therapies. And then specialize in perimenopause and menopause.
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Dr. Kelly Casperson
I wanna get trained in EMDR.
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Dr. Rachel Boyle
It's amazing. It has over 90%.
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Dr. Kelly Casperson
Like this random urologist over here. I'm like, dude, it's like, fascinating. And I was a neuroscience undergrad, so like, they would let me in, right?
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Dr. Rachel Boyle
I would think so. I mean, why not?
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Dr. Kelly Casperson
So emdr, for the people who don't know. Oh, rapid. It has to do with rapid eye movements and basically reconnecting the brain back to like a more regulated state.
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Dr. Rachel Boyle
Right. It's called eye movement desensitization and reprocessing. So what it does is it. It brings up the memory, the painful memory, and process it. So it's based on REM sleep. So what happens when you go to sleep and you're in REM sleep is when the brain cleans itself out. It works through all the stressful things that have happened during the day or the past couple days. And so EMDR mimics that process and so it takes the looping memories. So what happens when people have trauma is they have memories that circle. They loop, they keep going round and round. And it takes those memories, it reprocesses them and it essentially puts it away in the proper file drawer. So you don't, like, necessarily forget the memory, but the intensity of the negative emotion, it doesn't, like, trigger and shut.
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Dr. Kelly Casperson
You down or, like, put you into freeze or whatever. It usually does.
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Dr. Rachel Boyle
Yeah. Yeah.
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Dr. Kelly Casperson
So how did you get here?
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Dr. Rachel Boyle
Oh, my gosh. Okay, so this probably started three or four years ago. I was in perimenopause. Right. I'm still in perimenopause because, you know, it lasts a really long time. And so I couldn't find any provider. I think I'm on the 15 years.
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Dr. Kelly Casperson
Like, economy plan. Like, I got the big box of Kleenex at Costco.
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Dr. Rachel Boyle
Got the two for one. But so I actually think I started whenever I was in my late 30s. So I had my son when I was 35. I breastfed for a year after that. I was, you know, 37. I was having night sweats. I was having joint aches and pains. And I thought it was just, you know, busy mom, new stuff. I just ignored it. And then I started getting blood tests. What's wrong with me? No one could find anything wrong with me. Fast forward another couple years, and the joint aches and pains got really bad. And so I thought I had Ms. So I was getting MRIs done at the Mayo Clinic. Of course, no one could find anything. So I had a girlfriend of mine who's 18 years older than me, and she's like, rachel, I think you might be in perimenopause. And I'm like, okay, I've gone to how many doctors and specialists? This is my girlfriend that's telling me I might be in perimenopause.
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Dr. Kelly Casperson
Oh, my God.
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Dr. Rachel Boyle
So then I found. I actually found your podcast, and I just started binge watching. I just was, like, voracious about this stuff. And so I couldn't find a doctor that was trained in Las Vegas, so no doctors trained. So then I went to Ishwish, and I was like, well, I want to learn about this.
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Dr. Kelly Casperson
And what was your career at the first time you went to ISSwish? What were you doing?
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Dr. Rachel Boyle
I was a therapist. I was doing a lot of therapy.
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Dr. Kelly Casperson
Okay.
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Dr. Rachel Boyle
Yeah. I was a therapist doing trauma therapy. And I got to Ishwish. It was in Phoenix. I did a fall course, and I just was amazed. There were probably several hundred people in the room, most of them doctors, nurse practitioners, wanting to learn about women's sexual health. And it was just so eye opening to me because I didn't know the majority. I didn't know, like, 95% of what they were saying. And here I was, a really educated woman who had done a lot of studying.
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Dr. Kelly Casperson
Did you just think that, like, we didn't know about women?
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Dr. Rachel Boyle
Yes. It just doesn't get out. And then I just remember this slide, and it had someone dressed up as a vulva. And it said, who's responsible for the clitoris? And I was like, who is responsible for that?
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Dr. Kelly Casperson
That sounds like a Dr. Rachel Rubin.
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Dr. Rachel Boyle
Yeah, she was there. So then I. I got, like, my big. My big girl panties on. And I, like, raised my hand and I said, you know, I need to know if there's any providers. And State of Nevada. Because this is where I'm at now. There were no providers in the state of Nevada. Not one single provider trained by Ishwish in the state of Nevada.
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Dr. Kelly Casperson
Whoa.
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Dr. Rachel Boyle
Yeah. Now there's two. There's me, though. I can't prescribe. I'm a therapist. There's me, and there's another nurse practitioner. And so I found her about, I don't know, six months and nine months after Ishwish. And so we started working together, doing talks with women.
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Dr. Kelly Casperson
So at that point, you're a sex therapist. You're seeing individuals and couples. You start learning about sex and perimenopause. Yeah. At what point does your, like, practice change or, like, how do you start integrating that?
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Dr. Rachel Boyle
Well, so, yeah, so then I started screening all of my clients. Right. Because. So what happens. This is what happens to therapists is they have women that show up in their office who have anxiety and depression, or they're having issues in the relationship, and they do not know that they're in perimenopause. The therapist does not know that they're in perimenopause. The psychiatrist who's prescribing their anxiety depression meds or the nurse practitioner, they do not know. No one knows that these women are in perimenopause. So I started screening all my clients. I printed off one of those checklists. Right. And I just started screening them. And nobody knew what perimenopause was. And so I just started working with my current clients. Then I changed up my website, started talking about perimenopause and what it was. So now most of my phone calls are for perimenopause or for, like, sex trauma, you know, women and men who've had sex trauma in the past or.
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Dr. Kelly Casperson
For couples in your experience. I mean, the data is crappy. Maybe you've seen this in your field. The incidence of divorce in midlife caused by perimenopause and menopause, not to blame the woman, just to say shit gets rocky.
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Dr. Rachel Boyle
It gets rocky, right? So it gets rocky for a couple reasons, right? So perimenopause, you have the wildly fluctuating hormones, and. Which creates a lot of this uncomfortableness, this, you know, anger. You know, women can get angry, they can get frustrated, they can weepy, sad, and then you have all the physical side effects. And then the gsm, right? So the genit urinary syndrome of menopause, the low libido, the irritation or pain during sex. So you have all of that. But then also what you have in addition to that is, for a lot of women, they're bearing the brunt of the emotional and mental labor in the relationship. Not all of them, right? There's some really great men out of there. But on average, in heterosexual relationships, women do bear the brunt of that. So it all comes to this, like, crescendo, this perfect storm. And so now she's just crashing. And so for some women, it is, get your hormones fixed. Go see Dr. Kelly Casperson. Go see someone trained, right? Specifically trained. And I talk a lot about this. You have to find someone who's trained, at least by ish wish, otherwise, you're not going to get accurate information. But for the majority of them, right, it's like, okay, now how do we start creating an equitable relationship? How do we start talking about sex? How do we start talking about how, as a woman, I want to have sex? Because we're all trained to have sex, what we call from the male grades. Well, not all of us, but most of us, because our culture is like that. So in sex from the male gaze isn't necessarily pleasurable for the woman, especially as you enter into perimenopause, and things might be a little more sensitive. You got to change things up. Because sex from the male gaze is what you know, you know, this is destination sex.
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Dr. Kelly Casperson
So how do you start that?
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Dr. Rachel Boyle
How do I start the conversation?
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Dr. Kelly Casperson
Yeah.
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Dr. Rachel Boyle
Well, it depends if it's an individual or a couple, right? It usually takes a couple sessions for the client to start to feel comfortable. I usually dive in by the second or the third session because it's like we just. They're coming to see me because they want to talk about this. So I just start diving in with the questions. And I start out with my first question is, is when is the last time you had sex? And how was it? How did it feel for you? And I see what they say.
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Dr. Kelly Casperson
So basic. And so, like, massively Important even just I wonder how many people actually reflect on their sex life. Good, bad or neutral. Right.
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Dr. Rachel Boyle
Well, I think we get into like a habit with sex. Meaning that when you're in a long term relationship, this is the way we.
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Dr. Kelly Casperson
Always clean the kitchen.
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Dr. Rachel Boyle
Yeah, kind of like that. Not everybody, right? But a lot of couples who've been in long term relationships do that. And it's kind of like you can go, okay, where you can do it in your head, okay, this is what we do. And then we do this next, and then we do that next.
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Dr. Kelly Casperson
Right? Like rote memorization. You could do it in your sleep. And then women are like, I don't desire sex. You're like, yeah, because you could do it in your sleep.
- [09:40]
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- [10:31]
Dr. Rachel Boyle
Right, so you've heard of Esther Perel. She wrote, I'm just reading her latest book, the State of Affairs. But anyway, she was on what, the Diary of a CEO. Anyway, she said, it's not that women are not interested in sex, they're just not interested in sex with you. They want to have interesting sex. Yeah, they'll just stop having it.
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Dr. Kelly Casperson
When you say that to a woman, be like, no, no, no. I'm pretty convinced that you could be sexual, just not with the situation you're doing. Do their heads explode because they don't know? It's like asking somebody like, what do you like in bed? And you're like, I've had Froot Loops for breakfast for 27 years. I don't know.
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Dr. Rachel Boyle
They don't even know that they can think about sex from a different way. This is what I say. I'll say, if you could create sex any way that you want it from start to finish, you know what it Feels like how you want to be touched, how you want to be kissed. Right. How you want to be held doesn't have to be penetration. We're trained to believe that penetrative sex is, is the way to have sex in the United States and heterosexual relationships. And they don't have a. They don't know what to say back. They're like, I don't know, I've never even thought if I were to orchestrate it. Because our culture really trains men to be the dominant ones in sex. Right. They're the ones who orchestrates it. So a lot of women just go along with what's happening.
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Dr. Kelly Casperson
Right. You give them some homework.
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Dr. Rachel Boyle
Yeah.
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Dr. Kelly Casperson
And then they come back. What sort of insights are they having?
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Dr. Rachel Boyle
It's really interesting. So some of them are like, I never thought about this before and they start to get excited. Other people will hit a block. It's like their body shuts down. So they're having a, what I call a nervous system response. So this is from their autonomic nervous system. So your autonomic nervous system controls your survival responses and also rest and digest. So it's everything automatic. So it's your blinking, it's your heart rate, it's your breath rate, your digestion, and all that's controlled by the vagus nerve. So anyway, whenever there's a body response, like a body shutdown or a body pull away and women who have done this will know what it is. That's like when you think about having sex and just kind of, you just pull away. You're just closed down on the inside. That's because there's something going on. Whether it's a belief system, whether it's something painful has happened in the past or they've told they have to look a certain way, or maybe it's a body image thing or that they've never really experienced true pleasure before. Some women haven't ever had an orgasm, so their whole system just shuts down. So it's like I'm a little detective and I tell them that, okay, like okay, we're going to be detectives together. And then it becomes, we start to look at what shutting down. So I'm looking at, you know, are they going into fight, flight, freeze or fawn? Those are the survival responses. And for those of people who don't know what fawn is, fawn is a people pleasing response. I'm going to take care of you. I'm going to make sure you're okay so that I can stay emotionally safe.
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Dr. Kelly Casperson
I mean, to me, I'M like, I would think, like, a woman's like, if I go down this and I discover something, this relationship might not be the same anymore.
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Dr. Rachel Boyle
It might not. And that's a big don't know. So in therapy, we don't know how it's gonna go. Right. So sometimes women go down the road and their relationship transforms. It's great. They're happy, their partner's happy. They're exploring things together. They're communicating. Like Disneyland for adults. Right. They're just on the rides.
- [13:52]
Dr. Kelly Casperson
That's like, when everybody's like, just do sex therapy. It'll be amazing. Like, those are the people that they're holding up. They're like, when it goes well, it's great. Unicorns and rainbows.
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Dr. Rachel Boyle
Yes.
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Dr. Kelly Casperson
Okay.
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Dr. Rachel Boyle
And sometimes it's not. Right. And then we gotta look at what's going on. You know, is there a mismatch? Does someone want to have sex a lot more than another person and start to find out what it is? And if it's an issue, that can be resolved? Right. So I think maybe people are scared, like, what happens if I do this and it can't be resolved? Right. Well, then there's. You can look at that and see what you want to do and how you want to go about it. And can it be good enough? Can it be good enough for the relationship?
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Dr. Kelly Casperson
Yep. It doesn't have to be good all the time. It should be good plenty of times. It shouldn't just be good enough all the time.
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Dr. Rachel Boyle
You don't want to have bad sex. You don't have bad. I mean, you don't want that, right? Yeah.
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Dr. Kelly Casperson
Sometimes you just want to. You just need to connect.
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Dr. Rachel Boyle
Sure.
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Dr. Kelly Casperson
Yeah.
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Dr. Rachel Boyle
Yeah.
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Dr. Kelly Casperson
Well, you make it sound so simple. Why are people getting divorced? Because they're not coming to Rachel Boyle.
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Dr. Rachel Boyle
No. No. Okay, so women are initiating 70% of the divorces. Yeah.
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Dr. Kelly Casperson
And if it's an educated woman.
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Dr. Rachel Boyle
If it's an educated woman.
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Dr. Kelly Casperson
I got that step from you. I'm like, repeating your step back to you, and I'm like, yeah, and if.
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Dr. Rachel Boyle
It'S an educated woman, it's 90% 19.
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Dr. Kelly Casperson
Nuts. I gave a talk. I gave a talk in Seattle to, like. It was a business event, women in work. And I gave them that stat, and I think I made some heads explode.
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Dr. Rachel Boyle
Well, there are a lot of wonderful men who want to be full partners, and there are men who don't. And so what happens is, when women reach perimenopause, they're either raised the kids or they're raising them. Right. They've run the whole house like a freaking CEO. Because that's what it is. When you run a house and a family, you're the CEO. Maybe they have a partner who helps occasionally. But now you're delegating. That means you're managing, right. That means you're still doing all of the mental and emotional load. And so they just kind of get to the point where they're just done, right? So their partner's gotta make some pretty drastic changes pretty quickly. And that can happen kind of like get with a program and they can do that. But if you're with someone who doesn't want to do that, if you're really with someone who doesn't want to contribute equally to the relationship and what you want is an equitable relationship, then that's going to be a difficult relationship to stay in and be happy.
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Dr. Kelly Casperson
The power of midlife.
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Dr. Rachel Boyle
Power of midlife.
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Dr. Kelly Casperson
I don't know. I. It's a very interesting. Again, I never want to. I never want to blame the woman. I think the attitude around perimenopause and menopause in midlife in general, you know, whatever the ovaries are doing, really needs to change as far as, like, this is an exceptional opportunity. Absolutely exceptional opportunity, yes. And people need to change their mindset from like, ah, isn't it rough? And blah, blah, blah. Like, the caterpillar doesn't complain about going into the chrysalis. They come out the freaking butterfly, right? It was like, it is what it is. This is part of life, right? Like, birth is messy. We can't make it not messy.
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Right?
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Like, midlife is messy. We can't make it not messy. But what we need to do is we need to normalize that it happens, and it happens to everybody. Just like birth, you know, and puberty. And I think our attitude around it is everything.
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Dr. Rachel Boyle
You know, there's so much around women's sexual health that is minimized. You know, you hide your period, right? Because that's going to be embarrassing if people know that you're having a period. And God forbid you have a leak, right? That's like every high school girls or.
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Dr. Kelly Casperson
Middle school girls, every. Every teen films Pain Point.
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Dr. Rachel Boyle
And it's like, but this is a normal part. Like, this is our culture. Our culture has that. There are things that women's bodies do that are shameful and embarrassing. So on some level, we take that in. Even if we don't want to take it in, there's still a part of us that takes it in. And that is what carries over into perimenopause. And do you think that explains.
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Dr. Kelly Casperson
Part of the reticence of women to not take hormones is they don't want to admit what's actually happening.
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Dr. Rachel Boyle
It could be that. And that they just don't know what's happening. Or they're scared. Right. So they're scared to take the hormones because of the whi. And everyone's told them they're gonna get breast cancer or a blood clot. But I think when they get educated, then they're like, then.
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Dr. Kelly Casperson
Well, they make very good decisions once.
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Dr. Rachel Boyle
They have educated decisions.
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Dr. Kelly Casperson
Have you seen some, like, amazing transformations in seeing some of your patients get on hormones?
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Dr. Rachel Boyle
Yes, I see a lot of really good results with anxiety and depression. So women who've never had anxiety can get into perimenopause and have anxiety. If they've had anxiety before, they get into perimenopause and they can have full blown panic attacks. Even if they've never had them, it's really quite terrifying. Especially if they're having things like heart palpitations from the perimenopause that can be really scary or hot flashes. And anxiety can go hand in hand. And the depression piece too, same. If you've never had depression, you can get it. If you've had depression before, you can get suicidal thoughts. All that's really terrifying. And women don't understand that it's hormone related.
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Dr. Kelly Casperson
Yeah.
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Dr. Rachel Boyle
And I can remember being in perimenopause, right. Sitting at home on my couch and I'm talking to Charlie, I'm my partner, and I'm like, holy shit, I'm having an anxiety. Something's going on. I'm having anxiety. Like here I am a therapist, I know all about this polyvagal theory, and I'm like, wow, this is just wildly uncomfortable. And then, you know when all that went away is whenever I started on the testosterone, the anxiety just was gone.
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Dr. Kelly Casperson
Yeah, yeah. I mean, testosterone insane for its neurocognitive benefits. And I mean, aches and pains.
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Dr. Rachel Boyle
Oh, yeah.
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Dr. Kelly Casperson
Like people's bodies just don't hurt anymore.
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Dr. Rachel Boyle
Oh, right. Yeah. So I was having all those aches and pains and they're pretty much gone. Nothing's perfect. So, you know, you are getting older.
- [19:24]
Dr. Kelly Casperson
I mean, we are getting older, let's not forget that.
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Dr. Rachel Boyle
But it's not like I'm waking up every morning with my feet hurting. That doesn't happen anymore.
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Dr. Kelly Casperson
Unbelievable. Do you think the poor sleep. So poor sleep, even if you're not having hot flashes, just poor sleep in General is like 80% of women 60 to 80% of women.
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Dr. Rachel Boyle
Bad.
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Dr. Kelly Casperson
It's very bad. What happens? Is there data on this? What happens when you're not doing deep sleep or REM sleep to those memories and the trauma consolidation and filing everything away appropriately? Do we know what happens to trauma?
- [19:57]
Dr. Rachel Boyle
Yeah. Sleep deprivation or, like, if you have insomnia and mental illness, they go hand in hand like this. So if I've got someone who's not sleeping, it's going to be really hard to work through whatever they're going through. And that's what, you know, with ptsd, right. People have nightmares, they don't sleep. And so getting with EMDR, if you do 12 sessions, right. It takes a diagnosis down from PTSD to like, just regular anxiety. So you can do that in 12 sessions so they can get some sleep. They've got to be able to get sleep. You. You have to get sleep.
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Dr. Kelly Casperson
You have to get sleep. That's crazy. I was learning about CBD gummies because people take those to sleep. And so I was asking a sleep expert friend, I'm pretty proud. Estrogen and progesterone to sleep. And the sleep expert said that CBD helps you fall asleep. So that's why people like it. But it limits memory consolidation, probably through REM sleep. And so I'm like, God, I knew it. I knew I didn't want to like it. It's like inhibiting your ability to take short term memory into long term memory.
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Dr. Rachel Boyle
Well, also, there's some data to show that if people are doing any kind of marijuana product, that it affects emdr. So EMDR is not as effective, which. Well, now I'm wondering if it's because of that. Because the memories aren't consolidating like you and sleep. Yeah, yeah.
- [21:15]
Dr. Kelly Casperson
Very, very interesting. Are people open? Like, when you talk to them, and they're like, maybe perimenopause is part of this. Like, are people open to that?
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Dr. Rachel Boyle
Okay, this is the thing that happens. This is where I get really frustrated, is I'll say, I think you're in perimenopause. We do the checklist, and then they go see someone who's not trained, and then they come back and they're like, I started some vitamins. I'm like, vitamins is not the same as estrogen, but I'm a therapist.
- [21:40]
Dr. Kelly Casperson
But they're made. But they're made from plants.
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Dr. Rachel Boyle
I know.
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Dr. Kelly Casperson
Plants are good.
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Dr. Rachel Boyle
Yeah. Okay. Well, I think you need to get a little more information. And then I go through my whole spiel, I give them your podcast. I'm like, go, listen. But then they just hear someone who's not trained say they're not in perimenopause or that hormones are dangerous or that they don't need them because they're not menopausal yet. That's another whole thing.
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Dr. Kelly Casperson
Then as soon as you don't have periods anymore, now you're too old to get on hormones. Like, there's literally like, one week in there that I think you're allowed.
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Dr. Rachel Boyle
For the rest of my life, I just. Like, I'll just be on my estrogen, my progesterone, and testosterone. When I'm in the coffin, they'll have my little estrogen patch on.
- [22:23]
Dr. Kelly Casperson
They're like, can I take. How long you take this? And I asked him, I'm like, what are your plans for death? Like, are we going to be cremated? Are we going to be buried? Like, what's your plan? And most people kind of know. And so they tell me, and I'm like, okay, well, you can burn it or you can. And then I said, or you can bury it. It was very interesting about testosterone. Testosterone kind of has this stereotype of, like, the desire hormone. And I would argue estrogen is a great desire hormone, too. But people think of desire as, like, a forward pursuit of sex. And I see. And this is way more subtle, but I see in women who are on testosterone, it's not so much that they're, like, gonna go pursue sex, but they're just a lot more open to receiving it. Yeah, it's like a positive receptivity that testosterone. And I think, like, that gets lost in the translation of like. Testosterone affects. Desire is like, you think you're gonna go out and ask a bunch of people on dates or something, but you're more just like. I would say yes. I would say yes a lot more today than I would have said yes a month ago.
- [23:21]
Dr. Rachel Boyle
Yeah.
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Dr. Kelly Casperson
Is there, like, a word for that in sex?
- [23:24]
Dr. Rachel Boyle
No, there's something similar. It's called responsive desire.
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Dr. Kelly Casperson
So maybe it's just like, more responsive desire.
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Dr. Rachel Boyle
More responsive?
- [23:31]
Dr. Kelly Casperson
Yeah, but like. Yeah, but even, like, the idea of sex, you're like, huh? If your face needs a moisturizer, chances.
- [23:37]
Are your vulvo vaginal skin does, too. During menopause, lower estrogen levels cause the.
- [23:43]
Sponsor/Advertisement Voice
Skin everywhere to thin and dry.
- [23:45]
Dr. Kelly Casperson
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- [24:49]
Maybe like putting some gas on the accelerator. But it's not like a pursuit.
- [24:54]
Dr. Rachel Boyle
No, I don't think so. Well, because it's still. We're still taking like one tenth of what men take. For the.
- [24:58]
Dr. Kelly Casperson
Yeah. I mean I think for some people, especially if they dose it high, they'll get a pursuit.
- [25:01]
Dr. Rachel Boyle
They could.
- [25:02]
Dr. Kelly Casperson
I just want to explain to women, like it's this more subtle, like, yes, I think yes to sex.
- [25:07]
Dr. Rachel Boyle
It feels a little more like the playfulness comes back. Playful flirting with our partners. We want to have this energy. It's like this playful, flirty energy. It's this kind of. Kind of back and forth. Right.
- [25:18]
Dr. Kelly Casperson
Yeah. Who doesn't love that?
- [25:19]
Dr. Rachel Boyle
That throughout the day is like what makes good sex.
- [25:23]
Dr. Kelly Casperson
Yep. What do sex therapists and you think about scheduling?
- [25:27]
Dr. Rachel Boyle
Absolutely. You have to. Everyone's response is, I don't want to schedule sex because then it's not natural, it's no fun. But then this is what I say, look, dating, nothing's natural.
- [25:36]
Dr. Kelly Casperson
Monogamy is not natural. For 40 years. I was reading this. Sorry, tangent.
- [25:41]
Dr. Rachel Boyle
Yeah.
- [25:42]
Dr. Kelly Casperson
Back in the day, before longevity, the average, like this is like the Victorian era or something. Average marriages were eight years long before somebody died.
- [25:49]
Dr. Rachel Boyle
There you go. But like that explains the seven year itch.
- [25:54]
Dr. Kelly Casperson
Right? But somebody died. Yeah.
- [25:57]
Dr. Rachel Boyle
There's just so many more ways to have relationships these days, to have good, longer lasting relationships. If that's what you want and if you want something else, then there's ways to have that too. But that energy is really super important, maintaining that energetic bond.
- [26:13]
Dr. Kelly Casperson
I think that's what Esther Perel shines in her teachings is she's like, do not let this get stale, people. That's on you if you let this get stale.
- [26:22]
Dr. Rachel Boyle
Well, and she's so good with words and so direct.
- [26:25]
Dr. Kelly Casperson
Well, she speaks. She only speaks like Eight languages.
- [26:28]
Dr. Rachel Boyle
She's brilliant.
- [26:29]
Dr. Kelly Casperson
She's got. There's a lot of words in there. All right, well, let's talk about that. Let's talk about consensual non monogamy. Let's talk about open relationships.
- [26:38]
Dr. Rachel Boyle
Yeah.
- [26:39]
Dr. Kelly Casperson
Because I think it's all. I don't say all the rage. So much is like, being talked about more. It's always been happening, but we're just a little more open about it now. People are like, it's actually quite difficult to maintain that. It might sound like a very good idea. Maintaining that long term is an absolute challenge, and it's not for everybody. And you have to really be an adult.
- [27:00]
Dr. Rachel Boyle
You know what I find with consensual non monogamy is there's a lot more transparent conversations that are happening. There's actually a lot of agreements that are put in place. So, like, in a traditional heterosexual relationship, you get married and the monogamy is just assumed. People aren't having really in depth conversations about what that means. Even a married heterosexual couple. Is it cheating if I watch porn? Is it cheating if I'm watching live porn? Is it cheating if I'm watching live porn? And now I'm starting to chat with that person. They're not even in the same city. Like, what's defined as cheating? We don't even know. Most couples don't even know until it happens. And then you cheated on me. Oh, that's.
- [27:45]
Dr. Kelly Casperson
That's what I'm talking about. I'm like, it sounds great. Like, oh, some novelty. And it's like, no, no, no, no, no. You better be a real good communicator. You better know your bound. Like, there's some rules you have to establish, right?
- [27:56]
Dr. Rachel Boyle
Yeah. So my practice is. My practice is like a vanilla practice. It's a lot of heterosexual couples. Right. I don't see a lot of consensual non monogamy.
- [28:07]
Dr. Kelly Casperson
You practice in Vegas.
- [28:09]
Dr. Rachel Boyle
I know. And no.
- [28:10]
Dr. Kelly Casperson
Vegas has a whole bunch of monogamous heterosexual couples walking around.
- [28:14]
Dr. Rachel Boyle
They're not monogamous. They have affairs. That's not consensual non monogamy. Right.
- [28:20]
Dr. Kelly Casperson
You're just like, let's start. We just have to start today. Like, we can't rehash that.
- [28:24]
Dr. Rachel Boyle
Oh, well, we have to rehash it. I mean, but we're not going to rehash it in detail. Like, whoever has done the cheating stepped outside the relationship. I guess it depends on where they're at and what they want in their life, if that's something that they want to continue to do, then we have that conversation. But there's just so much mistrust that comes up in a relationship. And people can have PTSD from being betrayed. Like, you can have emotional PTSD from that. When it happens, you can't sleep, you're having nightmares, you're reliving it over and over. I mean, it's the same symptoms as ptsd, and so it's really difficult. And, okay, there's a big difference between someone who's maybe just done it once. I don't like to say it just happened because there's a lot of choice points along the way. Right. But if they've been really a great partner for 10 years and this happened or 15 years, that's different than you're in the first or second year of marriage and this is happening repeatedly. That's completely different in relationship.
- [29:21]
Dr. Kelly Casperson
Got it. The sense of safety, I think, for women's sexual desire and a woman's ability to experience orgasm and her ability to actually, like, let go and relax and enjoy the present moment. Nobody talks about amazing power of safety. And I don't think a lot of people think, like, psychological safety. They're like, oh, we lock the door. But it's like, do you feel safe both in your body and with your partner? Like, there's a lot of safety that's kind of assumed but never talked about.
- [29:52]
Dr. Rachel Boyle
No, that's super, super important. Right. So that safety piece, right, because once again, that's regulated by your autonomic nervous system. So if a woman is not feeling emotionally safe, her survival center is going to kick in. Fight, flight, freeze, or fawn. So this is the deal. Your survival center doesn't know the difference between a physical threat or an emotional threat. It will respond the same way because it's both. Pain in the body. So if I'm feeling emotionally hurt by somebody, I actually feel pain in my body. Like, if you've ever been really hurt or you've lost someone that you loved, it's like you feel. Feel the ache in your heart. It's a physical sensation. So most of us are just separated from the sensations in our body because we orphaned them off a long time ago. We cut it out. Those things, we don't need them. Right? But then that becomes a real problem because now I'm not feeling safe in my body, and maybe I don't know why I'm not feeling safe in my body. And it could be things that happened in childhood. It could be things that happened in past relationships or current relationships. But a huge part of emdr or polyvagal therapy or parts of memory is getting people back in their body to notice the body sensations so that they know when they're feeling safe and when they're not feeling safe and then what they can do about it so that it doesn't feel out of control for them, that's really important. And as it's especially important during sex. So a lot of people spectator, so they're outside. It's like they're outside watching what's happening versus being in the present moment.
- [31:22]
Dr. Kelly Casperson
Yeah.
- [31:22]
Dr. Rachel Boyle
And so learning how to be in your body is important. And so if people go into like fight, flight, freeze or fawn, they're not in their body. And so if people have had pain in their body before, then this is all happening unconsciously. By the way, everything I'm talking about, if there's pain in their body, they're automatically pulling away and they do it unconsciously. They don't even know. So when women in perimenopause start having like maybe the little tissue irritation, it feels a little uncomfortable. Their body will start to unconsciously pull away and they don't even realize it until they're just not even having sex anymore because it happens a little bit at a time. And women are so conditioned to think that it's normal for sex to feel uncomfortable. Okay. It's not normal for sex to feel uncomfortable. If sex is feeling uncomfortable, then let's have a conversation. Because there's so many things that could be happening as you know, that they're not warmed up enough, they're not turned on enough, or maybe somebody's gone too deep or there's something going on with the tissue. Right. In heterosexual relationships. So if their body's not feeling safe, even if they are safe but their body thinks that they're not safe, they're still going to pull away on an unconscious level. So we have to bring the unconscious to the conscious so that they can be present and work on it.
- [32:34]
Dr. Kelly Casperson
I love it. ASEC is the best place to find a sex therapist who kids trauma informed can talk sex.
- [32:41]
Dr. Rachel Boyle
Yep. You can look at ASAC and also see if they're trained in emdr. You want to find someone who is at least trained levels 1 and 2 in EMDR and does a lot of EMDR. Brain spotting is another good one. I don't do that. And art is another good one. I don't do that one. So there's a few really good ones out there. So if you can find someone who does both, that's really good.
- [33:00]
Dr. Kelly Casperson
Amazing. I love It. What's one common myth about women's sexual health in midlife that you want us to debunk today?
- [33:07]
Dr. Rachel Boyle
That women don't want to have sex.
- [33:10]
Dr. Kelly Casperson
If a woman comes to you and she's like, I don't want to have sex, are you like, yes, you do. Like, how do you work with that?
- [33:16]
Dr. Rachel Boyle
Let's explore that, right?
- [33:18]
Dr. Kelly Casperson
Yeah, let's look at that.
- [33:19]
Dr. Rachel Boyle
And maybe she really, really does. You know, some people are just done with it. You know, and if they're done with it and their partner's done with it, not a problem. They're both done with it, and they want to have, like, a loving roommate situation where they care for each other, they do fun things together, okay, that's fine. But if one person wants it and one person does it, well, let's start to look at that and why she doesn't want it. Because if it is pain related and she doesn't know that it's pain related because she thinks sex is supposed to be uncomfortable, or if she's had a partner who is doing sex in the traditional way, the destination sex, and she just may not want that anymore and may not even realize that's not what she's wanted because she's never been asked the question, if you could have sex, how you want to have sex and what feels good for you, what would that look like? I love it.
- [34:06]
Dr. Kelly Casperson
It's like, what are your top three feelings you would want to feel with sex?
- [34:10]
Dr. Rachel Boyle
That's a good question.
- [34:11]
Dr. Kelly Casperson
Work it that way too. Lots of people are gonna have very different answers to that. How many people have actually asked their partner what sex means to them? And it's usually different than what sex means to you. And then those two people are living together. Yeah, you just help you. You help them communicate. But yeah, okay, so it's fair to say when a woman's like, I don't want to have sex, I could take it or leave it. I don't have sex for the rest of my life. I'm done. Let's ask a couple of questions first before then saying, okay, I agree that you do actually seem done. I think a lot of women suss this out for us. A lot of women are like, am I asexual?
- [34:42]
Dr. Rachel Boyle
Well, some women might be. That's zero interest. And there's so much between 100% gas pedal fully down and zero. There's a lot of room between there. Some women are really okay having really great sex once a month, but that's not asexual.
- [35:00]
Dr. Kelly Casperson
Right. And, like, sex that Serves her and that it's not a chore and she's not doing it. Like doing sex for another person, but not in a like, I want that turns me on to do this for you. Not in that way.
- [35:12]
Dr. Rachel Boyle
But women are conditioned. Women are conditioned, typically from a very young age, that it's their duty to have sex when they get married, that they need to satisfy their partner.
- [35:21]
Dr. Kelly Casperson
Dude, that is right. Like, never explicit in the marriage vow, but it is right under there.
- [35:27]
Dr. Rachel Boyle
Oh, absolutely. And it is that. So our culture has this idea that men are the pursuers and women are to be pursued. This is the culture. Right. So women are to be the object of desire. So when you're the object of somebody else's desire, then you don't think about what your own desires are.
- [35:47]
Dr. Kelly Casperson
Yeah. You're constantly like, am I pretty enough? Am I thin enough? Am I? To make sure you match up to society's ever changing definition.
- [35:55]
Dr. Rachel Boyle
Ever changing definition of desire. Everywhere in society, you know, magazines, billboards, you know, social media everywhere, it's always telling women what they can do better. Have better skin, have better hair, have longer eyelashes, have perkier boobs, have less.
- [36:10]
Dr. Kelly Casperson
Wrinkles, cut off your effing labia.
- [36:13]
Dr. Rachel Boyle
Oh, my God. I can't with that. Right?
- [36:14]
Dr. Kelly Casperson
I can't with that right now. I'm struggling big time with it.
- [36:17]
Dr. Rachel Boyle
Like, are we telling men to have smooth balls? No, we're not telling them to have smooth.
- [36:23]
Dr. Kelly Casperson
Men are getting reversible fillers in their penis. And then there is a surgical procedure that actually puts a sheath around underneath the skin of the penis, but that makes it look bigger. Flaccid doesn't actually make it look bigger.
- [36:36]
Dr. Rachel Boyle
Erect.
- [36:37]
Dr. Kelly Casperson
So it's great for, like, walking around naked and stuff, but is fraught with complications. I mean, men have the same pressures as women, but I'm like, dude, women, we don't have a place to go online to safely say, are we normal? OMGs would be one. Make love, not porn would be one. So there's two places, but people don't know about those.
- [36:57]
Dr. Rachel Boyle
They don't know about those places.
- [36:58]
Dr. Kelly Casperson
And so then they look at surgically altered or atrophic vulvas and then they pay money. That's the thing is, like, women don't have as much money as men in our culture. Don't make them spend it on cutting their labia minora off. And then they all come to see us in perimenopause and menopause when they've got clitoral adhesions and no labia minora and, and they freak out because nobody tells them it goes away. It's like you're damned if you have labia minora. You're damned if you don't.
- [37:22]
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Dr. Kelly Casperson
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- [38:20]
Dr. Rachel Boyle
Well, there's a lot of sensitivity in the labia minora. And it's like when you start cutting that you're risking losing sensation. Not to mention that, you know, they close so it helps to prevent infection.
- [38:34]
Dr. Kelly Casperson
They're protection. They're protection.
- [38:36]
Dr. Rachel Boyle
They're protection.
- [38:37]
Dr. Kelly Casperson
Yeah. Yes. And I'm not talking about the people who truly, you know, have hypertrophy and it pulls in and it gets caught on the bike seat. Like, I'm not talking about that. I'm talking about cosmetic ever moving societal norms of what you. And I'm like, how many people are you actually showing your labia to? Not that I'm judging, but I'm just saying it's not like nice dental work where it's kind of, kind of your forward facing hello to everybody. It's not a handshake.
- [39:01]
Dr. Rachel Boyle
Right. And don't you want a partner who's gonna love your vulva? It's like, well, why wouldn't they?
- [39:07]
Dr. Kelly Casperson
I know that's the thing is like I don't want my partner to judge me. And I'm like, if your partner's judging.
- [39:11]
Dr. Rachel Boyle
You, let's talk about that in the free.
- [39:13]
Dr. Kelly Casperson
Let's talk about that. Can you write a book and call it let's talk about that?
- [39:16]
Dr. Rachel Boyle
I should talk about that.
- [39:17]
Dr. Kelly Casperson
I think we've, I think we've, I think we've named your book for you going, going forward. So let's say we've got a perimenopausal woman, monogamous, heterosexual relationship. She is having intercourse multiple times a week, but she comes to you and she's like, rachel, I don't have any desire for sex.
- [39:35]
Dr. Rachel Boyle
Oh, that's fascinating. Yeah. Well, so I do the perimenopause and menopause checklist. I do the GSM checklist. Right. Let's just see physically where things are at. And almost always there's stuff that's being checked on that. Right. So we have to check, like, what's going on with you. And then I refer out, right. So I'll send to a specialist, Right. If there's hormonal things going on with perimenopause and menopause, if all of that is fine, then it's like, well, let's start having conversations. Have you talked to your partner about this? What do you feel? And they're like, I could never tell my partner this. I could never tell my partner that. And then it's like, well, let's, you know, let's start to do a little deep dive. What are you worried will happen if you say this to your partner? And there's usually some fear that's underneath that, or they have some body image issues going on. And women have beautiful bodies throughout their whole lives. And yet we've been trained to believe that we have to look as really a certain way. And I think that a lot of men are actually really wonderful partners. And they. They love who they're with and they love their bodies. But when you have it inside of you that you're not attractive, it doesn't matter what your partner thinks or says.
- [40:42]
Dr. Kelly Casperson
It creates cognitive dissonance. Like, cognitive dissonance. The more you're told that, like, Republicans are right, the more you double down on being a Democrat is like, the more you're like, but you're beautiful. But you're beautiful. You're like, I'm fucking not.
- [40:53]
Dr. Rachel Boyle
Yeah, right. Like, what's wrong with you that you think that.
- [40:56]
Dr. Kelly Casperson
Right, exactly. Like, it makes that cognitive dissonance worse sometimes.
- [40:59]
Dr. Rachel Boyle
Yeah. Yeah. So then we start to look at that and, you know, we just start to explore what's going on with them. And there's little exercises that people can do. You know, you've probably done this, but I'll tell people, like, well, let's see what happens. You know, have you ever listened to anything really spicy? I mean, you can read A Court of Thorn and Roses, right? That's a spicy fantasy book. If you don't want to go full on erotica. I don't know. Couple of the passages, though.
- [41:26]
Dr. Kelly Casperson
Kelly's rapidly downloading. It's available in audio. God, Kelly.
- [41:32]
Dr. Rachel Boyle
I read the first book and then I listened to the second book and I was at home in my kitchen and I like cleaning the cab. I had to stop for a minute. I. Can anyone hear what I'm listening to right now?
- [41:46]
Sponsor/Advertisement Voice
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- [41:47]
Dr. Kelly Casperson
Does anybody know how hot I am right now? You know, people will be like, my doctor just told me to listen to my porn. My doctor just told me to read erotica. And it's like there's a sliver of truth in that statement of like, the brain. You're putting yourself in a sexual context. The brain's responding. It can feel quite pleasurable to see how being turned on that feels. I'm always like, you know, doctor's appointment is 10 minutes. If the doctor leads with like, just watch some porn. It's tone deaf. But there is truth in the recommendation. It just has to be given kindly.
- [42:18]
Dr. Rachel Boyle
Well, and I'll give them options, like, depending where they are. Right. Some people are okay with porn, Some people are not okay with porn. So I'm like, well, let's just start with something spicy. We'll just have a little spice. You want something?
- [42:31]
Dr. Kelly Casperson
What's the difference between spice and porn in your book?
- [42:35]
Dr. Rachel Boyle
Well, so like a quarter Thorn and roses. That's really. Could be crossing the line.
- [42:42]
Dr. Kelly Casperson
Rachel better be texting me this.
- [42:43]
Dr. Rachel Boyle
When this podcast ends, I'll text it to you.
- [42:45]
Dr. Kelly Casperson
I mean, I need to do some research. I. For the podcast.
- [42:49]
Dr. Rachel Boyle
Spicy, right? With an actual plot. It has an actual plot.
- [42:54]
Dr. Kelly Casperson
Got it.
- [42:55]
Dr. Rachel Boyle
Versus just full on erotica.
- [42:58]
Dr. Kelly Casperson
Got it.
- [42:59]
Dr. Rachel Boyle
It doesn't really. You're not listening to it for the.
- [43:01]
Dr. Kelly Casperson
Plot or there will not be a test.
- [43:03]
Dr. Rachel Boyle
There's no. There's no test. You don't have to remember the characters.
- [43:05]
Dr. Kelly Casperson
Names to go completely off script right now. But there's a Rodica of like characters we know, right? Like there's like Star wars erotica and there's like Harry Potter. It's like science. It's like fan fiction.
- [43:18]
Dr. Rachel Boyle
Yeah, fan fiction.
- [43:19]
Dr. Kelly Casperson
I'm like air quoting. It's like fan fiction, but erotica that people write. And these are like huge genres. Yes, huge, huge, huge genres. You gotta find a erotica fan fiction author to come on the podcast.
- [43:35]
Dr. Rachel Boyle
That would be great. Maybe you can get. What is her name? The Court of Thorn and Roses. She would be great. Have her on your podcast.
- [43:44]
Dr. Kelly Casperson
Okay. So yeah, it does things to the brain that can help the accelerator and for you to be like, oh, that's what being turned on feels like. I'll try to bring that into the bedroom or get that going.
- [43:56]
Dr. Rachel Boyle
It can be very useful.
- [43:57]
Dr. Kelly Casperson
Okay, so if you're having intercourse multiple times a week, but you say you don't have any desire for sex, I think two things. I think either maybe you're having great sex, you're not letting enough time go between to actually let the natural desire come back. You're just kind of like just scheduling sex frequently and not letting like, hey, it's been a while and you're looking kind of good.
- [44:15]
Right.
- [44:15]
So maybe you've just dampened down the refractory period for when desire could come up. Or you're having sex for somebody else. It's actually not enjoyable sex and you don't have desire for it because you're. It's a chore. Like, I floss three times a week, right?
- [44:29]
Dr. Rachel Boyle
Yeah. And it doesn't feel good when you have to do something. No one wants to do something that they have to do.
- [44:34]
Dr. Kelly Casperson
Nobody does, dude. My 7 year olds don't want to. The 45 year olds don't want to.
- [44:39]
Dr. Rachel Boyle
No.
- [44:39]
Dr. Kelly Casperson
Because by the time you're 90, 90 year olds really don't want to do what they don't want to do.
- [44:43]
Dr. Rachel Boyle
No. And then you're like, can we just get it over with? Well, that doesn't feel good for either person. I mean, do you want to be having sex with someone who's like, let's just get it over with? That doesn't feel good. Oh, I know. I don't tell. I don't. I don't say that. But it's like, when you think about it, it's like, I don't want to do. This is not good for you. And it's not good for them. Yeah.
- [45:05]
Dr. Kelly Casperson
I think at the end of the day, Mo. And again, we're talking. We're heavily heterosexual in this conversation, but most men do care. Most men want to give pleasure. Giving pleasure is pleasurable.
- [45:16]
Dr. Rachel Boyle
Yes.
- [45:17]
Dr. Kelly Casperson
And nobody ever talks about that.
- [45:18]
Dr. Rachel Boyle
It was very pleasurable. Like, that's a whole visual piece. Right. And an auditory piece of seeing the person that you love receiving pleasure. And I would say that most men do want to do that.
- [45:30]
Dr. Kelly Casperson
Yeah. They like to know they're good at the. Men like being good at things they do.
- [45:34]
Dr. Rachel Boyle
Right. So. And a lot of men are really receptive to, hey, change this up, change that up. But it's not like what you're doing is horrible. It's like, oh, well, you know, What I might really feel good is, hey, let's do this.
- [45:47]
Dr. Kelly Casperson
You know, that's what's so interesting. They're always like, change it up. And they think they have to, like, buy a swing and have 12 different vibrators. It's like, no, no, no, no, no. Like, pressure, touch, frequency. Be at this angle instead of that angle. Like.
- [46:00]
Dr. Rachel Boyle
Yeah.
- [46:00]
Dr. Kelly Casperson
It's subtle things. I was. You know, the flow state. When you research the flow state of, like, what's. When you get into a flow state, the novelty part, it can't be more than 2 or 3% novel, because otherwise it's too new and you lose your focus and your flow.
- [46:15]
Dr. Rachel Boyle
Yeah.
- [46:16]
Dr. Kelly Casperson
And that's, like, super interesting. When you bring that into sex to be like, spice it up. It's like, yeah, but by 2 to 3%.
- [46:22]
Yeah.
- [46:22]
Dr. Rachel Boyle
It doesn't take a lot.
- [46:23]
Dr. Kelly Casperson
It doesn't take a lot.
- [46:25]
Dr. Rachel Boyle
What happens is that a lot of couples can't have the conversation of how to do that because neither person knows how to have a vulnerable conversation about sex. Because it is vulnerable. When you request something of your partner, you don't know what they're going to say, even if it's just a little something new. And so in couples therapy, I'll assign people like, okay, well, you're going to massage each other's feet or, you know, whichever one you like. And then it's. You're going to practice that. What feels good? How's the pressure? Do you want it to be tickled a little to the left, a little to the right? And you're doing it, like, with your hands or foot massage. Right. So no genital touching. We're just going to practice asking for what we want in a kind way, in a hearable way, and giving that communication to our partners.
- [47:11]
Dr. Kelly Casperson
That's great homework.
- [47:12]
Dr. Rachel Boyle
Yeah. You got to start with something really small sometimes. Really, really small. Because, you know, sex is so vulnerable for so many people to talk about because none of us have really, really learned. We didn't learn. That's why you wrote your book. You know, you did your TED Talk. It's the sex education that should have had but never did.
- [47:29]
Dr. Kelly Casperson
Yeah, I agree. I'm like, sex is really best in the hands of adults. Like, what I mean by that is, like, we can take feedback. We can ask for what we want. We can be good listeners. We cannot take things personally. We can decide not to assume.
- [47:45]
Dr. Rachel Boyle
Right.
- [47:46]
Dr. Kelly Casperson
It's like, that's all the adultness that, like, good sex actually does best with.
- [47:52]
Dr. Rachel Boyle
Absolutely. But adult selves. So we're not in our adult selves all the time. No human is in their adult self all the time. Right. Because then we'd be perfect and nobody's perfect. But so we have all these other parts to us. We have toddler parts and preteen parts and teenage parts that pop up whenever we get activated. Right. I really like. His name is Terry Real. So he and his wife Belinda, they do relational life therapy. And so he talks about the adapt adaptive child. So the adaptive child is the part of us that comes out when we're not in our adult self. And that's the part of us that gets defensive, that wants to blame, that wants to argue, that wants to explain. And we, most of us, we do not know our adaptive child because it's so familiar. It just feels like it's part of us. So we don't know. When we click into it, it's just like, oh, God, there she is again. So truth. Well, at least that's how I am with myself.
- [48:40]
Dr. Kelly Casperson
Yeah. But you can, with practice, you can be like, she's here right now, or, there she was an hour ago.
- [48:46]
Dr. Rachel Boyle
Well, that's the goal.
- [48:47]
Dr. Kelly Casperson
Yeah. With practice.
- [48:49]
Dr. Rachel Boyle
Yes.
- [48:49]
Dr. Kelly Casperson
You can start to see it and be like, okay, well, I'm going to try to not just. I'm going to try to just listen right now.
- [48:55]
Dr. Rachel Boyle
Yeah. Or to just be like, I'm in my adaptive child. Right. I can feel like I just want to yell at you right now. I feel like really strong. Really strong. But I'm not going to do that. Right. So I'm going to take a different choice. And when you take a different choice than what your body's been programmed to do, it feels wildly uncomfortable.
- [49:11]
Dr. Kelly Casperson
It's like a glitch.
- [49:13]
Dr. Rachel Boyle
It is like every cell in your body is screaming to not make this new choice.
- [49:19]
Dr. Kelly Casperson
Yeah. It's just so. It's just so easy to do what you've done for 30 years.
- [49:23]
Dr. Rachel Boyle
Oh, of course it's easy.
- [49:25]
Dr. Kelly Casperson
But then it's like it burns way less calories.
- [49:27]
Dr. Rachel Boyle
But you gotta do something different. You gotta change things up. That's the only way is. Or you'll just keep getting what you've gotten for 30 years.
- [49:34]
Dr. Kelly Casperson
Yeah. Oh, thank you for helping adults be adults. Even though we can't be adults all the time because we're not perfect people. So you practice both in Nevada and Washington state? Yeah.
- [49:45]
Dr. Rachel Boyle
So I have clients virtually in Nevada.
- [49:48]
Dr. Kelly Casperson
Is it Nevada? And I say Nevada, so the natives.
- [49:52]
Dr. Rachel Boyle
Say Nevada, Nevada, Nevada.
- [49:55]
Dr. Kelly Casperson
I'm like an American. I should.
- [49:57]
Dr. Rachel Boyle
Well, I had to learn that when I moved There someone's like, Rachel, you can't say Nevada anymore because I grew up in Texas. Just Nevada. Yeah.
- [50:03]
Dr. Kelly Casperson
Okay, Nevada.
- [50:04]
Sweet.
- [50:04]
Dr. Rachel Boyle
There you go.
- [50:05]
Dr. Kelly Casperson
So you see people in Nevada and you see people in Washington state, virtually in Nevada. And my question is, are they stereotypically different people with different relationships and different problems? And if you were like, this is our Pacific Northwest main sex issue and this is our Nevada main sex issue. Are they two different issues?
- [50:25]
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- [51:28]
Dr. Rachel Boyle
Yeah, so when I was in.
- [51:29]
Dr. Kelly Casperson
Interesting.
- [51:31]
Dr. Rachel Boyle
I'm. I'm not taking any new clients from Nevada anymore because I'm, I'm just taking in person now because I'm pretty much getting close to full, so I'm only. I'm not taking. But anyway, so I was in person in Las Vegas and the relationships are different there. I would say the relationships are more, more volatile. There tends to be a bigger gender differential. So the men are very money and power oriented and the women are very much more like beauty oriented. You know, there's a lot of money in Las Vegas and there's a lot of problems. So I find the therapy here in Bellingham to be refreshing. So I dealt with a lot of narcissism in Las Vegas. And so narcissism has to be diagnosed. It's a very specific criteria. So I dealt with a lot of narcissistic traits, but narcissistic traits are still non relational. It's really hard to be in a loving, kind, connecting, equitable relationship with someone who has narcissistic traits and who's not willing to work on them. There's a lot of that in Las Vegas and a lot of the Women I worked with didn't realize that they were being gaslit, that they were being lied to, cheated on. And they didn't realize that someone who has lots of narcissistic traits, it's actually in an emotionally abusive relationship to be in a relationship with somebody like that, and it just kind of whittles women down. Their self esteem just shrinks down. It's like the slow form of brainwashing. And then they're caught.
- [52:59]
Dr. Kelly Casperson
Oh, God.
- [53:00]
Dr. Rachel Boyle
I know. Not. I. I don't really see that here. Very rare do I see that here. Here I have a lot of problems. Oh, let's just say.
- [53:10]
Dr. Kelly Casperson
Let's just say vulva, everybody.
- [53:13]
Dr. Rachel Boyle
I find that. So the men here, they know the terms emotional labor and mental labor. Right. They're very open to being equitable partners. People here get a little sad in the wintertime. I have some of that seasonal affective disorder. That's nothing compared to narcissistic traits.
- [53:30]
Dr. Kelly Casperson
Oh, well, we're so glad we. I mean, we still have problems, so we're glad that you're here.
- [53:34]
Dr. Rachel Boyle
Yeah. Yeah. But they're. I find it very refreshing. I love it here. I know.
- [53:39]
Dr. Kelly Casperson
I keep saying that it's the best place ever. And the sun's out now, so. Yeah, we're soaking it in. Oh, my gosh. Thank you so much for coming on the podcast.
- [53:47]
Dr. Rachel Boyle
Oh, well, thanks for inviting me. This was a lot of fun.
- [53:50]
Dr. Kelly Casperson
It was so fun. All. So many fun tangents. We'll. We'll figure out the erotica. And I will. I'll do a personal research inventory on how it's different than porn.
- [53:59]
Dr. Rachel Boyle
Yeah.
- [53:59]
Dr. Kelly Casperson
And I'll write a blog on it. Everybody can find you@rachelbo.com.
- [54:04]
Dr. Rachel Boyle
Yep.
- [54:05]
Dr. Kelly Casperson
I mean, that's the big thing. When I moved to Bellingham, there were zero sex therapists. Now there's probably six.
- [54:11]
Ish.
- [54:11]
I'm just off the top of my head, but, like, it's still really hard to get in and see people because they're, like, awful.
- [54:17]
Dr. Rachel Boyle
Yeah. And I would say for someone who's in perimenopause or menopause or things, they might be. You really want to find. You want to find a therapist who is aware of that and is screening for that so that you're getting proper treatment. Because if you are having anxiety symptoms or depression symptoms or low libido or all the things and it is related to perimenopause, you don't want to have that dismissed.
- [54:38]
Dr. Kelly Casperson
God, you can't do all the. All the other stuff if the hormones are off. I was telling somebody the other day, I'm like, the hormones are solid foundation, a nice basement. Like, they're not everything, but they're a nice floor.
- [54:51]
Dr. Rachel Boyle
No, they really are. And therapy goes so much faster, has neurotransmitters.
- [54:56]
Dr. Kelly Casperson
Shocking.
- [54:56]
Dr. Rachel Boyle
Yes. And they're getting proper sleep and they're able to exercise because they feel good.
- [55:01]
Dr. Kelly Casperson
And their clitoris has blood flow.
- [55:03]
Dr. Rachel Boyle
And their clitoris has blood flow. That's a huge difference.
- [55:06]
Dr. Kelly Casperson
It makes a huge difference. All right, my friend, until next time, thank you so much for coming on the you're Not Broken podcast.
- [55:12]
Dr. Rachel Boyle
Thanks for inviting me.
- [55:14]
Dr. Kelly Casperson
Thank you for listening to this week's episode of you 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 in 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.