346. Vibrators As Medicine

Summary

Podcast Summary: "You Are Not Broken"

Episode 346: Vibrators as Medicine

Host: Dr. Kelly Casperson
Guest: Dr. Alexandra Dubinskaya, Urogynecologist
Date: November 23, 2025

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Episode Overview

This breakthrough episode explores the fascinating topic of vibrators as medicine, challenging conventional thinking on sexual health interventions, midlife care, and women’s wellness. Dr. Kelly Casperson welcomes Dr. Alexandra Dubinskaya, a leading urogynecologist, to discuss her research on vibrators as a therapeutic tool for genitourinary symptoms, pelvic pain, and more. Together, they navigate the science, patient perspectives, and the emerging evidence behind prescribing vibrators not only for pleasure, but also for medical health and quality of life.

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Key Discussion Points & Insights

Dr. Dubinskaya’s Journey to Urogynecology

• Personal and Professional Background ([00:48]–[04:31]):
  • Grew up in Russia; trained as a surgeon before immigrating to the U.S. with minimal English and $400.
  • Found her calling in pelvic health during clinical stints in the U.S., especially after working with trailblazing female urologists.
  • "One day I convinced my mom to help me. We collected some money, like $400, and I was on the way to United States... and I had my surgical instruments in my suitcase..." (Dubinskaya, [00:54]).
  • Chose OB/GYN residency to focus on sexual health in women, not just pregnancy and delivery.

The Clinical Niche: Focus on Midlife and Sexual Health

• Finding Her Patient Population ([04:43]–[06:14]):
  • Swapped residency duties to focus on older patients and those with sexual and pelvic floor concerns.
  • Observed a glaring gap in knowledge and treatment options for sexual dysfunction and menopause symptoms among OB/GYN attendings: only recommendations offered were “wine, Tylenol, lidocaine, and changing partners.”

Genesis of Vibrator Research

• Inspiration for the Study ([06:15]–[09:22]):
  • Noted the parallel between penile rehab post-prostatectomy and potential use of vibrators for women.
  • "If that dilates the blood vessels, it brings more blood flow... it would make total sense." (Mentor, quoted by Dubinskaya [07:25])
  • Secured vibrators for her study from the company V4 Vibes after initial rejections; began pilot research.

Study Design & Key Findings

• Methodology ([11:01]–[13:16]):

  • Utilized external vulvar vibration (not vaginal insertion) based on preferences, anatomical concerns, and infection risk.
  • Protocol: 5–10 minutes, 2–3 times per week, over three months, not necessarily orgasm-focused.
  • "You don't have to be in the mood. You just have this protocol. You're part of the study. You have to do it two, three times a week for five to ten minutes for three months." (Dubinskaya, [13:28])

• Results & Insights ([17:08]–[20:47]):

  • Improved symptoms of lichen sclerosus and genital atrophy, as shown by before-and-after physical exams.
  • “We noticed significant improvement... moderate atrophy became less and more people have minimal atrophy.” (Dubinskaya, [19:06])
  • Anecdotal and theoretical support for vibration aiding not only sexual function but also overactive bladder and chronic pelvic pain, independent of orgasm.
  • Vibration may modulate nerves, improve blood flow, and follow similar principles as TENS units and physical therapy.

Clinical Applications

• Reframing “Use It Or Lose It” ([24:17]–[26:34]):

  • Traditional messaging about atrophy being prevented by penetrative sex is flawed and emotionally charged.
  • Vibrator therapy can maintain tissue health via blood flow, regardless of partnered sex or penetration.
  • “Use it or lose it in terms of bring attention to your organ, not in terms of go and have vaginal penetrative sex.” (Dubinskaya, [26:34])

• Vibrators for Pain, Incontinence, and Vaginismus ([16:21], [31:46]):

  • Potential applications include bladder not only overactivity but stress incontinence (depending on application), vaginismus/dilation therapy, and pelvic pain (including interstitial cystitis and chronic pain).
  • “I never tell women to use dilators because I think it’s very boring... I always recommend them to use a vibrator.” (Dubinskaya, [31:46])
  • Vibrators are accessible, affordable, and allow for self-management and independence.

Practical Implications for Providers

• How to Recommend Vibrators ([34:02]–[36:48]):

  • Context, tone, and normalization are crucial. Vibrators should be presented as a “pelvic device,” not taboo.
  • "I always compare vibrator to the Theragun—you’re not going to have any issues using Theragun... Vibrator is the same Theragun but applied in a different area." (Dubinskaya, [36:10])
  • Emphasizing external use lowers barriers for many women and helps destigmatize.

• Addressing Barriers ([39:40]):

  • Time constraints, baseline sexual health knowledge, and discomfort with terminology are obstacles for providers.
  • Adjunct educational tools (YouTube, handouts) can help.

Future Directions and Ongoing Research

• Further Studies & Unanswered Questions ([36:58]–[42:44]):
  • Clinical trials underway for lichen sclerosus and GSM (genitourinary syndrome of menopause).
  • Surveys on vibrator usage patterns (settings, design preferences).
  • Dream: create a custom-designed, physiologically tailored vibrator for various pelvic conditions and user abilities.
  • Accessibility focus: designs for arthritis, different body types, intuitive controls.

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Notable Quotes & Memorable Moments

• On Changing the Narrative
  “It switches from this, like, vibrator is this dildo from pornography to, okay, vibrator is actually really good pelvic device.”
  — Dr. Dubinskaya [35:36]

• On the Wider Implications of Blood Flow
  “What’s cardiac rehab after a heart injury? It’s bringing in blood flow to the heart, right? ...We’re doing this in other body parts. What’s physical therapy after an ankle injury? It’s bringing in... movement and blood flow to the injured area.” — Dr. Casperson [30:03]

• On Study Surprises
  “Lichen sclerosus, it was very unexpected.”
  — Dr. Dubinskaya [19:06]

• On Solo Sexual Activity and Research Gaps
  “When I start picking the questionnaires to assess sexual function, I realized that there is not really a good questionnaire that would assess solo sexual activity...” — Dr. Dubinskaya [25:38]

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Key Timestamps

• Dr. Dubinskaya’s immigrant story: [00:48]–[04:31]
• Origin of vibrator research: [06:15]–[09:22]
• Study methodology (protocol, external vibration): [11:01]–[13:16]
• Main findings (improvement in atrophy, lichen sclerosus): [17:08]–[20:47]
• Reframing “use it or lose it”: [24:17]–[26:34]
• Clinical utility for pain, incontinence, vaginismus: [16:21], [31:46]
• Provider communication strategies: [34:02]–[36:48]
• Future research & accessibility: [36:58]–[42:44]

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Tone and Language

The episode is marked by warmth, candor, and humor, with both Dr. Casperson and Dr. Dubinskaya bringing energy, compassion, and practical wisdom to an often stigmatized topic. Research, clinical anecdotes, and personal stories are delivered with clarity and empathy, making complex evidence accessible and actionable for listeners.

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Final Thoughts

This episode makes a compelling case for considering vibrators as legitimate medical tools—not just for sexual pleasure, but as accessible, effective interventions for a range of pelvic, urogynecological, and sexual health issues. Dr. Dubinskaya’s research opens the door for further innovation, stigma-busting conversations, and improved quality of life for women everywhere.

Transcript

[A]

Welcome to the youe Are Not Broken podcast.

[B]

I'm your host, Dr. Kelly Casperson, a.

[A]

Board certified urologist, thought leader, and conversation starter on midlife living, hormones and sexuality.

[B]

Enjoy the show.

[A]

Hey, everybody.

[C]

Welcome back to the youe're Not Broken podcast. The big question today is should doctors be prescribing vibrators? And I'm here with a fellow vibrator aficionado, Dr. Alexandra Dubinskaya, who is a urogynecologist in California. Welcome to the podcast.

[D]

Thank you so much for having me, Kelly.

[C]

So you did gynecology residency and then urogyne fellowship and now you practice in the Los Angeles area?

[D]

Yeah, my story is a little bit longer than that. I'm happy to share.

[A]

Yeah, sure.

[D]

I actually grew up in Russia and I did a general surgery residency in Russia.

[C]

No way.

[D]

Yes. And I'm coming from family of doctors, surgeons. So I kind of knew how the life of medical professions are. And it sought very reasonable for me and logical to go to medical school. And I also wanted to make a difference. So while I was in medical training, I got a chance to travel in different countries. And one of the country was the United States. So when I came here, I fell in love with the hot air of New York, of the tall skies of the east coast, of the heavy rains of Virginia, tall mountains of California. And I thought, why not? Maybe I could become a doctor in the United States. Like, how crazy could it be? And that thought continued living with me. And one day I convinced my mom to help me. We collected some money, like $400, and I was on the way to United States. So I didn't really know anyone, didn't know English had $400. And I had my surgical instruments in my suitcase because that was very valuable when you're in Russia. And I also had a box of Vicrel sutures. 3, 0 Vicrel. I remember because those sutures is not just available for general public. So I made sure I have my instruments with me and United States put me through the rigor. And with all the learning English, doing all the USMLE exams, one of the hardest part of being in the US Was to learn small talk.

[C]

Because you don't do small talk in Russia.

[D]

It's very brief. It's like, hi, hi. And then I knew. And I understand that I have a second chance. I'm able to do not the general surgery. I can do anything I want in the United States. And I needed some practice. So one day I realized that I need to get some clinical experience. And I was Walking into offices in Washington D.C. area in medical offices and asking to be taken as an intern or something. And I had my CV with me, and probably majority of people thought I'm crazy. So I walked in the office of urology, trained Uruguay, and she happened to fire her medical assistant that morning. So she looked at me and she asked me, when can I start? Can I start right now? And I said, absolutely. So that how for the first time, I got exposed to pelvic reconstruction, to urology, to GYN and to sexual health. Again. Kelly, you know, there's not too many women in urology, and she was one of them. And she did a reconstructive fellowship with Dr. Russ in LA and somehow, like all the women, gravitated to her for reconstructive procedure for sexual health. And I was kind of like her right hand for the whole, like a year, year and a half that I was with her. And I got so sucked into that field and I really wanted to continue with that. And she told me, you should go into urology. But I knew better. I wanted to be a vagina doctor and I should go into obgyn. She told me, you will be surprised. But she supported me and I went into OBGYN residency. And again, remind you, I never been on any clinical rotation in the US So when I went and started my residency, I was surprised that you're supposed to deliver babies all the time. And it's not like optional.

[C]

I know they put those things together, the beginning of American medicine. Those two are separate things. And then culturally, they put all the women in one corner, basically, and said that these people had to do it all.

[D]

Exactly. And it takes such a different personalities of the providers, such different skills, and I don't think it's possible to. To be good at everything women's health. So I had to figure out how to have more people of who I like, more patients who I like to treat and less of pregnant people. Nothing against pregnant people, but I just didn't feel like I make a significant change in women's life by delivering her child compared to when I can, like, make her stop being herself or teach her something about sexual health. So we had this setup of like resident continuity clinic, and I start swapping patients, I start getting all the older patients because, you know, general obgyn, they don't like when women stop having children or if they have any sexual concerns. So I realized, okay, that's my niche. I have to. In order to survive. That's what I have to do. I start swapping the patient. Like all pregnant patients, I would swap with my co residents. It was super easy because everyone loved those. And I was dealing with incontinence, I was dealing with sexual health. And I realized that there is no one of our doctors who like attending school, we work with could help me with helping women with sexual health like literally zero. The recommendations of wine, of Tylenol, of topical lidocaine and changing the partners. That was it.

[B]

Yes.

[D]

And I started doing my own research and that's how I discovered Addie Flibanserin. And at that time you supposed to do like that certification in order to prescribe Addie. So I start doing that and somehow my attendings were okay with that and I was doing that and I formed this like clinic of pelvic floor disorders, sexual health, menopause. I loved it. And nobody of my co resident loved the clinic, but I loved my patients. So I applied for fellowship, got in and I did fellowship at Cedars Sinai. So I had amazing mentors and I supposed to come up with a research project. And one day I came to my mentors, Dr. Karen Alber and Dr. Jennifer Enger. I'm sure you know them. And I said, you know what? I want to research vibrators. And I expected to get the rejection. I mean I had so many rejection in my life, one more wouldn't make a difference. I would still make it work at some point. But they looked at me and they said, you know what, it makes sense. If that dilates the blood vessels, it brings more blood flow. And we do similar thing with Viagra. When we give Viagra to men after prostatectomy to do a prostate rehabilitation, penile rehabilitation, it would make total sense. Sense. And also there is some role of neuromodulation of vibrators. Let's do it. I couldn't believe what I'm going to do for my main project is learning about vibrators. What can be cooler. And then the next thing that I had to figure out is how we're going to do it. Where can I get the vibrators? And it was beginning of 2020, so beginning of like pandemic already started. But the sex toy industry haven't took off the way how we see it right now. So when I started reaching out to the companies, can I get the vibrators? Can you give me 20 vibrators? Can you give me 50 vibrators? They looked a little bit like funny at me because it didn't seem real thing. And just some person reaching out to get some vibrators.

[C]

I figured they'd be tripping over themselves for research on this.

[D]

Right? And there is no really like return on your money. It's not guaranteed. My husband, my boyfriend at that time, he offered to contribute and buy vibrators from China. And it was very sweet of him. But he also wanted to advertise his company in the final research. So I'm like, I'm not sure it's very ethical. Eventually we found the company who I just so incredibly grateful to her. And she said, okay, no problem, I can give you 100 vibrators. Just acknowledge me in whatever study you're going to write. And I received three boxes full of vibrators. I didn't care what type of vibrators, I just cared that I have them.

[C]

What company, what vibrator did you use in your studies?

[D]

V4 vibes.

[C]

V4 vibes.

[B]

Okay, cool.

[D]

Yeah. And if you look at the paper like the prospective research study that we did, there is actually a picture of that vibrator in acknowledgement because we keep our props promises. So that company made it actually possible to do that research.

[B]

Amazing. This show is sponsored by MIDI Health. When we experience perimenopause, menopause and midlife issues, we feel unheard, dismissed and unserved by the traditional healthcare industry. And here's the powerful truth. It's time for a change. It's time for midi. MIDI is not just a healthcare provider, it's a woman's telehealth clinic. Founded and supported by world class leaders in women's health. MITI is leading the way by providing expert personalized insurance covered virtual healthcare for women in midlife, empowering us to thrive and experience our second act with vitality and confidence. Ready to feel your best and write your second act script? Visit joinmitty.com today to book your personalized insurance covered virtual visit. That's joinmitte.com, midi, the care women deserve. Now back to the show.

[C]

Shocking that all of them didn't.

[D]

It kind of was very validating. After getting those two papers published, how the company started approaching me and offering the vibrators.

[C]

Oh, you had to do a proof of concept.

[D]

Exactly, exactly. I think that also helped me to show myself how much, how badly I wanted to make that research happen. Yep.

[C]

And the vibrator that you used, correct me if I'm wrong, but one of the things I liked about it is that you did external vulvar vibration. It didn't need to penetrate the vagina, is that correct?

[D]

Correct. And that was. We made that decision based On a few reasons. First, majority of women like from the prior studies, they don't insert vibrators vaginally. They use it strictly like on the clitoral area, on the vulva area. Then a lot of my patients and one of the focus that I kind of like wanted to focus on in the population like perimenopausal, postmenopausal and every one has a different degree of gsm. So some women just physically not able to insert the vibrator inside or some women, they're very concerned about possibility of getting UTIs. So that would be one of the factor for them declining to be in the study. So we decided to do it externally.

[C]

I love that you did that and I loved what your results showed. Saying this will benefit you and you don't have to put it in your vagina. I think that is actually a strength of this study. Yeah.

[D]

Thank you. And I'm sure there is also some role in doing study focusing on only insertion because that would probably help more with stress urinary incontinence. So with leakage, with physical activity, coughing and sneezing because that would bring the vibration closer to the sphincter muscles. But even then we did see some improvement in urge urinary incontinence. It was not statistically significant, but we could see the positive trait into getting statistically significant. So I think if in the in the future we get more participant and give more power to the study, I'm sure it will show significant improvement.

[C]

Do you think it is because of blood flow to the pelvic floor or do you think it was orgasm and pelvic floor muscle contraction and strengthening? Were you able to suss that out if people had orgasms or not and if the bladder got better?

[D]

So it's a really good point. The one of the main things of our study is women encouraged to use vibrators with the goal of using it and not necessarily achieving the orgasm.

[C]

And I love that about your study too because it was just what, 5.

[D]

Minutes, 5 to 10 minutes, 5 to 10 minutes.

[C]

Not goal oriented, just vibration externally, how you please.

[D]

Exactly. And one of the most difficult moments to kind of like habits to break in it was to change the mindset of women from I didn't use it because I didn't feel in the mood to switch it to. You don't have to be in the mood. You just have this protocol. You're part of the study. You have to do it two, three times a week for five to 10 minutes for three months. And it's actually took me multiple reminders of literally just following up on them. And again, I'm fellow with the time in my hands just to following up and make sure that they're using it that like no life events, no mood, staying on the way of using the vibrators. But back to your point, I think it would be very interesting to see if it's actually the vibration itself or the orgasm at this point. I do believe that it's probably the vibration that stimulates the mechanoreceptors and it also helps relax the muscles, helps to like neuromodulate the mechanism of urination of pelvic floor function. But again, I think there are definitely more research needs to be done to have the exact answer.

[C]

Very interesting. I mean it's kind of like, you know, people will use the Emsella chair, which I have issues with because it's expensive and it doesn't last long. Whereas if you have a vibrator at your house, that can last a long time and you can have sustained benefits. But it's kind of the same sort of like vibratory theory of how it works with bladder. Overactive bladder.

[D]

Yeah, exactly. Yes. And it's a good point because vibrators is actually like very accessible and there is different price points for everyone. And also the interesting thing, if you look at PTNs, peripheral tibial nerve stimulation, the way how we treat like overactive bladder, it's kind of like acupuncture on steroids, SNS. The frequency that we use in PTNs and SNS is very similar to the vibrators. It would be like a lower frequency, like about 10-20Hz and vibrators usually start at 20Hz, but the low frequency will provide the similar changes to PTNs and SNS. So I do think there is some role of that. Neuromodulation that vibrators provide is independent of the orgasm. Exactly.

[C]

Yeah. That's super interesting. I mean I would think vibration plus the orgasm is going to give you two mechanisms that help bladder issues. So more is better in that department that you can use one without the expectation or pressure of orgasm and just.

[A]

Say no, no, no, no.

[C]

Vibration alone helps the bladder.

[D]

Exactly.

[C]

That is so cool.

[D]

And also if you think about the pain, my patients, right. The interstitial cystitis, chronic pelvic pain, when we think about vibration, it also can help decrease the amount of pain. Again, it's all the theory, but following like the gate pain theory, vibration would compete with other pain fibers, oversaturate the mechanoreceptors and those nerve fibers preventing the pain. So that's why actually in some children's hospital, they use some vibration before giving the injection to kids.

[C]

Yeah, they have the buzzy bee for, like, IV draws, because when you're feeling the vibration, you can't feel the pain.

[B]

It's magic.

[C]

I love it. So your paper had said that it appears because you guys did a physical exam before and physical exam after, in addition to ask people subjectively their symptoms. Both lichen sclerosis and atrophy got better with vibration therapy. Can you talk about that? Were you expecting that? And can you talk about that?

[D]

No, it was unexpected finding. And just to kind of also give you a little bit more perspective on the protocol. So first I would talk to the patient, review, like the story, what the concerns are, if they're interested in participating. We would do exam, pelvic exam, assessment of muscles. If there is any prolapse and incontinence sensation. Obviously, like, part of my comprehensive pelvic exam is assessment of the atrophy. Any changes on the skin, and they will completely give you forms as well for, like, sexual function, pelvic floor health and mental health and quality of life. So. And then because we assessing those parameters, we added assessment of lightning sclerosis and assessment of atrophy. There is no actual grading system, unfortunately, for both of those. So in our practice, we usually assess, like, okay, severe.

[C]

I think you should create that. I've never thought about that. You're absolutely right. And it'd be nice to have one so we could communicate about it. Like grade three atrophy, grade three lichen sclerosis. Oh, my God. Could be the Dubinskaya protocol. All right, find a new fellow.

[D]

We should do that. And it actually would be very helpful because likeness sclerosis not only happens in postmenopausal women, also in premonarchal girls, and they obviously undergo significant changes. So that would be nice to know how your anatomy changes between, like, you being 5 years old and later in life.

[C]

Yeah, Like Tanner, stage one through five.

[B]

We should. We could have stages for lichen sclerosis and atrophy.

[C]

I digress. But it's a very good point.

[D]

So we're just assessing it by, like, mild, moderate, severe. And we assess it at the three months and at three months at the initial intake and at three months follow up. I wish we would have randomization of whoever is assessing it initially and whoever is assessing it in three months at different people, but we didn't have it. But the way to prevent bias is we would not allow to review what was the exam at the initial appointment. Again, as the providers who deal with down the belt anatomy all the time, you weirdly remember people people by the appearance of the genital area. But we tried to prevent those biases and I definitely didn't remember like what grade I sign. So we noticed significant improvement. And if you look at the stratification of let's say vaginal atrophy, we could see that the moderate atrophy became less like less numbers of people had moderate atrophy and more people have minimal atrophy, which was actually really good. And the lightning sclerosis, it was very unexpected. So now we have actually two clinical trials. We're preparing for them. We're not recruiting yet, but those two clinical trials focusing on the GSM and on lightning sclerosis with vibration.

[C]

Amazing. And you didn't change any hormone protocol for the three months that they were on? If they were, I'm assuming if they were on vaginal estrogen, they just continued. But she didn't start any vaginal estrogen to be used in the vibration.

[A]

If your face needs a moisturizer, chances are your vulvovaginal skin does too. During menopause, lower estrogen levels cause the skin everywhere to thin and dry. That's why we get wrinkles in crow's feet around our eyes. The same thing happens to vaginal and vulvar tissue, leading to dryness, irritation and even pain with sex. That's why I recommend Via vaginal moisturizer from Solve Wellis. Via is a non hormonal hyaluronic acid based moisturizer that helps replenish moisture and soothe dry skin. And for anyone using vaginal estrogen, Via is a great companion. You can use it for supplemental moisture on off days or as a standalone option for those who choose not to use vaginal estrogen. To learn more about via visit viaforher.com that's via the number4her.com new customers get 20 off their first purchase and an extra $5 off with code. Dr. Kelly 5 that's D, R K E L L Y. The number five providers can request patient education materials and samples by visiting hcp.solvewellness.com.

[D]

One of the rules that people who were on vaginal estrogen for more than three months before being recruited, they continued that regime. People who were not on a vaginal estrogen who was actually 80% of participants, they were not started on the vaginal estrogen.

[C]

Fascinating. Did you think atrophy was going to get Better. What was the original working hypothesis? What were you looking for? The vibrators to improve.

[D]

So because the vibration dilates the blood vessels, it bring more blood flow, so it will improve all pelvic floor conditions, including the atrophy. So we thought maybe got it was.

[C]

Atrophy was statistically significant.

[D]

Yes, atrophy and likeness sclerosis was statistically significant.

[C]

So help me figure this out, because there's two papers I know you probably know about them. There's a recent one just published in Japan, and then there was one from 1983 that was the original use it or lose it paper. And they were observational trials, not use it or lose it or improvement papers. And what they did, just for people who don't know these papers, gynecology clinics did exams. And then they asked the women if they were sexually active or not. And it turns out the people with less atrophy were more sexually active. And then the media took these studies and they said, use it or lose it. Have sex so you don't get atrophy. And I think it's a very awful thing to tell women to use it or lose to have penetrative intercourse, which is what that is. And we don't know the quality of that. We don't know if they're aroused at all. We don't know if they have orgasms at all. We don't know the quality of that sex. But to say you must use or ELUSA to prevent a hormonal issue, GSM's hormonal issue is very upsetting, I think, to all of us. But now I've changed my tone a little. Like, I'll explain those studies. I'll say, we don't have data. Penises don't change hormone levels. We know that. But now we do have this data that vulvar vibration therapy. So not putting anything on the inside with or without orgasm seems to improve atrophy. I don't need it to be easy. We're allowed to be nuanced. But I'm like, that's technically use it or lose it a little bit of like, there is some good that comes from putting vibration on your pelvis. Can you help me with that?

[D]

Yes. So I hear what you're saying. And initially it took me a little bit like, yeah, if we broke our leg, we're bad bound and we're not losing our legs, it will become a tropic. So we do physical therapy. We're trying to move. And if we tell that patient, if you're not losing you Lose it. There's no emotional attachment to it. People understand that's logical. Let's use Owlet. But when it goes to pelvic health, sexual health, when we tell someone, oh, you're not using it, you're going to lose, creates a lot of negative thoughts. But the reason being, it's because culturally, historically, we think about sex as penis goes in the vagina. So it's appropriate for men to masturbate and nothing wrong with that. But for women, the solar practices, they not socially acceptable. So anytime we talk and say like, okay, you not going to use your vagina, you're going to lose it, we all think exactly about vagina and how we forced to have sex because what if we're going to lose it? And you know, this actually came up in our study. When I start picking the questionnaires to assess sexual function, I realized that there is not really a good questionnaire that would assess solo sexual activity because you can be sexually active and not have a partner, and you can have sexual dysfunction even if you don't have a partner. So you might not have a desire and be bothered by that. And until we develop those questionnaires, until we ask women actually are you sexually active, like solo over the partners, we're going to have those issues. So I think as any organ in our body, same way as we go on a walk, we go on a gym, we eat healthy, we do need to bring more blood flow to our pelvic area and vibration is one of the way to do it. So use it or lose it in terms of bring attention to your organ, not in terms of go and have vaginal penetrative sex.

[C]

I love it. I think it's wonderfully nuanced and I think this research is so helpful. Most people, I would think, use vibrators for sexual activity, but. But again, yours didn't even require an orgasm. It's blood flow alone. And in the male data, we know that if a man doesn't get an erection, and this is just erections, this isn't orgasm data. I'm pretty sure this is just erection data that their penis, the smooth muscle of the penis will contract because you're not using it. So that's another thing. And what's an erection? Erection is blood flow. And so again, we're telling man have an erection, but we're kind of assuming orgasm. But again, it's the blood flow that helps keep the penis functioning, the length, the smooth muscle working. And we're kind of like, everybody thinks of sex when I say sex. They think of a different thing. So it's actually our fault for not being specific when we're like, we don't have orgasm data on preventing atrophy, but we do have vibration data looking like it does prevent atrophy. And that might be a use it or lose it scenario. But yeah, I think if you were just to talk to like the general population and a woman's like, should I have sex to prevent atrophy? I mean, you have to be like, what's sex? Putting somebody's penis in your vagina where you aren't aroused, you have no blood flow and you have no orgasm. That's not going to prevent atrophy. So we actually do have to do a better job, I think, of being specific in answering that question. And I think your research is absolutely helping us with that. And it's so insightful.

[D]

Thank you.

[C]

And now you have to come up with a grading system for lichen sclerosis, a grading system for atrophy, a better questionnaire for soloed sexual partner. There's. There's clearly a lot of work to be done. So what was the reception when you published this paper? Was it hard to get published? Were people like, thank God we finally have some data?

[D]

Yeah. So there are two papers. One is the systematic review. And I didn't have any issues with publishing that. Goldstein loved it, so. And I think that helped that as well. The second paper, the prospective study, I did have actually some difficulties, challenges of publishing it because a lot of people have a lot of questions and the issue is that it's a pilot study. So the idea was to see, okay, what, what happens. We were not striving to do a randomized control trial to have everything 100% perfect, but we wanted to try and I totally was very open in the discussion and all the limitation of the study that we need to have more research. But this is what we know so far with also resources that we have. Eventually it got published and I was very excited. My next stressful moment about this paper will be that I'm taking my Uruguayan oral board next year. And for OBGYN trained Uruguayins, you're supposed to defend your thesis. So I'm looking forward to it. And I already anticipating so many questions and critiques about this paper, about that research.

[C]

Oh my gosh, if anybody challenges like you on, I'm like, this is where the research needs to go. Because my question is like, do we have any data on vibrators with vaginismus? Clearly we want to learn more about lichen Sclerosis, right? Like clearly we want to learn more about bladder leakage. Like to me, I'm like, this is the tip of the iceberg.

[D]

Thank you. I hope they think the same way.

[C]

I'm like, I have, I just have a podcast. But, but to me, I'm like, if they're not realizing the incredible gap in our knowledge of what bringing in blood flow to the pelvis can do, I mean, what's cardiac rehab after a heart injury? It's bringing in blood flow to the heart, right? Like we're doing this in other, in other body parts. What's physical therapy after an ankle injury? It's bringing in like movement and blood flow to the injured area.

[A]

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[D]

Absolutely. And if you think about hypertonic pelvic floor, I actually in my practice I never tell women to use a dilators because I think it's very boring when you like feel like you have to insert something in your vagina, sit and do it like every day. I always recommend them to use a vibrator because you get that vibration that helps with pain. You also have some perks that comes with the use of vibrator and you can do it with a partner and it's at least a little bit more involved, more interesting. And you also get this positive feedback that doing vaginal dilation doesn't necessarily mean pain. It kind of also prepares you to have like let's say penetrative vaginal intercourse. You Break that vicious cycle of anything goes in vagina. It hurts. There is so many use of vibrator. And again, as you said, it just tip on the of the iceberg. And I have been recommending vibrators almost to like every other patient in my practice.

[C]

I feel like, correct me if I'm wrong, there's not a lot of data, but I feel like there's a vibrator company who's looking at vibration on the lower abdomen for uterine cramps for periods. Again, the GATE theory of pain of like, if you can fill the neurons with vibration, it can't carry the pain receptors as much.

[D]

Yeah, that's actually. It makes total sense. Think about tense units.

[B]

Yep.

[C]

Yeah. Tens units. We use vibr. Yeah, exactly.

[D]

But tense units usually more expensive than average vibrator. Yeah.

[C]

And with your vaginismus patients or the people you would think of vaginal dilation. But we want to use vibrators instead. Are you starting out just vulvar vibration? With the protocol, five to ten minutes, two to three times a week. Get comfortable with that first. And it probably is helping blood flow and everything before we even try to put something on the inside.

[D]

Exactly. I want them to be aroused. I want them to want to have an orgasm because it also relaxes the muscles in some ways. So. And then try that so there is no pressure of like, okay, I just have to insert something in vagina. Yep.

[C]

I love it. How do you recommend. You know the paper that you published, the one in the Goldstein in sexual medicine reviews. Is it time for doctors to prescribe vibrators? I took insurance for 20 years and now I'm cash. So now I have like an hour and a half to talk to people about vibrators. By the time I'm talking about vibrators, they know me, they like me. We have a relationship. I think the 10 minute doctor patient visit. Maybe you've never met before. Maybe the patient doesn't know anything about sex. And for a doctor just to be like, hey, try a vibrator.

[A]

It can be very flip.

[C]

It can be very dismissive. How would you best like doctors to utilize your research in explaining the benefit to women?

[D]

Absolutely. Well, first to start, if you think about, well, women exam how much time ob GYN has and usually it's like, hi, let me get your pap smear. So you're already in like the most vulnerable position. What I usually do. And again, it depends on the issue that we're dealing with. I go through serious options, like serious options first. And then I tell Them, okay, there is like pelvic floor physical therapy. And actually, you know, vibrator showed to improve blood flow to the area, helps to stimulate mechanoreceptors in your muscles. I go through all the benefits and, you know, majority of women feel very comfortable using vibrators. Do you have a vibrator that you can use or would you like me to give you a suggestion?

[C]

Oh, I like that. I love that approach.

[D]

Telling women that she's not the only one who I recommend that in particular, like something wrong with her, but showing that that's my common practice and a lot of women use it. It's actually helped women to feel more included, part of the bigger circle. And also I think for a lot of women, when the doctor brings it up, that helps them, kind of gives them permission to use the vibrator. It switches from this, like vibrator is this dildo from pornography to, okay, vibrator is actually really good pelvic device. And I always compare vibrator to the theragun. Like, you're not going to have any issues with using theragun. You're going to think like, okay, it makes sense. Vibrators is the same paragon but applied in a different area.

[C]

I think the other strong emphasis is it doesn't have to go inside, it can just stay on the outside.

[D]

Exactly. And then I tell women, you know, the stimulation usually most pleasant on the outside, you can use it externally. And then I tell them, by the way, we did a study and the study showed.

[C]

Yeah, I love that. It's so good. Is there a next? Is there a current study in play? Is there something you absolutely want to study next? Like, where are you going to take this?

[D]

Yes. So right now, currently we have the ongoing survey on the vibrator settings. So you know how when you buy the vibrator and there is like 15 settings, I hate it.

[C]

I think it's intimidating for a lot of people.

[D]

Exactly. So my partner, Dr. Albert and I, we were thinking like, okay, who uses all those settings? Why are we having all those settings? And I think majority of women, they probably think that all other women use all those settings, but they the only one who only uses one.

[C]

They just use the first one, the simple one.

[D]

Probably, yes. And probably the reason why we have so many settings is whoever in China created that motors. That's why all the company gets that type of like vibrators.

[C]

It doesn't mean it's useful or women want them all or they all feel good or they all are supposed to feel good.

[D]

Yeah. So we trying to collect the data. What's the most used setting, what area people apply to women and men and any changes that or adjustments that they wish they could do in the vibrator. Because for example at Mystery Vibes there is an app you can adjust how many patterns you have. If you want to have one, you can just have one. If you want half eight, you can have eight. So that's a survey that's ongoing. Another survey that's coming up is for the providers to see what obstacles providers have when recommending vibrators to patients.

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[D]

Love it.

[C]

I would say time, time and baseline sexual health knowledge. That's my guess.

[D]

Yes. And also like what can we create to facilitate that communication? And actually in my practice I also refer patient to my YouTube channel and there is like one of the videos that talks about different vibrators. So how to choose your vibrator which can be helpful. Yeah.

[C]

That's awesome dude. It's so exciting.

[D]

Thank you. And there's two trials that hopefully will go live soon again on lightning sclerosis and vaginal atrophy. And talking about what ideally I would like to do. I have this dream that one day the way how we make a vibrator is I could talk to the mechanic to create the perfect motor that would be physiologically appropriate and we can take that motor and investigate it first on like do the trial for women. Because right now what I see more and more is the product is already made and now we researching and Seeing like what differences create, but not. Why not go from the opposite end? We want this particular type of frequency amplitude. We wanted this combination and let's see if it works. And we want to know what material women like. Because there is also important thing about material, how it will conduct the vibration, create that perfect vibration that will be very user friendly. If you think about vibrators nowadays, they all have this like flat buttons that it's very difficult to press. It's not logical. You press one, you press twice. What if it's very important culmination moment and you accidentally push the button? Now you have to go through all the 16 settings to get back to that. So to make better buttons, make it actually more ergonomic, there is a movie, this TV series, Grace and Frankie. And one of their series was about creating vibrators for people with arthritis and, you know, funny but not funny. In my study, it was one of the common complaints for women that it was very difficult to hold the vibrator in the hand due to like arthritis or some neurologic issues. So we need to make vibrators easier to operate and also think about all the different body habitats that some people, they can't reach down there, they have to have other ways to do it. So I hope one day it can make the perfect vibrator that will serve as a tool for multiple pelvic floor conditions and sexual health and mental health. And hopefully it wouldn't cost as much.

[C]

Oh, thank goodness for you and your trip to America that inspired you to come here and do a residency. That is for anybody who doesn't know. That is no small feat, my friends. That is a very large accomplishment in and of itself, let alone you're at the forefront of women's sexual health and actually trying to figure out what makes people feel better. Thank you so much for doing what you do.

[D]

Thank you so much, Kelly. Thank you for doing all this podcast because they also so important. I see so many patients when they come in and say, I watched the episode Such and such and I want the same. Yeah.

[C]

Oh, I love it. Let us know what your Instagram is or where you want people to find you.

[D]

Instagram alexdubinskaya or Dr. Uraguain. Same as YouTube.

[C]

I love it.

[B]

Thank you so much.

[C]

I'll put it in the show notes. Thanks for coming on today.

[D]

Thank you for having me.

[B]

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 Master class 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. 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.