Podcast Summary: "You Are Not Broken"

Episode 346: Vibrators as Medicine

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

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.

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.

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]

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]

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.

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.