Podcast Summary: You Are Not Broken

Episode 358: "It Was Never All In Her Head" with Dr. Elizabeth Comen
Host: Dr. Kelly Casperson, MD
Guest: Dr. Elizabeth Comen, breast oncologist, author of All In Her Head
Date: February 15, 2026

Main Theme / Purpose

This engaging and candid episode features Dr. Elizabeth Comen, a New York City oncologist and author, in conversation with Dr. Kelly Casperson. The discussion centers on the historical and ongoing inequities women face in medicine, especially regarding sexual and reproductive health. Drawing from Dr. Comen’s book, All In Her Head, the conversation reveals how gendered medical bias is deeply rooted and still impacts women’s experiences with diagnoses, treatments, and validation in healthcare. The episode blends medical history, anecdotes, and critical social commentary, empowering listeners to better understand (and advocate for) women’s health.

Key Discussion Points & Insights

1. The Genesis and Purpose of "All In Her Head"

• Dr. Comen’s background in the history of science (Harvard) fueled her fascination with the social and cultural influences on medicine, especially for women (01:19–02:11).
• The book is a fact-rich, meticulously researched exploration of women’s health “syndromes," tracing their history and uncovering the non-scientific influences—religious, cultural, economic—behind modern medicine’s approach to women (02:32–03:43).
• Notably, much of women’s health history is marginalized; symptoms that persisted without clear biomedical explanations were often reduced to "female hysteria" or simply chalked up to women’s emotional states.

2. Medical Bias and the Legacy of Pathologizing Women

• Examples ranging from 17th-century records to Freud’s theories to recent practices highlight the persistent mislabeling and mistreatment of women’s health issues (04:41–05:41).

  • Surgeons once performed dangerous operations to move the clitoris closer to the vagina, aiming to "adult-ify" women's pleasure, based on Freud’s conflation of clitoral and vaginal orgasms.
  • "Can you imagine being so shamed about the way that you find pleasure that you have to completely change your anatomy in a gruesome, potentially mortality causing way simply to have pleasure?" (Dr. Elizabeth Comen, 05:23)

• These attitudes linger, seen today in cosmetic genital surgeries and continued ignorance about what "normal" female anatomy is (06:02–07:07).

3. Sexual Health: Comparison with Men’s Health and the Language Gap

• Dr. Casperson points out stark differences in post-cancer sexual health care:
  • After prostate cancer, male patients are immediately counseled about sexual side effects; for women, post-breast cancer sexual health is rarely addressed—even though hormonal treatments can induce severe menopause and sexual dysfunction (07:41–09:10).
  • "You can be damn sure if you’ve been diagnosed with prostate cancer, one of the first things…they’re going to talk to [you] about [is] their erectile dysfunction... But we effectively castrate so many women with breast cancer." (Dr. Comen, 08:36–09:10)
• Revealingly, there is no direct word for "female castration"—a symptom of medical oversight (09:22–09:40).

4. Misconceptions, Informed Consent & Education Gaps

• Misinformation about menopause and breast cancer treatments persists, including confusion over whether medications cause menopause or only the symptoms (10:20–10:48).
• Early breast cancer often has high survival rates, making proper risk assessment and informed consent vital (10:55–11:28).
• Popular risk calculators sometimes use outdated data, inflating the risks of hormone therapy for women (12:27–13:01).

5. Genetic Testing for Breast Cancer Risk

• Advances in genetic testing have broadened beyond BRCA1 and BRCA2, with many gene panels now available, but access (and patient understanding) can still be a barrier (13:44–14:51).
• Anyone can pursue genetic screening, but insurance coverage may vary (14:51–14:55).

6. Technology & Bias: ChatGPT in Women’s Health

• Anecdotes reveal how AI still perpetuates gender bias and misinformation. For example, ChatGPT erroneously warned against vaginal estrogen for breast cancer patients, despite recent evidence and changes in medical guidance (15:12–16:23).
  • "ChatGPT and I are going through a break. It's been very traumatic." (Dr. Comen, 15:12)
  • ChatGPT defaulted to using male pronouns for doctors, echoing societal biases (16:30–17:02).

7. Quality of Life in Cancer Care

• Despite aggressive efforts (and insurance coverage) to prevent chemotherapy-induced hair loss—a visible side effect with real psychosocial impact—there is a lack of equivalent efforts to preserve women’s sexual and reproductive health after treatment (17:57–18:54).
  • "Why are we not preemptively thinking about these things for women and waiting for them to be uncomfortable and in pain before we preemptively treat it?" (Dr. Comen, 18:54)

8. Barriers to Treatment and Preventive Care

• Preventive treatments for Genitourinary Syndrome of Menopause (GSM) are much more effective than trying to reverse severe changes, yet "pretreatment" for the vagina and pelvis is rare (18:54–19:12).
• There is a pervasive lack of provider education—Dr. Comen, a breast oncologist herself, hadn’t learned about the extent to which the vaginal canal can shrink after induced menopause (19:29–20:22).
  • "I never even knew what pelvic floor PT was. How is that possible?" (Dr. Comen, 18:02)

9. Harmful and Outdated Medical Advice

• Even in major city cancer centers, breast cancer survivors are sometimes given embarrassingly outdated or harmful advice such as “use Crisco" as a lubricant (20:33–21:03).
• Sex education and sexual health training are almost entirely absent from medical training—leaving practitioners unprepared to address patient concerns (21:21–22:43).

10. The Rise (and Roots) of Misinformation & ‘Snake Oil’ in Women’s Health

• The episode draws parallels between 19th-century quack remedies and today’s social media misinformation, both capitalizing on women’s health fears and gaps in provider knowledge (24:48–26:19).
  • Notable quote from a historical ad: “Quite often the doctor is too busy and too hurried to make the necessary effort to obtain the facts. He frequently treats symptoms for what they appear to be on the surface when the real cause...is deeper and more dangerous.” (Dr. Comen reading from 1896, 25:37–26:19)
• The Host and Guest emphasize that history is crucial to understanding persisting patterns of gender bias and exploitation.

11. Hormone Therapy Education & Its Implications

• Hormone education is currently focused on undoing decades of misinformation (since the Women’s Health Initiative), but is not a panacea—lifestyle factors (exercise, nutrition, sleep) remain essential (27:02–27:44).

12. Memorable Chapters & Stories from the Book

• Dr. Comen’s favorite chapter is the "Bitches Be Crazy School of Medicine" (neurology chapter, 27:54–30:45), exploring how “hysteria” and mental illness diagnoses marginalized women:
  • Story of Augustine, a woman committed to a Paris hospital, who escaped by impersonating a man—underscoring the gendered nature of illness and freedom.

13. Patient Advocacy & Practical Tips

• Both hosts stress the importance of bringing an advocate to medical appointments and of not giving up when told “it’s all in your head.” Even highly educated people (including Dr. Comen herself) can be dismissed or gaslit when vulnerable (32:29–34:38).
  • "When I was in pain and when I was anxious, I got completely steamrolled...and I even apologized..." (Dr. Comen, 33:06–34:38)

14. The Role of Community and Platform in Changing Healthcare

• The hosts reflect on how social media, despite its pitfalls, has enabled professionals who challenge the medical cultural status quo to connect, share evidence, and push for better care (35:32–36:19).
• Dr. Comen joins NYU’s new Women’s Health Collaborative, aiming to transform clinical care and research in women’s health (36:40–36:55).

Notable Quotes & Memorable Moments

• On medical history’s relevance:
  "History is accessible...but really necessary to understand the legacy that we inherit when we go to the doctor's office, whether we're showing up as a doctor, a healthcare provider, or as a patient." (Dr. Comen, 03:09)

• On dangerous surgeries shaped by cultural beliefs:
  "Can you imagine being so shamed about the way that you find pleasure that you have to completely change your anatomy in a gruesome, potentially mortality causing way simply to have pleasure that you could, that you already knew you could have? It's tragic." (Dr. Comen, 05:23)

• On sexual health disparities after cancer:
  "You can be damn sure if you've been diagnosed with prostate cancer, one of the first things...they’re going to talk to [you] about [is] their erectile dysfunction, their sexual function, because God knows that's important." (Dr. Comen, 08:36)

• On the persistence of misdiagnosing women:
  "So many women with real issues have been told, it's all in your head. Nothing's wrong with you." (Dr. Comen, 30:45)

• On personal vulnerability, even as an expert:
  "Here I am with all the resources in New York...and yet when I was in pain and when I was anxious, I got completely steamrolled, and I even apologized." (Dr. Comen, 33:06)

Timestamps for Important Segments

• Dr. Comen’s background, book genesis: 01:19–02:11
• Medical historical rabbit holes and biases: 02:11–04:41
• Freud, surgery, and pathologizing women’s pleasure: 04:41–05:41
• Contemporary echoes—cosmetic genital surgery, "Barbie vaginas": 06:02–07:07
• Disparities in sexual health post-cancer (male/female): 07:41–09:10
• Word gap: "female castration": 09:22–09:40
• Breast cancer risk calculators and hormone therapy: 12:27–13:01
• AI & gender bias: ChatGPT and medical misinformation: 15:12–17:02
• Lack of proactive pelvic/vaginal health care: 17:57–19:12
• Provider education gaps—vaginal canal shrinkage after menopause: 19:29–20:22
• Outdated advice: "use Crisco" for lubrication: 20:33–21:03
• Comparison to 1890s snake oil ads: 25:24–26:19
• Favorite chapter: The "Bitches Be Crazy" School of Medicine: 27:54–30:45
• Advocacy and the importance of bringing a companion: 32:29–34:38
• Power of community, social media, and new platforms: 35:32–36:19

Resources & Where to Find Dr. Comen

• Book: All In Her Head—available on Amazon and other booksellers (36:33–36:40)
• Clinical Practice: NYU Langone Health / Women's Health Collaborative (36:40–36:55)
• Social Media: Dr. Comen is active and shares resources online.

Closing Note

This episode is both an exposé and a call to action for patients, providers, and advocates: Make history visible, question medical "norms," and know you are never "broken." The work of Drs. Comen and Casperson exemplifies a powerful, articulate, and evidence-driven movement to rewrite the narrative of women’s healthcare—with science, accountability, and humanity at the center.