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Welcome to youo Are Not Broken, the podcast that challenges everything we've been taught about midlife hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author and a leading voice in women's sexual and hormone health. Enjoy the show. Hey everybody. Welcome back to the youe Are Not Broken podcast. Today we are doing a Ishwish 2026 review that is the topic of this. I'm also live on Instagram for people who are in the moment. Hi, welcome to 2026. Busy things are happening. Not. Not as crazy as 2025. That was nuts. But happy to be in 2026 and setting the year off right. I've been to Los Angeles and the surrounding Los Angeles area three times so far in 2026, which is a bit above average, but direct flights would be nice. Bellingham Airport. So before we go into the ishwish annual meeting 2026, I'm going to do some housekeeping things you guys need to know. So much of my podcasts are me interviewing people that I really love. Like me just riffing and answering questions and like to get you guys all caught up on the happenings. So we're going to run through some housekeeping items first. First of all, ishwish annual meeting 2027 is going to be in February 2027 and it's going to be in Vancouver, Canada, which is fantastic. So I'm obviously there because I live in the Pacific Northwest and it's an easy drive for me and I think you guys should come too. So. So for people who've never been to Ishwish, two things to consider. First of all, people who don't know ishw Society for the Study of Women's Sexual Health. Started by a urologist, fantastic organization, very multi, multi disciplinary and like you go there and like women's testosterone is normalized. Like you don't have to explain yourself. You're not fringy, you're not weird. You don't have to justify yourself. You just know you're surrounded by people who know that female dose testosterone is a thing and women's orgasms are important. Like you don't have to explain yourself, which is refreshing. So for people who are interested, if you're new to the whole, like I want to know more about female sexual health, et cetera, et cetera, I would recommend their fall course which is usually held in Arizona. It's usually in November. That is a didactic classroom style. They have hands on vulvar exams. That's your intro to do the annual meeting is more like research what's new in the field, thought leadership, what's up and coming. That said, and if you can't make it to Arizona for the fall course, the beginning. So like the day, day to two days before the Ishwish meeting is like intro stuff. So it's like Intro to Female Sexual Health. I think they did hormones this year. So they do have intro sessions for people who kind of want to get the baseline. Because otherwise you're kind of thrown into like academic style language. And if you don't understand the nuts and bolts in the bread and butter first, it might be a little like, how is this practic practical and relevant, right. To like your day to day clinical practice. So I would certainly, if you're a beginner, do the fall course. I think I did the fall course two or three times before I went to an annual meeting. So that's my recommendation. That's what I did. And I'm glad I did it because you're kind of drinking out of a fire hose doing like abstract, like it's an academic meeting, the annual meeting. So if you do the annual meeting and you haven't done the fall course yet, that's fine. They let you in. But. But I would, I would recommend paying for the additional like beginner intro class days that they have at the front end of the conference. So see you next year in Vancouver for isshish Annual Meeting 2027. Next Housekeeping. The M Factor 2.0 is coming out for people who don't know M Factor. The first M Factor was on PBS about two years ago about menopause. And this is the sequel, which is actually a prequel because it's perimenopause, whereas the M Factor was menopause. And it's very. Well, I have seen it four times already. Four times. And it is going to be out on PBS March 18th. And there are multiple tours going on in major metropolitan cities. I just did the Seattle one at the Nordic Museum. I did that the night before I flew to Los Angeles to do the Ishwish conference. So I went down to Seattle, did the M Factor Seattle premiere, did a hour long Q and A and then flew to Long beach. So Bellingham, Washington. I'm hosting the March 22nd. That's a Sunday. Doors open at one, event starts at two. We're going to do a documentary premiere. The documentary is only an hour long because PBS documentaries are an hour long. And then we're going to do an hour Q and A Casperson Dog and pony show with two special guests that have agreed to be on stage with me. So I'm very excited about that. That's March 22nd. Tickets will be available by the time this podcast is live. The tickets should be up. So for the first one we did two years ago, we sold out the first floor of the theater and we are going to do the same. So don't delay on getting your tickets. M Factor 2.0 with special guest me and two other people. All right, number three, if you've been living under a rock, I have a vibrator now which I don't have to show and tell you right now. It is made with my good friend Laura Pack who founded Elixir Play. It' amazing high quality female curated vibrator company based out of Sydney, Australia. And we just, just released the Explorer which sold out in like two days because it's awesome and it's just very unique. If you follow me on Instagram, you'll see some reels showing showing that. So if you go to elixirplay.com and go to the vibrators, Explorer is my vibrator and it will be. You can pre order it now. Will probably be caught up with the pre orders and the backlog from being sold out March and April. So to get yours, it's awesome. It's focused for the vulva because underneath or inside the labia minora is the clitoris. Clitoris is like a wishbone, right? It's not just the tip of the iceberg that you see and really there's not a lot on the market to stimulate the vulva. So this is created for the midlife woman. Maybe pain with penetration, maybe history of trauma, maybe has doesn't know what arousal could possibly be. Trouble with orgasm. Really stimulating the vulva is why this was created so non penetrative and to truly bring in blood flow to the entire clitoral vulvar complex. The discount code for the vibrator is not broken20 so go to the website discount code notbroken20 to get your pre order because it's currently sold out. All right, next is to thank the leadership of ISSwish these three people. I wanted to shout out the most to many, many amazing leaders at iSwish. But I want to shout out to Dr. Sarah Sigma Cigna. Dr. Sarah Cigna and then Heather and Tammy. You know who you are, you are amazing and I don't think is would be ishwish without you guys. And you guys are smart, you guys are professional, you guys take feedback like A champ and help run the educational committee of a pretty big organization. And my life is better with you in it. So Dr. Tammy Rowan, Dr. Heather Quayle, Dr. Sarah Signa are all amazing upand cominging leaders. And Dr. Samina Rahman, also gynecologist out of Chicago. Check her out. If you need a, if you need a sex med hormone specialist in Chicago, go see Dr. Romina Samina Ramon. She's amazing. All right, the next thing I want to talk about is my sex ed course that I did with Commune. It's now up on the Commune's website. You can actually get to it through my website too if you go under courses and it's a very well done professional course all about adult sex ed, things you were never taught. And it's, it's doing really well. People are really liking it. So check out my sex ed adult sex ed course filmed with Commune. It's on their website if you're a Commune member and you can get to it via my website as well. Check it out. Also under courses on my website. I just did an alcohol one. So that's going to be available for purchase pretty soon. Basically talking about how do you become a person who doesn't drink alcohol in a society that worships alcohol and normalizes alcohol? So did that kind of. Did some showed some papers about it, people. I was getting feisty at the end of this alcohol webinar too because people are like, so can we just replace it with marijuana? And I'm like clapping at the scream. I'm like, you are not listening to me. The point is to not numb your life. The point is to not put drugs in your system. The point is to become the person who doesn't need to put drugs in your system. The point is to become the person who feels the feelings and doesn't numb yourself. So I was feisty at the end. I'm like, you are not listening to me. So alcohol webinar, a little off topic from what I usually talk about, but if you go to my website kellycaspersonmd.com and you go to the dropdown menu courses, alcohol one is not up there yet, but it'll be coming soon along with other courses on there. So many people on Instagram I see this too. They ask all the time about is am I too late for hormones? Is it too late for hormones? I have a course called is it too late for hormones? Go listen to it. It'll be very helpful. Basically breaks down the data on safety of estrogen as we get older and ultimately it is A risk benefit conversation with a trained clinician. I Learned something at ISSwish this week which it's kind of embarrassing not to know this, but I don't think most clinicians know this. And so if most clinicians don't know this, most other people don't know this. The actual definition of evidence based medicine. Shout out to Dr. Corinne Men for like pointing this out. I'm sure we learned this in medical school at some point, but the actual definition, and you can Google, Google, fact check me on this. The actual definition of evidence based medicine is three things. Number one, data science, published literature, number two, experience of the clinician, number three, wishes and informed consent and input from the patient. All three things. So many people think of informed consent as like, what does the data say? And they also will take that and they'll be like, what do randomized placebo controlled trials say? That's not informed. That's what evidence based medicine is. And we're like, no. Evidence based medicine is actually data expertise of the clinician and discussion with the patient on what their risk, benefits and wants and goals are. So I just think that's incredibly powerful to reframe actually. What is evidence based medicine? Because I think how when people, especially on the Internet, they've got evidence, we use evidence based medicine, blah, blah, it's like back up, do you actually know what the definition of evidence based medicine is? So shout out to Dr. Corinne men, what are we working on right now on an advocacy level? Two things, two of the biggest things. Number one, getting vaginal estrogen over the counter. Very exciting. We'll see where this goes. Marty Macary was just talking about this on CNBC last week. They're listening. Which is fantastic. A female dosed testosterone, certainly high up on our list. That's probably the biggest lift because of the cost of getting a pharma and studies, et cetera, et cetera. And then I think de we're going to deregulate testosterone. So it's not a scheduled two or three medication to make access easier and to correct the stigma on how safe it actually is and the proper regulations to reflect its actual safety when used in normal physiologic doses. All right. Somebody had asked what's a good book for post menopause? I see a lot of books for perimenopause and menopause, but what's a good book for post menopause? To which I replied, menopause is one day, every day. After that, one day of no periods for a year is post menopause. So when you see a book written for menopause, it's the same as any book written for post menopause. People just don't know the definition. So I say, of course, get my book the menopause moment, because that covers perimenopause, the day of menopause, and all the days after menopause, which we kind of call menopause, but also post menopause. So wanted to clear up that definition for the person who's like, where's all the books for postmenopause? I'm like, it's the exact same thing and the same books as the menopause books. All right. Somebody had asked a really great question. When to switch from a telehealth to a more like expert clinic for hormone needs. And I love telehealth. We need telehealth. I call telehealth mass transit. Like all cities need mass transit. We need this. We can't like the math on this. You guys. There's 1 million physicians and 80 million women over the age of 40. Like, we need mass transit, but sometimes you need to get in a car and go down a road that mass transit doesn't go down. Right. And so I can't say specifically, this would actually be a really great substack. Maybe it'd be a great podcast episode of like, what are the five reasons to switch from telehealth to a clinic expertise. I think you will know, like, I think it's an individual if you're like, I'm not getting my needs met with mass transit. But by and large, mass transit is absolutely necessary and can help the large majority of people. It's just some people are need, you know, they've got special health care concerns. They want a deeper relationship. They want, you know, in person care. They want, you know, they need stuff that's not typical as far as hormones go. So certainly it's the minority. But it's a great question and I should probably do some more work on that. So God bless all the telehealth. They work for the gross majority of people. I'm so glad they exist because we are not going to get out of this under treating problem without them. But at some point, some people do need to make the decision if they want to seek specialty expertise care, which can't. I mean, specialty expertise care can't take care of 80 million women. Right? There's just not enough. My new patient visits are an hour and a half long. I can't. You can't. I can't. 80 million women. That right. So it's certainly like what you're looking for. All right, up and coming. I have a very exciting stuff on the podcast coming as far as heated rivalry goes. So if you know, you know, if you don't know, I've just prepared you watch it. HBO Max is like $10.40 a month. You can like. I literally binge it in. It's six episodes. I binged it in one night, stayed up very late and that's not good for you. But I highly, I highly recommend it. So if you aren't, if you haven't watched he Arrival yet and you're curious, it is the number two streaming television show on the planet. Planet. It's huge. So we've got some exciting things coming up on the podcast in regards to heated rivalry. I won't share any further things, but I, I just gave you a warning if you want to be in the know when we drop some cool things on the podcast. Maybe you want to watch it, maybe you want to get obsessed, maybe you want to live rent free in your brain. That's what it does. But truthfully, heterosexual women are what's driving the success of this television show and there's a lot to analyze. Um, the series on HBO is called Heated Rivalry. You've been warned. It is erotica. It's not porn. It's erotica. There's a difference. I recommend my new vibrator. My vibrator plus heat of rivalry. Heart shaped emoji. Now it's time for an ad from Midi Health, the online experts in menopause and perimenopause. If you're about to hit pause or grab a snack, give me 30 seconds here. If you've ever wondered whether what's happening in your body and brain is just in your head, it's not. Stay with me. Let's talk about what's really going on. Midlife hormone changes. This is where MIDI comes in. Created by women for women, they offer personalized treatment plans with safe FDA approved hormonal and non hormonal options. I have so many women. Tell me about how they're so happy with their midi clinicians and they're available 247 and they accept insurance. It's time menopause care caught up with women. Book your virtual visit today@joinmidi.com that's join M I D I dot com. All right, I think that's all my pre courses. So now like now what I'm going to do is I'm just going to run through like the notes that I took at the ISSHISH annual meeting and this is not comprehensive. I will leave out people's names. I apologize in advance if I get anything wrong. This is just like Dr. Caspersen taking notes at the Ishwish conference. So when we were there, the FDA actually had announced that like officially the boxed warning has been changed on six estrogen products. So that was a very exciting event that happened. When we were at. At ISSwish, I had a vibrator party for my explorer, which was awesome. I had some of my closest friends come to a cafe and we had a vibrator party. And nothing like coffee in the morning with vibrators. So if you are on my Instagram, you can see some reels that I did about that. It was very awesome. There was some data on sex after breast cancer. About one half of breast cancer survivors have with their sexuality, whether that's pain, decreased arousal, lubrication, chemotherapy is associated with worse sexual satisfaction after breast cancer. And your sexual dysfunction is worse if you were younger at age of diagnosis, maybe because they had farther to drop as far as, you know, higher functioning sexuality before treatment. But certainly younger age of diagnosis is a risk factor for worse sexual dysfunction after breast cancer. Shout out to all of the medical students who presented. It is intimidating. I was there. We've all been medical students. It is a great opportunity certainly for your CV and your resume and just experience talking. I did it too when I was a med student. Huge honor, but scary as. So shout out to all the med students who were there and who presented because you're amazing and you're brave and I want you to know that we saw you and we were cheering you on. All right, so. And shout out to Ishwish for having medical students present, which is super, super awesome. All right. There was a talk on the purity culture of sexual shame. There was some research that had come out of Texas that was super interesting. And I found out when I were at Ishwish that my first book, you are not broken, stop shooting all over your sex life will be Translated into Spanish July 2026. That'll be Spain July 2026 and then will be released in the US and Mexico three months later. So what's that like? October 2026. So I'm super excited to see that cover. It's gonna be super great. Huge, huge need for the Spanish speaking community. And that was a super exciting thing that happened during Ishwish was amazing. Between like the vibrator parties, the fda, you know, officially having the box warning off of six estrogen products you are not broken being translated into Spanish. Seeing like all my friends and basically just like, I've just like, hang out at Ishwish now. It's super fun. Okay, The. They did some research. They did a presentation on research on clinicians who recommend, quote, have a glass of wine, quote, for people who come in with sexual health issues. And then the clinician says, have a glass of wine. So it's. It's a very gendered thing to say. Clinicians don't tend to say that to men. It's much more gendered that they tend to say it to women. We don't tell a man with erectile dysfunction to take a shot at alcohol as a solution. And they research like, why do you say this? Why do you say, have a glass of wine? And what they found is that this persists because of a belief that it will help. 36% of people thought it would help people relax. 18% don't know what else to say. 11% says that it's an accessible thing to recommend to people. And the shocking thing of this presentation was that the more that the clinicians were trained in sexual health, the more likely they were to say, have a glass of wine. And they had some theories on why, but they didn't actually, like, look into that, to my knowledge. But that was a very interesting discussion. They did some presentations on oral sildenafil. So sildenafil brand name is Viagra. Again, this is a women's sexual health conference. So we looked at female sexual health, and it varies. So oral sildenafil varies in efficacy. It decreases orgasm latency. So the time it takes to orgasm and it can increase orgasm intensity. And the doses for this that the women were taking was 50 milligrams. They do have data that it helps in type 1 diabetes. So sildenafil is a blood flow medication. Blood flow medication. That's how it helps erections. More blood flow into the penis, more blood flow into the clitoris. They're also coming out with a product, it's Dare D A R E Pharma. It's coming out with a topical sildenafil. Some people, you might hear that, you know, there's a variation of that you can get compounded called Scream Cream. But Dare Pharma is actually doing a sildenafil topical for females. Still a prescription, but I think the website is up on that. I mean, probably Google dare. DARE Pharmaceuticals. Topical sildenafil will probably come up. They were looking at the role of placebo, right? So we know placebo is huge in the male Viagra studies. So they were looking at women in their 20s with no sexual dysfunction. If they suspected they got Viagra, they did better. Right. So the data is kind of all over the place on this. But what they did show was that if you take Viagra daily, kind of like men take Cialis daily, like if it's a daily medication, they tend to do better than taking Viagra on demand, like an hour before sexual activity. There's actually in, this is more male data, but there's data that sildenafil and these blood flow drugs actually people who take them have a lower risk of dementia, likely because blood flow to the brain. Right. So these medications are cheap. They are blood flow medications. They, there is a signal towards less dementia. So in the longevity world, people are like Viagra as far as brain health goes and it helps orgasm and erections. So they did some studies looking at sildenafil and oral testosterone combined. It was oral testosterone, 0.5mg, sublingual and 50mg of the PDE5 inhibitors. And the outcome was satisfying sexual events. Testosterone seem to increase the sensitivity to sexual cues. So we're, you're more like going to pick up on sexual cues even. And I, I, we see this a lot when we give women testosterone. It's not that like you become this like seeking, horny person where you're seeking out sex, but you're more receptive, like your responsive desire is more supported when you're on testosterone. So that'll be interesting to see more combo research looking at the combo of testosterone and sildenophil. So again, they, they act in different ways, but they seem to be complem in supporting sexual health. Dr. Rachel Rubin did a talk on GSM guidelines for anybody living under a rock or new to me, the American urologic Association in 2025 came out with genital urinary syndrome of menopause guidelines. Free online. Love it. All right, amazing talk by Dr. James F. To PhD. It takes two to tango. It was all about estrogen and testosterone. One of the best things that he said, I wrote it down. Penises are prolapsed clitorises. Seriously, like, just make me a T shirt. Testosterone's conversion to estrogen makes the male brain. Estradiol makes dopamine, androgens, which are testosterone. And androgen makes, increases your serotonin and increases your dopamine. So again, going back, these are brain neurochemicals and he's talking about like rat studies that were done in like 1937. So in 1937, 90, 90 years ago, 89 years ago, they took female rats, they removed their ovaries and they found they give them testosterone. And they show that testosterone restored their gonadal tissue. Amazing paper from 1985 from Sherwin. Estrogen and testosterone in surgical menopause. Testosterone helped arousal and desire. Talking about how long it can take for testosterone to work a bilingual testosterone takes about four and a half hours to kick in. And this is how long gene transcription in cells takes from like the, from the hormone being on the cell surface to going inside the cell to actually transcribing a gene into a protein takes about four and a half hours. Testosterone seems to help with arousal, desire, concordance. What does that mean? It means when your pelvis is aroused, you, you are desiring of sex. So in a, in a man, stereotypically if you have an erection, he's interested in sex because the his arousal which is the erection and then he has desire. Women, it's not as tightly linked. You can have blood flow in the pelvis and not be desirous of sex. But testosterone seems to cause arousal, desire concordance or more matching satisfying sexual events go up when you combine testosterone with sildenophil. Androgens make nitric oxide and prevent dopamine uptake. So there's more dopamine around in the brain. And he talked about using estrogen and testosterone so that desire and arousal can co occur in response to sexual cues. So you still need to put yourself in a sexual context. People many podcast episodes on that hormone. Then he said hormones set the stage. Your experience writes the play. I love that. Estrogen testosterone increases mood and energy. Testosterone augments the effects of estradiol and P D E5 inhibitors. So they all work together. My friends, everybody's like can we just take one? Sure. They're all like players on the same team, just kind of cool. Fiscally responsible financial geniuses, monetary magicians. These are things people say about drivers who switch their car insurance to Progressive and save hundreds. Because Progressive offers discounts for paying in full, owning a home and more. Plus you can count on their great customer service to help when you need it. So your dollar goes a long way. Visit progressive.com to see if you could save on car insurance, Progressive Casualty Insurance company and affiliates. Potential savings will vary. Not available in all states or situations. Another talk about sexual education is social change. Sexual health survivors should not be responsible for stopping the abuse. We need our leaders to step up better on this. Sexual education decreases childhood Risk of sexual abuse, sex education decreases intimate partner violence, sex education decreases gender based violence. And sex ed decreases the acceptance of misinformation. So again, see also I did a adult sex ed course on commune. Go watch it. It's very useful. You'll learn a lot, I promise you. Comprehensive sex ed. The first step is just start talking about sex. You will, you will not die. I promise you, you will not die. It's very good. Comprehensive sex education is a tool for equity and well being. By grade 11, which is age 16 to 17, 75% of Canadian high school students will engage in fondling, 43% in intercourse. And sexual dysfunction is in some people by their teenage years. And somebody asked a really good question about that. They're like, how do you know? How do you know it's sexual dysfunction versus you're just inexperienced at sex? And they were like, I don't think we, we know the difference between those things right now. This is Canadian research. 35 to 40% of teens already had experienced at least one type of trauma in their life. Childhood adversity increases the risk of adult sexual dysfunction. Sexual abuse is associated with negative sexual outcomes in cross sectional studies of women. It's not healthy, very harmful. Stop harming. Stop harming humans. People. I'm looking at you men term wa waves. This is not just me being biased. This is a data men, not all men. We know, okay? Rates of childhood maltreatment by age 14 to 15 are very high. Again, this is looking at some Canadian data. Increase emotional abuse predicts sexual dysfunction in the future, and it keeps getting worse. And you also have more problems with orgasm. 56% of girls reported psychological violence. 20% of teens report physical violence. 9% of teens report sexual violence. This is again Canadian data that was presented. Then there was a talk on female genital mutilation, also known as cutting. 230 million girls and women in the world, about a half a million in the United States, usually performed before the age of 15. Then there was a talk on black women's sexual function called the. They talked about superwoman schema. An obligation to manifest strength, a resistance to vulnerability, a drive to succeed with limited resources. Obligation to support and help others. There's a maternal modeling of the superwoman schema. The obligation to help others is passed down from generation to generation. And the suppression of your emotions is modeled in this culture. So again, I don't mean to overgeneralize. I'm merely talking about some very awesome talks at the Ishwish annual meeting. They're talking about faking orgasms and that women do this for many reasons. To suppress emotions of disappointment and frustration to protect the partner's ego. The superwoman schema. Women tend to have lower sexual refusal skills, self silencing of sexual wants and minimizing of pain. There is a talk on post SSRI which is which are antidepressants sexual dysfunction. Especially when started early in adolescence they can have more sexual dysfunction. Stay tuned on my podcast in the next upcoming months. I don't know when it's going to come out. Right Now I interviewed Dr. Mark Horowitz who wrote the book on deprescribing guidelines for antidepressants, benzodiazepines, gabapentinoids and Z drugs. Fascinating talk. I'm so glad I interviewed him. Fascinating to think about and very touchy still in our society and we talk about that. We talk about why it's so touchy to talk about this. Somebody had made a comment in one of the talks. Some women don't know they have the right to be distressed. That was powerful. That landed for me girl. Girls partnered with girls have more orgasms than girls partnered with boys. This is more teenage research. And then somebody had said that there are two states in America that got A's in sexual health literacy. California was one of them. But I don't think we ever learned what the other one was. For a second I thought it was Washington state, but I don't actually think it's Washington state. Always good talks about pain at the Ishwish conference. Talked about a history of endometriosis, liberal tears, final issues. All as a reason for pain with sex. Venous pain. So like because of like heavy veins and venous congestion in the pelvis can lead to post coital pain. Heaviness in the pelvis symptoms are worse later in the day. Those are all signs of venous pain. I wanted to shout out the tight lipped organization. Great nonprofit helping raise awareness for sexual pain. We talked about the double standards. We're comfortable talking about erectile dysfunction and digital rectal exams for men during super bowl ads. But we still don't talk about female sexual pain. Somebody did a talk on clitoral adhesions. 23% of sexually active women have clitoral adhesions. They lysis of clitoral adhesions decreases pain and increases sexual function. And then they kind of quantified it as severe is less than 25% of the glands is exposed. There was a talk about body image and that body image is an embodied experience like how you experience your body. Right. Very interesting. Then there was a talk about breast cancer treatment. 60% of mastectomy women who've had mastectomies have post mastectomy pain syndrome, which is not just a loss of sensation, but it's an actual pain from it. 38% acknowledge complete numbness after their surgery. 57% complete numbness of nipples. And it was more of awareness of the importance of nerve sparing mastectomies to preserve not just preserve sensation, but to minimize pain from nerves being cut. Um, I talked already about how testosterone for women is normalized at ISSwish. It's just a breath of fresh air. I just love it. There's a talk on re restoring body image after cancer care. There is a abstract about creating confidence in clinicians. And I just wonder the role of feedback. Right? Like how many people, when they're learning new things, get feedback after you are like out of school and out of residency? Probably not much. There's a talk about porn. 90% of men use it one time a week. Women use porn two to three times a month. Heterosexual women use the least amount of porn. Male use of porn may lower desire towards partner. Women's use of porn is shown to increase desire towards both the actor of the porn and their partner. See also heated rivalry. Oh, my Lord. Women are obsessed with these actors. One big question that we were having is, who's training the pharmacists? With all of the new data on safety of hormones and the fact that you can use vaginal estrogen and systemic estrogen at the same time, and that women produce testosterone and testosterone is normal in women, but women get huge roadblocks at the pharmacy. So the question. I have this question. Who's. Who is training the pharmacists on this? Like, we. We can't do it all. I need, I need. I know, I know. We have amazing pharmacists who follow this podcast and I know how hard you guys are working to try to make this more equitable and actually up to date 2026 level of like, not obstructing women from accessing hormones. So I know you guys are working on it, but it's like, I just heard a lot at Ishwish about how pharmacists are obstructing women's access to prescriptions. So I wrote that down. Porn may leave the partner to feel inadequate even if they had sex that day. Females using porn are then report more lubrication during sex. Females using porn may improve communication. Interesting, interesting topics. We had a abstract Was presented about menopause being used as a social, social construct. So it was about how in France, I don't. When was this? In the 50s, I don't remember in France, basically a man had said like menopausal women now can't vote or something because they're no longer women or something like that. So menopause being used against women or to control women. And in that sense, menopause is a social construct. Menopause is still very real biologically, physiologically. But these, the social construct is because of menopause. You now can't X, Y and Z or you are X, Y and Z. Like creating a societal meeting to something that biologically has happened to you. Very interesting. Only 5% of women use porn more than their partner. And again, these are like individual studies. I'm not like quoting like all of the studies in the world. These are just talks that we got. 64.6% of women underestimate their partner's porn use. 18.3% of men under us underestimate partner porn use. This is heterosexual couples. If women know about porn use, is it positive? Partners porn use, is it positive to the relationship? If they were are to disclose it and discuss it, it can be a positive thing. 35% of people think porn is infidelity. There is such a thing as pornographic jealousy that the relationship could be threatened, self esteem could be threatened or somebody might view masturbation as disgusting and they have not communicated that with their partner. Cisgender women had the most porn jealousy. Then there was an interesting, interesting talk about camming, which is like live action erotica that it's not passive, it's connecting with somebody, there's an exchange of money. So are these relational, Are they transactional or are they both? That was a very thought provoking talk. Is camming cheating or a boundary violation? Very interesting. Online intimacy may disrupt real world relationships. Data shows people are developing relational bonds with camming. Not so with porn. Right? So porn is viewing something that's been created. Camming is interacting with somebody sexually, but you don't have like an in person relationship with them. Then there was a talk about cancer and hormones. They reviewed the soft and text trials which are long term follow ups looking at aromatase inhibitors with the goal of cutting back on people who don't actually need aromatase inhibitors for as long because of the minimal gains in survival versus a more high risk person with lymph nodes or a higher stage that is gonna benefit from a longer aromatase inhibitor use and using the soft and Text trials to try to help. See, like, let's not overuse these medications because they do have significant side effects that can cause harm. Let's make sure we're using them in the right population that are really gonna benefit. So that's exciting to come come away with. And the amazing statistics. 7 in 10 cancer patients will survive for more than 5 years after their diagnosis. So really starting to shift into quality of life life choices. Because cancer is so survivable now, quality of life really does need to matter. Okay. And there is talk about a randomized placebo controlled trial out of England. It's called the MENO ABC trial looking at hormones after breast cancer. I don't have more information on that right now. When I have it, I will share it. I don't think they're currently enrolling, but I have to look into it more. But like we've said, like, we need a randomized placebo controlled trial looking at systemic hormones after breast cancer. And it looks like there might something happening in England. So that's very exciting. Reviewed. Premature ovarian insufficiency is menopause less than age 40, which is 3.5percent of all women. Early menopause, again, less than age 45. Premature ovarian insufficiency. And sexual function is multifactorial. They can have genital pain from gsm and they have hypoactive sexual desire disorder. What I found a lot at isswish, and I think this is just in general, but it kind of came out to me at ISSWISH that like, one woman's experience is not all women's experience, which sounds so simple when I say it. But, like, a woman will be. For example, a woman will be like, well, I don't have vaginal dryness after menopause, so I don't see what the big deal is. Or like, I didn't have hot flashes with menopause. So, like, you know, what are you guys making a big deal about? And always remembering, like, one woman's experience is not all women's experiences. And. And I think people, of course, you know, we're all egotistical beings, but like, you people take that and then they like, extrapolate onto all the humans of, like, how they should live their life because of your lived experience. I think that's really about it. I mean, we're at 40 minutes. That's Ishwish 2026. I love you all. I love giving it. This is probably. I'm trying to remember. This is probably my second or third ish review now on this podcast. Because this podcast is in year seven I tend to go to conferences like every other year but Ishwish 2027's in Vancouver so obviously I'm gonna go. So I will see you guys there February 2027. If you wanna see where I am gonna be speaking this year, if you go to my website I have an events page. You can check that down down. So nice to chat with you all, just one on one. Let me know if you want more solo episodes of the you Are Not Broken podcast. I'm here for you. I love you and I know this was a fast rundown of like my key awesome takeaways and I literally probably Left out like 70% of the conference, but those were just some interesting facts that I thought I'd take down. All right guys, I love you. Until next time. You are Not Broken thanks for being here. Share with your friends if you found this episode funny, helpful, insightful, Please take a moment to follow rate and share the youe Are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people and thank you for courses, books and my monthly membership and the Casperson clinic information. Visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here and remember, you are Not Broken.