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Dr. Kelly Casperson
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.
Dr. Rachel Rubin
Hey, everybody. Welcome back to the youe Are Not Broken season finale. These are the final two. So this is number five of the heated rivalry Urologic Thon. Again, not joined by Dr. Josh Gonzalez, but we have Dr. Ashley Wincher and Dr. Rachel Rubin. Episode. Episode five is everybody's. Is it everybody's favorite?
Dr. Ashley Wincher
I don't know if it's my favorite. I don't know. It's either five or four is my favorite.
Dr. Rachel Rubin
There's a lot that happens in five. Five's busy.
Dr. Ruben
There's surprisingly little talking in five. Like, there's a lot of, like, there's actually almost no talking. Because I know that as I was watching it in the background, trying to do other things, because it's like the 10th time I'm watching it and I realized how little I remember of episode five because they don't freaking say anything in English. It's all in Russian.
Dr. Rachel Rubin
There's a lot of Russian.
Dr. Ruben
Or text message. It's Russian and text messages the whole damn episode.
Dr. Rachel Rubin
That's true. You could watch it with the sound off.
Dr. Ashley Wincher
It's interesting how much happens. But also in terms of time lapse, it actually, like slows down intensely. Right. Like in all the prior episodes, we're going over the course of years and years and years, and this is now. We're suddenly like, in the present, in my opinion. Like, we're suddenly.
Dr. Rachel Rubin
We're like, catching up to the present.
Dr. Ashley Wincher
I mean, it's not the present. It's like 2017. But it's like what it's meant to be that now is 2017. Kind of.
Dr. Rachel Rubin
Totally. So episode five is called I'll Believe in Anything. It's a big, big episode. Lots of personal growth for both. For both the boys.
Dr. Ashley Wincher
Yeah. So what we start off with the scene where Shane is with Rose at dinner? Well, that's not like. No, the first scene is where they're like, done with their night together and it was clearly suboptimal and he didn't.
Dr. Ruben
And she was wearing a Montreal Bagels T shirt that I really liked.
Dr. Rachel Rubin
Oh, you gotta get one of those. Every time you watch it, like, the 10th time through, you're like, oh, bagel shirt. Like, your brain's like, where's the new.
Dr. Ashley Wincher
Never noticed.
Dr. Ruben
Mostly I'm just, like, annoyed that, like, she looks so cute in jeans and a T shirt.
Dr. Rachel Rubin
And I was like, she's gorgeous. I love her lips.
Dr. Ruben
Okay, so she's wearing. So. But they have that awkward conversation. He's like, sorry, didn't go. I think I'm just stressed. He's like, sorry, I couldn't do it. I could. My guess is he couldn't finish. And again, I think we put too much pressure on men that orgasm, like, must happen at every single encounter. We don't do that for women. We don't care if women orgasm ever, let alone every encounter.
Dr. Rachel Rubin
Yeah.
Dr. Ashley Wincher
Yeah.
Dr. Ruben
So does that automatically make him gay? I mean, in this case, yes, it does. But in every other case.
Dr. Rachel Rubin
What is this teaching people?
Dr. Ashley Wincher
Well, no. Like, a few factors. Right. So completely agree with you that just because you didn't orgasm doesn't mean you're gay. Also, they were at a nightclub. If you had alcohol, obviously that can make you not perform, even if you're profoundly sexually attracted to your.
Dr. Rachel Rubin
What if you're super dehydrated?
Dr. Ashley Wincher
Like, what, Whiskey dick?
Dr. Rachel Rubin
Because he played hockey first, then went to the club. Like, this guy's exhausted.
Dr. Ruben
He is not a robot. He acts like one sometimes, but, like, we should remember that men are not robots.
Dr. Rachel Rubin
A lot of women internalize what the soft dick means. And they're like, he's clearly having an affair and he doesn't love me, and I'm unattractive and I need to lose 10 pounds. That's what this soft dick means.
Dr. Ruben
So this. This plays into that sort of stereotype. Right? Like, even Rose Landry can't get him to keep an erection. But. Right. There are three things, as we, as urologists know, there are three things that make an erection work. Good muscles, good arteries, and good nerves. And we do a lot to mess up with those things. And none of those things are how attractive you are and how good you
Dr. Rachel Rubin
are at sex and how much you love somebody.
Dr. Ruben
Yeah, it's biology.
Dr. Rachel Rubin
What if Shane's on. I mean, Shane could be on prescription medications, too. Like, this guy could have massive anxiety.
Dr. Ruben
He could be on Adderall. My guess, he's on Adderall or something
Dr. Rachel Rubin
for anxiety because he gets a lot of panic attacks. Paxil, maybe, but that can. That can affect sexual function, too.
Dr. Ruben
Yes. Antidepressants can delay orgasm, can lower libido. They absolutely can.
Dr. Ashley Wincher
Cause he could be on a beta blocker for nerves.
Dr. Rachel Rubin
Yeah, he could get anxious before his games.
Dr. Ruben
Was this before or after the concussion?
Dr. Rachel Rubin
Before.
Dr. Ashley Wincher
Before.
Dr. Ruben
Before.
Dr. Ashley Wincher
Before.
Dr. Ruben
So we can't blame it on. We can't blame it yeah.
Dr. Ashley Wincher
Yep.
Dr. Ruben
Okay. So here's how I explain performance anxiety to my patients. I literally did this today for a few men. I was like, listen, you are running from a tiger. Do you want to get an erection? Right. Like, you don't. Like. Adrenaline is a biological chemical that goes through your veins and it tightens your penis muscles to make them not hard anymore. It squeezes all the blood out of your penis. So adrenaline. So if you're running from a tiger, if the fire alarm goes off, if you're with a partner that you're uncertain if you're going to keep an erection, or you're with Rosalandry, who's really, really, like, attractive and a movie star, are you going to be nervous that you're going to have so much adrenaline in your body that you are going to squeeze all the blood out of your penis? And that's biological erectile dysfunction. We used to call it psychogenic erectile dysfunction, but we're really trying to call it adrenaline mediated erectile dysfunction because the adrenaline is causing the erection not to happen. Which is why morning erections are a thing. Because when you sleep, you're so relaxed, and that is like the most parasympathetic relaxation state. So you get really good erection. So it's biology. There's so much biology to learn from that moment in this.
Dr. Rachel Rubin
And that can be for women as well.
Dr. Ashley Wincher
Yeah.
Dr. Ruben
Tell us more. Because no one ever really said, nobody
Dr. Rachel Rubin
talks about erectile dysfunction in women or erections in women, let alone the dysfunction of the erections. Yeah. So somebody messaged me and they're like, hey, I totally get what you mean about, like, being stressed and overworked and not relaxing enough? Like, that's my life. It's chaotic. Is there some drug that I could just take to, like, undo my day so then I could have sex? And I'm like, I think that's why people drink, basically. But I'm not. I am not a proponent of that. I'm just saying, like, people just want to shut it off with a pill instead of being like, what in your life causes calm? Maybe a little more of that.
Dr. Ashley Wincher
Yeah. Just a comment on the female side. Right? I mean, this is female sexual arousal disorder. The medical term. Right. Is what we're talking about. So, like, female erectile dysfunction is female sexual arousal disorder. And so that could be the clitoris not engorging. It could also be you not becoming lubricated in response to the cues that normally would make you lubricated. Right. Because we know obviously the hormones need to be there to become lubricated. But also you have to have the relaxation. You have to have the pro sex signals, and you have to have the blood flow go there and engorge and lubricate. And again, right. If the predator is following, chasing you, you want all the blood flow going to your legs, not your vagina, because that's not going to save you. So. And I mean, I think times in my life I have had a partner who I was super interested in and sexually attracted to, but maybe I was very intimidated by them or it was a new situation or for some reason it didn't feel the most safe. And I had issues with that. And so, you know, this is like, so much more universal than I think we sometimes think about. It doesn't mean you're gay.
Dr. Rachel Rubin
It. And it doesn't mean you're gay. I did an Instagram reel three hours ago, and I want to talk about
Dr. Ashley Wincher
it because it's perfect for you.
Dr. Rachel Rubin
And this, this is what somebody messaged me. I had a doctor tell my friend that vaginal estradiol would cause her husband's penis to shrink. I about died when my friend told me this.
Dr. Ruben
All right, let's talk about numbers and biology, people. No one actually cares about biology. They just care about thoughts and feelings. So estrogen cream that we use for the vagina is a.01% estradiol cream. When you give it to someone at correct doses, does not significantly increase their blood levels of estrogen past 20 picograms per milliliter. Okay, so if we do a blood test, your estrogen level is not going to go above 20. If we measure every man's estrogen levels that you are around, their estrogen is higher than 20. It's usually around 25, and it can be even higher than that. And so you having a little estrogen cream on the penis could potentially help with wrinkles on the penis. But it will not make the penis shrink.
Dr. Rachel Rubin
It will not make your penis shrink. The comments are so good, right? Because people are like, do we not care about her pleasure or her GSM or her any. Like, it's all about the penis. Yes, my friends, it is for many people, all about the penis.
Dr. Ruben
Yeah, I was just got back. I'm. I'm feeling, like, angry mostly every day. I just got back from a big urology meeting, right? 13,000 urologists descended on Washington, D.C. and there is nothing about sort of. There was, you know, one lecture on female sexual health that the room was empty. There was one course on GSM where the room was full that was Good. And it's just incredibly frustrating, right? We have, you know, I gave a plenary to a room of 2,000 chairs because there are about five people in the chair. So 2,000 empty chairs. Yes, there were 2,000 empty chairs and there are about 25 people in the room. And me talking about the FDA box label removal of estrogen products. But the frustrating thing is when you're in the sexual medicine rooms, they are arguing and talking about the minutia of size, girth, shape of penile implant surgery. And that's really. And when you ask men if they care about their penile implant surgery, they basically say like, they're mostly happy, but only about most people are unhappy with how it looks and the size and the girth. And as we all know, if we've all placed penile implants, the patient Ashley probably has placed the most of all of us. That the people who complain, they literally will say, well, I need it bigger and harder and better for her pleasure. That's what they always say. I need it for my partner's pleasure. And that is where we have to stop fooling ourselves. They don't actually care about the partner's pleasure because they don't bring devices into the room. They don't have communication skills about what their partner actually wants or needs. They don't even know if they're on vaginal hormones. They don't even know if they have orgasms. They don't show any actual curiosity about their partner's pleasure. And they just say, well, I need it bigger and harder and I need it to work because I want to pleasure my partner. No, sir. No, you do not.
Dr. Kelly Casperson
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Dr. Rachel Rubin
Thank you for that.
Dr. Ashley Wincher
It's so interesting. So we were talking about this a little bit before, before we started recording, and I had this wonderful opportunity to basically do a consult with a younger individual who was about to kind of go off to college. And basically, for the record, so Ashley
Dr. Ruben
and I work in the same practice and we do this a lot. We take care of mom and then grandmas, and then they bring in the daughters for us to talk about sexual health issues. We've done this a lot over the years and it is so much fun to do.
Dr. Ashley Wincher
It's amazing. It is the best. But the thrilling opportunity I had was to say, hey, a really important thing for you is to figure out how you derive pleasure. And then when you have partners throughout your life, when you have sexual partners, to communicate that to them. Because, I mean, Kelly loves saying this. Nobody's coming to save you. Like, you cannot. Even if somebody loves you and decides they want to get married to you, we see it all day, every day. That does not mean that they know how to pleasure you.
Dr. Ruben
And, and even if they knew how to pleasure the last partner, they don't know how to pleasure you.
Dr. Ashley Wincher
Yeah, yeah. Learn what it takes and communicate it. Because like Rachel said, they're thinking about how hard and long and big and girthy they are. And they are. You will take, take ownership. Learn, take ownership. And that is, like, one of the keys to, like, having pleasures around your life, my friends.
Dr. Ruben
We three urologists know more about the penis than any man does. Right? Like, unless they're all like, we know more about your partner's penis than they do. And when I tell you they don't know very much about how their penis works and what they like or need or how it works. They have no idea. Which means they really have no idea how the clitoris works. They really don't know anything about the vulva.
Dr. Ashley Wincher
Literally.
Dr. Ruben
We can't even get gynecologists to know how to examine the vulva or examine, examine the clitoris. And you expect your partner to know your buttons and know how it's going to work. And even. Right, even same sex couples who I take care of, like, don't have all the anatomy and the knowledge and the ability especially to know how it changes through the life cycle. I mean, how many couples do we take care of in my practice where you know, there's so much GSM or genital urinary syndrome of menopause and dryness and, and PH problems and sex becomes painful and they don't do it anymore. Right? They don't have sex anymore. So like, no. Everyone is so clueless when it comes to just basic anatomy and physiology. So for you to expect your partner to know what's going on and to expect them to change with you is
Dr. Rachel Rubin
like, did she come in being like, tell me all the things or she come in like intimidated and shy and then how did she leave?
Dr. Ashley Wincher
I don't, I don't know if she was intimidated or shy. I mean, I'm sure there was some intimidation and shyness because when you're a young adult, maybe you've only been used to like going through a pediatrician. And not that pediatricians are amazing, but like, I don't think their average training is to ask people like how they masturbate, if they do, do you wear
Dr. Rachel Rubin
a seatbelt, do you eat vegetables? And do you know where your clitoris is? Right.
Dr. Ashley Wincher
And I always find, I found throughout my career, no matter what age, no matter what gender, no matter how much experience or lack thereof, the key to making people comfortable is acting like it's not a big deal and asking direct questions like, I'm just like, hey, I'm excited to whatever, how's the weather and your mom is cool and how do you masturbate? And when somebody is not comfortable with it, when the doctor is not comfortable with it, the patient can always tell. And if you're just comfortable with it, they will let their guard down and they'll be like, nobody's just talked to me about this in a matter of fact way.
Dr. Ruben
Any gender. I have found that true for any age and any gender, whether it is a 7 year old with pelvic pain, a 98 year old woman, a 60 year old man at any age, any like, yes, if you show up confident and competent, you're going to someone for that purpose. Yes, it's received very well. I'd say it's probably a challenge for people who are more generalists, right. That with a patient's coming with a stubbed toe, it's hard to make that about, oh, how's your clitoris? Like, you know, we are sex doc. We are sex doctors specifically. So it does, it is a little different for us, I would say let's
Dr. Rachel Rubin
talk about people who are started on birth control, maybe at age 14 or 15, for whatever reason that happened and now that they're 45 and they've been on birth control this whole time. I think a lot of people don't understand that there can be a lack of development of the external genitalia or I'm going to say it wrong and get murdered. But like, but there, and we have published literature on this, that the way that birth control can block androgen receptors, block estrogen receptors, they might have had pain their whole life, not understood pleasure as much, have more kind of GSM early on. But a lot of people do not get, I think, an informed consent on the conditions under which the pelvis develops when birth control started early or prolonged.
Dr. Ashley Wincher
Right. So of course, what you're getting at, Kelly, right, is that combined oral contraceptives suppress ovulation and therefore they suppress endogenous production of all hormones coming from the ovary. Estrogen, progesterone and testosterone. And we know that in 100% of people who take combine oral contraceptives, there is lower total and bioavailable testosterone 100% of the time. So the problem is that, yes, if you start somebody who is not fully formed or not fully self actualized as a sexual being, maybe they have not never had sex before. Maybe they're teenager years, maybe they're put on it just to like, so that they don't ever get pregnant or because they got acne or because their periods were irregular, which is, by the way, irregular periods are a normal part of puberty. Then they may not know that what they're experiencing would have been any other way because that lowering of your testosterone can lead to reduced desire, it can lead to pain with sex, it can lead to overactive bladder, urinary urgency, urinary tract infections. And if you have not experienced your body in any other way because you were started on this during the puberty, essentially, or before you ever became sexually active, then that can have profound implications. And I have had patients who come in and they are 45 and I'm like, look, you may have spent your entire adult life not knowing the sexual person you would have been if you hadn't been on this. And, and again, I am all for contraception. Contraception is a modern miracle. For professional women like us, it is a miracle. But yes, part of avoiding these problems requires discussing the implications of that hormone modification and potentially, if possible, waiting to start it, if possible.
Dr. Rachel Rubin
Do you think Rose Landry has an iud? I hope they use condoms.
Dr. Ruben
What if that's a twist that she comes out? No, it goes beyond.
Dr. Rachel Rubin
You can get pregnant without a man ejaculating. Let's clear that up for people who need to know. There is pre. There is pre.
Dr. Ruben
There's pre ejaculate. It only takes. I heard Dr. Ruth speak one time, and I heard her say, it only takes one until it takes one sperm.
Dr. Rachel Rubin
You heard my talk at Harvard.
Dr. Ruben
And there's.
Dr. Rachel Rubin
I'm like, we're all miracles.
Dr. Ruben
40 million sperm for a generation.
Dr. Rachel Rubin
30 million. 30 million is considered low sperm volume. 30 million.
Dr. Ruben
Yeah.
Dr. Ashley Wincher
So it just takes 100 million. My. My cousin was that. My aunt and uncle said that they. When they got pregnant, they said they had not had sex. They were just very close.
Dr. Ruben
They were like, okay, so we're still in that first scene, and we cannot be here all night. So let's keep going. Okay.
Dr. Rachel Rubin
I'm voting condom and iud.
Dr. Ruben
Well, we know he has condoms because they had condoms and other. Maybe he couldn't keep his erection with the condom on. How do you feel about people who say that? Josh would probably have a lot to say about that, but he's not here.
Dr. Ashley Wincher
I mean, I think it could be a real thing. I think it's a real thing.
Dr. Rachel Rubin
But so is safety.
Dr. Ashley Wincher
Yeah.
Dr. Rachel Rubin
I mean, there's female condoms.
Dr. Ashley Wincher
Agree.
Dr. Rachel Rubin
There's getting tested options. But drunk hookups with strangers? I'm sorry. Put your seatbelt on. When operating at highway speeds. We had a little foreshadowing of them playing together at the American cup. So we knew they were gonna be in the same room together again. And now shoot to the restaurant with Rose Landry. She was there for an agenda.
Dr. Ruben
This is a really good scene.
Dr. Rachel Rubin
It's so good.
Dr. Ashley Wincher
This is also what Rachel would have done if she was dating him. That's why she.
Dr. Ruben
Oh, my God. Yes. I'm very direct.
Dr. Ashley Wincher
This is exactly.
Dr. Ruben
I actually am so honored that you said that.
Dr. Ashley Wincher
Actually, I would have ended up in a very drawn out, miserable relationship not able to
Dr. Rachel Rubin
have two children with him first.
Dr. Ashley Wincher
Yeah.
Dr. Ruben
So this actually happened when I was in college. A friend of ours we were pretty sure was gay and she sort of didn't know. And we, like, literally locked her in a car and we, like, confronted her. And we're like, hey, I think you might be gay. And, like, we could talk about. It's okay. Like, you can talk to us. And she was like, what? You're talking about. And now she's married to her best friend from college who is a woman, and they have children together and they're happily ever after. But I did have that exact conversation with not my own partner, but a good friend of, like, just straightforward. Of like, hey, like, You're.
Dr. Rachel Rubin
You're gay.
Dr. Ruben
I know you don't realize it, but, like, let's talk about it.
Dr. Ashley Wincher
Of course you did that.
Dr. Rachel Rubin
Of course.
Dr. Ruben
She also.
Dr. Ashley Wincher
Yeah, for the record, she also wanted
Dr. Ruben
to become an ob. We went to medical school and she wanted to become an OB gyn. And I had to. I literally had to be straight with her. Be like, that's not you. You can't do that with your life. You would not be a good. You hate OB gyn. Like, you're meant to be an internal medicine doctor. And she ended up doing that. Right. Like, it's so funny because I, like, was very. I'm a jerk. I'm like, maybe that's why I like being a doctor, because I can just tell it like it is to people.
Dr. Ashley Wincher
Tell people what to do.
Dr. Ruben
Sometimes they'll listen more than friends. Friends don't listen. I've gotten better with friends.
Dr. Rachel Rubin
I mean, I listen to heated rivalry. And here we are.
Dr. Ashley Wincher
You also would be very good at those. Like, you'd be very good at being like Judge Judy. Like, you would also be very good.
Dr. Ruben
Like, I'd be able to, like, I don't know. I just, like, I call us. I see when I see it. I just can't, like, pretend like it's not there. Which makes certain relationships challenging if they're not good communicators or if they like to hold everything in. And then it's like, wait, I, like, can't we just talk about this giant elephant in the room? Like, I get frustrated by those types of things. Yes. But I loved her approach. Like, it was so lovely and warm and straightforward. And then he comes out, like, so surprising in what he says. And she's like, so she says something so beautiful. She says, like, a problem is something that you can fix. Oh, right. Like. Like, you can't fix this. This is not a problem that you can fix. Like, this is who you are and like, that's okay. But she should be suspicious that he's not interested in Miles because Miles is attractive.
Dr. Kelly Casperson
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Dr. Rachel Rubin
trouble sleeping, and dry mouth.
Dr. Kelly Casperson
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Dr. Rachel Rubin
miles is probably too much for him.
Dr. Ruben
Yeah, he loves Ilya.
Dr. Rachel Rubin
And he loves Ilya. So here's a thought. Do you think Shane didn't know he was gay before the conversation with Rose? Because it did seem kind of like
Dr. Ruben
a. Oh, the way his eyes got so intense and teary and like full of, like human. Like what that man can do with his eyeballs. And his face is.
Dr. Rachel Rubin
Same with Connor's story.
Dr. Ruben
Gets. They're both of them. What they can do with their face. The emotions that they can express through no words and just facial expressions. Ashley's just moaning guts me to my deepest core. Yeah. It's unreal how he nods his head yes and no and how he's like. And then it goes, ugh.
Dr. Ashley Wincher
I think this, like you're saying there's this intense waterfall of emotion happening in this restrained way. And to me, I think that is a relief of this secret being out. And yes, the specific secret of, like, Ilya is not out, but like that somebody other than Ilya sees him.
Dr. Rachel Rubin
Yes. It was a profound scene.
Dr. Ashley Wincher
It's not happening. Yes. And it's not happening in this awful way that he envisioned for whatever period of time. And I think this is a profound relief. Profound relief.
Dr. Ruben
It's so beautiful. It's so beautiful. And then when he says that he prefers to be the hole and not the peg, it's just like, incredible.
Dr. Rachel Rubin
It's so sweet.
Dr. Ashley Wincher
Diffused. Diffused.
Dr. Ruben
And I think a lot of the show, right when the serious moments, like, it's real Life, they use, or it tries to be like real life. They use humor to diffuse the situation to. They call each other boring. They call each other, you know, names. You're an asshole. Like, you know, the playful banter that is in every human interaction, I think is just, again, that beautiful reminder of, like, you can be serious. Like, sex is supposed to be serious and silly and fun and joyful and intimate. And, you know, like, you have to, like. I find some people are often too serious about their sex lives. And you're like, what about the fun parts? Like, what about the jokes and the laughter and the. The weirdness?
Dr. Ashley Wincher
The farts?
Dr. Rachel Rubin
When Ilya gets in the car and he's like, what is this, a Jeep? Like, it's like, dude, Ilya knows cars. Like, he knows cars. Fetlana runs a fancy carp thing, right? And he's just like. Like, ribs them a little bit. It's like. It's a Range Rover. You know that Ilya, you know, this
Dr. Ashley Wincher
is a Range Rover. So circling back to their expressiveness, right, I think, like, one of the next scenes after that, Rose and Shane in the restaurant scene, right, Is then they're at, like, in Tampa or whatever.
Dr. Rachel Rubin
We have Ilya and Svetlana in bed watching hockey next. And you also see that playfulness. And you see Ilya resting his head on her lap, which is a foreshadowing of episode six, when his head is on camera.
Dr. Ashley Wincher
And they're both having these moments with, like, that primary girl figure in their life that, like, loves them unconditionally. So you're like, just.
Dr. Rachel Rubin
Does Svetlana know?
Dr. Ruben
Yes, Svetlana's known the whole time.
Dr. Rachel Rubin
Yeah. And I think, like, later in the. In this episode, when Svetlana is in Moscow with him, Svetlana knows that there's a man, and she knows that Jane is the man. You'll never love me like you love of Jane. And he's a lucky person.
Dr. Ruben
Yeah, I love that part.
Dr. Ashley Wincher
I mean, it's amazing because, like, I mean, is she kind of putting her life on hold for Ilia? Like, I mean, she knows that he's not in love with her, but she's
Dr. Ruben
also, like, I don't think she needs. I think she's this fabulous human that doesn't need, like, has not, like, her prince.
Dr. Rachel Rubin
Her prince will come, but she's still, like, adulting and developing.
Dr. Ruben
And I'd watch the spin off. Yeah, the Svetlana series, Svetlana in the city.
Dr. Ashley Wincher
I would totally watch that. I just wanted to say, in that scene in Tampa, right, where he Shane walks in and he's got his, like, and he admits to having a stylist adorbs. They're interacting in this way. Like, I think this almost giddiness to, like, reconnect. And just the way that Ilya looks at Shane's mouth while he's talking is like, like, so sexy. I feel it in my body. Like, I feel the way he's looking at Shane and his mouth when he's talking, like he wants to kiss him.
Dr. Rachel Rubin
It just says it all again, you can watch this episode with the sound off.
Dr. Ashley Wincher
Oh, it is just like he's unraveling. He's taking off that nice stylist outfit of Shane's with his eyes. Like, he is doing that and it is so.
Dr. Rachel Rubin
Oh, he likes it. He likes Shane's dressing a lot because he likes nice things. So this is like who he loves. Made even more gorgeous with good styling.
Dr. Ashley Wincher
Yeah.
Dr. Rachel Rubin
Okay, so we're at 2017 All Star Game. The famous bar scene. Again, the personal development. Like, this is where we start seeing Ilya as very playful Ilya in the pool with the kids, playing around, joking, like this serious, stressed out person. And kind of pairing that with what else happens in this episode of, like, him going through some significant loss and like a rupture with Russia. So there's a lot of Ilia development in this episode.
Dr. Ashley Wincher
I think that him being that playful guy in the pool while Ilya, while Shane sits there is like a glimpse into the life that they would have if they could be openly together. Right. Because being in love with somebody is like this. Sitting there while they're playing with the kids and you're loving them for that too. It's like this window into what would they be if they were like boring married people together for like 20 years?
Dr. Ruben
So it's like also a very public place where they're together in the same place and it's okay. And it's not about hockey. And it's like, it's a really intimate scene. They could just like, be themselves for like a minute and that's why. Then you have the hotel room scene. That's like, pretty intense.
Dr. Ashley Wincher
Also, why is Scott Hunter not in the All Stars him?
Dr. Rachel Rubin
Maybe he is. We. They just don't talk about it.
Dr. Ruben
Great question.
Dr. Rachel Rubin
Good question, though. Is he injured?
Dr. Ashley Wincher
I don't know. It really bothers me.
Dr. Rachel Rubin
I think you could make heated rivalry with Ilia as a true. And it would be so much less of a story than the way they've made Ilya.
Dr. Ashley Wincher
Yeah, I mean, that's just too, like, That's. There's too many shows like that.
Dr. Rachel Rubin
Exactly, exactly. It's a trope.
Dr. Ashley Wincher
Too many. That's been done. It's been done. Yeah.
Dr. Rachel Rubin
Okay. So then they meet on the beach and they touch hands, and then you think they're going to go immediately into, like, a hot sex scene, but they go meet back in Ilya's hotel room. Ilya is in a hot black tank
Dr. Ashley Wincher
top, which is very sexy.
Dr. Rachel Rubin
We don't see enough of that. Not enough of that.
Dr. Ashley Wincher
Although it should always be tank tops.
Dr. Rachel Rubin
Yes. And then Shane confesses his feelings. It goes very quickly from Ilia kind of being like, what?
Dr. Ruben
What?
Dr. Rachel Rubin
I thought we were just gonna fuck. And, like, why is this serious? And, like, kind of being playful and not really listening to, like, Ilya crying. Like, the energy shifts very quickly. We see for the first time that, like, Ilia, him coming out is a big catastrophe. And it's not just that he doesn't like Shane. It's like, his loss of his country.
Dr. Ashley Wincher
Yeah. No, just that I don't understand how he hasn't figured this out already. Like, I'm. I. But I guess it's not a journey I've been on before. So I.
Dr. Rachel Rubin
That Shane hasn't figured out he's gay or that Ilya hasn't figured out he needs to, like, break from Russia to live his life.
Dr. Ashley Wincher
Oh, that Shane hasn't realized he's gay. Like, did he think he was, like, asexual?
Dr. Ruben
Or, like, I think Rose made him realize, like, it wasn't just about Ilya, or maybe it is just about Ilya. Like, I don't know. That he sees, like, his identity in this person that he enjoyed having sex with for many years. Right. Like, where he sees Ilia able to have sex with women easily and be more sexual. Like, Shane couldn't do that. And maybe that's what made him realize. But like you said this, Kelly, over the year, like, over many epic times, watching this of something about how, like, Shane had to come to terms with being gay. Ilia had to come to terms with, like, the trauma of his family, I
Dr. Rachel Rubin
think, in him, like, trusting love and to, like, be vulnerable enough to be seen and loved by somebody after that childhood.
Dr. Ruben
So Shane had. Shane had no problem being vulnerable and loved by Ilia. But, like, that's where they both. Right. Tore apart. Shane had trouble admitting he was gay. Ilya had trouble admitting he, like, was in love with.
Dr. Rachel Rubin
And I think, like, especially by episode five, like, Shane is really coming into himself. He's like, I'm gay and I like, you Right. Like, he's getting a lot more solid on, like, not just kind of being a recipient of somebody's desire. He's getting more clear in his core. And as that's solidifying, I think Ilia is kind of understanding that a little bit more of, like, Shane's not to be fucked with. Actually, Shane's getting kind of solid. And it's your. And it's.
Dr. Ruben
And he says his truth, right? He pulls the Rachel Rubin and Rose Landry where he, like, just says, like, I can't pretend I don't like you anymore. Like, he says what he feels, and then when they're at the cottage, he's like, can we just be honest with each other? Can we just, like. Can we just, like, not pretend?
Dr. Rachel Rubin
Oh, it's so sexy.
Dr. Ruben
That's his, like, neurodivergence, where he's just, like, gonna say it like, it is.
Dr. Rachel Rubin
He needs. He needs clarity. Where's the paper on that? How many couples aren't being truthful to each other? 98.
Dr. Ashley Wincher
Yeah, totally.
Dr. Ruben
98 and a half percent.
Dr. Rachel Rubin
Okay. So we got. Then we switched to Boston. Two weeks later, Shane goes over to Ilya's. They have sex, then they play against each other. And the next day, Shane finds out Ilya didn't go to Nashville with his team. And this is the fracture with the Russians. I mean, because he's like. Because literally, like 20 minutes ago, he couldn't come out as gay because he could never go back to Russia. And then he's literally fracturing Russia because mom dead, dad died, brother's a dick. And here's the question. Is the brother older or younger than him?
Dr. Ruben
I think younger.
Dr. Ashley Wincher
I think older.
Dr. Rachel Rubin
I thought older. And then I was reheated, and I'm like. I mean, I don't actually know.
Dr. Ashley Wincher
You think he just looks old because of all the vodka?
Dr. Rachel Rubin
Oh, yeah. It like, hard living. Hard living. Drugs, Drugs in the cold Moscow winter.
Dr. Ashley Wincher
I'd say no. It's because I feel like in the beginning, when Ilya, like, in the very beginning, in the first episodes, when Ilya was still basically a teenager, I feel like the brother already had a kid or something. Maybe I'm wrong. Which, I mean, I guess he could have it be a teen dad. I just could be older.
Dr. Rachel Rubin
In the next question about Ilya's brother, why does he hate Ilya? Because Ilya says this in the Russian monologue in the tunnel, he says his brother hates him.
Dr. Ruben
He's jealous because Ilya's hot and rich and good at hockey and probably was the favorite son but he couldn't take care of the dad. Right? Like, the dad, even though it treated Ilya like crap, I'm sure he was the favorite son. And Ilya felt like, you know, he probably blamed. I'm sure there's something about the mom and like, just like a lot of anger.
Dr. Rachel Rubin
How does. How does Shane not know Russian yet? You would have thought he would have, like, taken a little side project and learned some Russian. Episode Season 2 I hope they speak some Russian to each other. He already speaks French.
Dr. Ashley Wincher
I know. Why didn't he read Russian books?
Dr. Ruben
Those glasses are very attractive. Oh, put on your glasses. I will feel better when you put on your glasses. Oh, he's such an alpha. Like, no, put glasses on. And then he goes.
Dr. Rachel Rubin
I love that when he goes.
Dr. Ruben
Like when he glasses on, he pokes his. Pokes his eye. Right? My dad just died, but glasses on.
Dr. Rachel Rubin
Okay, let me control the situation.
Dr. Ashley Wincher
So hot.
Dr. Rachel Rubin
One week later, they play each other. And I didn't pick this up, but I just picked it up on the reheat and I need to point it out to Rachel. Marlo smacks.
Dr. Ruben
I know. I picked it up too. And Marlo is spelled differently.
Dr. Kelly Casperson
Who fights Marlo?
Dr. Ruben
Who fights him? Oh, is it. It's Hayden. Hayden and Marlo fight. That needs to be talked about more.
Dr. Rachel Rubin
Hayden fights with Marlo. So Marlo smacks Shane. Hayden pike, because you can see his shirt. The back of his shirt says pike, who fights him and calls him a motherfucker.
Dr. Kelly Casperson
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Dr. Rachel Rubin
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Dr. Ruben
the bros. The boys fight for the boys.
Dr. Rachel Rubin
I was like, I must.
Dr. Ruben
And Ilya just sits there like right next to Shane. He's in shock, looking all like a sad puppy.
Dr. Rachel Rubin
Yeah.
Dr. Ashley Wincher
At some point in that episode, right after the concussion and everything and Shane is like back at his. He's at his parents house at the lake. It's not the sixth episode, it's the southern. The fifth episode he's on the phone with Rose and Rose is getting like painted. You know what I'm talking about?
Dr. Ruben
Yeah.
Dr. Ashley Wincher
And she's on speakerphone in front of the makeup artist. Very clearly on the phone with Shane and very clearly talking about how gay.
Dr. Rachel Rubin
Yeah, I didn't like that.
Dr. Ruben
Good point for that. I didn't put that very exposed. But right before that is you. You can't gloss over his doped up hospital bed scene. Will you go to the cottage with me? We could take a week or even two. Come to the cottage.
Dr. Ashley Wincher
So my husband is sober and he's been sober for like 12 or 15 years. So I've never actually seen him intoxicated. And the only time I ever saw him basically like high was after he had an endoscopy. And obviously it wasn't exactly like that scene, but I felt like it was a little like that scene. Like he came out of his endoscopy and he was like acting really good and fucked up and I had never seen him act fucked up like that. And I. That's what I thought when I saw that scene.
Dr. Ruben
It was. It's like so sweet how like drunk he is and like. Yeah, I was really looking forward last night asking you a question.
Dr. Rachel Rubin
I like it when he reaches out and he gets Ilya's hand and he goes, better. So cute. Apparently that wasn't how that scene was written for him to play it. Kind of stoned and. And he then he played it stoned and they were like, oh yes, it was awesome.
Dr. Ruben
They're such good actors. It's bananas.
Dr. Rachel Rubin
It's bananas. They're so good. Okay, who wants to wrap up? Who wants to wrap up? The last. The finest.
Dr. Ruben
Wrap it up. The you're my sunshine. So this is foreshadowing from the scene where Elena dances with Scott Hunter. Scott Hunter. And then she says, you're deserves sunshine. And so now the song was you're my Sunshine. They win the cup. Scott Hunter wins his cup. And then he. All the families come down to celebrate. He's alone and he calls Kip from the audience into the Big arena. And it's this big, giant, public, beautiful coming out thing where everyone's like, oh, there's a fan coming. That's one lucky fan. Oh, who is it? What's going on? And then they embrace and they start making out and they say, I love you. And it's this very big, giant, loud moment, very public moment. Everyone is glued to the tv, watching what's happening.
Dr. Rachel Rubin
Glued. And the whole, like, cinematography, right? So you've got the. They're panning in a circle around the ice, and then they're panning around Shane's head, and they're panning around Ilya's head. Like it's all, like happening at the same time.
Dr. Ruben
And you just feel it so deeply. And then the phone rings. I'm coming to the cottage.
Dr. Rachel Rubin
I'm coming to the cottage.
Dr. Ruben
Then Shane lets out like a.
Dr. Rachel Rubin
There's like a.
Dr. Ruben
There's like a noise that he made. Like, you don't even hear what he says.
Dr. Kelly Casperson
It's like.
Dr. Ruben
And. And the captions is like. It's like the most perfect, like, moment. And then it just ends.
Dr. Rachel Rubin
I love that. I love that we don't get. We're not privy to any more of that conversation. And that actually happens when they're in the tunnel in Russia too. So. So they're still talking and Ilya walks away, away, still on the phone. And so I'm like, there's more to this conversation that we don't get to see.
Dr. Ruben
You're so snoopy. Why do you want to. You've already seen them have sex.
Dr. Ashley Wincher
Why do you need to see?
Dr. Ruben
Exactly.
Dr. Rachel Rubin
I'm just saying they're building the relationship. All right, episode five is effing fantastic. Final thoughts or should we wrap it and then see you next time for the final episode?
Dr. Ruben
If anyone is still watching this, we should hear from you in the DMs because I'm impressed.
Dr. Rachel Rubin
This is where we tell all the secrets. Because this is where people. Only the true fans are listening. But you did that poll on Instagram last week, and everybody said they were gonna listen. So at least 12 people are here, still here, listening.
Dr. Ruben
At least 12.
Dr. Rachel Rubin
The last time I checked your poll, it was 12 to 0.
Dr. Ashley Wincher
I mean, I. It would kind of hurt me if there was somebody in the corner of the Internet who's like, I'm gonna take time to respond no to this survey. Like, why would you click on that? Why the would you click on that?
Dr. Rachel Rubin
I mean, like, get a life. Get a life. Or swipe.
Dr. Ruben
Wait, there is one. Hold on.
Dr. Rachel Rubin
Hey, what's the countdown on that. Can you look at that poll?
Dr. Ruben
Okay, I'm gonna tell you. Let me see the view of the result.
Dr. Ashley Wincher
That person's a miserable. That's what's going on there. That person.
Dr. Ruben
50. There were 53 responses. 96% say yes, so that's a solid eight. No, that's pretty good. But 53. If there are 53 of you listening, I am impressed with all of you, and we need to put your intensity.
Dr. Rachel Rubin
And I'm only going to take this slightly personally, that Reuben thinks nobody actually listens my podcast.
Dr. Ruben
No, they do. This is. Your podcast is so much better than listening to us talk about, like, our weird musings of heated rivalry for six goddamn hours.
Dr. Rachel Rubin
This is like, you know, if people don't like it, this is my experimental dance. Like, I'm gonna do a. A month and a half of us chatting on heated rivalry, and we'll see what happens. Let's throw it into the universe. I'm the. I'm the boss.
Dr. Ruben
I decide. I just want you to succeed, Kelly. We're just here to let you succeed. What is that an iud?
Dr. Ashley Wincher
Yes. Why?
Dr. Rachel Rubin
Okay, to wrap up this episode, we've got Dr. Ashley Winter waving an IUD at us. Is that for Rose Landry?
Dr. Ashley Wincher
It is. I care about her so much, and Ruben already went to her and was like, rose, you fucking need listen.
Dr. Ruben
She needs to be able to Harry straightforward with residents.
Dr. Rachel Rubin
Her career's on the up and up. She should decide when family planning is right for her.
Dr. Ashley Wincher
That was not the time.
Dr. Ruben
What's going on with. Why she's 80? Gay boyfriends. We got to get her to find some real, like, straight boyfriends she loves.
Dr. Ashley Wincher
Well, because she was in theater two or.
Dr. Rachel Rubin
She's six. She's very dramatic.
Dr. Ruben
I just want to know what her favorite musical is. She was in theaters. My mom.
Dr. Ashley Wincher
My mom went to fashion school, and she always said, like, all her boyfriends were gay.
Dr. Rachel Rubin
Your mom went to fashion school?
Dr. Ruben
That's why Ashley's so fashionable. Her dad's an engineer, and her mom's a fashion.
Dr. Rachel Rubin
How did they meet? Like explains.
Dr. Ruben
It looks at their DNA and it just explains.
Dr. Rachel Rubin
And then the. And then the universe is like. And I give you gorgeous smiles. Art and stylish. You're welcome.
Dr. Ruben
Yeah, she's like, this genius engineer who, like, has amazing fashion sense and looks. It's. It's literally unfair that humans.
Dr. Rachel Rubin
Like, how did an engineer knock up a fashion.
Dr. Ruben
It's a great question.
Dr. Rachel Rubin
We need to know.
Dr. Ashley Wincher
They met at a gas station on bicycles. My dad was at the free air pump at the gas station, pumping up his bicycle. This was, like, the 70s, obviously. And my mom comes there, and her bike. Bike was, like, busted. And he said, oh, I saw her, and she was hot. And he was like, your bicycle is busted. You need a new inner tube. I have one laying around my house, and I live right around the corner. And the truth was, he did not have one laying around the house, and he did not live around the corner. And he's like, wait for me. And nobody has any cell phones. So she stood there and waited for him in the sweltering heat, because this was in Houston, Texas. And she stood there in the sweltering heat at the fucking air pump at the gas station for 45 minutes while he rode his bike back to his apartment, disassembled his roommate's bike, took the inner tube out, and brought it back to her. And then he asked her out on a date. That's how they met.
Dr. Rachel Rubin
Get that AMEX Gold card ready.
Dr. Ruben
I'm too tired to cook.
Dr. Rachel Rubin
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Dr. Ruben
And then sperm met egg, and Ashley Winter was born.
Dr. Rachel Rubin
You are. This is like, everybody needs to realize that they are goddamn miracles. That is an impossibility. What if it was 4 degrees warmer and your mom got heat stroke?
Dr. Ashley Wincher
No Ashley Winter.
Dr. Ruben
Or four minutes or four minutes later.
Dr. Rachel Rubin
Four minutes later. Or he didn't have low air in his gas in his tire.
Dr. Ruben
It's insane. It's legitimately insane.
Dr. Rachel Rubin
Ruben, how did your parents meet?
Dr. Ruben
My parents met because of a typo. My dad was editor in chief of the college newspaper, and he was writing a story about campus jobs, and he interviewed my mom, and he misquoted her, and he wrote the wrong. He wrote her roommate's name down as the quote. And my mom went to him and said, what the fuck? Like, this is my name. You misquoted me. And he said, do you want me to print a revision or whatever? Do you want me to print a retraction? And she said, no, I want a job, and I can type a million words a minute. And he's like, great, you're hired. So then she joined the college newspaper as a typist. And then I'm sure they just got together, because that's what people did in the 60s. They, you know, they were on probably lots of drugs and stuff. But anyway, that's how they met. Was a typo. And my dad recently found the article My dad recently found the article that the typo was to show us. I know. It's cute.
Dr. Ashley Wincher
That's so good.
Dr. Rachel Rubin
I don't have a good story, you guys. I don't have a story. My mom moved to Duluth, Minnesota. My dad was in Duluth, Minnesota, and that's where my story ends. Like, Duluth, Minnesota. God, that's not.
Dr. Ashley Wincher
Two people there. Like, what does that mean? Very cold. He walked into Duluth, and she was just there.
Dr. Rachel Rubin
Or I think there was, like, a party, and I think my mom went to the party. And then, like, my. The Caspersons are kind of well known in Duluth because my grandpa was a famous radio person. Ergo, me and podcasting.
Dr. Ashley Wincher
Oh, wow. I did not realize it's in your DNA.
Dr. Rachel Rubin
It's in my DNA. Well, my brother's a famous. A big podcaster, too, too. So, like, the Caspersons are kind of a famous name in Duluth, Minnesota.
Dr. Ashley Wincher
Yeah.
Dr. Rachel Rubin
So maybe I'm, like, throwing. Like, that's all I got. That's all I have. It's good.
Dr. Ruben
I mean, you did okay. Like, we're not mad about how you were formed.
Dr. Rachel Rubin
We're all goddamn miracles.
Dr. Ashley Wincher
I just need more details. I need more details.
Dr. Rachel Rubin
I don't have it, but I have a progress.
Dr. Ashley Wincher
Yeah. Yeah.
Dr. Rachel Rubin
Episode five. We'll see you next week for episode six. We're gonna wrap it up.
Dr. Kelly Casperson
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.
You Are Not Broken – Episode 379: Heated Rivalry, Episode 5 Recap
Released July 12, 2026
Host: Dr. Kelly Casperson, MD
Guests: Dr. Rachel Rubin, Dr. Ashley Winter (Wincher in transcript), Dr. Ruben
This episode, part of the “Heated Rivalry Urologic-Thon,” is a lively, in-depth, and irreverent panel discussion recapping Episode 5 of the popular queer hockey romance drama Heated Rivalry. Drs. Casperson, Rubin, Winter, and Ruben use the show's events as a springboard for honest, often hilarious conversations about sexual function, anatomy, cultural taboos, contraception, and communication in relationships. The energy is playful, blunt, and supportive—reminding listeners: “You are not broken”—and the conversation weaves together pop culture fan-chat with evidence-based, shame-busting sexual health insights.
Low Dialogue, High Subtext:
Catching Up to the Present:
The Dinner & The Montreal Bagels T-Shirt:
Breaking Down Misconceptions:
Biology of Erections:
Performance Anxiety in Women:
Anecdote from a Urology Conference:
Partner’s (Lack Of) Investment in Women’s Pleasure:
Sex Ed for Young Women:
Expecting Partners to Be Mind Readers:
Conception Real Talk:
Condom Use and Function:
Rose’s Directness with Shane:
Coming Out and Relief:
Humor and Seriousness in Relationships:
Ilya and Svetlana’s Dynamic:
Beach and Hotel Scenes: Vulnerability and Consequences:
Contrast in Emotional Journeys:
Honesty as Erotic:
Speculation About Side Characters:
Comic Relief & “Miracle” Visuals:
On Sexual Myths:
On Medical Misinformation:
On Communication:
On Sex Education:
On Relationships:
Comic Relief:
This episode expertly blends fandom, medical myth-busting, and radical honesty about sex, desire, and communication. Through the lens of Heated Rivalry, the doctors reinforce that everyone—regardless of orientation, gender, or age—benefits from self-knowledge, clear communication, and challenging cultural scripts around sex. The frank, funny tone and clinical authority make this recap both a love letter to queer romance on TV and a tool for real-life sexual empowerment.
For more resources, books, and membership, visit KellyCaspersonMD.com. This content is for educational use only.