← You Are Not Broken
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- [00:01]
Dr. Kelly
Queen Carvania stood haloed by the morning sun. An army hung on her every word.
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Carvana Ad Voice
My champions, I have sold my chariot on Carvana. Twas a lovely suv, an inexplicably queenly offer. They're even coming to the castle to collect it. Tonight we feast. An offer you can feast on. Sell your car today on Carvana. Pick up fees may apply.
- [00:30]
Dr. Kelly
Mom, can you tell me a story?
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Carvana Ad Voice
Sure. Once upon a time, a mom needed a new car.
- [00:35]
Shauna Watts
Was she brave?
- [00:36]
Carvana Ad Voice
She was tired, mostly. But she went to Carvana.com and found a great car at a great price. No secret treasure map required.
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Dr. Kelly
Did you have to fight a dragon?
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Carvana Ad Voice
Nope. She bought it 100% online from her bed, actually.
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Dr. Kelly
Was it scary?
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Carvana Ad Voice
Honey, it was as unscary as car buying could be.
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Dr. Kelly
Did the car have a sunroof?
- [00:52]
Carvana Ad Voice
It did, actually.
- [00:53]
Dr. Kelly
Okay, good story.
- [00:54]
Carvana Ad Voice
Car buying you'll want to tell stories about. Buy your car today on Carvana. Delivery fees may apply.
- [01:01]
Podcast Host
Hey, friends. Welcome back to the you are not broken podcast. This is an amazing episode I recorded with Dr. Shauna Watts, who's an amazing physician in Australia, when I was over there giving some talks in Sydney, Australia, earlier this year. So I hope you enjoy. And thanks to Shauna Watts and her amazing podcast team for letting me also put it on mine, because it is so amazing. So in this episode, we dive into the complexities of menopause, hormone therapy, and the societal perceptions that shape how we view these. Unpack some of the biggest misconceptions about menopause and explore the evolutionary lens behind it. I call out the naturalistic fallacy that often scares women away from hormone replacement therapy. I also touch on the stigma around men's health, especially testosterone treatment, and why education is absolutely key when it comes to making empowered choices about hormone therapy. Then we go even deeper into women's sexual health, libido, the impact of menopause, and the pressure society puts on us when it comes to body image and desire. We also share insights on interstellar cystitis, risk factors for bladder cancer, and even the benefits of exercise and rucking for women's health. So me and Dr. Shauna Watts bringing you clarity, breaking the silence, and normalizing what so many women experience but are rarely taught to talk about. So let's get into it. And for more with the amazing Dr. Shauna Watts, check out her podcast, all about you with Dr. Shanna Watts.
- [02:32]
Interviewer / Co-host
Doctor Kelly, I'm so delighted to have you back on the podcast. How are you?
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Dr. Kelly
I'm so good. Happy to be here in person.
- [02:38]
Interviewer / Co-host
Amazing. So let's just get straight into it. We've had a few questions where people are asking, what actually is the point of women having a menopause? Is there like an evolutionary benefit to this thing?
- [02:50]
Dr. Kelly
Yeah, yeah, no, it's a super interesting question. And I'm actually, I dove into it because my second book, which is way more about menopause and hormone therapy, is coming out later this year in September, I believe. And so I looked into it because one of the things that people talk about is like, people use it as a justification, I think, to not take hormones because they think that there must be some sort of evolutionary benefit to living without hormones
- [03:20]
Interviewer / Co-host
and.
- [03:20]
Dr. Kelly
No, not that we can think of. And the other big myth that I love to dispel is people will always say humans and four whales are the only people to go through menopause. First of all, menopause means no periods in one year. Most mammals don't have periods. Most mammals self resorb their uterine lining. They don't bleed. Right. So you can't really say other animals have menopause or not because they have different bodies and uteruses than we do. Okay, so there's that if you take mammals and you have them live in captivity, which means clean water, no predators, antibiotics when they get sick, right. If you take care of them, they all live longer than their ability to reproduce, which we're going to use that as a marker for menopause because they don't bleed, right? So, okay, well, we're well preserved. I actually wanted to name my second book Living in Captivity because we are being well preserved now. Right. Antibiotics alone have extended the average life expectancy by 26 years. It's crazy. And we don't think, because we are living now and not before, we don't think of the fact that we are aging as a population longer than we ever have. And that's brand new, right? Like, we're just figuring out how to do this. And that's why I think Gen X is so powerful, because we're seeing people do it poorly and we're like, what if there's a different way? What if we can prevent frailty in the first place? What if we can prevent heart disease, prevent osteoporosis, prevent dementia? And in order to do that, you have to preserve the body a little bit better. So this, this whole, like, evolutionarily benefit. Yes. In the fact that from yeast species to fruit flies to like, all species that reproduce, there seems to be an evolutionary benefit to living longer than you can reproduce, reproducing is very expensive as far as resources go. So they, all of these species will live a little bit longer than their ability to reproduce. We don't call it menopause. Fruit flies don't go through menopause, but they live a little bit longer. You take the fruit flies and you put them in captivity and they live exceptionally longer. Right. So I think of humans as, we're humans in captivity now. We have the ability via sanitation, clean water, antibiotics, trauma surgery, exceptional cancer care. We have the ability to live 40 years past our reproductive ability. And that's where the frailty comes in, because the hormones work everywhere in our body, not just reproduction. So I think when people oversimplify it and they're like, menopause is God's gift to humanity because now we can take care of the grandbabies and not worry about being pregnant. I think it's, we're not understanding actually how our bodies work and the fact that we're kind of fake in living to 90 as a population. But we all want to do it. Right. So it's like if you wanted to truly be natural, we wouldn't be living that long. If you look at Victorian England, where they kept track of the wealthiest men for death records, right. Because nobody else paper was expensive. They weren't keeping track of people that were important, the most important people, they kept track of birth and death records. Average age of death for men, the wealthiest men, was 47. And there are some data in women where they had babies into their early 50s, death was 57. So this whole, like, is it natural to not take hormones after menopause because it was meant to be, I would argue, living to 84, which is our average age of life expectancy in developed countries. That's not natural. But we all want to do it, so let's do it.
- [07:01]
Interviewer / Co-host
Well, agreed. And what about the people who say, well, HRT isn't a natural thing, I'm just going to let my body do it naturally? I mean, can you just extend that a little bit further and talk to the fact that we are using hormones ultimately that are pretty identical to what our body makes?
- [07:18]
Dr. Kelly
Yeah. And I'll even take it one step further. The, the social psychologists have researched this, this, this myth of natural, or what they call the naturalistic fallacy. And what that is is the belief that if something is natural, it's therefore superior or it's therefore better, or it's therefore the just and right thing to do. And that's just a thought error. Right. It's like anthrax Is natural. You know, drinking water that has feces in it is natural in nature.
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Podcast Host
Right.
- [07:46]
Dr. Kelly
So it's like, natural. Isn't this utopian, mother nature, pristine environment? We actually work, we have trauma surgery because falling and breaking a hip might be natural. Right. So it's this. I like to just say, you know, yes, the hormones we use now are exactly what our body makes. And check your bias. If you're living your life by only doing things that are natural, why do you have on shoes? Why'd you put on sunscreen? Why do you get dental care? Right. It's all unnatural when you start picking at it. And so you can get, you know, you can open people's eyes to their bias. Because again, we use that naturalistic fallacy to withhold care, I believe, withhold preventative medicine from people's bodies.
- [08:30]
Interviewer / Co-host
Well, even the word natural is used, for example, in the world I am in, which is skin care. Like, and we, you know, lots of people will put the word natural on skin care, and it improves sales. So clearly there is, like a subconscious bias that people, you know, gravitate towards a product that says something. But what is the definition of natural? You can't. You can't define it. It doesn't actually mean anything. So lots of patients will say, oh, I like to use natural skincare, but what does that even mean? Yeah, so it's. It's definitely a word that has a very emotive thing for people in very many realms.
- [09:09]
Dr. Kelly
Yeah. I think, I mean, it ties into purity culture. Right. It ties into all, like, what you should do. And it kind of takes away the ability to think critically about things because you're kind of putting pressure of doing it right by this belief, again, in the naturalistic fallacy. So I like to point that out. Like, yeah, we've researched people's, like, belief in this, and that's what we're all doing.
- [09:30]
Interviewer / Co-host
It is same.
- [09:31]
Dr. Kelly
You can put natural on a candy bar and charge more money for it. And that word natural in the. In the health foods world actually is meaningless. It's less meaningless. Like, the word organic is more defined.
- [09:42]
Interviewer / Co-host
Yeah.
- [09:42]
Dr. Kelly
The word natural is actually meaningless. It's marketing.
- [09:45]
Interviewer / Co-host
It was interesting when I did my little piece where I went into the street and talked to people and asked them, you know, their thoughts on hormones and their thoughts on menopause and things. There were a number of women who said, oh, no, I just think, I just want to do menopause naturally. And I nearly feel like it becomes like a badge of honor to do it naturally. And you know, I just wonder how we've got to that point where women feel that that is the superior choice whenever the data and the research clearly shows us that it's not in terms of not only longevity, but living well for longer, living healthier. From your bones, from your heart, from your bladder, everything is probably going to be improved by taking hormones. And yet people seem to feel like, I don't know, there's like nearly like this that makes them, I don't know, that it proves they're more resilient or something by not taking hormones.
- [10:47]
Dr. Kelly
I mean, to me, it's lack of education. When I hear a woman say that, I think, does she know what menopause is? Because the video you do is so insightful. Is like going back to the basics of do you know what menopause is? I mean, the definition again of menopause is one year with no natural periods. But it's actually a profound hypogonadism. It's a profound grand decrease in the function of the ovaries. And once women start understanding that this is. This is like a man's testicles stopping working, we never tell a man who has low testosterone in his 40s, 50s, and 60s if that's natural. Erectile dysfunction is natural, and Viagra is one of the top selling drugs in the entire world. So the other thing I like to do is hold up the lens and say, okay, fine, if women should do it natural, let's apply it to men as well. And we then we say, oh, we treat, we treat their issues associated with aging, we treat their low testosterone, we treat their erectile dysfunction, we treat all of these things in them. So why aren't we doing it in women? And so it's like, I love holding up because ultimately I don't care if people take hormones or not. You know, me and the other advocates out there, it's like your body, your choice, but your body, your choice with education, understand what's happening, and then you choose.
- [12:02]
Interviewer / Co-host
Kelly, I'd love actually for you to talk to us a little bit about testosterone and low testosterone in men, because I know that as a urologist, you look after both. How does that present, and does it present in a similar manner to some of the symptoms we see in women with low hormone levels?
- [12:19]
Dr. Kelly
Yeah, actually, it pretty much does. So the most dramatic way to see a man deal with low testosterone is prostate cancer treatment. So we actually give them medication that drops their testosterone really low. Those men say, I'm lethargic, I'm tired, I have no more get up and go. There's no libido. I'm gaining weight around the middle. I'm losing my muscle. I don't even want to go to the gym. And then hot flashes, really bad hot flashes. And those men are some of the most sympathetic men towards what menopause is. That's when you take your hormones and you drop them. And same with women. That's why you take your hormones and you drop them. One of the problems, I think, with low testosterone or low hormones is like, these hormones are in every cell in your body. So it can look different in everybody. If you're like, what does a broken arm look like? That's very clear. In all humans, a broken arm looks like a broken arm. But for you, it might be, well, your hormones are affecting your brain more. This other person's hormones are affecting their heart more. Right. So it presents different. And that can be vague for some people. And the symptoms of low testosterone can be vague, like decreased energy, decreased mood, decreased muscle mass. Right. It presents differently in everybody. It doesn't mean we shouldn't treat it. It just means we're all individuals. And it's not as cut and dry as, like, if you have a piece of wood in your eye. Everybody presents the same way with that.
- [13:46]
Interviewer / Co-host
And in terms of. So I don't know if it's the same in the US there's definitely in the last, sort of, I would say two to three years, been a real interest among young men, older men, about testosterone, testosterone levels, what their testosterone like. I have to say, in the previous sort of 20 years of my career, I'd really never had anyone as a male present asking for testosterone levels. And then suddenly in the last two years, lots of men asking for me to check their testosterone levels. Do you know where that's come from? And is that something that as doctors, we should be doing a lot more regularly than we do.
- [14:23]
Dr. Kelly
Have you ever heard. I'm going to answer your question legitimately, but have you ever heard a man say, I'm just going to deal with my lotus testosterone naturally?
- [14:30]
Interviewer / Co-host
No, I have not. To be fair, they. They come and they tell me, oh, I want to have my testosterone checked because my friend who I go to the gym with had his checked and it was low and blah, blah, blah, and I want you to check it and replace it. Yeah. No one's talking about.
- [14:44]
Dr. Kelly
Nobody's talking about doing it naturally. Right. So it's fun to hold that mirror up to be like, women, what are you doing? When men are suffering, they know that there's Solutions. They know it's okay to be treated. They know they're going to feel better that it's safe. Right. So it's like, I want to get that into the women's head, too. Of like, yeah, it's the same stuff. Like low hormones. Low hormones, but no man's like, I think I'll just, like, learn how to breathe more deeply.
- [15:07]
Interviewer / Co-host
Go and do some Pilates for your low testosterone.
- [15:10]
Dr. Kelly
Exactly. Like, exercise is fantastic, but it will not replace gonadal function. So the testosterone in men, it's been growing in America for quite a while. The exciting news about testosterone in America is March 1st. The FDA just announced they're going to take off the cardiovascular risk from the boxed warning, which is fantastic, because one big myth of testosterone is that it might be dangerous or it might increase your cholesterol or it might increase your cardiovascular risk. That has not been shown to be true. So the fact that the FDA is correcting misinformation on testosterone, I'm very excited because they need to correct the misinformation on vaginal estrogen, and I'm hoping that they will do that. But again, I think it goes back to men want to feel good, they want to be optimized. They. They have in the male culture, it's like to be fit, to be vital, to have a healthy sex life that is normalized, appreciated, and supported. That's not always true in the women's health domain.
- [16:08]
Interviewer / Co-host
And is there a danger from having too high testosterone or taking too much testosterone as a male?
- [16:14]
Dr. Kelly
Yeah, I mean, I think it's a. It's a fun myth because even though women who are on hormones, they'll be like, give me more, give me more, but give me more. This myth that, like, more is better. Right. Whereas in medicine, it's like, if the blood pressure medication's working, you don't give more. Right. If the. If you. Your insulin is controlling your diabetes, you don't give more.
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Interviewer / Co-host
Right.
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Dr. Kelly
So there is like, supra physiologic, meaning giving more doses than your body naturally deals with. A little bit's okay for some people, but to a point, you're going to start getting side effects. Just like, if you give, you know, coffee's good, more is not always better. Right. Like, there is a point where you can have too much. And we see that in the testosterone world. I see that in people, women who are on hormones, they think, more, more, more, more, more. Or they think hormones might be a cure for everything. They are not.
- [17:03]
Interviewer / Co-host
Yeah, absolutely. You touched on vaginal Hormones there. And as we know, the same in Australia, we've got this terrible piece of paper that comes inside the box. And sometimes, you know, women can be a bit overwhelmed in their consultation and they'll come back and say, oh, actually, I didn't take that because I read that the brochure. I'll be like, remember we talked about that. Can you explain what is going on with that leaflet and why it is actually not relevant to vaginal hormones?
- [17:37]
Dr. Kelly
Yeah, so vaginal hormones are very, very low dose. They don't go in your bloodstream to any appreciable amount, and it's very, very safe. Skincare. So even when we talk about replacing or hormone therapy for menopause, even that's higher and it's not high compared to birth control pills. Right. That's higher than vaginal estrogen, which I just call skincare for down there. It's like not absorbed. But after the Women's Health Initiative came out in 2002, our FDA, the American FDA, put a label on any estrogen type. Didn't matter. The dose, didn't matter, the route, didn't matter. The indication just having to do with estrogen got the warning. So inappropriately applying this to everything. And so it's also on vaginal estrogen. So the vaginal estrogen packet will say, this can cause blood clots, cancer, heart disease. And it doesn't say possible dementia. It says probable dementia. So anybody who knows words that's worse than possible dementia. And so I tell my patients, I say, listen, if you read leaflets, you're gonna read that this is what it says. It is wrong. I'm sorry you have to choose between me and the FDA. Now, the FDA's had some controversy in America, so most of my patients are happy to believe me over the fda. But my friends did a study and they said women who get a vaginal estrogen prescription, about 20% still won't use it because of the warning label. So physicians have petitioned the FDA twice to take that warning label off. FDA has still not done it. So we have a citizens petition in America. If you go to letstalkmenopause.org, you can sign it. Americans only can sign it. But if American can get those labels off, I think it'll follow suit for Canada, for Australia, for all the other countries that have that label on there.
- [19:27]
Interviewer / Co-host
So if someone starts vaginal hormones, how quickly do you think they would usually see an improvement in their symptoms of, you know, dryness or that sex is painful? You know, what, what's the Timeframe that people could expect.
- [19:42]
Dr. Kelly
We usually tell people six to eight weeks because. And I tell people it's literally building healthier skin. Right. So it takes some time to do that. It's not just, like a sexual lubricant where it's gonna be moisture tonight. So it really does take a little bit of time, but in the grand scheme, that's not that long. And you have. The other myth is that you can stop taking it then. And it's actually like, well, I used sunscreen last August. What do you mean, I have to use it now? Like, no, you have to keep using it to get it to work. So that's another myth.
- [20:12]
Interviewer / Co-host
I'm so glad you said that, because I have to say, that is one thing that I just come up against repeatedly. People. I'll say, you haven't had a prescription for that in a little while. Are you still using that? And they're like, oh, yeah, no, I kind of stopped using that. Will I start that again? I don't know.
- [20:28]
Podcast Host
Why?
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Interviewer / Co-host
It just seems to be. People just seem to. Once they feel a bit better down there, they kind of seem to forget about it until it starts to get really sore again, and then we end up back in a vicious circle.
- [20:38]
Dr. Kelly
Yeah. You know, some people do moan about it, and I get it. Like, we're busy. Like, self care is not always the number one priority. But I'm like, there's lots of other maintenance things we do all the time that we don't whinge about. Like, I wore a seat belt last September. You mean I have to keep wearing a seat belt? Like, I have to keep flossing. Right. So it's like, we do things all the. I have to drink water today. I drink water yesterday.
- [21:00]
Shauna Watts
Right.
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Dr. Kelly
So you just. I just point out those inconsistencies in people's health behaviors, and then you're like, okay, yeah, well, a little bit of skin care down there. We all do skincare on our faces every single day. This just. This is just a little bit more skincare.
- [21:14]
Interviewer / Co-host
I was attending a presentation at the World Menopause Congress, and it was for the vaginal DHEA product, which I have to say, I really love and love to prescribe. And they were talking a lot to how we've actually got testosterone receptors at the entrance of the vagina, on the clitoris, on the trigone of the bladder. And do we know if using those intravaginal products is actually getting to those places as well?
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Podcast Host
Yeah.
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Dr. Kelly
So I love that product, too. It's just so much more expensive in America, so I don't use it as much as vaginal estrogen. There hasn't been a lot of research on how much is improved. The thought is that it's local, just like vaginal estrogen. But the vagina and the bladder share a wall. I always joke their condo mates. So we do know that those hormones can penetrate into the bladder and the bladder is very responsive to hormones. Dr. Luis Newsome's actually presenting some posters this week in Perth at the Australian Urologic meeting looking at the role of systemic testosterone decreasing bladder issues in women. So we know one in three women will have issues with bladder leakage. Bladder leakage is one of the top reasons that women go into nursing homes. It's one of the top reasons you get up at night to go pee and you fall and you break your hip.
- [22:34]
Interviewer / Co-host
Right.
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Dr. Kelly
We never talk about bladder leakage, but it's actually incredibly common and can be debilitating you. I see older women that they can't leave their house. They're too worried about the bladder leakage. So it's like, why aren't we looking at natural solutions? And again, it's not going to help everybody. Some people do need physio, some people do need some surgical procedures, but these are safe hormones our body naturally makes. We're just simply living longer than our ovaries and going, you know, going back to living longer. It's like, do we ever tell anybody? I'm sorry you outlived your eyes. You don't get glasses.
- [23:06]
Interviewer / Co-host
I'm sorry you keep your cataract.
- [23:08]
Podcast Host
Yes.
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Dr. Kelly
I'm sorry you outlived your teeth. I'm sorry you outlived your hearing. Like, why are we making this crazy exception for ovaries? I think it's probably because we can't see them. Right. Because they're hidden. If we could watch a man's testicles shrink over time, it's a lot more obvious what's going on. We can't see our ovaries.
- [23:26]
Interviewer / Co-host
I think people also assume that your ovaries are just about having a baby. And then, because no one's having a baby when they're 60, well, then why would you need them? And so we're just caught in this paradox down where everyone's always thought of these hormones about sex and babies and puberty and nothing really else. Yeah. And then until we get the message out there that actually these hormones are for every cell in your body, I think it's, you know, we're going to struggle to, to, to get that over the Line.
- [23:54]
Dr. Kelly
Well, I think some researchers are going to put me out of business in a decade. It's going to be fantastic. So I was sitting. It was in 2024. I was sitting at south by Southwest, which is a big kind of thought leadership conference in Austin, Texas. And, you know, me and my team, and we all talk about, you know, and education and hormones. We think we're kind of radical at this point because 10% of women are on hormones, right. Where there's a lot of work to do. So I'm sitting in the audience. This group of PhD researchers goes up on stage and they say, what if menopause is optional? We're working on that. We're figuring out why ovaries do end in the mid-50s, and there likely will be a medication that will keep them going. So, number one, it might be possible to have a baby when you're 60 plus. Do you still want to have your period?
- [24:40]
Podcast Host
Right.
- [24:40]
Dr. Kelly
And number two, even if it's not a fertility thing, figuring out how to keep the hormone producing cells functioning. And I was simply blown away because I'm like, when that research comes to fruition, I'll be out of a job. You know, like, you don't even need to take supplemental hormones. We'll just keep your ovary going. Right. And so it's like, that's the next step of, like, I'm not even all that crazy and saying, let's reproduce. You know, bring back in the hormones we're making. These people are trying to figure out how do we just keep the ovary going a little bit longer, which is brilliant. That's what we need to do.
- [25:14]
Interviewer / Co-host
I attended a conference in Monaco about two and a half years ago, and it was exactly the same. There's a whole female team presenting, and they were looking at how you could preserve ovarian function and seemed to be making really pretty amazing progress. They were like, and this is what the future is going to be, that we will be able to do something that makes your ovaries continue to function. Yeah, that would be pretty.
- [25:41]
Dr. Kelly
Yeah. And so I, like, look to my friend. I'm like, I think we're the radical, you know, thinkers. And it's like, nope. Like, these are the big, big, big thinkers in the, in the field.
- [25:51]
Interviewer / Co-host
Kelly, I want to move a little bit sideways and talk about a group of patients who I think are sort of silently suffering in the background with a diagnosis of interstitial cystitis. And they, these patients are in hell. I have patients who have this condition and they, they tell me they're, like, literally sitting in the shower at times, having to run a hot shower over their body for hours on end to try and relieve the pain and the discomfort. They're having to always have, like, a hot water bottle or a hot pack on them. Like, these symptoms of this bladder irritation are just of the chart. And obviously, we. You and I have discussed previously, you know, potentially, are some of these patients being missed in terms of being given vaginal hormones, et cetera. But can you explain a little bit about what that condition is?
- [26:44]
Dr. Kelly
Yeah, and thank you so much for bringing it up, because I think these people are hidden and suffering often in science, just like you said. So interstitial cystitis is a chronic.
- [26:55]
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- [27:25]
Dr. Kelly
This is how it's described. A chronic incurable disorder of the bladder, usually associated with inflammation and pain. There's no blood test for it. There's no X ray for it. It's supposed to be a diagnosis of exclusion. Right. So you rule out bladder cancer, you rule out a urinary tract infection, you rule out a hip issue. Right. And. But often what I see, and a lot of friends who are female urologists or take care of women in their pelvis is that it's kind of just thrown on people like, I don't know what it. It's probably interstitial cystitis. And then these women will go online and they'll say, oh, my gosh, I'm not allowed to eat all of these foods. They become very food restrictive trying to figure out what's inflaming their bladder. Sometimes that does help. I say, I always tell women, like, is it possible you don't have a chronic incurable disease? You just have a sensitive bladder? And I'm like, what do you like better? And they're like, I like the idea I just have a sensitive bladder to some things. Like, okay, well, my skin is sensitive to something. Doesn't mean I have a chronic incurable disease. Right, right. It's like this. I always say, it's like you're adding Bricks to a backpack for women, and they can never take the bricks out of the backpack. They're stuck with this. This label of something that I think nine times out of 10, they don't actually have. So I'll see women just with recurrent urinary tract infections, they've been labeled with ic. I am not, to clarify for everybody. I'm not saying it doesn't exist. I'm not saying it's not real. I'm saying we're not being curious with a lot of women, and we're just throwing a label on them when a lot of times they. Other things going on, they didn't get a thorough workup. They didn't meet with a pelvic floor physical therapist to look at muscle musculoskeletal options. Certainly hormones have to be part of the discussion. I have so many women, and they'll be like, oh, my interstitial cystitis hasn't bothered me in 20 years since I started vaginal estrogen. I'm like, hubble, get rid of the idea that you have interstitial cystitis then. Right. You just had genital urinary syndrome of menopause that was treated with hormones, and now you're symptom free. But they carry the bricks in the heavy backpack, thinking they still have this. And I think this is, you know, for people much smarter than me, like, the psychological burden of carrying around a diagnosis. Like, we never take diagnoses away from people. Yeah, right. Like it's a kind of a psychological crazy town at some point.
- [29:42]
Interviewer / Co-host
Yeah. We're just adding to the list on their. On their medical records.
- [29:46]
Podcast Host
Yeah.
- [29:46]
Interviewer / Co-host
In terms of bladder cancer, again, a cancer that's not talked about a lot. What are the risk factors and what are the things that we can do to prevent and reduce the risk of us getting bladder cancer?
- [30:01]
Dr. Kelly
Don't smoke. Smoking is the. Is the number one biggest risk factor for bladder cancer. So the metabolites of cigarettes, and I mean for anybody smoking cigarettes, marijuana, vaping, like all of the toxic chemicals get metabolized and then basically hang out in our bladder before we pee it out. So that's how the lining of the bladder gets those chemicals. That's the number one risk factor. Being male is actually a huge risk factor. Women have a lot less bladder cancer, but women get diagnosed at later stages. Why is that? We don't know for certain, but it's likely. We blow her off. She says she has blood in the urine. We say she has a urinary tract infection, she has blood in the urine, we say, well, maybe it was just her period, right? We blow them off more. So by the time they're diagnosed, it's a much more invasive level than when a man comes in and he's like, I got blood in my pee, he gets a workup, right? Women get ignored. And I've seen it in my practice, you know, blood in the urine for half a year, for a year, before they actually get referred to a urologist for bladder scope, CAT scan, and actually see it. Now, that said, the majority of blood in the urine is not cancer. But I always tell people it's kind of like blood in your poop, right? It doesn't mean everybody has colon cancer, but we gotta do a workup to find the people that do.
- [31:14]
Shauna Watts
On Sunday morning, when I was out walking at Terragle beach, which is a local beach, I kept crossing paths with a number of women who all had vests on just like me.
- [31:23]
Interviewer / Co-host
Weighted vests, vests.
- [31:25]
Shauna Watts
And we all gave each other a bit of a knowing look because these have become very, very popular in peri and postmenopausal women. You might not know what rucking is, but basically what it is is walking with a, either a weighted vest or a weighted rucksack. I personally opt for the weighted vest because I find it very, very comfortable
- [31:43]
Interviewer / Co-host
and very, very quick to put on.
- [31:45]
Shauna Watts
So for Perry and postmenopausal women, there are definitely a number of health benefits that you can get gain from walking with extra weight. One of the health concerns that many women have at this stage of life is developing heart disease. And unfortunately, we know in the post menopause the rates of heart disease for women really start to accelerate. So why might rucking or walking with weight change that? Well, basically whenever you're walking with additional weight, it increases your heart rate more and it basically makes your heart exercise thighs a little bit harder. So hopefully making your heart a lot more healthy. So that's one of the benefits of rucking in comparison to standard walking. So if you're intrigued and ready to start rucking, my recommendation would be that you start low and go slow. So start by choosing a weight that is 5 to 10% of your body weight at maximum and take it slowly. You know, go for maybe a 10 to 20 minute walk at first. First, don't decide to go on a five hour hike the first time you strap on your, your weighted vest. So we've been chatting to our friends at Rucksack and I've got a special discount code for you. So if you go to their website which is www.rucksack.com. so R U-K-S-A K.com and use the code SHAUNA15. So that's S-A U N A15. You're going to get a 15% discount. So whether you decide, decide to go for a vest or whether you decide to go for one of their backpacks, either way, you're going to get 15 off. Now let's get back into the episode.
- [33:20]
Interviewer / Co-host
Can we change gears again? Yeah. Let's talk about sex.
- [33:23]
Dr. Kelly
Wonderful.
- [33:24]
Interviewer / Co-host
Okay. I know it's your favorite topic.
- [33:26]
Dr. Kelly
It's a fascinating topic. It's so interesting.
- [33:29]
Interviewer / Co-host
So let's talk. I know you're a urologist and you're interested in the whole person, but when we think of urology, we think of pelvic organs. But I want to talk about the brain side of sex, and I want to talk about libido. Tell me what on earth is going on with women's libido?
- [33:46]
Dr. Kelly
Yeah. So libido. Libido. No. Adults get adult sex education. We get a crappy disease and pregnancy prevention plan. When we were younger, we never learned how to talk about it. We watch Hollywood films. We might watch porn. We get a very skewed view of what our bodies actually work. So. So Sigmund Freud kind of wrecked it for us as he did many things, and he called libido appetitive, which is a fantastic word. But appetitive means appetite driven. And so if you don't eat, you're going to get more hungry. If you don't drink, you're going to get more thirsty. If you don't sleep, you're going to get more tired. Those are appetitive drives. And he said, sex is an appetitive drive for most people. If you don't have sex, you don't want more sex, Right? And so women sit around saying, well, I don't want sex. I guess this is how it is. Now. How our body actually works is the responsive desire is like, no, you shouldn't have sex 24 hours a day because you got to have a job and you got to raise some kids and you got to get some sleep, right? It would be destructive for you to want sex all the time. And there are some people who do have that high appetitive drive, and it can be quite bothersome to them. So how our bodies work is we say, you know what, you're focused on other things. If you put yourself in a place to be receptive, to be open, to be surrounded by sexual cues, it's the sexual cues that actually prime your body for saying, all right, let's prep for having some sexual activity. Those sexual cues are gonna be different for everybody. But it often means being in a relaxed state, not chasing around trying to get 10 things done. Right. Your body needs to be relaxed, to be receptive, to be open, to be able to focus in the present moment, to be focused on bodily sensations. Because it's the combination of the sensations in the pelvis and the brain primed together that makes the best orgasm.
- [35:34]
Interviewer / Co-host
Okay, and so do we. I mean, clearly, then it's a very complicated thing to say why women in the peri and post menopause are struggling with libido. Because it's clearly not just a purely hormonal thing.
- [35:49]
Dr. Kelly
That's right. Yeah. It's. I mean, it's complex, right? Because we're complex. We're complex things. We wouldn't want to be otherwise. You know, we aren't bacterial.
- [35:55]
Podcast Host
You.
- [35:56]
Dr. Kelly
So sex is biopsychosocial, which means it's a little bit biology, a little bit psychology, how our brain is thinking, and then a little bit about how we're socialized. Right. Are you allowed to be sexual? Who's allowed to be sexual? Who's allowed to be sexual more than other people? Like, how are we cultured? Right. Who's allowed to have their orgasm prioritized in a sexual event? The biology part is really where perimenopause and menopause kicks in. And I always joke, like, I got into up menopause because of sex, because I really wanted to understand when women said my sex drive went down with perimenopause, menopause, what did the research say? Now, again, because we're complex, not everybody's sex drive goes down in midlife. Some sex drive goes up probably because they're more confident, they give less shits, they know they can't get pregnant. They're in a partnered relationship that is wonderfully caring and explorative and like. Like, sex positive.
- [36:49]
Interviewer / Co-host
Right.
- [36:50]
Dr. Kelly
So it is a stereotype to say everybody's libido goes down, some stays the same, some gets better. But there is a role. Again, estrogen and testosterone work in the brain. That's where libido comes from. Multiple areas in the brain, too, not just this little box labeled libido in the brain. And so it is more of a myth to say testosterone is the only hormone for sexual desire. I have tons of women using. You throw an estrogen patch on them, their hot flashes are done, their heart. Their heart palpitations are Done. They're sleeping better, their mood's better, and the libido's allowed to rise naturally because she's just simply feeling better. Right. So it is wonderfully complex, but it is very real if you notice that your sexual function is changing in midlife.
- [37:33]
Interviewer / Co-host
So I kind of feel like I see a number of different. You know, you see patterns among your patients. So I think one of the patterns that I see are people who are very happily partnered. They're very loyal to their partner, but they've got a lot of guilt because they just can't be bothered. I had a lady who, I have to admit, she did make me burst out laughing because she said she'd rather have a warm ham sandwich than have sex. You said she just couldn't be bothered. She's like, just leave me alone. Let me watch my Netflix show. But a lot of women express a huge guilt. Yeah. They'll say, I feel so bad for my partner. And sometimes they'll say, well, do you have sex? And they, oh, yeah, I do. But, like, I. I don't want to have sex at all. Or it's uncomfortable. They kind of put up with it because they feel like that's the thing that you should do.
- [38:31]
Podcast Host
Yep.
- [38:31]
Dr. Kelly
Yeah. Yeah. What we call. I mean, there's. There's so little research in it, I think, because we don't prioritize women. But this, like, duty sex is what they call it, or. Or, you know, you just have to do it to keep other people happy. Now, some people do it out of love, but some people do it out of, like, I don't want this relationship to end. I want to prioritize it. So a good sex medicine, doctor, is they're just curious people. Right. Because if somebody says, I don't want to have sex, that could be 12 different reasons why? Is it because of pain? Is it because you never had great sex in the first place? Or is it because the sex was great, but now really the idea of it? And we have to then think about dopamine receptors. We have to think more about hormones. Right. The people. And then there's the people who simply say, I want to want. Okay. Versus the people who are like, no, I'm not thinking about it. I'm running a business. I got kids. But when I am in that sexual context and I know how to focus on my pelvis and I know how to relax my brain, we have a wonderful time. I just need to prioritize that in my life more than I have been doing. So it's wonderfully. Complex. There's really help for everybody. The, the International Society for the Study of Women's Sexual Health, which is a mouthful, but it's the Ishwish conference, it just happened in Atlanta in the States this week. And they're coming out with exciting processes of care, specifically looking at orgasm. That's kind of that. We've done a lot more work on desire than we have with orgasm. So that's. That's going to be the kind of the exciting new thing. I can't wait for them to publish that paper. Probably still another year or two out from that. But they're starting to talk about in a more scientific way instead of just blowing off like, o, you can't orgasm, drink wine. Right. Instead of like, no, no, this could be biologic, it could be psychologic, it could be sociologic. Let's look at orgasm and how to help women achieve that.
- [40:21]
Interviewer / Co-host
Have you have any resources or, I don't know, websites or apps or courses that you think are helpful for patients?
- [40:29]
Dr. Kelly
Yeah. As far as, like, sex, like orgasm. Yeah. So a very old book she's unfortunately passed. It's by Betty Dodson. It's called Sex for One. And that's really understanding your body, how orgasm works. Becoming Clitorate by Lori Mintz is fantastic. I think that book is still in print. OMG yes.com is a great ed.
- [40:50]
Podcast Host
If you.
- [40:50]
Dr. Kelly
If video doesn't turn you off and you really like. It's. Sex is hard. Right. Because you can't. With Dr. I have heart palpitations. The doctor can put the stethoscope on the heart and understand that. But when somebody says, I don't like sex, you're like, that's a black box. I don't know what you're doing in there. Right. Are you rubbing elbows? So if you want more video, how to. Omg yes is useful. Make love, not porn is amazing for sex education. Just normalizing sexuality for normal people, normal bodies and for people. They have, you know, they have videos and stories of people with ostomies. They have videos and stories of people who are survivors of sexual assault. So really kind of opening up and normalizing sexuality for all people, all bodies, all ages. Because again, that. That sociology part of biopsychosocial is only certain people are allowed to be sexual. You have to be a certain age, you have to look a certain way. That's all made up and so really opening that up to everybody. There's a lot of work being done with sexual health and people with disabilities. So there's. I forget they were just at a
- [41:57]
Podcast Host
conference I was at.
- [41:58]
Dr. Kelly
It was like, oh, clitoral model. If you go to clitoral model on Instagram, they're doing. They're coming out with a book on perimenopause and sex and doing a lot with, like, what does healthy, normal anatomy look like? Because probably a whole other podcast episode, but the amount of women who don't know what normal bodies look like because our images have been banned on the Internet, and then they go in and they literally have cosmetic surgery to fit a fake ideologic normal pattern. To me, that needs to be talked about. I think education will go a long way into body acceptance.
- [42:33]
Interviewer / Co-host
Do you encourage your patients to, like, get a mirror and have a look at their body parts?
- [42:38]
Dr. Kelly
Absolutely. Yeah, Absolutely. It's tough. You do need a mirror for some of these parts. But just in exploring people's discomfort with that idea of, like, do you have a problem looking at your elbow? No. Right. Like, okay. Isn't it so interesting that there's a part of your body you're uncomfortable looking at? Wow, what's that about?
- [42:58]
Carvana Ad Voice
About?
- [42:58]
Dr. Kelly
Where did that come from? So it's even like, just exploring that a little bit. And even if you end up never looking at it, just understanding, oh, my gosh, there's a part of my body that society's told me not to look at. That's super interesting.
- [43:12]
Interviewer / Co-host
I will just share an anecdote, but when I moved from being a GP in Northern Ireland to being a GP in Australia, I found it incredibly interesting how Australian children are much more comfortable talking about body parts arts than children in Northern Ireland are.
- [43:32]
Dr. Kelly
Interesting.
- [43:33]
Interviewer / Co-host
Very interesting. So it's obviously very culturally driven.
- [43:37]
Podcast Host
Yeah.
- [43:38]
Dr. Kelly
I mean, parents are role models, and people always ask, like, how do you have the sex ed conversation with different ages? And for the young ones, normal anatomic words for our body parts, they can communicate better. They can communicate with their partner better. They'll be able to communicate with their doctor better. So with my children, it's just like, you know, if they say something hurts, I'll say, what hurts? Is it your labia that hurts? Is it your, you know, vulva that hurts? Is it more on the back? Is it your anus? Is it your rectum that hurts? And, you know, not that they need to get it right, but just me normalizing. There's a lot of different body parts down there. And I think a big problem, you know, going to the doctor is people saying, it hurts down there if they don't get an exam, if they don't know what body part it is. They're usually just given antibiotics for a suspected urinary tract infection. Right. And there's so much more that happens to our pelvis than urinary tract infection.
- [44:30]
Interviewer / Co-host
Well, I don't know whether you have the same experience, but I think it's very interesting that whenever you do examine a woman as a doctor, they're always apologizing. So they'll be apologizing that, you know, they haven't waxed or they'll be apol. You know, they just are so apologetic. And I think that's another. That's probably a conversation for another day. But, you know, no one apologizes when I need to listen to their chat test.
- [44:57]
Dr. Kelly
Right, right. I'm so sorry I didn't clean my ear today.
- [45:00]
Shauna Watts
That's right.
- [45:01]
Dr. Kelly
And that you have to look at it.
- [45:02]
Interviewer / Co-host
Yeah, but they're so. And they'll. And even after you do their cervical screening or I do an internal examination, they'll always apologize and say, I'm so sorry that you had to do that. That must been awful for you. I'm like, no, like, that's my job.
- [45:17]
Dr. Kelly
Well, I mean, thanks for calling that out because I think a lot of people don't realize even that behavior is tied into society telling us that parts of our body are shameful and we carry stuff with us. I saw a woman, middle aged, she was probably mid-60s, and she was there for whatever reason that we needed to do a pelvic exam. And she apologized. And I said, listen, I look at so many vulvas that I'll just draw a bell curve and I'll just tell you where you are on the normal scale. Right. Spoiler alert. Most vulvas are normal. So she said, okay. And so her. Her husband was with her. And I'm like, listen, your vulva is completely normal to the point that your vulva is completely forgettable to me. I will never remember this vulva. Right. It's so normal. And she had had an ex husband, I believe, tell her how abnormal she was and how unattractive her vulva was. And she decided that that person's opinion was the most important opinion and that she would carry that with her for the rest of her life. And her current husband was like, I told you. I told you it's lovely. I told you it's beautiful. Like, can you believe the doctor now? Because I've been telling you this for years. She was carrying this opinion with her the whole time. And it's like knowing you're normal matters. Knowing that your Body's health. But where are you going to find that? On the Internet, right? It's, it's banned, it's blocked, it's considered vulgar. And I think that's where make love, not porn, comes in. And then all, all of the, the websites where they actually can show like vulvas are like fingerprints. Right?
- [46:52]
Podcast Host
Beauty.
- [46:53]
Dr. Kelly
Listen, not all scrotums look the exact same either, by the way.
- [46:56]
Carvana Ad Voice
Right.
- [46:57]
Dr. Kelly
Like, we're not, we're not Barbie dolls. We're not all supposed to look a certain way.
- [47:01]
Interviewer / Co-host
I loved yesterday, you and I were looking at that model and, and there is some asymmetric asymmetry because I've had so many quite young women coming in, asking. So in, in Australia, if you want to see a special specialist, you need to get a referral from a general practitioner. So if you want to see a plastic surgeon or urologist, you know, you need me to refer you. And so they will come to me. I've had probably in the last six or seven years, definitely have had a few young women who've come in and said, look, I've checked it out online, I've looked and I know that there's an abnormality. I'm asymmetrical and I want to go and have plastic surgery. But whenever they're checking out the images, I'm saying, okay, well can you show me what images? You're looking at one. They're either looking at a very, you know, diagrammatic drawing out of an anatomical textbook or they're looking at pornography. And again, you know, nothing looks completely normal there either. And it is definitely such a, like, I just think it's so sad that people are going to the lengths of having painful surgery to try and have some kind of cosmetic normal.
- [48:14]
Dr. Kelly
Totally. I mean, these are sexual organs. There's nerve endings that can be cut. There's, you know, know, reports of diminished orgasm, trouble with arousal. Labia are erectile tissue. So it is not to be taken lightly that we're going to trim these away. And by the way, labia go away after menopause with a low hormones. And women are horrified that their labia goes away. So I'm like, okay, we spend years wanting to cut it off and then we spend years trying to get it back. Can we stop the madness? Right? And I'm also very aware of women, women tend to have less money than men. For us to be spending our hard earned dollars on stuff that at the end of the day, maybe we should be spending our money on something else versus, like, I mean, how many people Truthfully are going to be looking at your labia. Now that said, there's always a, there's always can be a medical indication if they're long to the point where it's difficult riding a bike, if during intimacy they're getting pulled into the vagina and causing pain. I'm not saying all labiaplasties is like to do a ban on it. I'm just saying the unnecessary ones that are not covered by insurance because there isn't a medical reason and for reasons of miseducation, lack of education, a lack of body acceptance, those are the ones where I'm like, it's quite possible all of those labiaplasties do not need to be done.
- [49:34]
Interviewer / Co-host
Yeah, 100%. Another group of women that I see are young women who maybe have only had, had one or two sexual partners and they also have very painful sex. So dyspareunia and it's causing, they've actually got a very loving relationship, but they just can't really have sex. Can you talk to what might be going on there for those women?
- [50:00]
Dr. Kelly
So again, biopsychosocial, it can be multiple things. So seeing a sex medicine physician, seeing some, somebody who can talk through all of that because otherwise you're just going to again be told, just drink a glass of wine, just do it anyways. Try using more spit. You know, all these things. There's always a sex ed component that I always go back to because so many people and the young people aren't having any better sex ed than we had when we were young. That sex begins by putting a hard penis in an unaroused vagina that causes pain. Hands down, that causes pain. And even young people with normal hormone levels, if you take it, an unaroused female pelvis and put a hard penis in it, that vagina is not ready. That alone causes pain. So vaginas, when they have proper blood flow, we have erectile tissue down there, just like penis owners do. The vagina will actually lengthen and the cervix and uterus will tip back to make accommodations for accepting something. If you don't have that arousal before you put something in there, it can cause pain. And also if your brain's not turned on, your brain's like, is this a tampon? Like what are we supposed to be doing right now? Like you have to tell, for lack of better words, warm up the body. Like, don't go run a 10k without like doing it a little bit before. You just do a full out sprint. Right. But when society Tells us, and Hollywood movies tell us that sex starts by putting a hard penis in a vagina without any warm up. That's pain. So I always think about that in young women. Like what, what kind of sex are you trying to have? And is your body warmed up for it? There can be tight muscle issues. There can be basically low hormone issues. If you're on oral birth control pills, your vulva can look, for lack of better words, menopausal. Because oral birth control pills do tend to block hormones down on the pelvis, especially some of the newer lower dose birth control pills. You can really look like a tight, irritated vulva down there. So sometimes we have to think about other birth control options or adding in vaginal hormones way before your menopausal. So also the role of the brain, right? Has there been trauma in the past? How's the body image? How is your mindfulness and being able to be present in the moment? So sex really is wonderfully complex, but it takes time to dissect this out. The sex medicine doctors are basically like detectives, right? My friend Rachel Rubin says we're sex detectives. So you've got to figure out what exactly it is. And this is often, can also be what happens happens. There are some men penis owners with very above average penis sizes. There are some women with very smaller pelvises. Not saying those people shouldn't be together, but to say sometimes the anatomy is a little bit challenging. Nobody ever talks about that, right? So all of that needs to be explored.
- [52:49]
Interviewer / Co-host
We talked about yesterday a little bit about this to mismatch libidos. Can you explain to the audience your thoughts on that?
- [52:59]
Dr. Kelly
Yeah, yeah, I like to normalize mismatched libidos or what, you know, the experts call desire discrepancy. Because what we tend to do is we tend to make the male level of libido the default. And so the woman's wrong no matter what if she's, if she's partnered with a man. So if we have a man's libido at like whatever level, Level zero, let's say if she wants sex less than that, then she's the problem because she has low desire. If she wants sex more than that, then she's the problem because she wants, she wants sex more. She has the high desire. So the woman tends to stereotypically be circled around what this default of normal is. And when you look at that, you're like, well, that's crazy, right? How come, how come we never say that he's the problem now? We do sometimes when she Wants sex more, then he's the problem. Instead of saying, like, like, no two people are ever perfectly matched on anything. Like, my husband likes to floss and then brush his teeth. I would like to brush my teeth and floss. Like, we. We are not matched on anything. And so this, like, societal expectation that you must be perfectly matched with your partner till death do you part is a complete myth that's really hurting relationships. You know, this. The stereotype awful story is when the man brings his female partner to the doctor and says she has low libido. Festival fix it. And we're like, can we fix you? Right. Like, the, the loving understanding that not everybody needs to match somebody else is where I always start, is just normalize it and then normalize that. Let's stop blaming the woman for her always being the problem.
- [54:33]
Interviewer / Co-host
What about if you have a happily partnered couple? I've had a few of these, again, probably in the last two years, who've come to me and they said, you know, we're actually very happy their children are grown up, up. But we're. We actually feel like we've had very boring sex our whole lives. We've been together since we were 17 and we're now 50. Whatever. Any resources or hints or tips of how these people can move forward and have a more enjoyable relationship?
- [55:02]
Dr. Kelly
Yeah, yeah. It's a great question. Because in medicine, you know, in my career, I. We spend so much time just getting out of dysfunction, right? Where we're kind of like, oh, it's average or mediocre. Congratulations, you've reached the pinnacle. But there's this whole other level of, like, what if it could be exceptional? Like, you know, you work out forever and then you're like, okay, well, what if there's, like, a next level of fitness? What if there's a next level of cooking? What if there's the next level of, you know. Right. Creative writing? Right. There's.
- [55:28]
Interviewer / Co-host
We.
- [55:28]
Dr. Kelly
We're humans. We want to optimize. So really, I love that the conversation is like, hey, let's not. Let's not call it good enough just to not have pain. Let's not call it good enough just to be okay with our sex life. What if there Is this optimization? Dr. Emily Jamia, J A M E A just wrote a book that just got published called Anatomy of Desire. And what I really like about that book is it's answering that question of, like, yeah, this is fine. Like, certainly better than all the horror stories I hear. But what if there's the next phase and people may have Heard of what we call the flow state. And the flow state is when you're like, like really engaged in something that you are, have kind of become a master of and time stops. Your brain's not thinking of the past or the present. And she basically goes down and knocks out flow state and applies it to sex. And what has to be present to really be in flow state with sex, where it is this like transformative, spiritual, amazing thing where time stops. You don't know what country you're in because you're so present with pleasure. So her new book I think is fantastic for this. Um, and I, I hope we're going to get more and more. The Magnificent Sex by Peggy Klein Platz is another good book. Just Basically she's a PhD researcher and she was like, hey, who has great sex? And you know, these people emailed her and then she interviewed all of them. And the most important thing I think about that book is nobody who said they're great at sex and they love sex. Nobody said it's because I have spontaneous desire for sex. Because everybody says, like, I just need desire to have great sex.
- [57:05]
Shauna Watts
Sex.
- [57:05]
Dr. Kelly
No, most people would say desire has nothing to do with great sex. And her research supported that. If it's. I'm okay to try new things, I'm okay to feel safe and to communicate the need for safety. Safety is horrifically under talked about in playing it. The role in good sex. Trial and error. Prioritizing time communication is an absolute must.
- [57:28]
Podcast Host
So it's.
- [57:29]
Dr. Kelly
If you research the people who are having extraordinary sex, you can learn from the pros.
- [57:32]
Interviewer / Co-host
And what do you think about those who recommend having, like scheduling it because we've all got busy lives and that. That you literally have time set aside that that's. Or do you think that's not really hard because it sort of feels counterintuitive?
- [57:46]
Dr. Kelly
Well, I wish I had a spontaneous desire to eat vegetables. And I wish I had a spontaneous desire to go to the gym. But we don't always, right? So you have to prioritize. Like, I need to have Jimin the
- [57:57]
Podcast Host
gym in my life. Life.
- [57:58]
Dr. Kelly
I need to have vegetables in my diet. And then when you're eating the salad and after your workout, you're like, yeah, this is what I want in my life. I'm so glad I do this. But I don't sit around, you know, scrolling on my phone, drinking coffee, spontaneously desiring those things, right? So you have to put yourself in the context. And that's what scheduling sex does, is it says, this is the time we're going to block everything out. The basically almost everybody believes scheduling sex is good. The people who have a problem with it are the ones who say there should be no pressure to perform, there should be no pressure to orgasm, there should be no pressure to have, to have penetrative intercourse. It's when you put pressure on that block of time that it can become problematic. But what they've found is scheduling sex, especially in that desire discrepancy couple. It takes the pressure off of one person always pursuing, hoping that they're going to get a yes at some point and the other person always having to say no and this person feeling rejected. It's like Monday through Wednesday, we're not even going to talk about sex Thursday for however many minutes you think is appropriate. And let's remember we don't rush through other pleasurable things in life. So let's not rush through this pleasurable thing. That's where we're going to say let's be together, let's connect, let's touch in. The role of non sexual touch throughout the week is incredibly important. Research has shown that people who just touch non sexual more during the week actually have more sex. So it's that connection. And I always joke, one final thing is I always joke there's two people living in a house. The person who needs sex to feel loved and connected and the person who needs to feel loved and connected in order to have sex. They've never communicated that with each other. They're living in the same house and they don't even know what's the likelihood
- [59:41]
Interviewer / Co-host
of a female having an orgasm with a male partner Partner.
- [59:46]
Dr. Kelly
It goes up the more connected and the more long term relationship it is. So right now the orgasm gap in heterosexual relationships is about 60% for the woman, man's clocking in around 98%, 97% of the time he'll have an orgasm. So even in a partnered, loving, long term heterosexual relationship, she's clocking in around 60% of the time. And that means of all people researched and but if it's hookup culture sex, you know, in America it's the university drinking culture, hookup culture, she's having an orgasm about 6 to 7% of the time. And for the purists out there, orgasm isn't always the end all be all for pleasure. But it is a marker of prioritizing one's sexual pleasure. So when you see that marker be as low as 7%, I say what the hell are these women doing this for? They're clearly prioritizing somebody else's pleasure. In these relationships, communication is usually universally not there, and penis and vagina or penetrative sex tends to be the model as to which 70% of women do not orgasm.
- [60:51]
Interviewer / Co-host
Unbelievable. I mean, it really is such a culture. And you do have to wonder what all these young women are getting from this, and is it because they're lonely or that's what their friends are doing or.
- [61:03]
Podcast Host
Yeah.
- [61:03]
Dr. Kelly
I mean, I'm no social psychologist, but to me, it's like, it's nice to be desired. It's nice to be wanted. It's nice to be thought of as. As being sought after and attractive. But if that's part of the game, to set yourself up to vulnerable situations, especially when alcohol is involved, it's a losing game for a lot of women.
- [61:25]
Interviewer / Co-host
Kelly, I just want to finish by asking you. I've been so lucky. This is the second time you've been on the podcast. I've watched you present live. I've shared a stage with you. You are incredible. You're funny, you are smart. You're so captivating to every audience. Why do you do this? What drew you to really put yourself in a position where people can criticize you and love you all at one time?
- [61:54]
Dr. Kelly
Yeah. I mean, it originally started again with my patient zero. Right. I had a woman crying in my office because of a sexless marriage. And I was told in my training, women are difficult. We're challenging. We'll never figure them out, and we take too long. I was told all of those things, and really, that patient. The lightning struck my brain to say, I don't know. Does anybody know? Was everything I was told true and really started. It was a point in my career where I was open to learning new things because you get kind of good at what you do, and it gets a little dull. Even surgeons, that's the way our brain works. So I was ripe to be able to be curious. And that curiosity has kept me learning and being on the forefront of, like, man, women's sexual health now is. Is booming more than it ever has been. Menopause now is booming more than it ever has been. Like, I'm just one step. I'm, like, catching these trends. I don't know what next trend there is. We have enough work for a lifetime. But realizing, like, at some point I had the knowledge I couldn't help enough people just by them coming to my clinic in my city. And the suffering is so incredibly profound. It's so like, nobody wants to talk about this, but as soon as you talk about it everybody wants to talk about this. The suffering is absolutely profound. And it's a spiritual journey for me. Like, I now truly believe I was put on this earth to change the world and I'm doing it with friends. You cannot do this alone. Some people are very invested in not being curious, in keeping the status quo the way it is. And we can see them for that and we can love them for that and say they don't have the vision of the world where it's a different place. We have that vision and that's what keeps us going. Because we don't do it for number of followers, we don't do it for number of likes. I don't do it for ad dollars. Those are all just amazing things that happen when how you're presenting is resonating with the world. And to me, I'm like, you know what? Keep doing. Sex is too interesting to ever be done talking about it. And there's always more coming out. So it's a wonderful, intellectually challenging thing, which keeps me engaged too. And I love making people laugh.
- [63:58]
Interviewer / Co-host
You're very good at it. What piece of advice would you give 20 something Kelly, if you could talk to her?
- [64:05]
Dr. Kelly
Oh, God, it's going to be really fun. Like, your hard work paid off. The world is big. I mean, even, even five year old or five years ago, Kelly, if you would have been like, hey, you'd be quitting your job to open up a clinic, to speak on the Sydney Opera House stage, to be on your book, to have the top five medicine podcast on Apple, like, I would have not known how to do that. I would have believed her and I would have been like, buckle up, enjoy the ride. You know, so I'm happy to be here.
- [64:39]
Interviewer / Co-host
It's very clear that you're definitely enjoying the ride, which is awesome. Thank you so much.
- [64:43]
Dr. Kelly
Thanks for having me.
- [64:44]
Interviewer / Co-host
This podcast and any information, advice, opinions or statements within it do not constitute medical, healthcare or other professional advice. Information is provided for educational and entertainment purposes only. If you have any health concerns, always consult your doctor.