#81 Perimenopause_Menopause: Empowering Sexual Health with Dr. Sadaf Lodhi

Discover the transformative power of understanding perimenopause and menopause with our insightful guest, Dr. Sadaf Lodhi, an OBGYN and intimacy coach. We promise you'll gain a deeper appreciation for the impact these stages have on women's sexual health, covering everything from the onset of symptoms like brain fog and hot flashes to the systemic factors that influence the journey for different ethnicities. Dr. Lodhi shares wisdom from her coaching practice and her own podcast, highlighting the importance of self-advocacy and the growing movement for better treatment options.

New book out "Dare I Say It: Everything I Wish I'd known about Menopause" by Naomi Watts...highly recommend it! https://amzn.to/3WXc6NF

Chapters

• 0:00 Effects of Perimenopause and Menopause
• 7:37 Effects of Menopause on Sexuality
• 13:44 Vaginal Estrogen and Vulvar Health
• 22:13 Empowering Mindset Shift for Sexuality
• 27:33 Empowering Relationships and Sexual Health
• 37:37 Sexuality, Pleasure, and Relationships

Transcript

Speaker 1: 0:00

Welcome to the Straight from the Source's Mouth.

Speaker 2: 0:02

Podcast Frank talk about sex and dating. Hello, Tamara here, Welcome to the show. Today's guest is Dr Sadaf Lodi, OBGYN and intimacy coach, and we'll be talking about the effects perimenopause and menopause can have on your sex life, her coaching practice and her own podcast. Thanks for joining me, Dr Sadaf.

Speaker 1: 0:23

Thanks so much for having me on. I really appreciate your time.

Speaker 2: 0:27

Yeah, I think this is a great topic. Obviously, as I read somewhere, half the population goes through this at some point, so it's good to know on both sides for the women and the men like the differences that can happen.

Speaker 1: 0:38

Yeah.

Speaker 1: 0:38

So I think that you know. What's important to realize is that perimenopause can start way before menopause. So menopause for the majority of people here in the US, for women, is at the age of around 52. Of course, it can happen either before or after, but that's kind of the mean age. And what's important to realize is that perimenopause is a time before menopause. So, and this is the time where sometimes women's period can become irregular, they can start to notice some brain fog, they can have some heart palpitations, maybe even some arrhythmias, they can have joint pain, they can have dry eyes. There's so many symptoms that come about with perimenopause and what's important to realize is that sometimes these and of course the most common ones that are hot flashes and night sweats, and that's what a lot of women will complain about around this time. What's important to realize is that sometimes, even after the menses completely stop, these symptoms don't always go away and sometimes it can get even worse, for example, like the joint pain can get even worse, and we'll talk a little bit about these things. But what's important to realize is that different ethnicities go through menopause for different lengths of time. So, for example, there is a study that was done. It's called the SWAN study and it was a multicenter study and it looked at women through mid midlife and what they noted was that Caucasian women tended to go through perimenopause for about seven years before they had a cessation of their menses. So when you have no period for a whole year, then you're considered in menopause. If you go, you know, like 11 months with no period and all of a sudden the 12th month you have a period, then you're not in menopause. Yet it's when you go a whole year without a period. Like I said, caucasian women around 7.2 years, african American women they say about 10 years, and Hispanic women 8.9 years, and East Asian women. So, for example, japanese women go through perimenopause for about five years and they think that perhaps, you know, african American women and Hispanic women tend to go through perimenopause for the longest period of time and they think perhaps that could be due to systemic racism that then affects their DNA, which causes their telomeres to get shorter, which makes them more at risk for certain diseases and also for going through perimenopause for a longer period of time. So you know, that's really important, because if we're saying that the mean age for somebody to go through menopause is 52, and we, you know, and if you're looking at a Caucasian woman, we say that she goes through perimenopause for seven years, then we're saying that perimenopause could start as early as the age of 45.

Speaker 1: 3:30

And that's important to know because if you start having hot flashes and night sweats and mood swings and all this stuff, and you go to your provider and you tell them, hey, I'm having all these symptoms, I think I may be in perimenopause, you know, don't accept it if they say you know you're too young, because that's not the case. You know, and I think a lot of women have these, all these symptoms that they can't explain and they don't know what's going on. And they, you know, there's actually a term that's been coined for this is called not feeling like myself. And you know, a lot of women feel like that.

Speaker 1: 4:02

And what's important is that once you know about all these things, then you can advocate for yourself and you can say well, you know what. I know that you think I may be too young to be going through this, but that's not the case. I have heard, you know, in this podcast. You know that I can be going through perimenopause for a long period of time. I really want you to take a listen to me and really listen to my symptoms and listen to what I'm experiencing so that you can best help me. Right and I think that's really the most important thing is knowing about what these symptoms are, how long they can last, and then you can go and advocate for yourself.

Speaker 2: 4:38

Yeah, and I definitely. I know lots of people that are having those symptoms and and I know it's becoming more of a thing now. I know Oprah has talked about menopause and more and more people are getting educated, but it's maybe not the medical establishment as much.

Speaker 1: 4:51

Yeah, yeah, and I think it's, you know, it's really important because I agree with you. I think that menopause is now really having a moment right now, and I think what's happening is that women are no longer standing for the status quo. You know, we're not accepting the fact that this is just something that happens and we have to deal with it and it's going to, you know, happen for the rest of our lives. I think that people are really wanting treatment and they really want physicians and providers that will listen to them, that will, you know, help them and not dismiss their symptoms, and I think that that's really what's happening and I applaud it. You know, I think it's really important. I think, also, there's been recent advocacy on how employers can support their employees during this time, and you know what are some modifications they can make in their offices so that they can better support women going through perimenopause, menopause, and I think this is super important.

Speaker 2: 5:46

Yeah, definitely. And then also we are going to talk about how it affects your sex life. But I wanted to ask first are you a fan of hormone replacement and like which? Like we talk about sex with or without hormone replacement? Maybe Absolutely.

Speaker 1: 6:00

Absolutely so. I, you know. So, just so your listeners know, I am, I am a board certified OBGYN. I'm also a menopause society certified practitioner as well as a sex coach, and I am what's called an Ishwish fellow, meaning like I'm a fellow of the International Society for the Study of Women's Sexual Health. So sexual health is near and dear to my heart and I just think that it's because, you know, one, sexual health is part of health and, two, we just don't talk about it enough. There's a lot of stigma, there's a lot of, I guess, shame or, you know, people just feel really uncomfortable talking about it.

Speaker 1: 6:36

But I, what I want people to know and understand, and your listeners understand, that it is a part of your health and it's really, really important that if you're experiencing some type of sexual dysfunction, that you go and approach your doctor or whoever provider, whoever that you see that you're having this dysfunction, and that you allow enough time. You know, unfortunately our health care system is really broken and so we have about 15 minutes to go talk to our doctor, right, like your doctor is trying to see like 40 patients in a day. And so now here you are, you're coming in, you're saying you know I'm having pain with sex. Your doctor has 15 minutes to deal with that. Unfortunately, a topic like that takes like about an hour. It is not something that can be resolved or even, you know, fully examined in 15 minutes. So you know when you, if you're having an issue like that, I really want you to make sure that you have enough time allotted in your appointment, you know, and just ask whoever you schedule with to ask them if you can get a half hour appointment, because you know it's going to take a little bit.

Speaker 1: 7:37

So you talked about you know what are some. Am I a fan of hormones? Absolutely A hundred percent. Hormones are something that we have naturally in our bodies, right and around the time of menopause. That's when our estrogens stop making hormones. So that's when you know we no longer are making estrogen or progesterone. It goes pretty much, you know, down to zero almost, and if not to zero. And what's really important is that when we have that steep decline of estrogen in our bodies, you know we are at risk for cardiovascular disease, we're at risk for osteoporosis. We have vasomotor symptoms like hot flashes, night sweats, mood swings.

Speaker 1: 8:16

We have the genitourinary syndrome of menopause, which we're going to get to now, because you know that was kind of the question that you had about how menopause and premenopause can affect your sex life, and that is a super important question and I really applaud you for asking that, because that's something that people really feel embarrassed talking about and they really shouldn't, because, again, sex, sexual health, is a part of our health and you know, for most, for a lot of women, they want to continue to be sexually active long into their 80s, 90s, however old you know that they're able to be. And just because you're in menopause doesn't mean that all of a sudden now you have to become, you know, abstinent. That's not it, you, it's really up to you. It's a decision that you make and you decide what happens. So, in terms of what happens to our bodies when we are going through perimenopause, menopause, and how does that affect our sex life?

Speaker 1: 9:08

So during this time, what we notice is, when we have this decline of estrogen, we see changes in our vulva, in the vagina, in our bladder health, okay, and what I want your listeners to know and you might be surprised, but I'm not surprised anymore that sometimes women come to me they're not really sure how many holes they have. So we just to kind of clarify that. We have three holes we have a urethra where we pee from, we have a vagina, and that's you know where the baby comes from through really that tunnel, that vagina, and we have the rectum where we poop from. So just, I just want to kind of get that out of the way. So what happens is that during this time, as the estrogen declines, we see changes in not only the microbiome of the vagina, where the pH goes up, making us more susceptible to bacterial infections, but also what we notice is that the tissue becomes thinner, and that's really important because, as that and it's because of the estrogen, because the estrogen goes down estrogen is responsible for so many things it's responsible for elasticity in our skin, it's responsible for the collagen, it is responsible for the blood flow, it increases blood flow, the blood flow, it increases blood flow. And so when that estrogen goes down in our vulva, in our vagina, that tissue becomes thinner and we have decreased blood flow in that area. When we have decreased blood flow, we have decreased lubrication.

Speaker 1: 10:38

We can have problems with arousal, we can have pain with sex. Okay, and that's the biggest thing is that people come in with because they're having pain with sex. Why are they having pain with sex? They're having pain with sex because one that tissue is thinner and so there's more friction, there's decreased lubrication, so that increases the friction right that your body, your cells are making decreased lubrication. That tissue is becoming thinner so it's more prone to, you know, tearing. It's not stretchy as much as it used to be, again, making it uncomfortable and possibly potentially tearing.

Speaker 1: 11:15

You know you can have decreased arousal because you're having pain, right. Anything that causes pain you're not going to want. So you know, for women, as they get older, if they're experiencing pain with sex they're not going to want it, and that was, I think, the key thing to remember. So if you're having pain with sex, you need to go and see your provider and let them know. Especially if you're in this perimenopause, menopausal time, you need to let them know so they can help you out.

Speaker 1: 11:42

So some of the treatments that we offer to women that are going through this and also I didn't mention that you can have issues with your bladder, you can have overactive bladder. Again, there are receptors of estrogen on that bladder and so you know, some women during this time feel like they have, they have this urgency where they have to go to the bathroom. They have to go right away. If they don't go, they're afraid they're going to. You know, pee their pants right. Because of that overactive bladder. You also have recurrent UTIs because that urethra starts to get bigger and if you saw a menopausal woman, if you saw her vulva, you would notice that the opening of that vagina has become smaller but her urethra has, which she pees from, actually gets bigger and making her more prone to have bladder infections. That's why women in like nursing homes, those poor ladies that are not able to get up and urinate and take care of themselves, you know they sit there and they can get these recurrent bladder infections that can then eventually go undiagnosed and lead to sepsis and even death, because you, you know we're not picking up on these bladder infections that these poor women are suffering through. So that's why it is super, super important that during this time when you are in perimenopause, menopause, and if you're having pain with sex, that you go and you get evaluated and you get treated.

Speaker 1: 13:00

So let's talk a little bit about the treatments that we have for women during this time. We have, you can do, lubricants, but I will tell you lubricant is not going to solve the problem right. What a lubricant does is it's great for sex and there's tons of lubricants. There's, you know like. You can have oil-based lubricants, you can have water-based lubricants, you can have silicone-based lubricants. I think the silicone-based lubricants are probably the best. They based lubricants. I think the silicone based lubricants are probably the best. They last the longest and they don't dry out and they don't, you know, you can use. They last a long time and they don't cause any type of like fungal infection or anything like that. So I think that that's why I really like those silicone lubricants and they're fantastic.

Speaker 1: 13:44

But a lubricant is only going to get rid of the pain with sex, right, it decreases friction. So, although lubricants are great and you know women during this time may be having a harder time making lubrication on their own those lubricants are great for that. However, they are not taking care of the problem, right. They're not going to help with that elasticity. They're not going to help increasing that collagen. They're not going to increase with that lubrication. They're not going to help with the bladder health that we're talking about, you know.

Speaker 1: 14:11

You, what women need during this time is vaginal estrogen. That vaginal estrogen does not go throughout the whole body. It only is in the vagina. It stays there. It's very low dose and it is really important, and what that vaginal estrogen will do is it'll help with all of those issues, right.

Speaker 1: 14:32

So with that, it'll help to plump up that tissue. It's going to increase blood flow to that tissue, it's going to increase lubrication, it's going to help with that overactive bladder, it's going to help prevent recurrent UTIs. It's going to do all of that and it's going to maintain your vulvar health and that is the biggest thing. So, even if women are not sexually active, it doesn't really matter. The point is, is that you want to really really maintain your vulva. Some women also use moisturizers, and moisturizers are fantastic. It's kind of like you know how you have a moisturizer for your face, you have a moisturizer for your vagina and what that does is it increases the water content in those cells to make it more plump. The one that's used the most in a lot of these moisturizers is called hyaluronic acid, and it's great for that. But again, it's not going to help with the bladder health, right, it's just going to plump up that tissue a little bit, but it's not going to do all of the things that vaginal estrogen will do.

Speaker 2: 15:33

Do you have a preference on bioidenticals or is whatever? As long as it's vaginal cream, that all of them work fine.

Speaker 1: 15:44

Yeah, so you know what? Okay, so when we talk about bioidenticals, what we're talking about are hormones that are similar to what our body makes, right? So we don't actually really need to go to a compounding pharmacy, unless it's something very specific. The FDA has approved vaginal estrogen and it's called estradiol cream. It's Not that expensive. It's going to be way less expensive than a compounding pharmacy and you don't really need to go to a compounding pharmacy.

Speaker 1: 16:08

This vaginal estrogen is FDA approved. We know it's safe and you can just ask your prescriber to prescribe it to you. You can typically get it from the pharmacy for like $10, like a copay, you know and or you can go to Mark Cuban's pharmacy that he has it's GoodRx, and you can get the vaginal estrogen very cheap as well. So you don't really need to go to a compounding pharmacy for this. You will get the FDA-approved medication and it's fantastic. All you need is vaginal estradiol, and that is estradiol is the most common form of estrogen in our bodies and it is completely safe and the amount of vaginal estrogen that you use is super small.

Speaker 1: 16:55

So what you, if you were to use the cream right the way that you would use it is, you would put it comes with the applicator. I tell patients not to use the applicator. It becomes a little bit difficult and I think that it's plastic and it may be uncomfortable. Whatever. People can just use their finger and I have them put the cream on up to the second line of their finger. I have them put it on inside and outside, so inside of the vagina, outside on the vulva, and they rub it in and they do that every single night for two weeks at night and then after that it's twice a week for the rest of your life and you never stop using it because you want to always maintain that vulvar health, because it's going to help you with recurrent bladder infections. It's going to help you decrease that painful sex. It's going to increase lubrication.

Speaker 1: 17:42

It has so many great benefits, even women, that there are studies out that show that even women that have had breast cancer can use vaginal estrogen. Even women that have a history of blood clots can use vaginal estrogen because it's local, it stays there, it doesn't go throughout the whole body. If you're worried about estrogen, you're worried about hormones, it's going to stay where you put it, especially the cream, and even there's there's tablets, there's a ring, there's different formulations, there's a suppository, so if you don't want to do the cream, you feel like it's messy. There are other ways to get that vaginal estrogen in.

Speaker 2: 18:14

Okay, yeah, that was the question I was going to ask about breast cancer, because there's a study which a lot of people say was a failed study, saying that you know, there's a lot of concern about breast cancer by doing hormone replacement, there's a lot of concern about breast cancer by doing hormone replacement, and from what I've heard that that's not necessarily accurate. But now that you're saying the vaginal cream especially is not going to affect anything like that, so it's not there.

Speaker 1: 18:34

Yeah, yeah, vaginal estrogen. I don't know about that study that you're talking about with hormones and breast cancer. I'm not too familiar with that. But you know, definitely, before you take any type of hormones, I would, you know, speak to your hematologist, speak to your oncologist to make sure that they feel that it's safe for you. You know, one of the contradictions to taking hormones is an active cancer, right, so you never want to do anything that's going to make your health worse. But vaginal estrogen is really, really safe and really safe and it's not going to harm you, it's not going to go all over your body. If you're worried about that, okay, awesome.

Speaker 2: 19:13

Yeah, I mean that's obviously great information, because I know someone that was complaining about painful sex and I didn't know to tell her about the cream. So now I know.

Speaker 1: 19:22

Yeah, absolutely. That cream is fantastic and it's so helpful and it really does change women's lives, you know. I mean when they're not having that chronic irritation, when they're not having that pain with sex, when they're not dealing with all of those things. It's really a game changer. In fact, I'll tell you, you know, I had a dermatologist friend and I was talking to her and she was really afraid to take vaginal estrogen herself because she had a blood clotting disorder and she's like no, no, no, I don't want to take it.

Speaker 1: 19:49

But you know, and I kept trying to make her understand and then I said okay, you know what, I'm just going to prescribe this for you and you take it if you want to take it. So I prescribed it for her, she took it, she did that and she does the moisturizers. And she said it was a game changer for her. And she said she's now going to tell all of her patients to take vaginal estrogen and do a moisturizer every day, because the vaginal estrogen once you do the maintenance dose is just twice a week. So if you still feel like a little bit of irritation or something like that, you can do the moisturizers in between to get that irritation to go away, and just so that everything in that area feels better.

Speaker 2: 20:47

Yeah, and you said it's a game changer for women and men as well, obviously, because if their spouse is not wanting to or their partner is not wanting to have sex because it's painful and they haven't talked about it, then now the problem is solved for both parties.

Speaker 1: 21:00

That's a very good point you make, actually, and I do want to talk about that a little bit.

Speaker 1: 21:04

So, you know, I was talking to another friend of mine and they were telling me that their friends are actually now having extramarital affairs as their wives are menopausal because, you know, their wives no longer want to have sex because they're having pain and they don't know what's going on and their doctors aren't helping them and nobody's listening to them, and so they've given up that part of their life. And, you know, although they still want to be sexual, they don't know how to have non-painful penetrative sex, although, as we know, you know, there's different forms of sex and you can definitely find pleasure in other ways. However, you know, for them and their partner, they wanted to have penetrated sex and it was so painful. So now they're you know partners are having these extramarital affairs and you know what could have really helped that relationship.

Speaker 1: 21:53

Of course, I'm sure you know they're going out and having extramarital affairs. There's probably lots of issues in that relationship to begin with, but you know, one of the things you know that was part of the problem was the fact that they could no longer have sex without pain, right, and so, like you said, you know it does save marriages and relationships, so it's really important.

Speaker 2: 22:14

Yeah, and I was going to say too, some, some women have even okayed it because they're like I don't want to have sex, it hurts. You go ahead and have it with someone else, just I don't want to have sex, it hurts. Go ahead and have it with someone else, just I don't want to hear about it or whatever. Whatever agreement they make, but yeah, they just knew they could not have it be painful, right, all right, you're absolutely right. And is this the kind of stuff since you do? Coach on?

Speaker 1: 22:37

this. Is this the kind of stuff that comes up I would imagine for your coaching. Yeah, I mean honestly, are from women that have had a lot of sex negativity. They feel that sex is wrong, dirty, shameful.

Speaker 1: 22:52

I just had a woman yesterday that I talked to about coaching and she has a really bad, traumatic relationship with her own body. She know she had all these procedures done, she just doesn't like herself, she doesn't like her body and so she doesn't really enjoy other people touching her body because she has a very bad relationship with her own body. And so, you know, we are trying to move from that sex negativity that she holds within herself to sex negativity that she holds within herself, to, if not, sex positivity, to a place of sex neutrality, which I feel is really important, because you know it's hard to make that 180 degree shift. But if you can at least slowly work your way where you're able to change your mindset a little bit and get to a place of neutrality, then I feel that you can at least be open to sexual stimuli, right, Be open to some type of sexual advances, and not be so, you know, feel so repulsed by the idea.

Speaker 2: 23:52

Yeah, and just knowing that men are just happy that you're there, like you know they. They just think so much less about it. You know, they're just so and it's easier said than done to like.

Speaker 1: 24:02

Yeah, absolutely Absolutely. And you know, I think what's important to realize is that there's so much you know. So what we say in sexual medicine is that the brain is the biggest sexual organ, and I remember the first time I heard that I was like what you know, that like kind of blew my mind. But it's absolutely true, right, it's. It's because whatever our thoughts are, whatever is going through our head, is going to affect our feelings, and whatever feelings we have will affect the actions that we take, right? So if we are thinking that sex is wrong, it's shameful, it's dirty, or that I don't like my body, I don't like the way it looks, this, and that the feeling that we're going to have is that maybe, perhaps one of shame, one of guilt, you know. And so the actions that we're going to have are those of like, perhaps, turning our partner away, turning, you know, not really allowing ourselves to experience pleasure, not really, you know, enjoying what we're able to enjoy because of the thoughts and all these, you know, all this chatter going on in our brain. And I think that that's really important to understand.

Speaker 1: 25:02

One, that the brain is the biggest sexual organ. And two, I think one of the most empowering things that I can leave your listeners with is that we are, we are able to choose our thoughts, and I think that that again was one of those. You know statements that I was like wow, really blown away with because we can choose. You know statements that I was like wow, really blown away with because we can choose. You know, sometimes, I think, people, you know, we go throughout our day, we have all these thoughts that come and go, whatever, and we just think that, oh, you know, they just happen, they. You know we have no control over them. But when we realize that we can choose our thoughts, right then you're getting to like the root cause, like if I can choose to be happy, if I can choose to find joy, then I can really change the feeling that I'm having and that will result in a change of action that I can take.

Speaker 2: 25:51

No, I totally agree. I just did that this morning. I was talking negatively to myself and then I caught myself immediately and was like no, you're just doing this, you know, I like did the complete opposite and spun it into a more positive way 100 percent and that you know that takes time.

Speaker 1: 26:06

One, it takes knowledge to realize that that is happening, right. Two, it's the other knowledge is realizing that we have that option and that we can choose our thoughts. And three is acting on it Right. So I think what really helps people is having positive affirmations that we say every day. Right, so we can choose to say whatever we want to ourselves, right, we can choose to say I am a great speaker, I am a great coach, I'm a great clinician, I'm a great doctor, I'm whatever. Whatever we want to say, we choose that.

Speaker 1: 26:37

And so when we decide that we are the masters of our own fate, when we are the masters of our own thoughts, it's a game changer, right, we can. And just like what you did, you saw, you know, you reflected on whatever the thoughts you were having and you immediately changed it. And I think that's so important and that can start with affirmations in the morning, right, and those affirmations are always. They start with I am and then I am whatever. Right. So instead of you know and I also heard of this one time is that you know we have worry, right, we worry about everything and that's you know. It gives people anxiety because they're always worrying about the future is that we can have positive worry instead. You know, like what if you know things work out? What if this is the best thing that ever happened to me? What if this is, you know, going to be so helpful in my career, in my relationship, whatever, when we really sit down and think about the things that we can do just by changing our mindset.

Speaker 2: 27:34

Yeah, I wanted to share one more quick example. So my example is I was recently told well, I was told I had ADHD. A while back I never thought anything of it, but then I realized I was impulsive. But then I changed impulsivity to I make I make good decisions with velocity, because that is really what I do. Yeah, decisions with velocity.

Speaker 1: 27:56

I love that, I love that and I think that's fantastic, and it doesn't have to be something that's wrong with you. It could be your superpower, right. It could be something that helps you to accelerate in your career, in your relationship, in whatever way right, as long as you're not hurting yourself or others. It's absolutely, it can be definitely a benefit to you and those around you. So I don't think that, you know, it's not always that there's something wrong with us, right, and I think that if we're able to reframe those thoughts, then we would feel better about ourselves.

Speaker 2: 28:29

Yeah, exactly, all right. So I would say, if you want to talk either more about your coaching or we can talk about your podcast, or how to reach you, like kind of all of them. In whatever way you want to do it.

Speaker 1: 28:40

Absolutely. I appreciate that. So, you know, my coaching really focuses on moving forward in your relationship, whether it's with yourself, a relationship with yourself, or whether it's a relationship in a couple, so a partner, your, your husband, whatever you know, your marriage, whatever it is, and it's all about moving forward. So coaching is, you know, it's not therapy and that's what I want people to understand. It's not, like you know, I'm a therapist. I'm not, I'm a physician, I'm a clinician, but I'm also a coach and you know if there are some things. So the difference of therapy and coaching is that, like for therapy, you know, we deal with things. Therapists will deal with things, perhaps in somebody's past to unpack it, and all of those things. So it's a little bit about, you know, going back into your childhood and things like that. Coaching is all about moving forward. Like you know, here I am at this place in my life how do I move forward in my relationship, how do I move forward in my career, how do I write? So that's what that coaching is about. They're not consultants, they're coaches, and that's what I do. I really help women move forward in their relationships so that they can experience pleasure, and it's about removing emotional and physical barriers so that women can experience pleasure. And that's really what I do and that's because I'm a gynecologist, so I can assess them anatomically. But also we talk a lot about mindset and about the thoughts that happen and you know what are they thinking and how can we reframe that. So it's a little bit of like cognitive behavioral therapy that I do, and so that's why that's really important. So that's about my coaching and it really helps women that say, for example, have vaginismus. So vaginismus is where the muscles around the vagina will tighten up in anticipation of any type of penetration. And so you know and these women have a really tough time with you know, whether it's a physical exam, whether it's inserting a tampon, whether it's with penile vaginal intercourse, with any one of those things, women really kind of those muscles just tighten up, right, because there's that fear that they have that it's going to be painful, it's going to hurt or perhaps that it's wrong. I shouldn't be doing this. Whatever you know, whatever the thought is, it automatically turns on those muscles, so then they become so tight. So for somebody that has that, I think that that is like a perfect example where you would need a sex coach, a sex med doc. A sex med doc to really assess what's going on anatomically, and also either sex therapist or sex coach to kind of help you move forward. And then pelvic floor therapist that would work with dilators and help you and teach you ways to relax those muscles so that they wouldn't clench up. So that's like an example of where sex coaching really works in well with you know, a diagnosis of, say, vaginismus.

Speaker 1: 31:25

You know my podcast is all about relationships. It's about, well, the reason why I do it. So I'll tell you why I do it. I do it to empower and educate women or men or anyone, anyone that wants to listen. It's not for a specific subset of people. I know it's called the Muslim sex podcast. It's not specific to Muslims, it's just a provocative title that gets people to pause and think, oh, what's this? But it's really about how do different conditions impact a relationship. I talk about libido. I talk about orgasm. I talk about arousal. I talk about painful sex. I talk about menopause. I talk about you know I'm actually in my third season of the podcast and we've talked about so many different topics in there.

Speaker 1: 32:08

I have a lot of times I'll have different clinicians on that'll talk about how. You know, those things that they specialize in affect a relationship. So, for example, I had a psychiatrist on that came in and talked about anxiety and depression in a relationship. I had a GI doctor come in and she talked about how, if a patient had a colostomy back, how would that affect a relationship? How would that affect intimacy? You know, I had sex therapists come on and they've talked about mindfulness in a relationship. I've had another sex therapist come on. She talked about something called sensate focus. That is a great modality to use in somebody that's experienced trauma or abuse or somebody that's never had sex before. And how do they start that relationship? How do they start that physical intimacy in that relationship? And so I've had on a whole bunch of great, fantastic guests, and so that's kind of what we talk about.

Speaker 1: 33:00

And it's a global podcast. You know, outside of the Western world I have a lot of people in the Middle East and Pakistan, india, wherever all over the world that listen to that podcast and that really enjoy it. So that's why I do that. And so how can people work with me? Well, people can either reach me on I'm on Facebook at Dr Sudef OBGYN. I'm on YouTube at Dr Sudef Intimacy Health. I have an official office, a practice, a brick and mortar that is located in Westchester County, new York, and I am currently open and accepting new patients, and you can go onto my website at wwwfemmehealthcom and you can get information about the practice. You can schedule a meet and greet with me. You can even call the office and schedule your appointment and book one today. So, yeah, those are all the different ways. I'm actually hosting a retreat.

Speaker 1: 34:11

I just finished a retreat in september and it was you may really like this tamra. This Tamara is was focused on perimenopause, menopause and sexual health and nutrition. I co hosted it with a friend of mine who is another gynecologist and but she was a dietician before she became a gynecologist and so she focused that. We do lectures every day, no more than an hour and a half. That's a max. You know they're usually for like an hour. We did it every day so that people could get information about perimenopause, menopause, sexual health. Those were my lectures. She would do lectures on nutrition and then, when the days that she would do her lectures, we would do them right before. We did a cooking class. So we did two cooking classes.

Speaker 1: 34:51

This was the retreat happened. It lasted a week. It was in Morocco. We started every day with yoga and meditation and it was so phenomenal it was the first year we did it and we had such amazing reviews. Everyone loved it.

Speaker 1: 35:04

But I think it's because we created an environment right at the onset of one of vulnerability and one where people could be honest with their feelings and about what they were going through. And I think, because we created that environment early on, people felt like they could really be open and honest about what was going on in their lives and what they wanted to work on and things like that. And everyone left there feeling really full and we all became really good friends and it was all about creating a community. And I really think that women, when they're going through these huge transitions in their lives, such as perimenopause, menopause they really need a community because you know, in that community you don't feel like you're alone. You feel like you know I'm with this tribe of women that are going through similar things and you know we can lean on each other, we can ask questions and, that being said, I actually have a Facebook group it's called it might be menopause support group by Dr Silla Flody that people can join, and it's on Facebook, so you know it's a.

Speaker 1: 36:07

It's a private group, though, and and people ask questions on there. You know people are concerned about brain fog. They're concerned about new and new onset anxiety and depression. They're concerned about weight gain that they have in menopause, perimenopause and how to mitigate that. You know lots of great questions that people pose and you know we come together and we answer those questions, so really fantastic.

Speaker 2: 36:30

Okay, yeah, the retreat does sound awesome. Is there a final closing comment? You wanted to kind of leave.

Speaker 1: 36:37

Yeah, I'd love to say, you know, what I want people that are listening to your podcast to realize is that there's always hope. And you know, I think sometimes, when we're going through something that seems really awful, you know, we may feel like there's no hope. So I want women to know that there's always hope. There's always something that we can do. And if we don't know, you know we'll at least try to find something that we can do.

Speaker 1: 36:59

For whatever it is that you're going through whether it's sexual dysfunction, whether it's your perimenopause, menopause or, you know, sex coaching or mindset or something like that I want you to know that there is always hope and to make sure that you seek out a healthcare provider that can help you. And if you find somebody that doesn't listen to you or is dismissive of your symptoms, then you need to find somebody else that will listen to you. You can go on the menopauseorg website to find a menopause society certified practitioner, and you can go on the international society for the study of women's sexual health org website to find a sexual health fellow that can help you out.

Speaker 2: 37:38

Yeah, and I was going to say I'd also recommend, come as you are, that book. Yeah, she talked about the brain stuff too.

Speaker 1: 37:46

Like you said, I love her. I love her. And she's the one that said and I quote this all the time is that to want sex is to have sex worth wanting. So you know you're not going to want something that doesn't bring you pleasure, that is painful, where you're not feeling like you're hurt or you're being seen. You know you're going to want to be in a relationship that you feel heartening, but also where you're experiencing pleasure and you're not having pain.

Speaker 2: 38:11

Yeah, yeah, definitely, and I have lots of episodes about the differences between men and women and the that kind of stuff, so that's a whole nother topic. But I agree, Like all right. Well, thank you very much for being on. It was a lot of great information. I was gonna say, if you love this episode, be sure to tell your friends about it and rate it as well.

Speaker 1: 38:30

And thank you so much for having me on, Tamara. I really appreciate your time and your audience's time and um, and I hope they all have a great day. But thank you so much for having me on.