Orgasm After Menopause: Vibrators, Testosterone & Solutions with Dr. Lauren Streicher (Pt. 2)

In our last episode of unPAUSED, we began a conversation with Dr. Lauren Streicher about orgasm, sexual function, and why these topics are still so taboo. Because there was so much to talk about, we decided to make this a two part episode. So today, Dr. Mary Claire Haver continues this conversation. Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Streicher's Inside Information Podcast, and the creator of Come Again, a 30 episode audio series on sexuality and sexual function. She's been at the forefront of sexual medicine for decades, pushing conversations forward that most clinicians still avoid. In this episode, we're diving into why vibrators work when nothing else does and what the research shows about vibration versus other types of stimulation. Dr. Streicher explains non-hormonal arousal creams, CBD oil for the clitoris, and whether these products actually help. We discuss the role of neurotransmitters in orgasm and walk through the FDA-approved libido drugs Addyi and Vyleesi, including why testosterone is often the preferred option for women and why pellets are problematic. Dr. Streicher breaks down the orgasm gap between men and women and explains why it actually narrows with age. She walks us through her clinical approach when a patient comes in struggling with orgasm, why pain must always be addressed first, and how to find a sexual medicine expert. We also talk about what gives her hope for the future of this field and why not every woman needs to have an orgasm for sex to be pleasurable and successful. Guest links: Dr. Streicher https://www.drstreicher.com/ Dr. Streicher https://www.instagram.com/drstreich/?hl=en (Instagram) Dr. Streicher’s Inside Information: Menopause, Midlife, and More https://podcasts.apple.com/us/podcast/dr-streichers-inside-information-menopause-midlife/id1615785832 (Apple Podcasts) Lauren Streicher - Faculty Profile https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=13740 (Northwestern Medicine) Dr. Streicher https://www.youtube.com/c/drstreichertv (YouTube) Subscribe to COME AGAIN: Sexuality and Orgasm DrStreicher.com/comeagain https://www.drstreicher.com/comeagain Use code UNPAUSED20 for 20% off (This code expires Dec 23) Dr. Streicher's Podcast Dr. Streicher’s Inside Information: Menopause, Midlife and More http://ow.ly/74TI50IvXK6 DrStreicher’s Substack https://drstreicher.substack.com/ Gyne Hacks! https://drstreicher.substack.com/p/dr-streichers-gyne-hacks (Including how to How to Get a Hands-free Free Vulvar View) Books: “Slip Sliding Away: Turning Back the Clock on Your Vagina,” https://www.amazon.com/Slip-Sliding-Away-gynecologists-post-menopause/dp/B092H87LHQ/ by Dr. Lauren Streicher “Hot Flash Hell-A Gynecologist's Guide to Turning Down the Heat (Dr. Streicher's Inside Information),” https://www.amazon.com/Gynecologists-Turning-Streichers-Inside-Information/dp/B09FC8C8CT/ref=sr_1_3?dib=eyJ2IjoiMSJ9.ygMOA9RRO8TIXDMld8zeGW2gkllKxOe7M24Z9zDayAajpZlJXzgk55cQe9qKcjdjtXDvJ7t4TI0Xr5GT2Ymv1_vIquUXRxFuklmhVjoW5p4. U_2DXcDBxat5vvUC3bwT00W2Ryl5M7i8tSI-SUMK5VY&dib_tag=se&qid=1763750751&refinements=p_27%3ALauren+Streicher+MD&s=books&sr=1-3&text=Lauren+Streicher+MD by Dr. Lauren Streicher <a href ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Sex ed, we know, is all about how not to get pregnant or get an SCI. It has something to do with pleasure, but the guys are not taught that. The guys are taught you should have pleasure. So that's part of the problem is that there isn't the expectation. So are they upset? I think the ones that expect pleasure are the ones who know how to have pleasure.

• 0:17Dr. Mary Claire Haver?

  Mm hmm.

• 0:17Speaker 00

  So older women, different story.

• 0:20Dr. Mary Claire Haver?

  So we have an older patient who comes into your clinic and she says, "I am struggling with orgasm. I used to have them, they're great, and I still want them." What's your first step? Walk me through.

• 0:31Speaker 00

  The first step is unless you're running a sexual medicine clinic, the likelihood of that happening is about zero. Let's be honest, how many of patients, when you were doing general OB-GYN, walked in your door and said, "Hey, Dr. Haver, I can't have an orgasm. Will you help me?"

• 0:54Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Welcome back to UnPaused. I'm Dr. Mary Claire Haver. In our last episode, Dr. Lauren Stryker and I started an in-depth conversation about orgasm, sexual function, and why these topics are still so difficult to talk about, even in doctors' offices. There was so much ground to cover on this topic that we decided to split this conversation into a two-part episode. So today, we're picking up right where we left off.

• 1:38Dr. Mary Claire Haver?

  If you're just joining us, let me tell you about Dr. Stryker. She's a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Stryker's Inside Information podcast, and the creator of Come Again, a 30-episode audio series on sexuality and sexual function. For decades, she's been leading the conversations that most clinicians still won't have. Today, we're talking about vibrators and what the research shows. Non-hormonal arousal. And whether they work, the role of neurotransmitters and FDA-approved libido drugs like Addi and Vilese, and why testosterone is often the preferred option for women.

• 2:21Dr. Mary Claire Haver?

  Dr. Stryker breaks down the problem with pellets, explains the orgasm gap between men and women, and why it narrows with age, and walks us through her actual clinical approach when a patient comes in struggling with orgasm. We also talk about how to find a sexual medicine expert, why pain must be addressed first, and what gives her hope for the future of this field. If you missed part one, I encourage you to go back and listen. But if you're ready to learn what actually is possible when it comes to sexual function in midlife and beyond, let's continue the conversation. Talk to me about vibrators, devices, you touched on them earlier, but why does vibration work so well?

• 3:00Speaker 00

  I call vibrators tools, not toys, because toys implies that it's going to give you additional pleasure, and it's going to make pleasure possible. A tool is something that makes having an orgasm possible. So let's call them tools, because I think that also really is kind of just empowering to women to say, you know, if I can't swim, and I'm going to go on a life raft to get me to have fun in the water, well, if I can't have an orgasm, then I'm going to use this tool to facilitate my ability to have an orgasm. Why did vibration work when nothing else does? Let me back up, because so often a woman will come to the clinic and say, I can't have an orgasm anymore. And I'll say, well, how about when you use your vibrator?

• 3:42Speaker 00

  And she'll say, well, of course, if I use my vibrator, I can, but I didn't used to have to use my vibrator.

• 3:49Dr. Mary Claire Haver?

  Got it.

• 3:50Speaker 00

  So what's changed? Well, before, I talked about those little nerve endings in the clitoris. It turns out, we have different types of nerve endings and different sizes of nerve endings. Some of them respond to soft touch, licking, stroking. Some of them respond to vibration. It turns out that the little nerve endings in the clitoris that respond to stroking and licking and touch are the ones that tend to deteriorate with age the most quickly. So even if you have the best liquor and stroker in town. Those nerve endings are just dead. They're just not functional. But there is a god or goddess, the nerve endings that respond to vibration are not only bigger,

• 4:35Speaker 00

  but they have a thick myelin coat, which is the protection around them. They are good to go and they are going to last and last and last. So what that means is that vibration will often work when nothing else does. And I think if people are going to listen to Come Again, if they're only going to listen to one episode.

• 4:57Dr. Mary Claire Haver?

  The vibrator one?

• 4:58Speaker 00

  Yes, yes. And then my daughter, who also joins in that episode, she's a sex therapist. She talks about how to get the partner in your life on board with a vibrator. Because a lot of times, women are embarrassed to bring it up. They think that the guy's going to feel like a failure. Partner's going to feel like a failure if you need to bring the vibrator in the bedroom. So she gives the script, the language, how to approach that. Because that's just as important as not being, it's fine when you're on your own. But if you're looking to have an orgasm with partner sex, you need to get your partner to be in on it.

• 5:24Dr. Mary Claire Haver?

  So has anyone done a head to head comparison of different vibrators? Because there's, you know, I guess I lumped them into only on the outside or optional, you know, penetration. And so people feel very strongly about what kind of vibrator they should have. And now there's the ones with the little suction cup.

• 5:41Speaker 00

  The suction, which is a whole different thing. The suction is different. Because what the suction is doing, well, it's a lot. It's pretty intense. And not necessarily in a good way. But, but what the suction is doing is it's drawing in blood flow. It's increasing blood flow. So that's not working with vibration. Have people done this study? Oh, you bet. There's a lot of vibrator companies out there who are really on a mission to find out what is the pulsation speed? What is the level of vibration? And there's data, there's data. I don't think I put that in Come Again because it just got too sciency. But when I, I do have a lecture. I have a lecture that I give to doctors on vibration. And I talk about how you get different levels of vibration and what seems to work better.

• 6:21Speaker 00

  For example, pulsatile is better for arousal, but steady is better to actually trigger the orgasm.

• 6:27Dr. Mary Claire Haver?

  Okay, because I have these conversations with my girlfriends and. It's all very different. They, most of them feel like the least complicated, the better. Like all these extra buttons and whistles and heat.

• 6:36Speaker 00

  Exactly.

• 6:38Dr. Mary Claire Haver?

  And then you have to go back through the cycles to get to the one you want.

• 6:41Speaker 00

  Well, not to mention, you've got to turn the lights on to see what the buttons are.

• 6:43Dr. Mary Claire Haver?

  Yeah, I'll put your glasses on to see.

• 6:44Speaker 00

  Exactly. Do you know what is one of the strongest vibrators out there? Your Sonicare toothbrush.

• 6:51Dr. Mary Claire Haver?

  Jesus God almighty. We just shot the stock of Sonicare up.

• 6:55Speaker 00

  Up. Okay. I want to be clear. Do not use your brush directly on your.

• 7:00Dr. Mary Claire Haver?

  So how would you do it?

• 7:01Speaker 00

  No, you get like abrasions of your clitoris. That would be a disaster.

• 7:04Dr. Mary Claire Haver?

  Okay. So I have a Sonicare. How would I use it as a vibrator?

• 7:07Speaker 00

  This is a big travel thing, of course, because people are worried about the TSA finding their vibrator in their suitcase, which, trust me, it won't be the first vibrator they found. As a matter of fact, it's really funny because when I come home from conferences and people are just throwing vibrators at me right and left, you know, this is great to be my friend because this is a gift that I give to all my friends because I have more vibrators than any human being would know what to do. So I go through TSA and they're like holding them up one after another saying, wow, what does she do for a living?

• 7:31Dr. Mary Claire Haver?

  Pink, purple, blue.

• 7:32Speaker 00

  And then they find, of course, my podcast microphone and they think that's some kind of really super duper special vibrator, but I digress. So, but travel, travel vibrator, a lot of people do rely on their toothbrush. You need to put something over it, like a gym sock at a minimum, at a minimum, and be really, really careful. I don't, I'm just to be clear, I'm not recommending a toothbrush. I'm just saying, this is what a lot of people do.

• 7:54Dr. Mary Claire Haver?

  I'm going to check the stock of Sonicare right now. We're going to invest today.

• 7:57Speaker 00

  Okay. So someone, I have a YouTube right next to my, I have, it's called Gyne Hacks and I have seven or eight YouTube videos on interesting hacks to solve problems, which is why I have the hands-free Volvo review, how to get your S-string out if you have long nails.

• 8:10Dr. Mary Claire Haver?

  Walk me through this. I'm so fascinated. Can you explain to our listeners how they would have a hands-free view of their Volvo? Is it possible?

• 8:19Speaker 00

  Oh, yeah. And with things you have at home.

• 8:21Dr. Mary Claire Haver?

  Okay.

• 8:22Speaker 00

  But I will say it's kind of hard to describe without a video, but. I'll tell you what it is and then I'm imagining a mirror on the floor. No, no, it's actually much more innovative than that. What you do is you take one of those magnifying makeup fold up round mirrors. Check. On a hinge, ideally with a light. Okay. You lift up the toilet seat. You put the unmirrored part under the toilet seat and you put it down. Now you're going to sit on the toilet seat because now it's holding it in place. Can you picture this? Yeah. So the mirror is now coming out from the toilet seat. Yeah. And you can adjust the mirror to get the perfect view.

• 9:04Speaker 00

  If you don't have a mirror with a light, you know, you can use a ring light. You can use your cell phone. Whatever. And suddenly you are sitting on it and holding it into place. And you've got a hands free view. That's amazing. So this is right after my gynecic hack on how to get your fem ring or your S string out. If you have long nails, dental floss. You tie a long ring of unmented dental floss, just like a tampon string. Push it off and then when it's time to take out your ring. Oh, and then you'd like a tampon, you made a string. Pull it down, it comes down to the opening of the vagina and you just grab it out. So I have fun with this. So I have about 15 gynecic hacks. I haven't put all of them on YouTube. People are going to be running to your YouTube. This is hilarious.

• 9:46Speaker 00

  Let's go through non hormonal arousal creams. Do we have any evidence? This is also a data free zone. However, there are a lot of them out there. These are also compounded products. I've seen scream cream. Yeah, we try not to call it scream cream because we think that's kind of offensive. Yeah. You know, women having pleasure shouldn't be labeled as we want you screaming. We want them anyway. I call it just arousal. Smile cream. Arousal cream, arousal cream, orgasm cream. What are these? Well, there's different combinations of products that are all basically vasodilators. Okay. They all increase blood flow. And do they work anecdotally? For a lot of women, they do seem to make a difference.

• 10:30Speaker 00

  Again, the instructions usually say use it just prior to sexual activity. I think you're better off using it on a regular basis to increase the health of the clitoris. Okay. It can be irritating to some women. And in that episode, of course, I go through all the ingredients to look for, all the things that might help. The, the other arousal cream that is out there that a lot of women are using, CBD. Really? Well, think about this. Okay. Again, data-free zone, although I've done some research on that, which I have not published yet, but the use of CBD on the clitoris, CBD, cannabidiol, is number one, a vasodilator.

• 11:07Dr. Mary Claire Haver?

  Mm-hmm.

• 11:08Speaker 00

  Number two, it's anti-inflammatory. Number three, this is where it gets interesting, in diabetics who have peripheral neuropathy, CBD cream has been shown to increase nerve sensitivity.

• 11:23Dr. Mary Claire Haver?

  Wow.

• 11:24Speaker 00

  Now, clitoral nerves are not foot nerves. However, nerves are nerves. And I will tell you anecdotally, that women who use CBD oil on their clitoris appear to have enhancement of their ability to have an orgasm. Again, rubbing it in for a long time helps. A lot of this might be placebo, we don't know. This is a data-free zone. But whenever I, I recommend something that we don't have data, at a minimum, I want to recommend something that is not going to be harmful. And we know that this is not going to be harmful with the information that we do have, because CBD is used in large amounts all over the body.

• 12:01Dr. Mary Claire Haver?

  Yeah.

• 12:01Speaker 00

  Not the same as using systemic cannabis. That's a whole nother discussion.

• 12:05Dr. Mary Claire Haver?

  Yeah.

• 12:05Speaker 00

  A lot of women will use that for orgasm, too. And without getting into the biology and the science, a lot of that is about disinhibition. It's working more in the brain in terms of maybe helping with general aches and pains, maybe just waking up your neurotransmitters. We don't know. We don't know. But that's not getting the same local application.

• 12:23Dr. Mary Claire Haver?

  Talk to me about neurotransmitters and kind of brain-forward strategies.

• 12:28Speaker 00

  Yeah.

• 12:28Dr. Mary Claire Haver?

  To help with orgasm.

• 12:29Speaker 00

  All right. So we know, we know that those neurotransmitters are critically important in terms of not only arousal, but in sending messages down to the pelvis. It's kind of, you know, that's the brain, like everything else, that's in charge of what's happening all over your body. We also know, and I know you've talked about this, Mary Claire, again and again and again, that we have estrogen receptors and testosterone receptors throughout our brain. What do they do? They prime the pump. They make those neurotransmitters work better, and they enhance the release of those neurotransmitters. So if you have something that's going to get in the way of that, you are going to lose the benefit of the brain.

• 13:07Speaker 00

  Talking to your pelvis. What's going to get in the way of that? Well, we've already talked about if you don't have estrogen.

• 13:13Dr. Mary Claire Haver?

  Right.

• 13:13Speaker 00

  Not only are you going to have problems in terms of what's happening right down at the level of your vulva, vagina and clitoris, but you're also going to have some problems in terms of the function of your neurotransmitters. They're not going to be primed as much, which is also why when people take systemic estrogen, even if they're not putting it directly on their clitoris, for a lot of women, in addition to getting rid of their menopause symptoms, that can, in some cases, also enhance sexual function. So there's that. We've already talked about the SSRIs and the impact that they have. When we talk about how else can we enhance the function of these neurotransmitters? Well, there are two libido drugs that are FDA approved.

• 13:51Dr. Mary Claire Haver?

  Yeah.

• 13:51Speaker 00

  One is flibanserin, the other is bremelanotide. And these are FDA approved for use in young women, of course, but we do have data in older women. And it's important to keep in mind that while we don't think of those drugs as being orgasm drugs, they really are because they are working on those transmitters, specifically dopamine. Dopamine is the one we really want. You know, when you're dopey with love, that's how I always remember it's dopamine. When I teach the medical students, I always say dopamine is dopey with love. Serotonin is stop, stop, stop. We got to go work and do laundry. So we know that those drugs enhance, enhance the release of dopamine.

• 14:27Dr. Mary Claire Haver?

  So most patients-

• 14:28Speaker 00

  Which in turn is going to help with arousal, which in turn is going to help with orgasm.

• 14:30Dr. Mary Claire Haver?

  So we have a terrible PR campaign around these drugs and I'm near a village. I don't think most women even know what they are, that they're available and what they could do. So I think just let's take two minutes to go over them again.

• 14:47Dr. Mary Claire Haver?

  Buy smart, drive for less and trade for more. That's Toyota affordability and it all starts with a great deal from your local Toyota dealer. Make a smart buy on an all wheel drive Camry, Corolla Cross, or get a Corolla sedan packed with the latest features, advanced tech and head turning style. Take a test drive in two of Toyota's most popular SUVs, the spacious, family-friendly Grand Highlander. And adventure-ready RAV4. And with so many hybrid and plug-in hybrid models available across the lineup, plus efficient all-electrics like the BZ, BZ Woodland, and all-wheel-drive CHR, you can drive your way and skip the pump. And long after you leave the lot,

• 15:30Dr. Mary Claire Haver?

  your Toyota keeps delivering with legendary resale value built on a reputation for quality and reliability. So when it's time for your next Toyota, you could trade in for more. From a great deal today to a great value tomorrow. A Toyota is right for you. Shop toyota.com for deals and details, or stop by your local Toyota dealer today. Toyota, let's go places.

• 15:55Speaker 00

  Flupanir has been FDA-approved now for, I think it's, um, boy, is it 10 years? Almost 10 years. The trade name is? Addy. Addy, and this is a pill that you take on on demand. You have to take it on a regular basis. It's like a vitamin. Exactly. Take it at night because it might make you a little sleepy, which is a good thing for most women. But other than that, it really has very few side effects. There was a concern initially about alcohol, which didn't really pan out. But for most women, it is a safe drug. And it does help with libido. It is FDA-approved specifically for hypoactive sexual desire disorder, which is decreased libido in women who want to do something about it. Not everybody does. And we know that decreased libido is actually the number one sexual problem that post-menopausal women have.

• 16:38Speaker 00

  And so, but of course, this is not FDA-approved in post-menopause women, but we have studies that show that it is. In our clinic, we use it off-line. That it is, you had to pay for it. That's the problem. So how well does it work? It works in about 50% of women at best, at best. And when people say, well, why is it so few? It's because desire is so multifactorial. You know, this is not the only thing happening here. The, the other drug, bremelanotide, the trade name is Vylici, and this is an on-demand drug. And the way Vylici works is that this is a pen, like a little EpiPen kind of thing. And you plunge it into your thigh about 30, 40 minutes before you would like to have sex. And again, it's going to modify those all-important neurotransmitters, kick them into action so that you are suddenly in the mood. And also works in about 50% of women. The number one side effect, which is a problem,

• 17:23Speaker 00

  it's not the fact that you've got to auto-inject. It's the nausea, you know, something about vomiting on your partner is a real libido killer. But most women, that doesn't happen. And actually, sometimes it happens initially and then it gets better. Do a lot of women use these drugs? No, they do not. Do they use them post-menopausally? No, they do not. Aside from the fact that a lot of people. Especially with Addy, they don't like the idea of taking something every day. I tell them about the nausea, that kind of scares them off. And when I talk to women who want something pharmacologic and I offer them these two, and then I also mention testosterone. And when I go through the options of flibanserin, bremelanotide and testosterone, most women opt to give testosterone a try. And I, and I think the reason why that is-

• 18:05Dr. Mary Claire Haver?

  We have the same clinical experience.

• 18:06Speaker 00

  And the reason why is there's a comfort level with testosterone. When I explain to women that just like estrogen, this is something that is in their body naturally, that we are giving them a little boost of their testosterone to help with their libido. And that just sits better. It sits better. There, there is more of a comfort level with that. But when we look at how well testosterone works for libido specifically, it's about the same.

• 18:29Dr. Mary Claire Haver?

  Yeah.

• 18:30Speaker 00

  It's about 50% at best, again, because it's so multifactorial.

• 18:33Dr. Mary Claire Haver?

  A lot of talk about pellets.

• 18:36Speaker 00

  Don't get me started on pellets. I have an entire episode called "The Problem With Pellets."

• 18:41Dr. Mary Claire Haver?

  Pellets.

• 18:42Speaker 00

  Pellets.

• 18:42Dr. Mary Claire Haver?

  So, um-

• 18:44Speaker 00

  The problem isn't actually the pellets, it's the pellet pushers.

• 18:46Dr. Mary Claire Haver?

  It's not the pellets, yeah.

• 18:47Speaker 00

  It's the pellet pushers.

• 18:47Dr. Mary Claire Haver?

  I'm like, I don't want to demonize a method of delivery to the human body. We have FDA approved pellets for certain medications. Like, it's just a way to get medicine in your system. But the way it's marketed, the way that they teach, I even went and signed up-

• 18:59Speaker 00

  To do a pellet, you're brave.

• 19:00Dr. Mary Claire Haver?

  To get, no, just because I wanted to see, what are they teaching these clinicians?

• 19:04Speaker 00

  As you said, it's not the method of delivery, it's what's in the pellet. And they are these super physiologic, meaning much higher doses than every woman has ever made.

• 19:14Dr. Mary Claire Haver?

  Patient come to me, we check everyone's levels, who was ever in a physiologic range.

• 19:19Speaker 00

  Sky high, sky high. And you know, we could go on and we could spend hours just talking about pellets. So let's cut to the chase and say that women should not use pellets, because not only are they getting unnecessarily high levels of testosterone, but when we look at the side effects, aside from the cosmetic side effects, like losing your hair where you want it, getting hair where you don't want it, like all over your face, getting an enlargement of, of the clitoris, getting oily skin, getting pimples, we look at more serious side effects long-term, such as a buildup- Up in the lining of the uterus, increasing risks of uterine precancer and even cancer. And we have very good data, which I talk about in my episode, um, and come again, about the increased number of hysterectomies in women on pellets.

• 20:03Speaker 00

  Because the levels are so high. Now, one of the things that's confusing for women is that the biggest sellers of pellets, of course, are women who have them, who tell all their friends how incredible they feel. And there's no question that a big bolus of testosterone is going to make you feel amazing, huge, huge amounts of energy, feeling sexy, feeling alive, feeling productive. The problem is, that's the initial, that's the initial feeling. Over time, people require higher and higher doses, the side effects get to be a huge problem. And it's not like you can just say, stop taking it. You, they, they sit there under the skin.

• 20:39Dr. Mary Claire Haver?

  For months.

• 20:40Speaker 00

  You cannot take them out. You have to wait for them to dissolve. And there have been some very serious problems. Women think they're FDA approved. There was a study that they were shocked to find out that they're very expensive doctor.

• 20:51Dr. Mary Claire Haver?

  And a lot of women, it's all they're offered. They're not given the cornucopia of options.

• 20:56Speaker 00

  Correct. And why is that? There are a lot of doctors that are making a lot of money off of pellets. Because, because they're not FDA approved, it's a cash business. And along with the pellets, they're not only selling pellets, they're doing unnecessary blood work, they're doing these panels, the Dutch panel, a lot of things that are not only extremely, extremely expensive, cash only, but are not helpful in any way, not necessary in any way. I love when they tell you, this is custom compounded just for you. They're giving everyone the same frigging pellets, you know, but they're drawing your blood every 10 minutes and charging you for it to make you feel like you're special. And this is just for you. So what I say to people is, if someone

• 21:38Speaker 00

  is pushing pellets, don't walk, run. Go to someone who is going to prescribe testosterone in a responsible way, in appropriate dosages. Do we watch levels? We do. When we prescribe estrogen, we don't, because we generally don't need to. There are exceptions. But in general, we're not getting levels. Testosterone, you need to start with a baseline level, because if your level's already high, I can tell you, taking testosterone is not going to help. And in fact, you are more likely to get side effects. And then because they're compounded, that means that the levels of testosterone that you're getting may not be consistent. So it is always a good idea, at least in the beginning, until you're on a steady, stable dose, to watch those levels to make sure that you're getting the right amount.

• 22:23Speaker 00

  And also, I just have to throw out there, for people that rely on their voice professionally,

• 22:27Dr. Mary Claire Haver?

  Yeah.

• 22:27Speaker 00

  We're talking actors, voiceover artists, singers. You need to know that if you take testosterone, even in the normal physiologic low doses, that for some people, and we can't predict who that's going to be, there will be a change in your voice. It is not reversible.

• 22:47Dr. Mary Claire Haver?

  Yeah.

• 22:47Speaker 00

  It's not reversible. And already, and that's a whole nother topic, is the impact of menopause on the voice, because you have estrogen receptors, of course, in your voice box, which is why opera singers very often will use estrogen and why there is a change as women go through menopause.

• 23:02Dr. Mary Claire Haver?

  Lots of questions from our audience. One is, and this is also very curious to me, is the orgasm gap between males and females and between heterosexual couples and same-sex couples for women?

• 23:15Speaker 00

  All right, orgasm gap. This is the realization that men are far more likely to have orgasms than women, because, of course, they know how, they're able to have orgasms. And we see this orgasm gap starting very, very young, twenties, thirties, forties. Well, I have good news for all the perineum postmenopausal women out there. The orgasm gap narrows as people get older, because the guys are losing their ability to have.

• 23:40Dr. Mary Claire Haver?

  Not that we get better, they get worse.

• 23:42Speaker 00

  Exactly. We're not getting better, they get worse. But actually, in some ways, let's just talk about the woman who's not having difficulty with orgasm. If you look at a 20 or 30-year-old who has no clue where her clitoris is or what to do with it, most women, hopefully by the time they hit 50, do know where their clitoris is and do know what to do with it and are well aware that if they stimulate the clitoris either manually or orally or with a vibrator, and they're not relying on intercourse anymore or a partner, because they know better, they're actually able to have an orgasm. So I know this sounds crazy, and you don't expect me to say this necessarily, and no one's really studied this, but the orgasm gap, in my mind, absolutely narrows.

• 24:24Speaker 00

  For two reasons. One, women are better at knowing how to elicit orgasm, whether with a partner or on their own. And men are losing their ability to orgasm. So it's a level playing field.

• 24:35Dr. Mary Claire Haver?

  Well, and I feel that women are not willing to sacrifice their own pleasure anymore. You know,

• 24:41Speaker 00

  Absolutely.

• 24:41Dr. Mary Claire Haver?

  They're not just gonna do it to do it. They're like, if I'm in, I'm in. You know, and we're gonna, we're gonna do this until I also have an orgasm. Rather than, than just putting themselves second. They're really putting themselves first, I think. In, for their pleasure.

• 24:55Speaker 00

  One of my favorite books, and it's an old book, is Ian Kerners' book called She Comes First. And this is a book that's intended for men, because men need this education, to say, okay dude, she comes first. Take care of her orgasm first, and then you can have your orgasm. And this is very, very important for people to be knowledgeable. Can we talk about the men for a second?

• 25:17Dr. Mary Claire Haver?

  Well, I'll tell you a funny story. And I, I, when the first divorce happened in our friend group.

• 25:23Speaker 00

  Yeah.

• 25:24Dr. Mary Claire Haver?

  I think that book went around, the guys freaked.

• 25:26Speaker 00

  Yeah.

• 25:27Dr. Mary Claire Haver?

  In our big giant friend group. And I think the guys kind of like, ah, and I think that book went around. Cause I noticed a definite, you know, more attention to making sure that I was gonna be okay. And there's sometimes I'm just like, it's fine. I, you know, I'm sick or I'm just not, you know, whatever. But, and I, I think it was born of that fear of that first divorce that happened. And like, what can I do to like, hang on to this relationship?

• 25:51Speaker 00

  Right.

• 25:52Dr. Mary Claire Haver?

  We were very appreciative of that book in my friend group. I think when I read the data, it's like 70 to 80% of men will have an orgasm with intercourse. And women, it's like more like 40 or 50%. Each time, when you look at the raw numbers, like that's how big the gap is. But then we see narrowing.

• 26:08Speaker 00

  You're talking about young women?

• 26:08Dr. Mary Claire Haver?

  Young women, yeah.

• 26:09Speaker 00

  Correct, correct. But then, again, we do not have data on the orgasm gap. That's one of the studies I want to do with Kinsey. I've been talking to him about that. But we do not have data on the orgasm gap as you get into older folks.

• 26:21Dr. Mary Claire Haver?

  Do you think it bothers women that there's an orgasm gap? Cause I see these like very, you know, politically slanted articles written about it.

• 26:28Speaker 00

  Yeah.

• 26:28Dr. Mary Claire Haver?

  Of like, you know, it's not fair and da, da, da. And most of my patients are okay.

• 26:33Speaker 00

  Are you talking about younger women or older women?

• 26:35Dr. Mary Claire Haver?

  Younger, yeah. Really younger. When they're coming to me older, they're coming with a problem they need fixed.

• 26:39Speaker 00

  Yeah. You know, if you, they say it's okay. It's because culturally, there's this expectation that men expect pleasure when they have sex. And women do not. Another wonderful book that, that addresses this is Girls and Sex. And, and it really talks about how young girls are not really educated in pleasure. You know, sex ed, you know, is all about how not to get pregnant or get an SCI. It has nothing to do with pleasure, but the guys are not taught that. The guys are taught you should have pleasure. So that's part of the problem is that there isn't the expectation. So are they upset? I think the ones that expect pleasure are the ones who know how to have pleasure.

• 27:17Dr. Mary Claire Haver?

  Mm hmm.

• 27:18Speaker 00

  So older women, different story.

• 27:20Dr. Mary Claire Haver?

  So we have an older patient who comes into your clinic and she says, I am struggling with orgasm. I used to have them, they're great, and I still want them. What's your first step? Walk me through.

• 27:32Speaker 00

  The first step is unless you're running a sexual medicine clinic, the likelihood of that happening is about zero. Let's be honest, how many of patients, when you were doing general OB GYN, walked in your door and said, hey, Dr. Haver, I can't have an orgasm, will you help me?

• 27:46Dr. Mary Claire Haver?

  Maybe one in 20 years.

• 27:48Speaker 00

  And thank God they didn't because-

• 27:49Dr. Mary Claire Haver?

  It was more common for them to complain about-

• 27:51Speaker 00

  Desire.

• 27:51Dr. Mary Claire Haver?

  Desire.

• 27:52Speaker 00

  Well, first of all, that's easier to spit out. And second of all, it is more common. It is more common. So when you, when you talk about across the board, if you look at women between the ages of 18 and 100, most of them are not going to bring that up, even though 40% of women across the board have these issues with, with sexual problems. Doctors are not going to ask because they're not going to be able to help them. The only time that we have a flip in that script, of course, is if you're running a sexual medicine clinic.

• 28:19Dr. Mary Claire Haver?

  Okay.

• 28:19Speaker 00

  Because that's why they're there. So if a woman comes to a sexual medicine clinic and comes to see an expert and says, I'm not able to have an orgasm, what are we going to do? Well, number one, we are going to take a very detailed history. We need to know it all. And in fact, I have the history form in Come Again that I use for clinicians. So they don't even have to make it up. They can just use my history form because it goes through all of the things that might impact on the ability to have an orgasm. We're talking, you know, menopause symptoms, we're talking medications, we're talking diabetes, medical problems, surgery, radiation, chemotherapy. I mean, there's a very long list of things that we need to go through. And then depending on what their issue is, and it's never one thing, it's always multiple things, then we're going to set up a treatment plan.

• 29:04Speaker 00

  But the number one thing that we generally have to get rid of in almost every woman is pain, pain, pain, pain. If someone says, I have no desire for sex, and if I do have sex, I don't have an orgasm. My next question is, well, when was the last time you had sex? Oh, it was a couple of months ago. How'd it go? Well, it hurt like hell. Well, your vagina's not stupid. And if sex hurts like hell, it's gonna tell your brain, don't go there. You're not gonna get aroused. And if you don't get aroused, you're not gonna have an orgasm. So until we fix painful sex, we've got nothing to talk about. So you've gotta do that. You've gotta look at the medications. You have to get rid of the menopause symptoms. If someone is flashing all day and all night, they're not gonna be aroused.

• 29:46Speaker 00

  Keep in mind, and I keep circling back to this, in order to have an orgasm, you must have arousal. You must. That's your clitoris, that's your pelvis, that's your brain getting primed to trigger those nerve endings to do their job, right?

• 29:59Dr. Mary Claire Haver?

  Right.

• 29:59Speaker 00

  So almost every treatment I have is going to help arousal. Get rid of the symptoms, get a decent night's sleep, eliminate pain, look at your drugs, show someone the map to their clitoris.

• 30:17Dr. Mary Claire Haver?

  So is everyone going to be successful with having an orgasm?

• 30:21Speaker 00

  I would like to say yes, but that would not be honest. The answer is no. But that's okay. What's important is we need to rewrite the script. There's this idea that sex is not successful unless you have an orgasm, which is why, quite frankly, so many women fake it, because they want them to stop trying already. It's, oh, my God, please, I just wanna go to sleep. And part of that script is that sex isn't over until you have an orgasm. Sex is over when you're ready for it to be over because you've been having pleasure. Stop having orgasm as the end game. There is a new normal, very often, for women to say, I don't need to have penis and vagina sex. I don't need to have an orgasm. If I

• 31:06Speaker 00

  am in a relationship, I need to have someone who is loving. Who is kind and who touches me in a way that's pleasurable. I was once on a, I think it was the Today Show or something, and I was on with a sex therapist. And, and we were asked the question, how often should people have sex? What's the right number? How many times a week? And the other person who was on this episode with me, I thought, gave such a beautiful answer. He said, the number of how often you have sex is unimportant. What's important is how often you are sexual, meaning that you touch someone, you kiss them, you speak to them in a way which is kind and loving and lets them know that you are attracted to them. That's great sex.

• 31:48Dr. Mary Claire Haver?

  What is a sexual medicine clinic? And, and how would you find one?

• 31:51Speaker 00

  That's a really hard question.

• 31:53Dr. Mary Claire Haver?

  How, who's a sexual medicine expert?

• 31:55Speaker 00

  It's not something that-

• 31:56Dr. Mary Claire Haver?

  It's not me.

• 31:57Speaker 00

  There is a fellowship in the International Society of the Study of Women's Sexual Health. They do maintain a directory. I don't even know if I'm on that directory or not, or if my clinic is. It's not complete.

• 32:05Dr. Mary Claire Haver?

  It's a starting place.

• 32:05Speaker 00

  I will tell you that-

• 32:06Dr. Mary Claire Haver?

  We'll put it in the show notes. Because people are going to be looking up stuff.

• 32:10Speaker 00

  For a peri and post-menopause woman, for a lot of them, their starting place is going to be with a menopause expert. Because while all menopause experts are not experts in sexual medicine, we've already established that you've got to get rid of the hot flashes. You've got to get rid of the menopause symptoms. You've got to treat your genital urinary syndrome of menopause.

• 32:25Dr. Mary Claire Haver?

  It's a decent place to start.

• 32:26Speaker 00

  Absolutely. And for a lot of women, that is going to be not only the best place to start, it may be all that they need. They may not need to go to that next level. But once they go see their menopause expert and get rid of all of those things, if they are still having trouble, then you may need to find a sex med expert. And some of the major medical centers have them, most do not, I will say that. I'm at Northwestern. We, we have a sexual medicine center there that I founded. I'm no longer there. But I have excellent, excellent clinicians who are using all the protocols that I put into place when we opened the center. And there are a number of places that do that. Interestingly, where you'll see it more than anyplace else is sometimes in oncology departments.

• 33:10Speaker 00

  Because we haven't talked about that, but, but certainly when we look at people who are having a great deal of difficulty with sexual function, it is young women, all women of all ages. Who are dealing with not just a cancer diagnosis, but chemotherapy, radiation, surgery. So that's a whole different world and very well recognized by a lot of the top oncology centers. University of Chicago has a wonderful, wonderful center for sexual function post cancer. So that's another place to look.

• 33:41Dr. Mary Claire Haver?

  What is in the future for you? Where do you see this going? Do you feel like access to this kind of care is getting better?

• 33:47Speaker 00

  I do have hope. One of the reasons I have hope is I am the mentor for a medical student organization that is all about sex education. There's a wonderful, wonderful, now she's a resident. When she came to me when she was a first or second year medical student, Jennifer Ramon, I don't know if you've come across her.

• 34:04Dr. Mary Claire Haver?

  I think you brought her to a conference somewhere in Chicago.

• 34:07Speaker 00

  I brought her to a conference, yes. And this is a young woman who said, wait a minute. Wait a minute. How come we're not getting this education? And she is one of those people that puts words into action. And she put together a medical student consortium, which started in Chicago, but I encouraged her because it was during COVID. I said, you might as well get medical students from all over the country. So now we have medical students, hundreds and hundreds of medical students from all over the country that are part of this medical student consortium for education. We'll put the link in because if there are any students out there listening, they have to get involved. And we have events and we have lectures and we do all kinds of things. They're doing research. They're working with Rachel Rubin. She's another faculty mentor.

• 34:50Speaker 00

  And because it was COVID, one of the few advantages of COVID is that I said, hey, this is all virtual. Let's get the best of the best of the best. And we got like the top 15 sexual medicine doctors to get on board for their board of advisors. And these medical students are loving it. They are all over it. We bring them to conferences. We get them involved in research and it gives me great hope. In terms of what kind of fields are they going into? Because this is a discussion, they're medical students. Well, if I want to do this, what field should I pursue? And there are many routes to being a sexual medicine expert. You could be an OB-GYN. You have to like doing surgery and other things. If you do that, a lot of them go into psychiatry. The talkers, the ones that want to keep their clothes on and don't really want to do those exams of the clitoris.

• 35:31Dr. Mary Claire Haver?

  Internal medicine.

• 35:32Speaker 00

  Internal medicine. Family medicine. There's urology. There's a lot of ways for people to become sexual medicine experts if they're interested. So, yes, I do have hope because we have this very large group of students who are very excited about this.

• 35:48Dr. Mary Claire Haver?

  Wrap it up with Come Again, what it is, how to find it, who it's for.

• 35:52Speaker 00

  Come Again is for everyone. It is for healthcare clinicians, meaning doctors, advanced practice nurses, anyone who's taking care of patients, not just gynecology, but in all aspects of medicine. There's not one single medical specialty that doesn't need to know about this. Come Again is for women who, at a high level, want to understand what's going on, what's changing, and most important, what they can do about it. Come Again is for men who want to understand what's going on with the women in their lives. Thirty episodes sounds like a lot, but I promise you it's entertaining. Some of them are short, some of them are 10, 15 minutes, some of them are longer. It started out as 50 or 60 episodes, so it could have been. And you do it in little bites, you little bites.

• 36:34Speaker 00

  And I throw in there a lot of history of this stuff, like we talked earlier about Princess Maria Bonaparte. I love that stuff. I would love to write a book about it.

• 36:41Dr. Mary Claire Haver?

  The history of all of it.

• 36:42Speaker 00

  So I throw a lot of this fun stuff. And it really is for everyone who has a curiosity about this. And even though it's skewed towards women who are perimenopause, because let's face it, those are the women that are having the biggest challenge, it is really for all age groups because these are problems that can happen at any time in life. And the most important is, I'm solution-driven. It's not enough to talk about the problem, let's talk solutions.

• 37:05Dr. Mary Claire Haver?

  Well, it feels like, you know, menopause is having this renaissance and that it's this new topic, but you've been doing this work. For third.

• 37:15Speaker 00

  A long time, you know, whenever we talk about how menopause is having a moment and that makes me a little crazy because I'm thinking it's not having a moment. I've been talking about menopause for 20, 30 years, but no one wanted to talk about.

• 37:24Dr. Mary Claire Haver?

  Right.

• 37:25Speaker 00

  And I used to do a ton of media, you know, Good Morning America and Today Show and, and on and on and all these shows. And I would always pitch to the producers, let's talk about menopause. And they'd be like, no, no, we're not gonna, no, no, give me another topic. And now, of course, that's all they want to talk about.

• 37:40Dr. Mary Claire Haver?

  Mm hmm.

• 37:40Speaker 00

  And, and I would like to think it's because.

• 37:43Dr. Mary Claire Haver?

  You like the groundwork.

• 37:44Speaker 00

  Hmm, I'd like, right, well, there's, there's that. But I would like to think that there's this interest in menopause because people are acknowledging that it is important. And there is some of that. A lot of it is, we, we know there's a lot of money to be made in menopause, which is why people have to be careful with.

• 37:56Dr. Mary Claire Haver?

  Right.

• 37:56Speaker 00

  Where they're getting their information. Um, but I am glad that this somewhat taboo topic is now being talked about, not just in the doctor's office, but with your manicurist, with your friends, with your brother, you know.

• 38:11Dr. Mary Claire Haver?

  The water cooler.

• 38:12Speaker 00

  As it should be.

• 38:13Dr. Mary Claire Haver?

  Yeah.

• 38:13Speaker 00

  That's as it should be. When women talk to their daughters about their first period, they should also be talking about their first top flash.

• 38:19Dr. Mary Claire Haver?

  Yeah, in their last period.

• 38:21Speaker 00

  In their last period, yeah.

• 38:22Dr. Mary Claire Haver?

  I'm guessing you could retire if you wanted to.

• 38:25Speaker 00

  Officially, I have because I'm not seeing patients anymore.

• 38:28Dr. Mary Claire Haver?

  But you're always working, Lauren.

• 38:29Speaker 00

  Somehow.

• 38:30Dr. Mary Claire Haver?

  Why? What keeps you going?

• 38:31Speaker 00

  My husband keeps saying to this. He said, wait, you've retired, but you're working harder than ever. What keeps me going?

• 38:38Dr. Mary Claire Haver?

  Why are you paused?

• 38:40Speaker 00

  Oh, gosh, I don't think.

• 38:41Dr. Mary Claire Haver?

  Are you unpaused?

• 38:42Speaker 00

  Well, no, I'm, I'm not unpaused. I, when people say you're retired and I'm like, no, I'm rewired. I, I'm now going on to the next thing, to the next chapter, because my passion has always been education. I mean, let's face it, I started off thinking I was going to be a journalist. I started off writing. I have five books. I have another one in the works. I've created this Come Again series. I'm, I have my podcast. Nothing gives me pleasure like getting out there and talking to people and making a difference.

• 39:08Dr. Mary Claire Haver?

  Yeah.

• 39:09Speaker 00

  Because whenever someone says, why this? Why not something else? And I've always been driven to go towards what is no one else doing? What's the unmet need? No one else is talking about alternatives to hysterectomy? I'm going to be that person. No one's talking about menopause. I'm going to be that person. No one's talking about the inability to have an orgasm. I'm going to be that person. That's what keeps me going, to be the one who's out there talking about these things that are going to make a difference.

• 39:36Dr. Mary Claire Haver?

  Yeah.

• 39:36Speaker 00

  That are really going to make a difference in someone's life. And what I also realized is I've always been in both worlds, the very academic world of lecturing to doctors and medical students, and I still do that, and then also in the consumer world. And they're equally important to me. And I would like to see those two worlds come together more because this is a conversation that needs to happen. And whenever I'm thinking, I just, I can't do this anymore. I'm overwhelmed. I have to stop. And then something will happen. A stranger will come up to me on the street. I had a stranger, I work on a treadmill desk, and my treadmill desk broke. And I called the company. They tried to troubleshoot over the phone. And they couldn't do it. And they said, let's talk to the owner of the company.

• 40:17Speaker 00

  The owner of the company gets on, and he said, are you Lauren Stryker that wrote Sex RX? And I said, yes, I am. He said, your book saved my marriage. I'm sending you a new treadmill desk. And you just go.

• 40:28Dr. Mary Claire Haver?

  Stop it. You're like, okay.

• 40:30Speaker 00

  And you thought, okay, this is why I do what I do, because it makes a difference.

• 40:34Dr. Mary Claire Haver?

  Yeah.

• 40:35Speaker 00

  We want to make a difference.

• 40:35Dr. Mary Claire Haver?

  I feel the same.

• 40:36Speaker 00

  We want to make a difference.

• 40:37Dr. Mary Claire Haver?

  Some days, you know.

• 40:37Speaker 00

  And you make a difference.

• 40:38Dr. Mary Claire Haver?

  It gets overwhelming.

• 40:39Speaker 00

  That's what drives you.

• 40:39Dr. Mary Claire Haver?

  I take a breath, and then someone will say something I wrote, or said, or did, made them find a doctor, you know, changed their life, whatever. And I'm like, that's why I'm doing this. Like I told you at the beginning, this is for the ladies on the couches in Ohio, in middle America, who don't have a sex med doctor, who don't have access, who don't know where to go or what to do, and are feeling so alone.

• 40:58Speaker 00

  And for those women, what I want to tell them is that not only do we have solutions, but if you don't have a doctor, it's okay. Because I'm going to give you the roadmap. I'm going to give you the script of to go to the doctor that you do have. You may not have a choice, but you can go to the script. You can go to that doctor, and you can say, Dr. Haver told me that it might help me to use a local vaginal estrogen. Will you prescribe one for me? Dr. Stryker said that if I use that estrogen on my clitoris, it might help with my orgasm. Will you prescribe it for me? They will.

• 41:31Dr. Mary Claire Haver?

  They will.

• 41:31Speaker 00

  They're not going to say no.

• 41:32Dr. Mary Claire Haver?

  Yeah.

• 41:32Speaker 00

  They will not say no.

• 41:34Dr. Mary Claire Haver?

  Well, thank you so much for coming on the podcast. It was an honor having you on today.

• 41:37Speaker 00

  Thank you for having me. It's been great fun.

• 41:40Dr. Mary Claire Haver?

  As a reminder to our audience, you can follow Dr. Stryker on Instagram at DrStryke, on Substack at drstryker.substack.com, and on her website at drstryker.com. She is also the host of Dr. Stryker's Inside Information podcast, and she has released a 30-episode audio series on sexual function called Come Again that is available for purchase through her website. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get honest, accurate information on health, fitness, and navigating midlife at thepauselife.com. My new upcoming book, The New Perimenopause, is available for preorder on Amazon. If you're loving this podcast,

• 42:23Dr. Mary Claire Haver?

  be sure to click Follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. UnPaused is presented by Odyssey in conjunction with Podpeople. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.