Don’t Let Menopause Stop Your Orgasms: Dr. Lauren Streicher Explains How

Dr. Sameena Rahman [: 00:00:01

Hey, y'all, it's doctor Samina Rahman. Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate, and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate. Welcome to Gyno girl presents sex, drugs, and hormones. Let's go.

Dr. Sameena Rahman [: 00:00:50

Hey, guys, it's me, doctor Samirman. Gyno girl. Welcome to another episode of Gynel Girl presents sex, drugs, and hormones. Today you are in for a special treat. Okay, I have a very lively discussion with a guest who is a friend of mine from Chicago, a colleague, an expert in so many things related to midlife and sexual medicine. But today I want to introduce you to the podcast that I did with Doctor Lauren Stryker. She is amazing sex med gynecologist as well as a midlife women's health specialist in menopause. She'd been talking about menopause before it was cool to talk about menopause.

Dr. Sameena Rahman [: 00:01:33

And she is a best selling author. She's been on tons of media outlets. She started the sexual medicine at Menopause center at Northwestern University Medical Center Feinberg School of Medicine. She does everything and anything. So she's pretty cool to talk to as well because she's hilarious. She comes with a wealth of knowledge and she's very evidence based. So you guys are going to enjoy this discussion because we're going to talk about orgasm dysfunction. And not just any kind of orgasm dysfunction, really acquired orgasm dysfunction related to midlife women.

Dr. Sameena Rahman [: 00:02:10

And we delve into what happens when you're on SSRI's. We talk about what happens when you have multiple comorbidities like diabetes, hypertension, metabolic syndrome, whether or not we should be using. Is Viagra good for women. We get into that discussion because no one really talks on that. And then you can also find out what happens when a sexmed gynecologist has children and what they become in life because she talks about her amazing daughter who is a sex therapist. And so we're going to get into it. So please join us. Let's get at it.

Dr. Sameena Rahman [: 00:02:48

Hi, everyone. Thanks for joining me. It's me, Doctor Samita Rahman, Gyno Girl I'm here today with my podcast. Gynel girl presents sex, drugs and hormones. I'm really excited, I'm super excited to have my friend and colleague, doctor Lauren Stryker here today. If you think about menopause and midlife, she is the OG. Menopause midlife has been talking about it for a very long time before it was hip to talk about. She has done so much in this field and is such an expert and talks to women in a way that I think really resonates with them.

Dr. Sameena Rahman [: 00:03:19

Very funny too. If you've ever heard her present, she's hilarious. She's a professor at the Northwestern School of Medicine, Feinberg School of medicine. She started their sexual medicine and menopause center. She's been on every media outlet you could imagine. She has written many books that are bestsellers. Her newest one are a series of books about midlife. One of the first ones was hot, flash hell and also slip sliding away.

Dr. Sameena Rahman [: 00:03:47

Is that right?

Dr. Streicher [: 00:03:48

Slip sliding away, turning back the clock on your vagina.

Dr. Sameena Rahman [: 00:03:50

Yeah. Slip sliding away, turning back the clock on your vagina. And today we are going to talk about her newest book. That's going to come out soon. And it's all about the big o because nobody addresses the big o when it comes to midlife women. You can look at all the menopause books. I kind of looked up into that before I went. Wanted to talk to her.

Dr. Sameena Rahman [: 00:04:10

I'm like, is anyone addressing the big o in midlife women? And no. So I'm super excited for doctor Lauren Stryker to tell us about everything she's been doing. Oh, she also has an amazing podcast. I recommend it every day to my midlife patients because it's just so thorough, so evidence based and so like, just easily digestible.

Dr. Streicher [: 00:04:30

Doctor Stryker's inside information. Menopause, midlife and more.

Dr. Sameena Rahman [: 00:04:35

There you go. So it's really good, guys. And I don't know, it's been, what, two years now?

Dr. Streicher [: 00:04:41

Lauren, I just started season three. I cannot believe it.

Dr. Sameena Rahman [: 00:04:44

Oh, wonderful.

Dr. Streicher [: 00:04:45

Lost in March 2 years ago. So heading into season three.

Dr. Sameena Rahman [: 00:04:50

Oh, my goodness. It's really good. And like I said, I recommend it to my patients all the time. So please welcome doctor Lauren Stryker. We're so excited to have you here today.

Dr. Streicher [: 00:04:59

Well, thank you for having me. And it's just so funny how you say nobody talks about orgasm, you talk about orgasm.

Dr. Sameena Rahman [: 00:05:05

Yeah, I talk about orgasm, but I'm not writing about it right now.

Dr. Streicher [: 00:05:09

Exactly. But no, but it's important. And that's what I love about you, is you go. There you go. There with all the topics that, quite frankly, a lot of people are not all that eager to have me get out there and get into the details.

Dr. Sameena Rahman [: 00:05:22

Yeah. And I think that it's a very neglected topic. I had doctor Lauren Mintz on a few weeks ago. She talked about all the great things that she loves to talk about, the orgasm gap, all the statistics around that. And as a sex therapist, how she kind of, like, works with that.

Dr. Streicher [: 00:05:43

What's so interesting about that book about cliteracy? And Laurie and I interviewed her on my podcast during season one, and I'm going to connect with her again shortly. And I actually quote her book a number of times. And the thing about her book is I look at it as the perfect companion for my book because my book is the biologic, medical, hormonal, physical, anatomic reasons that someone has difficulty with orgasm. What Doctor Mintz is talking about, of course, is much more the psychosocial issues, the cultural issues in terms of the orgasm gap, and how we really have to change our discussion around women's sexuality. So it's like, okay, you start with her book, and then if you can't have an orgasm because in spite of doing all the right things, nothing is happening, then you read my book.

Dr. Sameena Rahman [: 00:06:32

Yeah. And I think I saw yesterday a CNN article that you were quoted on about. Well, we can just dive right into some of the topics that you're discussing, but because this is relevant, I'm talking to you today, and it's March 22. Yesterday, you had been quoted in a CNN article about antidepressants and sexual function. And we know that when you get all that serotonin on board, you can really blunt your sexual function, including orgasm. So do you want to talk a little about that?

Dr. Streicher [: 00:07:03

You know, so funny about that article is you do a lot of interviews for the media as well, and you do these articles, and honestly, you forget about them because two, three times a week, you get, someone contacts you and says, oh, can we talk to you about? You say, sure, and then you forget about it. So the CNN article, I don't even remember when we had the conversation. I honestly completely forgot about it. And then it went live yesterday, which was coincidentally, was the exact same day that my podcast went live about the impact of SSRI.

Dr. Sameena Rahman [: 00:07:33

Oh, my God. That's so funny.

Dr. Streicher [: 00:07:34

Actually, it wasn't planned at all, but it was just kind of like, oh, wow, that was meant to be that. This is the week that I talk about. And so, yeah, it is an interesting topic, but the thing that really struck me as I was preparing my podcast. And when I was talking to the CNN writer, is the number of midlife women that are taking SSRI.

Dr. Sameena Rahman [: 00:07:57

Ssrs, right. Yeah.

Dr. Streicher [: 00:07:59

We are talking one out of four women, by the time you hit 60, are taking an SSRI, which is crazy. But when you think about why, that's really the important part, because when you think about why and when they started it, most of these women were put on SSRI's during perimenopause because they were having changes and because they were having hot flashes. And they were either told or believed that they could not take hormone therapy, and therefore, the default was to put them on an SSRI. And so you suddenly have this enormous population, millions of women, millions, millions of perimenopause women, and post menopause women who are taking an SSRI to deal with symptoms that could be managed with other ways, that are not going to make them gain weight and are not going to make their orgasm go away, and that are not going to take away their libido. And yet, this is the go to. I don't know when this happened, that an SSRI became the first line treatment for women who are struggling with menopause. So let's just start with that. And I'm not minimizing the people who have anxiety and depression that predated perimenopause, menopause and are appropriately need to be on an SSRI.

Dr. Streicher [: 00:09:16

But those are not the big numbers. The big numbers are the ones who were put on just for that reason. And to that point. Last night, I was doing a talk to a group of women here in Chicago, where we both are, and it was a group of very, very bright, educated women who had brought me in to talk on this topic. And one of the attendees said to me, she goes, look, I'm a doctor. She was a pediatrician. She said, I'm a doctor. And when I went through perimenopause and started having these symptoms, I went to my Ob Gyn and said, I'm having these symptoms.

Dr. Streicher [: 00:09:47

What should I do? And she gave me a prescription for an SSRI. And he said to her, I don't want an SSRI. I want hormone therapy. No, no, no. We start with this, and then if this doesn't work, then, and this is a northwestern doctor. You know who this is. No names, and this doesn't work, then. Then maybe we'll reluctantly try hormone therapy.

Dr. Streicher [: 00:10:08

And she said, well, I don't like that idea. So she went to her internist, and her intern has said, you know, oh, no, no, no, no. Hormone therapy. You get the picture, right? Went to three different doctors before she finally found someone who would prescribe her hormone therapy, which took away all of her symptoms. And she's perfectly happy.

Dr. Sameena Rahman [: 00:10:27

Right.

Dr. Streicher [: 00:10:27

But had she not been an educated, savvy physician patient, he never would have known and would have thought that hormone therapy was out of the question. Okay, but. So we got off track here, because what you want to talk about is what's going on when you take an SSRI. Well, let's start with how many women actually have sexual side effects? And when you look at the data, it's kind of all over the map. And most data is in that 30% to 50% range of people that have some kind of a sexual side effect. And there are other factors, of course, that go into it. And some of these women already come to the table with sexual pain or other reasons that just gets exacerbated. But if you just look at de novo, a woman who's having no problems, and she starts her ssrI, and suddenly her libido's in the toilet and she can't have an orgasm.

Dr. Streicher [: 00:11:19

That seems to be around 30% to 50%, which is really high. Really, really high.

Dr. Sameena Rahman [: 00:11:24

Alarmingly so.

Dr. Streicher [: 00:11:25

Then you say, okay, well, why does this happen? And as you said, this is really about. It's all about the neurotransmitters. You know, dopamine is. I always say dopamine is all about, you know, sex all the time. You're feeling dopey with love, you want your dopamine to be high. Serotonin is stop, you know, stop thinking about it, do the laundry, go to work, do something else, and it's this balance, right? And so what happens when you take an SSRI is your dopamine goes down and your serotonin goes up, because in someone's depressed, their serotonin is low, and you want it to go higher. So it's good for depression, but it's not good for your sex life. So that's why it's happening.

Dr. Streicher [: 00:12:01

As far as libido, the question is, well, what does this have to do with orgasm? Because when you think about orgasm, what you and I think about and talk about all the time is what's going on down in the clitoris. Do you have a blood supply? Are those nerve endings sensitive? Are they firing off? Are your pelvic floor muscles contracting? So where does dopamine and serotonin come in with that? Well, where it really comes in, is that what we're looking at? Is what's going on in the brain, because the brain is the one that's talking to your clitoris.

Dr. Sameena Rahman [: 00:12:34

That's the biggest organ, right?

Dr. Streicher [: 00:12:36

Yeah, exactly. It's saying, okay, hello, respond. Getting those pleasure centers ready, getting ready to trigger all of that. So mostly, when you look at sexual side effects with SSRI's, it's mostly libido issues. But for a lot of women, it's orgasm, as we. And then the downstream effects of, if you have libido and you don't get aroused because you have to have arousal for orgasm. So it's complicated, but it's also simple, right? You know, you load your body with the wrong neurotransmitters and it's going to put things to a dead stop. Correct.

Dr. Streicher [: 00:13:07

So then, as we go on, you say, okay, well, then what are you going to do about this? And sometimes it's going to go away on its own. So if you wait it out very often. But if you're like four or five months into it and nothing's changing, chances are it's not going to. And that's the point when you say, okay, well, let's start to look at other strategies. And I always preface this by saying what you and I always say is, this is not a do it yourself project. If you're going to mess with your SSRI, please talk to the clinician that actually prescribed it, because some things you can mess with yourself. I mean, like, when you and I talk about vaginal estrogen, it's like, have at it. You know, you want to use less, you want to use more.

Dr. Streicher [: 00:13:49

Who cares? But with an SSRI, you know, you can talk to the person that prescribed it. Yeah, but sometimes it's that you can lower the dosage, and that will help. Sometimes you can switch to a completely different antidepressant. Some SSRI's are worse than others, but there's also other antidepressants. And it also depends, are you treating hot flashes or are you treating anxiety or depression? Depending on what you're treating, is going to determine alternatives. Now, of course, the obvious alternative is that if you're treating your hot flashes and if you're treating perimenopausal things, and if you think you're not a candidate for hormone therapy, chances are that's not true. I mean, we could even talk about women with a breast cancer diagnosis, which is really not science based, that they don't take hormone therapy. Exactly.

Dr. Streicher [: 00:14:37

But certainly if somebody doesn't have a breast cancer diagnosis, there's very few reasons in the world that someone cannot safely take hormone therapy.

Dr. Sameena Rahman [: 00:14:45

Exactly.

Dr. Streicher [: 00:14:45

But assuming that someone doesn't want to go that route, a lot of people just prefer to avoid hormone therapy. And so, yes, you can talk about lowering the doses. You can talk about changing to a different antidepressant.

Dr. Sameena Rahman [: 00:15:00

Never abruptly stop your antidepressants, though.

Dr. Streicher [: 00:15:03

Yeah, well, there's the drug holiday thing where you're like, okay, you're gonna stop it on Thursday, Fridays, and with the idea that it's gonna be out of your system enough. The Saturday, Sunday. And there was one study that I talk about in my podcast that actually does seem to help and did not have a negative impact on mental health. And in fact, it actually improved it, which I think is. Cause people were, like, happy they were having sex about their mental health. I don't know. I don't know. But the really interesting story is the whole Viagra story, this story.

Dr. Streicher [: 00:15:35

So do you prescribe for women with.

Dr. Sameena Rahman [: 00:15:38

I do, and then do it topically. And I. Sometimes I'll do it orally, too. Let's talk about it. Because the urologists always say that when men have erectile dysfunction, it's your first sign that something might be happening cardiovascularly or neurologically. But no one talks about what's happening to the clitoris in midlife. You know, comes to the neurovascular bundles down there and how Viagra may or may not help with that. But, you know, with midlife, right, you have the diabetes, the hypertension, that might come along and help.

Dr. Sameena Rahman [: 00:16:08

Like, let's talk about.

Dr. Streicher [: 00:16:10

Absolutely. And when you talk about who's at the highest risk for having. When we talk about you and I, what we're talking about is acquired orgasmic dysfunction, which is very different than the person who's never had an orgasm. That's a whole different situation. Talking about women who say, yeah, I used to have orgasms just fine, and then something changed, and now I can't, even when I do all my tried and true things that always worked for me before. And as you said, you know, you need healthy nerves, you need healthy blood supply. And if something changes, that's an indication that something is up as far as the blood supply or as far as the nerve endings. And just like with the guys, I mean, the penis is a big clitoris.

Dr. Streicher [: 00:16:47

And so there's a lot of similarities, but the difference is that the nerve endings and the blood supply and the clitoris are much smaller and more vulnerable. I mean, you know, think about that. Yeah. And, you know, what was about a year ago when they came out and they said there was 10,000 yeah. Oh, this is so great. This is so exciting. And a blog post or something. This is nothing to be happy about.

Dr. Streicher [: 00:17:14

This just means they're even, you know, this is like an area the size of a pea and you've got 10,000 nerves in there and people are happy.

Dr. Sameena Rahman [: 00:17:22

I'm thinking, I like, I remember your blog that day. I was like, yeah, that's exactly right.

Dr. Streicher [: 00:17:27

Right. So to your point, you know, I mean, it's the people with, you know, diabetes, it's the people with vascular problems who. It's going to be the first to go. And so, yeah, so the whole idea of, is Viagra going to help? And we don't have good data. We have very bad data. If you look, I mean, I've looked at every single study that's ever been done on the use of Viagra in women, and they're lousy studies. I mean, you and I talk all the time about. You can't just take a study at face value.

Dr. Streicher [: 00:17:57

You have to look at it. How many people were in it? Was it a placebo controlled trial? How long did it last? Who did they exclude? Who was part of it? You know, all that stuff. So the studies are terrible. They're really not good. They're very inconsistent. But the groups that it did seem to help the most, and I'm talking about an oral Viagra, which is FDA approved for guys, of course, not for women, but the group that it seemed to help the most was women with SSRI induced problems with orgasm, women with multiple sclerosis and diabetics. But honestly, the testing and the data is so just not adequate. And I think you and I can.

Dr. Streicher [: 00:18:42

I mean, we're very data driven, but sometimes when there is no data, you kind of have to go on your own experience. And certainly I have found that for many, many women, it has been helpful, even if they don't fall into the specific areas that we're talking about. And then there's the topical stuff. Are you prescribing the compounded topical sildenafil?

Dr. Sameena Rahman [: 00:19:03

But I have done the oral stuff because as a South asian, you probably know the statistic. We make up 25% of the world population, but 67% of the world. Diabetes and heart disease. So South Asians, I'm always asking them about orgasms in midlife, and they're like, non existent because there's so many diabetics and so many hypertensives. So those are the ones I'm like.

Dr. Streicher [: 00:19:28

Jesse, metabolic syndrome, all of it.

Dr. Sameena Rahman [: 00:19:32

I know your husband's on Viagra, like, let's just take a propell and try it. And so, you know, some of them have had success.

Dr. Streicher [: 00:19:39

Yeah, yeah. And then the topical stuff, that's, you know, right now in clinical trials, and you can get it compounded. And, you know, there's. There's that as well. So.

Dr. Sameena Rahman [: 00:19:48

Yeah, and I think the clinical trial, what do you think about that so far?

Dr. Streicher [: 00:19:53

Well, we can't. I mean, we don't know a lot about it. And basically all we know is that it's like, I think, a 3.5% sildenafil cream, and with the idea of they're talking about it as an arousal cream as opposed to an orgasm cream. And I think that that's really just to get it through the FDA, quite frankly. And you need arousal to orgasm, and arousal leads to orgasm. So we all know what we're really talking about. I mean, I've heard through the grapevine that the results are promising. I've also heard through the grapevine that they are not including postmenopause women in their trials, only premenopause, which we've already seen this story with Flabanser and Brie mulanita, because it's easier to get it through the FDA if you don't include post menopause women, because post menopausal women have too many variables.

Dr. Streicher [: 00:20:41

That makes it trickier. So even assuming that it will get approved, and I assume that it will because it appears to be effective, I doubt that it's. It's. Has a lot of side effects, but it's going to be approved probably just for premenopause women, which doesn't mean we can't use it. Of course we use it. We do these things all the time. It just means the insurance isn't going to cover it, which is.

Dr. Sameena Rahman [: 00:21:04

Right. You just have to pay out of pocket like every other thing that, you know, midlife women have to do. Because, you know, like you said, flabanserin and vermilitide are not covered.

Dr. Streicher [: 00:21:14

No problem.

Dr. Sameena Rahman [: 00:21:15

Fortunately. I don't know. It's the whole FDA's issue that they won't approve it for. Well, they wouldn't include them in the study, but the studies for the other, for, like, flobanserin and Bilisi are looking. Are there for postmenopausal women and looks good? I think so.

Dr. Streicher [: 00:21:33

We have the data that shows that it works and we know that it's safe. So I think a lot of people get confused about the term off label.

Dr. Sameena Rahman [: 00:21:39

Right, exactly.

Dr. Streicher [: 00:21:40

You know, off label doesn't mean it's illegal or inappropriate, it just means that's not what the FDA cleared it for. You know, the example I always give is birth control pills. Because how many people take birth control pills for cramps and for heavy bleeding? Guess what? That's off label. The birth control pill is only FDA approved for contraception. That's it.

Dr. Sameena Rahman [: 00:21:59

So that's very interesting. Oh, so I was going to ask you, too, I think. I don't know if you. Did you tell me that? Because I know your daughter is a sex therapist, right. And I want to say, did you say that she's helping me with the book at some point? Did you tell me?

Dr. Streicher [: 00:22:13

Yeah. So what we decided to do when I was writing this book, and of course, I was only writing the medical aspects of it, but orgasm, more than anything else I've ever written about, and libido, you can't ignore the psychosocial impact. You just can't. And a few books ago, my book, sexrx, hormones, health and your best sex ever, which was a comprehensive sexual medicine book. And I ended up writing about some of the psychosocial stuff. But I always felt like, stay in your lane. That's not my thing. That's not my expertise.

Dr. Streicher [: 00:22:45

And certainly you and I speak to that all the time because that's just part of what we do, but that's really not what we're trained to do. And I thought, okay, I have a daughter who has a PhD in this stuff, and she is an extraordinarily talented. Not only therapists and sex therapists, but you may not know about her. This about her? She was a journalist. Yeah. She was a journalist in New York, and she started writing health stories, doing freelance stuff just to get a little extra money. And then she had interviewed a sex therapist about something and said, well, this is interesting. How did you get that job? And was so interesting that she literally moved back to Chicago, went to northwestern, got her master's, and then ultimately got her PhD and is now an Asex certified sex therapist.

Dr. Streicher [: 00:23:34

But the point is that she's a really good writer. And so when I started writing this book, and I thought, okay, this is something that we can collaborate on. We've collaborated on a lot of things. And she just finished her own book, which she's in the process of getting published. So I went on pelvic pain, completely different topic. And so I said, do you want to. You wanna join in? You wanna be part of this project? And she said, sure. So she is writing all the psychosocial aspects.

Dr. Streicher [: 00:24:01

Her name is Rachel Tsar. It's a different last name. She's very good writer. She's very clever. And in fact, she came up with the title of the book, which is, come again? She's really good. So, yes, we are working on this together. And we do a lot of stuff together. We do a lot of talks together.

Dr. Streicher [: 00:24:22

She's been on my podcast as a guest many times. I think my favorite episode that she did was faking orgasm. You know why women fake it and. Yeah, but so, yeah, so, so my daughter is collaborating with me, but we. But we're actually, the way we decided to do it, we kind of went back and forth is I have my chapters and she has her section. Like, we're not like, incorporating it into it. It's like, okay, I'm writing all the meat of it in terms of the. And then she's got a whole another five or six chapters at the end, which are all the psychosocial things.

Dr. Streicher [: 00:24:56

And I told her, you take the chapter on how do you buy a vibrator and how do you talk to your partner about using the vibrator and all that kind of stuff. So we're really having fun with it.

Dr. Sameena Rahman [: 00:25:05

Yeah. So if you ever wonder what a sex med gynecologist kids turn out to be.

Dr. Streicher [: 00:25:11

My other child therapist and we can't even say vagina in the room with her because she covers her ears and goes running away. Unbelievable. I mean, she's so funny because we all grew up, you know, and this. They all grew up in the same. And she. I don't. It's so weird. It's so funny because when she was little, you know, even when she was in grammar school, in high school, she was the one that was.

Dr. Streicher [: 00:25:37

You have a period problem, come to me. You know, she thought, we thought she was going to go to medical school because she loved talking to the medical stuff. And then she ended up being a therapist. And no, she does not want to talk funny.

Dr. Sameena Rahman [: 00:25:49

I have two daughters, and one of them, when I did her puberty talk at school. Cause she's eleven, she's like, I can't believe this is what you decided to spend your life doing. And then my five year old, when I took, I took my girls to see Barbie and there's that whole scene where they say, where she says, I don't have a vagina and he doesn't have a penis. And my five year old blurts out, but mama, we have vaginas, don't we? Like all the whole, like three people turned around and looked at me with evil eyes. Like, why is your five year old saying vagina?

Dr. Streicher [: 00:26:21

Listen, I have a two year old granddaughter who proudly told me that this is my vulva.

Dr. Sameena Rahman [: 00:26:28

There you go. I love it.

Dr. Streicher [: 00:26:31

But seriously, I think just to circle back to the whole orgasm thing, women do not know where their clitoris is. They are, they are taught that this part of their body is shameful, that not only do you not talk about it, but you certainly don't touch it. And no one points out to them where things are and what to do. And guys obviously have the advantage that they don't need instructions sitting right there for them to two years old and they know what to do with it and everything just works out fine. And so many times when a woman has never had an orgasm, it's because no one has told her that these clitoral stimulation or how that's going to happen. And then when you have someone who develops a problem later in life, as we've been talking about, there's such shame about the fact that they even do want that pleasure or miss that pleasure or expect that pleasure. They don't talk about it. And their doctors aren't asking them.

Dr. Streicher [: 00:27:25

You and I know that every time I talk to a group of women, and it doesn't matter how big the group is, it could be 50, it could be. And I say raise your hand if your doctor has ever asked you if you can have an orgasm. And generally not one single hand goes up because doctors don't ask that. They just don't. So here we have this enormous population of women that are struggling that this is really frustrating, making them really unhappy, impacting on their sexuality, on their self identity, on their sense of self worth, on their relationship, all of that. And yet they feel like this isn't something they can talk about with their doctor. And if they do, because doctors aren't trained in this stuff, they'll say something like, well, you know, this just happens when you get older. End of discussion.

Dr. Streicher [: 00:28:13

I mean, it all comes back, you know, circling back to how do you approach sexuality with your kids? How do we approach sex education? You know, sex education, instead of it being this is, it shouldn't just be about, you know, how to not get pregnant and how not to get a sexually transmitted infection. It should be about pleasure. And it never is.

Dr. Sameena Rahman [: 00:28:34

It never is. And, you know, any other layers on top of that, cultural taboos or whatever, religious taboos, you're never going to hear about it. So.

Dr. Streicher [: 00:28:42

That's right.

Dr. Sameena Rahman [: 00:28:44

And what other issues around acquired orgasms does your book kind of delve into other than the psychosocial stuff, you know?

Dr. Streicher [: 00:28:55

Well, it's interesting because when I first kind of mapped out this book, I think I had twelve chapters. I'm now up to 32. 32.

Dr. Sameena Rahman [: 00:29:04

Is it bigger than your other books? Because, you know, your other books bigger.

Dr. Streicher [: 00:29:08

And I didn't mean to be, but this is the problem. You know, we, you and I, both gone down that rabbit hole, that you start to research something, and suddenly it's like, oh, I didn't know that.

Dr. Sameena Rahman [: 00:29:18

Yeah.

Dr. Streicher [: 00:29:19

Know that. Yeah, I didn't know that. So, you know, I really, really do the deep dive into, what are the medical conditions? What is the impact of things like alcohol and cannabis? What is the impact of when you do have nerve damage? What are your solutions? What can you do? You know, not everyone. We talked about Viagra. That's obviously not gonna be the solution for everybody. So I talk a lot about the different options there are in terms of increasing arousal, increasing clitoral blood flow, making those nerve endings more sensitive, even for something as obvious to us and as simple as use a vibrator. For a lot of women, not only is this something they haven't thought about, but it's kind of shocking, you know, that a doctor would say, here's a prescription for a vibrator, right? And I call it a sexual tool, not a sexual toy, because this isn't just to make things more fun. It's to make things happen.

Dr. Streicher [: 00:30:19

It's to make it possible, like any other tool. And we use so many tools in medicine that we don't think of these devices as being tools, but they really are. And I think we need to frame it that way. And this is something that we write prescriptions. When I first went to Northwestern and started the sexual medicine, and I suggested to him that we really, really, really should, in our clinic, sell vibrators and lubricants and books and educational materials, not only to make it easy and accessible to our patients, but really acknowledging that most of these women are not going to be comfortable going on Amazon and buying a vibrator.

Dr. Sameena Rahman [: 00:30:59

Take it home from your doctor.

Dr. Streicher [: 00:31:01

They're not going to walk into a sex store. And just like when they go to the dermatologist and you walk out with $9 million worth of creams and ointments for your skin, that when they come to the sexual medicine or to the menopause clinic, I would like them to walk out with a nice goodie bag of things that are really going to help them. And so then I revisit. Exactly. So I revisited about a year later because I don't. You've been.

Dr. Sameena Rahman [: 00:31:24

You.

Dr. Streicher [: 00:31:25

Have you ever been to the center that, you know, anyway, I don't remember, but there's this area when you walk in right past the waiting room that's like this nook that would have been perfect to, like, have, you know, a display shelf with all this stuff. And then someone could just order it and walk out with their bag and they had like a dying plant there. And I said, you know, this would be a really good place to put our vibrator display and our lubricant display. But seriously, this is an issue that you have a major medical center that's dealing with real life medical problems, and we have real tools and solutions. And yet, and yet I'm being told that, no, you cannot sell vaginal dilators here. You cannot sell lubricants here. You cannot sell all of these things that you and I are recommending on a daily basis that really help our patients, and they just say no.

Dr. Sameena Rahman [: 00:32:21

And that's a big problem in our medical community, just not taking the issues around sexual dysfunction seriously. And, I mean, it's enough not to. Not to ask. And then the people that are asking want to help people, and we can't even, you know, get to that next level.

Dr. Streicher [: 00:32:36

Yeah. Yeah. So therein lies one of many issues.

Dr. Sameena Rahman [: 00:32:40

Exactly. Well, I think it's a perfect way to end our talk by going out and buy a vibrator. Guys, like I say, the only thing.

Dr. Streicher [: 00:32:48

That vibrates is your cell phone. It's time to go shopping.

Dr. Sameena Rahman [: 00:32:52

There you go. There you go. Well, thank you, guys. Tuning in today for gyno girl presents sex, drugs and hormones. Thank you, doctor Lauren Stryker. You're always a wealth of knowledge and just so much fun to talk to. So please like and subscribe to my podcast and comment if you want to hear more. I'll have a doctor Stryker back at another time.

Dr. Sameena Rahman [: 00:33:13

Tell me what you want her to talk about. But until the next episode, I'm here to educate so you can advocate for yourself. So please tune in next week. Thank you so much.

Dr. Sameena Rahman [: 00:33:24

If you have a second, please subscribe to this podcast. I'd love for you to be a follower and learn as much as you can about the things that we're going to talk about with all the people on our journey. Please review us on Apple or Spotify or wherever you listen to podcasts. These reviews really help review us. Comment. Tell me what else you want to hear. To get more information, my practice website is www. Cgc.

Dr. Sameena Rahman [: 00:33:49

My website for Gynell Girl is www.gynegirltv.com. my Instagram is Gynell Girl so please follow me for some good content. Additionally, I have a YouTube channel, Gynel Girl TV where I love to talk about all these things on YouTube and please subscribe to my newsletter Gynell Girl News which will be available on my website website. I will see you next time.