Dr. Debby Herbenick – Rough Sex, How to have the “Talk with your Kids”, & Understanding the Risks

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.

Dr. Sameena Rahman [: 00:00:47

Let's go. Hey guys, it's me, doctor Samina Armand, Gyno girl. Have you guys heard that song? I don't like no whips and chains and you can't tie me down but you can whip your lovin on me you can whip your loving on me. And so if you've heard this song by Jack Harlow, you know that, you know, even you listen to the words about choking, you know that rough sex is pretty pervasive in the media in what we read and what we sing. And so if we're hearing it, you can bet your kids are, too. And so I wanted to introduce this next podcast that I did with the awesome doctor Debbie Herbernik. She is an amazing researcher at Indiana University. She's a provost professor at the School of Public health and director of the center for Sexual Health Promotion, has done tons of research in the last 25 years and is always quoted for some of her research.

Dr. Sameena Rahman [: 00:01:50

And she wrote a book that was published in November called yes, your kid. What parents need to know about today's teens and sex, plus how to talk to your child about communication, consent, sexting and pornography. So I think that you guys are really going to get some good information today and understand that some rough sex practices are very pervasive and they have consequences just like anything else in life. There are consequences to what we do. There are risks and benefits to, to everything we talk about. And here I am just wanting to educate you so you could advocate for yourself in whatever realm that you can. So tune in for this podcast. You're going to love it with doctor Debbie Herbernick.

Dr. Sameena Rahman [: 00:02:28

And we talk about the rise of rough sex practices and choking and strangulation and what you should know about your kids and how to talk to them about it. So let's get at it. Hey, y'all, it's me, doctor Samina Raman. Gyno girl. I'm so excited today to bring you guys another episode of Gyno Girl presents sex, drugs and hormones. Today I have a very special guest and I'm excited for you to hear from her, doctor Debbie Herbernick. She is an amazing researcher and clinician. She is a provost professor at the Indiana University School of Public Health in Bloomington, Indiana.

Dr. Sameena Rahman [: 00:03:04

She's a director of the center for Sexual Health Promotion and an ASEC certified sexuality educator. Her new book, yes, your kid. What parents need to know about today's teens and sexual an amazing book. I really recommend it. See, I have it right here. And I've been reading and taking notes extensively. And, you know, she's amazing. She's done a lot of research.

Dr. Sameena Rahman [: 00:03:26

A lot of what you hear quoted in the literature is from her research that focuses on women's sexual health, on population based research, which is very important to understand how sexual behaviors are around the country. And she's published more than 200 peer reviewed scientific articles related to sexual and reproductive health and serves as a principal investigator on the award winning National Survey of sexual health and Behavior, which has been ongoing since 2009. She writes books, she researches, she's been featured New York Times, Washington Post, Vogue, Tyra Banks show, Discovery, health, and many, many, many more. So thank you, Doctor Herbernik, for being with us today.

dr. debby herbenick [: 00:04:04

Very happy to be here. Thank you for having me.

Dr. Sameena Rahman [: 00:04:06

Yes. So it's interesting, I met Doctor Herbertich at the International Society for the Study of Women's Sexual Health conference. You guys hear me talk about ishwish all the time as I'm on the board, and I've been a prominent member for many years. And we had her come last year. I'm on the research committee. We wanted to talk about rough sex and practices and she kind of blew my mind. Her and doctor.

dr. debby herbenick [: 00:04:29

Koatta.

Dr. Sameena Rahman [: 00:04:30

Koatta, yes. They kind of, we went into a whole discussion on bdsm and rough sex practices, and she presented her research on what's happening in the world of rough sex and how it impacts your overall health. So we're gonna get into all that today. But thank you, Debbie, for all the amazing work that you do that's really been so helpful for us as clinicians and as parents and everything. So I wanna first thank you, but can you tell me how you kinda came about wanting to study sexual health? I think most of us have some propelling force. Like, I grew up in the south and my parents were immigrants and never talked about sex in front of me ever. And so I had to learn everything on my own. And so, you know, I don't know if what journey brought you into the realm of sexual health.

dr. debby herbenick [: 00:05:18

Yeah, I certainly, I think, like many people came to study sexuality and care about sex education so passionately because nobody did talk to me about it growing up. And so, I mean, I'm a third generation american, but that conservative immigrant lines on both sides of the family, different cultures, but sort of british and Irish on one side and Czech on the other side, but nobody was talking about sexuality. And so conservative catholic families. And I think my parents would have wanted to, and I think they tried to do better than their parents did, but at the same time, it was difficult for them. So I didn't get good puberty talks growing up. My school did the very limited kind of puberty video that many, you know, fifth or 6th graders get. That doesn't really say enough.

Dr. Sameena Rahman [: 00:06:10

Guess what's coming.

dr. debby herbenick [: 00:06:13

Yeah. And so when I graduated college, I was looking for a job, and I sort of graduated a bit early in December and found a job that I could do just for a few months before I started graduate school. And that job ended up being as a research assistant for studies on sexuality and specifically on child adolescent developed. So the participants were adults, but they were reflecting on their own childhood and adolescence and, you know, the messages they got about sexuality, the family or school education, their own behaviors and development. And I realized through that project that I was just around all these people who were sexuality researchers and educators who knew so much, it became very clear to me how little I knew and that there were ways of learning more that I could study it. I could learn and I could make a career out of fulfilling or meeting that curiosity that I had about what people were doing and how they felt about it. And so I've had a 25 year career in sex research so far.

Dr. Sameena Rahman [: 00:07:17

That's wonderful because I know we always quote some of your earlier data on, like, orgasms and how patients or women orgasm and some of that earlier data with just regards to, like, sexual behavior and the response cycle. But now you're doing some even more. I think, you know, all your work's been compelling. I think what I've recently read, you were in the New York Times just last month about what your teenagers are learning about sex. And, you know, quoted some of your research from yesterday. Kid, the book that you published last year, was it?

dr. debby herbenick [: 00:07:51

Yep. In November. In 2023. Yeah.

Dr. Sameena Rahman [: 00:07:54

So let's talk about some of the latest research. I mean, you know, sex has changed so much from us, how we absorb information. I know when I was growing up as a gen xer, like, you know, we didn't. Porn was very hard to access. Like, if you wanted to, you'd sometimes get the HBO fuzzy, like, where you could kind of see, like, you know, some of the stuff, but, like, it was, you know, some people could get it from their playboy or whatever, but, you know, sex in the media was not as prominent and as easy accessible. So. And you make a lot of that in your, in your book, the points about how much sexting and pornography has contributed to some of what we're seeing. So let's talk a little bit about that, and then you could tell us some of the staggering data points you mentioned in the book about what's happening and what type of sex people are having.

dr. debby herbenick [: 00:08:42

Sure.

Dr. Sameena Rahman [: 00:08:42

Yeah.

dr. debby herbenick [: 00:08:43

I mean, and I'm a Gen xer myself, and I can completely identify with how different access to sex and technology and pornography, but other, just even representations of sexuality in media. I mean, I often give the example that, you know, when I was a teenager, Beverly Hills 90210 was a popular show, and my parents didn't watch it, but I watched it, my friends watched it. And if I was watching it, I had to turn it on, on a tv in the house. And so even if my parents weren't watching it, they could overhear what was happening. There was no private tablet device or phone that I could watch it on. So my media use was somewhat apparent within the family, and so parents had more access to step into the conversation. And I think here, what we see is that a lot of the, you know, the media that that young people are seeing is on Twitter. It's on TikTok videos.

dr. debby herbenick [: 00:09:42

And even if you're following your kid on Twitter or TikTok or other, you know, other social media that they're at, you're not necessarily seeing what they say. So, you know, everything. Of course, like, the media that we get fed is based on our viewing patterns and our various algorithms of the tech companies. So parents may not realize there's so much on TikTok that's really about, like, rough sex and choking and various kinds of topics, you know, drugs, whatever the case is. And they may just be seeing, like, fun dances on TikTok and thinking that's a lot of what TikTok is. And they love when their kids send them TikTok dances and stuff, so they may not see this other side. And so I think, you know, not only is all of this out there and represented in the media, but many parents and educators just aren't fully aware of the depth and breadth of what tweens and teens may have access to.

Dr. Sameena Rahman [: 00:10:32

And that exposure and what it represents to them about sex, I think, is very prominent. Let's talk about some of your research and some of the statistics around rough sex and how it's much more common now. And you can correct me, I think you had quoted that maybe two thirds or 67% of women, and you can verify the age range, but had, I think there were college age women who had been choked during sexual intercourse. And it was. It's that common. I mean, it was really shocking to hear this, actually.

dr. debby herbenick [: 00:11:04

It is, and it's not a fluke. We've now conducted four college campus representative surveys since 2020, and we consistently find that number or a little higher. So it's kind of inching up a little bit so that by the time college women are in their senior year, somewhere closer to 80% of them would have been choked at least once. But if you look at overall, you're right, it's about two thirds of, you know, of undergraduate and graduate students who have been choked during sex. And it's not just a college student phenomenon. So nationwide, we see that 35% of women between the ages of 18 and 24 were choked during their most recent sexual event. So that's not just ever, but that's just during the last time they hooked up or had sex with somebody. So it's not only something that many people have tried at least once, but it's something that they do often, and it's really part of many of their sexual experiences.

Dr. Sameena Rahman [: 00:11:57

Right. And I have to say, you know, in the sexual medicine world, we always say, don't yuck my yum or whatever. You know, that's the phrase that we hear a lot in terms of that. And so I do want to be cognizant of the fact that there are subgroups of individuals who are into sort of rough sex and bdsm under the context of doing it in an algorithmic way, almost, where they know the consent is involved, that, you know, I think that they have their safe words. You know, the people in this community, you know, have a way of expressing it, and they feel comfortable with it and they love it. I think our concern around that is like, is this the exposure you're getting from popular culture and this is what you think is the norm and what that can, what happens when it accumulates? Right. So I think any kind of asphyxiation, lack of oxygenation to your brain over time, you know, it's, I think the doctor that came to Ishwish, and I forget, I forgot his name again. Doctor.

dr. debby herbenick [: 00:12:54

Yeah. Doctor K. Kawato. Yeah.

Dr. Sameena Rahman [: 00:12:56

So he's one of your colleagues. I think he was mentioned in your book as well. And he also came to Ishwish to talk about, you know, or we talk about the encephalopathies that football players have and that those that are getting recurrent concussions and how that develops over time from recurrent asphyxiation. And the analogy that he made was like the same that can happen to people that get choked recurrently as well. Right. And can you talk a little bit more about that data?

dr. debby herbenick [: 00:13:21

Yes, absolutely. And so, yes, Doctor Kawada and his team, he's a fantastic colleague here at the Indiana University School of Public Health and largely has studied concussions and sub concussive injuries among athletes. And so he was so generous to lend his expertise here. But what he and his team did was invite groups of women into his lab to undergo brain scans and also to have blood draws to look at blood biomarkers to show how the brain is responding to, in this case, the experience of being choked or strangled during sex. And we say strangled because even though almost everybody calls it choking, technically choking refers to the internal blockage of the airways. But strangulation is really about, you know, use it applying external pressure or squeezing of the neck to reduce blood flow or breathing. And so that's why you're going to hear me sometimes say, or strangulation. We're still referring to the same behavior.

dr. debby herbenick [: 00:14:17

But so they looked at these groups of women who had been choked or strangled four more times in the past month, as well as those who reported never having been choked during sex. And they found, you know, several differences between them. One of the ones that has always stuck out to me was these working memory tasks that they asked the women to do while they were in the brain scanner, and they found that both groups of these otherwise young, healthy, college or graduate student women were able to arrive at the correct answers. However, it was the group that had been choked or strangled recently, in the past month, that it took them longer to arrive at the correct answers, and they had to recruit more of the areas of their brain. So, as he often describes that their brains demonstrated, there's some sense that their brains are less efficient than the groups of women who had never been choked during sex. So that's certainly concerning, and certainly more work needs to be done, and we're planning to do more work, and we hope other people get inspired and want to look at this area as well. But it's an important first step in understanding the extent to which there may be some cumulative impact on the brain.

Dr. Sameena Rahman [: 00:15:28

And I think the importance of understanding that if you do participate in this practice, how it can have a potentially long term effect on you, that it's not as benign as just enjoyable sex. What is it, when you talk to these individuals in these surveys, what is it that they find so compelling about choking? What is the reason that most people, other than what they see in pornographic videos or they hear on songs or whatever, what is it that you think that most of them are saying that why they want to have it done, or.

dr. debby herbenick [: 00:15:57

Yeah, you know, there's a diversity of reasons. And as you mentioned, there is a subset, you know, it's actually very small subset that is into asphyxiation or choking or circulation. There's different kinds of asphyxiation as part of kink and bdsm communities. And so reasons for wanting to do it in that capacity can be really different than in the mainstream culture, where in mainstream culture, many people say, oh, it just. It seems kinky or adventurous, or I, you know, that's just how sex is and so on. And it's kind of an part of sex. And so there's not necessarily a real, you know, reason for wanting to do it other than kind of identity or what you think sex is supposed to be like. And so I think the one of the real challenges with that is that, again, many of those individuals have not really looked into it that much, may not know much about the risks, may not have even.

dr. debby herbenick [: 00:16:45

May not even really be asking their partner about choking them before actually doing it. So they might put a hand on their neck and then say, is this okay? Like, while their hand is still on the neck, which isn't. Doesn't always give a lot of opportunity for somebody to, like, think about it and decide they may feel pressured or coerced. Some people do talk about wanting to do it for the effects of low levels of oxygen in their body. So some people do experience the known effects of euphoric sensations or kind of sometimes they'll describe it feeling, like, cloudy headed, or they might like another aspect of it, which is they kind of have. They come down a little bit while they're being choked and their oxygen levels are low, but then, and when they re oxygenate, the pressure comes off and they get their oxygen back. They feel a burst of energy. And so some people like that part of it.

dr. debby herbenick [: 00:17:34

So there. And for others, it's about, you know, power and control and trust and feeling like, you know, it's exciting and connecting that their partner trusts them enough to let them choke them. So the reasons vary, but it's definitely a new era with this many people engaging in this higher risk sexual practice.

Dr. Sameena Rahman [: 00:17:55

And where does consent fall into this? I know that you've done some work on, you know, how many people actually verbally consent, or this is something that was discussed. Like you said, sometimes it happens in the heat of the moment. But I know you've done some research around consent as well, because that's a critical element here, is really that this is a mutual, you know, benefit for both parties. Right. So talk to us a little bit about how, what you've learned about consent when it comes to these, at this age group.

dr. debby herbenick [: 00:18:19

Yeah. You know, when we got into this research and started conducting interviews with people, we were very curious what consent was looking like, because, again, we knew, being in public health, that this was a higher risk sexual practices. So we thought that perhaps people would be going through more careful or explicit consent, talking about it rather than just assuming. And that wasn't the case. Sometimes people had talked about it. Sometimes they talked about it just once in the sense of getting together and kind of making a list or just talking through. What would the things be that you would be open to? What would you like to try? But they wouldn't necessarily talk about choking again, and they might just do it a few weeks later without bringing it up again or without any detail. Right.

dr. debby herbenick [: 00:19:01

So people don't usually talk about the intensity or, you know, how light or how hard or for how long, and that can really matter. So sometimes some people want to be choked. They may ask to be choked, but they did not expect that somebody was going to choke them to the point of unconsciousness. And so, you know, so people don't always, in fact, they usually don't negotiate the details of choking, or they might be fine being choked with hands, but be very upset about being choked with a belt or some other kind of ligature without any communication or consent. And ligature is a high risk form of choking. And so we found that some people describe engaging and really no verbal or verbal communication about it, but they just say that they rely on the vibe or the energy in the room, which is true for some other kinds of sex, too. But again, we thought maybe with this high risk forum, there would be more communication. So there's a whole lot of lack of communication or lack of detailed communication.

dr. debby herbenick [: 00:20:02

And what we are seeing and we hear from college campuses, I regularly hear from people in title ix offices and sexual violence prevention folks and legal systems who see these cases very often where people have agreed to hook up or have sex, they've consented to that, and that part is fine. But what they didn't consent to was either being choked or hit or smothered or something else, or they didn't consent to the level or the degree of being choked that ended up happening.

Dr. Sameena Rahman [: 00:20:32

That's very surprising, actually. And I know you mentioned even some in the book also, how when discussing what some of the college kids about sexual assault and having sex, some, I think some lawyers, you know, come talk about these cases, how that actually, like, opened up some of their minds. Like, they're like, oh, this is like, I'm teetering on this sexual assault thing. Can you, can you speak to some of the involvement of your other authors in your book?

dr. debby herbenick [: 00:21:00

Yeah. I was so fortunate to have Susan Stone and Christina Supler join in as contributors to guess your kid. And they are two attorneys who see cases around sexual, sexual misconduct and sexual assault all the time. So they really deal with these cases all over the United States. And they have, they guest lectured in my class, and it was very eye opening for my students to really think through the real life implications of some of their behaviors, anything from learning that, for example, it can be intimidating to stand between somebody and the door or to lock the door and stuff, and that somebody might feel trapped. Some of them hadn't really thought through those power dynamics and that those can be seen as pressuring or, you know, pressuring somebody or coercing or kind of be intimidating to needing to talk or needing to talk more than just text. So many young people find it so much easier to talk with a partner or a potential partner about what they're into over text. And that makes a lot of sense.

dr. debby herbenick [: 00:22:04

A lot of people feel more comfortable having those digital conversations. But what's so important and what Christina and Susan said, you know, they had seen in so many of their cases, is that that's where the conversation not just started but ended for too many of them. And so in, yes. Your kid, for example, we talked about the importance of really making sure once you're physically in the same place that you, again, check in with what you feel like doing with each other that day and again, how it feels and what you want to do and what limits or boundaries might be or if something is higher risk, safe words or safe gestures that you might use, but not just relying on text or message conversations.

Dr. Sameena Rahman [: 00:22:43

Yeah, absolutely. And I think that's one of the biggest things that's changed for us gen xers, right, is that, you know, there used to be so much accountability when it came to, like, meeting people and dating. And because it was always face to face or, you know, you knew some of their friends or family members, and it was something that you, there's just that human sort of value of being around somebody and speaking to them in person where you can see how what you say affects them.

dr. debby herbenick [: 00:23:10

Right.

Dr. Sameena Rahman [: 00:23:11

Versus, like, I'm just going to text you to f off and like, you know, whatever, you know. And they don't, they don't know how it affects them because they don't see that communication. And I think that's changed dramatically. That's changed the dating world. That's changed how we, you know, how people find people to marry all the time. And I feel like, and you could say this as a whole, that how social media, how, you know, these devices have affected relationships in general. Right. But I think it's really had a dramatic impact on sexual relationships.

dr. debby herbenick [: 00:23:37

Absolutely, it has. And so it's very important, again, to think about, like, those real life conversations and how much they matter for consent, for seeing how, you know, people's reaction to you and treating them as human beings and not just words on the screen.

Dr. Sameena Rahman [: 00:23:52

Right. Because we all know, I mean, all of us have some social media presence, and it's very easy for someone to troll you and tell you that x, y or z, and you just have to be like, okay, this. I'm a human being like you to realize that.

dr. debby herbenick [: 00:24:04

Yeah.

Dr. Sameena Rahman [: 00:24:04

And I, and I saw, like, the chapter that you did on, you know, individuals that are on the spectrum. That was very interesting because I don't feel like, and we had someone talk about this at ishwish this year, too, sex on the spectrum. So I like that you brought that up. Can you speak to a little bit about your chapter on that? Because I feel like, you know, we do see, you know, so many people that are neurodivergent, you know, they're not as understood, and potentially communication becomes an issue for some of them. But let's.

dr. debby herbenick [: 00:24:29

Yeah, so I used to work with kids who are on the autism spectrum for quite a few years and really, really, really loved that work. But at the time, you know, there was almost no, you know, support for parents in terms of dealing with sexuality education or puberty education. So it's been an area of research that's really grown over the years, and there's a lot more educational programs. We also have many more autistic students on college campuses than we used to, and at least, or at least who feel comfortable, you know, talking about that. We have more support on our college campuses in terms of, like, student accessibility offices. So we do have more autistic students. So that's also changed the dynamics of my classroom. I have many more students who tell me that they're autistic, who may talk about some of the challenges that they experience in their sexual life.

dr. debby herbenick [: 00:25:18

And we've had more autistic students as part of our research studies who share about their needs, their curiosities, communication issues, and in the realm of both just general sexuality and connecting to my work on rough sex. One of the things that's been so interesting to me and we've seen emerge in the research is so many more, you know, young autistic adults who talk about having interests in kink and BDSM and for different reasons, and sometimes it's related to social interactions and communication and really, really appreciating the principles that are often part of BDSM or kink communities around having explicit negotiation and conversation. Because then you're not relying on kind of these unwritten nonverbal cues that so many, you know, of people in society go by because things are laid out so they can really appreciate that there's going to be a lot of communication, and it will be clear to them and to other people. Sometimes people who are autistic also really appreciate and enjoy a lot of the sensory issues that are, again, very openly available. And people talk about a much broader range of the sex menu, if you will, in Kink and BDSM communities. So they might say, oh, I really want some sensory deprivation, or actually, I really want harder impact. And here's people who are open to lots of possibilities. So I did write a little bit about that because sometimes we do hear from parents who say, I've got a 16 or 17 year old autistic son, and I found this porn that they're watching, and it's really focused on all this king stuff, and I'm trying to understand it.

dr. debby herbenick [: 00:26:57

And although there's lots of different reasons that kid may be watching that, and some of it's just because that's what's out there on websites these days, some of it also might be related to the experience of being autistic as well, and to sensory issues. So whether it's that side of things or even just more general sexuality education, I think writing that chapter was really fun and interesting for me. And, you know, I talked with some of my students and other adults who I know on the spectrum, but, you know, even thinking about things like the importance of using very clear language and not relying on vague euphemisms, I mean, that should be for everybody, right. But often sex education is people talking about, like, notches on the belt or sleeping with somebody. And really, everybody does better when we have frank, clear communication. But that is especially important for autistic kids and tweens and teens who really, really need to not be guessing what people mean by kind of, you know, sort of beating around the bush with their language.

Dr. Sameena Rahman [: 00:28:00

Yeah, no, I love that you did that because it is so much more common and it's probably not talked about as much as it should be in terms of, like, how patients or, you know, parents or anyone that is neurodivergent, like, how do you sort of help navigate, you know, sexuality for them, you know, and first, and, you know, we know there's a big spectrum and so it can vary in terms of what you need and what they need. But I love that you incorporated that because I think that that is often missed by a lot of people who talk about sexual education. And, you know, you also talk a little bit about sexting and, you know, how that looks in terms of, you know, people that, how that can impact relationships. I feel like that is something that is, you know, can get people into a lot of trouble when, you know, I think that, you know, do you want to talk a little bit about what you found out about just sexting in general?

dr. debby herbenick [: 00:28:51

Yeah. And I think to take a step back, I would say really just about taking and sharing nudes. And so, you know, we Gen xers often call it sexting, as I mentioned in the book, you know, young people just talk about, like, nudes and stuff like that, so. But I still lean on the language of sexting as well because of, you know, my generation, but. And of course, and I mentioned taking and sharing of nudes, too, because I think it's bigger than just sexting and sharing text and messages. And I think. So one thing that all tweens and teens, anyone with a phone access to a connected device, you know, really good information for parents to give to their kids is not to take or share nude images, not to ask other people for nude images. We find that even some elementary age kids are being pressured to send nudes, especially girls, are often on the receiving end of that pressure.

dr. debby herbenick [: 00:29:41

So one thing that some parents can even do is check out the policies in their school system. And if the only people who get in trouble are the ones who are sharing the nude image, they should also talk to their school about revising policy to be about asking or pressuring other people for nude images. So looking at the upstream behavior, because a major reason that people, especially, again, girls are sending images is because they're being pressured and hounded for them or they feel like it's the only way they're going to get someone interest and attention. Young people also need to know that in many states that, you know, these nude images of minors will be treated as child pornography or as image based sexual abuse. So even if it's just you and your dating partner and you're the same age and you're both 15 or 16, in some states, it just doesn't matter. And so, in fact, in most states, it's going to get you into some kind of trouble. There are very few places in the US where truly consensual, non coerced sexting is, is not a problem. And so most of the time it will, it could at least lead to school suspensions or expulsions.

dr. debby herbenick [: 00:30:47

And of course, you know, the principal seeing these images, I spoke with one woman whose dad was a middle school principal, and she said, you know, it's just been so upsetting for him over the years to have to see sometimes images of his students. He doesn't want to look at these pictures. He doesn't want to have to get the police involved, but he has to, right? He has to do these things as part of his job. So also, many of us who are professionals in this space could be advocating more for decriminalizing these images of consensual, non coerced, non pressured images so that fewer kids have to go through those systems, right? And have police and judges and lawyers and principals and everyone looking at that. I think these days, what we really worry about too, though, are these AI generated images. And we've seen lots of headlines in the past. Really, even in just the past few months, they've exploded where middle schoolers, in high school, schoolers have been charged with, you know, with creating deep fake, or AI generated images, nude images of their classmates. And in some cases, all they've done is friended somebody on Instagram, gotten one or two, you know, images off that student's Instagram with fully clothed, put them into an app or an AI type of program, and then they take and share and, you know, and pass around images of this classmate that looks like they're completely nude.

dr. debby herbenick [: 00:32:06

So some states, fortunately, have quickly worked to enact laws, but not all of, all of them have that. So in some of these states, families have no recourse or very limited recourse. And so that's changing. There's also a federal bill that has been proposed. It's not passed yet, to my knowledge. But again, like, as technology keeps changing, you know, we need to be aware of this. And so for parents with tweens and teens, you know, they need to know not only don't take or send nude images, but don't make them of other people and talk with them about what that could do to somebody else. And you don't want to hurt your friends.

dr. debby herbenick [: 00:32:41

You don't want to be seen as the creepy person at school who's doing this. And you don't want to get our family in trouble and have to pay thousands of dollars in legal fees and all of these other things. So really just, I would say, and it's not to scare. Anyway, as I say throughout, yes, your kid, I'm not trying to scare you, but I am trying to prepare you. So it's not about scaring folks, but do talk with your kids. And, you know, what a lot of research finds with parenting, whether it's about drugs or alcohol or sexting, is that a warm, informational approach is very effective. It's not too strict, it's not too passive and lenient, but caring about your kids saying, I want you to know this. I want you to know the laws in our state.

dr. debby herbenick [: 00:33:24

We, you've got to know school policy. So, you know, here are the things, like, here's what I think, you know, you should or shouldn't do, but also don't ever make your kid feel like they're doomed because we don't, we always want our kids to feel like they can come to us because sometimes things don't go according to plan. Right. But we, they still need our support.

Dr. Sameena Rahman [: 00:33:43

Absolutely. I have to say. Yeah, I mean, obviously there's some statistics in the book that are scary, and it's just scary to learn about how things have changed from our generation. But you do give a lot of great advice about communicating with your child about, you know, even starting as early as, you know, pre puberty. I was telling you earlier that I give the puberty talks at my school for my kids school. And, you know, this is where my daughter at ten realized what I do for a living. And she was, like, really appalled.

dr. debby herbenick [: 00:34:09

Like, this is what you do.

Dr. Sameena Rahman [: 00:34:11

But, you know, I think it was very important for me to just know what they're learning in a correct fashion. And, you know, like, the vulva is the vulva the vagina is the vagina. You have to say the right terms. And even one of the teachers were like, I had no idea was vulva, like. And she was, like, 40 years old or something like that. So it was very interesting to do these talks at my kids school. But I have to say that, you know, I've been going to ish wish, you know, maybe for the last, you know, nine years or something. And when my kids were smaller, I would always take them to the conferences with me because I didn't have, you know, someone to watch over them necessarily the whole time.

Dr. Sameena Rahman [: 00:34:43

So they would try, like, what is this sex stuff here? You know, and at the time, you know, growing up child of immigrants didn't talk about sex, I adapted what my parents would say, don't talk about it. Like, just don't worry about it. This is not for you. Like, this is. This is what I would tell them initially, then after reading your book and after, like, coming to terms with it on my own, because it is something that even though I try to fight my own, you know, like, you know what? My own upbringing, right? Like, even though I talked to my patients about it very openly, I give talks all over the country about sexual medicine and sex and all this stuff. But when it came to your own kids, you were very, like, a little. Still a little bit hard to do. And so, you know, after reading your book and hearing what you said at the conference, I just, you know, and I've talked to my kids about puberty ad nauseam, but, like, the actual sex stuff.

Dr. Sameena Rahman [: 00:35:30

So I've really just sat my 14 year old down, and I was just like, look, I gave your phone last year for the good or the bad. You're not on social media. I get it. But I know that you've been, you know, probably scrolled and you might have seen something that, you know, is considered pornographic. Let's talk about it. And he's like, well, mom, I mean, you know, if I did, I didn't watch it. I don't. I don't want you to think I'm watching pornography.

Dr. Sameena Rahman [: 00:35:51

And I'm like, no, I get it. But I want you to understand that it's okay to talk to me about it because I want you to get the right information from me and understand sort of, you know, the things around sex and consent and, you know, where we stand, you know, and where we, you know, where I want you to be in terms of, like, relationships and, you know, with. With other individuals. I mean, I just wanted them to be. To realize that they could come to me, you know, so it was, it was, it was interesting for them because they were, like I said, you know what I do, right? Like, you guys see my PowerPoints all the time, and it's the topics that you don't ever talk to me about. But this is what I want you to know that you can talk to me about. So I think, you know, even after hearing you and reading your book, it really forced me, like, I gotta have this conversation. So I appreciate that, actually.

Dr. Sameena Rahman [: 00:36:34

And I was telling you also that I appreciate the fact that, like, now when I talk to my patients who have sexual dysfunction, I do always try to, you know, talk about what sexual practices are involved so they can be aware of some of these issues around, like, asphyxiation and choking and strangulation.

dr. debby herbenick [: 00:36:51

Yeah. And of course, I always love hearing when parents decide to expand their conversation with their kids after reading, yes, to your kid. I mean, that is so affirming. Like, that's why I wrote the book. And I also love, you know, hearing that you're talking with your patients because so many of them really don't understand the risks of being choked. We've done some research looking at the media articles online and the social media memes, and they really just portray it as, you know, not that harmful or there are safe ways to do it. And, you know, we talked about some of the potential cumulative risks on the cumulative effects on the brain. But there's even, like, the carotid arteries.

dr. debby herbenick [: 00:37:25

Right? And so potentially damaging the arteries in the neck. So this idea that, oh, it's safe, just only touch the sides, not the trachea, not the windpipe, is not the case. And I've already heard from some clinicians who have seen carotid artery dissection in patients who have come in and had emergency situations. Right? And we know that that happens, and it's rare, but it can happen. And now that so many people are doing it concerning, and certainly in, like, ob GYN, I mean, we also need to be thinking about pregnant people who are lowering the oxygen in their body and in their blood system, you know, by engaging in choking and so on, and what that could possibly do to, you know, to fetal development. So I think just asking those questions gives an opening for a conversation to have all of those. What I think clinicians are so good at, too, is taking in sometimes some really difficult information and figuring out how to provide, like, again, like, at least in my experience, I feel like, calm, steady, you know, fact based information, but that, you know, really supports the person having enough information to make a choice for themselves that supports their health, and they may not get that advice from anyone else in their world. And, you know, I know I even recently saw someone who's around my age, an old friend, and she said, you know, I was.

dr. debby herbenick [: 00:38:47

She said, I have to tell you, I, you know, she said, I stopped engaging and choking because I heard you on someone's podcast. And she said, you know, you and that person were talking, and she said, I didn't want to do this, but the person I was dating had, you know, reassured me it was completely safe. So we had been doing it for a while. And after I heard, you know, you and this other person on their podcast, and you both were saying, no, this, you know, this actually has some written to it, I sort of went to him and said, you know, it's not as safe as I think you thought it was. And I don't want to do this anymore. So just having that information can give people the tools they need to figure out what's right for them. Right?

Dr. Sameena Rahman [: 00:39:25

And at least then, I mean, it's kind of like just informed consent, right? Like, we talk about it all the time in procedures that we do. Like, we don't anticipate these things or we don't want these things to happen, but it is a possibility, right? Like, we, you know, when. When you start someone on birth control pills, you might tell them that you might develop sexual pain or, you know, low libido, and that's a risk. But you have to know your risks going in. You can't think that you're right, that this is a safe, you know, practice that's not going to impact, you know, my quality of life or my cognition or any of that. And I think that's the key. And if you're willing to take the risk, that's your, that's your, that's your, that's your thing. That's what you have.

Dr. Sameena Rahman [: 00:39:59

But I do like that you've gotten information out there. I mean, even I know you talk about that song by Jack Harlow. I hear my. Listening to my daughter sing it one day, and I'm like, do you know what he's talking about when I don't like nose whips and chains, you know, like, let's talk song. And she was like, mom, all right. I was like, were you singing, like, put your love it on me? Let's talk about what that means, you know? And she was like, God, mom, she wasn't ready for it.

dr. debby herbenick [: 00:40:29

You know, it is. And at least she knows you're there for the conversation, and that's it might give her something to think about. And I know many of us can probably remember singing along to certain Madonna songs or other things that look like we're like, oh, did we really know what that meant?

Dr. Sameena Rahman [: 00:40:44

But I think there are so many stalker songs.

dr. debby herbenick [: 00:40:49

Yeah, there were. There were. And so I think I do tell people often with parents, there's upsides and downsides to how pervasive choking and rough sex is in the media these days. And certainly the downsides are just the normalization of it, especially without communication, consent, or really awareness of the true risks. But the upside is that it means you have so many places to step into those conversations. If you hear them singing loving on me, you know, you can bring it up. If you know that they've seen pornography, talk about it, you know, so, I mean, you have options. You have a lot of ways in other than just kind of a random awkward sit down.

dr. debby herbenick [: 00:41:28

You know, it's, you can, you can connect with your kids over the media, right?

Dr. Sameena Rahman [: 00:41:32

You can sing with them and then they just get really disturbed by the fact that you're singing this. Yeah.

dr. debby herbenick [: 00:41:37

If you really don't want them to like that song, just sing with them.

Dr. Sameena Rahman [: 00:41:40

Well, I mean, I think everyone should get this book. Yes, your kid. It is a wonderful book, especially if you're in the sexual health realm, if you have kids, if you know kids, if you have any idea, if you're practicing any of the rough sex practices we talked about, just to get more information for yourself, because like I say here, I'm here to educate so you could advocate for yourself. And it's, whether or not it's advocating for yourself in the healthcare realm or advocating for yourself with your partner, you know, you have to, you have to know what the impact is on your body. So thank you once again, Doctor Herbernack. I really appreciate you being here. I love what you're doing. I can't wait to see all the new data that, you know, you guys are working on.

Dr. Sameena Rahman [: 00:42:20

So, and then you can come back and tell me about that.

dr. debby herbenick [: 00:42:22

Thanks for having me.

Dr. Sameena Rahman [: 00:42:24

Thanks again, guys. This has been gyno girl presents sex, drugs and hormones. Again, I'm here to educate so you can advocate. Please join us again next week for another great episode. If you have a second, please subscribe to this podcast.

Dr. Sameena Rahman [: 00:42:36

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.

Dr. Sameena Rahman [: 00:42:47

These reviews really help review us.

Dr. Sameena Rahman [: 00:42:50

Comment tell me what else you want to here to get more information. My practice website is www.cgccago.com 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, Gynell Girl TV where I love to talk about all these things on YouTube and please subscribe to my channel newsletter Gyno Girl News which will be available on my website. I will see you next time.