S03_E01 - Sex-Ed Rescripted: Audio automatically transcribed by Sonix

S03_E01 - Sex-Ed Rescripted: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi. I'm Kristyn Hodgdon, an IVF mom, proud fertility advocate, and co-founder of Rescripted.

Staci Tanouye:
And I'm Dr. Staci Tanouye, a board-certified OB-GYN striving to make reproductive and sexual health fun and empowering for all.

Kristyn Hodgdon:
Welcome to Dear Infertility. This season, we're going back to the basics. From menstrual cycle red flags to what you need to know before you start trying, we're giving you the tools you need to take control of your overall health and fertility.

Staci Tanouye:
Does birth control cause infertility? Do painful periods mean that I have endometriosis? We're here to answer all of your real-life questions and provide you with patient-centric advice and support so that you can be your own best health advocate.

Kristyn Hodgdon:
Now let's dive in and talk about everything sex-ed failed to fill you in on.

Kristyn Hodgdon:
Hi everyone and welcome to season three of Dear Infertility. I'm your host, Kristyn, and I'm so excited to introduce you to my brand new co-host, Dr. Staci Tanouye. Dr. Tanouye is a board-certified OB-GYN. Welcome, Dr. Tanouye.

Staci Tanouye:
Thank you. I'm so excited to be here this season!

Kristyn Hodgdon:
Absolutely. So happy to have you. Do you want to give everyone a little background into what made you so passionate about reproductive and sexual health?

Staci Tanouye:
Sure. I trained up in Rochester, Minnesota, at Mayo Clinic and did my residency there. I was on faculty there for a little while, and then after a short stint there, I moved down to Florida because my husband got recruited for his job down here, and I kind of had to reestablish myself in my career when I was here. And long story short, I did a huge career pivot about five years into our move here. And when I did that, I really needed to kind of start recruiting a new patient base for my clinic, for my practice. And in doing that, I got on social media, and I was like, I'm going to advertise myself locally so I can recruit patients. Well, we all know how it kind of ended up. It really didn't end up as local marketing at all, it ended up being this much bigger adventure that I went on in terms of being able to educate the masses of everything that I thought that people were missing out on, that people were misinformed on, and just stuff that we never talk about. And it's really evolved into its own thing, and it's been really exciting, and I've loved doing every second of it.

Kristyn Hodgdon:
That's awesome! And how can people find you on Instagram? What's your handle just so that everyone will follow?

Staci Tanouye:
Yep. I'm at Dr.Staci.T on Instagram and really all of my platforms.

Kristyn Hodgdon:
Perfect. Well, so excited to have you. And this season we're really hoping to take it back to the basics. There are so many things that sex-ed failed to teach us when it comes to our fertility or reproductive health, our sexual health. And it's only fitting that this first episode is called Sex-Ed Rescripted. And actually, we posed the question to our community like, what do you wish sex-ed had taught you? And to no surprise, since we're a fertility community, the number one comment question we received was, why didn't sex-ed teach me how hard it actually is to get pregnant? So let's start there. What do you feel like is wrong with sex-ed? And can you go into why we're not taught that it actually is maybe slightly harder than we're taught to believe to get pregnant?

Staci Tanouye:
I mean, what's not wrong about sex-ed in this country? Everything's wrong about sex-ed in this country. I feel like if you did get sex-ed at all in your schooling or from your community or even from your family, it was often more fear-based. A lot of talk about the bad parts of sex, like not really establishing a healthy relationship with your body and with your sexuality and sex. It was talking about STIs and unplanned pregnancy. And you're a teenager, don't get pregnant. And a lot of it was really just fear-inducing. And obviously, that's if you got sex-ed at all. I posed the same question to my audience on Instagram one time and ask them, did you have sex-ed and what did you wish you had? And the massive amount of people that had none, that had zero, was absolutely astounding. I mean, we knew that. But it's still just to see it is, it's, really explains a lot. And obviously there's so much societal taboo about bodies and sex and sexuality that even if you don't have sex-ed in like a formal educational setting, talking about it with adults, with your mentors, with your people who are supposed to love and support you, your parents, your family is also really difficult for parents to do because they weren't raised to talk about these topics. They were raised to shut up and keep it behind closed doors, and so to break that mold is really hard for us as adults to do as well. And obviously we're trying to get better with each generation, but it's really hard to do. And so that's one of the great things about this podcast, about what I do on my platform is part of that is breaking those taboos. I've done a couple of posts on my Instagram about sex-ed for younger kids because there is standardized curriculum out there, there is a standardized curriculum put out by, and I'm going to mess this up, but it's it's SIECUS, it's S I E C U S, Sexuality Information and Education Council of the United States. And they actually put out national standards for sex-ed for K through 12 of all the different topics and how you should approach them in age-appropriate ways to address each of these topics. And really, if everyone just adopted a new about that sort of kind of standardized curriculum, we'd be in a much better place. To get to the question of like, why did no one teach us that it was so hard to get pregnant was obviously because no one teaches us great sex-ed and just, no one just talks about how everything works, the basics of how it works. And because, if you did get sex-ed, it is all fear-based, like don't get pregnant, use condoms, get on birth control. I mean, if they tell you that at all, but it's like you're a teenager, if you have sex, you are going to get pregnant. So you better be scared as hell that you have to protect yourself as much as possible to not get pregnant. And that's what sex-ed is is like scaring you into either one, being abstinent, or two, just being so scared that you're going to get pregnant with touching any sort of genitalia. And so no one knows that, well, actually, there's something called the menstrual cycle. And with the menstrual cycle, you have to ovulate, and this ovulation only happens once per month, and so there's really only this little window of time that you could get pregnant. And even if that window does happen, we as humans really aren't great or effective at reproducing. Like there's really somewhere only between a 15 and 30% chance every single month that we hit that window and we'll get pregnant then. And there's so many other factors that go into it. And now I'm rambling, but you can just see that like we just get none of that education. No one knows that stuff.

Kristyn Hodgdon:
And I'm personally convinced, as someone who's been through infertility, that like, that is so much of why so many of us are blindsided when we get an infertility diagnosis, because we're not taught that that's even really a thing. It's like, you know, I didn't even know, I came off birth control after ten years and never got my menstrual cycle back and didn't even realize that I had to ovulate in order to get pregnant. And I'm like a college educated person?

Staci Tanouye:
You know? It's.

Kristyn Hodgdon:
I felt like I knew enough about my body, but I guess I did not.

Staci Tanouye:
I also talk a lot about how it really is like when, for women who are in that situation, it's a total mind fuck to be going on like your whole life of I have to be on contraception, I have to not get pregnant, I have to go to school, I have to start my career. Don't get pregnant, don't get pregnant, don't get pregnant. And when you're finally at the point where you're like, oh, I want to start a family, doing that mind shift of don't get pregnant, don't get pregnant to okay, now I'm actually actively trying to do what I've been so afraid of doing my whole life, that mind shift is really, really kind of messed up and how we are taught to approach this topic too. And so not only do we have to really shift that mindset, but then when you get tumbled into having, oh, now it's hard to get pregnant, and I've been working so hard to not get pregnant. I even realize like that it could be possible that I couldn't get pregnant very easily. Like, it's, it's such a crazy mind shift to go from one to the other.

Kristyn Hodgdon:
Exactly. So for those who are sort of trying to conceive, beginners out there, can you go a little bit into the science behind ovulation and when you should actually be having sex to get pregnant?

Staci Tanouye:
Yes. And so, in general, in a healthy cycle, a healthy menstrual cycle, is this like finely tuned dance of your hormones that have to be very well coordinated throughout the entire month. Your hormones are secreted from your brain, that sends signals to your ovaries, and back and forth. And they talk back and forth to try to get this perfect wave of hormones that signal your ovaries to ovulate once per month. So at the beginning of the month, you have a bunch of these little follicles in your ovaries, and when you are born as a baby, you're born with every single follicle you ever have in your life. As we get older, those follicles decrease in number. But the first half of the month is based on, you know, the ovary kind of getting all of its follicles ready. And then this fine hormonal dance comes around and selects out one follicle to mature and develop, and kind of somewhere in the mid-month ovulate. Typically you ovulate 14-ish days prior to your period. So it's harder to predict going forward when you're going to ovulate, but it's better in retrospect to see behind when you did ovulate, because the second half of people's cycle is the more, kind of, set in time cycle across the board, it's a little more consistent in timing. So approximately 14 days prior to your period is when you typically ovulate, and when you ovulate that egg that is released from its ovary, that has to be swept up by a healthy, normal fallopian tube is only viable for fertilization for somewhere between 12 and 24 hours, okay? So it's a really short period of time that the egg could potentially be fertilized. Now, we have to remember that sperm can live longer in vaginal area in the uterus, and so sperm can be viable for up to five days. Some people maybe even say up to seven, but five is kind of commonly accepted. And so if there is sperm, they're waiting for that egg to be fertilized, that's the most optimal thing for it to do, because that will be most efficient, is having sperm up there waiting for this egg that's only going to be viable for 12 to 24 hours that can then be fertilized and then have a healthy implant into the uterus. And that's how we ovulate, so simple, right?

Kristyn Hodgdon:
Yes.

Staci Tanouye:
So simple.

Kristyn Hodgdon:
So my next question is, do you have to have sex on ovulation day or is there a window?

Staci Tanouye:
You don't have to have sex on ovulation day, some people do. Some people believe, and some research would suggest that sex about the day or two before ovulation might be more efficient for pregnancy because, again, it takes a little while for those little swimmers to swim up the vagina through the cervix, through the uterus. And that egg has to be fertilized in the fallopian tube so that sperm has a long way to travel and to remain healthy. And if it's waiting in that area to fertilize that egg when the egg is released, that's going to be most efficient. So there is some thought that sex a day or two before ovulation might be optimal, but sex on the day of ovulation is fine. And again, if sperm lives for up to five, maybe seven-ish days, sex a couple of days before that, ovulation could be possible too, which is why we have what we call that window, which is a couple of days before ovulation and kind of that 24 hours after ovulation.

Kristyn Hodgdon:
Right. So what do you typically recommend for tracking your menstrual cycle?

Staci Tanouye:
For tracking? And it really depends on the person and like your goals and what you need and what you don't need. For people who have really predictable cycles, who are really regular and can predict their period down to the day every single month, they may not need a whole lot at all to track. They may just need a menstrual calendar to track their cycles and they can kind of predict ovulation from there. There's a whole bunch of new fancy apps out there that are trying to, that you have to track a couple of months and then it will predict in the future your fertile window for you, that can be really helpful. And then there are some people who either want to do more or need to do more because there's lots of other things that we can track. We can track basal body temperatures, we can track our cervical mucus changes, we can do OPKs or ovulation predictor kits, which are kits that you buy over the counter, that you pee on a stick, kind of like a pregnancy kit or a pregnancy test. And you can do one of these, a combination of all of them, really, whatever you are comfortable with, whatever you need and whatever's going to work best for you.

Kristyn Hodgdon:
Awesome. And just FYI, for our listeners, we will be doing an episode on menstrual cycle irregularities and what to do if you don't have sort of a typical cycle each month, so stay tuned for that. So the next question we received from our community, actually, it's more of a statement than a question. A lot of, a lot of people wrote in saying, why did no one tell me that vaginal discharge is a normal bodily function? So my follow up question is what causes, is cervical mucus, by the way, the same thing as vaginal discharge? And how does, how does it sort of change over the course of the month?

Staci Tanouye:
So cervical mucus is parts of the vaginal discharge. It's one component of the vaginal discharge because vaginal discharge is not only the cervical mucus, that is mucus secreted by the glandular cells inside the cervix, it's that combined with the secretions from the vaginal cells themselves. And those vaginal secretions are part of your vaginal discharge as well. And what those secretions do is those can help sweep up and kind of exfoliate the vaginal cells and the topical cervical cells. It's it's kind of like a self-cleaning mechanism of the vagina. We always say the vagina is like a self-cleaning oven, right? Like that's, its natural cleaning mechanism. So you don't need to do anything special or insert anything special to cleanse or clean your vagina. Your vagina is perfect, it does it all on its own. And that's exactly what vaginal discharge is. It's, it's this self-cleaning mechanism. And I, as a teenager, also didn't know it was normal and thought I was a super freak and was so embarrassed by this this natural thing. And so that's another reason why I want to talk about it so much and just say vaginal discharge over and over and over again, because I was, at the same time I wore penny liners over all the time, I wash my underwear like crazy, I cleansed like crazy, I was like that. And it was like the exact wrong thing to do that I have learned over years of expertise.

Kristyn Hodgdon:
Yeah! I don't think a lot of people know that they don't need to be cleaning down there.

Staci Tanouye:
Correct. Yes.

Kristyn Hodgdon:
And there you go, someone who sees a lot of vaginas. ...

Staci Tanouye:
... So we could talk all about that because I can go on for days about cleaning, but.

Kristyn Hodgdon:
I think we do have a subsequent. ...

Staci Tanouye:
Yes we do.

Kristyn Hodgdon:
So thank you for that. And the same thing came up about periods like sex-ed never told me that having a period is not gross or shameful. Like I'm just thinking of, still in my thirties, you're passing tampons under the table to your friends and like why every person with ovaries experiences periods. Why is this not normalized?

Staci Tanouye:
Do you remember like getting those little like period kits from, I know that, like the period product companies where they would send us like really discreet little like pouch that you, look like maybe a makeup pouch so you could put your stuff in there so you could hide it away in your purse. So even you didn't have to see that it was like a period product. Like we're just taught that we need to keep all of this stuff under wraps and in secret and in the bathroom. And it's just it's such a normal bodily function that because we're hiding it away, we don't learn about it, we don't normalize it. And that just breeds the embarrassment about it, and that's why so many of us think that periods are dirty, periods are icky, periods are embarrassing or messy. And if we would just do what we're doing here and talk about it more and normalize it and get the education in our classrooms and in our communities early enough, we can normalize periods and normalize talking about them and normalize throwing a tampon across the room to someone who needs it or having them on display in our bathrooms for friends that might come over and need that sort of stuff. Like we shouldn't be hiding this stuff away. Toilet paper is sitting right out there in our bathrooms like so tampons and pads should be too.

Kristyn Hodgdon:
I love that, yeah. There's a company called Aunt Flo that I follow on LinkedIn, and their whole mission is to sort of end the stigma of period health.

Staci Tanouye:
Yeah.

Kristyn Hodgdon:
Pretty cool. So you're an OB-GYN, what can someone sort of expect on their annual OB-GYN appointment and like if they are trying to consider, starting to consider trying to conceive, what questions should they ask you?

Staci Tanouye:
Yeah, I think what to expect at your annual GYN visit can vary quite a bit because it can vary depending on how old you are, what preventative tests are do or not do. But at the very least it should be a really comprehensive review every single year of your medical history, your menstrual pregnancy, menopause history, what contraception you need or don't need, what your goals are, what your symptoms may be, if you're on something, it should always include offering STI screening for sexually transmitted infections. And we should also always ask about bodily functions, bowel habits, bladder habits, sexual function. So at the minimum, an annual GYN visit should include all of that discussion and talk, which I know we have a lot to cover in like 15 minutes in a visit. And then depending on your age and some other factors, you may need a breast exam every single year, you may need a pelvic exam to grab a pap smear to screen for cervical cancer. Most people won't need that, a pap smear, every single year, it's usually every 3 to 5 years depending on your age and the guidelines and your previous results, etc.. But all of that kind of depends if you are not due for a pap smear, in my clinic, we generally talk about, you know, the benefits versus risks or discomfort of doing an exam. And what can that tell us or not tell us and do we need to do that if we're not due for a pap smear? So we kind of have that discussion because that may or may not need that pelvic exam, may or may not need to happen if a pap smear is not due that particular year. And those are some of the things that we kind of tailor from person to person to really hone in on what you need and kind of make it more personalized to help you the best and also keep you the most comfortable, because no one likes to go to the gynecologist. Everyone hates my exam room. so what can I do to make things more comfortable and make kind of you more in control of what we do every single year? And that's kind of the basics of what should happen, could happen. And obviously that's going to differ provider to provider, but yeah.

Kristyn Hodgdon:
And I would say if your provider isn't taking your concern seriously or isn't offering any personalized care, probably time to get a second opinion or switch providers because you know, this is important stuff and you deserve to be listened to, and this is a once a year thing. And my best friend passed away from breast cancer, so I'm always very passionate about, about doctors listening to patients.

Staci Tanouye:
Yes. Oh, I'm so sorry. That's, I mean, we all have like similar stories. And as a physician, we see that far too often, and it's so sad. But, and, and I totally agree, like we should, I wish we had like all the time in the world to spend with each individual patient to really address everything that we need to, address everything you want to be addressed. What I usually do is if someone comes in for an annual, like an annual is strictly for like preventative care, like quick review of all your histories, get all that preventative care in and if concerns are brought up, like bring them up. But also know that I might say like, wow, that's a really important problem and I really think we need more time to dedicate to that, let's schedule a completely separate appointment so we just concentrate on that particular issue. And that way that gives us more time to concentrate on that. And I know it's so annoying to come back, but really that's how I can manage and give people the time they need to address some of their more important concerns. And the other thing I will throw out there too is like, if you are establishing with a new doctor or a new provider of any sort for GYN care and you have any sort of history of trauma or any sort of just really extreme anxiety over that appointment, I always recommend scheduling a non-annual exam first, literally just schedule a consultation with this provider. And again, yes, it's annoying because it's a separate appointment and maybe it's subject to a deductible, which I know that sucks and that's just how our health system works. But if you are someone who needs that extra time and preparation, schedule just a plain old consultation to discuss all of that stuff ahead of time, and that way you can kind of establish that relationship, establish that connection, talk about the plan of how you are going to approach even a simple breast exam or a simple pelvic exam if that needs to be done. And so if you can get that done in a, in a completely separate appointment ahead of time, that can kind of mentally prep you and also help prep the provider to prepare for that next visit. Because we all like to, you know, in an ideal world, all of us providers would be trauma-informed and would provide trauma-informed care 100% of the time. But we obviously don't live in an ideal world. And so if you need that extra time to prep, schedule a completely separate appointment first before your annual exam.

Kristyn Hodgdon:
That's such great advice, thank you. So why, this is another question we got a ton of, why aren't female fertility hormones tested across the board at age 25?

Staci Tanouye:
It's such a good question. And I feel like this is something that I think that advent of the Internet and social media has really kind of put that bug in our ear of being aware of our fertility and testing options and that sort of thing. And this is another big conversation to have with person to person. The short answer is, is that universal hormonal testing for healthy people is not recommended because it may not be totally helpful. If someone is having normal menstrual cycles every single month, most likely they're ovulating and most likely they are fertile. However, obviously, if there are any problems that are coming up, we need to evaluate those problems. And evaluation of problems can involve certain hormonal testing. Now, the question of actual fertility testing is a totally separate one because there are some tests that you can test your ovarian reserve or what some people like to think of is as fertility or what we also call fecundity. And those tests have a lot of nuance that come with them because they're not perfect, they can't necessarily predict if someone's able to get pregnant. And that's a big conversation of the benefits of those tests, which can be helpful for some people and the negatives to those sorts of tests. And so some of that testing involves having a conversation of are, is this an appropriate test for you at this time? So specific fertility testing for ovarian reserve really is a discussion between doctor and patient about the benefits that that testing can provide, which for a lot of people it can. But when we discuss that and are talking about ordering that testing, we also have to prep with discussing the, the downsides to that testing, the negatives, the limitations of all that testing because there's a lot of nuance that goes into some of those results. And so to just blanket test everyone, it can be hard. But we also need to be offering that to most people, if not all people, at a certain point of time, or at least prompting that discussion of have you thought about your fertility? What do you think about future family planning? And bringing those questions up allows me to gauge kind of where someone is in that mindset, in that journey, and then we can discuss if those sorts of tests are appropriate and what that means for them. So universal testing may not be kind of the best standard or idea, but again, it's a little more personalised until we get better tests or until we get better predictors. We really have to discuss all the nuance that goes into that testing.

Kristyn Hodgdon:
So that makes total sense. So to wrap up episode one, I alwayslike to ask this question because our, our company name is Rescripted, so what would you sort of rescript about how people understand their reproductive health?

Staci Tanouye:
I would script everything, like literally everything, scrap it all and start from stage one, ground zero, start at the foundation. We need to rebuild sex-ed in this country, we need to rebuild the discussion around sex and periods and bodies and sexuality. And we need to rebuild and take away the taboos and the societal kind of stigma of all of that. And as we can do that more and more than I think all of these conversations will start getting a lot easier. We will start understanding our bodies more, we'll start understanding menstrual cycles and periods and fertility and sex and the pleasure behind sex and all of that better. So yeah, I would rescript everything.

Kristyn Hodgdon:
Same, we're on the same page. Well, thank you so much, Dr. Tanouye, and we'll we'll chat next episode!

Kristyn Hodgdon:
Thank you for tuning into this episode of Dear Infertility. We hope it left you feeling more educated and empowered about your reproductive and sexual health. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe and to join Rescripted's Free Fertility Support Community, head to Rescripted.com.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

Automatically convert your mp3 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you'd love including automated translation, upload many different filetypes, advanced search, world-class support, and easily transcribe your Zoom meetings. Try Sonix for free today.