Dear Infertility_Season 3_Episode_8_Sexual Health: Audio automatically transcribed by Sonix

Dear Infertility_Season 3_Episode_8_Sexual Health: 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 (In)fertility. 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 back to Dear (In)fertility. I'm your host, Kristyn, and I'm here with Dr. Staci Tanouye. Hi, Dr. Tanouye!

Staci Tanouye:
Hi, Kristyn! We're talking about sex now.

Kristyn Hodgdon:
Yes! Let's talk about sex! Yeah, we sort of saved the best for last here. And, you know, like a lot of the topics this season, sex is often stigmatized. People don't talk about it, but really, you know, it's a normal, thing, mostly everyone does it, and especially when you're trying to conceive. It can be incredibly utilitarian, but it can also be fun. And so let's, let's get into it. Where should we start? I literally don't know where to start. There’s so much to talk about.

Staci Tanouye:
Yeah! There's so much to talk about, like this, this whole, you know, this whole podcast is teaching on taboo topics. But sex is probably like the most taboo of everything. And I, you know, I always have a love-hate relationship with social media and the Internet, but I think one thing that social media and the Internet has helped with is it's helped to normalize sex a little bit more. Normal, normalized sex is a normal human function as a healthy human function as something that's not dirty or shameful or, you know, being sexual is a normal, healthy thing for a human being to do. And I should just I'll make a note to that. If you are asexual, that is also normal and healthy, right? Asexual is people who don't have sexual desire, but it is not at all distressing to them, they're totally fine with that, and that is normal as well. So there's a whole spectrum of sexuality and sexual desire and sexual function and most of it is normal. When it becomes not normal is what it's distressing or bothersome to you or interruptive to your life in some way. And so we need to stress that there's so, like sex is just normal, it's normal, normal, normal. And we shouldn't be afraid to say it or talk about it and talk about it in detail.

Kristyn Hodgdon:
Absolutely, completely agree. Since a lot of our community is trying to conceive or thinking about trying to conceive. I just wanted to mention, like, when you are trying to conceive, sex can feel like a chore. But you know, it's important to remember why you got together with your partner in the first place and that sex isn't necessary and normal part of a relationship in a lot of cases. And keeping that part of your relationship alive is is kind of crucial to getting through it and getting, getting to the other side.

Staci Tanouye:
Yes. I mean, I can't think of anything more unsexy than repetitive schedule sex month after month. Like that's the most unsexy thing possible. But I mean, we do what we have to do and there are certain tricks that we can try to, to help it not be so monotonous and repetitive. But yeah, I'm trying to conceive in timed intercourse, it's, I mean, it's tough. It is. It is, it's not like a chore, it is a chore. And it's hard to get out of that kind of rut of chore.

Kristyn Hodgdon:
Absolutely. So what are some of your tips for how to increase libido while trying to conceive and like what even is libido?

Staci Tanouye:
Yeah, libido is sex drive. What people think as sex drive. The female libido, and most people with vulvas and vaginas our libidos are very, very multifactorial. There is not just one thing that goes into a person's or a woman's sex drive. There are about a million things that go into that. It is, so a lot of people are like, oh, it's my hormones fixed my hormones, like 98% of the time, it's not your hormones, I can guarantee it, it's something else. Our sex drive is affected by our entire body and our entire environment, so everything around us. Did I get enough sleep last night? Did me and my partner get into a fight because they didn't take out the garbage? Did I yell at my kids all morning? Did I have a stressful day at work? Did I have a glass or two, or two of wine? Did, what medications am I taking? What is my past history like? What is my past history with sex like, in relationship with that? What is my relationship like with my body and how do I feel about my body? Am I pregnant? Am I postpartum? Am I post-menopausal? What is my vagina doing? Is it, is it dry? Is it painful? Like all of these things go into sex drive. And so all of these things are libido killers and it could be a combination of everything or it could be predominantly one thing or the other, it's just it's so complex. So when patients come in to me in the office and are like, I don't have any libido, fix that, well, I usually can't in one visit because again, it's a big topic and we need a dedicat avisit to really dive in and talk about everything. We need to talk about your health, we need to talk about your stress, your environment, your relationship, your relationship with yourself and your body, everything, because there's so much that I need to tease out when it comes to libido. So it's not as easy as like just fixing sex drive or just increasing sex drive. There's different tips and tricks, but they all depend on what was affecting it to begin with.

Kristyn Hodgdon:
Yeah. I hadn't really thought of the whole body image thing, but it's so true. Like if you're not feeling great about yourself, it doesn't really help your libido for sure.

Staci Tanouye:
Yeah, I mean, there's a lot of things that affect body image that have been studied with sex drive. Cancer patients in particular. As your body significantly changes after treatments, after something like a gynecologic cancer or a breast cancer, you know, being, getting comfortable with sex in that body is very difficult and hard. Post-menopausal, post-partum like all of these things are major life changers that really affect how our body reacts to sex and how we feel about ourselves when it comes to sex and it all goes into sex drive. Like if you don't feel good about your body or are comfortable with where you're at or in pain, for whatever reason, you're not going to have a sex drive. So there's not going to be a whole lot that I can do or fix if we can't fix how you feel about yourself and your body.

Kristyn Hodgdon:
Yeah, absolutely. And in the setting of infertility and IVF, it can be tough because like you're on IVF meds or you're just feeling the side effects or you're just exhausted from all of the appointments or whatever, it just adds a whole nother layer to, to the issue.

Staci Tanouye:
It does. It adds a really big layer to the issue, actually. So, yes, it's hard trying to conceive and trying to kind of keep that spark going, it's, it's really tough.

Kristyn Hodgdon:
Absolutely. So can you explain the orgasm gap? Because this is something you had brought up and I, I hadn't heard of it, so.

Staci Tanouye:
Yeah. So the orgasm gap, this is a real phenomenon, and we had some good hard data on this back in 2018, in the Archives of Sexual Behavior. They surveyed over 52,000 adults and asked all kinds of questions about their sex lives and sexual practices and orgasm. And one of the questions was, what, what percentage of the time do you, do people always orgasm? So, during every single sex act. And they stratified it by basically sexuality. Heterosexual men responded that 95% said yes, I always orgasm, and heterosexual women said yes 66% of the time. So that is the orgasm gap, specifically with heterosexual self-identifying men and women, 95 versus 66%. And so it goes I mean, it's very deep rooted into sex practices and how we feel about the power dynamics of sex. But orgasm for men is very different from orgasm from women. And and again, I'll go with self-identifying women who have vaginas and vulvas too. Orgasm is complex and can involve multiple different functions within the reproductive system. And everyone is different with what they need to achieve orgasm for women that it is, it's just more complex. And because we don't give enough attention to women and our bodies, that's why we have that gap, is because we don't talk about it, we don't communicate for it, we don't communicate our desires like we should be, we don't direct in the ways that give us and offer us pleasure. A lot of times because people are scared or ashamed or think there's something wrong with them, or it's just hard to talk about sex because of how we were kind of raised and brought up. You know, sex is shameful, sex is dirty, we don't talk about it, it happens behind closed doors, it never happened at all. You know, all that stuff, we've been taught all this kind of shame surrounding sex, it's really hard to talk about it and to communicate about it. But women need that because we need that to be able to bridge that orgasm gap so we can get there, too. And yes, it's just, there's a lot more that goes into it, but that's the basics of it.

Kristyn Hodgdon:
It’s so interesting. And so within that subset of women, are there people who literally can't orgasm or is it just because of that power struggle and, and the gap between men and women?

Staci Tanouye:
Yeah, there are, there are conditions where people can't orgasm. They're pretty rare and anorgasmia is pretty rare, but sometimes it's due to neurologic issues or anatomic issues of some sort. So some underlying issue that's kind of physically preventing an orgasm from happening. It's a small percentage of people, so most people can achieve orgasm in some way, shape or form, it's just figuring out how. Like what cause, what gives you pleasure? Because what works for one person is not going to work for the next person is not going to work for the next person. Everyone is very different in what they respond to and what their body responds to. And so, yes, it's much, there's a much wider variance in what can bring about climax or orgasm in women.

Kristyn Hodgdon:
Got it. So what are some reasons for painful sex?

Staci Tanouye:
Lots of different reasons, tons of different reasons. Not enough foreplay, not enough natural lubrication, low estrogen states, like breastfeeding or post-menopausal states where your body, it can't produce the natural lubrication that it needs. Infection, all different types of infection, yeast infection, bacterial vaginosis infection, STIs, vaginismus. We talked about in our last episode of vaginismus and that involuntary contraction of the vaginal, muscular walls that can cause pain. Something as simple as just positioning. People ask me all the time, well, I get this pain that feels really deep and in my belly. I said, well, when do you feel that pain? And if you only feel that pain in one particular position, that might just be that, it's positional. And just the angles of where your cervix is getting hit and your anatomy. And so that we just have to work with and adjust sometimes. Pelvic floor dysfunction. The pelvis is lined with muscle and all these little muscles interact. And if there's tension or pain in any of those pelvic floor structures that can cause pain during sex too. Conditions like endometriosis, we've talked about that in past episodes, too. Endometriosis could cause painful sex, lots of different things.

Kristyn Hodgdon:
Got it. And is it okay to have sex during your period?

Staci Tanouye:
Yes. There's nothing wrong with sex during your period. If you don't want to get pregnant, still use contraception. It's less likely because we know that your fertile window is during ovulation and a less likely ovulation is less likely to happen around your period. But we also know that sperm can live in the body for five, maybe up to seven days. And so if you have sex at the end of your period and that sperm is lingering around and you have a short cycle, it is technically possible, less likely, but still a little bit possible.

Kristyn Hodgdon:
Okay. And we actually got a lot of questions on the lube. Like what, what's your opinion on using lube for sex or when trying to conceive?

Staci Tanouye:
Yeah. So just for sex in general, regardless of if you're trying to conceive, lube can be a great thing because again, women and people with vaginas in general need more foreplay and need more stimulation because it's that stimulation and arousal that then creates that natural lubrication that lubricates, so the friction feels good and the friction doesn't hurt, and that's what we need for pleasure and to not have pain during sex. And so a lube is a great way to add to that, to decrease the bad friction and increase the good friction and lube, you know, there's not tons on the market out there. Some are better than others, some are better for some people, and not for other people. And so it is a little bit personal preference. But in general, you want something minimal, unscented, less additives that's going to work for you. That's not going to be irritating to you, that's going to help. At the very basic level, there are three different types of lubes. There is water based, there is silicone based, and there is oil based. Water and silicone based are great and can be used with condoms and latex. And silicone is a great product because it actually it's thinner and it lasts longer. So silicone is one of my favorite, favorite types of bases for lubricants. Oil base is great if you're not using condoms, but oil and latex do not mix because oil weakens latex, and so you increase risk of breakage there. But if you don't need to use condoms, something as simple as coconut oil can be really, really helpful, it's a great lubrication. We don't want to use coconut oil too much because too much coconut oil can predispose and mess up that vaginal microbiome like we talked about in the last episode. But occasional use as a, as a lubricant is totally fine and can be helpful. And then I know we were going to talk about fertility-friendly lubes and there's, I feel like there's like a lot of controversy over some of this, like the original fertility-friendly lube, the one that's supposed to not impact sperm motility very much is Pre-seed. And so that's traditionally so the one that we often recommend. There's a lot of newer ones on the market. Yes, baby conceived plus, some of the newer brands have their own, quote unquote, fertility-friendly lubes. Now, whether or not these actually help, anything can be up for debate. But yes, if we want to optimize things and we're trying to conceive, you can use a fertility-friendly lube. You don't have to, but you can.

Kristyn Hodgdon:
That makes sense. So we talked a little bit about how women's sex drive is fact, is usually multifactorial and affected by everything. But I wanted to touch a little bit on mental health and stress and how that can affect your sex life. And obviously, when you're trying to conceive, that's a factor. Are there any tips that you have to just, whether it's communication or like how to kind of make your sex life better during a stressful time.

Staci Tanouye:
Yeah, I think mental health and stress are such huge parts of sex drive in general, and so whatever we can do to minimize and optimize those things is good. So taking control of our mental health, getting the therapy that we need, practicing meditative techniques or cognitive behavioral therapies to kind of help with that. If we need to be medicated working on that, and that's a whole nother topic because some of those medications may work against us, too. So it's finding the right mix of medication versus treatment of what, of what could also be harming sex drive, right? Because you could get it from both sides when it comes to medical, mental health and medications in terms of stress, decreasing stress, self care, exercise, sleep, all of those things to decrease that as much as possible, because of, mental health and stress is impacting us in our bodies, it's also going to be impacting our sex drive. There's a lot of little tips and tricks that I use with my patients, just depending on what I feel is going on and what they can use in the bedroom. What are, one of my favorite ones is the concept of arousal versus desire. We as women often wait for the desire to come first and want the desire to then trigger the arousal and the desire is what we commonly think of as sex drive, right? So if that desire is not there, we're never going to get to the arousal portion of it. But what if we try to flip that? What if we tried to trigger arousal even if we're not feeling the desire for sex? What if we try to trigger those arousal centers first and then in turn circle back and bring in the desire because we are already aroused. So think about this, think about, you know, all the millions of people out there who read 50 Shades of Grey, right? Or watched the movies. What happened when you got to the sex scenes, right? Like it was super steany, you're starting to feel a little tingly down there and you're kind of, it's kind of building up and you're starting to feel that kind of sex drive, right? Your, your mind is in it, your visual is in it, your imagination is in it, so that's triggering arousal first, that's then bringing on the desire. And so now we're ready to go with our partners, right? So there's a whole movement of bringing in things like what we call erotica to sex drive. So things like reading or listening to stories or watching something sexy to trigger those senses, to trigger that arousal first, that then sweeps in and or circles in our desire into that. So that can be really helpful. That's one of the biggest tricks that I, that I use and I talked about with people.

Kristyn Hodgdon:
I love that.

Staci Tanouye:
Yes. So flip the switch on arousal versus desire, trigger your arousal first with the external stimuli of those words or images or imaginations, and that will bring in your desire as well. And you can do that with or without a partner, so we should point that out too, it’s like you don't need a partner to work on this, you can work on this yourself. Self stimulation and masturbation is a very normal process and we talked a little bit about the orgasm gap earlier. We can start closing that orgasm gap by knowing our bodies too, and that often comes from self stimulation. And so knowing and understanding what is pleasurable to us so we can then communicate it to a partner is going to help that, so.

Kristyn Hodgdon:
Absolutely.

Staci Tanouye:
That was a long winded answer for.

Kristyn Hodgdon:
No that.

Staci Tanouye:
That's a trick. But yeah.

Kristyn Hodgdon:
That's such a switch you can flip at any times, like you know, we all have lives, we get busy and you think, oh, I don't really feel like it right now, but at the end of the day, it's you know, just like anything in relationships, you have to work on it and sometimes it's, it's just reversing that arousal versus desire, like you said.

Staci Tanouye:
Yeah. And it can be really tough, like we mentioned before with trying to conceive because it becomes a chore. So it's hard, it's hard when that is a, that is a daily stress in your life and you really can't take that stress away because it's there, and so we have to try other tricks that might be helpful for us. So whether that's communicating with our partner, talking about it, strategizing with our partner, coming up with something different to, to try or dropping little hints throughout the day to try to build up that anticipation. Whatever we can do, it's really, really hard. So I'm not going to say we can solve that problem because it's just a really tough place to be in, but there's little things that we can sometimes try.

Kristyn Hodgdon:
Totally. So last question, but if you could rescript one thing about how people think about sex and sexual health, what would it be?

Staci Tanouye:
Well, it would be for us to all normalize and understand that sex is a normal human function, that if we understood this, I feel like our entire season would be easier. Like we talked about sex ed, if we could just normalize sex, teaching sex ed would be so much easier because it would be a normal human thing to teach about if we could just normalize sex, talking about vulvovaginal health, which would be so much easier because it was part of our normal thing. If we could just normalize pleasure and self stimulation and giving ourselves pleasure, it would, just it would narrow that orgasm gap. You know, if we could just normalize sex as a normal human function, I think it would help all of these kind of peripheral topics that we've been talking about all season.

Kristyn Hodgdon:
Yeah, I was just going to end on that. I'm really hopeful that we did demystify some of those topics this season and that's, that's our goal, we're rescripting the narrative.

Staci Tanouye:
Yeah, I think we hit so many great things this season.

Kristyn Hodgdon:
Absolutely. Well, thank you so much again, Dr. Tanouye. This has been so fun and I learned so much and I think a lot of people are going to find these episodes really helpful.

Staci Tanouye:
Thanks, Kristyn, these conversations have been great. You can tell I love these topics and I just want to, like, talk about them forever. So thank you so much.

Kristyn Hodgdon:
Thank you.

Kristyn Hodgdon:
Thank you for tuning into this episode of Dear (In)fertility. 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.

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