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Speaker 1: Wind Down with Janet Kramer and I'm Heeart Radio podcast.

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Speaker 2: On today's Whine About It Thursday Therapy, we have Karen

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Speaker 2: Iliber and she is a BORED certified urologist and she's

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Speaker 2: got a BORED certification in female pelvic Medicine and reconstructive

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Speaker 2: surgery and has over twenty years of experience taking care

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Speaker 2: of women.

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Speaker 1: Most intimate needs.

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Speaker 2: She's also a professor of urology and I can never

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Speaker 2: say that word obastrous. She knows as a woman in

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Speaker 2: gynecology at Cedar Syana Medical Center, so she is full

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Speaker 2: of knowledge. She also has a book out called A

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Speaker 2: Woman's Guide to her Pelvic Floor. What the frick fuck

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Speaker 2: is going on down there?

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Speaker 1: I love it.

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Speaker 2: Let's get her on. Hey girl, I'm Jana. Hi Karen,

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Speaker 2: nice to, welcome to wind Down. I was just I

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Speaker 2: was reading your breakdown. So I've been obviously going to

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Speaker 2: the gynecologists, you know, whenever or what started?

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Speaker 1: What?

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Speaker 2: When do you just start? Sixteen seventeen eighteen around that time. Yeah,

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Speaker 2: I still cannot say the first part of that. Ohb's oh,

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Speaker 2: oh what obstetrics.

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Speaker 1: Obstetrics. I'm like, why is that so hard?

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Speaker 3: Obstetrics That's why everybody says obi guyin.

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Speaker 1: Yeah obg y N.

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Speaker 2: That's like, what is even obstrics obstetrics?

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Speaker 4: So obstetrics is actually like delivering babies, and then the

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Speaker 4: guy ecology Like so the obstetrics is the pregnancy and delivering,

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Speaker 4: and then the guyn ecology is really just anything vagina.

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Speaker 1: Okay, so you do you do that and the urology.

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Speaker 3: So I do not deliver babies.

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Speaker 4: I'm a urologist and I have subspecialty training in euro gynecology,

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Speaker 4: so I do like all bladder and vagina surgery, so

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Speaker 4: like if your bladder is falling, or if you're in continent,

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Speaker 4: or we take care of a lot of female sexual dysfunction,

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Speaker 4: So anything in the vaginal area that has nothing to

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Speaker 4: do with babies, I will take care of.

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Speaker 2: What is what female dysfunction? Things are you referring to

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Speaker 2: when you say that.

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Speaker 4: So some women can have pain with intercourse because they

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Speaker 4: have like to their public muscles are too tight. Some

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Speaker 4: people actually have nerve disorders. Unfortunately, you can have a

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Speaker 4: very traumatic vaginal delivery that causes nerve damage, but also

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Speaker 4: hormonal changes like a perimenopause and menopause or surgical changes,

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Speaker 4: so there can be a lot of unfortunately causes the

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Speaker 4: pain and then of course for women.

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Speaker 2: So my mom I remember, I'll never forget it because

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Speaker 2: I went to the doctors with her because she thought

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Speaker 2: she was pregnant and it was when she was thirty

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Speaker 2: four years old and she was actually going through menopause,

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Speaker 2: so she wasn't pregnant and she was Her doctor was like, no,

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Speaker 2: you're you're in menopause and she's like, I'm thirty four

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Speaker 2: years old. So since that, yeah, since that moment, I'm like,

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Speaker 2: oh my god, I have to have kids early because

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Speaker 2: I'm going to go through menopause at the same time,

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Speaker 2: because they say that it can be gene. I mean,

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Speaker 2: obviously I've had kids. I'm now thirty nine, still have

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Speaker 2: not well I don't know, I'll ask you that, but

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Speaker 2: you know I've I've had kids. Yeah, I was like

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Speaker 2: I had my I had my son at thirty five.

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Speaker 2: But that always like freaked me out, and I'm like,

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Speaker 2: how how did she get menopause that early? Like is

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Speaker 2: that is that like is that super rare or like it?

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Speaker 2: Because I've always wondered that.

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Speaker 3: I mean, it's not that common.

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Speaker 4: They used to use the term primary Oberian insufficiency or

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Speaker 4: bear In failure. Now they like to say primary over

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Speaker 4: and insufficiency, and some people can actually get it back.

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Speaker 4: I mean, it could be like an illness, it could

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Speaker 4: be like a lot of stress. But I have known

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Speaker 4: women who have literally stopped having periods and then you know,

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Speaker 4: did meditation other things fix any health. Like like let's

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Speaker 4: hear a thib raiate is off. That might make your

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Speaker 4: periods stop. But that happens actually in a very small

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Speaker 4: small percent of women.

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Speaker 1: Mm hmm. It's yeah.

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Speaker 2: I because it was about it was last winner, I

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Speaker 2: commpletely skipped my period, and I'm like, that has never happened.

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Speaker 2: I mean, girl, I am like twenty six days like

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Speaker 2: on like the mark. The only thing that's changed with

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Speaker 2: my periods is after I had my second son. It's like,

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Speaker 2: I'm like, is this normal? How much I bleed? Like

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Speaker 2: it's it's a lot. Yeah, And I know that's like

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Speaker 2: massive TMI. But for the girl's thing, the guys, maybe

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Speaker 2: this is not like you're or if you want to

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Speaker 2: have some knowledge, share but this one. But yeah, it

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Speaker 2: was just like I remember going in going like I'm

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Speaker 2: kind of scared, Like I think I'm losing too much

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Speaker 2: blood and she's like, well, this is actually very common

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Speaker 2: after kids and you know you're getting older, periods are

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Speaker 2: changing and.

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Speaker 1: I'm like, whoa.

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Speaker 2: But then it was Leah. Last winter, I took a

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Speaker 2: pregnancy task because I was like, I think I might

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Speaker 2: be pregnant because I'm like, I missed my period.

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Speaker 1: And then I wasn't. So I called my doctor.

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Speaker 2: I'm like, it's been like, I mean, I'm on like

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Speaker 2: day forty I still have not had my Like what

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Speaker 2: is going on? And she's like, well, you probably missed.

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Speaker 2: It's called like a miss period. I'm like, I've never

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Speaker 2: even heard of that too. I'm like, what is like?

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Speaker 2: So then we did some blood work, but they didn't

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Speaker 2: really find anything. So I'm like, is that is that

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Speaker 2: super common?

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Speaker 3: Again?

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Speaker 4: I mean, skipping a period here and there is not uncommon,

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Speaker 4: especially like stress.

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Speaker 3: Are you still nursing?

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Speaker 1: Oh no, my kids are seven and four?

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Speaker 3: Yeah, I mean it can happen, but yeah, missing a

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Speaker 3: period here and there is not.

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Speaker 1: Am I going through menopause?

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Speaker 3: Probably not? If they checked everything.

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Speaker 2: Okay, because perry is the beginning of menopause, right, Like,

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Speaker 2: aren't we all in perimenopause? When we hit forty I mean,

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Speaker 2: statistically speaking, yes probably, but you know, symptoms of perimenopause.

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Speaker 2: But that's why it's much harder for a four year

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Speaker 2: old woman to get pregnant than a thirty five year

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Speaker 2: old woman, you know, because unfortunately we're like on the

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Speaker 2: downhill five.

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Speaker 3: But perimenopause typically.

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Speaker 4: People start having symptoms like you know, difficulties, sleeping, hot flashes.

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Speaker 3: But the perimenopause can go on for a long time.

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Speaker 3: So by definition, menopause is when you don't have a

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Speaker 3: period for twelve consecutive months. So let's say you went

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Speaker 3: ten months no period, then you had a period. You're

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Speaker 3: not actually metopausea yet.

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Speaker 1: Hmm, okay, got it.

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Speaker 2: What for the pelvic area? What is the most what's

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Speaker 2: the question that women are always kind of embarrassed to

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Speaker 2: say or ask about.

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Speaker 3: Women are really embarrassed to ask that. I mean, like,

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Speaker 3: is what I look like down there? Normal? And my

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Speaker 3: normal size? Is my odor normal? You know? There is?

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Speaker 3: It's these are things that we.

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Speaker 4: Don't ever talk about, you know, which is why, like

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Speaker 4: my colleagues and I wrote this book like a Woman's

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Speaker 4: Guide to a Pelvic Floor subtitled what the F Is

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Speaker 4: going on? Down there because we see a lot of

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Speaker 4: very educated, smart women who just don't know, and it's

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Speaker 4: because we've never told them about these things. Right, you

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Speaker 4: have one health class, maybe somewhere in junior high, and

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Speaker 4: you learn some very basic things than that you were

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Speaker 4: on your own, figure out what your birth control options were, right?

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Speaker 4: What is a normal period? What I mean, every time

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Speaker 4: sex is brought up, it's negative. Either you can get pregnant, right,

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Speaker 4: or you can get infection. Sex is never like, oh

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Speaker 4: maybe you uhoul to do it, you know, so you

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Speaker 4: can enjoy yourself type of thing, right, So I think

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Speaker 4: that also, I mean, women are embarrassed to ask a

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Speaker 4: lot of things, you know, just intimate questions like you know,

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Speaker 4: is it normal that you know, my orgasm isn't as

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Speaker 4: good as it was before I had babies, And there's.

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Speaker 3: All sorts of things.

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Speaker 4: So I the reason I can't only answer your question

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Speaker 4: is probably the question they're the most embarrassed to ask.

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Speaker 3: They're not asking sure.

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Speaker 2: Yeah, I think I think the one that I always

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Speaker 2: get really embarrassed sound is like if it was having

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Speaker 2: weird discharge, like even just like saying that, and then yeah,

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Speaker 2: it comes with it because it's like certain things, like

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Speaker 2: I used to have a yeast issue, so I'm like

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Speaker 2: I always get east infections, and like I didn't realize

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Speaker 2: it was the soaps that I was sensitive to, the

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Speaker 2: soaps that I was using that had like the fragrance

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Speaker 2: in it. So I was like, all right, you know,

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Speaker 2: then I looked into this, but I didn't I was

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Speaker 2: embarrassed to ask it. So I was googling, like you know, odor,

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Speaker 2: all these things, and then I saw this one website

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Speaker 2: where it was like, you know, do boric acid and

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Speaker 2: apple something and it had like an actual cleanser. So

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Speaker 2: I was like, oh, thank god, okay, and so like

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Speaker 2: I got that, but it was like I was even embarrassed,

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Speaker 2: and like my doctor, why didn't I trust my doctor

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Speaker 2: to like ask that and say that, you know.

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Speaker 4: It's it's so well because because I think there's a

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Speaker 4: part of every person that they fear that if they

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Speaker 4: ask the question, the doctor looks at you like I've

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Speaker 4: never heard of that before, right, Like you don't really

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Speaker 4: want to be like a dinner party you're talking to

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Speaker 4: your girlfriends, you know, yeah, you know, like when you

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Speaker 4: call for you laugh and you wet your pants and

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Speaker 4: you're waiting for him to go yeah, and like nobody

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Speaker 4: says anything, right, you really don't want to be that girl.

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Speaker 1: Right, yeah, hmm.

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Speaker 2: What is something that in your you know, your studies

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Speaker 2: and your years of doing what you do. Is there

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Speaker 2: something that has stumped you that's go, oh wow. I

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Speaker 2: don't know the answer to that.

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Speaker 3: I've been doing it. I'm sure there was along the way.

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Speaker 4: I've been doing this for like over twenty years, so

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Speaker 4: there's not a lot of things that I haven't seen.

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Speaker 4: There is always something that kind of stumps, but those

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Speaker 4: are very unusual. But I think that people be surprised

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Speaker 4: at how few things do stump specialists like me, because

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Speaker 4: I think general urologists, general kind ofcologists, I think, for

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Speaker 4: the most part, just aren't necessarily interested in this stuff

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Speaker 4: that my colleagues and I do, and not because they

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Speaker 4: don't like taking care of women, but you know, it's

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Speaker 4: more fun to deliver babies and you know, to take

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Speaker 4: care of discharge per se or also you have to

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Speaker 4: have specialized training to take care of women if they

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Speaker 4: have in continence. But it's so satisfying because I can't

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Speaker 4: tell you, like how many times I've seen a woman

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Speaker 4: who she just cries out of relief to know that

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Speaker 4: she's not the only one who's experiencing these things, right.

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Speaker 2: I saw something in one of the questions, but it

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Speaker 2: was like, like vibrators, I mean, like, is that a

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Speaker 2: cause for things that you know can be problematic for

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Speaker 2: the pelvic area.

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Speaker 4: They can be problematic, but they're probably more beneficial. So

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Speaker 4: I actually recently had a case where it was one

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Speaker 4: of the section vibrators I think was just too strong

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Speaker 4: and so and you know, the clitterist has this crazy

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Speaker 4: concentration of nerve endings, and I think it was so

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Speaker 4: strong that like for weeks afterwards she would have symptoms.

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Speaker 3: So that's pretty unusual. But for the most part, especially if.

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Speaker 4: You're not sexually active with a partner on a regular basis,

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Speaker 4: I think it's really good to use a vibrator. So

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Speaker 4: one of our research projects that we've done has shown

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Speaker 4: that regular use of a vibrator, whether a woman used

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Speaker 4: it to orgasm or not, was beneficial for things like

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Speaker 4: pell of the pain pain with intercourse incontinence because you're

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Speaker 4: increasing blood flow to the pelvis when you're aroused. So

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Speaker 4: if you're not sexually active, then it's good to use

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Speaker 4: a vibrator on a regular basis.

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Speaker 1: Oh see something we wouldn't know.

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Speaker 3: So when your partners use your rybrary or your bedstand

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Speaker 3: or your nightstand, you could just say my doctor recommended it.

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Speaker 1: We love that.

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Speaker 2: I mean it's like that's so sometimes like you know,

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Speaker 2: the glass of wine and like it was doctor recommends it.

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Speaker 1: I know, I know, you know.

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Speaker 4: I think that's also when you're asking about what people

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Speaker 4: are embarrassed about. We just don't really normalize sexuality specifically

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Speaker 4: for women. So as a urologist, I take care of

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Speaker 4: men and women, right, and we talk about viagra all

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Speaker 4: the time and a rectile dysfunction. It's like it's an

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Speaker 4: everyday conversation, but we don't talk about female sexualist function

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Speaker 4: because you know, traditionally, if a woman enjoys sex, you

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Speaker 4: must be something wrong that you must be like some

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Speaker 4: kind of core or slut or something right. It's not

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Speaker 4: just because it could be the equivalent of males enjoying it.

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Speaker 4: And we really have not paid as much attention as

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Speaker 4: we should to female sexual dysfunction. Right, So women who

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Speaker 4: have had bad sexual experiences, or they have conditions like

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Speaker 4: endometriosis that cause pain and they can't enjoy sex and

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Speaker 4: no one has helped them with the pain. You know,

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Speaker 4: it can cause a lot of stress in her life

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Speaker 4: and also in her relationships.

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Speaker 2: Yeah, I have a friend that has like a very

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Speaker 2: like how her I don't know what it is, but

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Speaker 2: it's how it's shaped. It's like she has so much

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Speaker 2: pain when she has sex, so like that that caused

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Speaker 2: a big issue in her marriage because she didn't want

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Speaker 2: to have sex. She's like, it hurts, like I don't

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Speaker 2: want to do it. And then it's like, well, obviously

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Speaker 2: that the husband wants to have sex, you know, so

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Speaker 2: it's like trying to you know, figure that balance out.

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Speaker 2: It's like it's it's embarrassing, but it's also like there

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Speaker 2: are resources to be okay, right or to get better.

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Speaker 3: There are.

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Speaker 4: But again back to Woldiam about who I think that

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Speaker 4: most women wouldn't even know off the top of their

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Speaker 4: head what doctor to call to discuss her female sexual issues.

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Speaker 4: You know, that's already embarrassing as it is, and you're

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Speaker 4: you know, you're really kind of being a little open

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Speaker 4: because you're seeking care because it's causing stress in your

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Speaker 4: relationship and sexes and everything in a relationship. But having

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Speaker 4: that level of intimacy I think is necessary, you know

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Speaker 4: for most couples, but it you know, you think about

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Speaker 4: seeing like a sex therapist, which is more like you'd

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Speaker 4: consider like a you know, a psychology or a therapist.

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Speaker 4: You don't really realize that there are people who deal

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Speaker 4: with the physical causes of pain with intercourse.

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Speaker 3: Mmm mm hmm yeah.

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Speaker 1: I Uh.

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Speaker 2: I get some hate because I promoted a vibrator on

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Speaker 2: my page, but I'm like, I'm all about just self love. Like, yes,

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Speaker 2: I'm very happy in my relationship and we have a

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Speaker 2: great sex life, but like also, you know, like it's okay.

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Speaker 3: Sometimes in the mood for chocolate, sometimes they move for villa,

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Speaker 3: but they're both.

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Speaker 2: Eviden. It's like, I'm like, why are like women hating

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Speaker 2: on me for posting about something that I'm like, I'm

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Speaker 2: just trying to like give you all a great code

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Speaker 2: for something.

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Speaker 3: That like men never masturbate right right never ever?

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Speaker 1: Nope, they are just perfect little angels.

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Speaker 2: But it's like, I'm like that always baffles me that

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Speaker 2: I'm like, why am I getting hate for something surprising?

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Speaker 4: And why why would anybody negatively look upon anybody wanting

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Speaker 4: to promote another woman for feeling good? See, That's what

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Speaker 4: I'm talking about like, I don't think any man would

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Speaker 4: ever discourage another man from masturbating.

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Speaker 2: Right, I think the piece that like ties into that

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Speaker 2: is like, you know, I talk about my faith a

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Speaker 2: lot in God. I'm like, I think my God's okay

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Speaker 2: with it, you know. So I'm like, it's so it's

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Speaker 2: like those ones that just live by and I don't

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Speaker 2: know the exact like quote or whatever, but I'm like,

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Speaker 2: for me, I'm just like that's the piece of Christianity

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Speaker 2: that I'm just like, you know, I think it's okay

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Speaker 2: to do that. So I'm like I shouldn't be condemned

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Speaker 2: one way or the other. And you know, better than

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Speaker 2: I agree with you.

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Speaker 4: I didn't realize it was against anyone's religious beliefs, not

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Speaker 4: to mean.

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Speaker 2: Yeah, I don't remember because I have like a few

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Speaker 2: of the people are like, if you're a Christian, like

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Speaker 2: you shouldn't do that, And I'm like, well, I'm also

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Speaker 2: having sex before i'm married, so you know what i mean,

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Speaker 2: Like I'm already screwed.

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Speaker 3: So I'm like everything's burned out.

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Speaker 2: Yeah, I'm like, I am not a born again I

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Speaker 2: don't know how Like I'm sorry.

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Speaker 1: It's just the one piece.

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Speaker 2: I like, I can't, but did you just sit around

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Speaker 2: with your girls and go, oh my gosh, we have

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Speaker 2: to just write this book to just normalize what it was.

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Speaker 4: It was honestly just years of hearing my patience say

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Speaker 4: you know, I'm so embarrassed say this, or like I

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Speaker 4: think it's so funny. I'll literally have just finished a

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Speaker 4: badgeal exam. They're like, you know, I'm embarrassed to say this.

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Speaker 4: I'm like, I literally just had my head like right

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Speaker 4: between your legs. I'm pretty sure, like all walls are down.

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Speaker 4: You can ask me anything, but you just come to

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Speaker 4: realize that very basic things women were really stressing out about,

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Speaker 4: Like you're just charge right, and like if you just

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Speaker 4: understand some basic things, I think you can probably figure

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Speaker 4: things out on your own, you probably have a lot

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Speaker 4: less stress in your life. And also just the women

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Speaker 4: know that whatever problem you have, there probably is a solution,

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Speaker 4: even though you're embarrassed to ask about it.

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Speaker 1: Right, is it?

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Speaker 4: No?

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Speaker 2: I think pineapples for the penis, But is there a

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Speaker 2: food for the vagina that's really good?

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Speaker 1: Isn't that it's like pineapple? Isn't that?

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Speaker 3: Those are all like myths?

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Speaker 4: You know? I mean, I think that probably the only

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Speaker 4: thing you really could do potentially is if you drank

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Speaker 4: lots and lots of fluid to delute things out. But

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Speaker 4: there is nothing that's consistently gonna make things taste better,

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Speaker 4: except for if you use like a flavored you know,

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Speaker 4: lubricin or something. But I mean, realistically, like nobody really

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Speaker 4: tastes good anywhere, Like even if you like suck on

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Speaker 4: your arm, it doesn't taste good.

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Speaker 1: No, no, no, no, no, no, no, not at all.

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Speaker 2: But it's so funny though that you say that about

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Speaker 2: the asking questions, because I'm like, yeah, like even the

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Speaker 2: other day I was at my Gaino's and when they're

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Speaker 2: like and scoot down, and I'm like, okay, Like you know.

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Speaker 1: It's just like it's I don't know why.

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Speaker 4: What we really should say is move down so far

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Speaker 4: that you feel as embarrassed as possible and you're in

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Speaker 4: the right posision.

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Speaker 1: Yeah, one thousand percent.

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Speaker 2: Is there something in the book where you guys, because

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Speaker 2: it's you and your is it two friends.

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Speaker 3: Two of my colleagues?

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Speaker 1: Yeah, the two of your colleagues.

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Speaker 2: Okay, I love that, And did you guys kind of

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Speaker 2: have like a piece where like I'm more knowledgeable in

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Speaker 2: this area or.

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Speaker 1: It was just like a real group effort.

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Speaker 3: I don't know if it's more.

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Speaker 4: I think we're probably equally knowledgeable, but everybody definitely has

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Speaker 4: their own interests. So like one of my colleagues, she

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Speaker 4: does transgender surgery, so she wanted to write that chapter.

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Speaker 4: And you know, I'm very interested in like female sexuals function,

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Speaker 4: so I wrote that chapter.

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Speaker 1: But interested in what and female.

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Speaker 3: Fe male sexual function and what is that? So like just.

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Speaker 4: How you're like if you have normal sexuality. So female

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Speaker 4: sexual dysfunction, whether it's because as of lack of desire

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Speaker 4: or inability, if you're buy to respond normally pain with intercourse.

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Speaker 4: A female sexual dysfunction is defined as if it is

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Speaker 4: actually causing distress.

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Speaker 3: In your life.

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Speaker 4: So let's say that a woman is, you know, seventy five,

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Speaker 4: she's widowed, she has no desire, but she's not bothered

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Speaker 4: by it.

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Speaker 3: That's not a dysfunction.

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Speaker 4: But let's say you're thirty five and you don't understand

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Speaker 4: you've totally lost your sex drive. It is putting a

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Speaker 4: lot of stress on you and your partner. That is

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Speaker 4: definitely a dysfunction.

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Speaker 1: Okay, got it. That's so interesting.

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Speaker 4: Well, The other interesting thing is, you know, I think

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Speaker 4: we attribute a lot of things to hormones that have

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Speaker 4: nothing to do with it, and we don't appreciate what

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Speaker 4: hormones can do, you know, half the time. So like

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Speaker 4: when I'm mad at you, it's not necessarily because it's

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Speaker 4: that time of the month.

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Speaker 3: Maybe you're just really being a jerk.

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Speaker 1: All right, maybe I'm just actually really angry you have.

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Speaker 2: Having said that, though it always does usually land at

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Speaker 2: the week I hear that, it drives me mad because

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Speaker 2: and then I hide my period. I used to hide

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Speaker 2: my period from Max husband so that he can be like, oh,

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Speaker 2: that's why you.

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Speaker 1: Were a raging bright You can't let her know he's

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Speaker 1: right away? Not a chance.

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Speaker 2: Will everyone go get a woman's Guide to her pelvic floor?

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Speaker 2: What the is going on down there? Thank you so

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Speaker 2: much for coming on the show.

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Speaker 4: I really appreciate it, and I thank you for bringing

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Speaker 4: attention to these topics that women, as you point out,

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Speaker 4: are embarrassed to ask about. So, you know, I just

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Speaker 4: want all women to know that there are people out

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Speaker 4: there to take care of these issues.

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Speaker 1: Thank you.

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Speaker 2: I appreciate that. Thanks all right, Bye girl, Seeya, Bye,