The Neuroscience of Desire, Dopamine, and Orgasm ft. Dr. Jim Pfaus

Join me as I sit down with Dr. Natalie Crawford, a reproductive endocrinologist and the author of The Fertility Formula. We start with what women should understand about their bodies before they try to get pregnant, which includes knowing what is going on with their ovaries and hormones. Natalie weighs in on one of the more recently discussed questions in fertility: should an IUD come out before you start building your family? Natalie shares what she and other fertility doctors are seeing in women who have had a progesterone IUD for years, and why she suggests taking it out about six months before you start trying. We also talk about how far egg freezing has advanced and how much better the results have become. Along the way, Natalie shares what an AMH test can tell you about your ovarian reserve and the timing of perimenopause, and how inflammation and lifestyle can influence your ovaries. What You’ll Learn What to understand about your body, including your ovaries and hormones, before you try to get pregnant. The debate over taking out an IUD before you start trying. How far egg freezing has advanced, and what it can and can’t promise. What an AMH test can tell you about your ovarian reserve and the start of perimenopause, and why it isn’t a menopause test. Why symptoms can get written off as perimenopause. How infertility and earlier menopause show up for women of color. How to choose a fertility clinic, and when to get a second opinion.

Menopause is biologically universal, but how women experience it, and whether they even have a word for it, depends a lot on where they live. I talk with Dr. Yewande Banire, a family nurse practitioner who cares for patients in the United States and in Lagos, Nigeria, about what women's health looks like through an international lens. Yewande shares how her own years of heavy periods and fibroid pain, and being told it was just part of being a woman, led her into this work. We talk about why women in Nigeria may not have a name for hot flashes or night sweats, how those symptoms can be mistaken for malaria or typhoid, and what limited access to hormone therapy looks like in practice. We also get into the role a husband's permission can play, early ovarian insufficiency in women under 40, and what birth control pills can offer when hormone therapy isn't available. Yewande closes with a message for patients and for clinicians. What You'll Learn Why perimenopause and menopause can feel like a "this is not a problem we have" in places where no one is talking about them. How symptoms like joint pain and night sweats get treated as other issues when menopause is the missing piece. What limited access to estrogen and progesterone means for women who can't easily get or afford them. How some cultures have stigma around age, and how a husband’s approval can shape whether women seek care for libido and vaginal dryness. What clinicians can do to meet patients where they are, and why it's okay to refer when you don't know.

Seven years ago, I started keeping notes on patient stories I kept coming back to, including a woman who hadn't been able to have sex in seven years, and a 68-year-old cancer survivor who wanted her life back. Somewhere along the way, I ended up writing about myself too, including something I've never told you before. Those stories became my new book, Brown Girls' Disease?, out October 6th. The title comes from a term I once heard used in a hospital to dismiss South Asian women with vaginismus, and I'm reclaiming it. Culture, religion, and ethnicity do shape how we experience sex, but they're context, not a diagnosis, and this book is for anyone who's ever been dismissed, not just South Asian women. Highlights: Why "Brown Girls' Disease" was originally a dismissive hospital term, and why I'm reclaiming it for a book meant for everyone. The patient stories behind the book. A personal story about my own experience with vaginismus that I've never shared publicly before. Why culture, religion, and shame shape how we experience sex, and why that context matters without becoming a diagnosis.

A lot of women notice their desire for sex fading over time and assume something is wrong with them, but there's often a real reason for it, and they're not the only ones going through it. I sat down with Dr. Lori Brotto, one of the most recognized researchers in women's sexual health, to talk about why desire changes and what actually helps bring it back. We discuss the difference between spontaneous and responsive desire, how to tell low desire apart from asexuality, and how sensate focus works in sex therapy. Lori also introduces eSense, her mindfulness and CBT based digital platform built to close the access gap for women who can't reach a sex therapist, and shares surprising research on how an AI-powered navigator stacks up against a human one. What You'll Learn How to differentiate low desire (a treatable concern) from asexuality (a sexual orientation). What sensate focus actually is and how it's used in sex therapy. Why sexless relationships often start with avoiding non-sexual touch, not sex itself. What mindfulness and CBT do as treatments for low desire. The origin and design of eSense: a self-directed digital program modeled on real sex therapy sessions. The risks of unregulated AI (like general chatbots) in mental health contexts, and how eSense was trained differently. Access, translation, and the biopsychosocial barriers facing racialized and non-English-speaking women. Technoference: how technology disconnects us in daily life, and how it can also be used to rebuild presence. A live guided mindfulness exercise listeners can follow along with.

We talk a lot about screening and treatment in the breast cancer space. What we do not talk about nearly enough is what happens after. What happens to a woman's fertility, her vagina, her relationships, her body image, her mental health, her cardiovascular health, and her sense of self when treatment ends and everyone expects her to simply be grateful to be alive. Dr. Eleonora Teplinsky is a board certified medical oncologist specializing in breast and gynecologic cancers, head of breast and gynecologic medical oncology at Valley Health System, and author of the new book Beyond the Pink: Navigating Life, Health, and Breast Cancer. Her work has long focused on young women with cancer, sexual health, and survivorship. And this book is her answer to a question medicine has not been asking loudly enough: how do we help women not just survive but thrive? We cover a lot of ground. Hormone therapy after breast cancer, including the nuanced conversations around hormone receptor positive versus negative disease, vaginal estrogen, testosterone, and Duavee. Bone health, body composition, sarcopenia, and the emerging data on GLP-1 medications and breast cancer recurrence risk. The difference between a local and distant recurrence and what ongoing screening actually looks like years after treatment. We also discuss the racial disparities in breast cancer care that begin with clinical trial enrollment and run all the way through treatment decisions, drug access, and who gets believed when they report pain. The medical distrust that Black women carry into the oncology office for very good reason. And what it means to practice truly patient centered care when the healthcare system was not designed to make that easy. Survivorship does not begin when treatment ends. It begins at diagnosis. And you are more than your breast cancer. Highlights: Vaginal estrogen is safe for the vast majority of breast cancer survivors, including those on aromatase inhibitors. Testosterone may actually act as a tumor suppressor in hormone receptor positive breast cancer. GLP-1 medications show early signals toward lower breast cancer recurrence risk. Black women are underrepresented in clinical trials and undertreated in guideline-based therapies. Survivorship care starts at diagnosis, not when treatment ends. Bone density should be checked right after chemotherapy; weight-bearing exercise, calcium, vitamin D, and body composition monitoring are all part of survivorship care. Black women are underrepresented in clinical trials, undertreated in guideline-based therapies, and underbelieved when reporting symptoms; medical racism in breast cancer care is real and documented.