373. Sexual Health: Cervix, Vulva, and Vulvodynia Research

Dr. Casperson is joined by Dr. Rebbecca Hertel, DO, MSCP, for a candid conversation about getting stronger through perimenopause and beyond. They talk about how hormonal shifts change training, recovery, and body composition. They also cover why bone health deserves your attention now, and how to read research and lab results with a critical eye. Along the way, Dr. Hertel explains what osteopathic medicine actually is. She also shares why your pain might not be coming from where you feel it. The two dig into protein, GLP-1s, testosterone, and hormone therapy, and why finding a clinician who listens matters as much as any prescription. In this episode: What osteopathic medicine and osteopathic manipulative treatment (OMT) involve Why pain can show up somewhere other than its source How perimenopause affects muscle, recovery, sleep, and body composition Why gaining muscle in midlife takes longer, and why it's still worth it Bone health, fracture prevention, and the case for resistance training Protein, hydration, and fueling your body during weight loss GLP-1 medications and strategies to help preserve muscle Hormone approaches in perimenopause and postmenopause Why hormone therapy is not contraception Testosterone: symptoms, side effects, and how to think about lab results Health span, independence, and prevention across the lifespan Hormone stigma and the need for better education at puberty, postpartum, and midlife

Episode 392 – When in Menopause: Advocacy, Policy, and the Power of Speaking Up Who gets to be a menopause advocate? You do. You probably already are. Dr. Casperson sits down with Jennifer Weiss-Wolf, a lawyer, women's leadership leader at NYU Law, and author of When in Menopause: A User's Manual and Citizen's Guide. Jennifer helped drive the fast, bipartisan wins in period policy. Now she's applying those lessons to menopause, and she's honest about why this one is harder. They cover where the policy wins are coming from, what still blocks progress, and why workplace perks miss the point. They also talk about why the real work is bigger than any one issue. If you're a clinician, an advocate, or just someone who wants to make change without a big platform, this one is for you. In this episode: How Jennifer moved from menstruation policy to menopause around 2020. It started with a friend's question about the policy landscape, not with her own symptoms. Advocacy as a choose-your-own-adventure. Legislative language, storytelling, and community-building all count. What period policy taught her about state-level wins and working across the aisle. Why menopause reform is more complicated than it looks. Decades of neglected science and deeply interconnected issues make it hard. She describes the field as organic rather than fractured. Language, stigma, and culture. How do you change policy when people still can't say "vagina" in public or on social media? Why most workplace accommodations fall short. Many are too small, too generic, or built on a weak understanding of menopause. Protections also have to come before anyone asks employees to disclose. The legal gap. The U.S. has no clear anti-discrimination protection for menopause. The ADA, pregnancy protections, and age-discrimination law help in some cases, but they leave holes. What actually moves the needle: access, research funding, clinician education and training, and reimbursement reform. Business leaders should fund these upstream fixes instead of offering superficial perks. Clinicians already have a platform. Patient visits, office materials, and staff handouts all spread accurate information, and small repeated messages add up. Community is the engine. Jennifer's examples include gyms, book clubs, schools, libraries, and PTAs. Midlife women are an underestimated political and social force.

Dr. Sameena Rahman on menopause, PMDD, PCOS, and why naming things matters This week I sat down with practicing gynecologist Dr. Sameena Rahman to talk about some of the most misunderstood areas in women's health: hormone replacement after oophorectomy, PMDD, and the recent renaming of PCOS. We move fast from clinical nuance to culture, stigma, and medical bias, and you'll walk away with plenty of practical takeaways whether you're a patient or a clinician. Sameena also shares the story behind her book, Brown Girls Disease, and why she's reclaiming language around pain, shame, and access to care. In this episode, we talk about: Why women who have their ovaries removed need full hormone replacement, not just a low-dose patch The difference between menopause management and medical neglect after hysterectomy or oophorectomy The evidence that early menopause plus hormone therapy can have major survival benefits What PMDD is, how it differs from typical PMS, and why it can feel like "Jekyll and Hyde" every month Why PMDD may be more about hormone sensitivity and brain receptor interactions than progesterone alone PMDD treatment options, including SSRIs, specific birth control formulations, progesterone, and in extreme cases medical suppression Why the old label PCOS creates stigma and hides the cardiometabolic risk behind the syndrome The new name, polyendocrine metabolic ovarian syndrome, and why I think the rename could finally bring primary care and internal medicine into the conversation How PCOS affects fertility, diabetes risk, heart health, weight gain, and endometrial cancer risk How pelvic pain, vaginismus, and sexual dysfunction are shaped by culture, religion, and medical bias Why Sameena chose the title Brown Girls Disease as a way of reclaiming a term that had been used dismissively How language changes care, from saying "vagina" out loud to replacing shame-based terms with clearer ones

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care. If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead. What We Cover What vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the body Why so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulva How symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSM Why numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worse Barrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdown How overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketing Waxing, microtrauma, and hair as a protective barrier GSM, recurrent UTIs, and why vaginal estrogen is still so underprescribed Late diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealth

In this episode, I walk through the basics of vaginal estrogen and vaginal DHEA for genitourinary syndrome of menopause, recurrent UTIs, painful sex, urinary urgency, and vulvar tissue changes. I also answer audience questions throughout, covering safety after breast cancer, use alongside systemic HRT, dosing, formulations, and what to do when symptoms don't improve. This one's for clinicians and the general public alike, the focus is correcting misinformation, improving access, and helping people understand that low hormones can affect the pelvis long before or long after menopause. What We Cover What genitourinary syndrome of menopause (GSM) actually means, and why it replaced older terms like vaginal atrophy The full range of GSM symptoms — urinary urgency, recurrent UTIs, bladder leakage, pain with sex, dryness, tissue thinning — as one unifying hormone-related syndrome Why GSM is so common (roughly 50–90% of women at or after menopause) and can start in perimenopause, during breastfeeding, on oral birth control, or after cancer treatment Data showing vaginal estrogen can reduce recurrent UTIs by about 50%, plus a large database study linking vaginal estrogen use to lower hospitalization, ICU admission, and sepsis-related death in women with recurrent UTIs Why "too old for vaginal estrogen" is a myth, and why age alone is never a reason to deny it Safety after breast cancer — why the evidence supports vaginal estrogen for many survivors, and why "zombie myths" keep resurfacing anyway The difference between systemic and local hormone therapy, and why some people need both Creams vs. tablets vs. rings vs. vaginal DHEA — and why DHEA can be especially useful for reversing established atrophy (it converts to both estrogen and testosterone) Practical stuff: burning, discharge, application technique, dosing frequency, and when it's time for a pelvic exam instead of another product Using vaginal estrogen alongside clobetasol for lichen sclerosus, and alongside systemic estrogen or testosterone when appropriate