Dr. Jennifer Berman on Female Urology & Sexual Health – Smart Sex, Smart Love

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On this episode, Joe is joined by world renowned expert, New York times bestselling author and one of the nation’s leading authorities in the field of female sexual health, Dr. Jennifer Berman. Jennifer and Joe discuss female urology and sexual health. Dr Berman believes that sexual health for women is a critical component of good general health. As one of only a few female urologists in the United States, she’s considered America’s leading expert on women’s sexual health issues.

Dr. Berman says sexual health issues are often sensitive topics for people to discuss and most people don’t realize that there’s a world of help available to them. “Women are much more complicated and multifaceted than men,” says Dr. Berman. “When it comes to sex, when sexual issues crop up, it’s almost like death, like an aspect of you dies. There’s a lot of shame and a lot of guilt. When women do eventually seek sexual health help, it’s like a seed of hope is planted.”

Find Dr. Berman at:
Website | Facebook | Youtube

Speaker 1:

today on the show. I’m honored to be joined by world renowned expert, New York times bestselling author and one of the nation’s leading authorities in the field of female sexual health. Dr Jennifer Berman. Jennifer is here to talk about female urology and sexual health. Dr Berman believes that sexual health for women is a critical component of good general health as one of only a few female urologists in the United States. She’s considered America’s leading expert on women’s sexual health issues. Dr Berman is a sexual health expert, urologist and female sexual medicine specialist. She is also a former cohost of the television show, the doctors, and she founded and created the Berman women wellness center in Beverly Hills as a comprehensive multidisciplinary state of the arts center dedicated solely to women and wellness. Plus she has a New York times bestselling coauthor with her books for women. Only a groundbreaking guide to overcoming sexual dysfunction and reclaiming your sex life and secrets of the sexually satisfied woman. 10 keys to unlocking ultimate sexual pleasure. I’m sorry, 10 keys to unlocking ultimate pleasure today. Dr Berman is featured regularly on the dr Phil show, the today show and good morning America. And she says sexual health issues are often sensitive topics for people to discuss and most people don’t realize that there’s a world of help available to them. Let’s talk about that. Welcome dr Berman.

Speaker 4:

Hi, thank you. Thank you for having me.

Speaker 1:

Thank you so much. I’m so glad to do this because, um, I do a lot of my own work on male sexual health and um, you know, not enough. We have a center, so we have 13 therapists and several of them do female sexual health, but I really wanted it to be part of my podcast, so thank you.

Speaker 4:

You’re welcome. I need to be here.

Speaker 1:

Would you be willing to share what, how is female sexual health, the problems that women have different to treating men?

Speaker 4:

Well, that’s, um, it’s a good question. I think, well, from the standpoint of ma, I am a urologist, so I was trained in male sexual health. And it’s interesting because, um, when I was in my, my residency in urology Viagara was just getting approved. And in 1998 and there was this an, I was at the university of Maryland and we were one of the main testing sites for biography. And Bob Dole was just coming out with his ed. There was a lot of interest in a lot of, um, media, uh, awareness about it. And women were lots of discussions and, you know, women were talking about it. And I was the only woman in the department at that time. Very few women were going. I was going into urology at that time. It’s since changed. But, um, so I, I was in kind of the trenches and in the forefront before, at a time when the medical community really wasn’t recognizing or understanding what female’s sexual health really was.

Speaker 4:

It was more about, um, you know, could you ha like, could you have sex? Like, could a penis go in there and could you conceive and issues surrounding satisfaction, arousal, orgasm, libido, those weren’t things. Certainly not things that doctors talked about at all. And you know, they in the, in terms of the anatomy and physiology and, you know, what we learned about in medical school, those weren’t things that were even, you know, mentioned that has changed since that time. But, you know, that was a big part of, of my, my research and, and, and pioneering. So, um, so from that standpoint, um, that, that really wasn’t anything that, that we understood now quite the contrary for men at that time, we really did have a pretty broad understanding of the anatomy and physiology of the male sexual response, your rock doll response, the, you know, on a cellular level, basic science to a clinical, you know, and a clinical understanding.

Speaker 4:

And when we were first, you know, looking at it and women, myself included, we sort of applied what we knew in men and kind of said, okay, well let’s do that. And women and women are much more complicated and multifaceted. And we couldn’t just take the male model and like say, okay, I would dig them, put it over here. And, um, so, you know, so it’s, it’s, it’s, it’s been been a journey. But you know, the good news is in my lifetime there, which I’m really excited about, there are now two FDA approved medications for low sexual desire and women that are, um, FDA approved, which is huge, um, and more calming and, um, you know, so that’s really, you know, kind of a breakthrough. And, um, there are, you know, in terms of sexual issues that women have, there’s problems with sexual arousal. So lubrication, sensation, um, an encouragement. There’s problems with libido, sexual interest, motivation to be sexual. Women have problems with pain that can be due to dryness and arousal, but other issues, um, problems with orgasm, difficulty achieving orgasm or inability achieve orgasm. Uh, what else? Arousal, lubrication, orgasm and pain. Yes. So those are the main thing. And men are kind of simpler. They have, you know, inability to attain erection, ILIT, inability to maintain an erection and, um, premature ejaculation that that’s one or delayed ejaculation. And uh, you know, they’re, they’re a little bit more straight forward.

Speaker 1:

You know what, I never knew when I was a student in my sexology PhD program, I had no idea. Um, and I should have known this, but I, I don’t know. I guess I wouldn’t because I’m a gay man and just a man that, that women have performance anxiety too. I had no idea that women would, can you talk about what that is?

Speaker 4:

Um, well the performance anxiety that men have is much more like obvious cause it’s like something, you know, that, that it’s, that there’s something that both parties can witness, um, which makes it more, um, you know, I think, um, from the performance standpoint, we’re both watching and you’ve got something that I’m going to notice, which is where the performance part comes in because you’ve got to do something. And I can see that it’s not working for the standpoint of women. Um, it’s not necessarily that they perform, isn’t it? I it, I don’t really like that word, but they do have, um, anxiety about orgasm. I will say that they get, they get into their heads a lot. And I, you know, it’s interesting that you brought that up because I, you know, it’s so funny cause I wouldn’t have drawn those dots. I wouldn’t have made performance anxiety in men and LinkedIn had you not just said that and linked that to what goes on in women with orgasm and call it that performance anxiety at all until right this second.

Speaker 4:

Because that is what happens in women and it’s something that goes on in their frontal cortex. It’s the chatter that goes on in their head, hyperactivity of, um, you know, what about this and what about that? Is it, it is it, this is it, this is, it is it that makes them very effective multitaskers and, um, you know, highly competent, um, you know, mothers, workers, leaders, innovators type a, kind of, um, uh, people that, that are extremely confident individuals in many areas of their lives. But it’s hard to shut that off to, you know, okay, now, so, so have sex men on the other hand can be much more goal oriented, task oriented than women. That’s not to say all men are, as you just mentioned, the performance anxiety, but men are better at it than women. Um, and so women do struggle with that.

Speaker 4:

And it’s funny because there are certain women that that struggle more and there’s a drug called Addie, one of the FDA approved drugs. Um, AR is designed specifically for that purpose. And, um, I, they, I do believe that they’ve looked at it in men, but it’s not, I’m not sure what the data shows, but that’s an interesting, I’m going to have to ask. There’s a woman named Cindy Whitehead who is, who’s kind of, um, the founder of that company who’s the one that brought it through the FDA. I’m going to have to ask her about that for performance anxiety in men, whether there’s any, um, whether it has a benefit for that because it does work through the saratonin system is their turn and pathway. But, um, but that’s a good question.

Speaker 1:

I like that. Um, it sounds like similar to man where, cause that’s what happens for men where they get erectile disorder problems is they’ve lost erotic focus and that’s what you’re saying happens to females. They’ve lost a lot of focus and that’s right. Then low sexual desire.

Speaker 4:

But what happens to women is that they can’t orgasm and having some men is they can’t get hard. Right. Or, and then in men with delayed ejaculation, um, what would you say? Like in my, as far as I’m concerned when with delayed ejaculation in my experience that happens, you know, obviously men are maybe, you know, it was drinking or drugs or things like that, but in men that have had prostate surgery and other things and older man that that’s not uncommon. What in your experience do you, would you say is associated with that?

Speaker 1:

Yes. And sometimes there’s been some surgeries done to the, uh, I forget the term when the penal opening penal opening isn’t at the centers. So there sometimes that will cause delayed and sometimes it’s about letting go. Sometimes it’s psychological, they’re holding back because with intimacy it’s such an intimate thing or they have judgment in their head from how they were raised, whatever. Sometimes it’s not just medical. Right.

Speaker 4:

So would you say also that in men that I thank you for reminding me of that too. And then that watch a lot of erotic porn and things that they have difficulty. Um, it, you know, in a real time situation because they’re accustomed to such high levels of visual stimulation that when they’re in an actual, you know, male, female or male, male situation, the level of um, erotic or visual stimulation doesn’t meet, you know, what they’re accustomed to, that that can play a role.

Speaker 1:

That’s a good point. Um, what I, here’s what I notice about the men with the erotic imagery elect in porn is that they get used to themselves. So we, we sit, we talk about it in terms of porn, but it’s not so much what they’re looking at. It’s that they’re used to their own hand. They’re used to their own timing. You’ll pour, never says no, it never has a headache. It never judges you. And so then when he turns to her, all that comes with another person and he’s not used to that. That’s what I ended up seeing. Um, yeah. But, um, and so now, um, when, when couples come in, the biggest thing I see is the desire discrepancy. And usually it’s not always, but usually it’s the women that have the lower desire and they feel so ashamed. So it’s great to hear about these new FDA drug drugs because I’ve been hearing people say that they don’t, they’re not effective. Is that true or is that not true?

Speaker 4:

Um, the, the two drugs, well, the problem is, it’s not that they’re not effective, it’s the, you have to wait. There’s, it takes approximately eight weeks on one of them for one of them to determine who it’s going to be effective for. So they, they’re, that’s the issue is that it’s not effective for everyone. Like I said in the beginning, it’s certain women, so they haven’t yet identified responders versus non-responders. So you have to take it for a period of eight weeks before you know whether you’re going to be a responder or not or not. That’s, that’s the issue. And they’re right there doing some genetic testing right now to try and figure out who’s going to respond versus not respond. So that, that will help. But, um, that’s the issue with the Addie, the other one, the [inaudible], um, that, that works to through a dopamine pathway and that most women respond to that.

Speaker 4:

But the problem with it is that, that there’s side effects associated with that. Now, again, these are the very two first FDA approved, you know, medication. So there’s going to be, um, you know, improvements and tweaks to them, the first diabetes drugs that came to the market. You know, we’re, we’re a little bit, you know, if we go back and look at those, we, you know, we, our eyeballs would pop out now too, so, so, but I, you know, I, I hear what you’re saying. It’s not that they don’t work, they’re not perfect yet. And, um, and the other issue with the, here’s the thing, libido, it’s like asking, you know, do you believe in God? Like it’s a feeling. So your libido is different for you than what it is. For me, I were trying to quantify a feeling, not blood pressure, not heart rate, not, you know, the, the pH of a cell.

Speaker 4:

It’s an emotional feeling and they’re trying to measure that and you know, and quantify with statistical significance and P values. It’s, it’s, it’s challenging. And so in a scientific, you know, laboratory settings. So I think that, um, you know, that, that, that makes, that makes it, you know, it’s hard to do, but, um, but we’re doing the best we can and every woman is different. And the subset of women that they’re looking at, you know, the, with, with the frontal cortex activity, I suggested to the right, has it maybe not start with that subgroup, but it just so happens is the drug, because it works as a serotonin pathway. I don’t know why they picked, you know, that that subset to look at. Um, maybe, uh, maybe, perhaps because the way, you know, the, the initial design, um, when I looked at the very first paper, that was the very, very, very first one.

Speaker 4:

Whoever designed the, the screening protocol was some sort of, um, probably in the same realm. You know, feel that you are, he was like a neuro psych guy that did these very complicated, um, screening instruments that looked how, how the women were answering these. He was able to assess like personality based on how she was asked, how they were answering tests so that they were, you know, whether it type a controlling, you know, the, it was based on how he, how so you could kind of profile people, um, based on how, how they were answering these tests. So based on that study now when people, when women are coming into my office with orgasmic disorder, I’ve started to like, you know, it’s almost like, I hate to say the word, but racial profiling. Like, Oh, she’s one of them, she’s going to be, I bet you know, she’s controlling, she’s type a, she likes things a certain way.

Speaker 4:

She does this and she did based on the way that that guy set up his instrument. And they all are like that. They all like, there’s a spectrum of character traits that we all have and they fall into this category. It’s really interesting. So, um, and women with orgasmic disorder and they’re either, they have difficulty achieving orgasm or inability to achieve orgasm. And by the way, it’s libido to the, these women in the Addie study, they had lifelong low libido. So they would they say that they never really were, had high levels of motivation to be sexual. They were always sort of like, eh, whatever, you know, not a sectional, not like slot, but sort of whatever.

Speaker 1:

That makes sense. Could we, um, change a little bit and talk about pelvic floor because, and pelvic pain because this is on talked about a lot now and it’s being done more. And I think a lot of women don’t understand. And I think some of my clients feel afraid. Like, what do I have to do? I’m going to a physical therapist and what are they doing to me? Could you speak to that a little bit?

Speaker 4:

Yeah. Well, pelvic floor disorders are, um, you know, a big, a big issue, um, across for men and women actually across, you know, all ages. The, um, and it can be I pelvic floor disorders can be either things are too loose, like as you get older and have babies or things or too, you know, too tense and too tight. So whether it be pain due to tension and tension or, or locks the city and, and looseness. Um, and men, we, you know, pro, they call it, um, prostate Denea, which is, um, pelvic floor tightness or spasm of the pelvic floor muscle. And, um, the men will experience recurrent, um, they say it’s not really prostititus but they have symptoms similar to prostititus. So frequency, urgency, burning dis urea and they, it feels like, um, pressure pain and perhaps a urinary tract infection. And they go to the urologist and they have prostate, you know, the, the guy, they feel the prostate and there’s pressure in the prostate pain, the prostate, perhaps the urologist does.

Speaker 4:

Prostatic massage looks at the, you know, the, the prostate fluid. Maybe there’s white cells, maybe there’s not, but there’s no, it’s non bacterial prostititus and they get diagnosed with what’s called prostate Denea. And that, um, is associated with pelvic floor tightness or spasm of the pelvic floor muscles. And that, um, that is the reason for that. I don’t think that they’ve really identified the cause for that, which is similar. There’s a similar, um, a similar issue that happens in, in women. Women have, um, tension or pelvic floor myalgia and women in women is frequently associated with interstitial cystitis. Interstitial cystitis can also occur in men, although it’s less frequent in men, but in women that have um, frequency, urgency, uh, and, and pain and pelvic floor pain, it also is associated with better conditions. Women also have something called Volta denia which is pain, irritation, uh, pain and irritation in the opening of the vulva without an infection.

Speaker 4:

So it’s just inflammation in the irritation in the, um, voles are opening the opening of the vaginal area and that’s also associated with pelvic floor spasm. The it traditionally these disorders were treated with, um, pelvic floor physical therapy. The cool thing now is that we have these, um, new radio frequency heat, minimally invasive radio frequency heat as well as laser light, laser, um, modalities to, um, that are, were developed for, um, incontinence, but yet they’re also helping for pain and lichen sclerosis and resurfacing. So for, um, vaginal dryness and I don’t know whether they’ve been used and men are not rectally. That’s now that you’re, now that I’m just having a stream of consciousness now I’m thinking about that. But, um, they’re used a lot in women for pelvic pain and it is the one, I can throw out some names though. TIVA diva, ThermiVa.

Speaker 4:

These are, um, do, you may have heard the term vaginal rejuvenation, um, technology. So these are, um, devices that function to, um, resurface and restore that original mucosal health also help to improve pelvic floor tone. They improve the collagen and Loston. They improve the vascular neovascular, Neo neuro regeneration. So it helps to regenerate new collagen, new lesson, new nerves. How it, how it functions to, for the vulva vestibular pain. Similar to the way that Botox where if, I don’t know if, you know, one of the treatments for, um, for vulvodynia is that, um, is Botox injections and Botox, Botox pills, the nurse and the new nerves regenerate with these new technologies. It doesn’t kill the nerves. It just causes new nerves to grow. So it’s less invasive and equally if not more effective. So for, um, for Volvo vestibular pain and pelvic floor spasm and pain. So I’ve had a lot of, lot of success for that. I don’t know of anyone that’s using them rectally in men, but, um, you’re spurring me to have a lot of, um, a lot of thoughts in that regard. So I’m gonna, I’m gonna think about that.

Speaker 1:

This is hopeful. I’m really glad to have you here talking about hopefulness for women because a lot of women give up easily. They’re too embarrassed or too ashamed. Sometimes their male partners have shamed them. Um, and I’ve seen so much disruption in my office, so I can’t wait to be able to be refer to this podcast and say there’s lots of hope and lots of effectiveness. Listen to dr Berman. Talk about all this.

Speaker 4:

Yeah. Thank you.

Speaker 1:

What would you say, um, are the secrets of a sexually satisfied woman?

Speaker 4:

That’s a good question. And um, and that was taught, that was the title of our book and we [inaudible] we did that with Rand and it was based on a survey and I would say, and I would say now based on that and, and all the years of wisdom that I have now, that was, I wrote, we wrote that when I was in my late thirties, maybe early forties, and now I’m 55. I would say with, with hindsight and wisdom that the secrets of a sexually satisfied woman is, it’s all you. It’s what we were doing then is trying to um, you know, take ingredients and mix them together and try and like, you know, bake a cake. And what I know now is that it’s really important to take a comprehensive, holistic approach and not just about from the medical, any, any emotional, sort of like her relationship, her husband, her children, it’s mind, body and spirit and the spirit.

Speaker 4:

And that I say that against spirit and I’m not a healer. And I’m not religious and I’m not any of that. But what I’ve noticed is that there, that, that aspect of, of whatever that is spirit thing is when people are in alignment with, with whatever that is the hope, you know, when it comes to sex, when sex, sexual issues crop up, there is part, there is, um, like, like it’s almost like death, like an aspect of you dies. You know, the, the, there’s a lot of shame, a lot of guilt there is, you know, the, the relationship is, you know, there’s, there’s fractures, there’s, by the time they come to me at least, it’s not like, you know, Oh, that just happened. I have a little, you know, they’re, people have been on a journey seeking help. They, they’ve been frustrated and, um, and loss of hope.

Speaker 4:

So, and, and oftentimes they’ve neglected it, ignored it, made excuses for it, you know, blamed it on other things and when, and over time, um, when that happens other, it becomes a snowball effect and they, you know, then there’s, this happens that happens and then they get, you know, headaches and, ah, yeah. One thing leads to another. So I’ve found that they start to neglect other things and other aspects of themselves. So I um, I have found that as soon as they, they recognize that I have been neglecting, neglecting my self, my self care, myself, respect myself, love my, you know, my, my hopes, my, you know, all of that stuff. Um, everything changes. And then they, I also noticed that when they are able to, and a lot of them have seen a lot of different doctors and they go to this one for this and that this lady said that this person put me on these hormones and these foods and when they are able to say, okay, I’m going to put my faith and I’m going to believe you that these you are going to listen to what you say and have hopes that what you’re saying is gonna work and you know, here we go.

Speaker 4:

And as soon as that happens, like a seed of hope is planned. And I remember all that faith or whatever, everything, everything changes. So I’m going to say mind, body, spirit, an aspect of faith and hope that without that faith and hope and something like when, when there’s just, when, when people just go to doctors and expect them, you know, put, take this pill or do that or, and don’t take responsibility. Like there’s 60 80% of what doctors are doing, you know, the patient has to participate and you know, recognize that they play a role in everything that’s happening in their body. So

Speaker 1:

that’s a great, no, it’s great. Instead of being so dependent on the medical professionals and a pill or something outside of you that you’re reminding us. Uh, and for men too and just everybody that, you know, gotta take it, you’ve got to do what your own work as well. And that isn’t always the case with a lot of people. What would you say? Um, cause we’re coming to almost the end or the Vage in terms of vaginal health, the do’s and don’ts.

Speaker 4:

Well the vagina is a self cleaning oven on its own. So don’t put things in there that shouldn’t be in there. Do Xing is bad, you know. Deodorizers perfumes, things along those lines are a no, no. Um, it, it’s really designed to clean itself. You know, deodorize itself. There’s um, there’s, there’s not too much that, that you need to do. The thing, um, I would say is there are some women that are predisposed for a number of reasons to urinary tract infections related to sexual activity and other things. Um, there’s a great product that I believe is coming to market now over the counter called thera works protect for um, urinary tract health. It’s an over the counter, um, barrier kind of that helps prevent urinary tract infections. So I think prevention is a great thing. Um, but the, um, there’s not so much that we need to do to our vaginas with when in perimenopausal and menopausal women that are experiencing vaginal dryness speak to your healthcare healthcare provider.

Speaker 4:

Cause those are times the pH of the vagina changes. Then you’re predisposed to vaginal infections, urinary tract infections, fungal infections. That’s a time when estrogen is important. But, um, there there’s really nothing that you need to do. If there’s an O there, vagina shouldn’t have any odor. The odor that occurs is if there is an odor, you know, a strong odor that means an infection. Other odor is just skin and sweat glands, but there are works. Protect by the way prevents skin odor. So there shouldn’t be any odor. If there’s a foul odor, it means that you have an infection. You need to go see your healthcare provider. Any that the regular odors just from sweat glands is the skin and that’s normal. A foul odor means that there’s an infection in perimenopausal, menopausal women. Um, Jen developed symptoms of vaginal dryness, irritation, itchy, that, um, is a result of lowering estrogen levels. That is also a time that you should speak to your healthcare provider because that when estrogen levels are lower, you can be predisposed to urinary tract infections, fungal infections and bacterial infections. So that should be, that’s a time that’s, that should be treated. Um, but otherwise, um, your vagina is a self cleaning of and like I said, and you should leave it alone. Um, wear condoms if you with, with, uh, stay safe and you know, no, carry on.

Speaker 1:

Thank you so much for this is very, very informative. Um, how dr Berman, how can people find you going forward? Are you on the internet? And if so, how? Where, where are you?

Speaker 4:

Yeah, dr Jennifer Berman. My website is Berman sexual health.com and you can find me on Instagram at Jen Berman MD.

Speaker 1:

All right. Thank you very much. I know you’re busy. You’ve done a lot of good work and keep, I’m sure you’ll keep doing it and it was a pleasure having you on my show. Thank you very much. Thank you. Bye bye.

Speaker 3:

Thanks for listening to this episode of smart sex, smart love. I’m dr Joe court and you can find me on Joe kort.com that’s J O E K O R t.com. See you next time.

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