Sexual Wellness AMA with Women's Sexual Health Expert Lyndsey Harper

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. In midlife, it's not game over where sex is concerned. Sexual health expert Dr. Lindy Harper joins me in this episode. That rapid-fire Q&A that we do is based on questions that are top of mind, even if not tip of tongue, for our community. So I did a roundup inside of our membership first— they're our VIPs after all— and then outside on a public Flipping 50-page on Facebook. If you two have questions and they didn't get answered, what I'd love for you to do is if you see this episode and you see it on Facebook or posted on Instagram, DM me, message us, leave a comment and just say this was valuable. That's all you need to say. Don't have to reveal anything more, but we will know to do another roundup and bring her back. So here's how I know this is such a popular topic. In opening applications for the Flipping 50 TV shows that I did. Now, this is an internet-based show. Each of the episodes was somewhere between 15 and 30 minutes long on average. I did 3 different seasons, they call it, right? And there were 39 episodes, 13 each. But I was so overwhelmed with questions about libido, and they were so prevalent that I gave in in episode 3 Episode 3 was about how to modify exercise to help, or at the very least, not to sabotage your libido. We'll link to that in the show notes too. And we have a little library of episodes for you if sexual health questions are top of mind for you, and we'll link to those in the show notes as well. I'm Debra Atkinson. You're listening to Flipping 50, where I address your top struggles and concerns. But most of all, we hope to inspire you so you expect and you demand better than any generation generation has ever had— their second half. I share what to eat, how to move, and how to change your mindset so you can have the energy and vitality that you want, need, and deserve in this second and better half. My guest is Dr. Lindsay Harper. She's a board-certified OB-GYN, associate professor of OB-GYN for Texas A&M, a fellow of the American Congress of Obstetricians and Gynecologists, and a fellow of the International Society for of women's sexual health. Dr. Harper is the founder and CEO of Rosie, a women's health technology company that connects women who have sexual health concerns with hope, community, and research-backed solutions. She's been named Forbes' Top 53 Women Disrupting Healthcare, People newspaper's 20 Under 20— I'm sorry, 20 Under 40, a top innovator in North Texas for 2020, and a DG DBJ, top woman in tech. Was that just a lot of alphabet soup? I did stumble through it, I believe so. Sincere apologies. But what I want you to know, she's a very smart and intelligent woman, and a lot of third parties have acknowledged such, and we're lucky to have her here. Let's dive in. All right, Dr. Lindsay Harpert is in the house, ready to— are you ready to play? Did you bring your play?

Okay, yes, I did. Let's go, let's do it.

So we are gonna volley, here they come. These are all from Flipping 50 community members. The first one, so I may be a little awkward reading these because we did not change the questions, so we'll, we'll get it right for everybody. But number 1 is, if you lose your libido during menopause, is it gone for good even with HRT?

Only if you want it to be gone for good. If you don't want it to be gone for good, then it doesn't have to be.

Awesome. Number 2, what treatments are there for vaginal atrophy post-menopause?

I love this question, but it's not a volley question because there's a few different options. But okay. Yeah, so atrophy just means that the vaginal tissue kind of gets thinner, it's less naturally lubricated, it's more prone to infection and bleeding and painful sex. And so it really just depends on how much the atrophy is bothering you. The first, you know, that everyone kind of starts with are over-the-counter lubricants. The most effective is vaginal estrogen that replaces, you know, the natural estrogen that then falls with menopause. There's also vaginal— an FDA-approved vaginal DHEA that replaces not only estrogen but also testosterone. And then there are also some off-label lasers that are sometimes used for this indication as well.

Great answer. All right. I'm loving this next question, so I couldn't resist peeking. I looked ahead. Meno has kind of made the big O a small O. How can I fix that? The big O was always toe curling and several minutes of luscious spasms and an hour of ooey gooey oxytocin, but now not so much.

Oh my gosh, I'm so— I love this question because it's so common, and I don't want anyone— I didn't want this question to go unasked. So to whomever asked it, thank you. Um, so yeah, menopause can make orgasms less intense or delayed, or even sometimes absent for women. And this is a mixture of things. Many, many times it's hormonal dependent. Other times it can be because your, you know, blood flow isn't as good to the pelvic floor, or that your muscle tone is not as good as it once was. So when it comes to better orgasms, there's really two sides of the story. The first is stronger stimulation, right? So you'll hear a lot about vibrators. Vibrators increase pleasure. We talk about them really as, you know, sexual tools rather than toys, because they're not. They should be taken seriously. A lot of women use them. You can use them for solo sex or partnered sex. No reason to be shy about that. It doesn't mean your partner's not doing their job. It's just a way to enjoy sex more. And then the second part is really, you know, providing hormones back to the vulva and vagina. And usually, you know, the estrogen can be super helpful, but also that DHEA, the estrogen-testosterone combination can be super helpful as well. So, if those things, you know, if you're having trouble, definitely have a visit with someone who knows what they're talking about, an OB-GYN or, you know, other women's health provider who's been trained in these things. And if those things don't work, there are still more options, but they're less frequently used and used for those indications off-label. So, there's always hope to get your orgasms where you want them to be, re-find them and re-enjoy them once again.

Sweet. Okay, this question, just as is, is there a natural alternative to estradiol vaginal cream used to help prevent UTIs?

Um, okay, so estradiol, the way that it helps prevent UTIs is because it helps to proliferate the good bacteria that live in the vagina, which they like the estrogen-rich environment. So when our estrogen falls, those bacteria also kind of wither away and die, and then your, your vagina and vulva are more prone to the bad bacteria kind of being able to grow. And so when we're talking about a natural alternative to prevent UTIs, there's really not anything that's going to replace that estrogen in a way that estrogen itself does. There's always, you know, things you can do in terms of hygiene, in terms of peeing after sex, in terms of, you know, making sure that if you are prone to UTIs, maybe you take prophylactic antibiotic, but that's definitely not any more natural than estrogen is. And then, there are probiotics that you can either take orally or vaginally, but what is known scientifically about how well those things work is very limited. So, I would say the most effective option is vaginal estrogen and the rest of these are kind of not as good alternatives.

Great answer. Can regular use of antihistamine H1 like Claritin and H2 Pepcid affect libido and cause fatigue? I'm taking for mast cell activation syndrome currently.

Oh wow, my— I have a family member with mast cell activation syndrome. It is a very complex disease, so I'm sorry for the person that wrote this, um, and I'm glad that you're asking and engaged. Um, So these medicines that you were describing are known for decreasing lubrication and fatigue. They are not known, and I'm sure it hasn't been studied, to be frank, about their effect on sexual desire, but you can imagine if your lubrication is decreased and you're tired, that even if it's a secondary effect, your desire will be lower as well, right? And so with something as serious as mast cell activation, you know, you definitely don't want to stop those medications if they are effective at controlling your symptoms and flares and hospitalizations. But there are opportunities to, you know, make that situation better, like we talked about with vaginal lubricants, vaginal hormones if you need it. And then from a libido perspective, you know, there's lots of different ways to increase libido. I'm sure we'll have some questions around that. But you can check out erotica. So that's like written words, written stories about sex. There are some, you know, if you're postmenopausal, menopausal, there's not an FDA-approved medication to improve desire, but there are two if you're premenopausal that are used frequently in postmenopausal patients. And then, sometimes women use testosterone off-label for that indication as well. So, it's important if this is affecting your life negatively to have a conversation with a knowledgeable women's health provider so you don't have to suffer with not only mast cell activation syndrome, which is enough to suffer from, but also sexual dysfunction as a result.

So good. All right, what can I do for painful intercourse? Tried KY jelly and like, but the pain is excruciating.

Oh, so this is why I do the work that I do, for this patient specifically, because this is such a common issue and women for some reason are not getting the help that they need for this. So I'm so thankful to be with you and for this question particularly. So If lube is not working for you, then that is the time to go visit your OB-GYN or other women's health provider. They can take a look and see what in the world is going on. Is this all vaginal atrophy and that skin thinning and lack of lubrication and elasticity that we talked about? Is there something going on in the vagina that needs more attention? Have you had shortening of the vagina due to many years of, you know, nothing in the vagina? Is the vagina more narrow so it can't accommodate anything inserted in the vagina? Have you been on medication such as chemotherapy that have caused these reactions in your body? This is easy to treat. I just want to start by saying that, but you do need somebody to take a look and just see with their eyes and with an exam what's going on. And that would open the door for potential vaginal estrogen, vaginal DHEA, pelvic floor physical therapy can be super duper helpful for patients who are having painful sex. And then just to make sure that there's nothing else, nothing more to this story that, that needs to be worked up. But very common, very easily treated. We never want women to be suffering with painful sex during or after menopause.

Amen.

Amen.

How to prevent UTIs beyond the basics. So I'm going to answer— ask this question again in case it's any different with the nuance. I've started using D-mannose. I may never have pronounced that correctly. A women's probiotic, for the rest of you, which seems to help, but wondering if if there are any other suggestions.

D-mannose actually does have some data to speak about its efficacy or how well it works. So that would be a great place to start. You know, there's a lot of probiotics that talk about increasing lactobacilli, and that is what, what changes in the vagina after menopause. So, you know, for some women, they use intravaginal probiotics, or they take oral probiotics to support the lactobacillus in their vagina, and they find that to be effective., and so, you know, that could be another strategy. For women who have recurrent urinary tract infections, so frequently, like more than 4 to 6 times a year, then they would qualify for prophylactic antibiotics as well. I know nobody really wants to be on antibiotics unless they have to, but that's another strategy to prevent UTIs, especially because as we age, urinary tract infections are not— they are much more serious than they were when we were 20 or 30. You know, I know we have all taken care of older people and, you know, we know that the havoc that urinary tract infections can wreak on the whole body. And so they— it becomes very important to get control of these. So D-mannose is an option. Lactobacillus probiotics can work for some women. Estrogen definitely works. And then a prophylactic antibiotic is also on the table. And then we— I think we briefly mentioned peeing after sex, always wiping front to back, right? So the urine is generally clean, meaning not any bacteria. So you want to wipe from clean to your, you know, to your anus or dirty or your poop. And we never want to be wiping back to front. So just general things. But the real problem is the pH and the lack of lactobacillus to keep that environment healthy.

So good. Any recommendations for keeping things fulfilling if spouse has erectile dysfunction? Yes.

Oh my gosh, these are such good questions. You know, I think that we have built our understanding of what sex is in a way that's pretty narrowly defined. And when most of us think about sex, we think about a penis and a vagina, right? And sex is actually so much more than that. Sex is erotic touching, erotic kissing, fantasy, intimacy, you know, oral sex. It doesn't— there doesn't have to be a penis and a vagina to make something enjoyable, to make something intimate, and actually even to make something orgasmic. This is something I learned after I started doing this work that men can have orgasms without erections, which I think is very fascinating. So the first thing I would say is that if this is a problem for your partner, then I would encourage him to go and visit with, you know, any number of doctors. For women, we have to seek out our highly trained, you know, sexual medicine doctors. For men, really everyone knows how to treat erectile dysfunction. So you definitely want to have that evaluated. If he's interested in treatment, there are 26 FDA-approved medications for erectile dysfunction. That's an easy part. If that— if you've gone down that route and it hasn't been effective, or for whatever reason he doesn't want to do that, then I would just encourage you to rewrite your sexual narrative or script, right? So sex doesn't have to mean penis and vagina sex. You grab a vibrator, you know, he can do whatever brings him pleasure outside of that. Because what happens sometimes is erectile dysfunction in our partners can lead to so much sort of, you know, thinking about and anxiety about sex that then it results in erectile dysfunction for us— they're not erectile dysfunction, sexual dysfunction for us, their partners, right? We are in our heads about how long this is going to take and are— do they— am I— are they finding me sexy? And it's just one thing after another. And at the end of the day, it serves us all best if we just throw those old ideas out and figure out ways to experience pleasure now in the moment that may or may not involve an erection.

So that's a great answer. Next is, can estradiol vaginal cream or estrogen HRT, either one, cause bleeding for those with fibroids and a thin endometrial membrane?

Yeah, so I think that, that this person means a thin endometrial lining. It is uncommon for vaginal estrogen to cause uterine bleeding due to fibroids. It— I wouldn't say it never happens, but it's, it's rare. And the reason is because the estrogen that goes in the vagina really is very low dose and stays in the vagina. So it doesn't really make it up to the estrogen to cause that endometrium to grow and proliferate and bleed. And fibroids are kind of in that same category. So vaginal estrogen, probably, or in most cases, no. Oral estrogen or transdermal estrogen, so the HRT type of estrogen, yes, it can cause bleeding, and particularly if women are not taking progesterone or if they are not taking progesterone as prescribed, like they forget to take it or whatever, because then the estrogen is what we call unopposed, meaning the progesterone protects the uterus from the growth of the lining that the estrogen would normally cause. But when the progesterone is around, it's like, hey, no thanks, we're not growing this endometrium or these fibroids over here in this uterus. You get out of here, estrogen. And so if you don't take the progesterone like you're supposed to, or maybe there's something wonky with your metabolism of the progesterone or the estrogen, it can cause bleeding. If that does happen, then, you know, it deserves an exam just to make sure that there's, there's no cause for concern.

Great. Okay. So I think this question you were waiting for— libido, even though I'm on HRT, it's virtually nonexistent. Resistant, difficult when your partner's libido stays healthy. What can I do about this?

Yeah, this is the number one sexual complaint of women premenopause, postmenopause, perimenopause, all the— throughout our lifespans. And 38% of women describe low desire. And so you are not alone. Nothing is wrong with you. Um, there are two types of low desire. The first is called responsive desire. So this may be You know, if you're in the right environment and you've had some exposure, say, to an erotic story or a sexy scene in a movie or something that you— that, that, you know, you— that turns you on, and in fact you have sexual desire in response to that, that's called responsive desire. And that's actually the vast majority of women who describe that they have low desire will, will say, oh yeah, you know what, last time we did start having sex and You know, I actually got into it and I enjoyed it. And so that's responsive desire. Now there's about 10% of women have something called HSDD or hypoactive sexual desire. And you can think of this the way I describe this is usually like you're on a desert island with the partner of your dreams, not a care in the world. Nobody needs anything from you that, you know, this place is just exuding sex and you literally could not care less. Like you could watch a sexy movie, you could read a sexy story. And nothing is going to make this part of your brain light up. And actually, that shows up on MRI, on functional MRIs of women with HSDD. It's really more of a neurotransmitter problem, kind of like we think of depression. Like, these parts of your brain just aren't firing like they once were, no matter what you're exposed to. And those women may qualify for a prescription for low desire if that's something that they want to work on. Now, if you have low desire and you could not care less about but you also, it's not a problem for you, then that's okay too. We're not trying to start people on medicine who are fine and don't have any problems. But if this is distressing, causing problems in your life and for yourself personally, then there are medications that can be discussed for HSDD.

Wow.

Okay.

You are a wealth of information, girl. Yay. Believe it or not, this is the last one. What are the best exercises for tightening up the pelvic floor muscles, please? The info out there, she goes on to say, can seem confusing as to which exercises actually work best. Do the toning balls that are inserted— what more— what's more effectively or effective than basic Kegels? Sorry, reading literally through typos.

Okay, yeah, no worries. So I think, you know, interestingly, because we as women have kind of been taught not to connect with ourselves sexually, been not taught to connect with our pelvic floor and be aware. And we don't even really know the right words for our anatomy and what's going on in there. Many of us also, by no fault of our own, even as gynecologists, are— it's very hard to understand what exactly is the problem down there, right? And so what this person might be describing is that, you know, she feels like what we call in medicine vaginal laxity, like the vagina has kind of just relaxed maybe due to childbirth or, you know, something like that. And she's experiencing symptoms like maybe sex isn't as pleasurable as it once was, you know, who knows, but there's, so there's that as a, as a complaint that might be going on. There's, you know, stress urinary incontinence, like we're leaking urine when we lift, laugh, cough, sneeze, that can be due to sort of relaxed pelvic floor muscles. And then, you know, also the uterus, the vagina, even the rectum can kind of— I hate to use the word fall, but like descend down in the pelvis where they used to have good support and live higher up in the pelvic sort of bowl. They now have kind of fallen down and are putting weight on our pelvic floor. And that leads to like pressure, throbbing. That's, that's uncomfortable when we're walking around for a long period of time. So all of these are symptoms of a relaxed pelvic floor. And honestly, if we are looking for the best treatment for a relaxed pelvic floor, We should all be going to pelvic floor physical therapy, hands down. There are pelvic floor physical therapists that you can see in person in your community. There are pelvic floor physical therapists you can see virtually or remotely through telehealth. So I think that that's probably the best place to start. If I'm giving the gold standard advice for what, what I would recommend to this person as a physician is starting with an evaluation by a pelvic floor physical therapist, because there may be things going on that you don't know, just because we're sort of going more on symptoms rather than on actual findings. So that's where I would start. Now, when it comes to Kegels, most women do Kegels incorrectly. We're tightening our butts, or we're doing all kinds of weird stuff. And if I ask a patient to do a Kegel while I'm examining her, most women will not actually tighten their pelvic floor because many of us have had these disruptions for years, decades even. And we can't— our brain can't connect to that muscle. And so that's really where pelvic floor physical therapy comes into play because they can teach you through many modalities how to reconnect your brain with the muscle, and then you can work on strengthening it. But if there's no connection between the brain and the muscle, you can do all the Kegels in the world. It's not going to work because you're going to be tightening your butt and say, maybe you'll get a great butt, you know, but not necessarily a tighter pelvic floor. Um, and then the other flip of the coin here is that some women have sexual pain or can even create sexual pain due to sort of overdoing it while trying to tighten their, you know, their vagina or their pelvic floor or whatever they're, they're working on. And so while Kegels are recommended, we number one need to make sure we're doing them correctly. And we number two need to make sure that actually you're the patient that needs Kegels because some people don't. And so the balls are kind of the same answer. I think they can increase awareness of like, oh, I can actually feel my pelvic floor muscles tightening around this ball, right? So it might increase our awareness. But to really get connected and to get the results you want, pelvic floor PT is the way to go, hands down. None of these things are inherently bad. It's just we don't have the tools we need, most of us, to use them correctly, if that makes sense.

It makes total sense. Okay, so that, that concludes all the questions that have come in from the community. But don't you think I'm going to let you go while I got you here? So I ask many guests this. Many of my listeners already know what's coming, so I'm going to ask you this. What should I have asked you? You're talking to a group of women, 45 to 70, some are older. That's the average. And probably, you know, you know the odds, you know the numbers. And I know as a personal trainer, I would hear this, you know, because we don't talk to anybody else about it. It was out of 39 Flipping 50 TV episodes. So these are internet-based shows. The applicants asking questions about libido were so numerous that it was the third question I asked. The third episode dealt with that. So what questions should we ask you?

Oh my gosh, I mean, I, I think that, you know, when we're talking about libido and how stinking common it is, I think it's really important to think about it. Like, I think that many of us have the perception that we need to increase desire to satisfy our partners. And I would really love to change that paradigm for women and to think, you know, it's when— if for those of us who have identified with, you know, enjoying sex, enjoying sexuality, enjoying sexual desire and pleasure and orgasm, there's really no reason that we would ever want that to not be part of our lives, right? And so I think that when we think about libido, I would love for us to think about it as something like fitness that we owe to ourselves, that we do for ourselves, that we want to reclaim as part of our identity as a whole person rather than something we're doing for someone else. Right? Because it, it helps us to be sort of the fullest version of ourselves if that's, if that's a positive experience for us. And I think when we reframe it like that, it does a few things for us. It, number one, makes it less of a chore. We're not doing it to check it off the list as a task for someone else. Um, it also gives us agency to really own what we deserve, to really say, hey, this isn't working for me, I need to figure this out. Maybe that's a visit to my OB-GYN. Maybe that's, you know, checking out a book or a platform that can help support these ideas and these efforts. Maybe that's having a real conversation with a friend about sort of what their experience has been, not like a laughing, joking, you know, eye-rolling conversation. And I think the more that we're able to reclaim these ideas of who we want to be as whole people, that it gives us the opportunity to be the most successful at accomplishing sort of that piece of the puzzle for us and in our lives. So, you know, I'm just, I'm extremely passionate about this stuff and I want women to be able to achieve, you know, their fullest, uh, most whole version of themselves and of their lives. And I think sexuality is a big part of that for many of us. And I want us to own that. And not make it, you know, someone else's fault or someone else's problem. And so I think as we enter perimenopause and menopause and we think about our health, we think about our cardiovascular health and our fitness and our diets and our mental health. We also need to be remembering our sexual health. And I would just love to communicate that as part of this whole conversation.

So good. Okay. I want to ask you this. So in examining women and, and really older women, so women over 40, over 50, 40, for sure, 60. So when we know we're definitely— you're probably examining postmenopausal women, and I would guess you probably less frequently than you did someone who's in their reproductive years. Is there a difference in like the health of tissues for someone who is sexually active versus who isn't?

Yeah, you're talking about the vulva and the vagina specifically, I'm assuming?

Yep.

Um, you know, it's interesting, there's really more of a difference for women who have estrogen versus don't have estrogen, rather than for who— for whom are sexually active and for whom are not, if that makes sense. So we do know that lack of estrogen over a long period of time, as we've talked about, can, can result in very painful sex. That can be because the skin is thin, because the elasticity is not there, and the vagina can get shorter and smaller. And I would say those, those, those things are more bothersome and prominent if, first of all, you haven't had sex for a long time, and then you go back to trying to have sex, if that makes sense. So the real, the hardest time for patients, which this is totally doable, by the way, if this is you, is if you've had no estrogen and no sex for 10 years, and then you get a new partner and you're like, whoa, I want to have sex again. But wait a Wait a minute, it's not really working down there. What do I do now? But for those who have stayed sexually active and are using lubricants with, you know, with success, that's great. For those who have stayed sexually active and are using estrogen, that's great. For those who are either not sexually active and not using estrogen, and that's the continued course, that tends to be less of a problem except for on the UTI part, right? They're like, oh, well, what this vagina like, isn't no one's trying to like, we're not having sex anyway. So the thinning, the shortening, the less elasticity aren't really an issue primarily, other than if they try, you know, in the future to go back to being sexually active, with the exception of the urinary tract infection sort of problem. So it's a very long answer to a short question. But it's not as easy as saying if you keep having sex, your vagina will always be healthy because there's that other factor at play, which is estrogen.

So, in answering that question, I'm going to have you answer it again, if you would. So, is that— does estrogen qualify if it's naturally— so we're talking still in perimenopause or hormone replacement— in both cases, is that what you mean?

No, estrogen— okay, there are many women who take hormone replacement and use vaginal estrogen. Because the vulva and vagina need that localized estrogen really to stay what we in medicine call well estrogenized. And, for many women, HRT is not enough to keep the vagina well estrogenized. So, it's really specific to that. So, there are many women who are off HRT because they're through sort of the intense hot flashes and insomnia, mood swings, anxiety. I know I don't have to tell you all these symptoms, but they stay on vaginal estrogen for that, that estrogenation that's required locally long-term. So the two things are really separate conversations.

Got it. That was great clarification, Lindy. Thank you so much for being here. I mean, this has been hugely insightful. And I think, you know, it's one of those things that women often do have questions, but there's no real great place to dump the questions without being called out publicly. So thank you to our community members who asked and got to stay anonymous, but probably asked a question that many other women had and benefited from. The one thing I would like for you to do if you're listening to this podcast is to share it, comment on it if you're seeing it in Facebook, or, or reach behind the scenes if you'd rather do that.. If you're in a private group, we have the Flipping 50 Insiders Facebook group. You can comment in there or you can DM me on Instagram and just say, this was really helpful. Thank you. That's all I need from you. But that kind of gives me a wink that, you know, more information like this and just a more frank answer my questions, please podcast would come in handy. And then we will circle back to Dr. Lindsay Harper and have her back. Thanks so much for being here. Where can listeners follow you?

Yeah, this has been great, and I— your community has asked wonderful questions, and I do want to reassure them that these are the same questions I get like literally day in and day out, so that you are not alone. Um, and there are evidence-based, you know, real interventions for the problems that your community and women everywhere really are facing. Um, and I started a platform called ROSY, R-O-S-Y. That's an app that you can download in the App Store. This is really all we do all day long is support women's sexual health throughout the lifespan, including perimenopause and menopause, but also in other areas like cancer and trauma and communication. And, you know, you name it, we've got it. And so I'd love to connect with people there. Our website is meetrosy.com. Our Instagram is meet_rosy, and I can be found at Lindsey harpernd on Instagram, but my name is spelled differently, so check the show notes so I don't have to put you through it.

And we got you covered. Thank you so much. All right, listeners, so if you did have a question and now you're sorry that you didn't hop in when I gave that roundup, there's still another chance. So we will— I promise you we'll have her back. This is really an important topic, I think, and not one that you just have to let go or say that ship sailed. So show notes for today will be at flipping50.com/sexualhealthexpert. What are you waiting for? Let's start flipping 50 today.