Am I Normal? w/ Dr. Maria Uloko

I spend so much time, one, destigmatizing, two, telling people to let go of shame, and then three, telling them there is no normal. There is truly no normal.

Look into his eyes. They're the eyes of a man obsessed by sex. Eyes that mock our sacred institutions. Bedroom eyes, they called them in a bygone day. You're listening to Sex with Emily. I'm Dr. Emily Morse, and I'm here to help you prioritize your pleasure and liberate the conversation around sex. Today, my guest is urologist and surgeon Dr. Maria Yuloko, who is revolutionizing sexual healthcare. Whether you have a penis or a vulva, you will learn so much from her expertise in sexual dysfunction, pain, and just overall sexual health. I also answer your questions. About when it's time to date again after toxic relationship, what to do when your partner's porn preferences look nothing like you, how to be a woman who actually wants to dominate in the bedroom rather than being submissive, and my recommendation for toys to amplify oral sex on a vulva. All right, Intentions with Emily. For each episode, I want to set off by setting an intention for the show, and I encourage you to join me and do the same. So when you're listening, what do you want to get out of this episode and how can I help you? Well, when I was creating this episode, I thought I really want to give you insights into the most common sexual issues people face, realize that you are normal, and also give you a glimpse into the future of sexual medicine. If you want to ask me a question, you can call my new hotline, 559-TALK-SEX. Just leave me your questions there or message me at sexwithemily.com/askemily. And include your name, your gender identity, location, and your age and how you listen to the show. All right everyone, enjoy the show. Dr. Maria Yuloko is the host of the Battle Cry Podcast, a comprehensive sexual medicine fellow at San Diego Sexual Medicine, a urologic surgeon specializing in both male and female sexual dysfunction, transgender care, erectile dysfunction, gender dysphoria, genital pain, penile curvature, low testosterone, low libido, sexual arousal disorders, urinary incontinence, and menopause care. Welcome to the show, Dr. Yuloko. Hi.

Oh my gosh. Thank you so much for having me here. It's such an honor to be here and talk about a field of medicine that I absolutely love and such an important condition for a lot of people with vaginas and vulvas.

Exactly. And you guys also work with penises too, right? So we're going to, we're going to get into all of that. Don't worry, penises, we got you. But can you tell me, so you're trained as a urologist. What made you go into urology?

I actually met a urologist named Dr. Hadley Wood at the Cleveland Clinic who was my first urologist that I saw that was a woman. And I was like, oh, I didn't know women could do this. And she was so relatable, so well-dressed, so well-spoken, telling hilarious raunchy jokes at dinner. And I was like, that's who I want to be.

How would you define— people don't even know what a urologist is. Could you just tell us real quick what is urology?

Yes. So we're kind of like the weirdos of surgeries. We are surgeons of the genital urinary system. So we perform surgery on kidneys, bladder, the tubes draining the kidneys, which are called the ureters, anything that has to do with urinary health, urinary incontinence, leaking. And then we also do male sexual health and andrology and infertility.

Right. That's why I think that's why I wanted to define it because people, most people think of urology as being a male field?

For the most part, that is still the case, and there are several pioneers in the field that are trying to make it more inclusive. We're excellent perineal surgeons of the perineum for those that have a vagina or vulva, and we deal with a lot of like urinary incontinence and prolapse and all of those things. But, you know, we don't deal with the sexual health side of things, but we're trying to change that narrative and change that game. I signed up for this fellowship knowing that I would be taking care of both men, women, and everything in between. And the frequent narrative that I heard from patients was the delay of care to diagnosis. They would go through their primary care provider, they would go to their gynecologist, and these patients were just not getting treated. And so that was eye-opening for me because as a urologist, we would see pelvic prolapse and we would treat that. And then they would say, you know, also, you know, it kind of hurts when I have sex or this and that. And we're like, whoa, whoa, whoa, whoa, that's your gynecologist thing. Go see them. And that's kind of of the dogma that's still in the field.

Well, I often say this, and that's why I was so glad to talk to you because so many women that I did that as well, I would go, I've got a problem with, with anything sexual health related or, you know, anything with my vagina or vulva, I would go to my gynecologist, but then you've come to find out that gynecologists, they really don't have this information, especially when it comes to like hormones or perimenopause or menopause or just all the things.

So when I think about the quote unquote, female sexual health is kind of what the terminology is, and I'm fully aware we're talking about biology at that point in time, not gender. And so we're talking solely about those with vulvas, and so that can include a whole gender spectrum. But when you group that umbrella, it falls into pain, orgasm, desire, arousal. And so we deal with conditions like Female sexual pain, anorgasmia, or difficulty with orgasming, issues with desire, issues with arousal. And then also we deal with perimenopause and menopause care on the female side of things. And then also a really common thing that we see at our clinic, we're very specialized, is something called persistent genital arousal disorder or PGAD, which is also a very shamed topic as well. And so we kind of COVID the gamut of all vulvar sexual dysfunction. It's, it's—

so what's the persistent arousal?

You know, the people that have 40 orgasms a day.

Oh yeah, that's what I thought it was.

Yeah. And every, you know, and for most people like, oh my gosh, that's amazing. But it's actually a really debilitating condition for a lot of people. Um, and there's high rates of suicide, um, cuz it's a condition surrounded with shame, surrounded with also again, a lack of access to care and it's, it really derails their life, which Wish just actually put out an article about diagnosis and treatment so that we're trying to get it out there, get it out to the world. That is, it is, although rare, you're going to be seeing patients with these, right?

Exactly. And I mean, well, here's the thing that you just, this going back to something you said is that there's so much shame around it. And I feel like in thinking about all of these challenges, someone has pain or someone has erectile dysfunction or whatever pain is going on in their genitals or a problem. Not only is there not anyone to go to with the right answers, but people might not even talk about it because the fear of being shamed and the fear of feeling like, well, something's wrong with them. And so, yeah, or even just talking about it to somebody. And so I think that's a huge part of this, that people won't come forth and it's changing people's lives because when you have kind of pain or dysfunction, it really, it's hard to live a normal, healthy life.

Yeah. Yes. Oh man. I could talk about this topic all day. That shame cycle prevents people from talking about it and Honestly, half of the treatment in any of these diagnoses is just acknowledging that what they're going through is real. It is not in their head. It is not a figment of their imagination. It's not, you know, it is a biologic cause and we're going to find out. And that's one thing I've noticed that a lot of people are dismissed. They're told, you know, just drink a glass of wine, just relax. Oh, it's supposed to hurt. And we aren't talking to each other. Those with genitals aren't really discussing these issues with each other. I've gotten to hear stories of people saying, I finally decided to talk to my friends, and turns out a lot of them are also suffering. And that's why I am so, one, inappropriate socially, but I'm also trying— and I do it for a reason. I do it for a reason because if you destigmatize this and just make it a normal part of a conversation, it really puts people at ease so that they can start discussing it. And I know this is a really difficult topic to even come into our office to start talking about. And so I have a very much a, um, a nothing surprises me. Absolutely nothing surprises me. I truly just want to make sure that your quality of life is good because it is a Black woman in medicine. I know what it's like to be dismissed. I know And I never want people to feel that. And I've always kind of been drawn towards things that are taboo because my existence in medicine is taboo just in general.

Right. I know. And it hasn't been easy to get where you are. Did you say you were the first Black urologist at your university?

Yeah. So every space I've inhabited, I've always kind of been the first, not kind of, I've been the first. And with that comes A lot of people telling you that you can't. And then I feel like a lot of people having all of these expectations, or I carry a lot of these expectations because I know that being the first, everyone's going to say, well, we let her in, so, and look, she didn't do well. And so I'm kind of the gatekeeper for the people coming behind me. And so there is a lot of pressure, but I'm super competitive and I'm Nigerian. We are cocky, we are tough. You know, I also go to a lot of therapy and I'm not gonna pretend like it's not difficult, but at the same time, I am someone that sees a challenge, especially if someone tells me you can't do that. I will say, bet, let's go.

I'm so happy you're in this space right now and that you, we, we really need you in this space, the sexual health space and fighting for it. And I really hadn't heard of many people doing the kind of work that you are doing. So. I always hear about like vulvodynia or vaginismus is a very common, and I remember years ago I was on Loveline with Dr. Drew and people would call in, I have vaginismus, vulvodynia. And I, at the time, like I'd finished grad school, but we were still learning too. And it was like, well, it might be cuz you have sexual trauma. That's why. And then we started telling people, go to pelvic floor physical therapists. But since those are very common, can we just kind of break these down real quick? What they are or, or what the cause of them are?

Yeah, there are several causes for female sexual pain disorder. You know, a lot of these conditions does actually take a biopsychosocial approach, meaning that we, we address biology, but we also address the psychology behind this and the social stigma behind this because all of these factors play into each other. Sex is a very complex thing from a scientific standpoint. Although biology is driving this, then comes psychology, then comes pelvic floor dysfunction. All of these things go hand in hand, and in order to have a successful sexual health practice, you have to start there and understand that all of these factors play a role into it. And having a sex therapist, physical therapist, it's a team sport. We have to play together. So when thinking about pain, the DSM-5 defines it, it's called genital pelvic pain penetration disorder, or GPPD. Persistent or recurrent symptoms for at least 6 months. So it's either pelvic pain during penetrative intercourse with associated fear, marked tensing or tightening of the pelvic floor muscles with any sort of vaginal penetration, and this has to be present for 6 months. That's the textbook definition. So there are so many causes for it, but the most common causes are Genital urinary syndrome of menopause. So people that are perimenopausal or are going through menopause will have a lot of vaginal pain, pelvic floor dysfunction, STIs. You can also have organ prolapse, vestibulodynia, clitorodynia. And then there's also something called genital pelvic dysesthesia, which is where you're having pain, but it's actually not coming from the genitals itself. It's coming from the spine and the nerves feeding it. And so that's been the most fun part, especially about my fellowship too, is that we do a lot with spine surgeons and a lot with neurology, that neurology, nerves and brain and all, all of that, that I never thought I would be doing. And so that's been very, very fun. Wow.

I mean, there's so many, so there's so many different, so we can't even say like, oh, vaginismus is this, or because for every single person with a vulva, there's a different reason why exactly they're diagnosed with it. Could be so many different things. Yep. And that's why you guys are like detectives. Yes. But most places don't have any of that. They don't even just— there's like, oh, well, we don't know what to do with it.

Yes.

That's crazy.

Because this is a urologist. If someone with penis came in and they said, you know, my penis hurts, I'd be like, all right, let's take a look. Versus when people with vulvas come in and say it hurts when I have sex, They're literally just like, oh, you tried wine? No exam, no nothing. And I tell my patients, if you were to come into the emergency room with chest pain, not a single ER physician would say, well, have you tried some wine? Just relax a little bit. They would do a workup. They would examine you because they know that that's important. And that's just not the same energy that's given to vulvas or vaginas.

You guys, we're not making this up. This is what happens every day. Every day we're gonna take a quick break after a quick word from our sponsors. When we come back, Dr. Yuloko dives into the best treatments for erectile dysfunction, vulva pain, and other common issues she sees in her practice. Don't go away.

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So what about the men that come in, the penises that come in?

Yeah.

I'm wondering if you've seen a rise in younger men dealing with erectile dysfunction.

Yes. I tell people that the incidence of erectile dysfunction is essentially your age. So 20-year-olds, 20% of people will have erectile dysfunction, 30-year-olds 30%, 40-year-olds 40%. And so one of the— again, I am someone that I hate shame. I hate the shame of sex. A lot of the men that come to our clinic are full of shame, especially the younger ones, of this isn't something that's common. This is something that's supposed to happen to me. And I'm like, Okay, true, but also 20% of the population also has this too. So you're not alone. I think telling them that and sharing that with them is so important because there is this societal pressure that men have of performing. And if they can't perform, they're not fulfilling their duty. And I'm like, all right, now we're taking that out of the equation. Like, no, that's not going to work. Again, that biopsychosocial thing, if you're not performing, you're getting in your head, you get performance anxiety.

Right.

It's just a whole cycle. And I try to approach it from a standpoint of compassion and also like normalizing it. It actually is fairly common. And, you know, in a lot of younger men, why they get ED is either from trauma, and that can either be from fractures, aggressive masturbation— team, that's actually a thing. You can actually, you can actually develop ED from that.

How do you know if you're masturbating too aggressively? Yeah.

Okay. So, so there's something called jelqing.

Yes. Tell us about jelqing. Cause I haven't talked about it in a while. Jelqing.

Yeah.

You know, I, I'm still like, yeah, they put like a rod in their penis.

Yeah. The things that people do with their penises, I'm just like, all right, well, let's figure it out. Like, okay.

I, again, no judgment, no judgment.

Um, and so what happens? So a lot of, um, ED comes from a buildup of scar tissue. Um, and so any sort of penile trauma, either microtraumas, um, whether it's like you get tapped in the penis or you, you, you joke, or you— when people think of trauma, they think of a pelvic fracture or a penile fracture, and that's a big, big trauma. But then there's these microtraumas that can happen over time, and that causes scar tissue within the muscle of penis. And that scar tissue prevents the penis from— it's called hyper-relaxation. So fun fact, when you— your penis is actually always flexed. When you're flaccid, your penile muscle tissue is flexed. When you have an erection, as blood is getting in that space, what's happening is that that muscle is now hyper-relaxing and causing the tissue to become erect. And so when you have scar tissue, that hyper-relaxation doesn't happen because it's a closed chamber. And if you're not hyper-relaxing and closing that chamber, blood can leak out. And so that's why people will either get an erection but not able to keep it, or not get enough blood in there because it's just seeping right out.

So it's the same systematic approach that you do with a penis who comes in. So we're also saying— so that was aggressive masturbation. You're saying medication can also cause ED?

Yeah. Yeah.

And anything else that we don't— anxiety, true, right? You can be anxious. That's the psychosocial factors.

Exactly.

Wow. It's hard because sometimes people— I'm not seeing people, but when they call in, it's like— and then I'm like, well, go to your urologist. But not your, your everyday standard urologist might— isn't probably going to do the treatment of care that you do at the clinic, right? San Diego.

What we do differently in our clinic is that we spend a lot of time on diagnosis and figuring out what the degree of scar tissue is present. Are you getting good blood flow to your penis? Are you trapping blood within the penis? And then from there, we can tailor a treatment plan because Not all of the treatment options that are out there works for everyone and not everyone wants surgery. And so it's, again, the beauty of quality of life is that you have options. And in order to know what the best option for you is, you have to know what the degree of erectile dysfunction is. And that's— so we spend a lot of time on diagnosis with ultrasounds, sensation testing. Yeah, it's really, really—

That's so amazing. But there's probably some patients go into clinics or they go into their doctors and they're dismissed. So what would a standard urologist in— I'm from Michigan, let's say. So in Michigan perhaps, or somewhere, might not have this standard of care, right? They wouldn't have this information. Most— would we say that the majority of penises who have erectile dysfunction just take a Viagra or they just silently like suffer with it? Or that's kind of what happens, right?

Yeah.

What's the equivalent of the wine of women saying you've pain, have a glass of wine? What are men getting? A blue pill?

Yeah, men are getting a blue pill. And then when it doesn't work for them, them, they're stressing, you know, and they're, they're being told that, you know, once that doesn't work for you, you have to move on to other things. And the other options work well, but, you know, some people don't like the idea of having to stick a needle in their penis to get an erection. Some people hate the idea of having to do surgery. You know, as long as you're informed about truly what's going on, it's again that the beauty of showing them science. Is showing them, okay, this is your degree of scar tissue and this explains why you're having these problems. And obviously we have them see our sex therapist too. And it's just such a synergistic relationship between those two of combating the performance anxiety and actually addressing the biology. Because most men can just go to a urologist and just get the pill and it works for them, great. Then they'll try the injections and that works for them. They stick with that. And then comes surgery. And if that works for them, great. But some people, these therapies aren't working. I mean, surgery is always going to work. Prosthetic is always going to work, but some people are just not ready for that.

Right.

Or, you know, just are so surgically averse. And one thing we also do at our clinic is that we do a lot of regenerative therapy where we not only like treat the symptoms of ED, but we also try to reverse the scar tissue that is present.

So how do we do that?

So we use two regenerative therapies: low intermittent shockwave therapy, which is acoustic sound waves that stimulates stem cells within the penis, and those stem cells then help to regenerate tissue. So another fun fact, everywhere in your body has stem cells. It just matters how active they are. So your skin, eyes, liver, heart, lungs, those metabolically active organ systems, their stem cells are constantly churning things out versus the genitals. They're kind of a little slower, a little lazier. They're not really doing much. Um, and so what happens is that when you use the shockwave, it stimulates those stem cells to wake up and start doing their job.

That's amazing. I've heard about some of these therapies for men and people always want to ask me if it's safe, but I feel like And it makes sense, right? Because it helps stimulate the blood flow. Yeah.

Again, helps stimulate the blood flow, helps with also re— taking away that scar tissue that's preventing the hyper-relaxation.

Okay. How do they get the scar? It has to— the scar tissue comes from an injury, or we were saying aggressive masturbation, or is it just scar tissue also accumulates over time?

It can be broken down into trauma, and then it can be broken down into systemic diseases. So one of the reasons why long-term that 60% of people with penises will develop scar tissue at 60 is because most likely they're going to have also systemic diseases like diabetes, hypertension, high cholesterol. And so those things are also causing microtraumas to the penis and that penile tissue as well. Another plug that I do, and I tell every single patient that comes in with a penis and ED is, penile health is heart health. ED is one of the first signs of vascular dysfunction and heart disease. And so unfortunately in this country, men are conditioned that they don't go to the doctor. They don't, you know, they're not in charge of their healthcare. And, but what does drive them to the doctor is erectile dysfunction. And so that's where I capture them and say, All right. If you want this thing to be working until you're 90-something, go to a doctor. Like, let's change. Let's talk about lifestyle modifications. Let's talk about changes in your overall health because you're spending all this money and you're hyper-focused on this one thing. This one thing is a cause of a systemic thing. So let's, let's, let's think big picture, right? Because if your heart's not—

I've got you here for your penis.

Exactly.

You got them by the balls, literally. And then you're like, okay, we got to focus on your heart health. Yeah, it's true. What's going on in your heart is going on in your genitals, right? Your overall health. We have to look at all of it holistically, which we just don't. Cause then you're like also making doctor's appointments, you know, you're like, okay, one day I go to the urologist, 6 months later I go to my general practitioner, but everyone needs to be talking.

Exactly.

Right.

Yeah. Yeah.

What are the most common causes of pain during sex? Is there anything— could you say here's like the 3 most common or is it just—

I think what we see the most, it also depends on the age too. So vestibulodynia, if you break that down, I like algorithms a lot too. You can break it down into hormonally mediated. So this is something that comes from the— actually, I have a puppet.

I have that puppet too. Show me, show us.

Yeah. So, um, the vestibule is actually mediated or it's kept healthy by testosterone. So those with vulvas actually have quite a bit of testosterone. Testosterone and estrogen go hand in hand. And I think one common misconception is that people with vulvas just have estrogen and progesterone. But there's never really a discussion about testosterone, but you need testosterone to keep a lot of your genital tissue healthy. And so things like hormonal birth control, a lot of cancer treatments that block hormones will cause what we call hormonally mediated vestibulodynia because it's taking away the testosterone, which keeps this tissue healthy. Um, and then there's something called neuroproliferative, which is essentially too many nerves and too many heightened sensation, and that can be either congenital, meaning you were born with just too many nerves there, or it can be acquired. So this usually will come after like a yeast infection, or, you know, we've had people that will have allergic reaction to like douching or to other topical agents, and that causes this inflammation, and that inflammation causes mast cells, and it's just the whole thing, and that just causes significant pain. The other thing is menopause. So it's called genital urinary syndrome of menopause. As people age, people with vulvas age, the ovaries stop producing estrogen, testosterone, progesterone. So it starts that steady decline as people age. What happens then is that again, all of this tissue is hormonally mediated, meaning that it is all controlled by these hormones. So when you take away these hormones, that tissue is no longer healthy. So A lot of people will report vaginal dryness or lubrication, pain with penetration, also get a lot of urinary tract infections because all of the healthy bacteria within the vagina and surrounding the urethra also need those hormones. And so if those hormones aren't there, all those good bacteria go away and then all the bad ones kind of come out and play. Those are the most common ones that we see. And then there's something called clitorodynia too that we see Which fun fact, the clitoris and the penis, same organ, but those with penises are taught if they're uncircumcised, how to pull back the foreskin and clean so that they don't get infections versus in people with clitorises, that's not talked about. Like clitoral anatomy has been, I mean, I'm sure, you know, not even addressed.

And so not even addressed exactly.

Like, it's just like, don't even look at the clitoris. It's like, no. We're going to look at the clitoris. And I, one of the things that I love that we do in our clinic is that every single person with a vulva that comes to our clinic gets a vulvoscopy where they actually get to see their anatomy on a TV screen. Because when people with penises come in, they get to see their penis. They can always see everything. And those with vulvas where it's inside and, you know, there's a provider just looking at your legs saying like, ah, things look fine. Versus no, I'm walking you through your anatomy. You're gonna leave here feeling empowered about yourself, knowing exactly where things are. I don't quiz them. I kind of want to.

That's so cool. Well, my friend called me, she goes, oh my God, after she did this, she goes, I saw my G-spot, like they showed me on camera my G-spot. She was like screaming. I'm like, every vulva owner needs to get in there and take a— I always say take a mirror, take a look, but they're just Yeah. A lot of it's internal and you can't see it.

Yeah.

What an incredible service that you are providing. Now, I know that you also work with the trans community.

Yeah.

So I'm just wondering like what kind of work you're doing right now.

My take on comprehensive sexual health also includes transgender and gender, uh, reassignment surgery and just transgender health in general. Yeah. Because I'm just a genital surgeon at this point in time. And so my goal is that everyone is happy with their genitals and have functional genitals that they can be very proud of and that, you know, they can and that does include transgender care. So that is part of my fellowship that I've just been very, very privileged to just be a part of.

You're such an incredible woman. I mean, I love the work you're doing here. What do you think about assigning gender at birth?

Oh gosh, that is, that's a great question. That's gonna be one of those things that's gonna be really hard to, to change, because that's what everyone thinks about. That's what, you know, what, what are you having?

What is this gender reveal party? What happened to that?

We need to get rid of those. It's a weird party where in theory what we're doing is we're having a huge party for your baby's genitals, which I love a genital party. I do. Well, don't get me wrong, but let's not start forest fires, right?

Of course it would be.

Like, I think we should be celebrating genitals, you know, as we're getting older, but that's, that's just me. Um, yeah, so it is, it's this, it is this weird thing. We, we hyperfocus on this thing called gender when in theory it's a social construct. And luckily though, the voices of medicine, like the upcoming voices in medicine that I'm so happy about at this, there's a whole class of activists that are coming up. That are saying no more.

That you are really going to be such an incredible force. I just, I can't wait to watch your career because you're young.

I mean, you are 29, 29, 29.

I mean, listen, you, and you have such a life ahead of you. So I can't wait to like watch you. And I believe in all the work you're doing. I think it is incredible. Is there anything that you find in sexual health that you feel like you're repeating with every single patient that you wish that people knew?

Yes. Oh my gosh. I spend so much time one, destigmatizing, two, let telling people to let go of shame. And then three, telling them there is no normal, there is truly no normal. The, and I, and I will, I will say this story. So my, um, all of the textbooks that you see is just some random dude that was like, that looks like the perfect vagina. And that looks like the perfect boobs. Like my best friend's a plastic surgeon and she does boob jobs. And she— again, I have no shame with my friends, or with anyone really. And she like told me about the equation for how to make the perfect boobs. And so she measured me and I was just like, I have like, nothing about it. I like, in my head, I was like, oh my god, I have perfect boobs. But in my, in my, the other reasonable side of me was like, this was just some random guy who's like mistress. He's like, that's, that's the perfect equation for breasts. And that's the same thing for genitals is that there is no perfect genital. Um, there is no normal, there is nothing as normal. And I spend so much time debunking all of that. It's like, that's weird that it— I'm like, it's not weird. There's only pathology and there's not. If it's, there's no pathology, it's normal. And so let's just debunk that. But if you're not happy, that's a whole nother conversation. And if it is really truly causing your problem, that's a whole nother conversation that we can have. But if you're just going through life being like, I think I'm weird and, you know, I saw some porn and this girl looked like that and that guy looked like this and I don't look like that, so I'm not normal. I'm like, you're normal. That's very normal, right?

Gosh, we have the same job. We really do. I mean, I'm seriously telling everyone it's okay. Like you're normal, you're okay. And not to have the shame and to talk about it, but you're really, you got hands-on, you are changing people's lives. Dr. Maria Lulaco, I'm so thrilled to have this conversation with you today. I have to ask you now the 5 quickie questions we ask all of our guests. So they're just quickie. You can just, you don't have to think about it. See, the first thing that comes to your head, what's your biggest turn-on?

Oh, thoughtfulness.

Biggest turn-off?

Ignorance.

What makes good sex?

Communication.

Something you tell your younger self about sex and relationships.

Let go of the shame.

What's the number one thing you wish everyone knew about sex?

It should be fun. It should be weird. You should just enjoy it, and it doesn't look one way. Make sex whatever you want.

Love it. Thank you so much for being here. Please tell us how people can find you.

You can find me on several mediums. So on Twitter, um, my handle is MarieYolocoMD. I also have an Instagram page where I share little tidbits about information about a certain topic every couple weeks because I'm also still a surgeon.

You're awesome.

And so just again, I just— my biggest thing is educating patients and educating people that they should not be tolerating no care, and they should also know that they are normal in the absence of like actual pathology. And then I also host a podcast called Battle Cry that it's a storytelling podcast focusing on Black, Indigenous, Latinx, and then otherwise othered or underrepresented minorities in STEM where they just get to tell their stories and get to tell how they got into their respective fields and really just give back their voices that kind of have always been stolen by these institutions that we work in. So it's just dope people Talking about dope things and it's fantastic.

I love it. Everybody has to check out, uh, Dr. Maria Yuloko. The work you're doing is incredible and a podcast on the side. I don't know how you're doing it all, but that's amazing. Thank you so much for being here. I appreciate you so much.

Thank you so much for this opportunity. I will thank you again for, again, destigmatizing sex and just, you know, in a way that is so inclusive and so shame-free. Because that is how people are getting their information. And sorry, I'm gonna— just thank you. Like, it, it— you're changing lives and just making a topic that everyone does, you know, for the most part, unless you're not, but a lot of people do, which is fine. Yeah, exactly, exactly. And you're changing their lives too, and like letting them know that, oh, okay, I might be normal, or no, I shouldn't be taking that, and accepting that, and just sharing information. And that is that changes lives. It really does.

Thank you. Thank you. You're so kind. Oh, we're in the same business. We're all want the same thing.

Yes, exactly.

All right. After the break, I'm going to get into your email questions, so don't go away. All right. Let's get into your questions. If you want to ask me a question, you have a few options. You can call my brand new hotline, 559- Talk Sex, or 559-825-5739. You can leave me your questions there or just message me, sexwithemily.com/askemily. Always include your name, your gender identity, location, age, and how you listen to the show. All right, this is from Lisa, 28, in Seattle. Hello, Dr. Emily. This April, I ended a 4.5-year-long serious relationship. I'm a very affectionate person and lover and very much a giver. During the past relationship, I was really neglected emotionally and actually from everything, like not receiving compliments to never receiving oral. It even got to the point where I gave him oral for the fleeting moments afterwards where he was affectionate, because that was the only time I ever received affection unless he was intoxicated. Leaving the relationship and moving out was really difficult, but I immediately felt my mental health improve, and for the first time in years, I felt truly happy. I recently started seeing someone new, an incredible man I had a strong friendship with. And we've had a really intimate, fulfilling connection the past few weeks. He's compassionate. He compliments me, encourages me, and works hard to satisfy me sexually. I have a good feeling about us. However, I know it's probably a smart idea to be single for a while, but this new romance came outta nowhere and I don't wanna miss the opportunity just because people might think it's too soon. My fear is that there's an underlying emotional damage caused from my last relationship and that I'm scared somehow it might be affecting me in a way I'm unaware of. I feel happier, but I know the breakup is really recent and issues might surface down the road. What's a healthy way to try and heal from a damaging relationship while also navigating a new one? Thanks so much. Okay, Lisa, I really like this question, Lisa, because you sound really thoughtful and you've thought a lot about your mental health and you got out of an unhealthy relationship. It's a really hard thing to do. And so I understand your trepidation about getting right into a relationship. But here's the thing, you get to decide when it's right for you. So I wouldn't so much worry about what other people think, but what I would do is I would definitely get into therapy right now because 4 and a half years in abusive relationship, it's really easy for you to, for all of us to kind of go towards something that feels great and try to kind of repress all the stuff that happened. But much like somebody who went through, had abuse as a child, things don't go away over time. We think it does. We think time's gonna pass, but it's not. The best time to work on relationship issues is when we're in a relationship with someone. So I recommend that you go into therapy and you start to work on this stuff because I'm sure a lot's gonna come out about the last relationship and perhaps reasons why you were in the relationship. And it probably stems from a lot of things that maybe you haven't unpacked yet. The good part about being in a new relationship is you get to practice new behaviors. You get to practice perhaps expressing your needs more. And letting this new partner know how things make you feel and the lessons that you've learned from your past relationship. And I'm sure things will come up when you're working with your therapist that might still be issues. Remember, you're in the honeymoon phase. The first 3 weeks of a new relationship is always amazing, right? It's always a good time. I mean, listen, if you're dating someone for 3 weeks right now and it's not incredible, then you should just get out. So I think that you are on the right track here. Date someone while also doing your own work, because then you get to practice. Now, while you know, it's good to take time in between relationships, I always think that's a good idea. If you found someone you like, keep working on yourself. So that's the best advice I can give you. And be honest, I wish I took some of this advice when I was in my 20s. I kept going from relationship to relationship, and I kind of knew that I should probably stop dating and take some time to work on myself. And each relationship felt so good. I kept swinging from one to the next, and I don't feel that I ever did the real work around relationships and then brought it into the current relationship. Like I never worked on the past relationship and brought it to the current relationship, but I can tell you now that I've learned so much. Once I learned about my own behavior patterns in relationships, then I was able to not repeat my mistakes from the past and also enter each new relationship in a much healthier place. I think it's really great that you are so self-aware and let me know how it goes, Lisa. All right. This is from Heather 25. My boyfriend watches porn, which I'm fine with, but when I was on his computer, I opened the screen and there were very specific types of porn that he watches that makes me question his attraction to me. He's been searching for Indian girl porn, Asian porn, Black girl porn. I'm white and he always tells me how sexy I am and how beautiful I am. I'm generally very confident. But this is sort of messing up my mind. Do you know what that means when he's looking at porn that's opposite of what I am? All right, Heather, very relatable to many of our listeners, including myself. Some of you might have heard this story before, but I was in the very same boat as Heather at 25, where my boyfriend was watching porn and the women looked nothing like me. They were blonde, they were tall, and I felt so violated, like he was cheating on me or he didn't want me. And so, and Heather, just so you know, I get emails like this all the time. But what I didn't understand then, and what I'm going to tell you, is that part of being a sexually healthy person is having healthy, rich fantasy life. And so just because we look at something in porn doesn't mean that he wants to be with someone different than you. It just means, like a lot of us, we want variety, novelty, something a little bit different. And so, Heather, if things are going well in every other area of your relationship right now, I wouldn't worry about this, but if he's given you pause, reason to think that maybe he's someone that you can't trust, or he's a little disingenuous, or he says one thing and means another, well, then I would, you know, have some talks with him if there's trust issues. But if there's really nothing, what I recommend for you, Heather, and I wish I had this advice at the time, was I wish that I started watching porn at 25. I wish that I said, well, you know what, I love that my boyfriend's getting off and watching porn and releasing stress, and that I started to develop my own fantasies. And if you've been looking for porn that turns you on, I recommend Bellesa. It's my new obsession because Bellesa is ethical porn, which doesn't really sound sexy— ethical porn— but it's porn that has all genders in mind. You're seeing real body types, you're seeing sex that might be a little bit more appealing to vulva owners than just penis owners. You know, remember, a lot of this porn that we see is made by men for men. You can just go to bellesa.com. That's B-E-L-L-E-S-A. And I don't know, I just think it's— a lot of us in the office have been watching their porn too, because I feel like it's, it's kind of what's been missing from a lot of porn. So anyway, I think you'll like it. We also, if you want to get their paid porn, which is awesome, I think that ethical porn, you know, I think that really good porn, it's okay to pay for it. And they've— that's bplus.co/sexwithemily. Heather, another thing is like, I, I also realized when I was going through this, and for a lot of people, I was so concerned about what my boyfriend was into that I wasn't taking my own sexuality in my own hands. So if you're not into porn yourself, just masturbate, figure out what feels good to you, what turns you on. And I think once we get busy with our own sexual desires and fantasies and masturbation life, that we are less concerned about what our partner's doing and more engaged in building a rich fantasy life ourselves. Thank you, Heather, for your question. This is from Taylor. Hey, Dr. Emily, I'm a huge fan of yours. And I've been listening for a few months now, ever since my sister told me about your podcast. I actually just listened to the episode with John Weiland, Best of Hot or Deeper Sex. And I'm so glad because masculine and feminine bedroom roles is a topic that's been on my mind lately. Unlike most women, I don't particularly enjoy being this submissive in the bedroom. And upon discussing this with other women, I swear I'm the the only one that feels this way. I'm more drawn to being in a dominant role when it comes to sex, and I'm not sure if it's a personality type thing, a limiting belief system, or what. I'd consider myself a soft-spoken and introverted individual, so it's interesting to me that I prefer the opposite when it comes to sex. After talking to my girlfriends who are mostly extroverted, very strong personality types, I learned that they're the opposite in the bedroom. When a man tries to playfully pull my hair or spank me during sex, I hate it, and I'm honestly offended at times that there isn't more space women to assume masculine roles. Sometimes dominance feels like disrespect to me. So I guess my question is, why do I feel this way and how do I address it with partners? I'm so looking forward to your feedback. All right, Taylor, thank you for this question. I love this because it is true that many women, probably the majority, would like to be in a more submissive role for many, many reasons. A lot of times it's because we are absolved of any responsibility for the sex. If we grew up somewhere where we were shamed for being sexual or being aggressive or asking for sex when we feel dominated. We sort of can have a sense of like, I'm not in charge here, but this person's just taking over. We don't have to lead. We don't have to initiate. And yes, if you have a really strong personality, sometimes in your day-to-day life, yeah, you just wanna be submissive in the bedroom. And the same thing goes for men. Again, not everything is absolute, but if a man's very strong CEO in the boardroom, sometimes those men wanna be dominated in the bedroom. So I swear to you, Taylor, you will find these men out there. You just don't hear about 'em as much cuz there's a lot of men who aren't as open about it. They're more shameful about it, or they feel like they can't find a woman to match it. And if you've been listening to the show, as you have, you know that the majority of people are not even having conversations about sex. So I recommend when you start dating someone, or if you already are, to start talking about what they're into and what turns them on sexually. And you can say, are you ever into being dominated? I think it would be really hot to dominate you. And let me just tell you a side note here about today's episode. I'm giving you all my personal experiences. But what I can tell you, Taylor, is that when I've had these conversations with men I've dated, when we've sort of switched and played roles, I'd say that many of them are down to being submissive. Because lots of men, if you think about the traditional roles, they're told to dominate, they have to initiate sex, they have to lead, they have to be in charge. And I think there's many men who like the experience of a woman taking charge. So how I recommend you do it is Again, when you're out with somebody, dating somebody, and you start to talk about sex, ask them what they're into. Tell them you think it'd be really hot to dominate. You could do the yes, no, maybe list, because the yes, no, maybe list is awesome because you could each download the list and figure out what you're both into. And the interesting thing, it does have on there like choking and dominating and dirty talk and has like 80 sex acts. But if you do the yes, no, maybe, you could say to them, well, you said yes here about domination. Have you ever thought about being dominated? There's a lot of playful ways to bring things up. You don't have to go out and say, I need to be with someone where you'll let me dominate you. But it is great to have these conversations sooner than later. And I'm also telling you that many men is probably going to be very thrilled to try something new and to not be in charge and to be dominated. So thanks for your question, Taylor. I know that's going to help a lot of people and hopefully you as well. All right, this is from Dan. Dear Dr. Emily, my wife and I have better and better sex every time we do it. I asked her if I could get a toy and she says yes. She loves it when I go down on her, and I was thinking of something to insert and pleasure her G-spot while I was sucking on her clit. Do you have any suggestions for toys or dildos? Yes, I do. I recommend the Je Joue, J-E-J-O-U-E. I just love their deep rumbly sensations. They're made really well. They feel great to the touch. And so there's two I'm going to recommend. There's the Uma G-Spot vibrator, U-M-A, and Uma is a great targeted toy that's really great for G-spot stimulation. What I love about the Uma is that it's contoured for precision stimulation of a lot of different pleasure points. So, I think you really like this one, and they also make this one that I can't believe there aren't more of these. They have a G-spot bullet vibrator, meaning it's a little bit smaller than something like the Uma, but it still reaches the G-spot, and you can use it in all different parts of the body. So that's what I recommend for G-spot. If you want a dildo, which means, just so you all know, a dildo is a toy that doesn't vibrate. There are some great ones on our site. If you go to the shop page and you go to the Good Vibrations store, there's some great glass ones in there too that are great. Glass dildos are really fun to play with. So I would check out one of those, and you sound like a really loving husband, and I just love that the sex gets better every time you have sex. So have fun and thanks for your question. That's it for today's episode. Thanks for listening to Sex with Emily. Be sure to like, subscribe, and give us a review wherever you listen to podcasts and share this with a friend or a partner. Believe me, if you got something out of this episode, they will too. We release 2 to 3 episodes a week. Find me on Instagram, YouTube, Facebook, and Twitter. Instagram, Twitter, it's all @sexwithemily. If you'd like to ask me a question about sex or dating relationships, email me feedback@sexwithemily.com or sexwithemily.com/askemily. And check out my website. We have so many great articles diving deep into topics like how do I have multiple orgasms, how do I last longer in bed, how do I stop thinking about my ex, what sex toys should I try, and so much more. Sign up for weekly emails. I've been told I give really good emails. I do. Was it good for you? Email me feedback@sexwithemily.com.