Episode 76: What the Kinsey Report Left Out

Hi, I'm Suzanne Noble, and I'm Zoe Noble, and you are listening to Sex Advice for Seniors. And we're very, very excited today to talk about the Kinsey Report and the over 60s that came out quite recently with someone who was directly involved in the research on it. So it's a really humongous pleasure to meet you, Lauren Stryker, and to hear all about what went into that research and what didn't get published in Cosmopolitan, who were, I guess, the major publication for the release of that research to the general public. So, yeah, welcome. And tell us, tell us a little bit about your background.

I'm so glad to be here talking with both of you. So as you mentioned, I am a gynecologist. I am a professor of Obstetrics and Gynecology at Northwestern University, part of the Feinberg School of Medicine. And I really wear two hats. One hat is a very academic hat. I do research, and my particular area of research is in menopause and in sexual medicine, meaning the hormonal, physical, and medical aspects of human sexual response. The other hat I wear is in getting out there and talking to women and educating them and letting them know what the challenges are and Even more important, the solutions. So to that end, I have a podcast called Dr. Stryker's Inside Information. I write a number of books, and my latest series of books is called Dr. Stryker's Inside Information and is specifically about postmenopause orgasm. It's called Quit the O in Mojo, because while you certainly hear about people talking about older women and men having sex and issues with libido, it is very, very rare that someone addresses the fact that 50% of women have difficulty having an orgasm, even if they had no trouble when they were younger. So that's what I'm doing in a nutshell.

Welcome to the very small group of people in the universe who are talking about this topic. Probably what, like maybe 10 of us on the planet that I'm aware of that are actually—

We're talking up for 100, so we'll wake up for it, right?

Honestly, gosh, seriously. Anyway, the Cosmo report came out a few months ago. I read the whole thing about what the report about Kinsey and the over 60s said. And what struck me was what they didn't say. It all seemed to me, for those who have read it, quite predictable, which was for me in a nutshell, there's a bunch of people who still don't have sex over 60. Who are women and maybe don't desire it anymore. And then there's a bunch of people who still do. And a lot of people say they do it a lot more than I suspect they may really do it. And I suspect some of those people are men because the stats don't really add up very well. When you look at the number of women that say that they're having it all the time and the number of men that say they're having it all the time, where are those men getting it from? I didn't— it wasn't clear to me that. But yeah, you said that you would release information to us about what they didn't say.

So absolutely, what you just said is, is this notion that there were no surprises. Well, there are no surprises for you, Suzanne Noble, and you, Zoe, because you are not representative of the majority of women out there who really don't appreciate the fact that it is healthy and normal and quite possible to have pleasurable sexual experiences. So while we're looking at this and saying, okay, tell me something I didn't know. For a lot of women out there, this was not only something they didn't know, but was very validating for what they're experiencing. So I think there was real value in that. To your point about what wasn't included, now keep in mind that the Kinsey research was very, very comprehensive, very expansive. I mean, this was a very long questionnaire that was put together by experts such as myself at the Kinsey Institute. And COSMO just took a little snapshot of that. Sure. And certainly there's a lot more data if they if they had included it all, it would've been a 50-page article. So the data will be published, but it will be published in a scientific journal, probably multiple articles. So the Kinsey team is now currently writing it up in a scientific way, not the Cosmo way, and we will be submitting it. So, so stay tuned on this. You certainly will get a lot more information. But one of the things that I really liked about the approach that was taken is the fact that if you look at older studies, and we can talk about what these studies show. But when you look at older studies about sexuality in women over 60, they are generally exclusively defining sex as penile-vaginal intercourse. And that's not sex. You know, sex is all manner of things that very often has nothing to do with penetration. So when we put these questions together, we were very much aware of that. And we very much were steering these questions towards non penetrative aspects to human sexuality. And that was really important because when people read statistics about sexuality and thinking, okay, well, that doesn't really sound like me. I feel like we have a very nice sex life. We're just not having intercourse. And this article very much addressed the fact that not only are women not having intercourse, but the ones who aren't are having just as good sex, if not better.

Yeah, there, I feel a little bit, while maybe there weren't a lot of surprising details and data in the Cosmo article, the Cosmo version of the Kinsey research, there were many things in that article that I felt were really encouraging and very validating in terms of what I'm doing in the trenches with my clients, many of whom are over 60. And I think that one of the things that is, you know, and I work with people also that are much younger in getting them to redefine their idea of what sex is. And so part of my, part of what I sort of see as this sort of sex ed, you know, pornography as the de facto sex education, is that it portrays sex as one particular way. And what this article really, I've, I kind of took to heart. I found it really heartwarming that older women are reporting that they are asking for what they want, that sex has slowed down. There's much more eye contact. Some of them, I love to hear that some of them, maybe even if orgasm is harder to reach, that the orga— quality of the orgasms are, uh, are great. There are a lot of—

in some cases, in some cases.

Yeah.

And we can— and I do want to talk about that because that's a particular area of interest for me. But I also want to comment, the thing about this article also was it wasn't all about partnered sex. And we were very careful to include questions that validated and helped us learn more about one, or what women are doing to be self-sexual. And When we think about this, as you well know, at least 50% of women over the age of 60 are either unpartnered, or they have a partner with non-cooperative penis, so that they are really left to their own devices, if you will. And this, and this article, and this study really validated that. And that was important because prior studies have not.

Yeah, definitely. And I think that for our age group, we didn't grow up to believe that masturbation was something acceptable. So for people to talk about solo pleasure at our age, it is in itself quite significant because most women especially don't acknowledge— you know, many women, I can't say most, but many women don't acknowledge that they do masturbate because of the shame associated with it.

So to acknowledge that there are people out there including myself, that are very happy doing that, then it's, you know, but you know, Suzanne Noble, it even goes past that because you are absolutely correct that there are women who don't masturbate and have never masturbated because of cultural norms and the shame attached to it. But beyond that, beyond that, there are women who don't know how to masturbate. You know, certainly men have always had the obvious advantage that it really takes no skill on their part to figure out what to do because it's just there. Women very often don't know where where their clitoris is. They do not know that clitoral stimulation is almost always required in order to have an orgasm. They think that they're supposed to have an orgasm with penetrative sex. So it's really twofold. It's giving someone permission to say, no, this is normal and this is okay. And second, to facilitate women's awareness of how to make it happen, including why it's important for older women to use a vibrator.

And what are the other things that you— that again, you discovered in the research? There were men involved in this research as well.

The men were peripherally involved, and actually the parts that I was very much involved in was the section on orgasm, because that's an area of expertise. I submitted all of the questions on orgasm, and the question that I was very curious about was, first of all, quality of orgasm. And then the second is the role of using vibration. And the reason why— let me back up a little bit. So to talk about what I was surprised and what I wasn't surprised. In the Kinsey report, as you mentioned, women said that they still had orgasms and the quality was pretty good. However, that was only 50%.

Yeah.

The data was 53% said that they were still having orgasms and they were about the same or maybe better. But then there were the people that said it was worse or not particularly good. So you have to say, okay, well, why is that? Well, we know with aging, it's harder to have an orgasm because what does an orgasm depend on? Not estrogen. Interestingly, you do not need estrogen to have an orgasm. It helps because it increases blood flow, but it's not required. What you need is good, healthy genital and specifically vaginal and clitoral blood flow. And you need nerve endings that are going to respond, that are going to wake up when they're stimulated. And as a consequence of the normal changes that occur with aging and then medical conditions like diabetes and cardiovascular disease, and then we look at things like chemotherapy, and then you add into the mix a lot of drugs that people are taking, including antidepressants, which are taken by more than 50% of this population. It's a wonder that any clitoris wakes up and says hello, because these are all things that sabotage the ability of the clitoris to respond. So, yeah, it's, you know, and the data shows that about 50% of women over the age of 50 are not able to have an orgasm, even if they were before. And that it continues to get worse until the early 60s, and then it kind of levels out. So with the Kinsey data, it was actually better than that. That was actually one of the things that surprised me. I expected the orgasm data to be worse. But this is where it gets interesting. We know that women who can have an orgasm after the age of 60, in many cases, can only have an orgasm if they use a vibrator. Why? Because there's different kinds of nerve endings in the clitoris. There's the teeny, teeny, tiny little nerves that respond to soft touch and stroking, licking. And then there's the bigger nerves that respond to vibration. And you know where I'm going here. When you look at the consequences of aging, medication, and medical problems, it's the little nerves that suffer. It's the little nerves, particularly in diabetes, that are just no longer functional. So it may be that the woman who before did just fine with licking and stroking is now not going to have an orgasm unless she uses vibration. So when we look at the Kinsey data, was the data better as far as the ability to have an orgasm and the quality orgasm? Because these women knew enough to use a vibrator. And yes, we know from the data that, you know, they were using vibrators. So it's, it's a little tricky just to look at the numbers itself, you kind of have to do the deeper dive into what are the other variables that are impacting on these results? And we don't know things like how healthy was this population? You know, was this a diabetic population? Did they have cardiovascular disease? How many of these women were taking antidepressants? So again, lots of variables, but still the data was for the most part validating what I've certainly seen in my clinical practice.

Yeah, that's interesting because of course we know from so many people that we've spoken to that as we age, obviously many people have health issues, right? Whether it's mobility issues, whether it's diabetes, cardiovascular disease, MS, whatever it happens to be, right? And as a result of that, they're on various medication. And frankly, it seems to me that if you don't have that information supported by the information that they're giving you around the quality of their orgasm, whether they're able to have one or not, then there's certain very big pieces of the puzzle that have been removed. Because then, you know, if somebody says that they're not able to have an orgasm and you don't know that they're on antidepressants, for instance— and I, I've been with men that are on antidepressants, just aren't able to come as well. So it's not— this is not exclusively a gender-related issue. This is something that happens to men and women.

And it is very complicated. And when I started to write my book, Put the OB-GYN Mojo, about postmenopause orgasm, and I thought this was going to be a relatively quick book to write, I now have 30 chapters, including— I just finished writing the chapter on physical challenges. Because if you can't hold a vibrator because of bad arthritis, and if you can't get into the right position, that's going to be a problem. So I'm going to tell you a term, maybe you'll surprise me and you have heard of it, but maybe, maybe not. Have you heard about Sexual ergonomics, ergo erotics. And basically, you know what ergonomics is, of course, it's, it's manipulating the external environment to facilitate your ability to do physical things. Well, you can also do that sexually. Sometimes it's with the right pillow, sometimes it's with a different position. But I actually just wrote an entire chapter on the ergonomics of sexual, um, sexuality, because this is no small feat for a population that's had hip replacements, knee knee replacements, back pain, arthritis. I don't have to tell you, the list is very long.

Yeah, yeah. Yeah, that's fascinating. The other piece of all of this, of course, that I'm curious if— I don't think it can be really addressed in the research. But what about attitudes towards sex? What about relational health? What about, you know, people who— I mean, I am supporting a lot of people in embracing a new paradigm, a new reality, and the new normal, as I say. This is a new normal, a new normal, a sexual self-esteem, you know, and not being stuck in the sort of mindset that this is just a pale comparison to what it used to be and there's something missing or broken. Right.

And also, just when we think in terms of sex, we are informed by the media. Young, beautiful, perfect bodies, perky breasts. And you start to think, okay, can I still be sexual with my cellulite and my breasts that are hitting my belt? So there's, there's that part of it too. And what you're talking about, of course, are the psychosocial aspects of human sexual response. And when I say that that's not what I do, it's because I'm not minimizing it at all, which is why I brought my daughter in, who's a PhD in clinical sexology, to write the chapters in my book to talk about all the psychosexual aspects, because they are every bit as important, if not more important. And particularly in— I don't want to say that in every age group, it's important, but, but certainly in older women, it takes on a whole different thing, particularly because they have a lifetime of having poor body image, of having certain feelings about what is sexy, what isn't sexy. So that's a huge part of it. I always tell people, you know, look, his eyesight isn't so great anyway, so don't worry about it. Light some candles and everyone will look nicer. And not to mention, he doesn't have a perfect body for people who are with men, you know, I mean, women who are in their 60s are generally having sex with men who are in the same age bracket. And it's not like they look like Adonis. So we have to get over that. And I don't— and again, I'm not going to oversimplify and just say, get over it. You know, there's work that needs to be done. But that's also when I talk about things like pharmaceutical agents to increase libido, etc. While those may give someone a little kickstart or a little testosterone, they get far more bang for their buck by meeting with a talented sex therapist. Even if you have a good relationship, that's where people kind of get confused and they don't— we don't need a sex therapist. We have a great relationship. Well, you might, but a sex therapist is going to help you connect sexually again, because too often it's just been on the back burner.

Been on the back burner, or we're taught to— like, we're taught all kinds of things to take care of our financial well-being and our dental health and to have spa days, but no one is really talking to us at a young age when we're starting out in our 20s about really investing in cultivating and working on our intimate relationships, you know, emotionally and physically.

But having said that, if you have a vagina that's like the Sahara Desert, it doesn't matter how good your relationship is, how much sex therapy you've had, how many dates you go on, and how much candlelight you have. You got to get your vagina to lubricate and have normal elasticity again, which is my job. Yes, my first book is called Slip Sliding Away: Turning Back the Clock on Your Vagina, and it sells very well.

Listen, it wasn't until a friend of mine who runs— who we've interviewed— who runs a sex shop and who sells lube and sex toys told me that vaginal estrogen had saved her life that I actually went. And because I, I had no, no idea about this, and, and things were starting to get a bit challenging down there in terms of pleasure. And, and I went to the doctor and asked, and he was like, sure. And he just, you know, I'm— I live in the UK, I've got free, you know, we got everything.

I know, I love it.

Well, for the, for the short term, we've still got free medical. So, you know, I got, I got some vaginal estrogen, and honestly, I, I just can't believe how different my sex life is now. I mean, it's like It's like night and day. It's just unbelievable.

Well, it restores, it restores normal lubrication, elasticity. And I need to ask you, because I've just heard a rumor, which I'm assuming is true, is that in the UK you can now get your local vaginal estrogen over the counter. You do not need a prescription.

Yeah.

And just yet another reason to move to the UK.

Suzanne Noble Noble.

Yeah, we're all—

all women should move to the UK for their vaginal estrogen.

Well, I'm trying to— no, but seriously, US should take note and follow that lead because virtually every single woman— I can't think of one woman who it's not safe for them to use a local vaginal estrogen, including women that have breast cancer that we know are perfectly fine. But there is still this idea out there that vaginal estrogen is poison and that something terrible is going to happen if you put a little dab of estrogen on your vulva or in your vagina. And that is certainly not the case.

No, and honestly, it's, it's, it is like a miracle drug. I am, I am, my friend who told me about it, it's like, I'm doing, I'm taking this stuff until the day I die.

And I'm like, you should. But you know, I mentioned earlier that you don't need estrogen to have an orgasm. And while it is not required, it certainly helps because you need to be aroused in order to have an orgasm. You're not going to be aroused if there is pain. You are not going to be aroused if things are dry. And estrogen is a vasodilator and will increase blood flow to the clitoris. So that is certainly one of the first steps in a woman who's having difficulty having an orgasm, is to make sure that she has adequate genital estrogen on board.

So we talked about the, the orgasm sort of challenges, I should say. And I do think that it's, it's really reassuring when women read a report which tells them that they're not the only one that, you know, needs a partner that's patient, as I always say, if you want to have one of those, which isn't always essential, but every once in a while I quite like one. And I just tell them, you know, it'll happen, but it might take a while. So, you know, but it's good to know that we're not alone, right? When we read about stuff like that, to know that that's, that's okay. And, and also that certain aspects of our physical, you know, what's going on inside of us is going to change, and therefore there's something out there that can help. I think for me that's always been absent in a lot of, of understanding of our sex lives as we got older, is that we were told to just accept things because we were older, whereas, you know, men got Viagra and they seemed, they seemed quite happy with that one.

Well, and the reason why women are told that more often than not, if they go to see their healthcare clinician or physician and they're told this is just a normal part of aging, it's very clear the reason that they're told that is because their healthcare clinician has no clue how to help them. It's not that there aren't solutions, but they just don't know. So they just say this is a normal part of aging. And that's really the story behind Viagra. It's not so much that it was more important for the guys, it's that doctors suddenly had a solution. And there are no FDA-approved products to help women specifically with orgasm. Certainly there are to help with, with painful sex. And, but having said that, a lot of doctors don't know about it. The other thing also that's very important is that with older women, whenever they have painful sex, if they go to see someone, more often than not, they are told that this is because of vaginal dryness and they're given a prescription for maybe local vaginal estrogen, along with lubricants and moisturizers. But there are many other reasons that women have painful sex. And in fact, I just published a very, very comprehensive article on all of the causes for painful sex in the over-50 crowd, other than dryness. And you're probably familiar with the journal Menopause, which is the journal of the North American— the Journal of the American Menopause Society. And, and a lot of times women are not examined. They go to see a doctor, they say it's painful. They're given a prescription for estrogen. It doesn't help. And they think it's hopeless. It didn't work for me. When it's not that the estrogen didn't work, it's that that wasn't the problem. So I think the other thing that I want women to, to hear loud and clear is that if you are having pain with sex, it is likely to be dryness from lack of estrogen because that is the most likely culprit. But having said that, there are many other things that are treatable, that there are solutions. And if your own clinician, if your own doctor has not been helpful, it doesn't mean there aren't solutions. It just means you need to see someone who has more expertise.

Yeah.

But that's why I'm writing my books. I mean, honestly, that's why I started my podcast. That's why I'm writing my books, because women do not have access to information. And one of the things that's interesting is, is the whole thing about telehealth, because since COVID of course, so many women are turning to telehealth. And I used to be completely against it. I thought, you know, I'm a traditional doctor. I want you to take your pants off. I want to see what's going on. I want to do the whole exam. And I really changed my tune on that because what I have learned over the years of doing this and talking to women and getting out there is, yeah, in a perfect world, that would be lovely. But the majority of people in this country do not have access to a physician who knows how to do an appropriate exam, who knows how to counsel them, who knows how to tell them what to do. And with all things menopause, not just sexual. So telehealth can fill that gap. I think, you know, that I'm working with a company called MEDI, M-I-D-I. And the reason that I'm working with them specifically is that they're not an online pharmacy. They're giving menopause care. They talk to women. They have all the solutions. Yes, if someone is having painful sex to the point that we're talking about, they will prescribe a local vaginal estrogen with the caveat that if it's not working, we partner and collaborate with medical centers and other doctors so that we can get you in the hands of someone that we trust who can actually do an exam. So it's frustrating for women, but know that there are solutions out there.

So we, you know, what, what I see, I'm 62, Zoe's coming up 60— and she's not there yet— is that we've got a lot of focus at the moment on menopause because menopause has its moment. And there's a lot of workplace discussion around menopause. There's a lot of what can we do to support these women in the menopause? And then once we get past the menopause like me—

Wait, wait, stop right there, Suzanne! You are not past menopause. You are in menopause until you die. Are your ovaries making estrogen right now? No, they are not. So menopause is defined as that your ovaries are no longer producing estrogen. So you may not have specific symptoms like hot flashes or sleep issues anymore, but the impact of lack of estrogen on your brain, your bone, your bladder, your vagina, your vulva, that has not gone away. So I am correcting you. You are still in menopause and will be for we hope another 50 years.

Fine. But specifically, I'm talking about the age of 50 to 60, where most of the, you know, big changes in your body are taking place. Right. And there's a lot of attention placed on that. And a friend of mine who's in her 60s who runs a psychotherapy matching platform said to me, she said, is is, have you noticed that when we turn 60, it's like everybody just forgets about us? They, they love to talk about the '50s and '60s. They love to talk about all the stuff they can do to help these women who are experiencing all these symptoms. But once we become, you know, on the other side of that, maybe we're not so symptomatic in that way, then there's nothing there. We are literally in the wilderness. We are— we are ignored. We are ignored by everyone. And frankly, I think they just want to neuter us at that point and just tell us to just go and sit somewhere and take up knitting and making soup.

Well, because traditionally that's what used to happen. What we are looking at now is we have a life expectancy that's well into the 80s and 90s for most women. Given the average age of menopause is 51, many women are significantly younger. There are women who are living over half their lives post-menopause. So, but to your point, when I was doing this big article, this research article that I published in Menopause about causes of pain with intercourse, I had a hell of a time pulling scientific articles because virtually every article I pulled only went up to 50, 55, at best 60. There was almost nothing over that. Nothing. And, and that's why I'm And again, the Kinsey data is really so useful because it does, it does go older. But then also to your point, when you talk about this menopause having a moment, I mean, I keep saying menopause has had a moment for me for the last 30 years because that's how long I've been working in this space. And while it's nice that it's out there, it's also really dangerous because what we have are quote influencers, which is not a real job, who are out there promoting things that don't work and that are sometimes even going to cause trouble. But yet we have a lot of people who are putting themselves out there as experts and taking advantage of the fact that menopause is having a moment because let's face it, there's a lot of money to be made. This is a huge portion of the population. And this happens to be the people that have money. The 20-year-olds generally don't have money. Yeah. But if someone's going to have money, likely they're going to be over 50. So that really again puts the responsibility on women to figure out what's real and what's not. And it's difficult because there is so much junk out there. And I mean junk. I usually use the word goop. There's so much goop out there that they don't know what works and what doesn't work. And I look at that as my job, you know, I mean, that's what I do. It's like I have two criteria when I recommend something. Is it safe? And is it effective? And then there's the third group, which is the biggest group that says we have no clue. It's never been studied. People's anecdotal information and testimonials are not science. It means nothing. And that's why people like you and me have to get out there and continue to spread the word that no, if you, you know, eat broccoli, it is not going to quote balance your hormones. But that's what you'll learn on TikTok.

Thank you so much for saying so, Dr. Streicher. It's really— it's, it's, it's an interesting time to be alive, and it's certainly an interesting time to be a woman, and it's an interesting time to be a menopausal woman trying to have sex and take care of her body. I'm, I'm curious if you could sum up for, for women men who, who have sex with women. For a woman in her 60s, 70s, late 50s, who is dealing with menopause and trying to maintain a healthy relationship with sex, with her partner, with her body. What are, what are like, you know, and, and there's, feels overwhelmed by what's happening internally. And also sort of externally in, in terms of information, what are like just 2 or 3 things that you would want women to know about this time in their lives?

Yeah, well, the number one thing, of course, is that there are solutions to these obstacles. And if you don't have the solution, it doesn't mean that it's not there. It just— you need to do a little extra work to get there. But there are a couple of very specific things. One thing that is hugely important in this time of life is sleep. I cannot emphasize that enough. People are not sleeping. If you don't sleep, when you see the pillow, you're not thinking of sex. You're thinking maybe tonight's going to be the night that I'm going to get some sleep. And so when women would come to see me in my sexual medicine clinic, I ran a sexual medicine clinic at Northwestern for the last 7 years. And when they would say, I have no libido, I'm I'm just not happy. I'm— have mood swings. I have this, I have that. And the first thing we say is, are you sleeping? And they say, no, I'm not. Well, we gotta fix that first. And when you look at why midlife women aren't sleeping, yes, hot flashes is a big part of it, but it's not the end of the story. We have restless leg syndrome. We have sleep apnea. We have arthritic aches and pains. We have sometimes the snorer in the bed next to you. So you need to address sleep. That's number one. The second thing I would tell women is don't be afraid of estrogen. We are still busting the myth that estrogen causes cancer. Estrogen decreases, decreases breast cancer by 22%. This is not my opinion. This is fact based on good data that if you start estrogen within 10 years of the menopause transition or between ages 50 and 60, you will have a 22% decrease in breast cancer. The small increase in breast cancer that was seen in the Women's Health Initiative years ago was only only in the group that was taking a synthetic progesterone. That has not been shown in women who are taking a micronized progesterone. So that's the second thing, because if you take estrogen, not only will you sleep and you'll get rid of your hot flashes and you will keep your weight in a healthy way, but you will also be helping your genital tissues, including your vagina, your vulva, and your clitoris, in terms of being able to be aroused and having a good blood supply. So I think those are really the, the, the top of the list pointers. But the other thing also is to educate yourself. We've already established that chances are that your doctor or other healthcare clinician is not going to be an expert. And so you really do need to do your own homework and to learn about what your options are, what you can do. And then sometimes that means going to your own doctor to say, listen, I heard this podcast, I read this book, and I would like a prescription for local vaginal estrogen. He or she will write that prescription. I can guarantee you. They might not bring it up. They might not offer it. But if you do, and the onus shouldn't be on us to do that, but it is.

Yeah.

You, you will get it. You will get it.

Yeah. Yeah. All really good points. And you know, it's a real shame that the medical profession is not so well educated around female sexual health. Because we know that for a lot of people it is very difficult for them to talk about this just generally, not only with their partner, but with a medical professional. So, you know, you need a certain degree of confidence to not only, you know, not only accept that you— that this might be the solution, but also to ask for it.

You have to ask for it. And then you have to find someone. My podcast episode and in my book, I have a chapter called How to Find a Clinician That Will Listen, because chances are they're not going to bring it up, but you do have to have someone who will listen to your concerns. And then if not offer solutions, refer you to somebody who will. It's so interesting to me that if you go to see a gynecologist and you're not able to get pregnant as a young woman, they will send you to a fertility specialist.

Yeah.

But if you go to a gynecologist and you're 60 and you say, sex hurts and I can't have an orgasm and my libido is gone, they say, this is just a normal part of aging. Instead of having someone in their back pocket to refer you to. And it's interesting because when I started the sexual medicine clinic and the menopause clinic, and of course we would ask every woman, how did you get here? How did you find your way here? And consistently, 90% of the women that showed up in our clinic were self-referred. They were not sent by their doctors. They were not sent by a nurse practitioner. They found their way on their own. Many of them had read my books or heard my podcast, but the point is, is there doctors were not referring them. And that's just the reality. And that's why, yeah, it's about finding an expert. It's about using telehealth that you can trust. And it's about educating yourself.

Taking ownership, right? Taking ownership of our bodies, of our vaginas, of our sexuality, of our wellbeing.

Yeah.

Which starts with reproductive rights, but that's another topic. And I try not to get too political too often.

Well, you know what they say, as the cliché says, if we don't do it, nobody else will. Well, so there you go. That's right. Anyway, it's been so lovely to speak to you. I could speak to you for another 2 hours.

We'll just have to do this again, right?

We will.

So many topics.

Please.

Listen, this is like episode 76 or something. And people just say, I can't believe that you still have stuff to talk about. It's like, look, there is no shortage of stuff to talk about.

No end. No end. I have a list. I mean, I'm on my podcast, I think is about episode 150 or 160. And oh my God, I have a long list of people I want to talk to, including you guys and topics. But what I'm also finding, and as you have more episodes, you will find the same, is that people don't go back and look at the early episodes. And I assume that they are. So my early episodes about local vaginal estrogen and DHEA and testosterone and all of that, I don't circle back to it because I think, well, I've already done that. But I think sometimes it's also good to keep hammering at home. You know, we can't say often enough that local vaginal estrogen is life-changing and is safe. Yeah.

No, can we also just—

And will keep your bladder in control.

Yeah.

Yeah.

I just, yeah, we just, I just want a sponsorship deal from them and then I'll just, I'll keep saying it forever. Yeah.

You know, I don't actually take sponsorship. I make no money from my podcast. I lose money on my podcast.

Oh, we don't. Well, we don't either.

It's because of people think, and it's not true. If I had sponsorship, I would only take sponsorship from trusted pharmaceutical certain protocols, you know, that I— but people don't think that. They think that if someone is providing funds to underwrite information, that they are influencing the information. And in some cases, that's true. In that case, case for me, I'm sure it wouldn't be the case for you, but I've decided to keep it clean just so people don't think that.

Well, I mean, I think there's another discussion about that. Personally, I think that there's a lot of bad stuff out there, and if you are promoting things that you believe in and that, you know, contribute in a positive way to female sexual health, I don't I don't personally have a problem with it because—

Oh, I agree.

All of this, you know, that's my thing. I mean—

No, no, I totally agree. I'm just saying the perception and then we have to turn that perception around.

Yeah, absolutely. Absolutely. Anyway, it's been lovely to talk to you and we're going to have to get you back on because you're so fabulous. Thank you so much. And we'll be posting all the links to you and your books and all the resources that you would like to share with us would be great. And of course, for those of you who haven't read the Kinsey Report, it is the, the Cosmo version is online and people can read that. And thank you.

Thank you. My pleasure.

Thank you so much, Dr. Straker.