Amanda: Okay, guys. Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura
Kendra: and I'm Kendra.
Amanda: And today I am freaking out fangirl-ling because we have a special guest, Kelly Casperson. I'm gonna read from the back of her number one, best selling Amazon book that just released yesterday, which was June 28th. She is a urologist wife, mom, sex educator, and top international podcaster, whose mission is empowering women to live their best lives. I do need to warn you that we are all doctors on this podcast, but we are not your doctor. And so this podcast is for educational purposes only. It is not to be used as medical advice.
Laura: And while we are normally rated E for everybody, if you are driving along with kids in the car, you might want to pre-screen this episode before letting other little humans hear it.
Amanda: The reason why is we're going to be talking about her new book, which is titled, “You Are Not Broken: Stop Shoulding All Over Your Sex Life.” And as physicians, we will be using the anatomically correct terms for genitalia.
Kendra: So what an exciting episode! Welcome Kelly! Thanks so much for taking time to be with us today on “The Drive Time Debrief.”
Kelly: Oh, thank you for having me. This is, this is totally a joy!
Kendra: We are very happy and we wanna get straight to it. So speaking of your new book, what was your number one inspiration for this book?
Kelly: The women, man, the women I see in clinic. So I'm a urologist, urologists do a decent amount of clinic. And it hit me one day when I was listening to this woman, talk about her asexual marriage. I was like the lightning struck and I'm like, do I have nothing but a box of Kleenex for her? Like, is that it? And the other question was like, hold on, who's taking care of the people who are sleeping with the people we are all giving Viagra too? Like who's taking care of the other half of that sexual relationship. And kind of that curiosity got me to deep dive. Like I was always told women were difficult and challenging and we're never gonna figure them out. This is what I was taught in urology. And I was also taught like, I should probably do a fellowship, so I don't need to deal with women. Which is like, now that I'm older and I'm wiser, and I can see that all I'm like, holy moly, look at the ingrained patriarchy and misogyny in kind of telling me what was expected. Right. And so I just dove deep and I'm like, actually people know a decent amount about female sexual function. It's just not permeating. It's not like getting out there. We've got like Hollywood and religion and our parents and the school system, that's giving us a sex education. It's mostly like a disease and pregnancy prevention plan, but like a truly adult education is totally lacking. So that's where the podcast came from. Two and a half years later, the book's now out and I'm just, I'm here to tell people that they're not broken. We just didn't get a good education.
Kendra: That's awesome. I do listen to your podcast and I listened to the most recent one where you took questions from your listeners. So, I love the part that you described how you actually are experts in the external female genitalia and OB/GYNs kind of have the internal organs and it was like a no-go zone. And even in residency, you didn't learn about it. So tell us a little bit about that revelation.
Kelly: Yeah. I mean, I had the biggest shock to me. I'm in a group of like sexual health people in my town. And one of the sex therapists brought in a model of the clitoris and she's like, “Here's the clitoris, I'll pass it around.” And like, I just remember, I'm like, Nope. U-huh. Nope. Like I would've been told. I would've seen this in medical school. Right. Like I would've seen this in a surgical residency where we put urethral slings right around where the clitoris is, but like, no. And here I am like challenging what the actual clitoris looks like, cuz we did not get an education. It blew my mind?
Kendra: Yeah. It's amazing how much we do learn a lot. But then when you get out into practice and see a few patients that struggle with these issues. You're like, oh, we didn't even touch this or we didn't even learn this. What inspired the title of your book?
Kelly: Oh, telling people over and over that they weren't broken. Because I mean, it’s like the podcast very naturally the title came because the more I started to learn. I'd see somebody, like a 43 year old and she's like, “I've never had an orgasm in my life.” And I'm like, “oh yeah, that's actually super common, about 10% of women haven't, you're not broken.” This is super common because we didn't get an education. And then another woman would come in and she's like, “I don't have any spontaneous desire for my husband and I want that, but we're in like marital counseling. I think we're gonna get a divorce.” I'm like, “oh yeah. well, you're not broken.” Of course you don't have spontaneous sexual desire for somebody you're like breaking up with. You know, like it was just like hearing the story and normalizing and normalizing. Like, “I don't actually like penis and vagina sex. I don't have an orgasm from that.” “Oh, well you're not broken, 70% of women don't.” You know, so it's just like part of the normalization of these people's experience. Because where are they supposed to go? Like you're trusting your sister or your girlfriend. The Internet's a quick sand steaming pile sometimes and doctors aren't helping either. You know, like we really, as much as we celebrate male pleasure in this country, look how we advertise like Playboy and Viagra. And like, we really say, “Hey, spontaneous desire in a man is a definition of masculinity.” We celebrate it so much for 49% of the population and the other 51% we completely ignore. I don't think we're 50/ 50. I think there are actually a little bit more women than men. I could be wrong.
Kendra: No, I would agree.
Kelly: This is not like a niche minority market, you know, it's like there's millions and millions of people who need help.
Kendra: I know. And when you throw out statistics like that, you think about how much less statistics of things we celebrate in this country these days and how it's 5% of the population, or 2%. But sure enough in the media, it seems like it's 98% of the population. And when you throw out a statistic, like there's 51% of women, it definitely gives you perspective for sure.
Kelly: Yeah, totally, totally. And I mean, the internet doesn't help. I understand. You know, Instagram and Facebook are gonna do, because there really is a dark side to sex. Like sex is used as a weapon. There is a dark side to it, and they're trying to protect vulnerable people. But somebody posted the cover of my book on Instagram and Instagram slapped a label on it and said, “this might be sensitive or violent information.” And literally, in my subtitle, it says sex in like 10 point font. And I'm like, that must have like triggered some sort of bot to put something over it. But it's like even trying to get out medically accurate stuff is very, very difficult. Like on Instagram I have to, I have to say intimacy a lot. Like intimacy is my code word for sex. But I mean, intimacy is so much bigger than sex, but I don't feel comfortable saying sex cuz I don't wanna get blocked.
Kendra: Yeah. Hence the censorship and the feelings of shame that we all feel and not making it be open and a welcoming conversation and comfortable, especially to women. Because as you know, it is much more than just clitoral stimulation. A lot of getting involved is before the bedroom or outside of the bedroom, which you talk about in some of your podcasts, which I love. But one of the things I love is that you talk about shoulding all over your sex life. And interestingly enough, we wrote an article in the emergency medicine news. We have a blog every month EMN publishes an article from our group and we have an article about stop shoulding on yourself. So tell us in your words, why people should stop shoulng all over their sex lives.
Kelly: Oh, well, it's not good for pleasure. That's for sure. Cuz it brings in so much judgment and shame and silence. Right. But like so many people they'll try to be like, “well how many times a week should I have sex?” And I'm like, oh my God, it's not the point at all. You know, don't turn sex into like, four hours of cardiovascular exercise and eight fruits and vegetables and eight hours of sleep and like, you know, two sexual things a week. It's like the whole point of this is adult play. Like it's supposed to be playful. It's supposed to be fun. It's supposed to be, you know, bring added pleasure to your life. And it's like all that shame and shoulds we put on ourselves. Like I should have an orgasm. I should have an orgasm this fast. I should have sex this many time a week. It should be easy. You know, I shouldn't have to learn how to communicate. Like all these “shoulds”, there's a million of them. Well, my body shouldn't change with age. I shouldn't need to try something new now that I'm 48 instead of, you know, 25. All these “shoulds” of like, not accepting what is, and not accepting like the immense awesomeness that can come from a healthy sex life.
Amanda: I like, one time, and we say this a lot, but I've heard it, you know, through our coaching training, that “should” is just “could'' with shame all over it. It, you know, it just brings this extra layer of judgment that's completely unnecessary. So that kind of ties into the next question of how our brains, I believe in your book, you refer to it as our, as actually our biggest sex organ. Can you tell us more about that?
Kelly: That's kind of like, you know, for a surgeon to go to life coach school. I still remember sitting in my car and being like, “oh my God, am I gonna get kicked out of the club?” Like somebody's gonna find out, right? Yeah, totally. So like for a surgeon to go to life coach school, like that was a leap. And I met a surgeon life coach and I was like, I literally called her and I was like, are you okay? Like, is she normal? Like I had to vet her. So I don't take this, like me going to life coach school, like very, like, this was a big freaking deal for me. But what I started paying attention to a lot of the sex med people are like, Hey Viagra. Hey lube. Hey, the new FDA approved meds for low desire. Hey hormones. Yeah, but if you've got decades of shame and, you know, marital discord and unequal workload in the household, like all of this crap, it doesn't matter what medication you try. And so I started listening more and more to life coaching stuff. And it was the, like, it got to the point of like, how do I learn to do that magic? How do I learn to help people see what's holding them back? And, and I still cringe at people like, “oh, thank God! We've got an FDA approved med for low sexual desire.” And I'm like, great! I'm happy to talk about it for a subset of people. That is good. But if we don't figure out our thoughts and our judgements and like our whys. Why do you wanna have sex? What do you get outta sex? Like all that, like a pill isn't gonna help. And then you're gonna, as you know, you're gonna fail the medication. Now you're a medication failure and there's like another load of shame. Right? So I'm like, I never want somebody to try a med and fail it. And then think now I'm really broken.
Amanda: We're trying to teach our listeners how much your thoughts are why you feel things rather than the actual circumstance. The circumstance is neutral. But one of the things in your book that kind of blew my mind and explained a lot of things to me was your description of the two different kinds of desire. Do you wanna tell the listeners about that?
Kelly: Yeah. I mean, it's so important again, it's the sex ed we never get. Right. So the researchers say… How much do you want me to talk? So in the beginning, if you, if you wanna look at like the Kinsey Institute masters in Johnson, like let's go old school to sex research in the 1950s in America. Desire was not even included in their paradigm. There was no desire needed. It was like arousal, orgasm, plateau, resolution. Right. And if you look at it, you're like, okay, well, these were people who are willing to drive to the Midwest, have sex in a laboratory, hooked up to wires to be watched by researchers in the 1950s. Yeah, totally. Like there was no desire necessary. These people were ready and willing. So like, but that's good to know, like they originally didn't even put desire in. Right. Then we add a desire to say, Hey, there's a stimulus kind of like hunger. Hunger will make you eat that sort of thing. And they really, they kind of biologically created that and they're like, Hey, it's a natural drive. Kind of like hunger or sleep or thirst. And a lot of people will disagree with that. They'll be like, well, sex is important to keep your species going, but you're not gonna die if you don't have sex. Right. It's not actually a life saving thing, like hunger or sleep, which is why I say, if you save sex til the thing that comes right before sleep in your life. Of course sleep's gonna win. You will die if you don't get sleep. So there's the desire we've put now desire as the thing that you have to have before sex can happen. I think that's actually pretty damaging. I see so many women they're like, well, I don't have desire. And I'm like, right. So that means you don't have a sex life and they're like “Yeah!” I'm like, well, that's like saying you don't have a stove, so you can't boil water. Like, well, totally true. You need the stove to boil the water, but you don't need any desire to have a wonderfully awesome sex life. And it does that Don't or have, have sex when you don't wanna have it. That's not what I mean. And I always wanna clarify that, but Rosemary Basan came out with this basically responsive, receptive desire model and said for a lot of women in their lived experiences, desire happens during, desire can happen after, like you have this great sex and you're like, “oh my God, that was so great. Can we do that again? I always forget how great this is!” That's totally a normal lived experience for a lot of people. But when women say, “well, I don't have desire, so I don't have a sex life.” It's like, well, it's not really an essential ingredient kind of once you understand the different types of desire and that, you know, some people didn't even put it even involved in the sexual cycle at all. So for a lot of women, it's getting aroused, getting the touch, getting in the act, starting to feel good. And then they're like, “Oh, yeah, Oh, yeah. Let's keep going. I want this. I always like to normalize responsive desire. And what we see is again, stereotyping, which is easy to do, but it's helpful sometimes. Is that women tend more towards responsive desire than spontaneous. Women tend to not have testosterones of 700, right? If we were gonna talk about it, the role of hormones, testosterone is probably the spontaneous desire hormone. Estrogens in rat studies, animal studies, is the more the hormone of receptivity. So we've got that and then we've got long term relationships, right? So in our culture, we celebrate and prioritize being in a long term relationship with somebody we don't break up with and find a new partner every six to 12 months. Which is really when that new dopamine drunk brain of like spontaneous love kind of mellows out into like the known and the accepting. And like, I know you're not super exciting to me anymore, cuz like I've known you for awhile. and that's just understanding dopamine and the brain and novelty and the role of novelty in sex. Right. If you're having boring sex, you're not gonna desire it. That's not how dopamine works. Again, I can go on and on, but like, this is why sexuality and talking about it and coaching on it is so cool. Cuz it's like all the things and it's just so great.
Amanda: Which is why just everybody, just go buy the book because you just, honestly, I honestly, if you're a doctor and you're listening to this and you treat women, well, it actually women and men, because all of this is not taught in medical school. And your entire book is just so helpful explaining what actually is going on and things that you can do and how it's been, how we've gotten it wrong. You know, in the past, speaking of, I grew up in the area where you weren't supposed to do any sort of hormone treatment in menopause and turns out that's not right.
Kelly: Yeah. Yeah. It was another big disservice that we did. So in order to understand where we are. We've gotta backtrack to where we were. So in the nineties, a lot of hormone therapy was happening, used to be called hormone replacement therapy. Now the new technical term is, menopause hormone therapy, but I'm still adjusting. But so there are lots of people, hormones, hormones help hot flashes more than any other drug. We've got great data on longevity, let alone just mood and, you know, feelings of wellbeing and energy, whatever it might be. So many, many, many women were on hormones and the government had a vested interest in saying could hormones help in preventing cardiovascular disease? So it was actually a prevention study was what they did and that's called the women's health initiative. And it was a billion dollar study that ended in 2002. What they did is they stopped it prematurely because some women had some side effects and the media went nuts. That's basically, if you talk to any woman who says estrogen causes cancer, it's from that kind of like permeation of our society, that estrogen causes cancer. Now my personal opinion is the worst thing you can do to somebody is tell them that something, their body naturally makes causes cancer. like way to be shameful and hate your body and fearful of your body. Right? When in fact estrogen does not cause cancer. estrogen in the estrogen alone arm in that study, it decreases the risk of breast cancer. And so once you can, you know, we've got 20 years to hindsight and pick apart the data and be like, oh, well, what they did was they threw 75 year old females who had never been on hormones, on hormones. And that actually can be dangerous cuz their plaques get destabilized. You know, they've already not seen hormones for that long. Those were the people who got the side effects. What we know is women between the ages of 50 and 60. So if you're started on hormones within about 10 years of that menopause transition, you have an increased life expectancy of three years in some studies, greater in other studies. If there is a drug that men could take that would make them live three years longer, what percentage of the population would not be on that drug? And that's the great privilege of being a urologist. Cause I take care of so many men is like, see the gynecologists don't get that perspective. I'm like, well, do you see how we're treating the men? Everybody would be on that drug. And so, you know, the, and what's happening right now is this big conversation of like, is menopause natural? Yes, but I mean, you guys are ER docs. How many things do you treat that are natural? But you know how to make it feel better as you go through these natural things.
Amanda: We are the guardians of the Darwinian shallow end. That's literally what we do is prevent Darwinism from happening.
Kelly: Totally. I mean, you know, the, and it's like they do this and it's like, oh, well, childbirth is natural. You shouldn't need drugs. So a femur fracture is natural. That happens. We give people drugs.
Amanda: Yes, exactly. Sunburns are natural. You still use sunscreen.
Kelly: And poor eyesight is, to be frank, is natural. Yeah. Yeah. And we don't tell people to not have great eyesight. Sorry, sorry. It's just that time in your life for bad eyesight. Yeah, but we do that to women. And once we put that lens on things, I had a lady come in and she's like, “well, I don't want hormones because it's not natural.” And I'm like, what's on your feet? and she's like shoes. I'm like Uh-huh. And I'm like, and how'd you get here? And she's like a car and I'm like Uh-huh. And I'm like, and in the summer, when it's super hot, what do you do? And she's like, turn on air conditioning and I'm like Uh-huh. So don't pick your, don't pick and choose your natural. And then tell me people shouldn't be on hormones. Especially since it's so stinking safe and actually can be protective. Now on a national level. They've said the preventative health services task force, which has been wrong about prostate cancer. I'm a urologist. And I have to plug that. Has said as a society and population we don't recommend hormones as preventative to any disease. So that's kind of like the big blanket statement and I get why they say that. It's certainly one thing to say. Remember when we said everybody should be on Lipitor. Yeah, we were like, everybody should be on Lipitor and aspirin and we should just put it in the water. Well, we've kind of back stepped from that. Cuz it turns out maybe not everybody. Right? It's like it's really individualized medicine.
Amanda: Right. Which is again why you should be going to your primary care doctors or whoever your doctor is and talking with them if hormone therapy is right for you, but the old data isn't necessarily accurate. Speaking of, I did a fellowship in integrative medicine and I just went for those people who are going to places that are giving you hormone pellets, instead of FDA approved medications. Or I guess it's not FDA approved for women, but have been tested and are safely made. Do you wanna comment on that at all?
Kelly: Yeah, I always say like one star, I do not approve. You're just, you're just making people rich. Right. But I mean, this is, this is how I, cause I always, I always try to come at it with compassion of like, why is this happening? Right. It's happening because women are suffering. Women want help. They want to feel better. They want solutions and Western medicine and our primary care and gynecologist, I'd say, you know, all doctors, but like the people who are on the front lines, didn't get the education. We stopped teaching doctors how to take care of women in a very natural part of their life, unless you don't wanna live past the age of 51. We stopped teaching them that. So they have nowhere to go. Except for these people who are like, Hey, I can make a quick buck by giving them super therapeutic, super physiologic doses. We have several papers now that have said compounded and pellets have a much higher rate of side effects because they're getting these super physiologic doses and it also costs an arm and a leg when like there's been generic hormones around for a long time, cash with good RX. It can be pretty darn cheap to feel pretty good.
Amanda: I love it. Now this brings me to the next question. As an ER doc, I saw throughout my career, well, it's still going on. I'm horrified that I didn't know this information, but turns out nobody did. Little old ladies coming in with recurrent UTIs over and over and over again. Do you wanna tell us about genito-urinary syndrome of menopause and what options are?
Kelly: Yeah, totally. So GSM, genito-urinary syndrome of menopause is the new long, like difficult way of saying vulvo-vaginal atrophy, but people didn't like the atrophy, like it can induce shame. I know it's neutral, but people don't like the atrophy word. So they said, and the thing is vulvo-vaginal atrophy doesn't actually describe why it's happening or like what the consequence. So like genito-urinary syndrome of menopause is a much more explanatory way of saying when the estrogen falls to near zero, which is what happens after menopause. The pelvis is incredibly profoundly affected. The bladder has estrogen receptors, the urethra, the vulva, the vagina. The vagina needs to be properly functioning because it acts as an infection barrier between the bowel contents, right, which is where most bacteria come from and the urethra and the bladder. And if you don't have a healthy estrogenized vagina, it can't be acidic cuz you it's not gonna promote lactobacillus, which makes it acidic. Which E. coli hates. So it's really, I tell women again, cuz our nation doesn't know that estrogen is incredibly safe and doesn't cause cancer. But I'm like vaginal estrogen just restores your natural microbiome. It helps you fight infections. And that's such a better buy-in than saying you just gotta put this cream in your vagina until you die. And it doesn't cause cancer, right? It's like, I've gotta reestablish. And what we know is if you take a course of antibiotics, let's say for a UTI or a sinus infection, I see recurrent UTIs happen after like dental extractions. You take a course of antibiotics. It takes you six months to regrow your natural microbiome. So you're kind of down and out and like more vulnerable to be insulted just because you took antibiotics. So that's where you see those women getting that pit of despair like you were just here two weeks ago, you were just two weeks before that. Why does this keep happening and I'm like, it keeps happening because we keep feeding you antibiotics and we don't repopulate your normal microbiome by giving you the vaginal estrogen that it needs to be healthy and functioning. The good news is, ER docs are learning. There was just a throwaway journal at, you know, the ER throwaway journals that said, Hey. Put these people on vaginal estrogen, it's incredibly safe. It's like one of the only medications that's actually getting cheaper over time. It used to be hundreds of dollars, now I can get it for 26 bucks at my local, you know, Hagens grocery store. And it really decreases recurrent UTIs by 68%.
Amanda: I mean, do you think like, I mean, I've seen you say this before that it's incredibly safe. Like, so could somebody who for instance had breast cancer even take it, like, it's that localized?
Kelly: It's that safe! If, if you think of like, you know, we're doctors, we like to think about it this way, but a full year of vaginal estrogen usage is the equivalent to one pill of menopause hormone therapy. Which is the equivalent to like 10 times as strong as one birth control.
Amanda: Okay. So we're good. We're good on this. So we're good.
Kelly: Yeah, and actually the ACOG, and I think it was ACOG and somebody else, they actually have guidelines on the usage and they totally say vaginal estrogen for active breast cancer. Post breast cancer is very, very safe. You're gonna get, you're gonna get very niche as soon as you say, you know, menopause replacement therapy with the history of breast cancer. But certainly vaginal estrogen is for everybody. Because we have to start caring about quality of life. Yes. Right. Survivorship after we're so good at caring people from cancer now. Thank God. Yes. And the thing is I never wanna downplay the fear of breast cancer. It's incredibly common and it's incredibly devastating. But if we don't understand what our risks are and understand we're hurting ourselves more by not taking this, again, just to plug the cause the fear of breast cancer is real. If you drink alcohol and don't want breast cancer, you need to stop drinking alcohol. It's strongly associated with breast cancer. And I say that only to, again, separate like drinking alcohol is worse for your risk of breast cancer than menopause hormone therapy. We're, we're afraid of the wrong thing.
Laura: Wow, so to be clear, menopause hormone therapy is taking oral hormone therapy?
Kelly: It's taking systemic. Now the systemic delivery, one option is oral, but we do think for several reasons that non-oral is safer for you. Because it doesn't have the first pass metabolism. Certainly, if we care about sex, oral estrogen increases sex hormone binding globulin in the liver, which hangs on to sex steroids. So oral estrogen is associated with decreased sex drive and sexual response. That's also seen in oral birth control pills. So systemic hormones is what menopause hormone therapy is, safest is either through a vaginal ring called FemRing or patch. Is the other most common one. You can get a cream, you can get a spray, but you're getting more expensive when you're doing that. The Pro tip, FemRing. $25 coupon for three months. This is like a 40 year thing. We gotta keep it cheap.
Laura: That's right. So FemRing would give you help with hot flashes too. Wow, that’s amazing!
Kelly: Yep. And remember, if you have a uterus, you need to protect your uterus with a progestin and that tends to be a once a day oral Progestin or an IUD, off label. But like, if you look at the pros in menopause that are like, IUD, FemRing, plug and play, you don't have remember anything, idiot proof. So yeah, it's a fascinating field and there really are decent guidelines. It's just, you know, online is chaos for women right now with hormones. And should you, or shouldn't you and they spend all this time, like, should I, shouldn't I, should I, shouldn't I, they're probably all like enneagram 5s like they're trying to get down the day. Like, just try it. You can always stop it. It's not, not an amputation. Try it. See how you feel, adjust stuff. You can always stop it. It's not a big deal. Just try something.
Laura: Oh, that's awesome. So you're very open obviously about sexuality. We're just curious how, first of all, how old are your kids? and how do you have these conversations with them? Obviously not about hormone replacement therapy.
Kelly: Yeah. Yeah. Like, well, they don't have any hormones either. Right? Like to think that being postmenopause is really like being pre-pubertal. You know, like if you look at hormone level, which is fascinating to think about. So I have two girls and they are four and almost seven. And the first thing, you know, and to me, I'm like, I didn't make this up. These are like my friends and people who write the books, but it's using medically appropriate body part names. We call it a vulva. We call it a vagina. We pee through our urethra. We have a rectum. There are fascinating studies like kids who actually know what the body parts are called are more likely to tell adults when somebody's approached them unsafely or done something, basically helps get them out of trouble better. Because they can communicate. Right? So it's like empowering your children to communicate. And for me, you know, in thinking about them growing up is consent, consent, consent. Only nine states, as of my last time I checked, mandate consent in any sort of sex ed conversation of like, you are not there to provide pleasure for somebody else. If you're gonna play a part it's for your pleasure as well, it should be equal and it should be talked about. Of course my kids are gonna know the statistics for hookup sex. The statistics, in talking about orgasmic inequality, right? Hookup sex, you know the college hookup culture, is orgasm rate in heterosexual women is about 7%.
Amanda: SEVEN!!
Kelly: orgasm frequency goes up in committed long term relationships for women. Which makes sense probably for a multitude of reasons, right? But it's like, be careful what you play with, you know, in college and especially the role of alcohol in non-consensual sex and doing things that you might, it might not be a “hell yes!” if you were sober. So really educating on the role that alcohol plays in the safety of the sex that you're having.
Laura: That's good information. That leads me to another question. When your girls are going off to make committed relationships or get married, what kind of conversation would you have with them at that point?
Kelly: I mean, hopefully for me, I've had the conversation 12 times before then. Right. But you know, in talking with kids, it's like, people are like, oh, it's one conversation and it's 30 minutes long. It's like, no, no, no. It's like 30 second conversations splattered throughout the years. It's like the other advice that the experts give, which I love, just loving that bodies change, relationships change. And if you can learn to communicate and if you can learn to like, be on somebody's team. Like at the end of the day, you're on their team and you're just trying to solve a problem. And, and what I've found in the sex coach thing that I do is like, is actually rarely about the sex. It's usually, there's usually something else going on.
Laura: Yeah. I love that, being on someone's team and being able to solve problems together. That's awesome.
Kelly: So good. The other one other thing for consent, just for more like kids, their age is like, I go to my kid's school. It's a very loving school. There's lots of hugging going on. And like, my daughter will, she'll be bombarded by kids. They come up to her and do this like huge bear hug. And she just like stands there super stiff. And I said to her, like, I wanna have the conversation with her, of like, are those types of hugs things that you enjoy? Do you feel safe when people do that to you? What, what could you do if you don't like that? What do you do if you talk to that person and they don't listen to you and they keep hugging you like that? Those kind of conversations, because women really are socialized of like, well, don't make 'em angry and like, well, they wanna have sex with you. Isn't that good enough? Like, no. Do you wanna have sex with them? Like, but we're so socialized to be the object of desire that we don't really think like, well, but what do we want? How do we wanna be touched? How do I communicate that?
Laura: So I laughed when I heard you say you didn't choose ER. You were gonna face all of society's ills and not be able to solve any of them.
Kelly: Did I get it right? I mean looking at it. Sorry to interrupt you, but like looking at it now, I got into urology, like, I needed to protect my soul.
Amanda: Yeah. Oh yeah, that's what we're all recovering from.
Laura: We're trying to undo that for a lot of people.
Amanda: That's our niche. We went to the dark side and we're trying to come back.
Kelly: Right? I don’t know your opinion on it, but like, ER is really sold as a sexy, sexy thing. At least it was to me. Yeah. Look how sexy it is. And look at the people who do it. They're sexy too. Like these are sexy problems too. It's not like they actually said that, but like, in my view of like, cause I still deal with med students. Right. And they're like ER, and I'm like watch out for the sexiness man.
Amanda: On the other hand, I was reading your book and I started laughing. So how it works, where Kendra and I work is we actually have very little interaction with our urologists because we've had this long standing agreement where if we agree to not bother them at night, they will just work them in clinic like the next day. So like a lot of our problems, it turns out. I haven’t had as much interaction with our urologists with other specialties that want me to call on everything. Not that they want me to, but they haven't figured out the savvy way that the urologists have worked around it. But you mentioned in your book how fun that urologists are. And I feel that's something that we have in common with urologists. Being ER docs, we have some wild party stories. So we were gonna use this section as maybe a favorite genito- urinary foreign body. And I will start with my own story. So again, we don't have that much interaction with the urologist, but my husband's anesthesia and started playing golf with one of our urologists. And he was like, I think you'll really like him and his wife. So let's go to dinner with him. And the night before, there had been, somebody had stuck a crochet needle up in their urethra and we couldn't get it out. So I knew that he had to come in to get it out. So we go to dinner and I'm like, oh man, I heard that you had to come in and get this crochet hook. I don't know why she stuck that up in there, but I heard you had to come get it out. Did it go okay? And he is like, yeah, actually I took it home and put it on my Christmas tree. I was just like, I'm sorry, what? And that's when I knew, I think I like urologists.
Kelly: Yeah. Urologists are so cool, man. I mean you can't take yourself too seriously. Like you're getting peed on. Right. And like, people will stick things that aren't, aren't made for it up their body parts. And just to explain to people, cuz you know, it's usually cringely of like why would people ever do that? There actually is some sexual stimulating feel good stuff up the urethra it's called sounding. So my advice to anybody: use stuff, use stuff that's actually like, meant for it. Same with butts. Mostly because we wanna sleep at night. Right? Like this is public safety for me being able to sleep.
Amanda: We also have the benefit of living where the federal medical center is for the entire nation. So all federal prisoners that have medical problems live where we live. And one of their favorite things to do is stick stuff up holes, make new holes, stick them in there. All that sort of thing. So we are quite accustomed too.
Kelly: That is a get out of jail technique. You literally get outta jail and they have TVs in the ER in, in some ER. Yep, yep. Yeah. I don't think there's TV in our ER, here. I'm failing to remember seeing TVs in my ER here. So I had a guy who put dried beans up his urethra, multiple. Dried beans. So when you pee over them for a couple of days, they expand. That was very hard. Very difficult to get.
Amanda: Oh my God. Did it just break up into like a thousand tiny bean pieces?
Kelly: Yes. tiny, tiny. And that's when you rely, you rely on your scrub techs, right? Because your scrub techs, like they know equipment that other surgeons use. And so I'm like, I feel like I need like a small spoon and they're like, oh yeah, well neurosurg has this tool they're scooping out the brain or whatever. And so like, I was relying on my scrub tech because I'm like, I'm out of ideas with the tools I usually use. But there are other tools I just, you know, you gotta get somebody who's like, oh yeah. Well, when you're in the brain, you can scoop out that with this.
Amanda: You can't just ask, “please pass me the bean-in-urethra” removing tool?”
Kelly: Yeah, yeah. Specifically the Pinto bean sized ones. So that was, that was very challenging. I had a guy put an industrial strength automotive motorcycle coil over the shaft of his penis. I know. And he kept it there for a couple. I mean, of course when you get into trouble, you're not like, well, let me rush immediately to the emergency department. Usually it's like, I just thought it would get better on its own, but it's been two weeks. Is like how it usually goes. Yeah. And so I remember the ER doc calling and He's like, I got this guy, he's got this automotive motorcycle coil over his penis and I'm like, just take it off. And the, and the ER doc's like no, I don't, I don't think you understand this. He's probably gonna require some sedation. And I remember just being annoyed, like, why can't you just take it off. You just put it on. And it had basically eroded his skin and like, it was, then it was all swollen. Right? Like you couldn't just slide it off. And so I called the fire department. And because I'm like, Hey, I think there's this jaws of life thing that like, can you bring that in? And that was not useful. So then I called the tertiary urology center in Seattle. Cuz they're like the only level one. So I'm like, Hey, got this thing. What do you, what do you have? And the guy's like, I'm just the oncology urologist. I'm like, well, that's useless, right? So like you're calling all the phone-the-friends, and nobody can help you. I ended up bringing in ortho, ortho used their diamond tip drill bits. And like, I was like squirting the water on it to like, keep it cool. And I was like protecting the, my job was to protect the penis. And so they saw all the way through the top of it. It's a coil, right. So it's like multiple saw it through the top of it. It's industrial strength automotive. So it doesn't just open. You've got a saw through the second side, right. To take it off. Like we ran through all of the drill bits. Yeah. Yeah. So we went to the local hardware store for the next day. Cause this was like, of course, 11:00 PM at night or something, go get some drill bits, bring it into the OR and saw the other side. And the ortho guy's like these drill bits work better than the Stryker stuff we have. That's good to know. That's probably like, that is good to know. Like you like all good stories. That patient was lost to follow up. Oh, yeah, of course, of course. You're not exactly gonna come back and be like, can you just look? But we were able to save the anatomy and like a lesser urologist would've just amputated the disaster. So that's, that's my, like, to this day, the only combo ortho-urology case.
Amanda: I don't, I don't wanna make a bone joke, but anyway you have to, you have to, you can't help yourself. I only have boys, so that's why, yeah, that's hilarious.
Kelly: But like, you know, but human brains, I mean, human brains are like the most creative thing on the planet. Right. We get ourselves into trouble. Yep.
Amanda: PSA. Just use things that are made for human entertainment.
Laura: So tell us how you got into life coaching.
Kelly: Oh, it was because of sex, sex got me into life coaching. It was, you know, the, the thing of like, how do I get, how do I do the magic? How do I get people to see that their brains are the cause? And I mean, I was always that typical surgery resident that like three years in was, you know, totally burnt out and was like, if I can just figure out how to get people to do what I wanna do, my day's gonna be better. So that was like my plan. I was like, how do I, you know, make friends and influence people like Dale Carnegie style stuff. Right. And I started researching it. And I came across John Cabot-Zin and Buddhist, like clearly how to, how to manipulate people, led me directly to Buddhist philosophy for some reason. But I was like, oh, everything I'm reading tells me I can't. Like, I literally can't change anybody and I can only change myself. And so I like looking back, I was into, and I was a neuroscience undergrad. So like the brain and the thoughts in psychology have always had an interest in and early in residency, I was like, oh, I have to change myself. Like the worst answer ever. I mean, I think that's why I'm such a good life coach, if I could say so, because like I'm not that peaceful. Woo woo. Engram 2. Like, I'm not that person. I had to struggle and fall and burn out and fail to be like, oh, well, did you know that humans have had this problem since the birth of brains? and this is just like ancient, stoic philosophy, ancient Buddhist philosophy just wrapped up into modern lingo and we call it life coaching.
Amanda: I love it. Well, on that note, we hear you are starting maybe a membership or talking about a retreat. People are gonna wanna find you. How do they do that? Tell us all the things.
Kelly: Yeah. So I'm most active on Instagram, Kelly CaspersonMD, and then my website, KellyCaspersonmd.com. I actually am starting, I haven't done a, like a sex ed group coaching in over a year, my last one was January 2021. I just, I didn't love it. And I need a membership. I need a private podcast. I need group coaching. I love group coaching more than one on one. Number one, I just don't have enough time for one on one. But number two, like I learned so much from watching other people be coached, right? Like there is something very transformative in that. And I was sitting in my town doing like my, you know, sex advocacy group stuff. And like all the therapists are totally booked out. The sex coaches are booked out. Nobody can get in to see anybody anywhere. And I'm like, well, one in 10 marriages is a sexless marriage. Like this is a really freaking problem. And so I created this group membership, which is starting July of this year. Just for people to deep dive more and to uncover their thoughts. And I talk about that a lot in the book too, is like, realize where you are with sex. Like, what are your views about sex? What do you think about sex? What do you use sex for? Like there's so much work in just understanding the answers to those questions. And I truly believe like working on your sex life doesn't just give you know, whatever a higher desire. Cause I'm not even here to tell you you need a higher desire or you should have a higher desire. Like to me, I'm like keep the desire you have and go have great sex. But it's like the work you do in uncovering how to advocate and communicate and understand your body and be deserving of pleasure anywhere in life, not just in bed. Sex is the ultimate in personal growth. It's gonna translate over into your work life, your other relationships, your self care with your body, all that stuff. So to me, it's like the perfect, the perfect niche.
Laura: That’s amazing!. What about your membership? So how will that work for people who are interested in doing that?
Kelly: They can sign up on my website. I'm keeping it small. I'm only gonna let in 300 people. So it's like I'm keeping it small and I'm closing it down. Basically it's month to month. So it's like, come in, take what you need. I've got tons of content in there from my previous courses, which is just like sex ed 101: understanding your body, understanding desire, orgasmic inequality, desire mismatch, like all of the big themes that I talk about in my book. And then they're actually gonna be able to be on as a live audience member when I do my interviews with like the experts and stuff like that, which to me, I'm like, that's the most fun to be in the bleachers when me and my guests are actually talking and, and be able to type in the questions. So there's a private podcast part that goes with that.
Amanda: if they don't get in this round of the membership.
Kelly: Oh yeah. We'll have a wait list.
Amanda: Okay, perfect.
Laura: That's awesome. That sounds like it would be amazing.
Kelly: My eBooks in there for anybody who signs up in July. I'm doing a signed copy of the paperback for U. S. citizens only. It's like 20 bucks to mail to Canada. So U.S. only. I just learned after I sent two books to Canada, I'm like, yeah, U.S. only. I'm giving a signed copy of my book, which is fun.
Laura: That's awesome. So from your book, what would be the biggest take home messages?
Kelly: Yeah. I mean, I think the biggest take home message is that you're in control. You have the power and getting like, that's the secret sauce you guys like, how can we, and in the work you guys do too, like how can you get a person to realize that instead of that life's happening to them, they get to drive life. They get to drive what they want their day to be like. It's incredibly empowering. And I'd say if we figured that if anybody has already figured that out, I wouldn't have a job. Right. But it's like figuring out how to get a woman to be like, Hey, this is my sexuality. I get to say no, I get to say yes, I get to say, ask questions. I get to evaluate why I got to where I am in my life and be curious. So that's what I take home is like you have all the power, you just have no stinking idea that you have any.
Kendra: That's amazing. Thank you so much, Kelly. This has been such an amazing awakening, not only as your colleagues, but also as women and as that 51% that could always use more encouragement to have our own back and show up for ourselves and finally kind of take charge or take our control back. So thank you so much for just your time. And I also wanna honor you and thank you for caring. Thank you for not just doing your job. Thank you for not just being a residency trained urologist, but thank you for stopping in your tracks, realizing that 51% of the population needs help in this area. And thank you for equipping yourself and being in charge of your education and making it so much better for the rest of us. So thank you. Thank you. Thank you. From one woman to the next. Thank you.
Kelly: I really appreciate that. That means a lot.
Kendra: So as we wrap up today, we hope that you just even could take one thing away. There are so many great pearls in this podcast today, but if you can just take one thing away, just know that we care about you. We see you. We know there's common struggles, you're not alone. And we hope that just a little bit of this podcast will stay with you. And you will sign up for Dr. Casperson's podcast and continue to listen to The Drive Time Debrief. So until next time, you are whole, you are a gift to medicine and the work you do matters!
