0:01

I'm Amy, sex educator, sex

0:03

and relationship coach and co-owner of purepleasureshop.com.

0:07

And I'm April, sex toy maven, VP

0:09

of Hot Octopus, and I've dedicated

0:11

my life to the business of sex. We're

0:13

two people with a passion for educating

0:15

and inspiring shame-free conversations

0:17

about sex and relationships. Welcome

0:20

to the Shameless Sex Revolution. Want

0:25

to learn more? Go to shamelesssex.com

0:27

and for 15% off of some of our favorite

0:30

sex toys,

0:31

use coupon code shamelesssex at purepleasureshop.com.

0:35

You are listening to a pleasure podcast. For

0:38

more from our sex podcast collective,

0:40

visit pleasurepodcasts.com.

0:43

Well, hello everyone. Hey

0:45

everyone. Welcome back to the shameless

0:48

sex podcast. April, if you could

0:50

sum our podcast up in two words

0:52

other than shameless sex, because that's cheating,

0:55

what would you say? Slip and slide. That's

0:57

three words, but actually that's two. Just

1:00

two. Slip and slide. Oh yeah, I see.

1:02

I see what you did. Okay, cool. I

1:04

mean, technically the and is

1:06

just a letter. So this episode

1:09

is with Dr. Castillo and Remy

1:11

Paillet, whom we

1:13

both have seen in person for

1:16

our own work on our hormones,

1:18

our health. Remy has been on our show for

1:20

episode 120, the STI or the

1:24

episode, the STI, I think it's the STI

1:26

episode, another STI episode. Yeah,

1:29

that's a lot of STIs and epiblblblblblbl.

1:32

And it is very informative

1:34

and helpful. And this is for folks of all bits,

1:37

genders on how to have the ultimate

1:39

sexual pleasure and health as you age,

1:42

whether you are 20, 30, 40, 50, 60, 70, 80. And

1:46

there's a lot of fun things. And it's in person, which makes it

1:48

even more fun. And this episode, yes,

1:50

it's not just for people as they're

1:52

aging. No, that's what I said. We're all aging. 20, 30, 40, 50.

1:55

You're not living or dying, yo. Let's get real.

1:57

And why would we not

1:59

want to have that? the ultimate sexual pleasure in health,

2:02

no matter what our age is. That's why we're both actually

2:04

going to see Dr. Castillo

2:07

and Remy. Which we didn't organize because

2:09

we're going tomorrow, but like, my appointment's at two,

2:11

and yours is at four? Why did we do that? Mine's at 340.

2:14

Yeah. I know, that's so funny. We go to carpools.

2:16

We're gonna be both maybe

2:19

walking with a limp after our testosterone

2:21

pellet implant. Oh yeah, well I've

2:23

been doing the cream. You can't do any squats or anything

2:26

after that. Oh shit. I'm gonna get

2:28

all my squats into my arm for

2:29

me. I'm serious. No,

2:32

thank you for reminding me, because I forgot about it. You

2:34

can't, otherwise you give bustas, I don't think

2:36

a stitch, but. There's no stitches

2:39

involved. No, there's not. We can

2:41

busta. They'll explain more as you listen. And

2:44

it's not just about that. There's a lot of other

2:46

pieces there. And Dr. Castillo has

2:48

pioneered various aspects of, I

2:51

know which sounds weird, you're like, so this dude

2:53

pioneered a whole bunch of aspects about vulva

2:56

owners, sexuality, or

2:58

health and sexuality related causes,

2:59

issues, advancements,

3:02

optimization, but I've talked

3:04

to so many people, whether there's

3:06

patients or not, that speak so highly of him. He's

3:09

so, so active in this. Also, remember April Yumek,

3:12

who was on our show. Yeah, she was talking about him. She was

3:14

the first one that had, we

3:16

had Remy on our show prior

3:18

to her actually joining Dr. Castillo's

3:21

practice, because Remy now works directly

3:24

with Dr. Castillo and April Yumek,

3:26

who I've worked with many times, was on

3:28

our show in person. She's just like,

3:29

Dr. Castillo, we're like, I know. And then

3:32

she was talking about someone medical and Dr. Castillo.

3:34

And then I set up an appointment nearly, I

3:37

think three days after that

3:39

interview with April Yumek. And.

3:42

Because April and I were like, did a full warm up panel. We're like,

3:44

everyone should be. And I had some shit out of whack. I knew

3:46

it. We all, well, yeah, so

3:49

this is not, so again, if you're 20, listen

3:51

to this episode. And as we age,

3:54

there are reasons why it's helpful to

3:56

get hormone panels and understand

3:58

your body. I've told so many people about.

3:59

that panel and then I

4:02

want to see your panel. I'll show it to

4:04

me your panel. And I want to keep your numbers

4:06

because Remy had suggested the,

4:09

the blood work that you get done and then

4:11

you can get it sent in. And so I had sent that

4:13

to my friends in the UK who can't access

4:15

Dr. Castillo cause they live in London. And

4:18

so I sent that to some of my friends who

4:20

are there between thirties

4:22

to forties. And, uh,

4:25

I don't know. Now they're like, I gotta go get it. They

4:27

all have said because they're like, that makes a lot of sense.

4:29

My hormones are shifting and I had kids

4:32

or even when people feel like,

4:35

uh, the brain fog or like they're

4:37

just constantly really down. We just

4:39

think, Oh, it must be X, Y, and Z,

4:42

but hormones have so much to do

4:44

with it. And then that sleep well. Yeah. And then it's

4:46

related to other aspects of the house. If

4:49

I was a spicy angry, spicy spicy,

4:51

baby, spicy,

4:53

baby, spice. I know I'm fucking scary.

4:56

Spies. Ooh. Not

4:58

only to dudes. Yeah. Sorry.

5:01

Sorry. Any dudes listening when I was scary spice. So

5:04

before we dive into that, I just want to say, so April is his

5:06

slip and slide. So we were talking earlier

5:09

and I just want to give this shout out to like how fucking

5:11

awesome my life is. Uh, and this is

5:13

not selfish, but I just want to say, you

5:15

know, it's selfish, but I

5:17

got to go to, I'm doing an air

5:19

clap for you. Thank you. A two day birthday

5:22

party that had a slip and slide where

5:24

I got naked and had two different men

5:27

rub Uber Lou. He sent me a video. One of them's

5:29

the creator of Uber Lou. It was my dear friend and

5:32

all over my body. But I was like only that from

5:34

the neck down. Okay. And you don't need to get in my orifices.

5:36

Okay. This is for a slip and slide. So they're super

5:38

respectful. And then I slipped.

5:41

So, so when I did well, slipping down that

5:43

slide, well, yeah, but my landing's not

5:45

so great. But you got caught.

5:48

And so I asked him because I was like, I'm going to

5:50

slip the fuck out of this because I'm covered

5:52

in Uber Lou. Whereas like most people without Uber

5:55

Lou, they'd stop like halfway through.

5:58

There was just water on the action. I

6:01

think it was like a smidge of uber lube. My

6:04

whole body was covered in, so I was like, I need a catcher

6:06

at the bottom. Yeah, because you were sliding real. Because I would

6:08

have gone five feet into the grass. And

6:11

so my, the owner,

6:14

creative uber lube was there, was like, can you be my catcher?

6:16

And he totally caught, he was like one of those football,

6:19

no soccer, where you're like the goalie, and

6:21

you're like, to the left, to the right, I got you! So

6:24

that was super cool. You were like, if you were the

6:27

puck or whatever they do and curling at

6:29

the Olympics, or when they shove

6:31

something down the ice. Yeah, but hockey. Yeah,

6:33

he's the goalie. It's like curling with Amy. Catching

6:36

a naked lady covered in the lube he

6:38

created, and it was so much fun. So

6:41

there's that, and then also. No

6:43

skin problems after. No, no, no, no.

6:46

I have multiple bruises, but they almost from.

6:49

You're gonna have to put it up over there. Oh yeah, well, you know,

6:51

Amy and I are trampoline is

6:53

a different story. So, okay, but also

6:55

I had two different people, the

6:58

Volvo owners, come up to me, and they were praising

7:01

OMGS, not even knowing that we've been praising

7:03

OMGS for a long time, and they were like, oh my

7:05

God, this program, OMGS is on

7:08

the program, changed my sex life. They didn't even

7:10

know we talked about it. No, no idea. Oh, wow. No

7:12

idea. And they were like, changed my sex

7:14

life entirely, my connection to my own body,

7:17

and then I can share that with my partners. And

7:19

I was like, fuck yeah, so by the way, did you know

7:21

that they're a sponsor, and they had no idea? So,

7:24

just wanted to say that, super cool, and I

7:26

highly advise that you do a

7:28

slip and slide with the Uber lumen in your

7:29

body, but have a catcher, otherwise

7:32

it's dangerous. I'm

7:34

going back to Chicago for

7:37

family vacation, and- Your family

7:39

probably wouldn't be in there. No, but I am going

7:41

to recommend that we get a slip and slide. I mean,

7:43

my 12 year old nephew is probably gonna love a slip

7:45

and slide, but I'm not gonna have

7:47

any Uber lube there. I mean, I will

7:49

have Uber lube, but only for personal use.

7:52

I will be like, you know what? I do want a slip and slide,

7:54

because when you sent me that video, it inspired me. I

7:57

used to love a slip and slide. It's fun,

7:59

even if you're not-

7:59

I'm a midwest summer. Oh my God,

8:02

I got to experience one. Welcome. All

8:04

right, so we're gonna do a sex question, but I wanna say two

8:06

different announcements. Number one, we get emails all

8:08

the time from folks asking how could

8:11

I become a sex educator, a sex and relationship

8:13

coach, or get into the field

8:16

of human sexuality where I am a teacher

8:19

or a guide or something. And we

8:21

have a whole blog post about this, but something

8:23

is coming up and is via Leila Martin,

8:26

L-A-Y-L-A. And

8:29

she has been on our podcast, I think four

8:31

times now. She's been in several times. We've

8:33

done actually in-person work with

8:35

her. She's a fucking badass. She's

8:38

a phenomenal, wonderful educator. So many offerings,

8:40

so you can take other classes,

8:43

of course, but she has a coaching program

8:45

to be a coach. It's coming up soon.

8:47

I believe it starts in like July or

8:49

August, but sometime soon, it might even have a

8:52

wait list, but if that is something you're interested in,

8:54

so a reminder, just go to our show notes. You can find

8:56

the link, go click that. You find all of the offerings,

8:59

including this coaching program. Last announcement

9:01

for a fun sex question. You've

9:04

also heard, if you're a regular listener,

9:07

Midori on our podcast talking about

9:09

all kinds of things from role play to how

9:11

to be a dominant, vulva-owning

9:13

human in the bedroom. And Midori only

9:15

offers this, I don't know, a couple times a year.

9:18

I think she might only have one spot left. And

9:20

it's her fourth day, I think,

9:22

femme unleash your authentic

9:25

power from the bedroom to the boardroom,

9:28

workshop course, et cetera, that is coming

9:30

up. And you should go and check

9:32

it out if you're like, I wanna be a badass. And

9:35

I think it's for vulva owners only, but again,

9:37

go check it out. Can we just say something about Midori?

9:39

She is an OG. Oh my God. She

9:41

is one of the leading sex educators in the

9:43

world. People pay her so much money to do

9:45

what she does. If you ask the sex educator,

9:48

do you know who Midori is? They're like, fuck

9:50

yeah, we know. She's the best. She's

9:52

been on our show a few times, and she's

9:54

just incredible. She's in our book. She's loved her

9:56

multiple times, actually. She's incredible.

9:59

So go check it out. It's Forte, so I

10:01

think that is how you say it, but Forte Femme, so F-O-R-T-E-F-E-M-M-E.com.

10:04

Again,

10:07

show notes. Fort Femme. Fort

10:10

Femme. All right, sex question,

10:12

ready?

10:14

All right, it's about sex toys. My

10:17

fiance and I are looking for new sex

10:19

toys. Any ideas on new

10:21

app-controlled wearable anal

10:24

toys that a man, penis owner, with

10:26

a prostate, I assume, can wear in public

10:29

already sounds really fun to me. Also,

10:31

a whisper, quiet, vaginal, or

10:34

clitoral toy or toys, because

10:36

we have two kids and are trying to keep our sex

10:38

life new and adventurous without

10:40

disturbing them. Oh, and here's a must,

10:43

they must be waterproof. Please, please, please, please

10:45

help, thank you. I like the please, please, please, please.

10:48

I know, I'm like, thank you for saying please. Many places. And

10:50

you're welcome. There's definitely

10:53

so many options here. So let's start

10:55

with the wearable anal toys that

10:58

a penis owner can wear in their ass in public. I

11:00

would recommend the Plex with

11:03

Flex

11:04

by Hot Octopus, because

11:06

not only is it remote controlled, you

11:08

can wear that so anybody with a butt can

11:10

wear it. So whether you have penis,

11:13

a vulva, anywhere in between, you can put

11:15

that in and you can

11:18

click a button and then your partner

11:20

or yourself can hold the remote and then

11:22

press and hold, and then it has two motors that

11:25

can gyrate your prostate. And

11:28

your anal canal. Yeah, so you get like two

11:30

different, oh, that's awesome. Okay, so this

11:32

is remote but not Bluetooth,

11:35

but I could still be across the room from you and

11:37

press this button and vibrate your ass. Three

11:39

meters. And no one would know I was doing it. Three

11:41

meters. Well, but your reaction might give it away. But

11:44

you know, that's not on us. It's also got a flat

11:46

base, so it

11:48

fits between your cheeks. It's a

11:50

great shape too. You could fit it over,

11:52

if you wanted to wear it out in public, you

11:55

could fit it under your garments.

11:57

Garments. You know, depending on what you're wearing.

11:59

The other thing I'd say about this is, and this

12:02

applies to a lot of anal toys that have

12:04

a curve for a prostate. Clean

12:06

it off first if you're using the ass, but you could

12:08

totally use this as a G-spot toy too,

12:10

by the way. Like it has a curve designed

12:13

for that. And it's also, so the plex is

12:15

flexible. So if you're moving around or you're sitting down.

12:18

Like at a dinner table perhaps? At a dinner table, or you're

12:20

out with your kids playing at, I don't know, that's what

12:22

they were talking about their kids. You're at your park

12:25

or at the... The one year old's birthday party.

12:27

You're like, okay, I got this butt plug

12:29

in that vibrates. And because the

12:31

neck moves around in a 360 degree,

12:35

it's ergonomic

12:36

because it moves around with your body. So

12:38

it doesn't move

12:39

around unless you want it to. We're not talking like

12:42

twirls. It doesn't twirl. However, it

12:44

does move and it kind of

12:46

glides with your body. It's powerful. And

12:49

I'd say one, it's quiet and you're

12:51

going to, if you're in public, you probably have pants

12:53

on or something, which will make it so no one will

12:55

know. So here's another thing. This would be good because

12:58

if it was in your butt, see, I'm

13:00

switching the switch, roll

13:02

swap right now. We should try this. Because Amy's

13:04

always like, if I were fucking April. Well,

13:06

you should just say this more often to me because I'd like

13:08

it. Oh, okay. I know you do.

13:09

And if it was inside of you, it was

13:12

on and I could just do the treble,

13:14

which is near where kind

13:17

of the prostate would be or the internal anal

13:19

canal if you don't have a prostate.

13:22

So that treble could be like, or

13:24

I could turn off the treble and then I could do the base, which

13:26

is by your

13:27

external sphincter. Where the nerve, most of the nerve

13:29

endings are. Where are the most of the nerve endings are. Or you can do both

13:31

of them. Or I could put it in my

13:33

pussy after I cleaned it or only use it for this purpose. We're talking about butts

13:35

right now. I know we are. But also like April

13:38

and I are on a date and she put this in my pussy

13:40

and then she's

13:42

like, I'm going to press this button. So it gets

13:45

to more like your clitoris slash vaginal

13:47

opening where there's a lot of nerve endings. And this

13:49

one will get to your G spot, G area. All

13:52

right. I love it. Love it. Love it. Law, plex, way,

13:54

plex. And it's only ninety nine bucks. Ninety nine bucks. And

13:56

all these things we're talking about, you can get at pure pleasure

13:58

shop dot com. Just use coupon. code shameless

14:01

sex you get 15% off. And it's waterproof as

14:03

they request. Oh, all of these are waterproof. Yes, okay.

14:06

So the other one that I would say is

14:08

the WeVibe Ditto,

14:10

D-I-T-T-O Ditto. If

14:12

you really, really need the app controlled,

14:15

I honestly prefer a remote than an app, but

14:17

if you're trying to do it from like another state

14:20

or country, then maybe you want an app. I

14:22

think a remote is like more, I don't

14:24

know, easy to navigate, simple to the point, I don't need to like

14:26

figure out to open the app and blah, blah, blah. But

14:29

if you need the app, the WeVibe Ditto

14:31

is really well known for being great for penis

14:33

owner folks who would like something in

14:35

their ass and someone else can control it. Do you want someone

14:38

from another place controlling your television?

14:41

No. Okay, that's how I feel

14:43

about that. If it was you, I'd like it. It's like, you,

14:45

I don't know, you've got good. No, you watch crime

14:47

shows, fuck that shit. Exactly.

14:49

All right, let's go to the pussy. So, again,

14:52

we're going with quiet, waterproof. Okay, so

14:54

internal April, what you got?

14:56

All right, so curve. With

14:59

a K. Curve. Curve.

15:02

They're like, see, you are, no, K, you are. With

15:04

a K has the, because

15:06

they asked for something very quiet. So

15:09

this has, again, this treble

15:11

and bass technology, which Hot Octopus

15:14

spent years developing and we

15:16

patented.

15:17

And it's amazing because

15:19

it's got this little gentle curve

15:22

but very rumbly strong motors that

15:24

when it's inserted, you can barely hear

15:27

anything. No one's going to think

15:29

you're running a vacuum or a hair dryer. It's

15:31

so quiet and it gyrates your

15:33

internal bits. So it's a great

15:35

squirting product. And it has that part

15:37

though that gets the best parts, which is

15:39

your vaginal opening clip. Yes, and it has

15:42

a squishy end. Like

15:44

I like to call it squishy or squishy. It feels so

15:46

soft, like you want to just like

15:47

bite it. But it's like the tip

15:49

of the product, it

15:52

feels soft. So when you insert it,

15:54

it gyrates on your G-spot. So

15:57

if you want to use this, ain't only don't because it doesn't

15:59

have a stopper.

15:59

Do you have to? You would have to hold on to it.

16:02

This is for the pussy. And I'm

16:04

picky about non-human

16:06

things inside my pussy. And I've

16:08

tried a number of toys and like this is one of the only ones

16:11

I actually really like. I've heard that from so many

16:13

people because people are like, I don't like internal toys.

16:15

I personally do not like internal toys. When I use Curve,

16:17

I'll use a Curve because I helped

16:19

design it and develop it. So

16:22

I feel like that's not even why we're talking about this. I

16:25

didn't help design it. I just like it in my pussy. And

16:28

I also am not biased because of that. I think

16:31

that all of our trials that we did with lots

16:33

of different humans helped that toy

16:35

be awesome. Yeah, it's probably one of the best. Yeah, it's

16:38

perfect for what you two are talking about here. You

16:40

are talking about with your partner. What else you got? What do you

16:42

got? So what I have is you want a like a bit essentially

16:45

whisper, quiet, waterproof, external

16:49

toy for the vulva owning humans. So

16:51

for the clitoris, I'm going with

16:54

the WeVibe Touch X. It

16:56

was just the WeVibe Touch. Now

16:59

it's the WeVibe Touch X. It's just the more

17:01

modern updated version. It's

17:03

super fucking powerful. It's not

17:06

loud at all. And it

17:08

also curves to your body and contours. So it can be great

17:10

for partnered sex. So it's just external

17:13

and you can have your partner on top of you, you on your belly, use

17:15

it on your own, you on top, whatever,

17:17

all the things. This is going

17:19

to work for you likely because everyone's

17:21

different. But if you're looking for powerful,

17:23

quiet and waterproof, the WeVibe Touch

17:25

X is fabulous. And

17:29

again, everything purepleasureshop.com, use coupon

17:31

code shamelesssex. Are these all the shameless

17:34

sex pics? I believe we have all or most

17:36

of them on there. The WeVibe Ditto might not

17:38

be on there only because I've only

17:41

tried it once and I didn't

17:43

get your opinion on it to add it to the

17:45

shameless sex faves. Whereas the

17:47

things that we put on the shameless sex faves are

17:49

generally things we've both tried. I was going to

17:51

look but I didn't have time. It's just you

17:54

and I doing this. Legend, if he had

17:56

thumbs, he could have checked for us. That would be creepy. All

17:58

right. Okay. So I'm talking

18:00

about your dog trying sex toys. No,

18:02

I'm typing in about the sex toys.

18:05

Oh, you could be our Jamie. Yes, that's what I'm saying.

18:07

Can you look at this one? Not trying sex toys, typing

18:09

what sex toys were available on Shameless. He's like, actually,

18:12

you like this and this and this, but only

18:14

Amy's tried this and she really liked it. See,

18:16

he would be useful. Oh, someday.

18:19

He is useful. You are useful. I love you. You

18:21

son of a monkey. All right, here we go.

18:25

Dr. Castillo is a female pelvic

18:28

medicine specialist and

18:29

the founder of Swan Medical Intimate

18:32

Wellness in Los Gatos, California.

18:34

He is dedicated to improving quality of life

18:36

conditions that affect millions of women,

18:39

is actively involved in clinical research

18:42

and on several advisory boards to

18:44

help shape new emerging therapies and

18:46

advanced treatment protocols for sexual

18:49

health and pleasure. And Remy Paye

18:51

is an adult gerontology nurse practitioner

18:54

who works alongside Dr. Castillo at

18:56

Swan Medical. Remy has years

18:58

of experience working as a primary

19:00

care provider with a deep passion for

19:03

functional medicine, as

19:04

well as pelvic health and intimate

19:06

wellness. To learn more, visit swanmd.com.

19:15

Hey, everyone. It's interview

19:18

time, but April, before we start, I have a joke for you. How

19:20

do you know if you have a urinary

19:22

tract infection when you're in France? It hurts.

19:25

Nope. European. Ah.

19:28

Ha.

19:30

We already heard it before, so it's not as funny.

19:32

You didn't do your deep belly laugh. I'm

19:35

sorry. When I know. Well, I do it authentically.

19:37

You can't fake it. I can't fake it, yeah.

19:39

Apparently, I have a really fun deep belly laugh. You're the best. It's

19:41

actually my face. It's like a cackle. Anyways,

19:44

hello, everyone. Welcome

19:47

to our interview of Shameless Sex. We

19:49

are very excited today because, one, well,

19:51

we just love talking about sex all the time.

19:54

Number two, this is an in-person recording with

19:57

repeat guest Remy Paye,

19:59

who is on.

19:59

I know the episode number Remy, by the way. It

20:02

was episode, should I be the front? Yeah, be the front. Back,

20:05

what? Back, front, all of it. Episode number.

20:08

Remy Prage. Okay, yeah. She the best.

20:10

Okay, that's it. Episode number. Episode number 120.

20:15

I didn't know. Yeah. Sorry,

20:17

it could have sound way better. Number 120,

20:20

the STI episode,

20:22

which we received, I feel

20:24

like more feedback than any other episode

20:27

because, and also the first one you added

20:30

to having herpes. That was the first

20:32

time I ever outed. You inspired her. Right, yes. I

20:34

shamelessly outed having HSV1,

20:37

Janet Lee. It really spoke to a lot of

20:39

people. That was hard. And since then we have done

20:41

another STI episode.

20:43

And anyways, this is not the episode,

20:45

everyone, because now Remy

20:48

has come together to

20:50

work with Dr. Castillo. And

20:52

if you listen to, oh, I don't know the number, but three episodes

20:54

ago with April Yumek, she gave Dr.

20:57

Peter Castillo praise. He's

20:59

located in Los Gatos, California. I

21:02

was talking about his work specifically in,

21:04

I'm gonna say urogynecology,

21:05

but not just neurogynecology

21:08

and pelvic floor health and women's sexual health.

21:10

Did I say that all right? Yeah. And

21:13

I am also a patient at their office

21:15

now, and I have to commute 30 whole

21:17

minutes. If you live in LA, you're like, fuck you, that's not

21:19

part. And it's

21:22

so worth it. I've learned so much more about

21:24

hormone optimization and sexual health optimization

21:26

and what's available to us now

21:29

in this day and age for folks

21:31

of all bits and genders. So before

21:33

we dive in further, let's,

21:36

I'm gonna open this up so this is a question for both of you to decide

21:38

who's going to go first. We

21:40

love a story and we can't do

21:42

this. Paper, rock, scissors. I always say rock,

21:45

paper, scissors. I always say, oh, okay.

21:47

Paper, rock, I like it.

21:49

But I always do triple rock. Does anyone say scissors

21:51

first? Don't out me on my triple rock, though. That is

21:53

my go-to. Everyone, yeah. Oh, they're doing

21:55

it now. Okay, so someone's going first, and

21:57

we'd like to hear a little bit about your story, about how

21:59

you got to where.

21:59

in the field of sexuality, Paper

22:02

Rock scissors, go. They're doing

22:04

it. Oh, don't do Triple

22:06

Rock. Oh, yeah.

22:09

All right. So paper wins. All

22:11

right. So female sexual

22:13

health is a common issue that

22:16

many of my patients deal with as a urogynecologist

22:19

and they're all quality of life pelvic floor issues. But

22:21

it's the taboo and the stigma that keeps

22:24

people from talking about it. So a lot of our patients

22:27

don't mention their issues that they're having sexuality

22:29

until the very last minute of the visit. And

22:32

as they're leaving, you're about to leave the room, I call

22:35

it the door handle question. So that became a very common

22:37

question as to, you know, so how is

22:39

this going to impact my sexual health? Or by

22:41

the way, doc, what do I do about this? This hurts

22:44

or this isn't working. And it was always the

22:46

last minute question that made me think and realize

22:48

and started listening to patients. And we

22:50

realized that there's a big void because

22:53

of embarrassment, because I think they're

22:55

alone in this for a variety of reasons. Socially, people

22:58

just don't talk about, especially

23:00

female sexual health. And it just became

23:02

a very obvious niche for us to fill because no one

23:05

else is doing it. Patients are living in silence,

23:07

unfortunately. And that's sort

23:09

of how we just started embracing it. And

23:12

it took a while for us to really embrace it and

23:14

really get involved in knowing how to ask

23:16

questions, how to even approach a

23:18

patient about their concerns. Me being a male,

23:21

six foot tall ball guy walking in and asking about their

23:23

sexual health. I think you're like

23:25

six three. I got my clogs

23:28

on. It's like wearing heels. We're

23:33

giving them praise before. Shameless. Perfect.

23:39

So, yeah, so that's how it all started. And

23:42

it's just been, it's just blossomed ever since. So

23:45

what we're saying, we interrupt

23:46

you by being the six foot ball guy

23:48

like that, that that is you, they people

23:50

usually don't think you're the person that should be. Well, sure. Well,

23:54

how do you approach a woman

23:57

that you've never met about intimate concerns

23:59

that they haven't.

23:59

spoken to their own primary care doctor, their family member

24:02

about, because they're themselves are

24:04

embarrassed, and now here I am walking in the room,

24:06

asking about these intimate concerns. So

24:09

we've become very good about empowering

24:11

patients to come forward with their information. They

24:14

share the most intimate concerns that they've ever

24:16

had because

24:18

they've already tried, it's been dismissed, or

24:21

they're embarrassed because their family doesn't

24:23

talk about these things. And so

24:25

we find a way to empower them to talk

24:28

about these things in a way that is non-threatening,

24:30

non-judgmental. They feel completely

24:33

open and safe. And

24:35

it's a process, and when you come to

24:37

visit us, we can go through that process, what it'd be

24:39

like, but it starts

24:41

before they even get to the door, before they even meet us.

24:44

I mean, I felt like going there, but I already am like,

24:46

I'm feeling pretty confident talking about my sexuality. I'm going,

24:48

yeah, yeah. Well, Amy,

24:51

you had sent me Remy's, well,

24:53

I had Remy's info, but you were like, message

24:56

Remy about, because I'm 40, and

24:59

it's not even being 40, it's going through changes.

25:02

So, PMDD probably, or something major bitch syndrome.

25:11

What do you have? Psychopathic,

25:13

I'm going to

25:14

kill someone disorder, but I'm like, can you

25:16

bleed already? We're trying

25:18

to record. But before we get to that,

25:21

also, Remy, will

25:23

you please share more about you? Oh,

25:27

yeah, so I started off

25:29

in primary care here in Santa Cruz, and

25:31

really enjoyed that. I got into that too, because

25:34

I love developing relationships with people. And

25:36

as you develop relationships with people, then they

25:38

start sharing

25:39

more and more of themselves. And

25:42

things like about sexuality

25:44

come up. What I found in my primary

25:46

care office is that I just didn't have the

25:49

tools to really be able to help people.

25:51

So I really was diving into integrative

25:54

and functional medicine, and I'm really passionate

25:56

about those things, and found

25:58

it really hard to implement within. and the constraints

26:01

that I was in, and then overwhelmed

26:03

with just the amount of complexities

26:07

in primary care. And so I thought, okay,

26:09

if I specialize, what would I

26:11

specialize in to kind of narrow things down?

26:13

And I got really lucky, and

26:16

sometimes I would be at work late at night charting,

26:18

and I would look on Indeed, and

26:21

I found Swan Medical

26:23

Intimate Wellness with Dr. Castillo, and I

26:25

would kind of look at it sometimes, but I wasn't

26:28

sure if I wanted to apply, and then one night

26:29

it was like eight o'clock at night, and I was like, dude, that's

26:32

it, I'm applying. So Dr.

26:34

Castillo and I started a conversation

26:37

at that time, and it's

26:39

really become a wonderful

26:41

place to be able to

26:43

utilize my functional medicine skills and

26:46

still have relationships with patients and

26:48

help people in this way that is often

26:50

underlooked, and there's just not the tools available

26:53

within primary care, so.

26:55

It's been a great, it's been a

26:58

great. I had a groove over here, I was like, why are you

27:00

leaving Santa Cruz? Fuck, and then I

27:02

was like, okay, this. You did have a grieving. Yeah, I was

27:04

like, Abby's gone! And then also

27:06

I was super stoked because you were so happy. Yeah,

27:08

and then I'm going over the hill now, and

27:10

I've been there, and I love what you all are doing though, and I just

27:12

wish it was something that everyone could

27:15

experience. Maybe we could talk about that, how people can access

27:17

this, but. This is also something

27:19

important for anyone to note out there. It's not

27:21

just about aging and hormones

27:24

or hormone imbalances.

27:26

Because I don't know. Something

27:29

that changed, a lot of folks are still on

27:31

birth control, or they're on some kind

27:34

of contraception. Maybe

27:36

it is hormonal. If you are a woman

27:39

out there, and a vulva owner, that

27:41

is anywhere from, I don't

27:44

know, 18, I guess we're supposed to be 18. 18, that's

27:46

what we're talking to. Okay, yes, 18 and up. We'll

27:48

be safe. Then things

27:50

happen every week with your body,

27:52

and sometimes every day. Every day. I'm

27:55

trying to go weekly right now, because we only launch on

27:57

Tuesdays. Mine's different every day. Yeah. but

28:00

it is different every day. And

28:02

I felt like I hit a point in my life where

28:04

I wasn't on any sort of hormonal

28:07

birth control, thankfully, that I was

28:09

so grateful about because I was

28:11

starting to understand my body. And having

28:14

this 40 point was a point where

28:17

I really recognized a situation

28:19

with where my hormones just took a

28:21

weird turn. And my

28:23

mom didn't have anything to share with me. And

28:26

that's why it's like having access to folks

28:28

that are on the medical precipice

28:31

of like, oh my God, this is what you need

28:33

to do. Or this is what maybe you, because

28:36

it's not like you shouldn't have done that. You shouldn't have done that.

28:38

It's like, hey, this is what you can do. So

28:41

yes, and even if you are on hormones

28:43

or birth control, or even if, because this

28:46

is so, I'm trying to get to is that

28:48

it's for everyone listening, whether

28:50

even if your partner was someone that is. Well,

28:52

I have some penis questions on here too. And there's penis

28:55

owners. There's penis owner questions too. They have hormones too,

28:57

right? I'm pretty sure, wait, do penis owners do hormones? They

28:59

do.

28:59

Do you have hormones? Do penis

29:02

owners man straight? I've been dying to ask

29:04

this. I knew it. It's real.

29:06

Is it? Oh my God. So really? Seriously?

29:10

I mean, I think so. Which question? Man-strating?

29:13

Yeah, man-strating. I

29:15

feel like they do. Andropause? Yeah. Okay.

29:18

They do. They really do. So. Yes.

29:22

The misconceptions out there that keep people

29:24

in the dark are that testosterone

29:26

is a male hormone, and estrogen is a female hormone. We

29:28

both need both. Different quantities,

29:31

similar ratios. In fact, women make 10

29:33

times more testosterone than estrogen for half

29:36

of their life. But who talks about that?

29:38

If you think evolutionarily, it's necessary. Back

29:41

in the Stone Ages, when you were young, you'd need

29:44

to procreate, defend your tribe, forage for food.

29:46

You have to take care of your tribe. But

29:49

then by 30, you're no longer that person. You're

29:52

now rearing the children while somebody

29:54

else is fighting the battles and foraging for food.

29:57

So testosterone drops off significantly

29:59

for...

29:59

women after 30, between 30 and 40, it loses

30:02

about 50%.

30:03

I knew it, I knew it, I'm sorry. Right,

30:06

so the same thing happens with men. Men have

30:08

testosterone dominance and

30:10

estrogen in a narrow range, and their tolerance

30:13

to them. But as they get older, they

30:15

go through a process of testosterone

30:18

loss called hypoandrogenism or

30:20

menopause. Menopause.

30:22

And what happens is their performance

30:25

suffers and drops off just like women do. But

30:28

because men can produce testosterone in their whole lives,

30:30

that's why some can father children at 90, which

30:32

I

30:33

don't know if anybody would want to do that. Sounds

30:35

exhausting. It does. But many

30:37

men will drift off. So typically, after 50,

30:40

they drop off significantly. Right around the

30:42

same time as women dropping off in

30:44

their hormone production.

30:46

Interesting. So this is

30:48

just- So menstruation though is a thing too, right? Every

30:50

month. Manopause. You're talking about

30:53

hormonal changes where all of a sudden they're

30:55

like- I always tell my partner, I'm like, you're menstruating right

30:57

now. You're being really intense. Being

31:00

a cousin of McPheagle. Yeah. This

31:03

is not a question. This is just a fact right

31:05

now in my life. Yeah. So

31:07

we curated this podcast to be just about us, just

31:09

so you guys know. So you came here to just answer our

31:11

questions. Okay. So we

31:13

talked about menopause and menstruation. I want to ask this question

31:16

about April Yumek said this when she came here

31:18

last time. So she was on her show and she told us that

31:20

you, Dr. Castillo- April Yumek. Yumek,

31:22

too. Yes. You're one of

31:24

the pioneers. One of the pioneers in a specific

31:27

form of laser technology or there's something that you

31:29

and maybe some other folks did that is very unique

31:32

in this field. Hayden, please tell us

31:34

more a little bit about this unique work.

31:36

Sure, sure. How to narrow this down.

31:38

So about 15 years ago,

31:40

there was the

31:42

realization that there's not enough being done for

31:44

women's vaginal health, particularly

31:46

the breast cancer survivor. What do I mean

31:49

by that? A lot of the vaginal health

31:51

problems that fall under the umbrella of GSM,

31:54

which is the Regenerative Urinary Syndrome of menopause, lead

31:56

to vaginal dryness, painful intercourse, urinary

31:58

symptoms, UTIs. the gamut of anything

32:01

that happens here are genital tissues. Well,

32:03

the same process happens to

32:05

breast cancer survivors at a much more accelerated

32:08

rate. So they really do suffer. And

32:10

because of the beliefs that they shouldn't have any estrogen

32:13

because they're breast cancer survivors, they're

32:15

not given options. So for them, they have

32:17

no options. And they've started... Someone

32:19

was brave enough to kind of

32:23

delve into new territory using lasers

32:25

to restore vaginal health. So

32:27

the concept of vaginal rejuvenation is this very

32:30

nebulous term. It's vaginal resurfacing,

32:32

vaginal therapy to restore the vaginal

32:37

characteristics, the natural healthy

32:40

form of the vagina back to

32:42

premenopausal states based on histology.

32:45

So that was done in a hospital

32:47

in Italy 15 years ago. And

32:49

they were true pioneers because who would ever

32:52

think to put a laser in the vagina to

32:54

restore vaginal health? And we've always treated like an organ.

32:58

So anyway, that fast forward,

33:00

we started getting involved with early research

33:03

and seeing how does this really work? What

33:05

is the proper technology to use for this?

33:08

And is this really safe for anybody

33:10

who's going through menopause or changes

33:13

vaginally? So that's really where it all started.

33:15

And that started for me about seven, eight

33:17

years ago. So this is related to the DVA? This

33:20

is related to any vaginal therapy. We

33:22

have several devices in our office. DVA is probably

33:24

our most robust, well-rounded device.

33:26

And this focuses so primarily

33:29

on the vaginal canal where there's a

33:31

lot of musculature, right? Because

33:33

a lot of folks out there aren't familiar

33:36

with the anatomy. Sometimes I'm like, do you know where your

33:38

cervix is? And they're like, I have no

33:40

idea. What cervix? So it's

33:42

not going deeper into like, does

33:46

it reach, does it touch the cervix? Because

33:48

there's a lot of things that

33:49

are going on in there. There's a lot going on in the vagina, sure,

33:51

sure. So what lasers treat

33:54

in the vagina is skin.

33:55

It's not treating muscles, not treating the uterus, not treating

33:57

cervix. It is really just skin.

34:00

And if you're talking about just vaginal therapy, you're

34:02

treating just the canal from the top

34:04

to the bottom, all the way down to the vestibule, just

34:07

beyond the hymen. So the vaginal

34:09

laser therapies really do restore

34:12

health in a simple way. What happens

34:14

when you injure tissue? You get a new skin,

34:16

you don't get old skin. So if you can control

34:19

the injury in a way that's gonna give

34:21

you brand new skin, you have a

34:23

menopausal woman that can have premenopausal

34:26

vaginal skin through resurfacing, which

34:28

is really outstanding because it's a game changer

34:31

in how we treat women's GSM

34:33

symptoms.

34:33

And so their experience with that, we've

34:36

talked about it a little bit with April, you,

34:38

Mick, I keep saying her name incorrectly, but we talked a little

34:40

bit with her and their experience with this

34:42

is more pleasure experience. Well, people

34:45

know that people that undergo this experience

34:47

that lasers is more pleasure,

34:49

more sensation.

34:50

Variety of symptoms. So

34:53

vaginal dryness for sure leads

34:55

to painful intercourse. Having pain

34:57

and intercourse don't go hand in hand. It's

35:01

a complete negative feedback to the whole

35:03

sex cycle. Urinary issues,

35:06

UTIs, urinary incontinence, and

35:08

then loss of sensitivity. The

35:10

problem with aging is that there's

35:13

a negative impact on sexual function, whether

35:15

it's because of just natural mechanical

35:17

changes to loss of libido and hormonal

35:20

loss to orgasmic response. So

35:22

that's really what our focus is, and lasers were just

35:24

sort of an entryway for us to get into

35:26

this space. We really sort of double down

35:28

into really getting involved in women's sexual

35:31

health. And having Remy's

35:33

input from a functional medicine standpoint

35:36

really rounds it out because we're not just

35:38

dealing with aging and sexual function,

35:40

we're also wellness and aging because

35:42

we're living longer. We all want to maintain sexual

35:45

function. So really we should be rounding

35:47

out, not just treating the root cause, but

35:50

then rounding out their lives as they're moving forward

35:52

in their health.

35:54

Time for a quick break so we can tell you

35:56

about our carefully chosen sponsors.

35:59

Please stay tuned. and buy their products

36:01

because we only tell you about what

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in and it helps keep this

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podcast free to you.

36:10

So how do you apply that Remy then coming

36:13

to Dr. Castillo's office that is now

36:15

your combined office? How do you bring the functional medicine

36:17

in there with the sexual health? Like what does that

36:20

look like when you're working with a patient? Yeah so

36:22

there's a variety of techniques one of them I brought.

36:24

Ooh do we get a diva right now? Oh

36:28

wait we have that we haven't tried yet. So

36:31

there's the amazing laser so the

36:33

vaginal laser the diva laser which works

36:35

really well when paired with other things

36:38

that help to improve the function

36:40

of the

36:40

vagina. So we use topical

36:42

estrogen because that's one of the

36:44

things as our estrogen levels decline that's

36:47

what can predict the vaginal

36:49

atrophy which leads to dryness and painful

36:52

sex so we use that for people.

36:54

Vaginal atrophy which for everyone because some

36:56

people are like what the fuck is that can you tell

36:58

folks out there? Yeah so vaginal

37:01

atrophy or another term for it GSM,

37:03

Genital Urinary Syndrome of menopause

37:06

is where our tissues when we lose

37:09

estrogen in our body our tissues

37:11

start to dry up they don't regenerate

37:14

as quickly we lose the pliability

37:16

and the elasticity and so sex

37:19

can painful we can see an increase

37:22

of urinary tract infections we

37:24

see a decline in

37:27

lactobacillus in the vaginal microbiome

37:30

and so we see all these changes that

37:32

just are on a downward spiral that can

37:34

lead to really big things later on in life.

37:37

So and that happens during is that pre-der

37:40

can happen probably anytime menopause

37:43

is kind of a spectrum so there's this whole

37:45

perimenopause and so it can start

37:47

anywhere from and it varies from

37:50

person to person but anywhere from our mid

37:52

to late 30s and then kind of continue

37:55

on throughout the lifespan. So that's what's been happening.

37:57

Damn not for you oh you

37:59

mean well you

37:59

Okay, I see. Well, I see. Well the vaginal

38:02

wet like so it's interesting

38:04

because I thought so vaginismus That's

38:07

a different that's different. Yeah, that's

38:09

the clenching of the pelvic floor Yeah,

38:11

okay. Yeah, would you probably work with

38:14

all these things though? Because how much time do you have?

38:16

There's

38:20

comprehensive things that we can do so

38:22

the laser is one thing and then you might add in

38:24

you also vaginal estrogen And

38:26

then you might use something like the v-fit plus

38:29

that I brought out here. That is something

38:31

that somebody could do at home That's

38:33

a vaginal exerciser with this amazing

38:35

red light therapy. And so all

38:38

of those can complement each other Okay, so

38:40

this has the infrared and I and if

38:42

we receive these and it vibrates as well And

38:44

if my writers X mine sitting by my nights

38:46

in It's

38:48

charged Yeah,

38:51

me too I want to have a self date Maybe

38:56

join us where I make my face Unused

39:02

but this is the demo for really cool.

39:05

It's very sexy And I

39:07

haven't I haven't passed out of the box, but it looks

39:09

easy to have in your body So

39:12

the infrared do you have strong feelings about

39:14

this infrared technology because I'm

39:16

dying to know about like this because

39:19

Susan Bratton was on our show and talks about the

39:22

for the cock and The

39:25

red and the pussy as well. However,

39:27

my partner used it for his cock is my cocking

39:31

No The

39:34

infrared is a wrap-around and

39:37

he said that it felt great and I and

39:39

he used it for three sessions He's 55

39:42

and I don't know what the benefits

39:45

are of using infrared But I

39:47

would love first to talk about that cock and

39:49

vulvas and anything in between And

39:52

then I don't even know if we know I have so many

39:54

questions That

39:57

one yeah, please

39:58

so the

39:59

The red light there, I'm not an expert

40:02

in red light therapy and some of those regenerative

40:04

areas. However, there's lots of great early

40:07

studies that demonstrate that LED wavelengths

40:09

or red light therapy is what a lot of people refer

40:11

to is very helpful

40:14

in activating increasing mitochondrial

40:16

activity, which is what is responsible

40:18

for a lot of our aging. So mitochondria

40:21

are what responsible for creating proteins

40:23

and proteins is what makes

40:25

the world go round. However, if as

40:28

a mitochondria age,

40:29

they are less functional. So

40:32

the concept of photobiomodulation

40:34

is what LED wavelength therapies are.

40:37

And they've sort of branched into all fields now. And

40:39

since it's still in the regenerative medicine

40:41

realm, it's still considered a very experimental.

40:43

There's lots of studies still need to be

40:45

done, but early studies show that there's some

40:47

benefits from hair growth to

40:50

skin rejuvenation. You can wear it on masks or

40:52

caps or full body ones. This

40:54

is the only, well, not the only device, but

40:58

this is one of the

40:59

intro vaginal LED wavelength

41:02

therapeutic tools. That you can

41:04

use at home on your own terms. That's exactly

41:06

right. And it's very safe to do. Has

41:08

several options, benefits to it.

41:11

One is the wavelength. The proper

41:13

wavelength matters. Just having a red light doesn't

41:15

do anything. So

41:15

I can't just put a red light bulb and like open my legs. No,

41:18

it's not. So it's not just a red light bulb at home.

41:20

I thought about this. Hello. Yeah.

41:22

No, it's different. Okay,

41:24

fine. It increases the

41:27

temperature of the tissue to 42 degrees Celsius,

41:30

which in the regenerative, in the

41:32

laser space, 42 degrees is where

41:35

increased collagen synthesis happens.

41:37

So that's a magic number here. 37 degrees and above is into 47 degrees,

41:44

is collagen increasing collagen synthesis,

41:46

increase in angiogenesis or more blood flow.

41:48

And that alone is a huge

41:51

benefit for vaginal health. So for

41:53

preventive needs, like are some of our younger

41:55

patients or patients who are just starting to

41:57

experience changes or if they've already.

42:00

had therapies and they want to help prolong their benefits

42:02

or do their own therapy at home. That's

42:04

where it's really helpful in that sense, in

42:07

the privacy of their own home and it's pretty safe to use. So

42:09

it's

42:09

supposed to be someone would come in and probably

42:12

do like the D.Va or something with y'all and then this

42:14

is for their home care afterwards because

42:17

it doesn't generally end or just like if

42:19

you did some sort of face treatment, right? It doesn't end then

42:21

like, okay, you're done. Like put it on the sunscreen,

42:24

take care of your face. So it's the continuation

42:27

of this process to take care of your body.

42:30

So you spoke to, so for penis

42:33

owners and you spoke to

42:35

something that your partner had tried. So the

42:37

technology behind that, like penis owners can

42:39

also do the same thing with the infrared

42:41

light. What do we call it? What do we

42:43

call it? It's for the cock. This is the V fit plus the V plus

42:46

that's for vaginal use. And

42:52

then the one that Susan Bratton introduced

42:55

us to is the, I

42:57

don't remember the name of it for it, but so it's supposed

42:59

to do like, so it's supposed to help with like erectile stuff

43:01

or. My understanding, I'm

43:03

not too familiar with the red

43:05

light therapy options for men. But

43:08

in theory you should be able to use it anywhere on

43:10

the body. There

43:13

seems to be ever increasing number

43:15

of devices and products out there now

43:18

and red light therapy has become one of those very popular

43:20

areas. So I wouldn't

43:22

be surprised if there's lots of products from it as

43:24

well. So exciting that we're in this time

43:26

where we have access to this, to

43:28

just all these different ways to like, to, to be

43:31

a vibrant sexual being from home.

43:34

Yeah. From home. We actually

43:36

had just like zoom, right? You can just do it from home and you can do it whenever

43:38

you want to. So okay. Question

43:40

about a fancy term in which I don't know if I already said

43:43

the show, but it's trying to practice or read earlier.

43:45

Ready? Is it Euro gynecology?

43:49

What the F

43:50

is Euro gynecology? We

43:52

can't say fuck anymore on the show. Sorry, what the fuck

43:55

is Euro gynecology? I

43:57

think Euro gynecology. It

44:00

used to be called urogynecology. Now it's called female

44:02

pelvic medicine and reconstructive surgery. Uh,

44:05

is there an acronym for this?

44:06

Yeah. There is. It's

44:09

the most silly thing. It's called FPMRS.

44:12

Okay, that sounds, that sounds,

44:14

that sounds. Right. So

44:16

it actually, over the last several years, it's

44:18

finally made sense to me that that's the, that

44:21

really describes what we do, but

44:23

there's so much more nuance in that field

44:25

within just urogynecology, all that

44:27

goes involved. So generally it was always

44:29

focused on pelvic floor disorders, pelvic pain,

44:32

pelvic organ prolapse, urinary incontinence.

44:36

But then of course, its impact on sexual

44:38

health. So there's, there's those that are, have interest

44:41

in the sexual function part. There's the

44:43

pelvic pain aspect of it, which is a whole

44:45

other realm and really requires, you know,

44:47

especially knowledge. So it's

44:50

the reconstructive part is understanding how the,

44:52

the, the female body and the re con, and

44:54

the orientation of organs and

44:57

the health of all those the connective tissue supports

44:59

within the cage of the pelvis work. And

45:02

anything you do, whether it's time related,

45:04

age related, trauma related, can

45:06

impact sexual function and its normal function,

45:09

just like intervention can impact sexual

45:11

function and any other function. So it's

45:13

a huge leap forward in the

45:16

way we manage a lot of the, the,

45:18

the common life events that happen in

45:20

women that impact their quality of life. So

45:23

having this, this more robust approach

45:26

to it, we're sort of like the quarter, the quarterback,

45:29

if you will, of a team. So between colorectal

45:31

urology and gynecology, and we kind

45:33

of help everything work.

45:35

Interesting. The quarterback. But

45:38

wait, so, but why, why

45:40

would prolapse happen? Oh,

45:42

these are, these are, yeah. So

45:44

the bigger question is, why is it that

45:46

women experience these, these problems?

45:49

And, and what's the incidence of these things? And

45:51

because people don't talk about it, only 30% of

45:54

women ever mentioned to their primary care that

45:56

they have any of their concerns, whether it's something

45:58

falling out of their vagina. urinary incontinence,

46:02

which if you ask some patients, do you have incontinence?

46:05

They say, oh, no, no, no.

46:06

Which is sneezing and peeing, jumping

46:08

and peeing, laughing and peeing, or just

46:10

not being able to control your bladder, or

46:12

what other things could be

46:14

considered incontinence?

46:15

There's a variety of different types of incontinence.

46:17

Did I sum it up? You

46:19

did a pretty good job. Elevator pitch

46:21

incontinence, I got it. You did great. Yeah,

46:24

and there's more. Yeah, and there's more,

46:26

and there's more. There's so many levels of incontinence, the two

46:28

most common type are stress incontinence

46:31

and urge incontinence. So those being,

46:34

just to give you an idea, 50% of women will have some

46:36

sort of incontinence in their lifetime.

46:38

Lifetime, I mean, until we live

46:39

to age 90 or something? Yeah.

46:42

Or 100, okay. Or 120. So those who

46:44

had children, 50% within

46:45

before menopause. Those

46:50

who haven't had kids, 50% will still develop

46:52

incontinence because of hormonal

46:54

loss, vascular loss, connective

46:56

tissue loss. So it's a very, very

46:58

common problem, but who would know these

47:01

things when nobody talks about it?

47:02

So Amy and I, so are

47:04

we, we're, we don't have children.

47:06

Neither of us has children. She's a 50% chance. So we have children.

47:09

Yeah, and I'm wondering if I can't

47:11

hold my, so right now, holding my bladder. She's got turbo

47:13

bladder by the way. I do have a turbo bladder. That's crazy. And

47:15

this is not about us, but there are people out

47:17

there that might think they're not prone

47:20

to having incontinence or I have a really

47:23

strong pelvic floor, I can hold my bladder or

47:25

I have to pee all the time. So I know that like

47:27

I can let out my, I have friends that are like,

47:29

I've had kids, but I'm fine with my, like

47:32

holding

47:32

my bladder. I never laugh and pee, but they haven't

47:34

gotten the aging process yet though.

47:35

That's exactly right. So

47:37

injuries happen usually with the first child,

47:40

but it doesn't manifest necessarily right away.

47:42

Some it's right away. Some it's years

47:45

down the road. For example, another type of

47:47

income is called fecal incontinence. So accidental

47:49

bowel leakage is a significant.

47:52

Is

47:52

that sharding? Are we talking sharding here? That's

47:54

part of it. Oh my God, thank you. That's

47:57

happened before. Okay, it's probably

47:59

just because you had too many.

47:59

Too many burritos. Yeah, too

48:02

many burritos. But

48:04

there's worse problems because birth

48:07

trauma, there's a

48:10

variety of types. There's those that are obvious.

48:13

They've had large episiotides, large tears. You

48:15

can see that, you can fix it. The vast majority of those

48:17

would do well. It's the ones that don't know that

48:20

it happened. So they didn't have a full tear,

48:22

but yet their anal sphincter is torn. But they don't

48:24

know that because 10, 20 years will go by

48:26

before they manifest.

48:27

Whoa, really? So they're

48:29

not having symptoms until, I can say manifesting,

48:32

right? So symptoms. As their aging. Yeah.

48:34

As their

48:34

aging, they're losing compensatory mechanisms, connective

48:37

tissue support, and then hormonal loss.

48:39

Wow. So you have no idea. And

48:41

then all of a sudden, then it feels like it's sudden,

48:43

but actually it was already happening. And hormones are

48:46

all tied into that. It's not just, wow. See,

48:48

that's something that you don't consider. So the

48:50

hormones, you're talking, there's like this,

48:53

the invasive and non-invasive

48:55

surgeries, but hormones can help with the

48:57

process of the repair of these kind of things.

49:00

It's a little harder to repair. So

49:02

hormones aren't the cause of all pelvic floor disorders.

49:05

In fact, most pelvic floor disorders happen

49:07

as a result of life events, chronic

49:09

forces, constipation, chronic coughing, childbirth,

49:12

extreme sports, right? So anything

49:14

that's repetitive chronic leads to

49:16

pelvic floor disorders could be prolapse

49:19

and confidence for pain, but then compound that

49:21

with time and then age and then hormonal

49:23

loss. So that's why it's such a common

49:25

problem as women get older, because

49:28

it either happened already and it's manifesting

49:30

or they're aging and it's gonna happen because of a

49:32

loss of hormonal support. So when

49:35

we talk about hormones as

49:37

a root cause treatment, it's more for the hormone

49:40

related changes, but the injuries

49:42

already happened. So those injuries sometimes

49:44

require surgery, sometimes require physical therapy,

49:46

sometimes require medical management.

49:49

So there's a lot of things

49:51

that can be done in this area. It's just so

49:54

much to talk about.

49:54

And dudes are not out of the question too.

49:57

Penis owners out there, they have to beware

49:59

as well. Like they can know. their own. They do.

50:01

Right. We actually, we talked about a recent

50:03

episode actually. We're like, can a penis actually break?

50:06

Can you break a cock? And like, actually, yeah, I think

50:08

you can. Yeah, you can. I don't know

50:10

if you, but you, so you're primarily working with

50:12

we're now coming out with a splint cock line.

50:14

Yeah. The cocksplint, shaven sex,

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power. The link is in the episode's

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52:53

But you're primarily working with vulva

52:54

owning folks? Primarily,

52:56

yes. Okay,

52:57

but you have knowledge around

53:00

this other world of other genitals

53:02

and bits. Are you also working with all the holes?

53:05

Are we working with asses too? Or are you all just focused on the vulvas?

53:07

Yeah? Yep, yep, absolutely. All the bits

53:09

and all the pieces. Okay, so I have a question

53:11

for you, because I've always wondered this, and this is a

53:13

little bit of a side note, but not really. Hysterectomies

53:16

have always freaked me out a lot, because I've

53:19

always thought that when you get all

53:21

of these parts taken out, your hormones are just all

53:23

out of whack and you're not sexually being. My mom had one at 33. There

53:26

goes your libido, the sex

53:27

is over, and you are now just

53:30

a human who doesn't really give a fuck about fucking.

53:32

Is that true? Are there things that you can do?

53:34

Like if I get all of my, if my uterus

53:37

and my ovaries taken out, and I think there's partial hysterectomies

53:39

to educate me on all these things, can I still

53:42

be a sexual being? Of course, of course. Absolutely.

53:45

You wanna take that? Yeah, take it with me. Yeah,

53:47

so hysterectomies sometimes are absolutely

53:49

necessary. Sometimes they are emergent.

53:52

One of my best friends had to have one after

53:54

childbirth, but a lot

53:56

of times they're able to spare

53:57

the ovaries and the ovaries are hormone.

53:59

So if we're able to spare the

54:02

ovaries, then that's great. Then we

54:04

still have our hormonal capacity. But

54:06

even with that, sometimes somebody can have a hysterectomy

54:08

and still an experience prolapse

54:10

as a result of the hysterectomy. So

54:12

that could be a part of that as well. So what would

54:15

be the reason why you would take out the ovaries then? Would

54:17

that be like you're having ovarian cysts and it's

54:20

problematic

54:20

or no? Yeah. What

54:23

would be the take out all the pieces? Generally.

54:25

Generally. So first

54:27

there's a misconception that that's constantly

54:30

going on is that I had a partial

54:32

hysterectomy. So a partial hysterectomy

54:34

means that just the uterus, not

54:36

the cervix was removed. The

54:39

hysterectomy does not imply ovaries. So

54:41

a total hysterectomy, you can have a total

54:43

hysterectomy and keep your ovaries. So meaning

54:46

this uterus and cervix. And that's important

54:48

because when you're counseling patients about

54:50

whether they need pap smears or not, I need to know if they

54:52

have a cervix. And if they have ovaries

54:54

behind, do we need to continue monitoring for issues?

54:57

They

54:57

still bleed if they have their ovaries

54:59

or you need your cervix and your ovaries,

55:04

what do you need to bleed? You need

55:06

a uterus to bleed. Okay. Your uterus

55:08

is the one my mom had everything removed

55:10

and she never bled again and she's

55:13

like, you're taking a uterus out sub bleeding

55:15

is done, but you

55:18

can still have a cervix

55:18

and ovaries. Yep. Okay. Okay. So

55:21

yeah. So the issue is removing

55:23

ovaries in a young woman leads to early

55:25

menopause. So surgical menopause is very detrimental

55:28

to health. In fact, one study showed a

55:30

lifespan being shortened if ovaries

55:33

are removed before the age of 55. So

55:35

that's why only really over should be

55:37

removed in a young woman. If there's an absolute

55:40

need like cancer or

55:43

massive trauma, you end up losing the ovaries for some reason,

55:45

but it's generally you preserve the ovaries until

55:49

55 or older, but after menopause,

55:51

when you're no longer having kids, the

55:54

uterus doesn't provide hormones just to make

55:57

that clear. So the uterus doesn't provide hormones

55:59

is only. the ovaries. So you can have a hysterectomy and

56:01

be fully functional, meaning all your

56:04

ovarian production, you'll continue to ovulate. You just

56:06

want to have a sign of it. One question

56:08

is what happens to the ovaries if you remove

56:10

the uterus? The ovaries have shared blood

56:12

supply from the aorta and from the

56:14

uterus. So when you have a hysterectomy and preserving

56:17

the uterus, by default, you've lost 50% of

56:19

the blood supply. So there is some suggestion

56:22

that there may be earlier onset

56:24

of menopause as a result of just

56:26

having a hysterectomy, even if they kept the ovaries,

56:29

but there's no way to measure that.

56:30

Interesting. I just think it's

56:32

wild that I don't know a lot

56:34

about what happens when people

56:36

are wrecking. Like my mom, when she

56:38

had her hysterectomy at 33 years

56:41

old, I remember when she said ovaries as well. She had,

56:44

I remember her getting, she told me everything.

56:46

So back then, I don't know like

56:49

exactly what, because I was, I don't know, it was like

56:52

nine or 10. Maybe she thought it was everything,

56:54

but it's just the uterus. I have asked her why

56:56

they took everything. She's never had a period

56:58

or anything since she was 33 and now she's in her sixties

57:01

and they didn't tell her. They just took, they

57:03

just, they just took it. I don't know. I

57:05

mean, that's a thing though. Not as much.

57:07

It is. And I believe you are there, Amy. When

57:09

I asked her about it and I've asked her about it again and she's like, I

57:12

don't know, April, I just trusted the doctors.

57:14

And then she's never had any sort

57:17

of, um, obviously cancer

57:19

or anything in her reproductive organs after

57:21

that, but she's never had a period

57:24

and she's never, the hormonal shifts,

57:26

I guess that would occur normally in people

57:29

that are, so she's never had menopausal. I've never been

57:31

able to ask her these things. And so it's

57:33

confusing for me because the information

57:36

I received from her when I was aging

57:38

and as I've been aging are really weird

57:40

because I feel like you want to go to your mom or

57:42

you want to go to friends. And so I

57:45

feel like I've also asked other people

57:47

and they're not sure what is it my cervix

57:50

or my ovaries or what it, what,

57:52

what does what, or what, what produces

57:55

hormones. And I'm only voicing

57:57

this because I feel like I'm an educated

58:00

And I don't know. So I feel weird about

58:02

even being like, oh, really? I didn't know

58:04

that. Who knows? That's exactly why.

58:06

So I'm so thankful to have you here. And

58:09

I'm just voicing that. So thank you for even

58:11

enlightening me a bit with this.

58:13

So, you know, and probably Remy would

58:15

probably concur is that, you know, it wasn't

58:17

that long ago. The medicine was very patriarchal

58:20

and hysterectomies were the most common procedure done. And

58:22

it was, it was, seemed as a,

58:25

as an elective organ, right? But then

58:27

if you're there, remove the ovaries. They didn't understand

58:30

what the consequences of early menopause

58:32

were for women. And now that we're living longer,

58:34

we're seeing the difference. I mean, the

58:37

health conditions that are catching up, cardiovascular

58:40

disease, dementia, osteoporosis are all as

58:42

a result of hormonal loss in part

58:44

of, not to mention environmental factors and poor

58:47

choices. You know, but, you

58:50

know, it's a shame that a lot of women back

58:52

in the day would have hysterectomies and not

58:54

understand why. They thought, oh, cause they

58:56

thought I was done having kids or because,

58:59

you know, the doctors thought that

59:01

that was the best way to help them stop their period

59:03

since they're done having kids. And it's just unfortunate

59:06

that they didn't ask questions and doctors

59:08

weren't very good at telling back then. But nowadays

59:11

it's different. Hysterectomy volumes have dropped

59:13

tremendously.

59:15

And because so many options. She

59:17

didn't even remember where it was. They took every,

59:19

like, I think that's fucked up to me. Wasn't there

59:22

something with hysteria? Yeah, hysterical.

59:24

So you take it out to the hysterectomy.

59:27

Yeah, you do a hysterectomy. But you

59:29

know what? The vibrator solved all the problems. Where

59:31

the vibrator came from, you're hysterical. So

59:34

we have to do this thing. And it started with the hand technology,

59:36

like a man using a hand on a woman. And all of a sudden

59:38

they're not crazy anymore. Really, they were just

59:40

depressed because they weren't having orgasm. Their husbands kind

59:42

of suck, but you know. And so then they

59:44

started having

59:45

orgasm hands. And then all of a sudden there's these big

59:47

devices that are being used. But yeah, you

59:49

would take, you do hysterectomy to, and

59:52

then now they're subdued. So they can't, they're

59:54

not complaining anymore

59:54

or something. You know, it's fine. It's amazing

59:57

when you really look at history. When is the most common

59:59

time for women to have sex?

59:59

have a hysterectomy to have their uterus removed, it's

1:00:02

around menopause. Why? Because

1:00:04

as they're going through their erratic

1:00:06

cycles, their erratic cycles

1:00:08

cause ranges from PMS to depression

1:00:11

in one month. And they're just going back

1:00:13

and forth. And their uterus is responding, so

1:00:16

they're bleeding like they've

1:00:18

never bled before. So they're having

1:00:20

a hysterectomy because of massive

1:00:23

blood loss and coincides

1:00:25

with what they used to believe is hysteria. They're

1:00:28

going through this emotional rollercoaster at the same time,

1:00:30

so why not take out the uterus? It made

1:00:32

sense in their way of thinking back then. But

1:00:35

really, they just need their hormones back.

1:00:37

Yeah, or they also need a

1:00:39

lot more support, love. This

1:00:41

is gonna be like a last

1:00:43

question, but we're not doing the podcast quite yet, but I'm just

1:00:45

gonna go into this right now. Which I think that, cause you

1:00:47

all, your work with people,

1:00:49

I know Remy definitely does this because I work with Remy

1:00:52

even before she worked with you, it's very personalized

1:00:55

beyond just the medical thing. There's like the,

1:00:57

how's your emotional life? And

1:01:00

there's that aspect there that I think is really important. So

1:01:02

what is your top advice for folks who are

1:01:04

going, or in a relationship with someone who's going through

1:01:06

hormonal changes, and they're

1:01:09

hysterical, they're going through menopause, they're

1:01:11

crazy, or manopause, or all of the pieces.

1:01:14

How do you support someone when you're seeing these body

1:01:16

shifts, or you're like, hey, just your bat shit and

1:01:18

you're going through menopause right now? Or like, how

1:01:21

are you someone that is really supportive in a

1:01:23

way that is helpful? Can you help them?

1:01:25

Yeah, is there a way to help them? Lovingly.

1:01:28

I feel like there's just so much education,

1:01:31

just kind of learning. One of the things I use

1:01:33

in my hormonal consults, as I say, I have

1:01:35

the squiggly line graph, and it's

1:01:37

got a squiggly line of estrogen

1:01:39

and progesterone. And it talks about how

1:01:42

during our reproductive years, those might be in

1:01:44

a really good balance. And then there

1:01:46

are teenage years, everything's crazy. And

1:01:48

so I have my patients who have teenagers at home. And

1:01:50

then if they are in menopause or perimenopause,

1:01:53

then we see that estrogen and progesterone

1:01:55

just get all catawampus. We might have really

1:01:57

high levels sometimes and really low levels.

1:02:00

other times. And that's when we get things like

1:02:02

the really heavy periods worsening PMS.

1:02:05

And then we might also get sleep disruption

1:02:07

as a result of progesterone just trickling

1:02:09

away, then we might get start to get hot

1:02:11

flashes as we get lower and lower levels

1:02:13

of estrogen. So it's kind of a time

1:02:16

of chaos. And so just being

1:02:18

able to understand that and educate

1:02:20

yourself and then seeing what you could do about it.

1:02:22

There's a lot you can do. And there's a lot that we can

1:02:24

do in perimenopause to help

1:02:26

reestablish the balance. So I say,

1:02:28

I'm not crazy. Hey,

1:02:29

partner. So I'm going through the

1:02:32

pause. And it's not but

1:02:34

sometimes I'm wondering if you pause with Yeah.

1:02:38

And when people say that I kind of have

1:02:40

been, I don't, I'm gonna be shameless

1:02:42

here. I've been getting offended about

1:02:44

it a little bit where I'm like, I'm not perimenopausal.

1:02:48

One of our close friends said that and you've said that Amy

1:02:51

to me and I'm like, No, I'm too

1:02:53

young. And, and I get it. It's not

1:02:55

a bad thing. That's not a bad thing. It's

1:02:57

not like it's not you're saying something bad about me, but I

1:03:00

did think it was negative. And I want

1:03:02

to, I want to shift that within my own

1:03:04

brain. And I also want to shift that for anyone out

1:03:06

there. Because to me, it felt like when

1:03:08

people when I was younger, and I was bitchy, when

1:03:10

I was like, before I got my period, like, are you getting your period?

1:03:13

And I was like, go fuck yourself. And

1:03:15

now I feel like I'm with that with perimenopausal.

1:03:18

And I'm like, No, but I want to

1:03:20

delay the effects of

1:03:22

my body. Not responding

1:03:25

how I want it to, hormonally,

1:03:28

to be able to be sexual, I want

1:03:30

to not be a fucking asshole, sometimes

1:03:33

out of the month. And I want to like, still

1:03:35

because I don't want my body to start to, to

1:03:37

do what you want. You want you want to keep

1:03:40

on being juicy.

1:03:42

So my question is like, how, like, how can

1:03:45

I do that? Is there a time when that

1:03:47

it's that is the optimum

1:03:49

time? Like, how do you know when?

1:03:52

When is the time? When do you go to Dr. Castillo's

1:03:54

office? Yes. Sure,

1:03:55

sure. Now this is this is perfect.

1:03:58

There's so many directions we can go with this.

1:03:59

So here's the reality

1:04:02

is that you mentioned something, everything you just mentioned,

1:04:05

you've prefaced with want. I

1:04:07

want to keep lubricated. I want

1:04:09

to feel normal. I want to stop being bitchy. I want to start

1:04:12

feeling better. These are wants, but

1:04:14

when you go to your doctor's office and you go to

1:04:16

your insurance for clearance and authorization for things,

1:04:19

they're looking for needs. This

1:04:21

is a want. So this, and yes,

1:04:24

this is normal. So the first

1:04:26

thing I always tell my patients is, one is

1:04:28

to validate what they're

1:04:29

feeling. It's like, this is normal.

1:04:31

This is correct, but it doesn't mean you have to accept

1:04:33

it.

1:04:34

How you age is your choice. And

1:04:36

if you have options, let's take a look at those. But

1:04:39

you're not going to hear from us that, well,

1:04:42

this is the way it is. Well, of course you're going to feel this way.

1:04:44

You're a metapostle. Of course that happened. You had kids.

1:04:47

Those are just events in a person's

1:04:49

life. You shouldn't define them. They shouldn't define the way

1:04:51

they live the rest of their lives. So by

1:04:54

validating them, hearing them out, giving

1:04:56

them options, letting them know that there's choices, now

1:04:59

they can make all the choices they want and they can

1:05:01

be happy with those choices as opposed to just saying,

1:05:03

well, here's a prescription for antidepressant.

1:05:04

You'll be fine. You'll get over it.

1:05:06

Yeah, that's, yeah, just

1:05:08

throw a pill at it. Well, and that's remember, Rumi, when

1:05:10

I called you in the last like six or eight months,

1:05:13

because I won't name names, but I went to a doctor

1:05:15

because I felt like my libido was on

1:05:17

the lower side for I'm 38 and I

1:05:19

felt like it was kind of this, it

1:05:22

had been there for years and it'll go up with like

1:05:24

that natural, like I'm walking down the street and just feel

1:05:26

horny sometimes. It was super

1:05:28

rare and it was this, and I know I'm like a co-creator

1:05:31

of my libido and my arousal

1:05:33

and I saw a, again, not naming names,

1:05:35

but saw a gentleman here somewhere in Santa

1:05:38

Cruz and described this, you know,

1:05:40

and I'm unhappy. So it was a want. I call

1:05:42

him a dude. It was a dude, a dude, but it was a

1:05:44

want, but he was like, well, that just sounds normal for you

1:05:46

and that's just how it is. And I was like, well, he didn't say that's

1:05:49

how it is, but that's just sounds normal. And instead I can't

1:05:51

go to the insurance companies and say

1:05:53

this is actually a problem, but it is a problem for me. You

1:05:56

just clicked something in my brain with the want and the need thing,

1:05:58

which is interesting. is a need for me

1:06:00

because I'm a sexual being and I wanna be very

1:06:02

alive and I wanna feel and live to my

1:06:05

optimum potential and I know people

1:06:07

who are 38, 45, who, you

1:06:10

know, 50, who don't feel this. And

1:06:12

I feel this and so I feel like there are things that I can

1:06:14

do and I'd like to check it out and you know, so that's why

1:06:16

I was like, Remy, I'm mad, I'm coming to

1:06:18

you now. And since then,

1:06:21

since coming to see you and I'm doing the testosterone

1:06:23

cream right now but I'll be on the pillow soon. Well that's when I was bitching

1:06:26

to you, you were like, text Remy and then I text

1:06:28

you and now I'm going to get my, because I

1:06:30

do, I wanna feel balanced. We're taking

1:06:32

it so we, as people, when we have

1:06:34

access, so if people don't have access,

1:06:36

then I wanna have, you know, have

1:06:38

honored that because not everyone has access, we have access

1:06:41

to that. We're at this time and place where we can

1:06:43

access this and take this in our own hands

1:06:45

or you know, take your hands on me and give me some cream or pellets.

1:06:48

And I'm grateful

1:06:51

for that. I'm so grateful to not have a man

1:06:53

tell me, you can't be this and this is how it

1:06:55

is, get used to it. Instead I have,

1:06:57

well, there's this nice, you know, six foot plus

1:06:59

bald man here who's saying, no,

1:07:02

you actually, yes, this is normal and you

1:07:04

also have other options. And then I have

1:07:06

Remy who's like, yeah, you could be whatever you want.

1:07:08

Let me help you. Yeah. And I

1:07:10

just, I just love them. So grateful for that. And

1:07:13

I feel so much more juicy

1:07:15

and alive in my body and I only know it's gonna get better.

1:07:18

Are there options for folks out there? What

1:07:21

do you think if they don't have access

1:07:24

to you, too, beautiful humans that

1:07:26

are helping not only us, but everyone

1:07:28

in this community, in this

1:07:29

area, what do you suggest

1:07:32

the first kind of steps would be? I think

1:07:34

they're starting to be more and more

1:07:36

options. So I think they're starting to be more

1:07:38

of a realization. I love that both of us both

1:07:40

came from mainstream medicine.

1:07:43

And I think it's really inspiring Dr. Castillo's

1:07:45

story where he was working as a Euro

1:07:47

gynecologist, working on all the structure and

1:07:49

then realized there was such a hormonal

1:07:51

component that was not being addressed.

1:07:53

And then there was such an intimate wellness area

1:07:56

that wasn't being addressed. And so I think

1:07:59

that.

1:07:59

we're gonna start seeing it more and more. One of my patients

1:08:02

recently said, Opa's going through menopause,

1:08:05

and so now she's gonna bring national attention to

1:08:07

this. So are you ladies, too. I

1:08:12

mean, your podcast is amazing. It's been really

1:08:14

inspiring for me in my journey. I wanted to mention

1:08:17

that as part of my path in terms of looking

1:08:19

into working in intimate wellness and

1:08:21

saying like, oh, there's things to be talked about. I need

1:08:24

to address this with my patients. We're

1:08:26

all doing this together. Yeah, all

1:08:28

are.

1:08:28

I consider it a new sexual revolution.

1:08:31

So women's sexual health is becoming a much more

1:08:35

prevalent or common discussion, conversation.

1:08:37

It used to be taboo, stigmatized.

1:08:40

You don't talk about these things. And if you ever

1:08:42

go to your doctor's office, oh, but that's not

1:08:44

a health problem. That's

1:08:46

a lifestyle choice. And that's

1:08:48

unfortunate because it's an important part of life, part

1:08:51

of relationships. So

1:08:54

there's a lot more interest now. There's societies

1:08:56

out there. I always get this wrong. The

1:08:58

Ishwish, so International Society of Sexual Health and

1:09:01

Study for Sexual Health in Whitman. I

1:09:03

always get it. Ishwish, just call it Ishwish. It's

1:09:06

an example. But there's so much

1:09:08

more. And now with internet and social media, there's much

1:09:11

more recognition and acknowledgment that you

1:09:13

don't have to just keep it quiet.

1:09:16

So it's becoming much more of a common conversation. So

1:09:18

there's options. There's growing from devices

1:09:21

to peptide therapies, to

1:09:25

even the increase in sex therapists.

1:09:30

So there's lots of options, really depending on

1:09:32

where the problem is, what the condition

1:09:34

is. And maybe in 20 years, we'll be

1:09:36

at a place where insurance will cover your

1:09:38

great sex therapist and hormone replacement

1:09:40

therapy, or five years or 10 years or something. And

1:09:43

maybe we are in that revolution. I love that idea

1:09:45

that we're getting into that place of

1:09:48

embracing what is available

1:09:50

to people and we're not living. You

1:09:53

can say, Dr. Castillo, you can talk about the patriarchy. We

1:09:55

can't hear because our listeners hate it, but you're a man, so you can say

1:09:57

it. You're cool. So I'll just say.

1:09:59

of the Haterade out there, but

1:10:02

I'm super grateful

1:10:03

where we are now. But you know, it's not just men.

1:10:06

It's not just men at all. And

1:10:08

it was a little disappointing for me to hear. I remember

1:10:11

as a story that kind of really fostered my

1:10:13

commitment was many years

1:10:15

ago, when I first left my past

1:10:18

life and went into private practice and

1:10:21

we started getting busy and I ran

1:10:23

into a colleague and she asked me how

1:10:25

things were going. I said, wonderful, just

1:10:28

not in a way that I was expecting.

1:10:29

And she said, what do you mean?

1:10:31

Our sexual health side is really taking off. That's

1:10:33

where a lot of our patients are coming for help. And

1:10:36

she said, well,

1:10:38

if that's not a first world problem is, I don't know what is.

1:10:40

Oh, wow. And yeah,

1:10:43

and I was, but it made me realize that

1:10:46

we're all subject to the same thing. Doctors,

1:10:49

male or female, we only know what we know and

1:10:51

we're trained to think one way and sexual

1:10:54

health is not a big part of it. So the longer

1:10:56

you practice in that world, the

1:10:58

deeper those beliefs stay. And

1:11:00

that's why there's not a lot of information

1:11:03

out there when you go to your, when most doctors, because

1:11:05

none of us know how to talk about

1:11:07

it. And that's why we have these specialty fields, just

1:11:09

like what we do or there's sex therapists

1:11:11

aside from a therapist who, you know, your

1:11:13

traditional therapist only needs like 10 hours of sex

1:11:15

education, whereas a sex therapist does a lot more.

1:11:17

And so for you all, you have chosen to spend a lot

1:11:20

of time, energy and focus and continue education

1:11:22

to this day and beyond to focus

1:11:25

on the sexuality field, whereas

1:11:27

some other folks in similar fields are not doing

1:11:29

that and it needs this. I

1:11:32

want to ask something before, because I don't want to

1:11:34

end this right, just a second. If

1:11:36

there are prompts,

1:11:37

anything for folks outside

1:11:39

of this area that you could encourage

1:11:42

them to ask their practitioners, if

1:11:44

they're feeling inspired to go

1:11:46

and talk about their sexual health, are there any

1:11:48

questions that you would suggest

1:11:51

for those folks to ask out there, even just

1:11:53

general things, because it's difficult to find the words

1:11:55

sometimes. I know that I have found it difficult

1:11:58

to find the words, whether it's about horror. hormonal

1:12:00

imbalances or sexuality because like

1:12:02

I don't want to have sex with my husband anymore.

1:12:05

Not even that, but like something with their body

1:12:07

because I know that's general, but is there something

1:12:09

that comes up that people because I think

1:12:12

that Dr. Castillo you mentioned and Rami I know

1:12:14

we've we've talked about it too where

1:12:16

it's like what are the prompts like because doctors

1:12:18

will go through the things when

1:12:20

you're in there. They want to make sure you're healthy.

1:12:23

But yes, so I don't know if

1:12:25

you have any suggestions. How do you how are you

1:12:27

saying how do you as the client

1:12:29

or

1:12:29

the patient inspire

1:12:32

yourself? You're asking if there's

1:12:34

any prompts like or if they have any doctors probably

1:12:36

their

1:12:36

own personal prompts. Yeah. Yeah.

1:12:38

So it's, that's a question for you. Sorry. Yeah.

1:12:40

And it's, it is a little bit challenging because it really depends

1:12:42

on who the listener is going to be. You don't know who your

1:12:44

provider is going to be and they may be dismissive

1:12:47

or they may be, they may be helpful

1:12:49

or they may recognize that, that

1:12:51

it's a need, but they don't have the tools, which

1:12:53

is fine, but then maybe send them off. So

1:12:56

I think the first thing that I would recommend because it's,

1:12:58

it's, it's hard to predict who you're going to

1:13:00

see, who's going to hear you is

1:13:02

to be a self advocate and be

1:13:05

committed to what you want to improve. So

1:13:08

if the problem is

1:13:09

doc, my, it hurts to have sex

1:13:12

and I'm avoiding my, I'm avoiding my, my,

1:13:15

my husband and he's an angel and he's being

1:13:17

patient, but it's not getting better and it's, and

1:13:19

this is ruining my sex life. It hurts.

1:13:21

I need this fixed orgasmic decline. I don't

1:13:23

know where my orgasm was went. Can

1:13:25

you, do you have any idea of how to help

1:13:28

them? And if they don't see if

1:13:30

they can help you refer up or do your

1:13:32

research. That's why we've really been successful

1:13:34

is cause it's hard to educate all

1:13:36

the physicians out there, but you can reach

1:13:39

out to clients and we reach out using their

1:13:41

terms. So if you name

1:13:43

whatever the condition or concern is and

1:13:45

Google it and you'll usually find us or somebody else

1:13:47

who's kind of being comfortable in this space

1:13:50

and we'll use the same terms.

1:13:52

And as just joining,

1:13:54

I joined Dr. Castillo about a year ago

1:13:57

when I was in primary care, I just didn't have the tools.

1:13:59

somebody would come to me and say, painful sex. And

1:14:02

I would say, okay, I want you to use a pea

1:14:04

size amount of topical estrogen

1:14:07

twice a week and cross your fingers.

1:14:09

And let's look at relationships

1:14:12

and here's some antidepressants, here's

1:14:14

some propropion. Those are the tools

1:14:16

that I had. And so there just

1:14:18

is not available. And now I still

1:14:21

subscribe to some mainstream medical

1:14:23

journals. And so I just got an article sent

1:14:25

to me recently called no expiration date

1:14:27

for sex. How to talk to your patients about sex.

1:14:29

And so it kind of brings up all the different things that

1:14:32

the way that

1:14:33

physicians and primary care providers,

1:14:36

nurse practitioners can talk to their patients about

1:14:38

sex. So there is a conversation happening

1:14:41

in that world. Yeah, so

1:14:43

there's room for physicians to learn

1:14:45

how to inspire the conversations. And it's not guaranteed

1:14:48

that they'll say everything. Like I've gone to various therapists

1:14:50

and not shared everything about my mental cycle.

1:14:53

I'm coming from, I get so shy when

1:14:55

I go, like I am in

1:14:57

the field of sexuality and

1:15:00

I get fucking shy. So

1:15:02

that's why I know folks out there.

1:15:03

My Midwestern self comes

1:15:06

out and I'm like, oh, I don't

1:15:08

need to talk about sex because I should know all of this

1:15:10

stuff. Or, oh, I'm married or, oh,

1:15:12

I have kids. I should know about my body

1:15:14

because I've had these things. So that's why I like

1:15:17

to ask for prompts because I feel

1:15:19

like as from the professional side, you may

1:15:21

have more information that would help

1:15:24

folks feel more confident or comfortable,

1:15:26

which is what you want. When you go in to

1:15:28

talk to your doctor, depending on who it

1:15:30

is, and it's about finding the right provider,

1:15:33

if you

1:15:33

are capable of finding the right provider,

1:15:35

and if it is someone that you have to have because

1:15:38

that is what your insurance or

1:15:41

where you are allows you to, then there

1:15:43

are questions that you can hopefully

1:15:45

direct them to help you in the best way

1:15:47

possible. And I would also say scheduling

1:15:50

an appointment. So if you wanna talk to your healthcare provider

1:15:52

about that scheduling an appointment specifically

1:15:55

to talk about that. Somebody might come with 16

1:15:57

things and your

1:15:59

healthcare provider.

1:15:59

might have an agenda, if you've got to get your mammogram

1:16:02

order, and I've got to get your colonoscopy.

1:16:05

And I know you need to talk about this, but

1:16:07

let's schedule an appointment for that. So prioritizing

1:16:09

it, making sure it's a priority. That's smart. Because

1:16:12

a lot of people are like, oh, I'm already there, so let me throw in

1:16:14

all this stuff. You're like, we have 20 minutes.

1:16:17

If you're lucky. And I have to see 18 people today. Yeah.

1:16:20

I always got Remy for at least a half an hour. But I remember Remy would mark me as, it

1:16:22

was an high maintenance patient. It was

1:16:24

like, I had a complex patient. I have

1:16:26

a complex, I have a genetic disease though,

1:16:29

and I was like, so will you tell them to

1:16:29

mark you as a complex patient? And

1:16:32

so I got like half an hour. I'm using

1:16:34

my genetic disease when I can. Even if we're not talking

1:16:36

about it, I'm like, I'm a complex patient everyone.

1:16:40

But I like that you're saying like schedule this other side

1:16:42

thing, just to gear your for it. Yeah.

1:16:45

Yeah. If you treat

1:16:47

it as an add-on, that's what your provider is

1:16:48

going to treat it as an add-on. And then you'll feel empty.

1:16:51

Like there are, or like you're not seen.

1:16:53

It's not going to be addressed. Yeah. The

1:16:55

economics of medicine today dictate that they see X number of people that

1:16:57

are in the room. And they're like, oh, I'm going

1:16:59

to do this one day just to keep the lights on. Yeah. Which

1:17:02

means that there's no room for extras. So if you want to have an appointment

1:17:04

about this problem, make an appointment about

1:17:06

that problem. Otherwise it'll, it'll be added on.

1:17:08

They'll say, I'm sorry. There's that a time. Yeah.

1:17:12

That's so helpful. Thank you for the prompt chip. That's

1:17:14

really smart. And I just want to put out there. Thank

1:17:16

you both for the work that you're doing. Really.

1:17:20

Thank you. And I just want to

1:17:22

invite the world. I don't know. Manifestation

1:17:24

is a fucking beast of an animal. Right. The

1:17:27

threatens of that, that's

1:17:29

how I feel about it. The

1:17:38

Everyone

1:17:46

can have access to folks like you, both,

1:17:49

and also to worldwide acceptance

1:17:53

for our changes in bodies, and you want

1:17:55

to get close to the Bay Area in Santa Cruz. You're

1:17:57

located in Los Gatos.

1:17:59

I've worked with Remy in person, but also

1:18:02

I've been able to go online, but I've missed a movie to start

1:18:04

with relationship in person. And if you're

1:18:06

somewhere else where you can fly out, but how can people find

1:18:08

you, work with you and what are the offerings?

1:18:11

Is it just seeing you in your office? Like how

1:18:13

can people get more of Dr. Castillo and Remy

1:18:15

Payet? So we can do some telemedicine

1:18:17

consults so we can certainly look at

1:18:20

somebody's hormones via telephone

1:18:22

call, order labs and things

1:18:24

like that and give somebody an idea

1:18:27

of what's going on with them.

1:18:29

And then we can

1:18:30

order some things from

1:18:33

pharmacies to be able to help people. So that's one

1:18:35

option. Seeing in person

1:18:38

is always best. And I know people do

1:18:40

fly in and come from all over

1:18:42

the place, drive hours to come see

1:18:45

the practice because Dr. Castillo has created

1:18:47

a really unique, safe place

1:18:50

to talk about all this. So it is worth the

1:18:52

trip.

1:18:53

Yeah. Yeah. We're

1:18:55

very blessed. We have patients that come from all

1:18:57

around. But we try to make

1:18:59

things accessible. There are patients that live in

1:19:01

our, I think our longest, our furthest

1:19:03

distance patient that came from Guam. Wow.

1:19:07

But we've had patients from different parts of the country,

1:19:09

Canada, Mexico. And

1:19:11

it's not because we're, I mean, there

1:19:14

are other specialists out there, but I

1:19:16

think we've just created a good space for patients.

1:19:19

But there's lots of options. Sometimes we can manage them by,

1:19:21

you know, through telemedicine only. There are

1:19:23

things that we can prescribe that can be sent to

1:19:25

them. Whether it's because

1:19:28

of hormonal loss or because of orgasmic decline

1:19:31

or, or other health concerns

1:19:33

that we can usually manage by phone. If it's something

1:19:35

that requires physical intervention,

1:19:37

whether it's surgery or laser therapies or

1:19:39

our PRP therapy, then

1:19:42

we'll have them arrange. We come, we have them come

1:19:44

in. We plan everything for

1:19:47

them so that when they show up, they already have everything

1:19:49

scheduled for them. They come in one day

1:19:51

for their initial consultation. If it's a

1:19:53

surgical intervention or a therapy, it'll

1:19:55

be scheduled either the same day or next day. Blood

1:19:58

work we have done ahead of time. before they even

1:20:00

get here. So by the time we even speak to them on the phone, we

1:20:03

have a lot of information. We

1:20:05

also offer, especially for

1:20:07

those that live remotely, from us, we

1:20:09

have a 15 minute consultation just to screen,

1:20:12

get an idea if it's something we can help with. Because

1:20:14

I don't wanna force people to

1:20:16

come all the way to see us for something I may not be able

1:20:18

to help them with. So give them an idea, and if they

1:20:20

feel comfortable with us, they feel much more comfortable

1:20:23

getting on a flight and flying in.

1:20:25

And what's the website where they can find

1:20:27

all of this information? swanmd.com.

1:20:31

I know because I just, I'm

1:20:34

actually tomorrow. Yeah, she's going there tomorrow.

1:20:36

And then two weeks I'll be after. I was there

1:20:38

last week, okay. It took some minutes to get the

1:20:40

blood work because I had to send it in. And I'm

1:20:43

really, I'm

1:20:44

so excited to have this. I

1:20:46

actually told my partner, he's like, really? He's

1:20:49

like, this is happening? You're not gonna be

1:20:51

a total see you next Tuesday before

1:20:53

every period. I have hormones

1:20:56

for men too. Oh, it actually comes to you if you

1:20:58

wanna see me. I'm down for

1:21:00

that. Yeah,

1:21:03

and if y'all don't have access, I would just say

1:21:05

like, if you take anything from this, and there's so many pieces

1:21:07

here, but I think one thing that y'all are really saying is

1:21:10

advocating for your health beyond what you might

1:21:12

be asked or shown in

1:21:14

the basics. If you're feeling

1:21:16

there's above and beyond a little bit, if you're feeling

1:21:18

there's something that's really challenging for you, and someone's saying that's

1:21:20

just how it is, it might not be just how it is.

1:21:23

And you might be able to advocate for that outside of your

1:21:25

doctor's office.

1:21:25

Yeah, a lot of us get caught

1:21:28

up in whether it's covered or not.

1:21:30

Because we've been all indoctrinated and trained

1:21:33

to believe that it only exists if it's

1:21:35

covered by insurance. And the reality

1:21:37

is, these are quality of life issues that sometimes

1:21:40

insurances don't prioritize. In fact,

1:21:42

for some things, you cannot indicate loss

1:21:44

of libido and be paid. So

1:21:46

you have to find another indication for it, for

1:21:49

the visit, and then that'll just be an add-on diagnosis

1:21:51

in order for the visit to be covered by

1:21:54

insurance when you go to a doctor's office for

1:21:56

any of these things.

1:21:57

That's why I was starting to cry earlier. I

1:22:00

was like, let's just have a world where it's okay.

1:22:02

Right,

1:22:02

so I like to just

1:22:05

point out that insurance decisions,

1:22:07

whether it's covered or not covered, has a lot to do with economics,

1:22:10

not to do with whether it's necessary or beneficial

1:22:12

to help patients. So that's why

1:22:14

I strongly encourage people

1:22:17

to be self-advocates. Yeah, yeah.

1:22:18

And there's some tools in there that April did

1:22:20

a nice prompt to help you to be your own

1:22:23

self-advocate and you all gave some really good follow-up

1:22:26

questions in ways that also medical

1:22:28

professionals can advocate as well.

1:22:30

And yeah, there's really helpful information

1:22:33

here. And I think this is gonna be a continued conversation. We

1:22:35

have to end this one right now. But it seems

1:22:37

like we're constantly learning more and more about

1:22:39

hormone optimization, about sexual health

1:22:41

and wellness, about these conversations that can happen

1:22:44

in the doctor's office and outside, to this vibrating

1:22:47

thing that has red light technology.

1:22:48

Tell me about that one more time. We're gonna do an Eiffel

1:22:50

Tower on FaceTime while we use

1:22:53

it together. Yeah. Just turn it on. Can people

1:22:55

order that on the website? Can they order this toy

1:22:57

or device?

1:22:58

They can. We don't

1:23:01

have an active e-commerce site, but we do mail order.

1:23:03

They can find a way. Actually, we know Susan

1:23:05

Bratton has access. Well, no, we're gonna create

1:23:07

some videos with them right now. So if you're all watching

1:23:09

us on TikTok and on Instagram, watch

1:23:11

us with our laser beams. That's

1:23:14

actually a great idea. A laser beam vibrator. It's

1:23:16

gonna be fun. Well, I wanna

1:23:18

say thank you again to both

1:23:20

of you. Dr. Castillo, Remy Payet,

1:23:23

who's in our book. We've quoted her. She's quoted

1:23:25

in our book, yeah. Did such a great

1:23:27

job of just being an incredible

1:23:31

human to advocate for all humans.

1:23:33

And thank you, Dr. Castillo. Can't

1:23:35

wait to see you. And if we

1:23:37

probably had met with you, you'd be in our book too, but

1:23:39

it's too late now. Okay? Book

1:23:41

two. If we write book two, yeah. Oh, we probably not. We said we'd

1:23:43

kill each other if we ever said that in person

1:23:46

and now it's happening. But we really

1:23:48

do appreciate you both. So thank you. And

1:23:51

to all of our humans that we love,

1:23:53

our shameless sex revolutionaries. I

1:23:56

love you. I'm not crying anymore because I'm gonna have

1:23:58

my hormones stabilized. soon. If

1:24:09

you haven't done so please, I'm inviting

1:24:11

you. Come to

1:24:13

our party on iTunes and Spotify.

1:24:16

Come to our party. Which

1:24:18

is rate us five stars. It helps folks

1:24:21

out there learn more about hormones,

1:24:24

about life, about sexuality,

1:24:26

about if this is a free resource for all of

1:24:28

you, about man, about

1:24:30

man, a pause, about man straightening,

1:24:33

about being a fucking human on planet

1:24:35

earth. It can be hard, but it can also be

1:24:37

beautiful. So great.

1:24:39

Us it just helps more people find you and find

1:24:42

me. All right. Five stars, Amy. Yes.

1:24:44

I love you. I love

1:24:44

you too. All right. We'll see you next

1:24:47

Tuesday y'all. Ciao for now.

1:24:52

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