You Are Not Broken

Dr. Sameena Rahman on menopause, PMDD, PCOS, and why naming things mattersThis week I sat down with practicing gynecologist Dr. Sameena Rahman to talk about some of the most misunderstood areas in women's health: hormone replacement after oophorectomy, PMDD, and the recent renaming of PCOS. We move fast from clinical nuance to culture, stigma, and medical bias, and you'll walk away with plenty of practical takeaways whether you're a patient or a clinician.Sameena also shares the story behind her book, Brown Girls Disease, and why she's reclaiming language around pain, shame, and access to care.In this episode, we talk about:Why women who have their ovaries removed need full hormone replacement, not just a low-dose patchThe difference between menopause management and medical neglect after hysterectomy or oophorectomyThe evidence that early menopause plus hormone therapy can have major survival benefitsWhat PMDD is, how it differs from typical PMS, and why it can feel like "Jekyll and Hyde" every monthWhy PMDD may be more about hormone sensitivity and brain receptor interactions than progesterone alonePMDD treatment options, including SSRIs, specific birth control formulations, progesterone, and in extreme cases medical suppressionWhy the old label PCOS creates stigma and hides the cardiometabolic risk behind the syndromeThe new name, polyendocrine metabolic ovarian syndrome, and why I think the rename could finally bring primary care and internal medicine into the conversationHow PCOS affects fertility, diabetes risk, heart health, weight gain, and endometrial cancer riskHow pelvic pain, vaginismus, and sexual dysfunction are shaped by culture, religion, and medical biasWhy Sameena chose the title Brown Girls Disease as a way of reclaiming a term that had been used dismissivelyHow language changes care, from saying "vagina" out loud to replacing shame-based terms with clearer onesNaming things matters. You are not broken.Dr. Rahman's IGAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is OpenListen to this podcast on Pinnacle to earn CMEThanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care.If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead.What We CoverWhat vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the bodyWhy so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulvaHow symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSMWhy numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worseBarrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdownHow overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketingWaxing, microtrauma, and hair as a protective barrierGSM, recurrent UTIs, and why vaginal estrogen is still so underprescribedLate diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealthNotable Quotes"My five year old can say vulva.""I really like talking about uncomfortable things and making comfortable people uncomfortable.""Just do what brings you joy."About Dr. Melissa MauskarDr. Melissa Mauskar is an Associate Professor of Dermatology and of Obstetrics and Gynecology at UT Southwestern Medical Center, where she's the founder and Director of the Vulvar Health Program — a tertiary referral center for gynecologists, dermatologists, and primary care physicians across Texas and the nation. She's a Fellow of the International Society for the Study of Vulvovaginal Diseases (ISSVD), founding president of the Vulvar Dermatoses Research Consortium, and serves on the board of the Women's Dermatologic Society. Learn more at utswmed.org/doctors/melissa-mauskar.As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I walk through the basics of vaginal estrogen and vaginal DHEA for genitourinary syndrome of menopause, recurrent UTIs, painful sex, urinary urgency, and vulvar tissue changes. I also answer audience questions throughout, covering safety after breast cancer, use alongside systemic HRT, dosing, formulations, and what to do when symptoms don't improve.This one's for clinicians and the general public alike, the focus is correcting misinformation, improving access, and helping people understand that low hormones can affect the pelvis long before or long after menopause.What We CoverWhat genitourinary syndrome of menopause (GSM) actually means, and why it replaced older terms like vaginal atrophyThe full range of GSM symptoms — urinary urgency, recurrent UTIs, bladder leakage, pain with sex, dryness, tissue thinning — as one unifying hormone-related syndromeWhy GSM is so common (roughly 50–90% of women at or after menopause) and can start in perimenopause, during breastfeeding, on oral birth control, or after cancer treatmentData showing vaginal estrogen can reduce recurrent UTIs by about 50%, plus a large database study linking vaginal estrogen use to lower hospitalization, ICU admission, and sepsis-related death in women with recurrent UTIsWhy "too old for vaginal estrogen" is a myth, and why age alone is never a reason to deny itSafety after breast cancer — why the evidence supports vaginal estrogen for many survivors, and why "zombie myths" keep resurfacing anywayThe difference between systemic and local hormone therapy, and why some people need bothCreams vs. tablets vs. rings vs. vaginal DHEA — and why DHEA can be especially useful for reversing established atrophy (it converts to both estrogen and testosterone)Practical stuff: burning, discharge, application technique, dosing frequency, and when it's time for a pelvic exam instead of another productUsing vaginal estrogen alongside clobetasol for lichen sclerosus, and alongside systemic estrogen or testosterone when appropriateNotable Quotes"The third pillar of academia is to communicate the research, to communicate the knowledge to the general population.""There is not an age your driver's license tells you if you're too young or too old for vaginal estrogen.""If atrophy happens because of low hormones and you add hormones back, you can reverse atrophy."Key FrameworksGSM as the unifying diagnosis for urinary, sexual, and vulvovaginal symptomsLocal hormone therapy vs. systemic hormone therapyPrevention vs. symptom treatment"Zombie myths" — outdated beliefs that keep resurfacing despite the evidenceWant to join me live for these? Get on my email list so you don't miss the next one.As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I talk with Dr. Lexx about how to have honest conversations about sex with kids, why sexual shame still shapes adult relationships, and how to think more clearly about desire, consent, and pleasure. We dig into misinformation around sex education, sex as a form of power, and what healthy support can look like from educators, counselors, and therapists.What We CoverSex-positive parenting and how to talk to kids about bodies and boundariesWhy sexuality education in the U.S. is more restricted than people think — and why "medically accurate" isn't a givenThe real difference between sex educators, sex counselors, and sex therapistsHow midlife, menopause, and shifting desire reshape relationshipsPractical ways to rebuild intimacy and connection when the spark fadesKey FrameworksPersonal parts — Language that reduces shame and emphasizes ownership over the body.Unwanted touch / secret touch — Clearer safety language than "good touch, bad touch."Sexuality as a whole-life concept — Not just intercourse, but identity, embodiment, relationships, and power.Compersion — Feeling happy for a partner's pleasure or joy, even if it isn't personally relevant.Sensate focus — Purposeful nonsexual touch used to rebuild connection and learn what feels good.Consent first — The baseline for everything, including fantasy, touch, and negotiation.About Dr. LexxDr. Lexx (Lexx, The Sex Doc) is a sex therapist, educator, and speaker whose work centers healing, pleasure, and connection — with a particular focus on Black, Brown, and queer communities often left out of traditional therapy spaces. Learn more at lexxsexdoc.com.https://lexxsexdoc.com/Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode 387, I sit down with Dr. Lucy McBride to talk about the widening gap between the traditional medical system and the wellness industry, and how patients can find solid ground in between. Lucy makes the case for evidence-based advice, realistic expectations, and actually engaging with your healthcare system instead of trying to DIY your way to health.What We CoverThe gap between the medical system and the wellness industryWhy evidence-based health advice matters more than everThe risks of wellness products and influencers overpromising certaintyHow patients can better engage with (not opt out of) the healthcare systemSupplements, vitamins, and gadgets — what's worth your money and what isn'tThe wellness industry often overpromises certainty and results it can't back up.Living in the "middle ground" means engaging with the healthcare system effectively rather than avoiding it.Dr. McBride's book, Beyond the Prescription, is a practical guide for navigating health choices.About Dr. Lucy McBrideDr. Lucy McBride is a practicing internist and the author of Beyond the Prescription: How to Contextualize Your Health and Break Free from a Lifetime of Fatigue, Anxiety, and Stress. Grab her book here: Beyond the Prescriptionhttps://www.lucymcbride.com/https://www.instagram.com/drlucymcbride/SubstackAs always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.Subscribe, leave a review, and share this episode with someone who needs it.🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/piThis episode is sponsored by Joi and Blokes.If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.