Episode 323: Let It Come with Dr. Maria Uloko
Doree receives a nice surprise from her tennis team and Elise deals with potty training a puppy. Then, they invite urologist and sexual health expert Dr. Maria Uloko on to discuss the changing generational discourse around sex, the life-changing magic of letting go, and why menopause does not mean you have to suffer.
Photo Credit: Tchanavia Lastie (@blackqueenphotography).
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Transcript
Doree: Hello and welcome to Forever35, a podcast about the things we do to take care of ourselves. I'm Doree Shafrir.
Elise: And I'm Elise Hugh. And we are two friends who like to talk a lot about serums.
Doree: It's true. Hello Elise.
Elise: Hello. It's a big week for us here at Forever35.
Doree: It is a big week for us. We have some exciting stuff coming on Wednesday. Just as a little tease, I had something really nice happen.
Elise: Ooh, do share.
Doree: So my summer tennis team got me a massage gift card.
Elise: Oh, I know. So well deserved. You have been. Yeah. You've been, wasn't that so nice, the leader of the pack and they took notice. I know you've been juggling not just your schedule, but all of their schedules and Oh, that's a lot of work.
Doree: I felt very appreciated. I went to cheer on the team on Sunday at their match after my son's T-ball game, and one of the women was like, Doree, do you like massages? And I was like, yeah, I love massages. She's like, where do you like to go? And I told her and I was like, oh, there's one actually near you. And she's like, oh, that's great. And then they got me a gift card. It was really nice. So I was very touched. It was very sweet.
Elise: And shout out, shout out to Doree's summer tennis team.
Doree: Shout out to my tennis team. They're just the best. I don't think any of them listen to this podcast, but if you do, thank you. I mean, I've already thanked them, but
Elise: Yeah. And it's also the kind of gift that I don't know about you, but I don't normally spend money on getting myself massages. I feel like when I go and get a massage, it's because A, I've been sent there because I'm in physical therapy for an injury, or B, someone was so sweet to have thought of that as a gift and get me a spot a or something.
Doree: Yes, yes, yes. Back when I had more money, I would get not regular massages, but I got every couple months I would get a massage, but I haven't had massage in quite some time. I had one for my birthday, which was five months ago, and I don't think I've had one since. So this is very appreciated and very needed. What else is going on with you?
Elise: I'm still getting up at five in the morning, if not before, to take the dog out because the puppy, I just don't know whether has the bladder control to last longer than that, so I don't know whether to push it.
Doree: Yeah, that's hard. That's hard
Elise: With babies because they wear diapers. If you're wanting to move their wake up time, I could just kind of incrementally go get them later. But with a dog, he's not wearing a diaper.
Doree: You can put a diaper on a dog, but I wouldn't recommend it because then your dog doesn't really get trained.
Elise: Rob had a problem with his free range chickens. Did I tell you about how Rob had free range chickens in his Santa Monica yard?
Doree: I'm sorry, what?
Elise: Yeah, we probably need to do another meet the spouses episode in which he should tell this story, but his chickens in his Santa Monica yard. This is with his ex-wife. Were just shitting all over the place, the only grass that they had because she insisted that they not be in any sort of pen. Oh,
Doree: Wow. Oh no.
Elise: And so there was no grass for him and his sons to kick the soccer ball around.
Doree: Oh no. Because there
Elise: Was chicken shit everywhere. Oh no. So a real tension point between him and his ex-wife was like, he was trying, he researched and it turns out you can get diapers for chickens. Oh my God. Stop. But then I guess the same idea. Do the chickens ever learn
Doree: To
Elise: Actually potty in the right place if they're wearing diapers?
Doree: I know it's a very interesting question. I know. I just want to mention that our giving circle, we are more than halfway to our goal.
Elise: I saw we passed the 50% mark, and that's all thanks to you all the
Doree: Listeners.
Elise: You have been showing up for Arizona, which is the state that we picked with the legislature we're trying to flip, and Arizona is one of the iest of swing states,
Doree: And they have
Elise: Abortion on the ballot for voters in November. We're only about a month out from election day, which is wild, and it's not too late to make a difference.
Doree: Yes. So please head on over to our giving circle. The link is in the show notes, it's in our Instagram bio. We're trying to figure out a more prominent place to put it on the website so it's easier to find, but please go and donate. It really makes a difference. We've had Melissa Walker on the show three times talking about how much of a difference literally every dollar makes, because there's a direct correlation between how much money we raise and how much they can get people out knocking on doors. It really, really, really makes a difference. So please, if you are able, please donate. All right. Well, Elise, should we introduce our amazing guest?
Elise: I'm psyched to introduce her today on the show we have Dr. Maria Loko. She is a urologist who does comprehensive sexual health. She treats all genders. I know that urologist tends to mean male parts, but she treats all genders when it comes to having healthy genitals. She is a much sought after specialist for vulva, vulvar, menopausal care and regenerative ed treatments. And she is so open and sex positive and has done a lot of research in sexual health that has garnered numerous awards. Among her many achievements, her pioneering research on the clitoral nerves has reshaped our understanding of human sexuality. No big deal. Doree
Doree: NBD. No big deal.
Elise: Her educational journey is super impressive as well. She completed her fellowship and comprehensive sexual health at San Diego Sexual Medicine and Scripps. She honed her skills in urology and general surgery during residencies at the University of Minnesota Medical School in Minneapolis. She started medical school and she talks about this a little bit at 17 years old. So she's like a real life Doogie Hauser. If anybody even knows the Doogie Hauser reference anymore,
Doree: I feel like they do because Doogie Hauser is one of those nineties icons that kids now are familiar with just to
Elise: Yeah, that makes sense. Well, I'm glad because I thought that was a fun show and I liked the neighbor coming through the window and always talking to him and typing his journal on the computer. It really inspired me to start an electronic journal in my youth. But not to digress too much, Dr. Uloko, a big part of her specialty these days is menopause and perimenopause. So we get into that in this conversation, which was a delight
Doree: Before we get to her interview, just a reminder, our website is Forever35 podcast.com. We have links there to everything we mentioned on the show or on Instagram at Forever35 podcast. You can join our patreon at patreon.com/forever three five. The annual membership sale is still going on. We'll probably have to go for another week. So if you want to get that membership at a discount, head over to patreon.com/forever three five. We also have a newsletter at Forever35 podcast.com/newsletter. And please call or text us. We might read your email or text or listen to your voicemail on an upcoming mini app. That's 8 1 5 9 1 0 3 9 0, and our email is Forever35 podcast at gmail com. And as we mentioned at the top of the show, we have some exciting stuff coming on Wednesday, so please tune in on Wednesday for some big announcements and we'll be right back. We'll be right back. Dr. Uloko, welcome to Forever35. We are so excited to have you on the show.
Dr. Uloko: Thank you for having me.
Doree: Yeah. We like to start off by asking our guests about a self-care practice that they have. And this can be very broadly defined, so whatever you might be doing right now that you would consider self-care, we'd love to hear about it.
Dr. Uloko: I am all about my self-care ritual in practice. I love the mornings. I'm an absolute morning person. I love a five o'clock workout, so I'll do start my ritual. My grounding ritual is five 30 hot yoga, yoga. And then I will come home, shower, and then I journal and meditate for about an hour and a half. And then I also do breath work two to three times per week, just taking care. If my brain and my heart are not healthy, I can't do the work that I do.
Elise: How did you discover this? How did you come to this really consistent self-care practice?
Dr. Uloko: It took a lot of discipline, honestly, and this is something that I try to tell everyone of when I've been on a self-care journey. I started medical school at 17, and so yeah, that was a whole thing.
Elise: You were like, Doogie Hauser, you're a real life Doogie houser, but better.
Dr. Uloko: Yeah, taller, hotter blocker, all the things. And so I just remember a lot of training. I couldn't take care of myself. I didn't have time. I didn't have resources. My job was to take care of other people. And so when I finally got a little bit of freedom, once I got done with training, I just didn't know. I was like 29. I didn't know how to do anything. And so I really looked at myself and I was like, okay, how are we going to get back to health medicine has taken a lot from us. We love it. And also how can we get back to ourselves? And so it's been, oh, it's 2020. So four years of trial and error. But a lot of it is just discipline. It's just showing up every day for yourself even. We always want it to look perfect, but if you just show up and if you want to meditate and you can only do it for two minutes, great. You at least started, you got two minutes of meditation, and then usually if it feels good, you'll keep coming back. And that's the beauty of having a routine is that you realize that at some point, discipline gets you there, but then how good you feel afterwards keeps you coming back.
Doree: Being okay with imperfection is a lifelong practice, I think.
Dr. Uloko: Yes, yes. I'm a recovering type A plus plus, plus plus person. So I now say I'm a type A minus person. So the things I care about, I care about a lot, the things I don't care about. I truly don't even know where I am half the time. You know what, I'm not going to waste brain space on that.
Elise: Yeah, totally. And speaking of things you care about, I was really curious how you came to choose urology as your specialty in the first place. Why urology? Why not obstetrics or gynecology?
Dr. Uloko: I didn't know the process or the steps. And so I did this special six year program right out of high school that you start seeing patients on day one. So at 17, I was taking care of patients. It was like
Nuts, right? What else is so cool? And what a privilege to do that. But when I got in, I still remember a lot of my friends from high school. I love, I was always the person telling dirty jokes. I was always the person this, despite never sing a penis. I told lots of penis jokes. I was such a late bloomer. Love that. So when I got in, everyone was like, oh, you're going to become a urologist. That was the joke. And I was like, ha ha. Yeah, penis doctor. And then fast forward four years later, when we start actually getting on our clinical rotations and going through the different rotations, I did my ob gyn rotation. I really didn't gel with a lot of the people there. Childbirth to me is one of the most traumatic things ever. Yikes. People that can do it. Amazing.
Not for me. And the attitudes was just the vibes were not there. General surgery also thought those paperwork, low key, very sad. General surgeons are great. Just the particular program I was at was really toxic. And so the people that I was like, huh, I really like the idea of surgery. I like the idea of seeing a problem and fixing it, but a lot of these surgeons don't gel with who I am. And I met a urologist. My first female urologist, Dr. Hadley Wood from Cleveland Clinic was so funny, so nice, so kind, so well dressed. And I was like, oh, I want to be you. That's what I want to do. And she's like, oh, I'm a urologist. Took my first rotation. This is why it's such a big believer of representation. Representation is important. And then also systematic change is also important. But I saw my first female urologist and I was like, oh, we can do that.
And then from there, I just kind of fell in love with the field and want to see the field continuously do better. Urologists focus a lot on quality of life. So we center quality of life in a lot of our training. And that's not necessarily what happens in women's health. They don't necessarily focus on quality of life. They focus on Did you die though? Did you die though? That's bleeding. Yeah, I mean that's the attitude. That's the unfortunate attitude in the standard training for women's health. And so I'm very, very fortunate to have trained as a urologist to directly compare how people access healthcare.
Doree: I want to dig into that a little bit more, but I first just want to briefly touch on what you said about representation, because I understand that you were the first black person from your medical school to match in urology.
Dr. Uloko: Yeah. In every space I've ever been, I'm always the first, which is so not fun. I think of a lot of people think of it as this really prestigious thing. And prior to experiencing it, I also thought it was really prestigious, but it's actually
Detrimental to, it actually should be embarrassing that in 2020, I was the first graduate from my medical school or from my residency, I was the first black resident to ever graduate from my residency program. It was the first black medical student to match into urology for my medical school. And so many people were like, wow, you're doing all these things? And I'm like, no, it's bad. We oftentimes praise those people without understanding. When you're the first, you then are now having to go into systems that have never experienced someone like you. And we know that America is not the most welcoming to people that look like me. And oftentimes when you're the first one experiencing a lot of that prejudice and no one is there to support you because they never had to deal with it before,
Doree: And you don't have mentors that look like you,
Elise: And ideally there's many that will follow now that you have been a trailblazer.
Dr. Uloko: That's always the goal. I always want to leave things better than I found them. And so understanding that I walk into a door, I have to leave the door open for the people behind me.
Elise: You pointed out that disparity, that huge disparity in care and the ways we think about care when it comes to women's sexual health, women's genital health, and men's sexual health and men's health and wellbeing, how is that disparity showing up for you? Where do you feel like you see it the
Dr. Uloko: Most? Oh, wow. It's so interesting because like I said, I've been in healthcare since I was 17. I'm 33 now. So going on year 16 of going into and seeing patients and being in this ecosystem, and it wasn't until my fellowship, which was my last year of training where I actually started learning about the vulva. I started learning about way more about women's bodies outside of pregnancy and cancer. And this is so interesting. You don't even realize that you're getting gaslit in the system, that you're not even learning about your, I didn't even know about my own body. How do you go through medical education and not even learn about your own body, but you don't even know because oftentimes you're going to medical school, they're telling you it's so hard. So the most prestigious can only get in blah, blah, blah. By the time you jump through all the hoops to get in, you assume that you're going to learn everything that could ever possibly be right. And it wasn't until my fellowship where I was like, I learned nothing. I learned truly nothing about women bodies. And this is someone that I have always been like, I'm an intersectional feminist. I strongly believe in all the things.
And I didn't even know how ingrained the misogyny and the self-hatred was in my medical education. And it was my fellowship where I unlearned so many of those things. And it was my fellowship where I started as urologists, we see everyone. Everyone has kidneys, everyone needs help with their kidneys at some point, whether it's kidney stones, whether it's bladder issues, at some point you may need a urologist, but we're still considered the men's health sexual health specialists or the penis doctors. And
Elise: A lot of ed.
Dr. Uloko: A lot of ed. And I thought that the counter on the other flip side was that gynecologists did what we do as urologists. So we not only do the scope of men's health, we do everything, their sexual health, their prostate health, all of the things. I thought that's what was going on on women's health. So we'd see someone with a vulva for let's say prolapse. They had issues with leaking urine or something. We'd see them and then we'd fix that because that's part of our scope of training. And then they'd say, oh, I'm also having pain with sex, or I'm also having this, that, and the other around my vagina. And they were like, we're like la la. Yuck. Go see your gynecologist. And it wasn't until my fellowship that I realized that, oh my God, I was turning these people away to no one.
No one was actually seeing them because that was such a wake up call to me of like, whoa, okay, if I didn't get this training as a urologist in the vulva, we're in this space, what is going on? And we actually just did a research study, a national survey, and it just adds to the body of literature that most doctors are leaving training without knowing about sexual health of women. They don't even know where the vulva is. They don't even know that it has specific, I mean, they know where it is, but they don't even know that hearts. They don't even know that the parts have different function. They don't know what happens when if the parts aren't working, it can lead to all these other diseases. It is nuts. I think from our survey, 70% of medical trainees just didn't know just 70%.
Elise: That is wild. And these are our providers.
Dr. Uloko: So many of the patients that I see have been told, you'll never get better. Like chronic bevo, vaginal pain, chronic yeast infections, recurrent urinary tract infections, infections, UTIs after sex, they're told they're never going to get better. It takes seven years to get their first diagnosis. And oftentimes people will see three doctors, 35% of these people will see up to 15 doctors before they get their first diagnosis. So to the patient, they're like, oh my God, I'm so challenging. I'm so difficult. They come see me for 20 minutes. And I'm like, yeah, you're absolutely not challenging. You're actually very straightforward. You're actually cookie cutter. And it's just the fact that the doctors truly don't even know how to do a basic
Elise: Exam. Doctors don't
Dr. Uloko: Exam and they understand the basic physiology or how your body should work. So it's not you. It's the system. And to watch them really unpack that trauma that they've experienced, medical trauma, if you're going through symptoms and people are constantly telling you, nothing's wrong with you, nothing's wrong with you, and something's wrong with you, that leads to such. It leads to so much heartache and heartbreak and expensiveness. It's so shitty, and I hate it. It's one of the worst things where I've had people suffering for decades. They come see me for 10, 20 minutes and I'm like, yeah, nope. This is super easy. Here's how we fix it. And to watch them start crying because
Elise: What a relief. Yeah, it's
Dr. Uloko: A relief. But there's also a lot of sadness behind those tears of and grief, if I had only known, if I had only known how to do my own exam, if I had only known what to look out for, because a lot of their conditions you can see on exam, there are so many people who are like, yeah, it looks red, but I don't know what that's about. I'm like, that redness is inflammation. That redness is bad. And doctors tell me that all the time. Yeah, I saw this patient, everything was red, but I don't know what it means. I'm like, what? No. And then the way I do my exams are very different than how I learned it in medical school. I actually have the patients do their exams with me, and I make them look, and every single person looks and sees how red everything is, how inflamed, how all the things,
Doree: Oh, fascinating.
Dr. Uloko: They start crying like, I could have seen this myself. I'm like, I know. So that's why I created the company that I have vulva AI to make these moments stop happening. Because if you understand, the science of the vulva at a hundred percent of people with a vulva will experience some sort of dysfunction in their lifetime. And yet a hundred percent of those people don't have doctors to go to. And you can't come see all of us just no way. There's just such a significant shortage of doctors that know.
Doree: Okay, so given that there's a shortage of doctors and not all of the 3 billion people with vulvas over the age of 18 are going to be able to see a doctor like you, what can people do on their own? And maybe this dovetails with your company that you started as well.
Dr. Uloko: So every time I do a penile exam, there's a little bit of discomfort sometimes just because I'm a woman. And that can be embarrassing for men, and I totally understand it. And we talk it out and we talk through it. Not one time has a patient ever apologized for their penis. They're not like, oh, I'm so sorry. This is disgusting. Oh, I'm so sorry. And that's every time I examined a woman or a person with a vulva, they would always apologize for their bodies. They're like, I'm so sorry. You have to see this. I'm like a baby girl. That's why you're
Doree: Here.
Dr. Uloko: That to me, that's culture. That's not, you learn this from somewhere, right? No one's ever apologizing for their kneecaps. They're like, if they go see an orthopedic surgeon, they're not like, I'm so sorry. You have to see my knees. I'm so sorry. That is something that is so deeply ingrained in our culture and western culture to be so disgusted by our own bodies. So people start looking at your vulvas, start, stop thinking of them as disgusting. That is what capitalism is teaching you. That is what this westernized patriarchal society is teaching you, that your bodies are gross. Because so many people, when they actually look at their own genitalia, they see the disease, they see, oh, wait, why didn't I ever look?
So you have to be your own biggest advocate in the healthcare system. That's something that I really want people to really understand is that your doctor most likely doesn't know you're going to have to be that person for yourself, your own advocate. And so that's really my goal is to empower patients to learn about their bodies. And my also other goal is to empower doctors to also learn about this. So ova AI not only helps patients, it also helps doctors, helps patients be able to advocate for their bodies by giving them insights into their bodies. And what is normal, what isn't normal, how to get diagnosed, how to talk to your doctor about diagnosis, what is the right treatment? We give you everything from start to finish so that you can get yourself diagnosed. And then we also teach doctors how to do this so that we ideally want doctors and patients working together, but not every single hospital system is going to sign up for vulva AI one day. So how then do we still protect the patients that are still having to go to through the system? And that's why we have two verticals we built for patients, we also built for doctors.
Elise: Let's talk more about this shame part, because it is so real. It's really showing up. There's a cost to not talking about our sexual health and our sexual parts. So what makes it hard for people to talk about sex? And what is your advice about how to make it more comfortable, especially because it could lead to not only better health outcomes, but better sex lives.
Dr. Uloko: Yeah. Yes. So I think that sexual health is just, it's such a great marker for your overall health. And it's someone, and I have just full disclosure of my, like I said, I was a late bloomer. I grew up in a very super hyper religious culty vibe. I just always attributed that to just being like, oh, I'm Nigerian and I just have crazy Nigerian parents. And then I met other Nigerians, and I was like, oh, you guys, oh, it's just my parents. Okay, cool. So sex was always super shamed. It was always this something to be, well, female sexuality was especially shamed. How dare I be a woman and be interested in sex? And so knowing me as well, when someone tells me I can't do something, that's when I'm very interested in doing it. So from a young age, I was always,
Elise: I can't resist a sign that says, do not touch.
Dr. Uloko: We'll always do it. So even though I was really interested and always curious about sex, it still took a lot to get rid of the religious shame, the cultural shame, all the things.
And it was a lot of defiance. It was a lot of defiance around this, of being like, you know what? Fuck this. This is something that is my pleasure, is my God-given, right? And if we look at prior to, I've been reading all about African sexualities and realizing that my tribe, my culture prior to Christianity was very sex positive, very, very sex positive. And the more I got really comfortable with my heritage and learning more about my history, I got more empowered to be like, oh, fuck yeah, I get to determine who I have sex with. I get to make this my own. And that's the other thing is that because we have such poor representation of what sex actually is, people always want it to look a certain way. And one person, Kelly Casperson, who leads this menopause amazing movement, she talks about, stop shoulding your sex life.
I should be this way. It should look like this. It should. And it's like, no, listen to your body. Start trusting your and listen to what feels good. Pleasure is literally like there's magic in your body, and you get to explore that magic, whether that's on your own, whether that's with a partner, but that takes owning your magic, owning your body, owning your magic. And for me, it was learning about my culture and my heritage, which then empowered me to push back against the cultural shame and the religious shame and really unpacking all of those things. But yeah, I think it starts with it's bravery. It's a lot of bravery. It's a hard thing to go against society and to go against culture. But I will tell you on the other side of it is a lot of freedom. So if you want to be
Elise: And ideally more pleasure. Exactly. I think a lot of conversation around women and women's sexuality is centered around desire and people having low desire, whatever. But if you center it around pleasure and it's fun, and we want to have fun time.
Dr. Uloko: Yes, yes. It's finding those moments of pleasure and almost romanticizing your life in a way of being like, no, I deserve this. This is my birthright. And owning that, because life is so short, we only have so much on this life. Have as many orgasms as possible, have as much pleasure as possible.
Elise: Amen. Sister,
Dr. Uloko: The goal.
Elise: Okay, let's take a break and we'll be right back.
Doree: Have you noticed any changes in the way younger patients are thinking about pleasure and their bodies? Has there been a generational shift?
Dr. Uloko: Yes. Yes and no. And yes, there a yes and no, and yes. Yeah. I think the no,
Elise: The best kind of answer,
Dr. Uloko: The no would be, there's just not great resources for them to seek, right? For it to have evidence-based, one source place to go and find this, if you want to go find about your bodies, about your pleasure, it's kind of scattered. It's really hard to, you have to do a lot of work to piece it together. I will say the younger generation, and I think every generation millennials, we at least open the conversation. I feel like, I don't know, I'll say the people that I see a lot are Gen Z. I see Gen ZA lot. I see a lot of patients in that. And the way that they go about their sexual agency is very fascinating. Oh,
Doree: Interesting.
Dr. Uloko: They are having conversations around sex that people in their forties are not able to have just really open and honest conversations around sex, their sexuality. It's just way more just way ingrained in their day-to-day life than
I still have my friends that are like, I'm never looking at my vulva. My husband will check that out. I'm like, baby girl, no. Look, if you're vulva, what fucking talking about, I'm a millennial. So I think the younger generation is a little bit more distrustful of the healthcare system. I've been really excited about that actually, because they're the first people, what? No, that doctor didn't know anything about me, or I didn't learn any answers from anything. And I think the older generations just still are very much, my doctor's, my doctor, and I'm going to trust them implicitly. And then they kind of hit menopause and they're like, my doctor kind of sucks and I'm suffering. And then each generation is like, wait a second. I didn't learn anything. Or I went to my gynecologist about my vaginal issue or concern, and I didn't learn anything. They didn't tell me anything. And that's what I'm really excited for is that with every generation, we kind of let go of being that good little girl. They just, and Gen Z to me are people that are learning about self-advocacy much earlier on than all the other generations.
Elise: Cool. And you kind of alluded to this already, but as a doctor, we imagine that when a lot of folks ask you about their sexual health or about their sexual relationships, what they're really asking you is if they're normal. So instead of aiming to be normal, what should people aim for?
Dr. Uloko: So why does anyone want to be normal? Why be normal when you could stand out first and foremost too? Yeah. A lot of my job is just normalizing things. So this is what I talk about a lot is that because we have such poor representation of sex in mainstream media, mainstream culture, we have a very rigid understanding of what sex should look like based off of our very limited worldview of sex and sexuality. So that's oftentimes when people come to me, they're like, I don't look like the person in porn. I don't look like the person in that magazine. I'm like this. They don't even look like that. What? Because I also take, I've taken care of people in the sex industry, and they will tell me all their insider tips and tricks, and I'm like, this is fascinating because so many people come in wanting to look like you and wanting to be like you, and then judge themselves about it. And they're then the sex industry workers are judging themselves for not being perfect. And I'm like, oh my God. Everyone just needs to accept their body exactly the way, and just to your body, listen to what your body feels good in your body. And it's building that self-trust of, because when your body is like, oh, I love this. And you're like, but you should love this. And you're like, just let your body be exactly what it is.
What I always want to scream at people is like, okay, great. And then what? There's disease, there's true disease, and we work through that and we eradicate disease, and then we go through to pleasure. And so many people, I had one patient that was like, I don't like to orgasm. So you had true pelvic pain. We were diagnosing that. And then as I did a comprehensive sexual health history, I was like, oh, what's your situation with orgasm? And she's like, I hate orgasming because I have difficulty orgasming because I pee. And I was like, so I hate orgasming. And I was like, oh, friend. That's called squirting. And there was a huge genre on people not urinating that notating. People love that. That's a whole genre of corn. And so I was like, I'm going to need you to go and Google it. And then she came back and she's like, oh, I'm really good at orgasms. And I was like, yeah. Oh my God. That was just general education. Because to her, she was so embarrassed. Her body was doing what her body normally does, but because her perception of what her body was doing was bad and not, oh, I'm celebrating my body doing this magical thing. She's like, I can't orgasm because I'm so embarrassed by the outcome. And I'm like, that is literally your body reaching peaks of pleasure. Let it go. Let it come literally.
And so that it's just accepting your body exactly where it's, and yeah, that's the start.
Elise: So in that spirit, where do you come down on all the cosmetic rejuvenation trends and things that are now being sold at ob gyn?
Dr. Uloko: Yeah, so this is where understanding the science of the vulva matters. So one thing, it all depends on what it's for. So many people will get their labia trended or shortened or this, that and the other because someone told them somewhere that it could cause pain, which it oftentimes doesn't. Actual whole cultures that actually do labial stretching because the labia having a big labia is actually really sexy to them. This is, again, how isn't it weird how bodies are trained?
Elise: It's a beauty standard, essentially. Yeah. It's like a body standard, a preference rather than
Dr. Uloko: In western, A
Elise: Biological imperative.
Dr. Uloko: Exactly. In western culture, they're telling you not to have smaller labia, which is, again, it's a body part. This is how your body developed. And so they'll then do a surgery where they'll trim it, which can have repercussions. It can actually injure the nerves to the clitoris, because a lot of doctors aren't even trained on vulvar surgery, so they'll injure the nerve. And the hilarious thing is, is that your labia actually starts shrinking when you hit perimenopause and menopause. So you didn't even need that surgery, but I digress. And also your labia
Elise: Aging will take care of it anyway.
Dr. Uloko: And also you want to preserve your labia. It helps with sexual pleasure. And then also it also serves as literally protective curtains for your urethra. It prevents you from getting infections like UTIs. So your labia are really important. And if people understood how the labia work or how the science behind the vulva is that your labia actually starts, they grow and they shrink with estrogen. So when you are a child, you have very small labia. When you go through puberty, your labia starts to grow. And then when you go through perimenopause, menopause, and if you're not well supported by a hormone doctor, your labia will literally start to shrink, and your vulva actually starts to go back to childlike states. So when people are like, I want to do a labiaplasty, I'm like, you don't need one. You're naturally going to have one. And we actually try to prevent that from happening.
So celebrate your labia. And again, this is, it's more so freedom. I want people to understand that there's freedom. If you're truly someone that's like, yeah, yeah, yeah, body positivity, body, all the things, and I still want my labiaplasty, then do that. But make sure that you're doing it from a lens of this is what I should look like. No one, genitals are different. Everyone's genitals are so different. And how beautiful is that? So if you're making decisions about, because I should look like something, that's when I usually give you this lecture. But then there's also things like the laser and all the other things. They actually do have a function and a place, but they could actually work better if more doctors understood the secrets of the vulva and how the vulva works. But yeah, so Labiaplasty is one of the ones that I push back on because it's just like your body's naturally going to do that anyways, and you actually want your labia.
Doree: It serves important.
Elise: It's very important.
Doree: You kind of touched on this earlier when you said that Gen Z has more of a skepticism of the healthcare industry and that women who are maybe entering menopause are sort of surprised to find that their doctors don't know what they would like them to know when they enter menopause. And this is a topic that we are very interested in here at Forever35, and we're going to little preview. We're going to have an entire series devoted to menopause and perimenopause later this fall. But just to kind of tee us up, what do you wish more people knew about menopause that they don't?
Dr. Uloko: Okay. I think of it as something to be celebrated. We never talk about menopause. I never heard anything about menopause until 2020 when people were like, what the fuck? Why am I suffering? And now there's a big movement around menopause, but I also don't think that people understand that this is coming for all of us. I need my millennials, and I need my Gen Zs to also know that menopause is coming for us. And the fact that there's only so many menopause providers and clinicians in our country means that you're not going to get the care that you need. Three, suffering isn't normal. We should stop accepting suffering. That's the other thing of so many people that are going to experience the symptoms of menopause will oftentimes be like, well, it's not that bad. Or they'll always kind of, it's something that's very, or
Elise: We're supposed to grin and bury it.
Dr. Uloko: Yeah. I'm like, no, this is again, this is where you are going for that pleasure life, right? You want pleasure. Why do you have to suffer when there are safe options out there? So many people are, and this is a healthcare system. The healthcare system also believes that it's okay for women to suffer, and I need women and people that are going to experience perimenopause and menopause to understand that you don't have to suffer. There is no prize for suffering. There's actually worse health. Health comes for suffering. So you don't have to quantify your suffering of like, oh, it's so bad. That's why I got on hormone replacement therapy, or that's why I chose to do something. You don't have to suffer, even if you're slightly uncomfortable, go in and see someone. My friends know this. I am one of the toughest people I know.
And also, I don't fucking like pain. I don't want to suffer. No part of me ever wants to suffer. I don't understand why we have this suffering Olympics, especially in women. Our womanhood is tied to our suffering, our ability to handle suffering. But that, no, I don't want to suffer and I don't want people to suffer, and I don't want people to feel like they have to justify why they want to stop suffering. And then two, understanding that most doctors aren't trained on menopause. And most doctors have an attitude that it's okay for women to suffer, and that women oftentimes will have to beg for their humanity, which is not something that we do in men. And that's why I love training as a urologist, because I had this foundation of not only do you treat disease, you make sure that their quality of life is impeccable after you treat disease.
That's not the way that we think about women in healthcare. It is very much of like, did you die though? She's okay. She's fine. She's not dead. And I'm like, yes, but is she thriving? Are they thriving? That's the other thing. So if you first and foremost get the courage to even say, you know what? I'm suffering enough and I hate it and I don't want to do this anymore. And then you go to your first doctor and they say, hormones are dangerous, that's a first sign to run because that person hasn't done any reading since 2002 and is not up to date on the science is not up on the things. I think it's so unfair that women have to justify their suffering. I think it's so unfair that they then have to justify then want to end their suffering. So if you find a doctor that says, that pushes back on HRT, it's not the only thing.
HRT hormone replacement therapy isn't the only thing out there, but it is the most effective thing out there. And I'm going to be on HRT until I am dead in the grave. You will put on my patch when I am 900 years old, I will be on my HRT till the cows come home because I don't want to suffer. Nobody wants to suffer. And so yeah, those are the things I want to tell people. You don't have to suffer. We are not doing a suffering Olympics. And there are safe options and affordable options out there. And if you go to your first doctor and they say, absolutely not, I don't feel comfortable, actually make them document that because that's actually against guidelines. There's guidelines for menopause. So if their doctor is going against the guidelines, that's actually reportable offense. So yeah, that's
Elise: Okay. Dr. Maria Loko, you have called them out. You've called out the irresponsible doctors.
Dr. Uloko: Yeah. It actually, it truly is irresponsible because there are chief in AFA ways. We know that the WHI study, which is a study that most doctors quote when they try to not give people HRT or hormone replacement therapy. If you actually look at the study and they've done reanalysis, it showed that hormone replacement therapy prevented heart disease, it prevented Alzheimer's, it prevented colon cancer, prevented endometrial cancer, prevented pathologic fractures, which if you break a hip, increases your mortality by almost 50%, you're 50% more likely at least to die after a hip fracture. And these are all things that are preventable. Just if your doctor got the training and the education and that is truly negligent at this point. It's out there. There's no excuse for this at this point, in my humble opinion.
Elise: We love your humble opinions. We've learned so much from you.
Doree: This was so great. Thank you so much, Dr. Loco. If our listeners want to follow you, check out your platform. Where can they do that?
Dr. Uloko: Yes, so they can follow me on Instagram. My personal page is Maria eloco md. They can follow@vulvaai.co. If you want to join the signup list, we are going to start putting out content and building our community educational content because so many people just don't know where to go and don't know why is my discharge this colored this day? Why does it hurt every time I pee? Why does it hurt every time I have sex? Great, we'll teach you. So sign up for that so that you can be first on the platform. We're also on TikTok. I'm on TikTok is sex med ed and involve ai.co. And then if you're in the LA area and want to, or in the California or even around the world and have a doctor that believes you and treats your sexual health concerns, whatever it is, I also have a clinic in that you can book through my website@mariaelocomd.com.
Doree: Thank you so much. Amazing. Thank you so much.
Dr. Uloko: Of
Doree: Course. I felt very educated after talking to Dr. U Loco.
Elise: Yeah. Yeah. I didn't know that. I didn't know there was so much that I didn't know. You don't know
Doree: What you Totally, totally, totally, totally. So let's go into the intention zone. Last week I was talking about my glutes, waking up my glutes,
Elise: Which then opened up a whole can
Doree: Of worms, a whole can of worms that I was not expecting with
Elise: Gluteal amnesia
Doree: And dead
Elise: Syndrome.
Doree: My intention was to continue with the Peloton Strength Program. I have done that. I completed week two. I'm now on week three. It's a four week program. And I will say my track record with these Peloton programs has been spotty. I did finish one, but it was at the height of the pandemic when nothing else was happening. And then since then, especially since I started playing tennis more, I've found it hard to fit in. But I think I mentioned this last time, what I like about this particular program is it's only after the first week. It's only two classes a week. So that like, oh, that's so bad. Feels doable to fit in. And I did, I think I mentioned this too, that I found some heavier weights on Facebook
Elise: Marketplace.
Doree: Very proud of myself, stronger for doing that. So this coming week, I talked about this on the casual chat, which comes out on Fridays on our Patreon, but I would like to figure out some sort of mini writing retreat that I can do to knock some of this book stuff out. So that's what I'm going to try to do this week. Just figure that out.
Elise: I'm excited. I hope it happens.
Doree: Thank you so
Elise: Much. It's so restorative just to get away, even if you're in the same town and you're just in a hotel or in an Airbnb or a friend's house. It's
Doree: True. It's true. It's really helpful. It's true. What about you?
Elise: I had a rough week, I have to admit, because my daughter was on sets for two days. She has her new show coming out on October 15th. So I will talk more about that coming up because all the parents are being called to help amplify as well. But because I was so, I spending so much time with my kids, I really didn't have time to exercise almost at all, so to say, nothing of strength training, which was my intention. I barely exercised my regular stuff. I barely walked and ran and I couldn't play tennis. And so today, I finally got back into some sort of physical activity, but I failed on my intention. I will continue to intend it, but I have a fresh one for this week. Given how crazy and hectic the past week was, my intention is solitude.
Even for a real people person like me, I need solitude to recharge and I don't have any, or I did not have a spot of solitude over the past week. It's not just the new puppy, it's not just the three kids and one of them being a working actor and the three podcasts and all that. It's actually, some of it is my lack of organizing my time in a way that allows for solitude because the kids are away at school. But then I am hosting friends in my back house, and so I've had it's Grand Central station in the backyard, people coming in and out. And then I also have fomo. And so when these friends from out of town, I have some friends coming in from Japan tomorrow, I feel as though I should maximize time with them. But that means I'm not getting solo time and I feel like it's kind of taking a toll mentally or emotionally. I just need to be alone sometimes.
Doree: Yeah, totally. So
Elise: I'm going to intend that.
Doree: Ooh, I like that. And
Elise: Carve it out.
Doree: Okay.
Elise: Feels good. Feels good.
Doree: Alright. Well, Elise, let's also remind everyone that Forever35 is hosted and produced by me, Doree Shafrir and you, Elise Hugh, and produced and edited by Sam Junio. Sami Reed is our project manager, and our network partner is Acast. Thanks everyone. Talk to you soon. Thanks y'all. Bye.
*Transcripts are AI generated.