Marcus Thorpe 0:15

Hello, everyone, and welcome back to the Ohio Health Wellness Conversation. We're so glad you're with us. I'm Marcus Thorpe,

 

Katie Lowe 0:20

and I'm Katie Lowe.  Today's topic is one that doesn't always get talked about openly, but it really is a critical part of women's overall health and well-being. Sexual health, from changes in desire to discomfort to hormonal shifts, many women experience changes over time without fully understanding why. 

 

Marcus Thorpe 0:42

we are joined by Dr. Cassandra Gray, who is with OhioHealth and OB/GYN. It is so great to have you here to talk about this conversation. I know that you are really excited about talking about this. You said it was one of the things when you were kind of getting into your OhioHealth journey with us that you said I think this is a really important topic that more people need to be thinking about. What is it about this conversation that you think gets underutilized, especially when it comes to couples and families and those kind of things?

 

Dr. Cassandra Gray 1:11

Yeah, so I'm very passionate about women's health and taking care of women, and especially educating patients and women of all ages about their health, their lives, and sexual health is such a large part of that. As a gynecologist, I don't think this gets talked about so much because it's just not a like public-friendly conversation. Most people aren't sitting down at the dinner table talking about like you know that kind of hurt the other day or whatever you know. So it's something that maybe people talk a little bit about in their little friend groups, but not so much at home with the family or in the public. So there's not a whole lot of cross discussion.

 

Marcus Thorpe 1:50

It's so funny when Katie and I sit down and kind of discuss what topics we want to cover on this podcast. That's almost word for word how we were discussing having this topic, right? I mean, what is going to resonate with people? What is something that people don't always talk about that maybe they should be talking about? And I think sexual health was one of those things that we knew would kind of be a nice flashpoint for people to have conversations that they don't normally want to.

 

Katie Lowe 2:13

For sure, yeah, it's something that's so extremely important, but again, just doesn't always get brought up because of that level of discomfort, so first of all, I wanted to talk about because this is something that doesn't always get talked about. Why don't we just first dive into what exactly is sexual health? What does that encompass?

 

Dr. Cassandra Gray 2:35

Yeah, so it's a large umbrella topic. It means different things to different people. So that's having like healthy relationships, healthier like safe sex practices, and then paying attention to what's normal, what's not normal, and then when you should get help for what's going on.

 

Marcus Thorpe 2:52

Yeah,

 

Katie Lowe 2:52

yeah.

 

Marcus Thorpe 2:53

It seems like in households it can be a difficult conversation, but I would imagine even in like your practice, when people come and see you, even with a doctor, somebody that you think you would be able to trust in a closed, safe space. Do you find that people are still reluctant to have those in-depth conversations about sex?

 

Dr. Cassandra Gray 3:11

Yeah, absolutely. Especially initially, where they're like, "You're a stranger. I don't know who you are or how you're going to react to what I'm saying, because it's not something. It's very personal. It's not something we talk about very much. So when I'm doing my screening questions for patients, looking for like, are you having pain or dryness or are you having a healthy relationship? The initial response is like, oh yes, yes, yes, no problems there. It's usually the next visit I see them where they start saying like, you know, you asked about that, and it actually it is a problem. I want to talk about it.

 

Marcus Thorpe 3:43

So that initial time, maybe okay, I'm still closed off to having that discussion, but you've planted the seed of okay, this is okay, and this is safe for me to talk about

 

Dr. Cassandra Gray 3:51

 Yes, absolutely.

 

Katie Lowe 3:52

I'm sure it's definitely the the younger generation may especially feel that discomfort. I remember when I was a younger woman, just just the regular screening questions, I would feel so uncomfortable, you know. But certainly, I think we we really would like to open the conversation today to encourage more women of all ages to feel comfortable bringing anything up to their doctor when it comes to their sexual health. And I mentioned, you know, any age. So let's talk about age when it comes to sexual health. How does it change for your different life stages between you know when you're in your 20s and 30s and then 40s and beyond?

 

Dr. Cassandra Gray 4:31

Yeah, so there are definitely changes in like earlier life. It's more so figuring out what's normal for you and when should you talk about like, oh well, that kind of hurt, or that didn't feel very good, or I'm worried about a discharge or something? A lot of it's focused towards like safe sex practices, STD prevention, all of that. But then also having a healthy relationship and screening for things like domestic abuse and violence and all of that. You get older into life; those things are definitely still a concern and things that we're screening for. But as far as the patients are concerned, they might be more worried about changes in libido or changes in dryness or just their relationship changes after pregnancy or after menopause and all of that. Like all these life stages look so different for everybody.

 

Marcus Thorpe 5:21

I think we're in different stages of our lives. You're having a baby, and you're in your 30s. I'm in my 40s, so my wife and I are obviously at a different stage in our life. We've got our two teenage boys at home and and raising them. But my wife, obviously, hormones have changed in the perimenopause, moving into menopause phase of of her life, can you talk about how hormones really play a critical role and sometimes a challenging role when it comes to desire, when it comes to comfort, when it comes to some of the issues that you know women see as they start to grow older?

 

Dr. Cassandra Gray 5:54

Yeah, yeah, hormones are so very important. So as you get into the perimenopausal and menopausal range, the ovaries are not making as much hormone as they used to, and you were in your 20s and 30s, and you were like in your most fertile times of life. It's a natural decline in the hormones as you get older, but with that comes several different risks, not just to your physical health, but then also to your sexual health. So, more likely to have decreased libido, either due to hormone changes or due to discomfort from dryness, which is one of the most common things I hear from patients in their perimenopause and menopausal years. That's one thing I screen for, and when I when I ask them like, "Do you have any dryness? they say, "Well, how did you know that? I've kind of done this for a while! 

 

Dr. Cassandra Gray 6:42

It's so common, and so many people don't realize there's there's things we can do for that that work very well.

 

Katie Lowe 6:47

Yes, that's that's what I've heard, and I'm curious. We talked about the different life stages and how hormones can play a role. Obviously, hormones are at a high during pregnancy. Yes, I would love to talk about that because I you know, I'm very pregnant myself. Yes. So how, how do, how does a high level of hormones affect your your sexual health and any sort of symptoms that may come from that?

 

Dr. Cassandra Gray 7:10

Yeah. So having higher levels of hormones in pregnancy, especially, there's a lot more discharge. You might be have more concerns about like, is this normal? Do I have an infection? And many patients, when they come in and they're bringing these concerns forth, it's the answer is actually yes. This is completely normal. Like it's the cervix doing exactly what it's supposed to do to protect the the baby from any bacteria on the outside world. So that's a common change from the hormones. And then there's positional changes like your ligaments and tendons, things stretch, the bones move, and so there's more pressure, and that can cause a different kind of discomfort during the pregnancy with with sexual health and intimacy.

 

Katie Lowe 7:53

Yeah,

 

Marcus Thorpe 7:54

Dr. Gray, let's talk about desire. It is one of those things where you know, hey, you're a teen. You're starting to hit puberty. Personal experience: everything is going crazy all at the same time, and it's hard to keep track of who you are some days. But then, as you start to get older, you know things change and desires change at the same time. How how impactful can just the body's reaction to growing older impact desire?

 

Dr. Cassandra Gray 8:22

Yeah, yeah, that's a great question. So sometimes the decrease in hormones as you get older can decrease libido or desire. Many times it's more so just relationship changes, priority changes. Maybe there's health problems that are making it difficult to be intimate, either for the woman or for their partner, and then you're just not as not as interested anymore. But on the flip side, I have patients well into their 60s, 70s, 80s, and they're regularly sexually active, and they have a very intimate relationship that's very healthy. So I don't want people to think that you're supposed to have a decrease in desire as you get older. Some people throughout their lives have less desire than other people. Generally, I don't tell people it's not normal to have a high libido or to have a low libido unless you feel like it's causing problems in your relationship.

 

Katie Lowe 9:20

Yeah, it seems like it can vary so much. So it can be hard, you know, when you when you experience a change to know is this something I should bring up to my doctor or how to navigate that. So when should someone be concerned when they're they're noticing a change when it comes to their libido or just their overall sexual health.

 

Dr. Cassandra Gray 9:41

Yeah, the the time to start talking about it is if you notice a change, and it's been like that for a few months, and you say like maybe my desire now. I noticed I haven't really wanted to have that intimacy with my partner in a little bit of time, and I used to want that all of the time, and. That's a good time to bring it up to your doctor, your primary physician, to start that conversation and see if it's a problem.

 

Marcus Thorpe 10:10

What about libido for somebody who never really had that strong libido? Missed something earlier in their lives? You know, maybe in your 20s. We talk about oh, well, maybe your libido changes when you get into your 30s and 40s, and you've had your kids and those kind of things. But for some people, what what do you say to somebody who comes in and says, "I've never really had that. I've never had that desire. I don't know what to do. Is that normal?

 

Dr. Cassandra Gray 10:33

Yeah. So that can be normal, and there's a lot of factors that play into it. Some people just based on their home life, their sexual health education growing up can play into it. Many people feel a lot of shame towards being sexually active or intimate with a partner, especially as they're in their teenage years and then into the early 20s. So some of that makes people very avoidant, and it's like I said, not a problem unless you feel like it's a problem. And if you feel like it's a problem, then definitely bring it up with your provider. Some of that can be addressed with checking hormone levels because maybe there is a hormone problem, or having like like a counselor or somebody to talk through maybe some trauma in the past or issues growing up that make you feel like you shouldn't have those desires, and then the last thing would be just becoming more comfortable with yourself, yeah, and learning like what should feel things feel like and how do you make things feel different. 

 

Marcus Thorpe 11:39

I liked what Katie when you said you know everybody is at different stages or different issues that are coming into their lives. I mean, we talk about stress or a lack of sleep or mental health issues, and all of those things play a role in libido. Sometimes it's like, hey, my house is a mess, or I walk in and there's dishes everywhere, and I just don't feel that connection to my partner because my space doesn't feel good for me. So there's a lot of factors that come into play that aren't just your hormones. Sometimes it's a lot of other factors and the environment that are impacting you.

 

Katie Lowe 12:12

And it seems like communication and that open dialog is such a huge part in addressing it and taking that first step towards you know, if if you do want to address it, the the first part is kind of acknowledging that that is there. I want to talk about discomfort because I know just from talking to a lot of women, a lot of moms, that that seems to be a pretty common symptom when it comes to perimenopause and menopause. What exactly causes pain during intimacy, and how common is that?

 

Dr. Cassandra Gray 12:47

Yeah, so it's it's very common. This is something I see regularly just throughout the week in my office. So it can be from growths on the the uterus, like fibroids, muscular growths. It can be from cysts on the ovaries, and then, like I mentioned before, it can be from changes in the vaginal and like the lubrication to the vagina from changes in hormones that can be natural. Could be infections. There's so many things that can contribute to that, and then also like prior trauma, pelvic floor muscle disorders. Just like some people have issues with their shoulder or their knee, and they have to go to rehab. There's rehab for the pelvic floor as well.

 

Marcus Thorpe 13:32

Are there misconceptions about pain that you wish women knew a little bit more, maybe understood a little bit differently?

 

Dr. Cassandra Gray 13:38

Yeah, yeah. I really just wish women would be more comfortable talking about pain and bringing it to their providers. I want them to know that this is very important. If it's something that bothers you, it's something we should talk through.

 

Katie Lowe 13:52

I think so many women feel that living in discomfort is just something that they should put up with, and it just kind of becomes the normal. But it doesn't have to be. So I'm so glad we're talking about it. It says, speaking of which, what can you do? What are the treatment options for people who may be experiencing dryness, which is leading to pain during intimacy?

 

Dr. Cassandra Gray 14:12

Yeah, specifically for dryness, the first line option to try is lubricants. So that can be like KY jellies or other like sexual lubricants you see near like the condom section at the grocery store, or that can be something like coconut oil or other specific lubricants marketed towards menopause years. And then beyond that, if those aren't helping, you can try an estrogen cream tablets, rings. Those are all prescription you can get from your gynecologist. They're very commonly prescribed and they're very effective for helping dryness.

 

Katie Lowe 14:51

That's great.

 

Marcus Thorpe 14:52

What what way would you encourage women to walk into your office and start this conversation? Again, sometimes. That first step can be the hardest part to to open that dialog, whether it's with your partner, whether it's with your doctor, your OB/GYN. How would you like to see women present to you in a form or fashion that you think is going to be helpful for them, and also helpful for you as a physician to really get down to the basics of what we can do and not have to live in this, you know, fear of of conversation and talking about these things.

 

Dr. Cassandra Gray 15:26

Yeah, absolutely. The best way to approach it is that we're we're going to need a whole set of time set aside just to go over this because, like we talked, there's so many things that can be going on causing discomfort. There's so many causes of that, and it deserves attention. So really, just bringing it up at your annual visits or scheduling an appointment. If you you weren't thinking about it at your annual visit, so you didn't bring it up, you can always schedule another one specifically for this issue. So then your provider knows that when you show up, this is what you want to talk about. So it's already on their mind, and they're prepared to give it all the attention it deserves. 

 

Marcus Thorpe 16:05

How closely do you work with women who come in and start with the medical conversation, and maybe it turns to a different level for you of saying, "I'm not sure this is necessarily a physical issue that we're dealing with. It may be more of the mental health side of things, and maybe you need to refer them beyond what you can do in your office.

 

Dr. Cassandra Gray 16:25

Yeah, yeah, that is very common because, as as you mentioned, relationships and stress, and then also like lifestyle factors, like what's going on at home? Is the kitchen a mess? Does that bother you? Have you been running around all day, or do you feel relaxed? Because intimacy is not something that can happen in a time of stress, at least not easily. 

 

Marcus Thorpe 16:50

it's good to have that next component, or somebody else that maybe is more of a therapist side of things beyond just the physical part of the body, right?

 

Dr. Cassandra Gray 17:01

Yes, because some of it is anxiety, some of it's depression. Decreased libido is a side effect of also mental health disorders and mental health problems that people are working on. Sometimes even medications that are used to treat mental health can also have the side effect of libido.

 

Katie Lowe 17:18

I was just about to ask about that. How medical interventions and also just lifestyle behaviors, whether it's nutrition or exercise, can any of those play a role in your sexual health?

 

Dr. Cassandra Gray 17:32

Yeah, yeah. Individually, they can, but then also all together. So having a healthy diet, regular exercise, you're more likely to feel good about yourself. You're more likely to feel good, have less medical problems that could be making intimacy difficult. And then, if you have all of that, you're also more likely to have a good body image. So, intimacy and healthy relationships start with having a healthy relationship with yourself and feeling comfortable in your own body.

 

Marcus Thorpe 18:02

Let's talk about the partners. We spent a lot of time so far in this podcast talking about women and women's health. Obviously, man here at the table. So, how can we as partners step up? How can we foster strong sexual relationships with our partners and those kind of things. What would you suggest our role can be in in the process?

 

Dr. Cassandra Gray 18:24

Yeah, yeah. The biggest thing is open communication, and it's like non-judgmental, open questions, and being a good listener. So asking, you know, that that seemed uncomfortable for you. Do you want to do you want to talk about it? And picking a time where they're able to talk about it, not when they're cleaning up and worried about the kitchen and all of that, and just like at the doctor's office, we want to spend time on this. You you need to spend time in on that in your relationship at home too.

 

Marcus Thorpe 18:51

Married for 20 years myself, how common is it for people to be at different points of their lives, or different points of their weeks, or different points of their days, and a lot of times those don't line up perfectly, and so maybe that can also be an issue. Do you hear that from women too? Of like, my husband wants it now, I don't, and now maybe I feel like I might want to initiate some intimacy, and he's busy or he's working or something's going on in his life. Is sometimes it's just ships crossing in the night, and and you can't seem to line those things up.

 

Dr. Cassandra Gray 19:22

Oh yes, absolutely, absolutely. Because maybe you've been out at work all day, and you're exhausted when you get home, and just your mind is racing with everything that happened during the day. So intimacy is not really what you come home thinking of the first thing, and you're wanting to de-stress from your day, and maybe your partner works from home, or they were off at their job, but it was a little less of a stressful day. So they've been looking forward to seeing you all day. So they have it on their mind that like tonight would be a great night to have some intimacy, and maybe you're thinking, I just I just want to relax tonight. Yeah,

 

Marcus Thorpe 19:58

yeah.

 

Katie Lowe 19:59

I think. You know, we're speaking about body image too, and as much as working out, eating well, those all play certainly a factor. I'm sure for a lot of people, their relationship with their partner also plays a role in their own body image, and I'm sure that also comes to play when it when it comes to your sexual health and intimacy. Is just how strong your relationship is with your your partner and how that affects your body image.

 

Dr. Cassandra Gray 20:24

Yeah, absolutely.

 

Marcus Thorpe 20:26

And conversation. You mentioned that. I mean, it's not just the the physical part of it. You have to sit and talk and figure out where each other can be and and where you are at that time.

 

Katie Lowe 20:36

That's hard.

 

Marcus Thorpe 20:37

Good luck to have those conversations. Even if you've been married for a short time or a long time, or you're just dating and those kind of things, like again, it's pulling back that curtain a little bit and saying these are healthy things to be doing, and it's how you're setting yourself up for success in the long run, right?

 

Dr. Cassandra Gray 20:52

Yes.

 

Marcus Thorpe 20:53

Yeah.

 

Katie Lowe 20:53

Yeah. It's just a vulnerable conversation to have, but so important. Which is again why I'm so glad we're talking about it today. Whether it's with your doctor or your partner or whoever, it's just hard to talk about. But the more we do, the the easier it'll get. Dr. Gray, I wanted to ask you if there is one message that our viewers and listeners can take home with them from this podcast episode today, when it comes to their sexual health. What would it be?

 

Dr. Cassandra Gray 21:22

Yeah, I think one message would be to take care of yourself and your own self care, and your relationships are one of the most important things you can worry about and try to improve. It's good for your overall health. It's good for your success in life, and these are these are things your doctor wants to talk to you about.

 

Marcus Thorpe 21:43

What's your take on the current state we all live in with the amount of misinformation that's out there? All right, I mean, at your fingertips at all points there can be somebody on TikTok or somebody on Instagram who claims to be an expert or just a random voice inside of your feed. Do you fight a lot of that when people come in and they say, "Hey, I saw this or I read this article, do you have to go back and say, "Okay, well, who did you hear that from, and how does that work? What is that like for you in your practice?

 

Dr. Cassandra Gray 22:09

Yeah, that is something I run into very frequently, especially with my my younger population of patients, but then also the older ones: TikTok, YouTube, Instagram, all of that, Twitter,

 

Marcus Thorpe 22:20

book clubs, book

 

Dr. Cassandra Gray 22:21

clubs, yeah, yeah. So people have a lot of thoughts and opinions on hormones, and is it all hormones? Can we just take like certain medications or injections or pellets, and that will just solve all of the problems? Really, it's a little more complicated than that. Unfortunately, there are a lot of products out there that are marketed towards women that are supplements. They're very expensive. They're not regulated, and there's just no science behind it. And some of it can actually be harmful. So I definitely want people to feel open having these conversations with their physician. I love when my patients ask me those questions because it helps me understand where they're coming from and what they're worried about and what they want to do about it

 

Katie Lowe 23:05

iYeah, we're talking about different generations, and I'm curious because I know at least me being part of the millennial generation, we still talking about sex is still kind of taboo, and there's some discomfort around it. Do you find with Gen Z, the younger generations, that they're coming to you and feeling more comfortable about this topic or asking more questions.

 

Dr. Cassandra Gray 23:27

Yeah, I definitely have noticed that, and of course, all the different generations they use different words to talk about different things. I don't care what words you use; what I'll use the same words that you're using in your visit. But I have noticed that the younger generations are more open to talking about these issues, which I think is wonderful. 

 

Marcus Thorpe 23:47

Is that something women that women talk about? I'm curious. Look, I don't hang out with a bunch of women groups, but like, do women talk about sex with like their friends and those kind of things? Because obviously, guys, we kind of shut those things off for the most part. We don't always talk about the things that maybe we could be for healthier man-to-man relationships, but like in your friend group,

 

Katie Lowe 24:06

typically more of just a private conversation. It's not something that'll be brought up like you know out in public at the dinner table. But

 

Marcus Thorpe 24:15

just like one-on-one with your friend, you'll have a little conversation here. Yeah. Okay, I think that's healthy, right? You would say that

 

Dr. Cassandra Gray 24:21

that's very healthy. Step in the right direction.

 

Marcus Thorpe 24:23

There you go. Yes, leading the charge. I like that. I. It's funny when we first started this conversation. I thought to myself, this is going to be a tough conversation to have, and the the more we've talked about it, the less I don't know taboo or weird it's been. So I I can see how having these conversations inside of safe spaces with your physician or with your partner is a healthy way to go about it, and I think that maybe this is the first step for somebody to start doing that. So we really appreciate you joining us, Dr. Gray. It's been great.

 

Dr. Cassandra Gray 24:50

Yeah, of course. Thank you very much for having me.

 

Marcus Thorpe 24:52

And remember, sexual health is a vital part of overall wellness. It really is something that women and families deserve to understand how to feel. Confident addressing some of those really big topics. If you found this episode helpful, if it's something that you think somebody else would be able to get something out of, we encourage you to like, favorite, subscribe, and then share it with somebody else. We think word of mouth goes a long way on topics like this, and so you could really help us out that way.

 

Katie Lowe 25:17

Absolutely, and remember, you can find all of our previous episodes wherever you get your podcasts, and at OhioHealth.com. So for more, you can check out the Ohio Health blog. Thanks for listening, and we'll see you next time.