Taking the Shame out of Sexual Health with Dr. Lyndsey Harper
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Kara Wada, MD: ​
Welcome back everyone, my name is Dr. Kara Wada. I am a pediatric and adult allergy immunology lifestyle medicine doc and systemic Sjogren's patient. We are so excited to bring guests on that are really helping empower us all through their work and I am so excited and honored to welcome Dr. Lindsay Harper today.
Dr. Harper is the founder and CEO of Rosy. It is a first of its kind platform that was formed out of frustration when she couldn't find modern and accessible resources to help her patients. A resource that connects the 84 million women in the US with sexual problems, with hope, community, and research back solutions to improve their lives.
Dr. Harper is a board certified obstetric gynecology physician who is based in the Dallas area and she was in practice for seven years now working as a hospitalist.
She is an associate professor of Obgyn for Texas A&M, a fellow of the American Congress of Obstetricians and Gynecologists, and a fellow of the International Society for the Study of Women's sexual Health.
She has been named Forbes Top 53 Women Disrupting Healthcare. People Newspapers' 20 under 40, and a top innovator in North Texas for 2020 and DBJ top Woman in Tech.
So thank you so much Dr. Harper, for taking time out of your busy schedule and and joining us on the podcast today.
Lyndsey Harper, MD: Yeah, thank you for that intro and I'm more than happy to be here to talk about all of my favorite things with you.
So thanks so much for having me. Yeah.
Kara Wada, MD: Maybe you can share a little bit more about some of those frustrations or things that were coming up as you were seeing patients that really put you in this place of saying," Ah, I have to do something."
Lyndsey Harper, MD: Yeah, it was definitely an accumulation of things over the years, right?
What happened was that when I was in private practice, moving and grooving, delivering babies, doing hysterectomies, managing contraception, screening for cervical cancer, breast cancer, STIs, this is what we call an obgyn, the bread and butter, right? Like the things that everyone does all day long.
But something that was happening in my practice as I was like getting closer, I think with my patients, we'd had two or three babies together, maybe a loss. You just start to develop these really close relationships. And my patients were starting to open up, even though I was doing a terrible job of talking to them about their sexual health, cuz I just wasn't trained to really ask more questions outside of," Are you sexually active?
Like really asinine unimportant things like how many partners have you? I wasn't asking them anything of substance but they started to share with me that they were having trouble with low desire. They were having trouble with diminished or absent orgasm trouble with arousal.
There were just a lot of, " Oh my gosh I have no idea what to do. I have no idea who to talk to this" and so then they would entrust me with this information and I was like, "Ugh. I don't know what to do either. " I had no training. I spent two weeks as a medical student, not even as a resident, as a medical student in an erectile dysfunction clinic. But when we compare that to my training for men's or for women's sexual health, it was really zero.
I knew a little bit about sexual pain when it comes to endometriosis and vagus, but when it came to desire orgasm arousal literally nothing so that kind of raised my eyebrow. I was like, "okay, is this my problem?"
I had a baby in residency, so I'm like, maybe I missed this rotation, right? I don't know. Or maybe my hospital, like my residency program just sucks at this and maybe everyone else got trained and I didn't. That wasn't the case.
Then I was like maybe my patient population is special, for some reason. We're in Dallas and for some reason we are all having sexual problems. No, what I found out is that no one's getting trained and that 43% of women have a sexual health problem. And I was like, "Oh my gosh. That's almost half of women." That's probably an underestimate, but that's what the data says so that's what I say.
Then we look over here, okay is sexuality something we just don't talk about? No, we talk about it a lot and when it comes to men's health, urologists treat patients with their patients with sexual dysfunction, particularly men all day, every day. Primary care doctors are taught how to deal with erectile dysfunction, other sexual problems for men.
So that even emphasize the need, the urgency to do something now, right?
Because this is a huge problem for women. None of us are getting trained and we are doing stuff. We can see that it's possible over here on the men's sexual health side.
So how can we create at least some semblance of parody for women?
Because the negative effects of the lack of conversation about this are that women feel like they're the only one suffering. They're like, "Oh, if my doctor doesn't even know about it, I guess it's not that big of a deal. I'm just extra broken." Just like it probably is with a lot of autoimmune stuff and then they think that there is no hope for them because nobody knows what to do or how to do it, and sometimes even worse.
They're sold things by these lifestyle brands. Not to name. I can name names. I don't have any shame in naming names, but where these things don't really work. So they're like buying like random $400 yoni eggs and expecting to become a like sexual goddess and that's just not what the problem was ever to begin with. That really compounds the hopelessness and isolation and shame that these people feel. So I got real mad pretty fast. I'm like, "This is a huge problem."
And I can't believe that this was in 2019. I cannot believe the world is where we are today and nothing has been done. So anyway, made the very like crazy and important and pivotal decision to share this with my partners whom I love and I'm still very close with. With my patients and then eventually to leave private practice and work on Rosy full-time so that we could really try to change this for medicine as we know it. Change it for women as we know it and be part of this bigger movement to really move things forward for women and our sexual health.
Kara Wada, MD: As we talk just a little bit before we hit record, thinking back, like one of the first symptoms that I now attribute to my Sjogren's, I brought up with my obstetrician gynecologist because she was the doc that I saw for my yearly exam and had a good rapport with her, but even still, even though that was a very trusting relationship she went on to deliver two of my babies. But it still was that door handle conversation of it took to the end of that visit for me to really feel comfortable enough to bring that information, and even still I could see from what you've shared now, maybe why her response was what it was, which wasn't at the time's super helpful .
Lyndsey Harper, MD: Sure. And unfortunately that's the experience that most of us have. Okay, so I spend a lot of time educating physicians about women's sexual health and the title of my grand rounds is, "Women's Sexual Health: it's not that complicated."
Because what we all think and what we were taught is, "Oh my gosh, if you ask a woman about sexual problems, it's like opening Pandora's box, right?"
You're gonna get the relationship problems and the past sexual trauma and the whatever. And you're just gonna be in the room with the patient for 30 minutes and it doesn't have to be that way. When we talk to our patients about their mental health, which we've gotten pretty comfortable screening, obgyns probably write more SSRIs than anybody.
We don't think about it in that way. We're not like, "Oh, here's, we're gonna come up with the childhood stuff and blah, blah, blah." That's not how we think about it. It's because we were trained to ask, and we were trained to think about it in a framework, and if this, then this, if this, then this.
The same is true for sexual health, right? There is obviously a psychological component. There is a contextual and educational component, and there is absolutely a medical component that we must own. So all we have to do is number one, ask the question. But there's some barriers to that, training and time.
But hopefully the game plan can be to demystify it where we can understand, "Okay, what is our piece of this puzzle?" Because we do have a piece in the puzzle. And then, who are the people in our community to which we can refer to help these patients with these really important problems?
So if I have a patient who's depressed and who's failed an SSRI, I'm gonna pass her on to a specialist. The same can be true for women's sexual health problems. Once we have that context, that framework, then we have the permission and we are armed to ask the questions and take the steps in the directions for her health.
But unfortunately, when we're not taught any of those things, there's a lot of emotion and like chatter tied up in these conversations, that's completely unnecessary, but it doesn't take long to unwind that. So I think if we can continue having conversations like this, get the message out there that in fact it's not that complicated and we can do it like we do, we can do hard things and this isn't that hard.
We can really change that experience for you, for people just like you, and for physicians, on the other side of that conversation as well.
Kara Wada, MD: Part of the conversation too is also just bringing awareness that we as women deserve that attention. Right? That we deserve a full and robust life. And that can include good sexual health as well.
Lyndsey Harper, MD: A hundred percent. This really gets to the core of like women's health generally, right? Because this is a whole podcast in and of itself.
There's medicine was built by men. There's just not any way to argue with that. When you are a person, you view something through context and through your lens, right? And so when, that's the one side of the coin, how medicine was built, and the other side of the coin, which is how women are socialized.
Which is to say menstrual pain is normal, which is to say, being up all night and having terrible hot flashes during menopause should be tolerated, which is to say, all of these things peeing on yourself, that's part of getting older, losing your sexual function and sex drive. That's normal. None of these things are normal!
And if we like flipped this script and pretended these were men, there was an amazing New York Times article about this week about menopause that sort of puts it in this light. So if all these stuff were happening to men, like this would've been solved a long time ago. Not to say that men are bad or evil, it's just that their context.
So now that we are in positions of influence and power and have the ability to change these things for ourselves, we have to do it. I think it goes back to all really of healthcare, but particularly in women's health issues and obviously in underserved underrepresented populations as well.
Yeah, there's a lot of work to be done, but it's exciting to be in the time where it's happening for sure.
Kara Wada, MD: Absolutely agree. It's fitting, so this will probably air in several weeks, but we're recording this on National Women Physicians Day which is just an exciting day that we was really only established in the last, I don't know, five or seven years but celebrating Elizabeth Blackwell the first American female physician in the US.
So I just thought of that as we were chatting and it's amazing. Just think about girl power.
Lyndsey Harper, MD: That's right.
Kara Wada, MD: And how far things have come.
Lyndsey Harper, MD: It's so exciting. Yeah. Things have come a long way because there have been so many pioneers and those stories are so inspiring because it really does take a lot to step out there in a way.
And I can't imagine being the first woman physician in the United like I just can't even imagine that. We just have to keep repeating those stories to ourselves because sometimes things are like difficult and we can't imagine how it could ever be done, but the world does change, so it's a great thing for sure.
Kara Wada, MD: Yeah. I always have a hard time, so my grandma in-law who since has passed on, she she went to medical school twice. First in Japan and then in the US when she moved back to the US after World War II.
Lyndsey Harper, MD: Wow.
Kara Wada, MD: So this is like the early fifties and through kind of some of those harder points during like medical school, residency, motherhood, whatever, I'm always like Dr. Ayako is she ? She did twice with taking names yeah, not even five feet tall and just.
Lyndsey Harper, MD: That's amazing. I have, my mother-in-law had six children, so when I have a parenting day I'm like, "Oh Carol did it. So can I." You know what I mean?
We do have to have those touchpoints cuz we need all the support we can get for sure.
Kara Wada, MD: Yeah, so I'm familiar with Rosy since you launched and we had talked about that and I had mentioned I still have my Rosy pen floating around my purse. I love that.
But can you share a little bit about the resources that, I'm sure you're gonna do a much better job describing it than I will, but what is all on the Rosy app?
Lyndsey Harper, MD: Yeah. So whenever I was first thinking about what's a great way to make a difference hopefully in this area and what I learned whenever I was getting my, I went on to get a lot more specialized sexual medicine training , just fyi.
What I learned is that so much of what women need is actually to be reeducated and behavioral change resources. That's not to say that's all what all of what we need, cuz it's not, but it's a big part of it. It would be like talking to someone about losing weight and skipping the part about, moving your body and making healthy food choices, right?
There are certain pieces that need to be in place for us to make progress.
Kara Wada, MD: Four Pillars.
Lyndsey Harper, MD: Exactly. Yeah. So really that's what Rosy represents is an evidence-based place where women can access information that has been shown to improve sexual function and other behavioral health tools as well. When a woman downloads Rosy, we have an onboarding questionnaire that takes into account really all aspects of everything about her sexuality.
One of my favorite sex therapists says that, "Sexuality is as unique as our fingerprint." That is because of there's so much context, right? There's how did we grow up thinking about sex? What have been our past sexual experiences? What's our current hormonals status? What's going on in our relationships, right?
So this idea of Pandora's Box goes from being intimidating to a beautiful experience that honors each of us as individuals, even down to religious context, which I love this aspect of things. If I ever go back to being a student, I'm gonna get a phD in religion and sexuality because it's just so fascinating.
But we've created resources for Orthodox Jewish women, for Muslim women, for conservative Christian women, and it's never Rosy's intention, nor did I think it should be anyone's, to change a person, but really to help her become more sex positive, more fulfilled in her current context. And so those are the types of resources that we wanna try to offer.
We have a ton of education. How women experience pleasure? Like switching up your sex routine. Yeah. All kinds of personalized information based on how you answered those first 30 questions in the onboarding and we we really try to tackle specific sexual health goals.
So if you're trying to work on low desire or sexual communication or a lot of our users just wanna spice things up, then we can't have like whole tracks to accomplish really lots of different goals. Then we try to take into account different life stages as well. This is something that I think is fun to think about with sexuality is it's never like, "Oh you run into a sexual problem and then you solve it."
But it really stays with us throughout our whole life from the time we're learning about our body parts when we're little kids, all the way until we die. Hopefully. That's my goal.
It's negotiating how we navigate the bumps in the road as we go. So maybe that's infertility. Maybe that's trauma. Maybe that's pregnancy and postpartum. Maybe it's breast cancer. Maybe it's your partner has a sexual challenge or issue. So there's always gonna be something that we wanna learn about or could you support for. And we have resources for all of those life stages as well.
We have a library of erotica, which is an evidence-based way to improve sexual desire. And actually, we have some new research coming out on erotica, which it just time and time again proves itself over and over. It's fascinating.
Kara Wada, MD: And this, I would, this is in part two what I find so cool about what you're doing is that it's this interface in addition to providing this empowering education, but also contributing back to the body of research that we have to only like totally grow this.
Lyndsey Harper, MD: Absolutely. That's so fundamental to who we are as a company. We started doing research within the first six months that we launched with like very little funding. We've been able to just crank it out conference after conference we're presenting something.
And the really cool thing that we're working on right now is getting our whole database IRB approved, so that academic research can send us an email and say, "Hey, I'm interested in infertility and sexual function or menopause and sexual function, or aging parents and sexual function."
Like literally we have so many different ways of looking at this stuff that we can then share the de-identified data so that we can contribute back to the greater body of knowledge. That's so important because I think at this point, and for probably the last couple of years, we've had the largest data set in the field.
It's just because no one's ever done anything . It's not cause they're like extra amazing. It's cuz nobody ever did it. So I think that's such a powerful like moment for us where we can be like, "Hey, we are not in this just for us. We are in this for for the greater change that we wanna be a part of."
And so I'm super pumped about that. We're hoping that approval will come through in the next few weeks. We can help to give back, and that way we can like, make new discoveries and understand things better. There's just so much to uncover that we don't yet know because, once again, we've just not asked the questions.
I forgot more things though. We also have community on the app where people can talk to one another anonymously. Then one of my favorite things, which are group coaching and workshops. So it's like group interactive moments where women on the platform come together anonymously, share their struggles and get like expert coaching or expert workshops led by sex therapists and things like. We're starting these conversations that we all wanna have, and then also individual coaching is available as well. So I hope that I named them all, but I think that I did. So thanks for letting me.
Kara Wada, MD: Oh my gosh, yes. And folks can download it from like the app stores, right?
Lyndsey Harper, MD: That's right. Yeah. We're available in both app stores and there are like, you don't have to pay to download the app. There are paid tiers of subscription based on how much support you want or need, but you can check it out completely for free.
Kara Wada, MD: Do you have anything like physician specific in mind?
Lyndsey Harper, MD: There's a special signup on our website for physicians and healthcare providers more generally.
Anybody who has an NPI and they can come to our website, sign up, they get completely free access to the platform so that they can vet it for their patients. And then we'll also mail them cards and pens like you have to share if they feel like it's appropriate for recommendation. Amazing.
Kara Wada, MD: And you have a big platform you're speaking at coming up, you were saying at the American College of obstetricians and gynecologists?
Lyndsey Harper, MD: Yes. Yeah. I'm so excited to get, to share all about sexual health. We spoke, I spoke with one of my favorite sex therapists there last year, and this year they're bringing us back for more last year. It was awesome.
The room was like, standing room only and it just warmed my heart so much to see so much support for women's sexual health. The goal always, like we've already talked about, is to demystify, to rally the troops, and to really get at least one person in every practice really pumped about this so that they can lead the way for their partners and the patients in the practice
Then we can start to see more and more, just like we talked about, more research being published, more conversations being had.
My goal really is for women's sexual health to be included on all women's health panels, right?
So when we're talking about women's health, there's so many important pieces of that, but sexual health is absolutely one of them and needs to be represented every single time.
Kara Wada, MD: And we know that meaningful human connection with other humans that may or may not include a sexual component, right? But that is part of what keeps us healthy and whole and.
Lyndsey Harper, MD: Absolutely. The World Health Organization recognizes us as such, so I think we have an obligation to ourselves as individuals and to society at large to really show and present how these conversations can be had in a respectful, evidence-based, scientific way that doesn't bring into it all of the embarrassment and emotions that so many of us were taught.
I think that should be definitely part of physician. And really all healthcare professional training.
Kara Wada, MD: I am snickering a little bit because there was a conversation I stumbled upon on Instagram this week about just using proper terminology to talk about our anatomy. And that, even something as simple as the vulva and the vagina are different structures and I have three kiddos. My older two are girls and they keep trying to call that whole region their booty, and I'm like, "No!"
Lyndsey Harper, MD: Good job, mama.
Kara Wada, MD: This part, and it's important, if we think about safety, we think about, just demystifying things and just giving folks even as simple as the right names to describe and talk about what's going on
Lyndsey Harper, MD: And why are we, the fact that we even have the conversation is like insane, right?
That I have to go around telling doctors to call a vagina. Like what they're calling a vagina is a vulva. I'm like, you're a doctor. This is a vulva. That's a scientific,
Kara Wada, MD: That's a not a dirty word. We have ears, we have fingers.
Lyndsey Harper, MD: We have vulvas. And so it's just so crazy. I may have seen the same tweet that you did that was Laurie Mintz, like retweeted something else about how a man like was, he was like it's vulva is like calling a penis a scrotum.
That's the thing. We would not do that. And the idea that we would do that is like so absurd. It's like a laughable meme. Do you know what I mean?
But we do that. But we do every single day. Yep. Every single day. Even doctors. And yeah, it's oh my gosh, there's so much to be done.
It is important to, for safety, but it's also important just because it's a fact. Man, it's so much, it's so much.
Kara Wada, MD: So I have been starting to ask all of our guests, if you had one closing thought that helps people feel more empowered and working on becoming more confident in their everyday lives related to the work you're doing, what would you share with them?
Lyndsey Harper, MD: Oh, that's such a good one.
I think that there's usually two things that I like to try to communicate.
The first is that if you're having a sexual problem, you are absolutely, positively not alone. And it doesn't mean anything about you as a human, as a woman, as a partner. It doesn't mean anything about your partnership, right? We sometimes take sexual problems and make them mean way more than they actually mean and what could be going on could absolutely be a medical issue that you need medical treatment or intervention for.
That knowledge in and of itself, I think, is super empowering because I think sometimes, especially with issues that we are not sure how to talk about or to whom to talk about it with, we get really stuck. So when you know that you're not alone and that you do deserve help then that can sometimes unstick us.
The best place to start with anything in this realm is really education because so many of us have missed out on that, or so many of us have had education that wasn't helpful to us. I love resources like Dr. Mintz who tweeted this and I spoke with at ACOG last year, wrote a book called, " Becoming Cliterate."
So good. Like I'm a gynecologist. I learned so much from that stinking book also there's another one called, " Come As You Are" by Emily Nagoski. So good. And then obviously Rosy, right? I mean I made it for this reason. Yeah.
So I think the first place is education because we empowered through education, just like I know that you do all the time, right?
If we don't know what's going on, if we don't have names for things, if we don't have resources for things, we're gonna continue to be lost. But when we educate ourselves, it empowers us to start thinking differently and then subsequently to start acting differently and taking more and more agency for the things that happen for us to us in the future.
So those are really, I wanna share that people are not alone in this struggle. And then the next place to go from there is educating so you can figure out what's the next step for you.
Kara Wada, MD: Amazing. The other book I'll throw out that I just read recently by a colleague of our, she's urologist Dr. Kelly Casperson " You're Not Broken. "
Lyndsey Harper, MD: I have it. I mean, I literally have it right over here. I should definitely start adding that to the list for sure. She's great and she's on social too, so great.
Kara Wada, MD: Yeah. Awesome.
Lyndsey Harper, MD: I love Kelly.
Kara Wada, MD: Amazing. Thank you. We so appreciate your time, your expertise, all the work you're doing. I can't wait to see, just see what happens next.
Lyndsey Harper, MD: Thank you so much for having me and for allowing us to have this important conversation on your important platform and really appreciate the support and your time. So thanks for having me. Thank you.
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