95 Bonus Episode: Female Orgasm with Sue Goldstein

*DISCLAIMER* This message contains adult themes and is not intended for little ears.

 

95. Female Orgasm with Sue Goldstein

 

**Transcription Below**

 

Jeremiah 30:17 (a) “But I will restore you to health and heal your wounds,’ declares the LORD,"

 

Sue Goldstein is a Sexuality Educator and the Clinical Research Manager at San Diego Sexual Medicine, responsible for sexual medicine educational programming and clinical research. She works with the SDSM team to develop clinical research projects, write protocols and oversee clinical trials.  She also arranges for training in sexual medicine for medical students, residents, fellows and clinicians from all over the country. She works with the Sexual Medicine program at Alvarado Hospital and regional support groups to provide education to providers, students and the public. In addition, she develops programs for The Institute for Sexual Medicine, a charitable corporation dedicated to research and education in the field. Mrs. Goldstein co-authored When Sex Isn’t Good to provide education and empowerment to women with sexual dysfunction. She is managing editor of the journal Sexual Medicine Reviews. Mrs. Goldstein serves on the board of the International Society for the Study of Women's Sexual Health (ISSWSH) as Industry Relations Chair. Past board positions include Global Development Chair, Education Chair, and On-Line Services Chair. She serves on the Education Committee of the International Society for Sexual Medicine and has contributed educational content for the ISSM Online University. She is a 2017 recipient of the ISSWSH Distinguished Service Award. She is a member of the Sexual Medicine Society of North America, the American Association of Sex Educators, Counselors and Therapists and the Association of Clinical Research Professionals. She is an AASECT Certified Sexuality Educator and an ACRP Certified Clinical Research Coordinator. 

 

San Diego Sexual Medicine

 

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When Sex Isn’t Good by Sue Goldstein and Lillian Arleque 

When Sex Hurts by Dr. Andrew Goldstein, Dr. Caroline Pukall, and Dr. Irwin Goldstein 

 

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Gospel Scripture: (all NIV)

 

Romans 3:23 “for all have sinned and fall short of the glory of God,”

 

Romans 3:24 “and are justified freely by his grace through the redemption that came by Christ Jesus.”

 

Romans 3:25 (a) “God presented him as a sacrifice of atonement, through faith in his blood.” 

 

Hebrews 9:22 (b) “without the shedding of blood there is no forgiveness.” 

 

Romans 5:8 “But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.” 

 

Romans 5:11 “Not only is this so, but we also rejoice in God through our Lord Jesus Christ, through whom we have now received reconciliation.” 

 

John 3:16 “For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.”

 

Romans 10:9 “That if you confess with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved.” 

 

Luke 15:10 says “In the same way, I tell you, there is rejoicing in the presence of the angels of God over one sinner who repents.”

 

Romans 8:1 “Therefore, there is now no condemnation for those who are in Christ Jesus”

 

Ephesians 1:13–14 “And you also were included in Christ when you heard the word of truth, the gospel of your salvation. Having believed, you were marked in him with a seal, the promised Holy Spirit, who is a deposit guaranteeing our inheritance until the redemption of those who are God’s possession- to the praise of his glory.”

 

Ephesians 1:15–23 “For this reason, ever since I heard about your faith in the Lord Jesus and your love for all the saints, I have not stopped giving thanks for you, remembering you in my prayers. I keep asking that the God of our Lord Jesus Christ, the glorious Father, may give you the spirit of wisdom and revelation, so that you may know him better. I pray also that the eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his glorious inheritance in the saints, and his incomparably great power for us who believe. That power is like the working of his mighty strength, which he exerted in Christ when he raised him from the dead and seated him at his right hand in the heavenly realms, far above all rule and authority, power and dominion, and every title that can be given, not only in the present age but also in the one to come. And God placed all things under his feet and appointed him to be head over everything for the church, which is his body, the fullness of him who fills everything in every way.”

 

Ephesians 2:8–10 “For it is by grace you have been saved, through faith – and this not from yourselves, it is the gift of God – not by works, so that no one can boast. For we are God‘s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.“

 

Ephesians 2:13 “But now in Christ Jesus you who once were far away have been brought near through the blood of Christ.“

 

Philippians 1:6 “being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.”

 

**Transcription**

 

[00:00:00] <music>

Laura Dugger: Welcome to The Savvy Sauce, where we have practical chats for intentional living. I'm your host Laura Dugger, and I'm so glad you're here. 

[00:00:17] <music>

Laura Dugger: Today's message is not intended for little ears. We'll be discussing some adult themes, and I want you to be aware before you listen to this message. 

Equip for Health is a health and wellness company that works with anyone who wants to achieve great health through simple, sustainable daily changes. They are passionate about improving health from the inside out and having a health journey that is both result-driven and enjoyable at the same time. Check them out today at equipforhealth.com and make sure you use the code SAVVY at checkout to save 10% on their online course. 

Thanks for joining us for this bonus episode. In the past, we have covered sexual intimacy and marriage from various perspectives. Including spiritual, emotional, and psychological. If you want to hear these episodes, they are easy to find on our website, thesavvysauce.com. [00:01:20] 

This week, however, we are looking at sexual intimacy and marriage through a more medical and scientific lens. Early in my career, I remember hearing about this talented Jewish couple who helped people from around the world with a variety of sexual issues. 

We had the privilege of chatting with Dr. Irwin Goldstein yesterday. Today we are going to continue this medical conversation with his wife, Sue Goldstein. 

Here's our chat. 

Welcome to the Savvy Sauce, Sue. 

Sue Goldstein: Thank you so much. I'm so pleased to be here with you. 

Laura Dugger: Can you just start us all off by sharing a little bit more about who you are and what you do? 

Sue Goldstein: Sure, Laura. I like to say I'm a jack of all trades and master of most, because I do a lot of things. But officially I'm a clinical researcher, which means that I do research with human subjects, with people, to find out if different treatments help them with their sexual dysfunction. [00:02:18] 

I'm also a sexuality educator. So in my office, I serve as kind of a patient advocate, separate from the clinicians that will treat the patients. And I also work to help educate both public and professionals so they can learn more about sexual health and sexual dysfunction. 

Laura Dugger: That's incredible. We're talking to general public today. So what information or encouragement would you like to share for a wife whose husband is struggling with erectile dysfunction? 

Sue Goldstein: Well, I think women need to understand there are two different things going on when their husband has erectile dysfunction, or ED. They have the biologic changes that make it impossible for them to have the firm erection they had when they were young. There are also the psychological changes. They may not feel whole. They may not feel like a man. 

So it's important that we think about what's going on from their psychological point of view as well as the biologic. [00:03:18] It's important that a woman makes sure that her partner understands that she still loves him whether or not he's able to have intercourse, that there are other alternatives to have sexual pleasure, and that if he wants to be treated, she should be there with him for treatment. There are so many treatments in this day and age that can help a man. 

There are cases of women who feel like if her partner has ED, it must be that she no longer is attractive to him. And that's totally not true. It's a biologic change that causes the ED through no fault of the partner or the relationship.

So for a woman to be supportive of her husband, to go with to the doctor's appointment, talk to him. If he'd rather not be treated, then help him come up with other ways for the bedroom. There are certainly many ways that a husband and wife can pleasure each other without having sexual intercourse. But if that's what their end goal is, then find a competent physician and get treatment because we really have a lot of alternatives these days. [00:04:22] 

Laura Dugger: Great. Thank you for just checking in with them and doing a little follow-up. Now I want to talk about a topic that is mysterious to some. But with your impressive medical background, I would like to hear your take on how you think women experience orgasm. 

Sue Goldstein: Well, orgasm is that big mystery. First of all, there really are two different questions going on at the same time. Women, it's a matter of what part of their body is going into contraction for orgasm, but it's also what part of the body leads you to get an orgasm. And very often when we talk about different kinds of orgasms, we get those two conversations mixed up. 

The most common way that a woman gets an orgasm is through clitoral stimulation. This also will end up with a clitoral orgasm. But the anterior vaginal wall, which we call the G-spot, that is extremely sensitive. And if that area gets stimulated, you may get a more intense orgasm. [00:05:26] 

People talk about a vaginal orgasm. We talk about La petite mort, which is really a time where you lose all consciousness. I mean, you're not going to pass out. But a very strong orgasm actually turns off blood flow to a certain part of your brain so that you actually may have music playing in the background, and you don't even notice it's there until you sort of come back to normal afterwards. 

So the question is, do we have an internal orgasm and an external orgasm? Do we have an orgasm that's stimulated because of the clitoris, because of internal? 

Women who are highly orgasmic can get stimulated and reach orgasm from having their nipples stimulated, which is a wonderful opportunity for those people who perhaps are spinal cord injured and they only have feeling in the upper part of their body, or a woman who has lost sensation through some kind of surgery. 

We have the LEEP procedure where they actually burn a portion of the cervix. [00:06:28] And women complain when they have that because there are three different kinds of nerves that actually innervate the cervix. That although if you put something against the cervix, you can't feel it, but if you destroy those nerves, you may lose your ability to have an internal orgasm. 

So there's a lot of complications, but the good news is that we have a lot of different areas in our body that are really erogenous zones. You think about Mae West, for those of you old enough to remember, blow on my ear and I'll follow you anywhere. Behind your ear is an erogenous zone. 

So if you don't get an orgasm through the more traditional methods for whatever reason, there are other parts of your body that can be stimulated. Some people only get an orgasm once in a long while, and some people get 5, 6, 7, 8 orgasms every time they have sexual activity. Everyone's different. There's no right and there's no wrong, except if you've never reached orgasm. 

Then it may actually be a physiologic problem. We've actually found women who don't even know, but they have no feeling inside their vagina. [00:07:32] They don't know that. We find that out on testing, and then we can potentially, for some of these women, treat them and they reach orgasm. But you also may not reach orgasm because your partner doesn't do enough foreplay with you. There are so many variables. 

If you feel you are having trouble with orgasm, then seek a specialist. Your gynecologist may not really have enough knowledge about this. You may need to go to a sexual medicine specialist. But in sexual medicine, we say, if you are different from somebody else, that doesn't mean anything. Everyone is their own norm. But if you have a problem that distresses you, that bothers you, if you're not reaching the kind of orgasm you did when you were younger, for instance, it's now a little blip when it used to be a volcano, you have a right to seek help and try to restore. That's sort of my mini-lecture on orgasm. 

Laura Dugger: That's incredible. And just how we were designed, you said, to have so many different types of orgasm. But let me just clarify. With treatment, do you believe it's possible for every female to experience orgasm? [00:08:38] 

Sue Goldstein: I think that the answer is yes and no. We are still learning so much that we probably don't know all the reasons why women don't experience orgasm, but we're slowly learning more and more. So yes, I believe that as long as we can discover the etiology, in other words, what is the problem, then we can have a solution. It's just we haven't yet discovered what all the problems are. 

Laura Dugger: Oh, that's very clear. From the flip side, what are you noticing with the women who are more easily orgasmic in any of these ways? Is there any type of pattern that you've identified? 

Sue Goldstein: Well, for a lot of women, it may be as they age, as they're going through menopause, it may be after they have a childbirth, they get what's called HSDD, hypoactive sexual desire disorder. And if you lose interest, you may still have sexual activity with your partner because you're having mercy sex or duty sex. You love your partner, you don't want him to stray, you want him to feel good, and so you have sex, and your body still responds, you still arouse, you still have an orgasm. [00:09:43] But it may be that little bump instead of the mountain. 

So we find if we treat the HSDD, that will improve arousal and orgasm if that's the particular problem. That's very common because HSDD is the most common sexual dysfunction among women. That's easily treated now. 

We have two FDA-approved treatments for premenopausal generalized acquired HSDD. That means that you once had normal desire, and now it's less, and that it happens in all instances, not just with one particular partner. So we can use those off-label for postmenopausal women. Matter of fact, in our office, we even use the mock label for men. But if you increase that desire, the data show us that those same medications also help with arousal and orgasm.

We have a thing called responsive desire. So once you're in the act, your body starts to have more desire, and so then it arouses more, and it's orgasm. And that is so common. It is the most common sexual dysfunction. [00:10:49] 

The other thing with orgasm that we have recently discovered, because we have a unique collaboration with a neurophysiologist named Barry Komisaruk at Rutgers University, and with a minimally invasive spine surgeon named Choll Kim here at Alvarado Hospital, we have discovered that some women actually have an annular tear or a cyst in the cauda equina, which is actually the tail end of the spinal cord. 

If the MRI is read by a radiologist, he's going to say, "Oh, it's incidental, it doesn't mean anything." But these very, very small defects sometimes result in a woman having severe pain or having persistent genital arousal, but sometimes it results in a woman having no sensation inside her vagina. 

We had a patient who hadn't had an orgasm in 30 years. This new collaboration with the spine surgeon, we discovered that she had just a minor annular tear, and he repaired it surgically. And she go home that day with a bandage on her back. That's all it is. It's not a big open surgery. [00:11:56] And she came back in for testing a week later, and she had full sensation, and now she's able to reach orgasm. 

Those are two very different ends of the spectrum of why a woman had trouble with orgasm. So my point was that until we know it's wrong, we can't make it better. But as we're discovering more and more things that can go wrong, it gives us an opportunity to make more and more women better. 

Laura Dugger: That's incredible. What kind of life change are you seeing for these women? 

Sue Goldstein: Our women who are treated report to us that when they have HSDD, they don't feel like a whole woman. They feel beige. They just don't feel like really participating in life. And when we treat them, they notice that not only do they feel whole again, but there's a playfulness in the relationship with their partner that they didn't realize was missing. 

They love their partner. They've had a good relationship. That wasn't why they had no desire or low desire. But it's the biochemistry in the brain has changed. And these new medications change the biochemistry in the brain, bring it back to where it used to be so that it brings a whole playfulness, a whole new dimension into that relationship. [00:13:06]

Laura Dugger: I love that you've just offered hope to people listening. I'm also curious, from your career in education and research, are there any commonalities that you've noticed among women who do struggle with sex? 

Sue Goldstein: You know, the only commonality is that they're all women. But the fact is that this knows no cultural lines, no age, no ethnicity. All women can get any kind of sexual dysfunction. It's not that all women get it, but all women can. Then all women go through menopause. The majority of women going through menopause because of the change in the hormonal milieu will have changes to their sexual function. But again, you can treat menopause, and that will restore sexual function. 

Can we talk about menopause for a couple of minutes? 

Laura Dugger: Let's do, please. 

Sue Goldstein: Okay. Women know they have vasomotor symptoms going through menopause. And most people think once those vasomotor symptoms are done that they're finished with menopause, and now they're post-menopause, which means they're no longer in menopause. [00:14:11] Well, that's wrong. Post-menopause and menopause are the same thing. 

Once you haven't had your period for 12 months, you are technically in menopause, unless, of course, you've been surgically, your ovaries have been removed, and then you're immediately in menopause. You no longer have the hormones going through your body that do a lot of different things, in particular, keep your genitals healthy. So women think that when they no longer have hot flashes, they are done. 

That's their choice, that they choose not to do anything. But the fact is, if you choose to go through menopause and not have any hormones, essentially your genitals go back to where they were when you were a little girl, before you had hormones. But they get small, they get dry, they get cracked, they get painful. 

Myself I'm on hormones because I want to stay healthy. And people will say to me, "Well, I want to go through menopause." And my response is, If you had hypertension, would you go through that naturally, or would you take an antihypertensive? [00:15:11] If you had diabetes, would you do that naturally, or would you want to take a medication? If you had cancer, would you deal with that naturally, or would you want to fight it? 

So to me, menopause is just another biologic change, and I choose to treat it so that I can stay healthy. That keeps my genitals healthy so that I can have intercourse without pain, without cracking and bleeding. And ladies, if you opt not to take any hormones, and you don't have to have systemic hormones, that's a different thing, but local hormones, in other words, medications, estrogens, and androgens, that you put on your genitals, prescribed by a physician or a nurse practitioner. Please do not do this on your own. 

But if you choose not to do that, everything will — atrophy is the word — dry up. Your vagina is an accordion. The accordion goes away. The skin itself will get thin. So if you're trying to have intercourse, it may crack and bleed. 

But all of that can be restored if you go on hormones, even if you don't have them right away. It will take a little time, but we can restore health so that you can have pain-free intercourse. [00:16:18] Because if that's your goal, then you have a right to get that treatment and have enjoyable sex. 

One of my jobs as a sexuality educator is to empower women. And I always say the educated patient is the empowered patient. You need to know about your own body, and you need to make shared decisions with your clinician, but ultimately it's your decision. And I would never say to a woman, you have to be on hormones. That's an individual's choice. But what I do say is you should find out the correct data and not get your medical information from a newspaper. You should find out what the real data are and make an informed decision. 

So my job as an educator is to say, well, educate yourself, and then make a decision. Don't just assume there's nothing out there to help you. Because too many clinicians don't want to start the conversation. Women believe there's nothing to help them. So if you're listening to this broadcast, please, if you have a sexual problem, you start the conversation with your clinician. [00:17:19] You may think he or she is going to be embarrassed if you start the conversation, but your doctor may actually be very relieved that you started it because they didn't know how to start that. 

One of the things we teach in our courses is how to start that conversation with the patient. Because patients want to hear what's available for them. Patients need to hear, you know, you're 60 years old, you've been in menopause for eight years, you're probably painful when you're having sex, right, Mrs. Jones? It's nice for you to know that you aren't the only one experiencing that. 

And then because that conversation has started, it's an opportunity to say, okay, what can you do for me so that I no longer have painful sex? Because you have that right. 

Laura Dugger: I love it. And I love that you point just to that word, restoration, and that hope is there. And now a brief message from our sponsor. 

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Laura Dugger: What are the differences and similarities between male and female experience of sex in general?

Sue Goldstein: That is a great question. For men, all sex is good, whether it's good sex or bad sex. For women, good sex is good, and bad sex is miserable. I'll go a little further. For instance, if a man, as he ages, isn't quite as hard as he used to be, he can still, I'm being very graphic, he can still enter his partner's vagina, he can still ejaculate, and he has good sexual experience. But because he's not as hard, it doesn't enter her vaginal canal quite the same way. It's squishy, for lack of a better word. And so she feels like he's pounding into her, and so she may have pain that she wouldn't experience if he were harder. [00:20:31] 

I mean, right there is literally a physical difference. She's miserable. All she can do is say, just get it over with already. I love you, but I'm miserable. And he is, "Wasn't that great, honey? I had a good time." That is a huge difference. 

Then the other difference, I think, is the fact that women are not necessarily comfortable saying to their partner, do this, do that, or comfortable saying to their clinician, I have a problem. Whereas I think a man is much more forthcoming if he has an issue. Not 100% of the time. Certainly, there are many men who don't want to talk about it. They may hide it from their partner. They may go to the doctor and get medication, whether it's oral, a pill, or injection that he does on the side because he doesn't want his partner to know. But he's more likely to get treated than she is, and she may just be totally in the dark. But to me, that's kind of a huge piece. 

The other thing is that a man doesn't need foreplay, and a woman needs foreplay. We worry, you know, did a woman not reach orgasm because he just had a firm erection? Two, three minutes later, he's done, and it hasn't had enough time for her. [00:21:39] So if she can have foreplay, then she's sort of primed and ready. And if he doesn't last a long time, then she has a better opportunity to reach orgasm. 

So that's why when we talked before about orgasm, we talked about etiology, find out what's going on. Let's find out if it's really a problem with her or if it's a problem with him. If she has discomfort, is it because he's not firm enough? So all sex is good to a man, but not all sex is good to a woman. 

Laura Dugger: One of our listeners specifically reached out to learn more about the O-Shot. So can you share why that's actually a marketing gimmick? 

Sue Goldstein: I have to tell you that that bothers me so much. O-Shot is platelet-rich plasma, which is an experimental therapy, and a lot of places around the world do platelet-rich plasma, including San Diego Sexual Medicine, where I work. We do it as an experimental therapy. We tell our patients, you know, try it and see if it makes any difference. [00:22:39] 

There are no data that show giving a woman PRP in her clitoris or in her G-spot makes any difference. The fact is that O-Shot is a trademarked name or a patented name. I'm not sure which it is. But using an O-Shot means you're getting discounted purchase of the equipment through being part of this larger buyer organization, and at the same token you have to charge a specific price. So it's all a marketing gimmick. It may help somebody. It may not help somebody. But I believe in being upfront. 

In our practice, as I said, we would offer one injection and say, if it makes a difference, we can try it again. Although I have to tell you we very rarely use PRP for women. We use it a lot for men with erectile dysfunction. And when I say a lot, we offer it. If it seems to help, we'll say, why don't you try it another couple of times? We don't use it very often for women. 

But the most important thing as a researcher is show me the data. And there is not a single publication that I am aware of showing the efficacy of PRP in the clitoris, PRP in the G-Spot, or what we call the O-Shot. So buyer beware. [00:23:50] 

It's important that you know what you're doing. I always say people spend more time shopping for a used car than they do shopping for a physician. And really do your research before you go someplace. Anyone who says this is going to work for you... No treatment, no treatment works 100% of the time. And anyone who tells you this always works is a liar. It's just not possible. 

Everyone knows Viagra. We know Viagra is great. That's a trade name. In my world, I would say Sildenafil. But it only works in 60% to 70% of people. Most of our sexual health treatments, our sexual medicine treatments work in 60% to 70% of treatments. Even aspirin, no matter what you take, there is no medication that works 100% of the time in 100% of people. Buyer beware. 

Laura Dugger: I love hearing your passion because I can tell you're protective of your patients and you do want what's in their best interest. 

If you've benefited in any way from The Savvy Sauce, we would love to invite you to become a patron. [00:24:53] If every listener gave just $1 per month, it would completely offset all our production costs. We want to keep majority of our content free to the public, and one way to do that is with your help. Please consider joining Patreon today and finding out what perks you can receive for pledging $2, $5, or even $20 per month. 

So are there any other sexual products or sexual trends that we need to be aware of or even avoid because they're also falsely advertised? 

Sue Goldstein: Whoa, that's a big question. I think we have to be careful of some of the compounding pharmacies that promote compounded medications that are available as FDA-approved medications. People don't understand the word bioidentical. People think that bioidentical means it's compounded. 

Bioidentical means it's the same chemical structure as the chemical that's naturally made in your body. [00:25:53] So when we use bioidentical estrogens and bioidentical testosterone, it means that if we give you the medication, we can then draw blood and we can see how much of it is in your body because it's identical to what your body naturally makes. 

The FDA has many bioidentical estrogen products that are available for women. And unfortunately, there are no testosterones for women. They're all for men. But what we use is we would much rather use a testosterone that's been FDA-approved for men. And by FDA-approved, it means it's been checked for safety and for efficacy so we know it's not harmful and we know it works. So we use that but in the correct dose for a woman. We wouldn't use the same amount for a man. 

But there are a lot of compounding pharmacies or companies that promote their compounded estrogens and testosterones, and they push making people think that that's the only way they can get treatment. Compounding pharmacies are wonderful. [00:26:54] We have medications that are not available any other way, and we depend upon them. 

But when you have a choice between something that's been approved by the FDA and something that's not, I would caution you to always use the one that's in the FDA. And that's really your clinician, how they write the prescription. But there are some clinicians that have these hormones they keep in their office and they sell them. It's not that it's a scam, but it's one thing that, are they there because they want to make you better or are they there because they want to make money? 

I always tell people we aren't in the business of making money in our practice. We're in the business of making men and women better, of healing them from their sexual health problems. And you know when you help men and women, the money will come. I mean I'm not rich. We put a lot of our money back into our practice because we do a lot of our own research that we pay for ourselves. But I will never starve. I will never be naked. 

If you do the right thing, you will always be okay. This is really my message. I mean make sure you're going to a clinician. [00:27:56] It can be a physician, a nurse practitioner, physician assistant. Those are the providers that can prescribe for you. And sex therapists who aren't prescribers, but they provide a different kind of treatment, just make sure that they're legitimate and they're not there because they're trying to sell you a product. 

Typically we see these men's health clinics for men where they promote inappropriate treatments for patients who shouldn't have them. We don't see them as much for women except for in the hormones. So be careful. Make sure you're getting a bioidentical hormone because otherwise we can't tell what's in your body. And make sure if it's available as an FDA-approved product, that that's what your clinician prescribes. 

Laura Dugger: Thank you for that education piece. We could go so many different directions. So as we're winding down, is there anything else that we didn't get a chance to cover today that you wanted to mention? 

Sue Goldstein: I think there are so many different kinds of sexual dysfunctions that people don't know about. One of them is the scariest. It's persistent genital arousal disorder. And it's a situation we're finding now that it's often caused by that defect in the cauda equina, in the spine that we talked about before. [00:29:03] But it causes a woman to have a feeling of constant arousal. There may be no actual physiologic arousal, but in her brain she feels aroused. 

The reason I want to broadcast this now is because we believe it's far more common than we knew. And these women are desperate. When they talk to their local provider, very often the provider's never heard of it. We've heard horror stories of a male gynecologist who said to the woman, Oh, I wish my wife had that. I mean, that's devastating when you have something that you can't even leave your house without having this awful feeling. 

We've had a school teacher, if she'd ever told anyone she had this, they would think she was being aroused by the children in her classroom. And of course, she's not. There's no desire. There's no interest. It's just your body is turning on you and doing this. So I caution anyone listening who knows of someone with PGAD, do not make fun of them. This is a devastating disease. Women kill themselves every year because they can't function with it.

If you're listening and if you have PGAD, reach out to your provider. If you can't find someone who can help you, reach out to us. We understand this disease state. It's horrible. But we've been able to help a lot of women. Some we've been able to cure, some we've been able to help them get under control. 

Keep your eyes on the prize. Do not lose hope. There is help out there. Every year we're learning more and more and more. And what we don't know today in our field, maybe we'll know tomorrow, maybe next year, maybe the year after. But this is one of the most devastating disease states in sexual medicine. So I just want to share that, to give women hope that we're helping these people. [00:30:37] And God willing, someday we won't lose anyone to suicide, but we'll be able to help everyone.

Laura Dugger: So true. I'm glad that you mentioned that. And whether that's someone's struggle today, or if there's another issue, and they're curious to find out more from you, where can they find you online, Sue? 

Sue Goldstein: We're sandiegosexualmedicine.com, or if your fingers are too tired, you can actually write sdsm.info, like Sam David, Sam, Mary. You can find me, you can find everyone in our practice, you can find out a lot of information about various disease states that we treat, and some of the treatments that we can do.

Or go on Amazon. I co-authored a book called When Sex Isn't Good. My husband co-authored a book called When Sex Hurts. When you come here as a patient, if you're a pain patient, we give you a copy of When Sex Hurts, otherwise we give you When Sex Isn't Good. 

When Sex Isn't Good goes back to the 1990s, but much of what we said still is true there, only we have the new treatments for HSDD and new treatment for PGAD. But they're there to educate, to empower, and to give women hope, because that ultimately is my goal. [00:31:42] 

Laura Dugger: That's incredible. We will link to all of that in our show notes, and also on our "Resources" page of our website, so listeners can find it very easily. Sue, I just have one final question for you. We're called the Savvy Sauce, because "savvy" is synonymous with practical knowledge. So we would love to hear today, what is your Savvy Sauce? 

Sue Goldstein: My Savvy Sauce is the advice I gave to my daughter and my daughter-in-law as they each had babies, and they weren't going back into the workplace right away. I think every woman needs to have something that they're passionate about. And it's something that's not involving your partner, your children, something that means something to you that you have ownership of.

I mean, I wake up every day loving coming to work, and I'm passionate about it, but I do that with my husband. I tell people he had a dream, and one day I realized it was my dream too. 

To me, I love Pilates. It keeps my body healthy. And when I'm on the Reformer, my body is totally focused on my own muscles and nothing else in the world. [00:32:42] I love to read. I love fiction. It's an escape for me. But most important thing to me is singing. I sing in my temple choir, and my husband comes to hear me sing. I sing in my car, and I'm alone. I always have music station on. That is my source of pleasure and focus. 

When my children were growing up, I was working part-time, and I didn't want to get lost in that great big world. I was able to join a group that every week we had rehearsal, we performed. So to me, having that thing that was mine, I own. My husband likes to think he sings, he can't. He doesn't really sing. But having my music... I play piano. I play guitar, I sing. Having my music and the passion that goes around the music, that's my savvy sauce. 

Laura Dugger: I love it. Sue, you are a fascinating and clearly a brilliant woman. I just really appreciate you teaching us about this topic, especially because it's not often discussed publicly with such accurate information. [00:33:41] So I hope listeners found this chat to not only be informative, but also helpful and practical so they can enrich this area of their lives with their husbands. Sue, thank you for being my guest today.

Sue Goldstein: Thank you, Laura.

Laura Dugger: One more thing before you go. Have you heard the term "gospel" before? It simply means good news. And I want to share the best news with you. But it starts with the bad news. Every single one of us were born sinners and God is perfect and holy, so He cannot be in the presence of sin. Therefore, we're separated from Him.

This means there's absolutely no chance we can make it to heaven on our own. So for you and for me, it means we deserve death and we can never pay back the sacrifice we owe to be saved. We need a savior. But God loved us so much, He made a way for His only Son to willingly die in our place as the perfect substitute.

This gives us hope of life forever in right relationship with Him. [00:34:44] That is good news. Jesus lived the perfect life we could never live and died in our place for our sin. This was God's plan to make a way to reconcile with us so that God can look at us and see Jesus. 

We can be covered and justified through the work Jesus finished if we choose to receive what He has done for us. Romans 10:9 says that if you confess with your mouth Jesus is Lord and believe in your heart that God raised Him from the dead, you will be saved. 

So would you pray with me now? Heavenly, Father, thank You for sending Jesus to take our place. I pray someone today right now is touched and chooses to turn their life over to You. Will You clearly guide them and help them take their next step in faith to declare You as Lord of their life? We trust You to work and change their lives now for eternity. In Jesus name, we pray, amen. [00:35:45] 

If you prayed that prayer, you are declaring Him for me, so me for Him, you get the opportunity to live your life for Him. 

At this podcast, we are called Savvy for a reason. We want to give you practical tools to implement the knowledge you have learned. So you're ready to get started?

First, tell someone. Say it out loud. Get a Bible. The first day I made this decision my parents took me to Barnes and Noble to get the Quest NIV Bible and I love it. Start by reading the book of John. 

Get connected locally, which basically means just tell someone who is part of the church in your community that you made a decision to follow Christ. I'm assuming they will be thrilled to talk with you about further steps such as going to church and getting connected to other believers to encourage you. 

We want to celebrate with you too. So feel free to leave a comment for us if you made a decision for Christ. We also have show notes included where you can read Scripture that describes this process. [00:36:45] 

Finally, be encouraged. Luke 15:10 says, "In the same way, I tell you, there is rejoicing in the presence of the angels of God over one sinner who repents." The heavens are praising with you for your decision today. 

If you've already received this good news, I pray that you have someone else to share it with today. You are loved and I look forward to meeting you here next time.