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9. Perimenopause: Gynecology with Dr. Sameena Rahman
68 Plays1 month ago
This episode of Perimenopause: Head to Toe features Dr. Sameena Rahman, an OB-GYN and specialist in sexual medicine and menopause. She is also the founder of the GYN and Sexual Medicine Collective
Dr. Rahman highlights that women in their mid-40s often experience confusing bodily changes. Symptoms include:
- Menstrual Changes: Unpredictable periods, with some becoming heavier or stopping for months.
- Physical & Emotional Symptoms: Intimate dryness, reduced libido, sleep issues, hot flashes, brain fog, and irritability.
Systemic Issues in Women's Healthcare
The conversation addresses challenges within the medical system.
- A Patriarchal System: The doctors agree that the healthcare system is historically patriarchal, resulting in a lack of research and understanding of women's health.
- Medical Training Gap: The doctors note that medical school training often overlooks the significant emotional and cognitive effects of perimenopause, focusing instead on hot flashes and irregular periods.
- The "Double Whammy": They point out that because the OB-GYN field is largely female, there's an unspoken expectation to manage all aspects of women's health with limited resources, leading to provider burnout and inadequate patient care.
Cultural Differences and Bias
Dr. Rahman, who is South Asian, discusses unique challenges for women of color.
- Earlier Onset: Women of color, including Black and South Asian women, often experience perimenopause and menopause earlier. This is linked to allostatic load, the cumulative "wear and tear" from chronic stress.
- Stigma: Cultural factors like stoicism and taboos around sex lead to a reluctance to seek medical help.
- Health Disparities: The episode notes higher rates of heart disease and diabetes in the South Asian population.
About Dr. Rahman’s Practice and Book
Dr. Sameena Rahman is a board-certified OB/GYN, sex-med gynecologist, menopause specialist and a clinical assistant professor of OB/GYN at the Northwestern Feinberg School of Medicine. She is the founder of the Gyn & Sexual Medicine Collective, a successful concierge practice that emphasizes evidence-based medicine and an affiliate of Ms. Medicine. Dr. Rahman is dedicated to evaluating and treating each patient with compassion, trauma-informed care, and an awareness of personal bias. Additionally, she hosts the podcast Gyno Girl Presents: Sex, Drugs & Hormones.
Her upcoming book, "Brown Girls Disease? A Guide to Sexual Health and Empowerment Through a South Asian Lens," explores sexual health issues from a unique cultural and religious perspective.
Recommended
Transcript
Understanding Perimenopause
00:00:00
Speaker
In my gynecological office, I regularly see women in their mid-40s who arrive confused and frustrated by bodies that no longer follow familiar patterns. These patients describe periods that have become completely unpredictable, arriving early with overwhelming flow that sends them searching for overnight protection during what should be light days, then disappearing for months at a time. leaving them wondering if they're pregnant or if something is seriously wrong. They speak hesitantly about intimate dryness that makes previously comfortable moments painful and a diminished libido that has them questioning their relationships and their own sexuality. Many have been told by their healthcare care providers that these changes are just part of getting older, leaving them feel dismissed and alone with symptoms that significantly impact their daily lives and intimate relationships. Through careful and examination and compassionate listening, I really try to help these women understand that their experiences reflect natural hormonal fluctuations of perimenopause, shifts in estrogen, progesterone, and testosterone that can be understood, tracked, and managed.
00:00:56
Speaker
Together, we develop personalized approaches to address their specific symptoms, explore treatment options that align with their values and lifestyle, and most importantly, i validate that their concerns are real and deserving
Meet Dr. Samina Rahman
00:01:08
Speaker
of attention.
00:01:08
Speaker
helping them to reclaim their agency over their changing bodies and maintain their quality of life during this significant transition. Today, I'm so excited to have on another co-gynecologist, sexual medicine, and menopause expert, someone I see at conferences but rarely get to just chat with. Dr. Samina Rahman is a board-certified OB-GYN, sex med gynecologist, menopause specialist, and a clinical assistant professor of OB-GYN at the Northwestern Feinberg School of Medicine.
00:01:37
Speaker
She's the founder of the GYN and Sexual Medicine Collective, a successful concierge practice that emphasizes evidence-based medicine and an affiliate of Ms. Medicine. Dr. Rahman is dedicated to evaluating and treating each patient with compassion, trauma-informed care, and an awareness of personal bias. Additionally, she hosts her own podcast.
00:01:56
Speaker
You should definitely check it out. It's called Gyno Girl Presents Sex, Drugs, and Hormones.
Symptoms and Insights of Perimenopause
00:02:01
Speaker
Please join me in welcoming Dr. Samina Rahman. She is a gynecologist, an expert. She's been doing menopause care for longer than most of us out here. She's one of the OGs, I'll say. You're a pioneer in this field and also doing sexual medicine. And that's how we know each other is through IshWish. So, so excited to talk to her about what she sees in perimenopause and her gynecological practice. So welcome, Dr. Raman. Thanks for being here. Thank much, Rachel. What an honor to be here. Yes.
00:02:31
Speaker
Yes. So I wanted to find out, like what do you see like most commonly? Let's just start with like the basics of what you see showing up in your office, how what you see happening for women from the GYN perspective during perimenopause. Yeah. I mean, i think it's so interesting because some of the biggest symptoms that I see, obviously, you know, we talk about bleeding changes that can happen, right? Like early perimenopause, maybe the cycle goes from 28 days to 21 or, you know, like the interval shortens between.
00:02:59
Speaker
And some some women never notice because they stop tracking their cycle because my husband has vasectomy. I don't think about it anymore, whatever. And so when they actually start tracking it, you might. But I think the biggest symptoms I see are really around mood disruptions. I feel like those are huge.
00:03:14
Speaker
You know, people are irritable. You know, they might not be sleeping well. The sleep disturbance is huge, too. I feel like that is such a significant burden. But mood disruption, you know, the cognitive distress that they have around word finding that happens with the brain fog people talk about. But for sure, like, you know, people all of a sudden they ruminate about things. I call them brain hiccups or thought hiccups. Like all of a sudden they can't get these ideas out of their head. They're up at 3 They're trying to figure it out. You know, we know about the the typical symptoms we all hear about. Of course, the hot flashes, the night sweats that are really, truly
Systemic Issues in Medical Training
00:03:46
Speaker
distressing and need to be treated. Like they're not just motor symptoms. But I think that.
00:03:51
Speaker
The impact of hormones on the brain is so significant that we don't even address them. Right. And we're learning so much more than we ever knew before. Yeah. Is there anything surprising that you learned about perimenopause that you didn't learn in medical school, but you wish you did? Yeah.
00:04:06
Speaker
Oh my God. I guess it's like everything, right? Like what have we, the only thing we learned about was hot flashes and, you know, periods are going to be erratic. But I do think I find like, you know, this whole notion of not feeling like yourself and not feeling, not knowing who you are, you know,
00:04:21
Speaker
USA Today just did an article on men of divorce interviewed me for it. But like just this idea of like all of a sudden having you know new clarity in your life, yeah especially when you get treated with your hormones. I feel like people have like this new clarity. And then they're realizing like people are pivoting, right? like You see all these midlife patients that are like, I don't want to do this anymore.
00:04:41
Speaker
I'm either going to work this relationship out or get a divorce, or I'm going to start a new job. I'm not going to deal with this. But I think the burden how disruptive hormonal transitions are to women, like it's something we never talk about.
00:04:55
Speaker
And I'm not just talking about perimenopause, you know, there's the postpartum, there's the puberty, there's like all the transitions where we know there's huge hormonal transitions in our body that we're just not addressing.
Bias and Cultural Challenges in Care
00:05:06
Speaker
And we don't learn about it enough in residencies. Like I've been postpartum three times now. And it's been like, you know, I almost went from postpartum right into perimenopause too, because we didn't know. It's like that third one, right? Yeah, I'm like, oh, are things going to get better? hair going to come back? Is dryness going to get better? Like, oh, I'm just going right into bari menopause, I guess.
00:05:27
Speaker
All dry, right? Dry eyes, dry vagina, dry skin. I just feel like it's so interesting that we dismiss these symptoms all the time. don't know about you, we're both gynecologists. like I do feel like gynecologists are really getting shat on on social media in the media.
00:05:45
Speaker
yeah and so And so to some degree, like we deserve it as a society because we haven't been the ones pushing forward You know, we need to be doing more for menopause and perimenopause. We need to be doing more for sexual dysfunction. Right. Yeah.
00:05:59
Speaker
It has been like urologists, but maybe because they're trained in a system where they learn how to treat men. We treat men and women so differently. I mean, OK, can I just make an argument about this? This is a really good point. And if we look at OBGYNs, we're mostly female.
00:06:14
Speaker
Right. And so, of course, we're expected to take care of all of this for you. i just keep un perfect like I'm sorry, but the getting the shit on about not knowing everything and like neglecting everything.
00:06:27
Speaker
I'm sorry. Of course, us as women, we're supposed to be able to take care of everything. Our population is supposed to suck it up and not actually have like real medical problems. right So we have like a double whammy of women. And like, yes, it's true for years. Like we've been neglecting menopause. We've been neglecting the vulva.
00:06:47
Speaker
but it doesn't mean that we haven't cared. Like, I feel like we care. and we're trying I tell patients that all the time. Like, well, how come you're the first one that noticed that on my vulva that I have lichen sclerosis and all I ever get is paps.
00:06:58
Speaker
And I'm like, listen, we're trained in a system that is set up to fail women. Period. Like we are trained in a patriarchal system. So we learn patriarchy, right? Like, what do we learn that I remember? And this will age me, but i remember not learning that the cervix doesn't have nerve ending. So patients don't need pain management.
00:07:15
Speaker
Right. yeah Like I use drugs medication. So don't give them the pain medication. Just do it without the pain. Yeah. I mean, we this is what you learn. This is what the the patriarchy has taught us because we haven't done enough research on women. Right. 1993, we started doing research on women. Right. But we learned in a patriarchal system. So we are not inherently like yeah we can't be above what we learned. We have to go back and realize, you know.
00:07:44
Speaker
and kind like we We are the ones making the change. Like now that our field is female dominated, we are making the change. We just have a lot of catching up to do. Absolutely. And I think that the other thing is like, it's just like how we realize medical racism exists, right? Like it exists on all platforms on across. It's a systemic issue. So is, you know, misogyny or, you know, this anti-women stuff that we have going I mean, it exists because that's what our society is.
00:08:09
Speaker
You know, and then so we're not above our society or but above this bias. I know. Let's talk about bias because I've heard you speak at our conferences about bias. And I think it's so important for us to recognize our own bias in taking care of patients and providing care. And are there biases or i guess even cultural differences that you've noticed that come up during perimenopause and menopause or in your care of those patients where you have to really adjust the way that you manage?
00:08:37
Speaker
Absolutely. Yeah. And I think this is very important because this is another reason why I think it's really hard to sort of navigate this field as a woman of color, because yeah number one, like, you know, there's a general distrust of the medical community among black women, among native women, among women of color because of the historic injustices.
00:08:57
Speaker
And, you know, we can't ignore our history. Right. But the other issue is, and the same is true, you know, like, you know, for South Asians who are colonized, we have this history that has happened to them. But what I find is that, you know, so there's obviously like maybe as women of color, we're less likely to want to participate in studies or to want to get that assistance.
00:09:18
Speaker
But we're also not above our own stereotypes because what happens is, you know, I can't tell you how many South Asian women I see in my practice. And I don't only see, I see all women, but that tell me that they were dismissed because You know, culturally, they don't talk about sex. And so, you know, obviously, this is something more about the fact that you come from a ah prudish culture or, you know, oh their physical symptoms. like Yeah. that's up there i mean Even like the term that I've that I use in my book, Brown Girls Disease.
00:09:51
Speaker
was it stems from the fact that like, you know, people would say, Oh, here's another South Asian with sexual dysfunction. Here's another South Asian with vaginismus, right? She can't. Oh, and it's because, and I tell this story in in my book and I've told this story many times in public is that when I was a resident and I was seeing a South Asian patient with one of my white attendings, she said, you know, like she has severe vaginismus. She couldn't tolerate an exam during her labor. And my attending looked at me and said like, what's the deal with your people? They act like they've never had anything in their vagina. And you're like,
00:10:20
Speaker
Excuse me. ah but Right. And so I was like, oh, OK, but this is what, you know, we have as a as a system, right? Like you're going to dismiss this woman because you think this is all related to her culture.
00:10:33
Speaker
And so this has to be in her head. When actually, like, of course, we know anxiety plays into pelvic floor dysfunction. We know that if you're clenching all the time, but, and you know, there are ways to like navigate this in a humble manner where you can actually, you know, approach things and say, okay, like, let's talk about, you know, what your view on sex has been. Let's talk about, you know, meeting people where they are.
00:10:54
Speaker
Yeah. How were you raised? You because obviously we know biopsychosocial, right? We know it's a huge part of sexual dysfunction. But even in perimenopause and menopause, like you have people that depending on their culture upbringing.
00:11:06
Speaker
Well, first of all, what we know is that, you know, women of color will have perimenopausal symptoms earlier, right? Like we know that black women, South Asian women on average, you know, Native women, Latino women experience perimenopause on average earlier.
Cultural Perspectives and Solutions
00:11:19
Speaker
It can be years earlier. So some studies say like on average, Southwest Asian women are in perimenopause or have menopause by 47, you know, in terms of officially entering menopause.
00:11:29
Speaker
And so you're years ahead of losing your estrogen. And why is that? We think that there is this allostatic load that develops over time because of the unique stressors that like, I think all women have an allostatic load, you know, like,
00:11:42
Speaker
the stress that you feel that actually affects your epigenetics, like at an epigenetic level. And over time, what happens is your body accommodates and your stress eventually leads to your earlier menopause and perimenopause. Are you feeling alone through perimenopause or menopause?
00:11:58
Speaker
Are you wondering if anybody else has the experiences that you have? Do you want more than just a few minutes with a healthcare care professional with expertise in menopause care? Come to our next menopause retreat.
00:12:11
Speaker
If you're based in Northeast Ohio, we have retreats on a quarterly basis. You can come in person or virtually or ask your employer to pay for it for you.
00:12:21
Speaker
We're happy to do corporate retreats as well. Everyone deserves community and care during perimenopause and menopause. play We know that South Asians in general also have like the highest rate of diabetes in the world, the highest rate of hypertension, where we represent, you know, close to 30% of the world population, but over 67% of the world heart disease, right? So a South Asian woman is more likely to die from her first heart attack.
00:12:47
Speaker
you have all these factors. And what does it mean? There's a guy actually in of my podcast, he's known as DesiDoc online, but he talks about how the hundreds of years of colonization that happened to South Asians in the so Indian subcontinent and the induced famines that happened year after year.
00:13:05
Speaker
actually change our epigenetics. Our vasculature changed. Going into starvation mode was helpful at that juncture, but not the way we should be doing now, right? But our body remembers that. And so over time, what we've had is this happening and then we're adapting to a new culture and acculturation and all this stuff.
00:13:22
Speaker
So the same is true in perimenopause, right? Like we have these earlier symptoms. We're less likely to seek help for them because family units are so tight. And I think this is true for anyone. Like no one is talking about their symptoms. Maybe they are now. Yeah.
00:13:34
Speaker
you're asking little bit more, but like, you know, I think that as a whole, like people are just not open to it. Like your aunt might tell you, you know, the aunties, they might say, don't try that. You know, it's not going to be good for you. And so you don't do it. Or you think like, why is she telling me this?
00:13:49
Speaker
Some people will find, you know, perimenopause and menopause to be very empowering because, you know, they can't enter temples or mosques or whatever during their period. And now all of a sudden they don't have to worry about it in menopause, you know? Yeah. Perimenopause may be more stressful because you don't know when you're going And like oh and you might you might have more patients who are Muslim that come in and they're going on pilgrimage and they're like, i don't know what's happening with my cycle. Help me out. you know And so these are factors that are very important to these women's lives. And we know that they're experiencing things in a much worse way in so many ways. And there's more stigma in those cultures.
00:14:23
Speaker
So, yeah And then when you were mentioning the cardiovascular health, then I'm thinking, oh my gosh, then people may want to get on hormones earlier for the protective factor. right? So like, genetically, you're at higher risk for cardiovascular disease than like,
00:14:38
Speaker
how much earlier like when, when do you get started to try to get that prevention work right started? And it's, you know, also like one in four South Asians have PCOS, right? Like that's a pretty style. Yeah. And so the insulin resistance is really built into our genetics in some way.
00:14:55
Speaker
And so I think that it's really important for clinicians to understand that because, you know, you do have to approach it in a different way. And and these patients might be the most reticent to start to like, I'm not going to start that. Like my mom didn't have to do that or my mom will get married. You know, I guess think it's the same with the patients that I see that are black and they have the same ideals that, you know, are transferred to them from their generations. Like, no, don't do that. That's just going to be dangerous for you. And, you know, and then, of course, access to care is always an issue. Absolutely.
00:15:23
Speaker
I know I was going to ask you about like stoicism, too, because I i see the women in my husband's family, many of them who listen to my podcast. So shout out to all of you. But I do feel like there is this element of stoicism, like you don't really want to And and it it exists in my culture too, but like, you don't want to admit when you have a problem, you want to try to like get through it until you get to the point where you can't.
00:15:46
Speaker
So like even help seeking and thinking about all of these women that I know on both sides of my family, like they're all like really highly successful, incredible women. It's like, they might even have time come up with the moment, like when they really need the help.
00:15:59
Speaker
So like catching these early signs of when intervention could be helpful. i just feel like that's gotta be a challenge for a lot of women. Right. And back to the stoicism, I think that's so true. Like it's so ingrained, you know, in the cultures as a nation, you know, we talk about women's suffering is more accepted, like across the board, right?
00:16:18
Speaker
But in these cultures, I think it's even more so like women suffer and that's just part of what we have to do. And, you know, that doesn't have to be that way. Suffering is not, you know, something that needs to happen. And I think that, you know, i mean, we see, I don't do obstetrics anymore, but, you know, you see the people that want, they don't want the epidural because they feel like they should feel the suffering of like, right.
00:16:39
Speaker
It's kind of the same thing, right? We're we're trained to suffer. And some of these cultures even have it more so, but I think as a whole, like as a gender we are too. yeah And so, and then it's like wearing what other people, like there's this concept in South Asian culture, at least like, little gakainga what are people going to say about this?
00:16:55
Speaker
You know, if they find out that you're on hormones, what are they going to say? Or they find out that you're, and you know, can't have sex, what are they going to say? You know, these kind of things. And so it's very ingrained in the culture. And that's something, again, that just contributes to stigma, which we have to kind of eliminate.
Personal Experiences Influencing Practice
00:17:10
Speaker
Yeah.
00:17:10
Speaker
So, okay. In the beginning of this, we were talking about going through perimenopause ourselves. And I was just curious, like how has treating women and managing women through perimenopause changed your own relationship with your health, with your body? Like, can you see it influencing yourself? Oh, for sure. for sure. I mean, I was telling you, like one of the reasons I decided to drop insurances, because it was a big battle for me to like, you know, not want to be accessible was because perimenopause had me like, you know,
00:17:37
Speaker
really depleted, you know, emotionally depleted. And so i was like, for my own health, I have to limit the number of patients I see in a day because I can't do it. I can't give and give, give and not keep anything from my family or myself, you know?
00:17:49
Speaker
Yes. So I would say it caused me to pivot, you know, it caused me to pivot my practice, which is huge. I would say, you know, like, I think that was a big change for me. And I think that, and I'm not saying that like, for instance, men who don't experience any of the stuff that we have to share are not great doctors or clinicians or empathetic toward their patient.
00:18:07
Speaker
But I have to say, every time I experienced postpartum, I was like, next level, I got to have fourth trimester in the thing. Like, I got to do this for fourth trimester care for my patients. yeah And I got to tell them X, Y, and Z because that was brushed over in most of our residencies, right? Like each time you're postpartum, I'm sure learn something else, right? Like, I feel like I learned something else that I needed to like tack on helping people with.
00:18:28
Speaker
And I was like, this third one I'm going to do right. Like I'm going have this minimum of help available right away. Like I had a nanny before I even got, like, I was like, you're coming now. like here yeah I think those learning experiences also, you know, help us bring these issues up to our patients because, you know, they might not even recognize the fact that some of this stuff may happen for them and and they're not getting the discussion anywhere else.
00:18:51
Speaker
Exactly. So you mentioned you're doing concierge medicine now. Tell us about that. What does that change? So just like we're officially launching next week. I used to be ah in academics like you and then started my own practice in 2014. And now I'm starting into this concierge space.
00:19:06
Speaker
It just means like, you know, removing the barrier of insurance from dictating how we take care of our patients. I mean, you know, you're in a big system. They dictate a lot of your care, but also like, you know, and you might not feel it as much unless you're actually having to pay your overhead. But for For me, like at some point, like not getting compensated because i took care of someone with persistent genital arousal disorder and that's an F code.
00:19:28
Speaker
You know, like F codes don't get compensated because they're psych codes, you know? And so a lot of what we deal with in female sexual medicine are codes. And so like, how does that work? that Then you're just not going to get the reimbursement for it. And so again, it's like people are suffering on both sides. Patients aren't getting the studies they need, but they're not getting the care they need because even from a system wise, we can't accommodate these issues.
00:19:50
Speaker
And so for me, it was a matter of just like being able to spend more time with less patients and and give higher level of care so that I can have my own sanity. Yeah. No, that's great. I'm sure your patients really appreciate it too Yeah.
00:20:05
Speaker
Yeah. it's ah I mean, some of them were very devastated because like, I think I told you before we were taught starting that I used to like try to provide this really extensive care in the model that I was in and it was okay for a while, but at some point I couldn't do it anymore.
00:20:18
Speaker
Yeah. That makes sense. But you're affiliated with Ms. Medicine. I love Ms. Medicine. started by Dr. Lisa Larkin, who is scheduled to be a guest on the podcast as well. She's incredible in Cincinnati and has really started this affiliate program throughout the whole country, right? Yeah. And I'm their first GYN, so they're mostly internist and family practice primary care. So this will hopefully open up the door for other GYNs who want to like merge in the space as well.
00:20:43
Speaker
That's awesome.
Sexual Medicine and Empowerment
00:20:44
Speaker
Great. Because it's a little bit different, you know, because we see patients, I think, and this has been, a you know, my team and her team navigating this because it's not the same. Some patients only see their GYN twice a year, like early perimenopause, menopause, you see much more, you know, frequently, you So that's why, you know, we even created different tiers for different types of patients, which, you know, most primary cures just have one basic package.
00:21:07
Speaker
Right. Oh, that makes sense. We have some options. Yeah. I mean, so you see women for perimenopause and menopause for kind of logical issues that might come up during that time. And then also for sex med, right? and Yeah.
00:21:19
Speaker
Can you talk to us a little bit about the overlap of the two fields? Yeah. I mean, I feel like both have been very neglected. And so say I always took a urologist to make the field of sexual medicine happen, Dr. Goldstein, as you know, mom who's coming.
00:21:34
Speaker
Yes, he's coming to Cleveland next month. Yeah, so excited. And he's amazing. i spent a little time under his mentorship in San Diego. But really, you know, he always talks about being a sex detective because you have to spend the time with the patient. And I remember the first day I spent with him, he was like,
00:21:49
Speaker
90% of what you will get is from the patient history, but you just have to like really unravel it. Right. And so that takes time and that takes, you know, looking at all their history and all their imaging and all the things. And so a lot of what I take care of, of course, is what we know, like low libido happens in perimenopause and menopause. We know that is ah one of our biggest things that we see for sexual dysfunction in any category, but particularly in this category. But we also have a lot of, you know, genital urinary syndrome menopause and sexual pain. And i i always say that, like, again, you know,
00:22:19
Speaker
It's called genitory urinary syndrome menopause, but you and I both know what happens with birth control pills, with lactation, with fertility meds and cancer treatments. And so it really is just like a genitory urinary syndrome of hormone. fle trend or something yeah I to get deficiency for her all and I was like, is it you know pure deficiency? and yeah guess Yeah, no, you're right. But anytime those hormones are low, those same symptoms and signs show up.
00:22:46
Speaker
Right. And so, you know, the sexual pain, the urinary frequency, their current UTIs, the vaginal dryness, which, you know, we also know, you know, treating it can be life-saving for these women with UTIs, right? Like huh so many patients who are not even elderly. I had a patient who was 45 who got admitted with PILO.
00:23:05
Speaker
Wow. Yeah. And I was like, she goes, we um I almost ended up in the ICU. And was like, What? I would say like my 60 plus year olds, you know, but like. Yeah. So from a youth guy that went to her kidneys, like that's yeah crazy. yeah Which we know the treating it with vaginal estrogen or DHEA can reduce the risk by 50%. So it is part of the huge prevention. yeah So it isn't just sexual pain or or dryness.
00:23:28
Speaker
It's really our life saving for so many people. So I think we have to acknowledge that. But then, and then, you know, a general pelvic dysesthesias or abnormal pain sensations, persistent general arousal, some of those things that we were treating in the office.
00:23:41
Speaker
Yeah. Oh, that's awesome. Well, the women in Chicago are lucky to have you. and Yeah. I think the last thing I want to ask you about is your book that's coming out. So exciting. Can you tell our listeners a little bit more about it?
00:23:54
Speaker
It's called Brown Girl's Disease, Question Mark, A Guide to Sexual Health and Empowerment Through a South Asian Lens. So I kind of talk about a lot of the issues of sexual dysfunction that every woman experiences, but I give it a unique perspective from like culture and religion and how they overlap.
00:24:11
Speaker
I talk about, you know, what traditional societies, how they viewed sexuality and what changed, you know, why do we become, you know, so stigmatized. And then I actually talk about like the treatments and and the therapies and just including things that are missed, how to advocate for yourself. I talk a lot about bias for women of color in this field and really, you know, how to how to get your clinician to to listen to you.
00:24:34
Speaker
Okay, well, I cannot wait to read it. And we'll put information in the show notes for people to either pre-order it or order it, depending on when you're listening. Thank you so much for your time today. it's wonderful to chat with you more and learn more about what you do. And yeah, honestly, thank you so much for your time.