EP. 46 — Dr. Jen Gunter Returns 

Jameela: [00:00:00] Hello and welcome to another episode of I Weigh with Jameela Jamil. I hope you’re well. I’m fine. I’m very concerned for those who are in areas like Texas right now, existing in subzero temperatures where they don’t have access to running water or food or heat or electricity or Wi-Fi to even tell people what they’re going through. You have families camping in tents in their own living rooms just for some warmth and heat. They’re losing a, I think, a degree of warmth every single hour. It’s just unimaginable what’s going on with no support whatsoever from the government that is adequate for what’s happening right now. I feel like people aren’t taking it that seriously because we only think of fire or water or wind as an emergency. We don’t we don’t see something as creeping and slow as ice, as something to really fear. But I feel as though this is a true catastrophe, like a historical catastrophe that we’re potentially on the precipice of. So anything that you can donate to relief efforts that are on the ground there, please do so or even just raise awareness. If you have no money to spare, totally understandable, especially after this last year. But even just raising awareness so that people start to take this seriously so that those who can donate will because they’ll understand that there’s a need. It just feels like this is still 2020. This feels like a hangover of 2020. I almost wonder if we’d take it more seriously if it was happening last year because it would feel more in line with the catastrophic year that that was. But this is just endless. And so it’s very, very stressful. Anyway, I’m going to make a completely clumsy segue because there’s no way to talk about that into this. But I did tell you a couple of weeks ago that I wanted to spend the next month bringing you as much information as possible. And last week I had the excellent Seema Yasmin on who was myth busting, all of the nonsense, misinformation all over the Internet, anything from covid vaccines to general covid information to diet and detox products, etc.. She was so informative and I got such great feedback from you guys so thank you. I decided to bring back a fave from last year because you just loved her so much. And I think I had maybe the most feedback all year from her episode from all of you, where this excellent woman, her name is Dr. Jen Gunter, came on and explained the vagina and the reproductive system and all of the misinformation around it and mystery around it to all of us. And the most hilarious and accessible and warm and interesting way. She has a book called The Vagina Bible, which is honestly one of the best things I’ve ever read in my life. It was life changing, genuinely life changing. And she’s just so illuminating. So if you haven’t heard my last episode with Dr. Jen Gunter, please go back and listen to it and then listen to this episode, because she did it again. She came back and she has just blown my mind once more. I, I read all of your messages the last time she was on and you were all so happy and you all learned so much. But there was more that you wanted to hear from us about things like PCOS, which is polycystic ovarian syndrome and endometriosis and things like menopause and HPV, these things that are just not discussed enough in the mainstream. So I asked to come back and we had a very, very frank discussion about all of these things. And I tried to incorporate as many of your concerns and questions into my questions as I could. And it made for an amazing episode. I wish she was I wish she just lived in my house or lived in my brain all of the time. I feel as though if women had Dr. Jen Gunter permanently as a resident of each of our brains, we would live a happier life. She’s an extraordinary gynecologist, an extraordinary activist and and speaker for women’s rights. She’s just the best. And I love her. I loved chatting to her again. I cannot wait to have her back on yet once more. If you send me more questions you have for her, give me an excuse to bring this extraordinary human being onto this podcast to talk about this part of our bodies that we feel for some reason too ashamed to discuss. We’re still funny about discussing this vital part of our bodies. It doesn’t make any sense. I myself am someone who has always been so sheepish when talking about the vagina or the cervix or the uterus or anything, and that is starting to fade in me. Since discovering the work of Dr. Jan Gunter, she makes me want to learn more. She makes me want to talk about it more, understand it more and protect myself. And knowledge is power. So that’s the only way to do that successfully. I hope you enjoy this episode. I had a bloody blast. This is the excellent Dr. Jen Gunter. [00:04:29][269.0]

Jameela: [00:04:47] Dr. Jen Gunter, welcome back to I Weigh. I feel like your stalker, I’ve already got you back within three months. I’ve never had a guest to return. Hello, how are you? [00:04:55][8.6]

Dr. Jen Gunter: [00:04:56] Oh, I am fine. Thank you so much for having me back. It’s a pleasure. [00:05:00][4.0]

Jameela: [00:05:01] Honestly, the response to your episode was outrageous. The amount of messages I had crashed my Instagram twice because people were so obsessed with what you said and so many people went out and bought your book, The Vagina Bible. There were a couple of people who sent me messages saying that they hoped to save up to buy your book. I bought them the book and I sent it to them on Amazon because I think it’s that important a book to have. I, I honestly, I think I think your God and I wanted to get that out the way. But also I feel especially emotional because on that last episode you broke down to me and hundreds and thousands of people that you’re not supposed to be in agony and terrified during a gynecology appointment, during a pap smear, any kind of regular care during a biopsy. A biopsy is obviously painful and uncomfortable and generally unpleasant, but that you’re not supposed to be in agony and you’re not supposed to feel terrorized and in the dark, which is how I’ve always felt with previous gynecologists. And I almost burst into tears in that episode because I really didn’t know that. And no one’s ever said that to me before. And there is something so archaic and male designed about gynecology. And there there is a it’s just it feels like a barbaric practice sometimes. And that can feel much worse when you have someone who isn’t empathetic and isn’t careful and who doesn’t offer you the respect of telling you what they’re doing, why they’re doing it, how it’s going to feel beforehand. So because of you, I fired my gynecologist and I went to a new one who was incredibly kind and and made me feel so safe. And she allowed my boyfriend to come into the room, which has never happened before, to hold my hand. Because just for anyone who didn’t hear last last time’s episode, I am a sexual trauma survivor. And so I have a particularly hard time anyway with that area of my body. And I need to feel safe and I’ve never been made to feel safe. She was so slow, so calm and and was so specific. And every single thing that she was about to do took it one step at a time. We had a lot to do because I have not been very well due to HPV related complications. And and she just made me feel like even if we had to do it all in several visits, that would be OK. We got it all done in one day because she was so excellent and I wouldn’t have found her if it hadn’t been for you un-gaslighting me. Gas-darking me about what I’m supposed to experience in truly the most vulnerable position you can be in is a woman in a gynecologist office. So thank you. [00:07:59][178.6]

Dr. Jen Gunter: [00:08:00] Oh, well, I’m so sad to hear, you know, your history. And I know that unfortunately that is common because I hear that every day in the office and I hear women every day saying, wow, this didn’t hurt. Like, what’s that all about? And, you know, I think that you hit on all these points that are really important. So first of all, many women are, you know, have never been told, you know, many people who go in to get, you know, pap smears or procedures are never told what to expect. So that’s scary. And many times they have this exam done with with no explanation. They’re scared. They tense up. If you have a history of, you know, sexual trauma, that even makes it worse. But even if you don’t, it can be very frightening and disempowering and, you know, slowing down, explaining things, telling someone that they’re in control and you can stop at any time and that you will stop at any time. You know, as soon as you see a little flinch, you stop, OK, just checking in. It’s it’s almost like continually getting a scent for the procedure, you know. Is it OK to go ahead? Is it OK to take the next step? And so I’m so sad to hear about your history, but I am so happy that you found someone who who took good care of you. [00:09:11][70.4]

Jameela: [00:09:11] So I, I really I really love you for breaking that down to all of us. And I got thousands of messages truly from people saying that they didn’t know either that you’re not supposed to feel traumatized in a gynecologist office. So if you are someone in particular, someone with a history of sexual trauma, but just generally anyone who’s having a bad time, find a new gynecologist, maybe find Dr. Jen Gunter, but she might be really busy because she’s always on my podcast. I want to talk to you about HPV because it’s something that we don’t talk about enough. There’s weirdly still quite a lot of stigma and shame around it, even though it is such a common and and ridiculous to be ashamed of condition, will you will you explain to people what it is? I think some people think HPV is is herpes. It is not herpes. It is the human papilloma people over pavlova. You say it. [00:10:07][55.5]

Dr. Jen Gunter: [00:10:08] Papilloma. [00:10:08][0.0]

Jameela: [00:10:09] Right. There we go. [00:10:09][0.4]

Dr. Jen Gunter: [00:10:10] The human it’s the human papillomavirus. And it is essentially ubiquitous. About 80 percent of people who have ever been sexually active, you know, have been exposed and infected with one of the strains. And there are or types and there are more than 100 types. And some you know, some have a particular proclivity for the genital tract, you know, so you all mean, you know, in human papillomavirus is basically the word virus. So if you’ve had, you know, plantar warts, you’ve had a human papillomavirus infection, but the ones that affect the genital tract and and the mouth, some of them do as well, you know, are the ones that we think about from a health screening standpoint, because the human papillomavirus is is the cause of almost all cervical cancers. And so that’s why, you know, screening for it and and identifying any precancerous changes is super important. [00:11:04][54.3]

Jameela: [00:11:05] Yeah. And and also, it can be referred to sometimes as a not to be too dramatic. And you can tell me off I’m being too dramatic as a silent killer because like, sometimes you don’t get warts and sometimes you don’t get symptoms and you have no changes in your physical health that you notice. And so unless you go and get a proper pap smear, which is not easily available to many people in the world, increasingly so because they don’t seem to care about women’s health and or just people’s health gynecology in general, it can creep up on you. And it’s definitely crept up on me and many of my friends in the past. I was amazed to find out how many people have had complications thanks to HPV. [00:11:46][41.1]

Dr. Jen Gunter: [00:11:48] Yes. So absolutely. I mean, it’s one of these things from a silent killer standpoint. Yeah, that I mean, that’s the whole reason cervical cancer screening was invented, because women were presenting with cervical cancer that was already advanced. And they were you know, they weren’t getting diagnosed until they were having, you know, bleeding after sexual intercourse or they were just having bleeding or they had a big massive mass in their abdomen. And so, you know, a researcher decided, you know, Dr. Papanicolaou actually was the the pathologist who started, you know, the the you know, the the screening, the original screening so that, you know, could we identify these cells before they became cancerous. So absolutely. There is no possible way you can identify them. And this is a super important point to bring up because there are actually Instagram influencers with over a hundred thousand followers who tell women that you don’t need pap smears, that your body will know if you have an abnormality. And that is so harmful. Oh, yeah. [00:12:42][54.5]

Jameela: [00:12:44] Oh, send their accounts to me. [00:12:45][1.5]

Dr. Jen Gunter: [00:12:46] Oh, I will. [00:12:47][0.4]

Jameela: [00:12:47] I will, I will go fucking ham. I can’t believe that. [00:12:53][5.5]

Dr. Jen Gunter: [00:12:53] Oh, yeah, I mean, and all you know, if your body could tell you had abnormal cells, no one would have ever got cancer in the first place. I mean, it’s so ludicrous. But, you know, think about your situation. You had had a bad experience. You were scared and you’re a trauma survivor. So imagine now a wellness influencer you’ve come to trust and now she’s telling you that. You might think, oh, well, maybe my doctor was lying. And and if your doctor made you feel uncomfortable and unsafe, then you would be inclined to believe this misinformation. You could see how that would happen. [00:13:27][34.0]

Jameela: [00:13:28] Hundred percent. [00:13:28][0.3]

Dr. Jen Gunter: [00:13:29] You know, so it’s is very predatory and it’s something that we see. So obviously, it is the silent killer. And you do that’s why we have screening, because we want to identify it early and get people treated before they get cancer. That’s, you know, that’s the whole point to the screening process. But the really the fascinating thing about the science of it is, you know, when I started in medical school in 1986, we had really no concept or very little concept that human papillomavirus had anything to do with cervical cancer. And by the time I graduated residency, so in 1995, we basically knew that this was one of the major causes, if not the major cause. So it sort of gives you an idea about like the arc of science and and how much that can change even just in, you know, 10 or 15 years. [00:14:21][51.1]

Jameela: [00:14:21] And I only just found out in the last week that even if you already have HPV, you can still get the HPV vaccine. I have always thought that once you have it, you’ve missed the window and you can never have the vaccine. So will you explain this? [00:14:39][17.7]

Dr. Jen Gunter: [00:14:40] Yeah, absolutely. So that the human papillomavirus vaccine is I would I’d call it a miracle, except it’s the result of science and it is you know, we all talk about a cancer moonshot. Well, we have one we have a cancer preventing vaccine. And so the HPV vaccine that we recommend, the Gardasil 9 is effective against nine different types of HPV, two that cause genital warts and seven that cause cancer. And the best time to get it is before you’ve ever been sexually active because then you’re protected against all of them. But even if you’ve been sexually active and remember how I said earlier, 80 percent of people who have been sexually active, have been exposed. So we assume that every essentially everybody’s been exposed. I tell people HPV is just part of having sex. That’s just the way it is. And so even if you’ve had one or two strains or one or two types, that’s the correct term of HPV. The vaccine can still protect you against the other types. Right. So it still offers protection and we recommend it now up until the age of 45. But when I started dating a few years ago, I got the vaccine because it’s not like at times out with your age, because I thought, well, I’m going to start dating. And, you know, I would I would feel I would just be so regretful if two years or three years after I started dating, all of a sudden I got HPV, you know, why not take the vaccine? And so I recommend it for every single person. And both of my children have been vaccinated. And, you know, so, you know, I’m practicing what I preach. [00:16:10][90.4]

Jameela: [00:16:11] 100 percent. And if you wait so you vaccinate, you can vaccinate boys against HPV as well. [00:16:16][4.8]

Dr. Jen Gunter: [00:16:16] Absolutely right. [00:16:18][1.3]

Jameela: [00:16:18] Didn’t fucking know that because that’s a big thing that people don’t know about, is the fact that men can carry it and never, ever have any symptoms of it. It’s not really. There’s no real test for it. Right, if you have HPV or not. And then they don’t get they don’t get fucking cancer. [00:16:32][13.7]

Dr. Jen Gunter: [00:16:33] Well, they do get anal cancer, actually. [00:16:34][1.4]

Jameela: [00:16:35] Oh, really? [00:16:35][0.1]

Dr. Jen Gunter: [00:16:36] And yeah. And they can get and they’re much more likely to get oral cancer from HPV. [00:16:39][3.7]

Jameela: [00:16:40] So how does one get oral cancer from from genital HPV. [00:16:44][3.3]

Dr. Jen Gunter: [00:16:45] Well, from oral sex. [00:16:47][1.6]

Jameela: [00:16:48] There you go. I think that’s really important for people to know. [00:16:51][3.0]

Dr. Jen Gunter: [00:16:52] Yeah. And, you know, here’s another way that, you know, misogyny fucks women up. You know, I’ve heard it’s men don’t get screened for HPV because there isn’t, as you know, currently a screening tool. So because because people with cervixes do get screened, then, you know, then it’s very then you start hearing these conversations. Well, I didn’t give it to you because I don’t have it. And so when you’re only screening half the population, it it does sort of create this sort of, you know, mismatch or unbalanced dynamic that if you don’t understand the fact that we don’t screen half the population so they don’t know if they’ve had it or not. But yes, we recommend everybody age nine to 45 get vaccinated. But you can get vaccinated when you’re older. It’s really just a cost effectiveness, right? So the older you are and the more sexual partners you have, the more likely you are to have more, more types of HPV. But it’s just the way it is. [00:17:46][54.4]

Jameela: [00:17:46] Yeah, and there are multiple different strains. I’ve got I have I have certain strains that now I won’t be protected from by the HPV vaccine. However, the other eight or nine, I can’t remember how many they were sorry that you said but, but all the other strains I will now be protected against. [00:18:04][17.7]

Dr. Jen Gunter: [00:18:05] Right. The seven other. And you know, even if you don’t ever have another sexual partner, your partner could have had HPV, you know, say a strain a type you don’t have it could have had it five years ago. Right. And then it went dormant and years later it could get reactivated. So even if you don’t have a new partner, there’s a possibility that old HPV could get reactivated. So why not get protected? [00:18:29][24.4]

Jameela: [00:18:30] I am I was talking to my gynecologist and she was saying that, you know, that the times where you become a bit more vulnerable to your HPV becoming active is in times of stress. You’re not sleeping enough. You’re not getting enough of the right kind of nutrients just to feel strong and healthy and and immuno healthy as you can. And that is that’s that’s that’s definitely planted a seed, in my mind, of some life changes that I need to make that I feel like all women in particular, all anyone who’s got who’s got a cervix, who who needs to maybe be mindful of this sort of stuff. We really, really our life depends on us not being stressed. So take this as a kind of New Year’s plan to cut as much fuck shit out of your life as possible, get as much sleep, don’t wake up two hours earlier to curl your hair, to look good for the patriarchy. We need to sleep. We need to rest. We’re not i mean we need to not be messed around by other people. This is going to make me take my own sense of peace and calm more seriously. But but thank you for explaining this to me because this is so interesting. I think there are so many people who aren’t having the vaccine who massively could benefit from it because they think it’s too late for them. [00:19:50][80.0]

Dr. Jen Gunter: [00:19:51] Yeah. And I mean, people just don’t get it because they think, well, that’s not going to happen to me. Or parents mistakenly don’t get their children vaccinated because they think, oh, it’s just going to make them have sex. And that’s obviously teaching kids about seatbelts doesn’t then mean they become bad drivers. Right. So taking safety precautions doesn’t increase your risky behavior. That’s actually been well studied. And and so, you know, getting people vaccinated as early as possible. There is also an Internet myth out there about the HPV vaccine that it causes ovarian failure. And that is untrue. You know, all these myths that come up from these anti vax conspiracy theorists. And so, you know, that’s not true so it is incredibly safe, incredibly effective. Prevents cancer of the cervix, will likely prevent cancer of the vagina and the vulva for a lot of people, because that’s often HPV related, will reduce anal cancer, especially for for men. And it will likely, although we don’t have good data for this yet, it has a chance at reducing oral cancer for men as well, because that’s a later peak. So, you know, cervical cancer peaks at an earlier age and we see the peak of of oropharyngeal cancer kind of sort of in the 40s and 50s. So there has been sort of enough lead time with people being vaccinated yet to be able to get understand all of the amazing ways this is going to help. But you also have to think about it. If you prevent the infection from happening, then obviously you can prevent a lot of the ramifications. [00:21:25][93.5]

Jameela: [00:21:26] Yeah, fascinating. So fascinating. OK, so we have so many things to talk about because so many people message me being like, OK, now you need to bring her back and we need to talk about many other different things. So I want to start with polycystic ovarian syndrome. Some people hear it known as PCOS. Can you tell me what it is? Can you tell me what we most need to know and what we most don’t know? [00:21:56][29.5]

Dr. Jen Gunter: [00:21:57] So it’s a complex metabolic hormonal condition that involves the ovaries, likely the brain, the adrenal glands. And basically it’s a disorder of ovulation. And what happens is you get these complex metabolic consequences that lead to an increase in testosterone levels. And there’s also changes in what’s called insulin resistance for many women, not always, but for many women. And so the most common symptoms are signs of excess testosterone. So facial hair growth, which is called hirsutism or hair, sort of in more of what’s called traditionally a male pattern, although that those terms are obviously outdated and and also. [00:22:48][50.3]

Jameela: [00:22:49] Male pattern, you’re talking about hair loss on top of the head. [00:22:51][2.5]

Dr. Jen Gunter: [00:22:52] Yeah. You get frontal balding. So all of the things that you sort of quote unquote associate with testosterone, you can see an increase in acne. That’s another one. And and then you get irregular menstrual cycles typically. So usually eight or nine or less menstrual cycles a year as opposed to 12 to 13 or sometimes even three to four months between menstrual cycles because of this disordered ovulation. And I think what what is very important to know about I mean, first, people always like to know what’s happening to their body. You know, if something’s happening, you want to know why? Why am I just different or what’s happening? But it’s it’s something that and this is it’s still not a completely understood condition, but it it increases your chances of having cardiovascular disease later in life. And so that’s a very important thing to know about. There is an increased risk of infertility as well, although often up until very recently that’s been the focus. And so all the people at risk for cardiovascular disease have sort of, you know, not had that important aspect discussed. And and so those are the common consequences. And then as well as you know, that the nuisance of irregular bleeding or, you know, the excess hair growth. And so the it’s really a complex syndrome that’s often misdiagnosed. It affects anywhere from four to 10 percent of women, depending on the diagnostic criteria that you use. [00:24:22][90.8]

Jameela: [00:24:23] Is it inherited? [00:24:23][0.2]

Dr. Jen Gunter: [00:24:25] So there’s probably a genetic component, but we don’t strictly understand, you know, what those are. So we can’t identify yet a really specific gene, but it certainly tends to run in families. There may also be environmental reasons for that. And so that’s not 100 percent sorted out yet. But absolutely, if you have a parent with one that with polycystic ovarian syndrome, you know, mother or sister, and then you’ve got irregular menstrual cycles and increased hair growth and obviously there’s an increased risk for you. [00:24:53][28.6]

Jameela: [00:24:54] You mentioned that somewhere between four and 10 percent of people can have it. [00:24:58][4.3]

Dr. Jen Gunter: [00:24:59] Yes. [00:24:59][0.0]

Jameela: [00:25:00] Do you think it’s possible that that number could actually be higher and that some people go undiagnosed? The reason I ask this is that I have a lot of friends with PCOS. A lot. A lot. A lot. And a lot of them were diagnosed later in life because you briefly touched on the term insulin resistance. And I believe insulin resistance can sometimes lead to weight gain. But friends of mine have definitely had that side effect from PCOS where their weight has dramatically changed. They did not know they had PCOS, their doctors saw them. And because we have such like rampant fat phobia in medicine, the doctors just took one look at them and told them that they needed to diet, they needed to lose weight. And when told, well, I’m trying or I’m not eating more than my friend or more than I used to. And yet I seem to be getting bigger. Their doctors responded to them with no sympathy and just kind of treated them as though they are perhaps lying or forgetting about some sort of secret midnight sleep muffins they must be eating. Therefore, because they were so distracted by the weight of my friends, they didn’t investigate further the possibility that this is PCOS. These are people who maybe didn’t have necessarily like big period interruptions or they were already on the pill so they wouldn’t notice if they had irregular bleeding. Do you find that to be a problem in your field? [00:26:22][82.7]

Dr. Jen Gunter: [00:26:24] So fat phobia is a huge issue in medicine overall, and certainly I don’t think gynecology is any exception to that. I think the four to 10 percent of people who have PCOS has been, you know, pretty well there’s some pretty defined criteria. And so these studies have sort of looked at like all comers and then evaluated them. So I would say that and some studies that use more liberal guidelines for PCOS say that perhaps a little bit higher. But I think most people say it’s you know, in the four to 10 percent, we say that that’s a lot of women. [00:26:58][33.7]

Jameela: [00:26:58] Shitload yeah. [00:26:59][0.9]

Dr. Jen Gunter: [00:27:00] So one in 10 friends. Now, whether all women who have PCOS get diagnosed early is a totally different thing. So when the literature tells us four to 10 percent, that obviously doesn’t mean that everybody is going to get diagnosed when they should be. And there is a very complicated relationship between PCOS and and and obesity that hasn’t been fully understood. And I think fat phobia probably comes into play a lot for that, because when certainly I was training, that was the old thinking, right. That it was simply related to weight. And now we know that is not true at all. [00:27:39][39.3]

Jameela: [00:27:40] As in they thought it was caused by excessive like or whatever. They thought it was caused by weight. [00:27:45][5.1]

Dr. Jen Gunter: [00:27:46] Yeah, or definitely related related to it in a much more causal causal way. And so now we know that really the incidence of of of of obesity with polycystic ovarian syndrome is really about 50 percent. And it’s it’s far more complex than than than than sort of the other PCOS causing that. In fact, it’s sort of more like those two things sort of working together perhaps to cause more problems. So so that. Yeah, I think that’s probably the best way to explain it, that, that maybe those things are additive together from a from a medical standpoint as opposed to a direct cause and effect. But that awful old and fat phobia, thinking that it’s cause and effect led many people to be dismissed. And you add on top of the fact that PCOS symptoms typically start, you know, very soon after puberty. Right. Often these women go from having the you know, the first couple of years into puberty your periods are typically irregular. And for many of these women, their periods just never become regular. So they’ve had this lifelong history. So they walk in the door and they just get sort of dismissed at first blush. So it does not surprise me and it saddens me that it happens to so many people as opposed to just, you know, taking a history and saying, you know, this is what you have and or this is what I think you have. We need to do an investigation, because if you have irregular periods, there could actually be quite a few causes. And you need to have, you know, have that investigated. And if you have increased hair growth or signs of, you know what I said hirsutism, that also needs to be investigated because there’s also other causes of that. So this sort of dismissal is incredibly wrong and very harmful and leads many people to not get not get the treatment they need. And if people don’t get diagnosed, then they don’t understand that they are at higher risk for having cardiovascular disease, which is something you might want to know about. Right. Because that might lead to how you get screened for those conditions. And, you know, we are we’re so used to asking people about smoking history. Right. And and the factors that increase a woman’s chance of getting cardiovascular disease are often just never asked. [00:30:01][135.7]

Jameela: [00:30:02] Wow, so what what is the next step upon someone thinking they have PCOS like they might have perhaps facial hair starting to grow, they might be having you know, receding hairline at the top, or they might have weight issues, irregular periods. They go to the gynecologist? [00:30:19][17.0]

Dr. Jen Gunter: [00:30:20] Yeah you could also go to an endocrinologist, a hormone specialist you could go to either, you know, typically if there’s a lot of menstrual problems, you know, most people would probably end up at their gynecologist. But, you know, we all work very well together. So, you know, it shouldn’t matter really how you access the system. Also, many primary care doctors will do a fantastic job as well. So you don’t necessarily have to see a specialist at all. There have been many family practitioners who who are able to manage PCOS very, very well. So really, I think it just depends on who you see. [00:30:55][35.9]

Jameela: [00:30:56] So then what is the the the traditional treatment for PCOS that people should be looking for? The reason I’m asking all these questions is just for all the many, many, many, many, many people who wrote to me saying that they cannot even get tested and they know that they’re not being taken seriously by the general practitioners, especially if they are heavier in size. And so I just want those people to be armed with the information of what to expect, what to know, what to even be able to ask for. So a doctor knows that you know a little bit of what you’re talking about. [00:31:25][29.4]

Dr. Jen Gunter: [00:31:27] Yeah, so absolutely. So if so, you know, people should the that the testing should be done. If you have, you know, any of the symptoms and this is, you know, the when you look at the medical guidelines, you know, weight doesn’t come into it at all. You know, when we when we ordered the testing, it doesn’t matter. You know what your body mass index, what your weight circumference is. None of that factors in it’s about irregular periods, signs of excess testosterone like that. Those are the things. And for somebody with a history of infertility, you know, not everybody notices how regular their periods are, right? I mean, like, you know, so some people are like they don’t pay attention to their irregular periods. And it isn’t until maybe they get to work up for infertility that they get diagnosed as polycystic ovarian syndrome. So so my have would. [00:32:16][48.7]

Jameela: [00:32:16] I have an app because it sends me a message to let me know that I’m about to start becoming moody and upset. Very cold. Sorry. Go ahead. Literally sends me a reminder, just being like your cycle’s coming, be ready and then I can start immediately, like pre warning people about my oncoming behavior. Go on what were you going to say? [00:32:36][20.6]

Dr. Jen Gunter: [00:32:38] OK, so. So if you have any of those symptoms like you have, you know, persistent menstrual irregularities, if you have infertility, if you have excess hair growth, then absolutely, you absolutely deserve an evaluation. And if if you’re not getting evaluated, then you need another provider and an even if you’re not going to do anything with those results, even if you say, oh, I don’t care, I don’t care what you going to offer me, you still need to know because it if you have polycystic ovarian syndrome, it increases your risk of cardiovascular disease. And you might want to know about that. You know, it may change it also changes how we recommend screening for diabetes. So, you know, there are sort of these other sort of consequences that, you know, you know, fall down the line. And so it may influence whether or not you have your lipids checked at an earlier age or not. So, you know, these are all important. [00:33:26][47.8]

Jameela: [00:33:27] Do they do they do do they give you, I don’t know, like estrogen to offset the testosterone? Like, is there any kind of hormonal treatment? What what happens? [00:33:34][6.7]

Dr. Jen Gunter: [00:33:35] So currently we don’t treat the hormonal disturbance per say. We we treat the symptoms. And so a lot of it depends on. So, for example, if somebody wants to get pregnant, then there’s a whole set of, you know, medications that are going to increase the chance that some of those follicles that are stopping them sort of midway phase are going to get kicked into action. The goal is to make you ovulate right on a regular basis. If your goal is to if you have irregular periods and your goal is to have regular periods, then there are a variety of different treatments for that. And it would depend on your contraception need, on other health risks, you know, other health conditions. So, you know, so it would depend on that. So many people might go on the birth control pill. Some people may just decide to get an IUD with the hormone in it to control their bleeding. But some people there are also drugs that are, you know, typically used for diabetes, like metformin and other drugs that can also be used to help correct the what’s going on in the ovaries. And those then, you know, then make may make you ovulate. But then also then if you need contraception, then you would need to think about that as well. So, you know, all of these need to be explained to someone so they can make a decision based on their goals and the side effects of the medication, you know, which fits best with, you know, for them, for their health. And then if you’re diagnosed with polycystic ovarian syndrome, you probably also need to be, you know, screened for diabetes depending on some other factors, your risk factors as well. [00:35:11][95.4]

Jameela: [00:35:12] It’s PCOS. And endometriosis that I really hear about the most of people being diagnosed later in life, being either kind of either being too embarrassed to maybe go to that doctor about it or just not knowing or thinking that the way that their body is behaving is just the sort of I guess I don’t know, like it’s just the way the cookie crumbles. OK, well, sex is just always going to be painful for me or my periods are just never regular or this, that and the other. I just have facial hair. We don’t we don’t think to question because there’s also so little really, really out there, hyper public information around it. I see a lot of misinformation around it and people saying, like, stop eating sugar to get rid of your PCOS or go in this juice fast to get rid of your PCOS. So and we don’t actually have any information about the actual condition itself. It’s very important to go to a doctor. I do want to talk to you a bit about endometriosis, because I feel like that is a huge I’m hearing more and more and more and more people of so many different ages and backgrounds struggling with this. And I feel, again, like, you know, I think Lena Dunham is someone who’s come out and spoken publicly about it. Perhaps Alexa Chung’s briefly mentioned, I would love to hear from you about endometriosis because so many of my followers are struggling with it. [00:36:30][78.2]

Dr. Jen Gunter: [00:36:31] Right. So endometriosis is a condition where the basically the tissue from the lining of the uterus or component of the tissue is actually growing in the pelvic cavity. And it can grow on the ovaries, it can grow on the nerves, it can grow on the bowel even, and it can range from being very minimal to having a few specks of disease. And it can range to being extremely severe. And it’s a very complex condition that we don’t fully understand. And I know we just said that with polycystic ovarian syndrome and and some of this is definitely related to the lack of of, you know, studies maybe earlier on. But some of it’s also related to the fact that it’s actually really medically complex. And you know, where as we develop new ways to study hormones and interactions and nerve growth factors and all these things, we’re getting more information. So endometriosis can present in so many different ways. And the cause, again, we don’t fully understand, but the prevailing hypothesis is that cells, some of the cells, when you menstruate, some of the cells go backwards into the fallopian tubes or the oviduct, and that some of those cells, it’s called retrograde menstruation, could end up in the pelvic cavity and could take seed. Why that happens for some people and why it happens for others, we don’t fully understand. There’s also an inflammatory component. So it we we believe that endometriosis triggers this inflammatory cascade, that those cells, when they’re not in the uterus, are are able to trigger sort of more of an inflammation and that can cause pain and scarring. And also, some of the inflammatory mediators produced by endometriosis may affect the way nerves grow and affect pain thresholds. And so there was a fascinating study, you know, where rats were impregnated with endometriosis. And obviously the rats don’t know what’s being put in their belly. Right. And other rats had sham surgeries where they were opened up and closed up and then they did things to the rats that were painful. These are how we study pain. And the rats that had been given endometriosis had exaggerated pain responses versus the rats that hadn’t. So the inflammatory responses of endometriosis affect how the whole nervous system can process pain, and I think that’s also another important concept, that it can sort of rewire essentially what’s going on, whether it’s inflammation or through nerve growth factors or other reasons. So, you know, it’s it’s not only just a local thing, but it can also basically be a widespread condition. And what can even make it more complex is in the pelvis, all of the nerves kind of come together in one place. And so your bladder, your bowel, your uterus, there are like a bunch of appliances plugged into a power strip. And if one shorts out, then the others can sort of short out in the same way. And so when when people have endometriosis, we see a higher incidence of having pelvic floor muscle spasm, which is also a cause of pelvic pain and pain with sex. And we also see a higher incidence of painful bladder syndrome, which is also a cause of those things. And so endometriosis can also start this cascade of other medical conditions and why it’s not very painful for some women and why it causes this sort of catastrophic sort of cascade for others is just not something that we fully understand yet. [00:39:56][205.4]

Jameela: [00:39:57] And some of the symptoms can be painful. Sex is one that I’ve heard from a lot of people that I know. [00:40:03][5.7]

Dr. Jen Gunter: [00:40:04] Yeah. So the most common symptom would be incredibly painful periods. So that would be the most common, painful period that also last very long. You know, the pain lasts not just while you’re having your period, but maybe five, six, seven days before sort of almost even being triggered sometimes with ovulation. Pain with sex can absolutely be part of it. The endometriosis can cause inflammation at the top of the vagina. There can be actually lesions in inflammatory nodules. But the pain with sex can also be because of that pelvic floor muscle spasm that I spoke about so that it’s triggered this other condition that causes pain with sex. And so that’s why it’s very important not to look at endometriosis just as a condition of some tissue that’s causing a problem on one spot of the pelvis. But to think about all the ways that it could be affecting you and just to get back to those the spots in the pelvis, there was a study done a few years ago that showed that where people have endometriosis in their pelvis is actually not at all related to where they have their pain. And so it’s really there’s a lot of complexities. [00:41:07][62.7]

Jameela: [00:41:07] Oh, my goodness. So it’s so hard to just really pinpoint how to how to treat that, I imagine. [00:41:14][6.6]

Dr. Jen Gunter: [00:41:15] Well, again, a lot of it depends on the symptoms and fertility goals. And so for someone who has, you know, very painful periods, you know, the first step might be to try some hormonal medication. So the birth control pill or the hormonal IUD, if that’s ineffective, then the next step could be to investigate for endometriosis, that requires surgery or someone might elect to try a different medical therapy. It’s really important to include people in you know, it’s their body and it’s their choice. And some people want to have surgery earlier, even though removing endometriosis, it certainly can come back and then that can sort of create scar tissue. And some people want to try multiple medications before they go to surgery. And there isn’t really a right or wrong answer. It’s just important to understand how each one might fit for you. So then you can make the right decision for you. [00:42:07][52.0]

Jameela: [00:42:08] Right. I’ve heard some people I mean, I know some people who’ve gone so far as to have a hysterectomy as a result of of endometriosis. Will you tell me what a hysterectomy is? [00:42:21][13.3]

Dr. Jen Gunter: [00:42:23] Sure, so a hysterectomy would be removing the uterus and typically most people also remove the fallopian tubes or oviducts when they do the surgery as well, simply because that reduces your risk of having ovarian cancer actually later in life, because most ovarian cancer probably comes from the fallopian tubes. It’s a kind of a fascinating sidebar there. [00:42:42][19.7]

Jameela: [00:42:43] Is there a link between endometriosis and ovarian cancer? [00:42:46][3.2]

Dr. Jen Gunter: [00:42:50] Some types. So there’s a specific the common type of ovarian cancer that we hear about. No, but a less common kind or endometrioid ovarian cancer. Yes. And and so either can be a link. Absolutely. And so a hysterectomy is something that, you know, would be possibly recommended depending on so many permutations of combinations. So it might depend on how successful medical therapy has been for you in the past. It might depend on the degree of endometriosis that you have. It might depend on how well you’ve responded to surgery previously. And so there are a lot of different factors to come into play. Many, many people can have the surgery and preserve their ovaries if all of the endometriosis is removed. Whether someone wants to do that or not, again, requires a lot of discussion, individual discussion with their physician, because there also are, you know, hormonal consequences from removing the ovaries earlier. And so it’s it’s such a complex discussion, you know, sort of hard to distill that part down here. But surgeries that. [00:43:54][63.4]

Jameela: [00:43:54] You don’t think we can cover in 10 minutes on a podcast? That’s really weird. No, I understand. [00:43:59][4.6]

Dr. Jen Gunter: [00:43:59] My goal here would be to give people enough information so they can ask questions and they can advocate for themselves. And, you know, if they’re told, you know, women, women are often told, well, you should not have a hysterectomy because of your future fertility. Well, that’s a pretty patriarchal thinking. You know, a person can decide for themselves if you know that’s important for them or not, and someone who’s in severe pain who is tired of surgeries and other things for them, that might be the right option, you know. So I just think you have to be very individualized and, you know, look at somebody’s case history. You know, I would always recommend for somebody contemplating surgery, you know, what we call definitive surgery, right? Removing your pelvic you know, your pelvic organs to probably get a second opinion because, you know, you can’t undo surgery and your body is important. And, you know, why not get an opinion from someone else to make sure that they agree? And you know what? They might have come up with a different they might come up with something that you hadn’t thought of before. So I think whenever you’re going to make a big decision, a second opinion is a great idea. [00:45:07][67.8]

Jameela: [00:45:15] Lastly, but not least, I want to talk to you about menopause, because, again, this is a hugely undiscussed issue and it is something that can happen to women not just in their 40s and 50s. It can happen to them earlier. And we carry a lot of shame around menopause. And it is seen as this moment where a woman goes, quote unquote, crazy and she starts sweating all the time. And those are kind of the only modern day things that we know. Perhaps she as she ages faster in her face afterwards, we only know these kind of five very reductive and are not particularly important facts about menopause. And I would love to talk to you about it. You know, I’m in my 30s. This is something that I really need to start learning about. And I think we all do. [00:46:03][48.6]

Dr. Jen Gunter: [00:46:05] Absolutely. I think, you know, that’s why I wrote, you know, my new book, The Menopause Manifesto, because for me, even though I actually did have a lot of symptoms going through menopause, none of it was shocking because I knew what to expect and I knew what I could do about it. You know, being caught unaware sucks and not knowing what’s happening to your body is incredibly disempowering. And even when people decide to do nothing, they’re having symptoms. The act of doing nothing is a form of power. Reclaiming power because you’ve made that decision. So, you know, so because menopause has been so shrouded in secrecy and so much so that many women don’t even talk to talk about it among themselves. They don’t even have like a whisper network to fall back on. Right. Like there’s no greater shame than an aging woman’s body, like the vagina and vulva, at least rate shame. Like we’re just like nonexistent when you get older, unless, you know, you sort of well know. I mean, it’s just, you know, aging women are dismissed. So, you know, I I think that what I wanted to do was to give people all the information that they needed to navigate that so they knew what was happening to their bodies that they’d be able to advocate in the doctor’s office if they needed anything, and they could be aware if they were missing important screenings. And, you know, I think understanding why we have menopause is such an important thing, because for so long, it’s been viewed as a form of ovarian failure. Right. So so patriarchal medicine has looked at men who can continue to produce sperm until they get pretty close to dying. Not that many of them have children at those later age. Let’s be honest with erectile dysfunction and other issues. It’s not like their you know, their partners are popping out babies until they’re in their 90s. But because ovulation stops, you know, around the age of 50, the idea was that, well, obviously women are diseased, but that’s actually part of the plan. And so, you know, the question people need to ask is not why did why why don’t women. Why do the why does ovarian function stop early? It’s how did women become so strong that they were able to live beyond their reproductive function? It’s actually a sign of, you know, sort of physical strength. [00:48:23][138.0]

Jameela: [00:48:23] Oh, wow. I’ve never looked at it like that. That’s fascinating. [00:48:25][2.1]

Dr. Jen Gunter: [00:48:27] Well, because the patriarchy looks at as a sign of disease. And, you know, people would look at. [00:48:32][4.9]

Jameela: [00:48:32] My dad used to call it men on pause, which is just so frustrating and such a dick move. [00:48:39][6.7]

Dr. Jen Gunter: [00:48:40] Well but so it’s really fascinating so menopause doesn’t have anything to do with men. It’s so but the guy who invented the term [00:48:46][5.8]

Jameela: [00:48:46] Don’t tell them that they never believe you. [00:48:48][1.6]

Dr. Jen Gunter: [00:48:49] So his last name is De Gardanne he was French and it’s from menes, which is, you know, Greek from menses or, you know, Month and Pausa, which is actually Greek for stop. I’ve probably butchered how to pronounce it or stop or cessation. And so together, a menes pausa sounded like menopause, right? So that’s how it came about. It’s nothing to do with men, but it’s a really I find the term awful simply because, you know, he was awful and he contributed nothing to the study of the subject. You know, his advice. I read his book on menopause. That was I read his initial dissertation that was written in 1816, and in his book, his two versions of his later book. And, you know, his advice to women in menopause was to not dress like your younger, blush was dangerous, to cover your arms, for God’s sake woman. Yeah. I mean, it was just, you know, and he basically blamed every single disease on menopause. So if you’re sixty and you get gout, well, obviously it’s menopause and it’s like, well, OK, but sixty year old men get gout and they don’t have menopause. And so it’s actually really interesting. I also read reviews of his book, and that was actually what some of the reviewers said was he just blames everything on menopause. That’s ridiculous. So, you know, the term was invented by someone who, you know, didn’t have an understanding who whose views were probably even patriarchal for the time, because there were some very advanced thinking physicians who actually didn’t view it as a disease. And they also wrote things. But, you know, here we are. [00:50:34][104.5]

Jameela: [00:50:34] It’s more just that it’s so much more taxing for us to reproduce than for men to produce sperm. It’s more taxing on our bodies. And so after a certain point, I imagine that just becomes less and less healthy and good for the mother, right? [00:50:50][16.1]

Dr. Jen Gunter: [00:50:52] Well, so it is reproduction is incredibly taxing for humans. Yeah. So for anybody who, you know, who has childbearing. For humans, childbearing is incredibly difficult. It’s a long process. It can result in lots of bleeding. Then there is raising a child, which, you know, is very actually labor intensive if you think about doing it without all of our modern stuff. So menopause, actually, the prevailing theory why we have it is it’s related to sort of not only our social structure as humans, but also grandmothers. So it’s basically it takes a village. So if you’re going to our closest relative, the chimpanzee, they stop reproducing in their 40s. They die shortly thereafter. But women don’t want to keep living. And the idea is that reproduction needs to stop several years before you can become a help. A helper. Right. So if you’re 50 and having a baby, you can’t be very helpful to your twenty five year old daughter who’s having a baby right so your reproduction has to wind down in time. So your youngest child is old enough to care for itself, for you to become useful to the younger generation. And so there are all kinds of studies that have looked at there’s data that looked at historical birth records from Canada and Finland, that if if a grandmother had children and they lived close by, they were more likely to have children. So she was more likely to have grandchildren than if her children moved away. And that was seen for both women and men. So it wasn’t related to having an easier birth. So the theory is that actually. You know, over the age of 50, we rock and, you know, we helped drive evolution. [00:52:45][113.0]

Jameela: [00:52:45] Of course we do. I also love you know, I had Gloria Steinem not to brag, but I had Gloria Steinem on this program. I had her on this podcast and she was talking to me about the great and joyous liberation of life, you know, older and after menopause. And when, you know, you are no longer seen as a kind of as a sexual object by society, which is fucking ridiculous because there are so many sexy and attractive and sexual women across the ages. But she talked about the freedom of finally no longer being shackled to only her viability, only her sexuality. And I thought that that was really joyous. And but it did remind me of just the ageism around the conversation of menopause. How young can menopause happen to people? How long can it come to people? [00:53:37][51.2]

Dr. Jen Gunter: [00:53:38] Sure. So menopause, as I’ve just discussed, is is age 40 and over. When people have when their ovarian function stops before the age of 40, we call that primary ovarian insufficiency. And the reason for that is twofold. It’s one, you know, if you’re thirty six, being called menopausal might be challenging for you. You don’t want to you want to be associated with a condition that is associated with age. But more importantly, it’s not usually the same thing. So people with ovarian insufficiency before the age of 40, sometimes they can ovulate sporadically. They’re not necessarily infertile. They may be able to get pregnant. The chance is much lower. And so it’s important that they understand that. So, you know, they can they can manage appropriately. [00:54:27][49.3]

Jameela: [00:54:29] And what is the treatment if you have any treatment for menopause? [00:54:32][2.9]

Dr. Jen Gunter: [00:54:34] Well, so there’s a lot of different factors that involve whether or not you need to be treated. So in general, for people who who have a stop of their ovarian function before the age of forty five, going on menopausal hormone therapy can help reduce your risk of heart disease if you take it until about the age of 50, the average age of menopause. So early menopause is actually associated with a decreased life expectancy because of cardiovascular disease. So so that’s important from a treatment standpoint. So once you get sort of older than that or older than sort of 45 to 50, whether you need treatment, it completely depends on your symptoms and what’s going on health wise. So twenty five percent of women have really no problems with hot flashes. So if you’re not having problems, you don’t need to have that managed. Right. So I would encourage people to check their symptoms. But the most important thing is actually knowing what those symptoms could be, because, again, just like we discussed with PCOS and just like we discussed with endometriosis women have their symptoms dismissed. Right. So if you say, oh, I feel like I have this, like, brain fog and your doctor says, oh, it’s nothing, well, then, you know, you don’t know to ask further. Right. You just sort of believe what your doctor says. So knowing the symptoms, being able to match it up and then, you know, deciding what you need from a treatment standpoint. [00:55:56][82.2]

Jameela: [00:55:57] I remember being at secondary school and a lot of our mothers being around the age at which menopause might start and hearing various reports from different kids at school that their mother’s behavior had changed. Is that common with menopause? [00:56:15][18.1]

Dr. Jen Gunter: [00:56:17] So definitely mood changes happen. But I think that also could potentially be a sampling bias, right. That, you know, the only the kids whose mothers were having problems would be talking about it. [00:56:27][10.2]

Jameela: [00:56:27] Yeah the loud minority. [00:56:28][0.9]

Dr. Jen Gunter: [00:56:29] No one’s like hey my mom’s having an awesome menopause. Right. So there’s also that. [00:56:32][2.4]

Jameela: [00:56:32] Yeah, it’s just something that I hear about all the time from people. It’s like, oh, she’s going to go crazy at 40. I’ve truly heard groups of men talk about that when a woman’s getting to a certain age. There was one one man I was at a party with who was talking about, you know, starting to date this woman. And when his friends found out that she was in her late 30s, they were like, there’s no point. And this man was the right age to date, a woman of that age. I mean, we could all date whoever we want to, but they were around the same age. And so he he was like, why? You know, I like the fact that she, you know, has the same amount of life experiences. Maybe I’m tired of dating people who don’t remember the things I remember from my childhood. And they were like, well, you know, she’s going to go through the menopause soon and she’s going to go crazy. And those are the exact words that I was just so horrified. So I remember the moment where you were like, I’d really like to discuss menopause on your podcast. I was thrilled because there’s a wealth of misinformation out there. [00:57:34][61.8]

Dr. Jen Gunter: [00:57:35] Yeah. I mean, it’s you know, that gets back to the whole sort of just those tired tropes that, you know, that women are crazy and women are hormonal, you know, some women do have, you know, a mild to, you know, mild mood changes that can be triggered by menopause. But there’s a lot of things that are also going on around that same time. Right. So you may be developing other medical conditions. You may be developing other life stressors. So there’s also those things to consider. It’s possible that menopause can also sometimes trigger for other women a more severe depression. The you know, the women’s brains have a different type of plasticity. You know, we are our brain actually can be essentially, you know, rewired. So when you have a newborn, the most important thing to you is the survival of the newborn. Again, that gets back to the toll of reproduction. And and so that’s why a lot of women say, well, you want to have a baby. I was like, I can’t remember anything else. That’s right. Because evolution wants you to just think about that baby. You become hyper acute, amazing caregiver of that infant. Right. Because think about it. You went through all those nine months and you’ve got to keep that’s an investment. You know, you have to keep that investment. So there’s a lot of, you know, theories about our brains being much more vulnerable to being rewired by hormones because of, you know, where we’re built for that essentially. So you can understand that that is that why some women, the changes in hormones at menopause that could have that kind of trigger. And so but if you don’t know that, you might, you know, be suffering in silence, you might be told it’s just your hormones suck it up. But, you know, there are real treatments and, you know, almost every symptom of menopause has some kind of treatment. And and so I think it’s really important. You know, you don’t have to suffer with vaginal dryness. There’s no reason why menopause needs to be the death of sex, which is what it used to be called. [00:59:28][112.7]

Jameela: [00:59:29] Is that when lube enters the chat? [00:59:30][1.4]

Dr. Jen Gunter: [00:59:30] Yeah, you can use lubricant, you can use vaginal moisturizers. They’re available over the counter. You can use a prescription estrogen for people when those don’t work. So there are a variety of treatment options, you know. [00:59:42][12.2]

Jameela: [00:59:43] Are there any vaginal moisturizes that people should stay away from, like I always feel like the word scented on toilet roll or on anything that’s going to go down you should i think stay away from. [00:59:52][9.5]

Dr. Jen Gunter: [00:59:52] So and typically a silicone based lubricant works better for for people who are menopausal. I tend to be less irritating. So if you’ve never if you haven’t tried a lube in a long time, that’s something to think about. But yeah, I mean, a lot of women have pain with sex related to menopause and then they’re just brushed off just like, you know, we say that, you know, women who have endometriosis pain with sex are brushed off. [01:00:13][20.7]

Jameela: [01:00:13] And vaginismus of pain is brushed off. [01:00:15][1.2]

Dr. Jen Gunter: [01:00:15] Exactly. Yeah. You know, so, you know, if I only have, you know, one thing that could be written on my tombstone, it would be pain with sex isn’t normal. Please, you know, get another provider. The number of women that I see in my office who have had pain with sex for ten, fifteen years. And I’m like, I’m like, well, what have you been doing? And it breaks my heart. Some of them say, well, I just put a pillow over my head. [01:00:42][27.1]

Jameela: [01:00:43] Jesus Christ. [01:00:44][0.4]

Dr. Jen Gunter: [01:00:46] And I just think is that where we are in society, that that it’s so normalized that your partner might not even notice that that you’re having this horrible pain experience that you’ve seen doctor after doctor, and you’ve just been told there’s nothing to do and there’s no diagnosis. Imagine having your body not working in a way that, like your friends working and every single person tells you they don’t find anything. I mean, it that’s just so wrong. And the psychological toll from that is just impossible to calculate because then you think you’re uniquely broken. I mean, it’s devastating. Every time I hear that, I’m just I have to just, like, not suck in my breath. And I go I’m just I just have to you know, all I can do is say to say to these women, well, first of all, you’re going to leave my office with a diagnosis that I can guarantee you we will have a diagnosis. And and that that you’re not the only one to to have this. And, you know, just those statements alone, I think can be very helpful for people. [01:01:46][60.4]

Jameela: [01:01:47] Fascinating. Oh, you’re a savior. I love you so much. Is so nice to have you on this podcast again. Thank you so much for answering those questions. Dr. Jen Gunter’s book, The Menopause Manifesto, will be coming out this year. Coming out in May, you say. [01:02:02][14.9]

Dr. Jen Gunter: [01:02:03] Yes, May 25th. [01:02:04][0.5]

Jameela: [01:02:04] And the Vagina Bible is out and ready for you to go and consume and learn so much. It’s funny. It’s so well-written and so, so, so informative. So therefore, I cannot wait for your next book and for everything that you do. Thank you so much for your for your advocacy and for how unpretentiously and how accessibly you speak about these things to everyone. I’ve learned more from you in the two hours in which we’ve ever spoken. That’s on the last podcast and this one then I’ve learned from all of the gynecologists I’ve known over the last ten years. So I appreciate you. And may we all have the pleasure of following your work for a very long time. Thank you so much for coming on again. And I’ll probably need you back after this. I’m probably going to get another thousand fucking messages saying, please, can you ask about this? And I will. I appreciate you so much and you’re welcome here any time. [01:03:02][58.0]

Dr. Jen Gunter: [01:03:04] Oh, thank you so much for having me. I really appreciate it. And I, I just I you know, I really appreciate you helping me get the message out. Thank you so much. [01:03:12][8.5]

Jameela: [01:03:14] Thank you so much for listening to this week’s episode. I Weigh with Jameela Jamil is produced and research by myself, Jameela Jamil, Aaron Finnegan and Kimmie Gregory. It is edited by Andrew Carson. And the beautiful music that you’re hearing now is made by my boyfriend, James Blake. If you haven’t already, please rate, review and subscribe to the show. It’s a great way to show your support. I really appreciate it. And it amps me up to bring on better and better guests. Lastly, at I Weigh we would love to hear from you and share what you were at the end of this podcast. You can leave us a voicemail at 1-818-660-5543 or email us what you way at iweighpodcast@gmail.com. It’s not in pounds and kilos, so please don’t send that. It’s all about you just you know, you’ve been on the Instagram anyway and now we would love to pass the mic to one of our listeners. [01:04:02][48.4]

Listener: [01:04:06] I weigh being a survivor of an eating disorder. I weigh being a proud member of the LGBTQ plus community. I weigh being an activist and an ally. I weigh being an artist, a writer and a lover of the sky. [01:04:06][0.0]

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