In Your Pants with Dr. Susie G - Vibrators for pelvic floor and sexual health

Starting point is 00:00:00 you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below Hey friends, today's episode is all about vibrators and orgasms with Dr. Alexandra Dubinskaya. We discuss the benefits and drawbacks using a vibrator, men versus women using vibrators, sex and aging, the pelvic floor, and much more. Let's formally introduce my guest today. Dr. Alexandra Dubinskaya is a board-certified gynecologist specializing in female pelvic medicine, reconstructive surgery, menopause, and women's sexual health.

Starting point is 00:01:08 She believes in advancing medical care for women through research. She has published multiple peer-reviewed journals and is a reviewer for several journals. She has contributed to several books, including urogynecology and colorectal textbooks. Dr. Dubinskaya serves as a Chair of Communication Committee for the International Society of Sexual Medicine and is overseeing the promotion of sexual literacy through the Society's website, newsletters, and social media platforms. She is an active member, speaker, and presenter at the American Urogynecologic Association, International Urogynecological Association, International Society for the Study of Women's Sexual Health, North American Society of Sexual Medicine, and North American Menopausal Society.

Starting point is 00:02:03 I hope you enjoy the show. Alexandra, thank you so much for being on the show today. my pleasure thank you for inviting yeah so i have hot off the press your paper i i was just fracking off the air about like alexandra's like wow you came prepared yes i do no pun intended because the show is all about vibrators and orgasms so the paper itself is called is it time for doctors to prescribe vibrators a systematic review of pelvic floor outcomes and i have Alexandra here to talk about her research and the findings of this paper. So Alexandra, what surprised you in doing this research? And really, actually, let me backtrack. What motivated you to even do this research? And then we can dive into what you found and

Starting point is 00:02:56 what surprised you? Yeah, of course. So I'm a physician. I'm a urogynecologist. So I take care of women who suffer with urinary incontinence, pelvic organ prolapse, frequent urinary tract infection, vulvodynia or painful vulva syndrome, sexual dysfunction. So I basically see those women every day in my practice, and I see how much they suffer. And in general, women's pelvis goes through so much during our lives, starting from puberty, childbirth, menopause. And nobody really talks about those changes. And nobody really instructs women on how to support the pelvic organs and how to prepare for these changes, or how to do rehabilitation. So we all go to the doctor and we all hear them saying like, make sure you eat healthy, you get enough sleep, you exercise, but nothing about the pelvis. so i was thinking what can we give women what tool we can provide them that they can um maintain their pelvic health and what i mean by that for example when women go from uh through labor it's

Starting point is 00:04:25 a very traumatic experience for pelvis um it can cause uh some tearing it can cause um nerve damage that then women experience later in life the consequences of that or when menopause happen and there is a fluctuation of hormones which changes the structure of vagina changes ph and it affects how they organ look how they function so i was searching for a tool that that can keep the blood flow going into the pelvic area and that can be used in the comfort of your own home as often as you want and we do know that vibration in general promotes the dilation of the blood vessels and when the blood vessels are dilated there are more blood flow going to the organs that those blood vessels supply so why not using vibrators

Starting point is 00:05:27 as a pelvic rehab for multiple conditions. So then I wanted to look in the literature and see what we know about it, what has been done about it. And basically what the systematic review discovered is that the vibrators, by stimulating the nerve ending on the pelvic region, they actually send the signals to the spinal cord and as a result they provide the changes

Starting point is 00:06:01 in sexual function so women would experience changing in desire in arousal orgasm and also in the same time there was study been done that showed that pelvic floor muscles by receiving more blood to flow, those muscles function better. So it can potentially help with the urinary incontinence. In women who have the pain in the vulva region, actually by applying vibrators, the pain significantly decreases. So that's kind of a quick background and preliminary findings. That's wonderful. And I have a couple of follow-up questions because as I was reading your paper, some of those papers had internal, external stimulation or both. And I'm curious in your research, when you went through the systematic review process, was there a benefit to doing one

Starting point is 00:07:08 versus the other or not really? It's an excellent question. And it's interesting that you ask me Because currently, we're finishing up a prospective study, meaning we actually recruited women and gave them vibrators and instructed them to use the vibrators. And when we're creating a protocol, we have the same question. Is there any difference between application externally or internally? I think there is for several reasons. first when like even though the pelvic floor muscles are all uh very interconnected i think when you apply vibrator externally it's a little bit too far from the muscles that participate in um continence mechanism that prevents um like that helps us to hold the urine

Starting point is 00:08:02 um i don't have much backing of this uh theory but in our prospective study we actually decided to ask women to apply vibrators externally the reason for that was because our population is predominantly um more mature women with some postmenopausal changes so not everyone um would be able to insert vibrator vaginally or the fear of having urine retracted infection would prevent them from using it. So based on the results that are coming up soon, we probably can further explore this theory

Starting point is 00:08:48 if there is any difference in outcome with applying vibrator externally versus externally. Awesome. That's exciting. Very cool. And how conscientious to consider the person, the people in the research study, as far as comfort and accessibility. So I just want to acknowledge that and appreciate that thoughtfulness in your research. And yeah, acknowledgement of different comfort levels and accessibility levels for folks. So yeah, thank you for that. um my second my my other question here is going to be about men versus women so i know your study is focused predominantly on women what do you know about the studies of vibrators in men because in my practice i do often advocate men to use vibrators and there's often this stigma around like when you when you even just mention the word vibrator to a guy they're just like me a vibrator

Starting point is 00:09:46 like no, or they would say my female partner, you know, uses one, but I've never considered using one. And there's almost the stereotype or maybe the stigma around using vibrators for themselves. But if they have like erectile difficulty, if they had prostate cancer that resulted in sexual dysfunction, I am a huge proponent of using varying kinds of stimulation to support everything that you just named for women. So, you know, I'm just applying that same theory. So I would love to hear what your thoughts are on that, men versus women and vibrators and such.

Starting point is 00:10:23 Right. You know, it's so interesting that there is this stereotype. Even though in urologic practice, vibrators have been used for many, many years to stimulate um like the penis and the scrotum to retrieve the sperm for for example men who is quadriplegic and um unable to do it on their own um and in general it's similar how you have like a massager at home it's not only for female parts of the family or like male parts of the family everyone has a back pain and everyone can use a massager with vibrators I think it's the

Starting point is 00:11:08 same and it depends on the I guess open-mindedness and another thing that I noticed in our prospective research that actually women whose partners whose partner were more open to try the vibrator they actually had the better outcome and it's not only findings of like our study there is a study from several years ago like national survey studies that show that when women like partnered women have a partner who's open about vibrator use they actually have a better improvement in sexual function and also thinking about couples let's say older couples where men experience like erectile dysfunction or any other chronic illnesses. Vibrator can be a tool that actually allow couples to continue being intimate and receive pleasure.

Starting point is 00:12:09 And I think it's just a wonderful underutilized tool. Thank you, Alexandra. That is so important, especially as you mentioned the aging population and sexual health. Can we talk a little bit about that? the let's de-stigmatize that because I don't know about you but there seems to be this air of stigmatization around aging and sexuality you know that it's it it's almost de-sexualized like older people are de-sexualized in some way or if they who do see them you know having sex in some imagery or what you know on the street having some sort of public display of affection it's more of

Starting point is 00:12:51 it's like oh well that's really cute it's like you know at what point does sex stop like is there like at what point do we become like non-sexual you know oh I hit a certain age no sex doesn't even matter that doesn't matter for me anymore like that doesn't happen so I'd like to talk about that and unpack this a little bit more about sex and aging yeah it's it's unfortunate that um at some point women like in general aging people consider to be asexual but i think we're forgetting that sexual pelvic mental health is all very important and interconnected components of um overall like general health and overall wellness and if there is a dysfunction or um something happening with one area

Starting point is 00:13:45 of, like, sexual health or pelvic health, it affects health in general. And I think it's very important to remember. And even when, like, people get older, like, sexuality is still present. It might change how they express it. But it's still an important component of the general health. And it has been shown in studies that, unfortunately, even among physicians, we stop asking women when they get to like 50 60 years old um if they have any issues with um with sex and it's considered to be like even inappropriate so right and um i think that's

Starting point is 00:14:27 something slowly changing and i think as we all age we we finally like talk more about menopause it's more like becoming more socially appropriate i think slowly people will realize that yes everyone having sex everyone having it in a different way and again um vibrators can be this amazing tool that people sometimes use it as a warm-up or just a tool to put them on the same page on the same timeline in um achieving orgasm achieving pleasure so um i think it's very important to remember um and speaking about vibrator use in an aging population there is we need to do more research in finding out if there is a certain setting certain intensity are better as people age because we do know that our nerve ending changes our like perception of

Starting point is 00:15:27 like touch changes um so it would be interesting to see um what different preferences uh in choosing of vibrators or settings between like more mature women versus younger that is very interesting and how the body just adapts speaking of adaptations and again i'm not sure if you can answer this or not but there's this misconception that that when you if you use a vibrator i'm sure you've heard this if you use a vibrator that is going to desensitize you in some way like like you'll need more of it or you'll need to have a stronger pulse or stronger stimulation because it'll almost desensitize you what what are your thoughts on that well if you take any body part and you're going to apply um vibratory similar stimuli or

Starting point is 00:16:25 any stimuli at some point your body will adapt but if you give your body with that body area a break and then reintroduce the stimuli you're going to feel it again so i think a common sense yes if you're going to use vibrators for an hour in your genital area you're probably gonna feel numb and irritated um so you're despairingly uh and i think another um why people also talk about it a lot of people can have orgasm in a certain like certain way like certain position with certain stimulation and it's true for vibrators or let's say manual stimulation if there is a certain things that keeps you going and makes you reach a big hole you're probably going to search for it and if for you it's a vibrator you're probably not going to feel as comfortable

Starting point is 00:17:24 experience similar orgasm if you don't have a vibrator and you just do like a manual stimulation but I don't think it's the pulse of the vibrator it's just how we as people operate right right and knowing oneself in that context like exploring and also being flexible because adding a vibrator is really it's a playful tool it's a tool it's not the be-all end-all of a sexual engagement or responsible for overall sexual satisfaction it's the intent of use right and knowing kind of what works for you through that exploration but it even starts with exploration which often we're not taught especially from a woman's perspective to masturbate explore our body self-touch like it's okay it's it's that that kind of narrative is not the normal narrative

Starting point is 00:18:16 at least historically and I think till these days it's kind of figure it out on your own right exactly here you go have fun you know like I don't know yeah yeah no I totally I totally get So I have, oh my gosh, a couple more follow-up questions, because you mentioned manual stimulation and the vibrator. And there was only one comment, I think, made in your paper around one paper, I think it was Sipsky's paper, that said there was no difference with manual stimulation or vibrator. Can you speak a little bit about that as far as, do we know if there's a significant difference, and if so, how do we know? um i don't think we really know about it that paper was very interesting because they were comparing women who has the spinal cord um defect versus not um i think stimulation in general would bring the more blood flow and would produce similar effect but how much how different are the changes I don't think we can like quantify it yet right so we still got to do some research around that right yeah it sounds like no that's great

Starting point is 00:19:34 because the other thing too is terminology around orgasm so when you were going through your systematic review how did researchers define orgasm because it is kind of all over the place if that's not my understanding of like how researchers define orgasm what parameters they're using to measure orgasm I can I can see how that might pose for maybe some some lack of cohesiveness as far as the literature goes what do you think what's your thoughts on that yeah so there is no exact measurement in the paper in reviewed papers researchers will use like a subjective um like outcome that women report if they are better worse if they have multiple orgasms and um there is actually a company right now uh leoness who developed a

Starting point is 00:20:30 vibrator that's being inserted vaginally and basically able to record uh the muscle contraction when you um when you like reaching orgasm and just being aroused and the amazing thing that they do is they collecting the data from all the users like obviously the users who consent to send the information so they're forming this like a large database um that hopefully we will know more um about um the chemistry and uh physiology of orgasm and how exactly to actually measure it right exactly exactly because that's why for me as far as just reading research in general on the topic is like there it there may be a potential benefit although the evidence really as far as just the quality of overall evidence but the way that people are measuring things it's just kind of

Starting point is 00:21:28 all over the place right so it's like yes and you know like right and I think what's also interesting um what's more important having an orgasm or having a stimulation is it the time of stimulation that promote uh that produces the positive outcomes because there is a blood flow going there is a nerve ending uh being stimulated or is it actually orgasm right exactly exactly and where where does even orgasm come from yeah a lot of questions we can do so much research in this area right exactly so philosophical because orgasm it it's really some it is subjective there's physiological responses associated with that feeling of intense pleasure or peak moment in pleasure but it's so it's it

Starting point is 00:22:27 varies you know and I think that's what also in general people think that it it it should feel or should be a certain way when it really in fact has limitless potential to be to be experienced by the experiencer absolutely and how it changes over the course of like lifetime like we do know based on this subjective i guess report um that with age orgasm tend to be like shorter more muted and not as intense that's why the older women my more mature women might need um a little higher settings of the vibrator um but how it's changed for for men how it's changed for different hormonal changes in your life it's still a lot of questions that hopefully we will have more answers sooner yes and it's to researchers like yourself that dive into this

Starting point is 00:23:26 this world of sexual health and ask the questions and stay curious so we thank you very much for for painstakingly doing all this research because it's not easy i always when i have researchers on on the show i always offer so much gratitude and respect because it's not easy doing research it's not easy at all putting this together so i really do admire and have great respect for the work that you do thank you um okay last question promise any adverse effects so so there's benefits there's talk about benefits but there are there any barriers barriers to using a vibrator whether biologically or psychologically or socioculturally i always love that biopsychosocial umbrella so are there any barriers to the use of a vibrator for people and and and and the second

Starting point is 00:24:23 part to that is are there any reported adverse effects of using a vibrator yeah okay so let's start with the first question thank you so some barriers let's talk about these a lot like physiologic anatomic barriers the way how many like predominantly vibrators are designed can be very difficult for women for example men who has an issue with manual dexterity for example like rheumatoid arthritis or just having this like vibration on your one hand can also cause like neuropathy like not like severe neuropathy but it can get uncomfortable so also um the habitus like if you have extra weight it might be a little difficult to reach to your genitals with the um the vibrators that currently available uh commercially available uh

Starting point is 00:25:23 that's pretty much it that i can think of right now the psychological um there are plenty of psychological barriers and the cultural barriers anything from um the religion some religions um prohibit masturbation and even though you use it as a um let's say rehabilitation of your like pelvic area the fact that you um have a possibility of experience orgasm um can preclude you from using it um it's usually usually the major religions they're a little bit more like linear towards women masturbating and more like they're more tailored towards the men masturbating but still it can be something just a mental barrier for people to use vibrators culturally it can be associated with the stigma of being promiscuous

Starting point is 00:26:25 uh also just the everyday situation if you have three kids who can walk in your room anytime they want um it's not going to make you feel relaxed so comfortable with using vibrator um i heard from my more mature patients that they they're very concerned that what if they die and their kids are going to go in their apartment and they're going to find those vibrators what they're going to think of that so there are a lot of um there are a lot of just cultural situational barriers and i think actually as a physician as discussing vibrators with patients can help overcome those barriers i'm not saying um everyone should be feel comfortable and don't care about your culture and religion i think it's just being culture aware and see the way how we

Starting point is 00:27:27 can implement um this intervention this rehabilitation um and the second what was the second question adverse adverse reactions or adverse effects yeah yeah so among the studies um that was reviewed there was no adverse effects reported in general in um review of literature there could be some irritation but again use your common sense if you're going to use it for too long it's going to be irritated um there were some very um isolated cases where somebody would like lose the vibrator but it usually happened more common when people insert vibrators anally okay so it's very important if your patient practice like practice anal sex or stimulation just to use the vibrators with a more like wider base so it has a lower risk of being

Starting point is 00:28:32 kind of like sucked into the rectum that makes that makes total sense and i can't tell you how many people I've interviewed on the show who have talked about that very thing of incredible things you will find in one's rectum and beyond so it happens it happens and we kind of have to be we have to talk about this so that people can be conscientious and safe about their their sex practices you know knowing how to work with their bodies and avoid such unfortunate circumstances right and also to your point nobody um talks about it nobody educates people and like it's very difficult to lose something in the vagina but in the rectum because of the like sphincter muscles at some point it's just gonna go in and can't come out so it's just important to know

Starting point is 00:29:26 if you work with a patient just to see what sexual practices they've engaged in and just give them a heads up. So, Alexandra, I know I said I had one more question. I have one more. Go ahead. This is such a wonderful conversation with you. Really, it's more for the clinicians and the practitioners. You know, if we want to support our patient's sexual health, and maybe we are a provider that have never addressed sexual health with our patient, but are leaning into these spaces a little bit more and have encouraged to do so, how would be the best way to start that conversation with your patient, especially if you as a clinician maybe feel a little uncomfortable or unsure of how to go about

Starting point is 00:30:13 asking about sexual health? Well, I would start with actually not every clinician have to feel obligated to talk about sexual health but if you feel and it's okay to feel uncomfortable um i think if you know and be honest with yourself if you feel uncomfortable talking about these issues just know another clinician who is and feel comfortable referring to that to that clinician physician i think that's already going to provide a lot of help for your patient and relieve you from the needing to discuss sexual health with your patient. And if you're a clinician who's really eager and passionate about it, but feels just

Starting point is 00:31:03 uncomfortable, I think starting with being comfortable with your own sexuality, being able to ask yourself the difficult questions, that would be a good place to start. and then think about sexual health as any other health like same way how you feel like how majority of people feel comfortable if you if your blood pressure is okay are you having headaches it's the same organ it's um has it's very it's still health it's still part of the health and just ask questions and um just known the majority of patients actually would really appreciate that because probably no one else have never asked them about their sexual health sexual concerns and at first it might feel awkward but i think it's important to remember just as awkward as

Starting point is 00:32:00 you wanted to make it right so um and practice the more you talk about it the more comfortable you will be with that absolutely a hundred percent a hundred percent okay well thank you Alexandra, I really, really appreciate you being on the show today. It was such an enlightening conversation. For those who want to connect with you, follow you on social media, where can they find you? I can be found on Instagram. It's a.dubinski. On Twitter, dubinski-a. Yeah, that's that's pretty much where you can find me wonderful wonderful so i will be sure to link all of dr alexandra's um handles in the show notes and link to her paper and her and her colleagues paper as well and again really appreciate you being on the show and taking

Starting point is 00:33:03 the time to illuminate us about vibrators thank you so much for having me i had a great time talking to you about it. And to all of you viewers and listeners out there, thank you so much for being here as always and loving wellness for your pelvis. Until next time. Thanks for listening to today's episode. Be sure to visit my website drsusig.com for show notes and related resources on today's topic. If you like what you're hearing, head on over to YouTube and subscribe to my channel on my youtube channel you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my channel be sure to type it in the comment box below

In Your Pants with Dr. Susie G - Vibrators for pelvic floor and sexual health

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