What College Women Need to Know About Sexual Health and STI's

Real Talk With Susan & Kristina

In this episode of Real Talk, KJK Student Defense Attorneys Susan Stone and Kristina Supler are joined by Dr. Lauren Streicher, a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, and the founder and medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Health. They discuss sexual and reproductive health in college kids. The conversation includes prevention, infection and maintenance of Sexually Transmitted Infections (STI’s), the myths behind contraceptives and how they actually benefit women, and how to empower women with education about sex, reproductive and gynecological health, and sexual pleasure.

Links:

• Dr Lauren Streicher's Website (Click here)
• Inside Information: the Menopause Podcast (Click here)

Show Notes:

• (00:38) How we crossed paths with Dr. Streicher and her amazing accomplishments to date
• (02:01) The irony between hot flashes and college
• (02:46) The surge of sexually transmitted diseases and infections…a.k.a. College
• (03:31) What measure should every mom and their child take to prevent contraction of STI’s known to cause certain types of cancer?
• (06:11) A scary new trend of how college students have fallen victim to STI’s
• (07:19) How this makeshift form of protection that is often ridiculed can allow women to safely enjoy oral sex…well for 15 seconds
• (08:10) Unraveling the mysteries of a female condom– yes, you read that correctly.
• (09:10) Saran wrap belongs in the kitchen, not on your lady parts
• (09:52) The real solution to safe oral sex for women (that’s FDA-approved)
• (11:50) How $6 can save you from a potentially life-long sexually transmitted infection
• (12:34) Why not all sexually transmitted infections can be treated with just creams or at all
• (13:28) The best safety measure you can take to prevent a permanent battle with HPV
• (13:40) Unfortunately, there is no catch-all screening test for sexually transmitted diseases
• (15:37) Common misconceptions about emergency contraception
• (17:31) The scientific explanation of pregnancy and fertilization
• (18:40) A non-pill form of emergency contraception
• (19:10) The ancient alternative to Plan B pills
• (19:50) An over-the-counter, essential component of your child’s college first-aid kit
• (21:14) News flash: You can still get pregnant after taking Plan B
• (21:42) Alternative forms of contraception with higher efficacies
• (22:36) The dwindling existence of access to safe abortions for unplanned pregnancies; 50% from failed contraception
• (23:52) A lesser known benefit of IUDs
• (24:20) Busting the myth that contraceptives like birth control pills lead to infertility in women; they actually protect it
• (25:44) The effect of marijuana on reproductive health in both men and women
• (26:52) Why in the end, money matters more than health; the explanation behind the lack of scientific studies on the effects of marijuana to a female’s reproductive health
• (27:53) What is the most prevalent gynecological health issue facing women in their early twenties today?
• (28:20) An online resource young women can utilize for sex education and pleasure; basically everything our mothers didn’t talk to us about
• (29:08) Female sexual pleasure and why it should not be overlooked
• (31:30) Sex should never hurt period.
• (34:56) The sex talk that every mother should have with their daughter before sending them off to college

Kristina Supler: Today we are so pleased to be joined by Dr. Lauren Streicher. Who's a clinical professor of obstetrics and gynecology at Northwestern University's Medical School. Dr. Streicher's also the medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Medicine.

Susan Stone: I just have to say, we are really excited. We worked with Dr. Streicher on a case where she gave us some gynecological expertise. There was an issue and we got to know her and it's an amazing colleague to have. She just released a book. Her recent books are Slip, Sliding Away, Turning Back the Clock on Your Vagina and Hot Flash Hell, a Gynecological Guide to Turning Down the Heat.

Susan Stone: And as a woman in her fifties, I can tell you that's important. But she's also an expert on issues that would pertain to women in college, which is why we actually met her.

Kristina Supler: Yeah. It's been such a pleasure to Work with Dr. Streicher and review all of her books and her social media content. I should mention she's also the host of a podcast called Dr. Streicher's Inside Information, the Menopause Podcast. So for all of our listeners out there, parents who are listening to learn about what to talk to their college kids about. Check out Dr. Streicher's podcast as well.

Susan Stone: we get a double bang for our buck because typically our podcast is for our listeners of kids in college.

Susan Stone: So if you think about it, Dr. Streicher, we're here to talk about health of college kids, but our listeners are their mothers who should turn onto your podcast. So welcome a board to Real Talk.

Dr. Lauren Streicher: Well, thank you. And, and of course your listeners are my listeners because isn't it just kind of strange how, when women have their first hot flash is also the time they're waving goodbye to their kid and redecorating their bedroom.

Dr. Lauren Streicher: So true. because women, as you know, tend to put off having kids, and it is not unusual for a woman to have a family starting in her mid, late thirties, which means hot flashes in college. It's all goes together. That is

Susan Stone: the great tie in. Why don't we lead off with our first question that would really impact women going off to college.

Susan Stone: What's new in the world of preventing diseases, anything new in that area?

Dr. Lauren Streicher: It's funny, you should ask, sexually transmitted infections is of course a big topic, which that issue starts long before someone goes off to college, you know, certainly in high school we addressing those issues, but there's no question that the numbers of sexually transmitted infections do go up in the twenties during the college years, because that's the time when young men and young women are exploring sexuality.

Dr. Lauren Streicher: Very often having multiple partners and quite frankly, very often having too much to drink too often, which can sometimes lead to sexual activities that even people who have the best of intentions find that maybe they don't use the condom. They don't use the protection, they don't need. Do what they need to do.

Dr. Lauren Streicher: So it is a time that stories going a day out well,

Susan Stone: and that's why we have a business. Right?

Dr. Lauren Streicher: So let me start why it talks about what's new in terms of sexually transmitted infection prevention. This isn't exactly new, but it bears repeating for parents that before you pack your kid off for college, make sure they have their HPV vaccine.

Dr. Lauren Streicher: And we are talking both boys and girls, you know, a lot of people, they put it. For a variety of reasons when their kids are 11 or 12, it's kind of on the back burner. Maybe the pediatrician doesn't bring it up. Maybe they don't see a pediatrician anymore. And this is critically important because what we know is that if a woman gets the HPV vaccine, that she's going to be protected against 90% of strains of human papillomavirus.

Dr. Lauren Streicher: Which of course are not only responsible for cervical cancer, but also vaginal cancers V our cancers, some head and neck cancers and the thing is, and also, yeah, and, and we have data coming out now because it's been around long enough that we're starting to see the fruit of that vaccine because it used to just be okay.

Dr. Lauren Streicher: We have less girls with abnormal. Pap tests, but now we are seeing people, we're now 15 years later seeing less cervical cancers, less other cancers. And this is just as important for the boys as the girls. You know, a lot of times I'll get a parent who says, well, you know, that encourages sexual activity.

Dr. Lauren Streicher: We know that it does not encourage sexual activity. And for the parents who say, my kid is not gonna be sexually active, you can think that, and, and maybe your kid won't be, but as you know, better than anybody, the rates of non-consensual sex are very high in, at college. And just like you wouldn't set your kid off to drive without putting on their seatbelt.

Dr. Lauren Streicher: You shouldn't send them off without their HPV vaccine. So. For starters, even if you don't wanna have the conversation with your kid about it they need that HPV vaccine. It is critically important and it is FDA approved, of course, for both boys and girls, up to the age of 45, by the way, moms, for those of you who are single out there, and as you send your kid off, you're saying, okay, now it's my time.

Dr. Lauren Streicher: Keep in mind that as you get out there, you wanna protect yourself as well. While it is not FDA approved for women over the age of 45. I give an HPV vaccine to any woman who asks I don't care how old she is because older guys have HPV too thought. I would just throw that in, even though it's a little bit, Hey, off

Susan Stone: topic, protect those moms out there.

Susan Stone: Protect single mom.

Dr. Lauren Streicher: Well, truly when we think about this being a time of sexuality for your young adult, for a lot of people, especially single moms, this is the time that you say, okay, my turn, or even the people who are married or in long-term relationships, suddenly you're not worrying about the, the teenager lurking outside the door and sure.

Dr. Lauren Streicher: They actually have a little bit more activity. But the thing that's new, that's really interesting. While anyone, any college student you talk to is certainly aware that condoms, um, will protect against sexually transmitted infections during intercourse. We know that there are a lot of sexual activities that have nothing to do with the penis going and the vagina.

Dr. Lauren Streicher: And in fact, there are a lot of people that will avoid. Penile vaginal penetration specifically because they are worried about pregnancy or they are worried about an STI. So they'll do other things. And a lot of times what other things might involve is oral sex. So the problem of course, has always been, if you have a woman who is on the receiving end, Of getting oral sex from a male or female partner.

Dr. Lauren Streicher: There's always the concern about the trans the genital oral transmission of sexually transmitted infections. And we're talking things like human papilloma, virus, herpes Even gonorrhea, even syphilis, you can transmit a lot through genital oral contact and you don't want to end up with an infection like that.

Dr. Lauren Streicher: So what options does a young woman have to protect herself and to protect her partner? In the past, a woman was always told to use a dental dam. Now, now you have you ever. Seen a dental dam outside of your dental office. I

Kristina Supler: never one had to try and mention it.

Dr. Lauren Streicher: No, it's like, no, of course not. They're not gonna buy it.

Dr. Lauren Streicher: They're not going use it. They, everyone hears about it and jokes about it's not gonna happen. So what's the alternative to the dental dam. Well, for the Martha Stewarts out there what you can do is you can take an UN lubricated condom. You can cut off the tip, you can cut open the condom, and now you've got a square of latex, which is gonna be impermeable.

Dr. Lauren Streicher: So theoretically. For the highly motivated, you can then teach which work and spread it over the vulva. And it's never gonna happen. That's gonna last for about maybe 15 seconds before it falls off or gets pushed aside or whatever. So that's really not a solution. And then we have the female condom, which a lot of people haven't heard of.

Dr. Lauren Streicher: And the female condom is basically an over the counter product, just like a male condom. Only this one goes inside the woman's vagina. And then there's a sheath, basically a tube with the ring at the end that goes outside on the VVA. And I know you're making a face. People can't see that, but I will tell everybody you're making a face and that's exactly.

Susan Stone: I am you making a face going, does that cause up an infection?

Dr. Lauren Streicher: Well, I affection, but the face you're making is the same face young women make when I tell them about it, because they say, are you kidding? First of all, I'm not gonna, you know, find buy one of these things. I'm not gonna put it inside me. I'm not gonna hang it out, have it hanging out on my vagina, just to have the guys say, what's that.

Dr. Lauren Streicher: So that's not gonna happen. And before we get onto what the real solution is, I also wanna mention that saran wrap is also not. An option. A lot of people, I know this is what's good. I mean, this is what's going on out. There is people are saying, okay, I don't wear nowhere to get a dental dam. They don't know about the condom thing and they saran wrap.

Dr. Lauren Streicher: I've got it in my kitchen. It's easy. I'll grab it. So they take saran wrap, they spread it over their Volvo, but here's the problem. Wrap is made to go in microwaves. And what that means is it's porous. Hello? Hey, there's a little ports of entry for all those bugs. You're trying to keep out. So aside from the fact that it's very amusing, when you go to the store and you see a woman buying jumbo cran wrap, and you think, gee, I wonder what that's for.

Dr. Lauren Streicher: It is not to prevent sexually transmitted infections. I have good news. What's the solution. The solution is there is a new product, actually, not a new product, but what's new is that the FDA has just sanctioned. It is actually protecting against sexually transmitted infections. And this product is a panty.

Dr. Lauren Streicher: It is called Loral L O R a L. I do not work for these people. And basically what Loral is, is it was invented for the purpose of preventing sexually transmitted infections when a woman is receiving oral sex so that she doesn't give it to the giver who you're always grateful to the giver. You don't wanna give them something, right.

Dr. Lauren Streicher: And you're not gonna get anything from the giver. So the way that this works is that these panties are made out of the same material as condoms. It's a latex panty, and they're kind of cute. They come in, very stretchy bikini style. It's, you know, you won't feel stupid wearing it cuz they actually are cute panties.

Dr. Lauren Streicher: And the idea is that the. where is this panty? And it's very, very thin so that if someone is giving her oral sex, she still gets all the sensation. She can feel everything he or she who's giving can feel everything. But if there's anything lurking on her genitals or on the giver's tongue, it's not gonna get transmitted.

Dr. Lauren Streicher: The panties are not looking. Not that

Susan Stone: we're Googling it everybody. And we see that it's, we're not getting paid either. I just learned about this.

Kristina Supler: Wow. Oh, look at this. We think it's about damn time undies were designed for pleasure of the, the pleasure of their wearer

Susan Stone: and it's $25 and vanilla scented and it's seamless.

Susan Stone: So it's not gonna super stretch.

Dr. Lauren Streicher: So I, when I was talking to the company and, you know, I always get on my high horse about, you're not supposed to cover up normal genital odors because women are not supposed to smell like English gardens. And this whole idea is offensive to say that you have to put something on that has a different taster or smell, but in this case it's actually valid because they're what they're the purpose of the vanilla scent is to get rid of the latex taste and smell mm-hmm , you know, mm-hmm so it's not to cover.

Dr. Lauren Streicher: The woman it's to cover up whatever, might be going on with the latex. So the, people block at the price, it's $6, a panty, but truth be told. There is you can't put a dollar value on not getting a sexually transmitted infection like HPV that you will be dealing with potentially for the rest of your life.

Dr. Lauren Streicher: And when you think about the cost of what you might spend on the lipstick to go out on the date, Or the drink you have on the date spring for the $6 panties. I'm just

Susan Stone: saying, yeah, I'd like to add, it says $25, but you get four, four individually packed undies. Yeah.

Dr. Lauren Streicher: So $6 did.

Kristina Supler: So let me ask you this STS are most, I think there's a, a perception.

Kristina Supler: Most STIs are treatable with an antibiotic and then the person's fine, true or not true.

Dr. Lauren Streicher: Well, it depends on the STI Uhhuh . So if you look at something like gonorrhea or syphilis, that would be true. If you look at herpes, herpes is, you know, obviously very, very common. And while we can control herpes using various antiviral.

Dr. Lauren Streicher: Medications you don't get rid of it. We hope that the herpes virus is just going to quietly live somewhere and not rear its ugly head too often, but it doesn't ever go away. So it is something that while it is certainly not a, yeah, I mean, I don't wanna. Make it sound like if you get herpes, it's horrible.

Dr. Lauren Streicher: It's not a lot of people get herpes and they deal with it and they're still good people and they're clean people and people love them and they have sex and all of that, but it is something you do need to manage for the rest of your life. And the same is true of HPV human papilloma virus, which is the most common, sexually transmitted infection right now.

Dr. Lauren Streicher: We do not have anything to eradicate it the best, but of course is to make sure that you're vaccinated. But if you are vaccinated, that is not going, that's 90% basically, which is pretty good, but it's not a hundred percent. And that is also something that you may be dealing with going forward.

Dr. Lauren Streicher: And when we talk about sexually transmitted infections and, and one of the things that you hear so often, which is so not true is when a woman says, well, my partner was tested for everything. There is no everything. There are something like 30 to 40 sexually transmitted infections. And when a woman comes to my office and says, I would like to be tested for everything.

Dr. Lauren Streicher: My response to her is I can't test you for everything, but let me tell you what I would recommend as a general screening as a general battery, what I would include, but then most important I say, but are you concerned about any specific exposures or have you had any specific symptoms that may then lead me to say, oh, I also wanna test for X, Y, Z.

Dr. Lauren Streicher: So there is. Everything. There's just good to know. Yeah.

Susan Stone: That's really good. Know we're gonna switch gears onto the next topic. We think impacts college women, and that is pregnancy prevention. Yeah. And Christina, wouldn't you say that every case that's coming in the door what's with the plan B everyone's talking plan B.

Kristina Supler: Well, it's really interesting, particularly in cases where we're seeing our clients. Who had a hookup whatever the circumstances are. And basically what I'm getting at is the sexual partners don't know each other that well. Yeah. And if there's a pregnancy issue, talk of plan B, it just really it adds a lot of stress and creates a really difficult dynamic that very few students are really.

Kristina Supler: Emotionally equipped to navigate. And so I can't tell you how many of our title IX matters across the country at schools of all different calibers and tiers. There's a title I case with a plan B issue at the heart of it. In terms of, issues of consent and coercion and so on and so forth.

Susan Stone: Well, we wanna go back to basics for our listeners. Yeah. Can you just explain what is plan B, how it works? What are the side effects? Just educate our parents about it because I didn't grow up with it.

Dr. Lauren Streicher: Well, no, we did not. And so plan B, we, we refer to it as emergency contraception. We do not refer to it as the morning after pill.

Dr. Lauren Streicher: And the reason why is because you don't have to do it the morning after. I mean, when I would, you know, I used to get these phone calls, emergency phone calls at 2:00 AM, where I could still hear the heavy breathing. Saying, you know, I need the morning after. The condom broke. I need the morning after pill right now, you have more time than you think.

Dr. Lauren Streicher: And in fact with taking plan B, these are pills and I'll get into the specifics, but you have up until five days now, the sooner, the better, you know, we would like you to take plan B or another form of emergency contraception within. Ideally 24 hours, 48 hours, 72 hours. Because when you look at failure rates, the failure rates are much, much lower early on, but the most important thing to know about plan B is first of all, it is not an abort patient.

Dr. Lauren Streicher: And I cannot say that enough. It is not. We've had many

Kristina Supler: students come to us, really confused about that.

Dr. Lauren Streicher: Very issue. And the reason why it's so confusing. Um, and we won't get into politics here and, and MIS, you know, messaging and all that. But they actually came out about the same time when you look at R 46, which is an AOR patient.

Dr. Lauren Streicher: And then you look at plan B, which is not, which is emergency contraception, meaning it prevents. Conception from occurring as opposed to disrupting an established pregnancy. So just to be clear, emergency contraception prevents a pregnancy and abort patient disrupts or aborts and already established pregnancy.

Dr. Lauren Streicher: So

Susan Stone: someone said to us though, and I just wanna have you clarify that there. EC does one, it prevents pregnancy one of two ways. One, it prevents the actual fertilization of the egg. Yeah. And two, it prevents implantation and some people argue that. It should be considered abort of if there's a fertilization, I don't wanna get into politics, but can you explain how it prevents pregnancy?

Dr. Lauren Streicher: So, so this is the thing when we look in terms of timing we know that the best time to take emergency contraception is, as I said, early on. When you look at, when does fertilization actually occur after a sex act, it's not immediately, it occurs in the fallopian tube when the sperm makes that journey up the cervix up the uterus out through the tube where it potentially will.

Dr. Lauren Streicher: Meet up with an egg. Well, this journey is not instantaneous. This journey can take 4, 5, 6 days. So what that means is that if you take emergency contraception within those first 24, 48 hours, conception has not occurred yet. When you're looking at emergency contraception, that's taken as an outlier.

Dr. Lauren Streicher: At five, six days when you, you really don't want to. Cause first of all, it's not gonna work as well, but is there the potential that the egg has already been fertilized, but just hasn't traveled down yet to the uterus? Yeah. And strictly speaking, if you think of that as being. An early termination of a pregnancy, but I don't look to me.

Dr. Lauren Streicher: A pregnancy is when you have a fertilized egg, which is implanted in the uterus, that's, you know, we have ectopic pregnancies, we have all kinds of things that happen in the tube that are not actually what I consider to be viable pregnancies. You can say the same thing for IUDs intrauterine device, which actually.

Dr. Lauren Streicher: A copper, I U D can be used as a form of emergency contraception. A lot of people don't know that they think it's just the pills, but you can also use a copper I U D, which is very similar in terms of it setting up an environment in the uterus where fertilized egg is just simply not gonna implant.

Dr. Lauren Streicher: But when you look at plan B, so it's actually, when you go back historically, when plan B first came out, Long before they came out with the actual plan B manufactured as such what we used to do as kind of our own concoction. If you will, is if a woman came in and said that she had unprotected sex, we would give her four birth control pills two in the morning, two at night, it was basically it's a high dose pill and that would work very well.

Dr. Lauren Streicher: I'm sorry, what would those women get sick and really nauseous from that?

Dr. Lauren Streicher: They would get sick. Yes, but they would get sicker if they got pregnant. So it seemed like a good, there you go. There you go. But, so that's what we used to do. And then of course, manufacturers came out with plan B, which is not the only emergency contraception.

Dr. Lauren Streicher: There's some others also, but the, the beauty of this is not in every state, but in most states you do not need a prescription. This is something that you can get directly from the pharmacist. It is state by state. But quite frankly, I think when we talk about, as a parent sending your kid off to school and there, you know, you pick the first you, you put your first aid kit together and I, and I know you had Dr. Grimes on as a guest and talked about her book. And in her book, she talks about all the things you wanna have in that health kit to send off. I don't think she has plan B, but that's what I would add. Oh no. Oh, I would add, I gotta talk to her about that cuz she's my friend. I would add the panties and plan B to that little kit that you send with your daughter.

Dr. Lauren Streicher: Or son off to school because we want the guys to be responsible and be able to share that. And if a guy's condom breaks, it's nice. If he's be able to give to the woman who's involved, here's plan B, you don't need to go and spend the money and go to the pharmacy and all that. This stuff doesn't expire.

Dr. Lauren Streicher: You it'll hang out for the year. So every year you can give them a new prescription, but instead of the prescription, just give them the actual pills because you're not giving your daughter permission to have sex. Trust me, they're gonna, if they're do it, they're gonna do it. You just wanna keep 'em safe.

Kristina Supler: You talked about like ideally taking it 24 to 48 hours up to five days and the longer you wait, I think it, it impacts efficacy, but let's say you take it early on. Can a woman still get pregnant after taking a plan B.

Dr. Lauren Streicher: Yes. It's not a hundred percent. And, and I think that that's important to know that if you, if you take it and and then you end up missing your period you still need to do the pregnancy test.

Dr. Lauren Streicher: You still need to deal with potential consequences, but the numbers are much lower. Ideally you don't wanna just rely on a condom because condoms do break condoms do get left off the absolute best form of contraception. For a young woman, hands down is what we call non-user dependent.

Dr. Lauren Streicher: Meaning you don't have to take the pill. I mean, pills are good, but better you get busy. You know, you've got a crazy schedule. You're not gonna take that pill at the same time every day. And that's why we love IUDs. We love the implant Nexplanon because it's said it and forget it. And we know. That the efficacy rates are up there in the 98,99%.

Dr. Lauren Streicher: And it doesn't get any better than that. So my feeling is, is before you go off to school or the second you get there, get an I U D get your next plan. It'll hold you for the whole four years. So it's a one time thing for most people. And then yes, you still need to protect against sexually transmitted infections, but at least if something happens, you're not worried about both.

Dr. Lauren Streicher: You don't have to worry about pregnancy and again, not to get too political, which is hard for me. We have states now and more soon to come and it may be across our country that the. The whole notion of having access to a safe and reliable abortion is simply not going to exist.

Dr. Lauren Streicher: And we need to deal with the reality of that. And we know that right now in this country, 50% of unplanned pregnancies are not no contraception, it's failed contraception. And that's a very important fact for people to know, because fascinating statistics. Yeah. You can get all these facts on the group mocker site but the thing that's so critically important is there are people out there that say, well, if someone gets pregnant, it's their own damn fault, cuz they weren't being careful or they weren't being responsible.

Dr. Lauren Streicher: And aside from the fact that we have non-consensual sex on campus, even responsible. Couples very often will have contraception that fails, whether it's the pill that's taken too late. I mean, this is an absolute fact that 50% of unplanned pregnancies occur in a cycle in contraception was used, but it failed.

Dr. Lauren Streicher: So quick

Susan Stone: question, just a transition just as a mother with, daughters. Is there any concern that the plan B or the implant would impact future fertility?

Dr. Lauren Streicher: Quite the opposite. We know that an I U D does actually, we don't advertise this, but can actually decrease the transmission of sexually transmitted infections.

Dr. Lauren Streicher: And the reason why is that one of the effects of the I U D that prevents pregnancies, it makes the cervical mucus very, very thick, very, very tenacious. So it keeps those creepy crawlers from going up into the uterus and the tubes. So it's actually protective, but again, we don't advertise that cause we want people to do STI protection anyway.

Dr. Lauren Streicher: And certainly birth control pills in no way are going to impact. Someone's ability to get pregnant down the road. And what's so interesting is when we think in just in terms of hormonal contraception in general, we know it actually protects fertility because when you look at the reasons why people can't get fertil, can't get pregnant.

Dr. Lauren Streicher: The number one reason is that they're too old. And so when someone's been on the pill for 20 years and they go off the pill and can't get pregnant, it's not cuz they run the pill for 20 years. It's cuz now they're 40. But if you look at young, Who go off the pill. What that means is if that young woman had a problem such as endometriosis, that has been controlled during that entire time and actually protects her fertility.

Dr. Lauren Streicher: So

Kristina Supler: while we're on this topic of fertility and just thinking long term, let me ask you, this is I'm sure you're likely aware most college students these days, and of course I'm generalizing, but they don't view marijuana as a drug whatsoever. It's like taking a cough drop. So right. Looking down the road, does smoking marijuana regularly, or maybe infrequently have any impact on reproductive

Susan Stone: health?

Susan Stone: And I just wanna say Christina. We take turns, working on the questions we have. And I said to Christina, Where are you getting that question? I mean, who would ever even think, like does marijuana or any drug use impact fertility? I'm like, I, I naturally assumed it wouldn't but then I thought

Dr. Lauren Streicher: that's a brilliant question.

Dr. Lauren Streicher: It is a brilliant question because the kids aren't thinking about it, but the potential grandmas to be are and thinking, you know, if my kid goes off to school and does four years of pot, am I a ever gonna have a grandchild? Or if I do is my grandchild gonna have two heads? And so it, it's a totally, totally appropriate question.

Susan Stone: So that's why I'm in business with you. There you go. There you go days. So this

Dr. Lauren Streicher: This is what we know. We, and we don't know a lot because of course it has not been studied nearly enough. We know that in men. That smoking pot can cause fertility problems and can alter sperm, but men make sperm as they go, if you will.

Dr. Lauren Streicher: So this pat, a guy smokes in college, as best as we know is not going to affect his sperm. 20 years later, women are born with all of their eggs and those eggs are just like sitting there ready to be released and we don't have any data. That says that that cannabis will alter fertility down the road, but we also don't have any data that says it does not.

Dr. Lauren Streicher: We don't, that's a big, we don't know

Susan Stone: why I just have to ask why aren't we studying that?

Dr. Lauren Streicher: Who's gonna do that study and who's gonna pay for it. Okay. Wow. Which is true of any pretty much all studies with cannabis. This is the thing that people forget when they say how come there aren't. the reason why pharmaceuticals will spend millions and millions and billions of dollars on a product is cuz that's the only way they can bring it to market.

Dr. Lauren Streicher: If they don't do every single test to see, does this make your nose turn green? Is it gonna make your hair fall out? Is it gonna cause problems? The FDA will never approve it, but cannabis is in a different category because cannabis. Available and doesn't need those tests to come to market. So what cannabis company in their right mind is gonna spend millions of dollars to prove that cannabis does something bad, not gonna happen.

Dr. Lauren Streicher: Right. That

Kristina Supler: makes sense. That's very practical. Yeah. So tell us this, based on your experience and that of your colleagues, what is the most prevalent gynecological health issue facing women in their early twenties today? Or

Dr. Lauren Streicher: where's there a knowledge gap? Yeah, the big knowledge back. Well, it, it depends it really depends.

Dr. Lauren Streicher: I mean, some young women are incredibly savvy, cuz if they have moms like you, they give them a ton of information and send them off, armed with information. They know quite a bit. And then there, of course there are the young women that come from families and schools where they don't get appropriate sex education, their mothers aren't telling them.

Dr. Lauren Streicher: And some of them figure it out on their own and, and some of them don't. And there's a couple of good websites. Sex education for young women. One of them, I think it's called Scarla. Teen is quite good, which is directed for young people to give you accurate information. But the thing that's so interesting to me is we can talk about non-sexual issues, you know, that young women need to know about, but when it comes to sexual issues, it's not difficult to, for someone who's motivated and wants to know about it, to learn about safe sex and and contraception.

Dr. Lauren Streicher: But when no one talks about his sexual pleasure and it's a thing, nobody,

Susan Stone: my mother did not talk to me about that.

Dr. Lauren Streicher: No. And even moms that, that are responsible moms that talk to their daughters about, you know, okay, ha you're going off to college and I want you to be. Safe emotionally and physically and STIs and all that stuff.

Dr. Lauren Streicher: But have you ever say, and I want you to have great orgasms, no women generally don't have that conversation. And that's where these young women are. Mm-hmm because societally, cause then they start asking about your orgasms. That's why, but the, but the problem is societally boys have an expectation that they are entitled to sexual.

Dr. Lauren Streicher: They just do, it's everywhere women. Have this idea that they are put on earth to give men's sexual pleasure, as opposed to that they should be enjoying sex on their own. And even if you look at enlightened sexual education, it's very, very rare that anyone talks about pleasure. So what's so interesting is my daughter's a sex therapist and we give a lot of talks together.

Dr. Lauren Streicher: She's quite amazing. She's I'm not a therapist. She's amazing when it comes to this stuff. We give a lecture together. We give a lot of, we give a lecture every year to graduate students at Kellogg, which is the school of business here at Northwestern. And we give one talk to the men and one talk to the women and it's their idea to do it separately.

Dr. Lauren Streicher: Not ours. I

Kristina Supler: am I gonna like fifth grade sex ed was because it

Dr. Lauren Streicher: allows them to more freely ask questions. And we've been doing this probably for about four or five years now, and it is a hundred percent predictable. What questions they are asking. And for the women, it comes down to pleasure. How come I don't have an orgasm?

Dr. Lauren Streicher: Is sex supposed to hurt? Those are the questions.

Susan Stone: Oh, well you are segueing into a question that we have. Yeah. Who actually have a lot of cases where females complain on about painful intercourse. And they're saying that the male caused it. Yeah, by being too

Kristina Supler: rough or, or perhaps because consent wasn't

Dr. Lauren Streicher: if they

Kristina Supler: weren't around and right.

Kristina Supler: Or, or they felt pressured to consent or something like that, there's a direct cause and effect to the painful incourse and seems like sometimes that may be true, but then sometimes there's yeah, very real medical reasons. What can you tell us about that?

Susan Stone: If we go into that, because that's how we met. Is there was the claim that a woman said, you can only don't go too deep. And there was complete confusion between the students about what is going too deep. And was that related?

Dr. Lauren Streicher: Yeah. Well, the first message and, it's so important for all young people to know this and quite frankly, adults too.

Dr. Lauren Streicher: Um, which is how I spend my day in the menopause center in the sexual medicine clinic is sex should never hurt period. Sex should never hurt. It is never okay to have pain during sexual activity. And a lot of people don't know that especially young women who maybe have never had a pain free or a pleasurable, we've gone from, okay, you should have pleasure to you shouldn't have pain.

Dr. Lauren Streicher: These are obviously two different things, but it's shocking how many women think that it is normal to have pain. It is not normal to have pain. So then that brings us more to your question. Why would someone. Pain. And of course the list is very long of reasons why a young woman might have pain. Um, sometimes it's a condition such as endometriosis.

Dr. Lauren Streicher: Sometimes women will have actually vaginal dryness because of a birth control, which is little. Understood, but it's a definite problem. Sometimes they might have other issues such as something called Vestia that all of those things have nothing to do with the partner. Okay. These are conditions that they may not know about until they have partnered sex, but.

Dr. Lauren Streicher: Those are not caused by the partner. If you look at conditions that are specifically caused by a partner that otherwise wouldn't be there with, let's say a different partner or something, then what you're looking at is a woman aroused. We know that sometimes, certainly when you look at nonconsensual sex obviously women are not aroused during non-consensual sex.

Dr. Lauren Streicher: They are expressly saying they do not want it and they will not stay

Susan Stone: out, stay out of my vagina. That's what they're saying.

Dr. Lauren Streicher: The vagina says stay out too. And the way the vagina says stay out is by not lubricating by the muscles tightening. And basically the vagina goes into keep out mode, which is in pain mode if someone attempts.

Dr. Lauren Streicher: So, no question that. Certainly that would be a partner related situation. And, and certainly in my practice, we have seen women that have had nothing but painful sex. And then with something as simple, as a different partner who they love and who is patient and they are aroused with things are okay.

Dr. Lauren Streicher: But I will say that for the most part. Women that have pain with sex it's because there is something going on with them that we can fix, you know, you're not broken. It just means that it's

Kristina Supler: an important message for women to understand what of all ages that right. You don't have to live with this forever

Susan Stone: and that it could be sign of something else that needs to be treated.

Dr. Lauren Streicher: Right. And that's why I've said, I think 10 times right now, pain is never, okay. Pain is never normal. But then the follow up to that is, and it is always treatable. It is always treatable. We have solutions for pain. It's funny cuz with these clinics that I run and obviously we see women that have a lot of different problems, whether it's libido issues or orgasm issues and the ones that we actually kind of like the best, if you will, are the women who come with pain because that we can fix.

Dr. Lauren Streicher: Yeah, we can always find out why is someone having pain and how do we eliminate the cause of the pain. But it is very common that women too common that women have pain and people, when they hear we have a sexual medicine clinic, a lot of times they assume that this is for women older, you know, over the age of 45, 50, 55.

Dr. Lauren Streicher: No, they don't come to our sexual medicine clinic. They go to our menopause clinic cuz we do. Sex and pain in the menopause clinic, but that's the menopause clinic. The sexual medicine clinic is only women in their twenties and thirties and forties. She's never, that's a wonderful resource.

Dr. Lauren Streicher: Yeah. So do you think the message should be for those moms who have daughters going to college?

Dr. Lauren Streicher: Because I don't think mothers gonna really, most mothers are gonna really wanna have a conversation about orgasm, but would it be more appropriate to say, look, I just want you to know. Sex should not hurt. And if you find yourself in pain, you need to call me and we'll figure it out or call the doctor.

Dr. Lauren Streicher: Oh doctor.

Dr. Lauren Streicher: So this is the other thing too. And this is, I know Dr. Grims has made this point and I dunno if she made it with you is as you send your young adult off, part of sending off your young adult is to send them off armed with the phone numbers of doctors, their insurance card because you can't expect a young woman to call her mom and say, I had sex with a guy last night and his penis was enormous and I'm now I'm in pain.

Dr. Lauren Streicher: What should I do? She's not gonna call her mother and say that, but very few girls are gonna do that. So, so to your point, the message is when you have the sex talk, the going off to college sex talk, the talk is I want you to be. Both physically and emotionally. And I want to make sure that if you choose to become sexual, that you prevent sexually transmitted infections and pregnancy, but I also wanna make sure that you know, that sex is not to please men.

Dr. Lauren Streicher: It is to please yourself and you should never have pain. And that's it. Oh my gosh. That's it. Yeah, that's alone. That's the message.

Kristina Supler: That was really profound and in, in some ways obvious, but yet I think it's so important that women of all ages hear that and really think about that. And

Susan Stone: if they do, I think that Kristina will see a lot of, a lot less sexual assault cases because women will know how to advocate for themselves and really communicate to the males. Stop. I, you need to get away from me. I don't like this. Hopefully,

Dr. Lauren Streicher: hopefully, well that it's not all about you. It's about me, you know? Yes. It's really where comes down to, because, from the beginning of time there's been this idea that if I don't have sex with him, he won't like me.

Dr. Lauren Streicher: And then that will end the relationship. And I will tell you that. I'm not saying that it might not cause be problematic in a, particularly a longer term relationship if you're not have sex, but it's, you know, this is actually one of the problems that my, my daughter, the sex therapist deals with a lot because she does support groups for young women who, who, who have painful sex.

Dr. Lauren Streicher: And a lot of what they're navigating is okay, I'm in this relationship. I really like this guy. I want to be able to have sex with him, but I can't because it hurts. How do I deal with that from a relationship point of view? And I can't answer those questions cause I'm not a therapist but I can tell you that there are plenty of guys out there who you know, you can have great sex without having intercourse starting with that, but they are.

Dr. Lauren Streicher: If, if they really care about you, they care about the fact that sex hurts and there will be workarounds. Wow. While you get it while you get it treated until you.

Susan Stone: Until we grow. And by the way, I think this applies to couples of all types, right?

Dr. Lauren Streicher: Yeah, absolutely. Well, that's why I've been careful not to say, you know, necessarily a man.

Dr. Lauren Streicher: I use the word partner for that reason. Um, that's right. Because I treat people with vaginas cuz I'm a gynecologist, but beyond that, I don't really it, it doesn't impact on me. How they identify whether they identify as male or non-binary or female. And I don't care for what someone has sex with. I just want it to be consensual and pleasurable and safe, that's it.

Dr. Lauren Streicher: And consensual.

Susan Stone: Yep.

Kristina Supler: Great words to end on Dr. Streicher. Thank you so much for joining us today. It's been a pleasure and again, to our listeners, check out Dr. Streicher's books that are available for sale basically everywhere, go to Amazon or anywhere else. And then Dr. Streicher's podcast, Dr. Streicher's Inside Information, the Menopause Podcast,

Susan Stone: we really enjoyed having you and could talk to you for hours more.

Susan Stone: So we're gonna have to have you back.

Dr. Lauren Streicher: I would love that. It's been my pleasure.