Sex With Emily - WTF is “Normal” Sex w/ Dr. Maria Uloko

Episode Date: December 13, 2024

Ever wonder if your penis/vulva/genitalia are normal? In this episode, I’m joined by urologist Dr. Maria Uloko who’s revolutionizing sexual healthcare. We get into why vulva-owners need testosterone, what happens when penis-owners masturbate too aggressively, how shame can interfere with getting the care you need, and how common it is to experience sexual dysfunction. I also answer your questions including when it’s time to date again after a toxic relationship, what to do when your partner’s porn preferences look nothing like you, how to be dominant in the bedroom and toy recs to amplify oral sex on a vulva. In this episode, you’ll learn: How to address common causes of pain during sex Treatments for sexual health challenges Why there’s no “normal” when it comes to sexual health Show Notes: More Dr. Maria Uloko: Instagram | Twitter | MUMD Sexual Health Beverly Hills VULVAi.co: Instagram | Website  Practice love every day with Paired, the #1 app for couples. Download the app at https://www.paired.com/SWE  Join the SmartSX Membership: Access exclusive sex coaching, live expert sessions, community building, and tools to enhance your pleasure and relationships with Dr. Emily Morse. Yes! No! Maybe? List & Other Sex With Emily Guides: Explore pleasure, deepen connections, and enhance intimacy using these Sex With Emily downloadable guides.  SHOP WITH EMILY! (free shipping on orders over $99) The only sex book you’ll ever need: Smart Sex: How to Boost Your Sex IQ and Own Your Pleasure Want more? Visit the Sex With Emily Website  Let’s get social: Instagram | X | Facebook | TikTok | Threads | YouTube Let’s text: Sign up here Want me to slide into your email inbox? Sign Up Here for sex tips on the regular. See the full show notes at sexwithemily.com

I spend so much time, one, destigmatizing, two, telling people to let go of shame, and then three, telling them there is no normal. There is truly no normal. You're listening to Sex with Emily. I'm Dr. Emily, and I'm here to help you prioritize your pleasure and liberate the conversation around sex. Today my guest is urologist and surgeon, Dr. Maria Ulogo, who is revolutionizing sexual health care. Whether you have a penis or a vulva,

you will learn so much from our expertise in sexual dysfunction, pain, and just overall sexual health. Please rate and review Sex with Emily wherever you listen to the show. It just helps get the show out to more people and it only takes a few seconds. You can do it right now. You can also find me on Instagram, YouTube, TikTok, X, Facebook, all at Sex with Emily. And check out my new article, Trending 2024 Pleasure Gifts for Lovers and Friends on SexWithEmily.com.

All right, everyone, enjoy this episode. Ever felt like dating apps just don't get you? Like, you're thinking they're all the same, they leave out what I actually want to explore. Well, let me introduce you to F.I.L.D.E. A space designed for curiosity, connection, and discovering who you are on your terms. Here's the deal. Field isn't just about dating. It's like a permission slip to experiment with your desires.

Whether you're exploring non-monogamy, looking for a third for a threesome, dipping your toes into kink, or just trying to find genuine connections, community, and friendships. Field has you covered. And the best part? Field celebrates your evolution. Okay, let's say your interests shift. Today you're exploring Paliamory and tomorrow, maybe it's solo dating

or finding a deeper platonic connection. On Field, 62% of users say their desires evolved in their first year and the app is built to support that journey. That's what it's all about. There's no judgment, no algorithms telling you who to like, and there's 20 plus gender and sexual identities to choose from. And there's profiles you can revisit, and transparency is baked into the culture.

Think of this like the antidote to dating app fatigue. It's a place where you can connect, communicate, and explore without all that pressure. So if you're ready to try it out, download FIELD, spelled F-E-E-L-D, on the App Store or Google Play, and take the first step toward discovering what connection really means to you. That's F-E-E-L-D on the App Store or Google Play and take the first step toward discovering what connection really means to you. That's F-E-E-L-D field. Let's talk about something most of us don't think about exercising. You got it? Think about it. It's your penis. You heard me. That's where Bathmate comes in. Bathmate is the world's best-selling penis pump and for good reason. It's not just a pump. Think of it like a workout for your most prized possession.

You use the power of water, and bathmate creates this hydraulic vacuum that draws blood safely into the penis, improving blood flow and tissue health. Listen, having stronger erections, better stamina, some users even have size gains, this is all about blood flow, and that's where a penis pump comes in. Oh, it can also help with girth. You can just think of this as part of your self care routine. Bathmate is the only FDA regulated hydropump. It's designed to be used in the privacy

of your own bath or shower, just three minutes, even a few times a week, and you're on your way to noticeable results. Bathmate is so confident you're gonna love it, they even offer a 60 day, 100% money back guarantee. That's two months to experience the benefits risk-free and right now you can get 10% off. Just visit bathmadedirect.com slash sexwithemily and use the code SWE10 at checkout. Your confidence and your partner will thank you. That's bathmadedirect.com slash sexwithemily. B-A-T-H-M-A-T-E direct dot com slash sexwithemily. Use code SWEEN at checkout.

Dr. Maria Uloco is a urologic surgeon specializing in both male and female sexual dysfunction, transgender care, erectile dysfunction, gender dyssorpphoria, genital pain, penile curvature, low testosterone, low libido, sexual arousal disorders, urinary incontinence, and menopause care. Welcome to the show, Dr. Yuloko. Hi. Oh my gosh. Thank you so much for having me here. It's such an honor to be here and talk about a field of medicine that I absolutely love and such an important condition for a lot of people with vaginas and bolbas. Exactly. And you guys also work with penises too, right?

So we're gonna get into all of that. Don't worry, penises, we got you. But can you tell me, so you're trained as a urologist. What made you go into urology? I actually met a urologist named Dr. Hadley Wood at the Cleveland Clinic, who was one of my first urologist that I saw that was a woman. And I was like, oh, I didn't know women could do this. And she was so relatable,

so well dressed, so well spoken, telling hilarious, raunchy jokes at dinner. And I was like, that's who I want to be. How would you define people don't even know what a urologist is? Could you just tell us real quick? What is what is urology? Yes, so we're kind of like the weirdos of surgeries. We are surgeons of the genital urinary system. So we perform surgery on kidneys, bladder, the tubes draining the kidneys, which are called the ureters, anything that has to do with urinary health, urinary incontinence, leaking. And then we also do male sexual health

and andrology and infertility. Right, I think that's why I wanted to define it because most people think of urology as being a male field. Yes, for the most part that is still the case and there are several pioneers in the field that are trying to make it more inclusive. We're excellent perineal surgeons of the perineum for those that have a vagina revolva.

And we deal with a lot of like urinary incontinence and prolapse and all of those things, but we don't deal with the sexual health side of things, but we're trying to change that narrative and change that game. I signed up for the fellowship knowing that I would be taking care of both men, women, and everything in between, you know?

And the frequent narrative that I heard from patients was the delay of care to diagnosis. They would go to their primary care provider, they would go to their gynecologist, and these patients are just not getting treated. And so that was eye-opening for me because as a urologist, we would see pelvic prolapse and we would treat that and then they would say, you know, also, you know, it kind of hurts when I have sex or this and that. And we're like, whoa, whoa, whoa, whoa, that's your gynecologist thing. Go see them.

And that's kind of the dogma that's still in the field. Well, I often say this and that's why I'm so glad to talk to you because so many women that I did that as well. I've got a problem with anything sexual health related or anything with my vagina or vulva, I would go to my gynecologist. But then you've come to find out that gynecologists, they really don't have this information,

especially when it comes to like hormones or perimenopause or just all the things. So when I think about the quote unquote female sexual health is kind of what the terminology is and I'm fully aware we're talking about biology at that point in time, not gender. And so we're talking solely about those with vulvas. And so that can include a whole gender spectrum. But when you group that umbrella, it falls into pain, orgasm, desire, arousal. And so we deal with conditions like female sexual pain

and orgasmy or difficulty with orgasming, issues with desire, issues with arousal, and then also we deal with perimenopause and menopause care on the female side of things. And then also a really common thing that we see at our clinic, we're very specialized, is something called persistent genital arousal disorder or PGAD,

which is also a very shamed topic as well. And so we kind of cover the gamut of all vulvar sexual dysfunction. It's- So what's the persistent arousal? You know, the people that have 40 orgasms a day. Oh, yeah. That's what I thought it was. Yeah. For most people, they're like, oh my gosh, that's amazing.

But it's actually a really debilitating condition for a lot of people. There's high rates of suicide because it's a condition surrounded with shame, surrounded with also again, a lack of access to care and it derails their life. Ishwish just actually put out a article about diagnosis and treatment,

so that we're trying to get it out there, get it out to the world that is. Although rare, you're going to be seeing patients with these conditions. Exactly. Here's the thing that you just, this going back to something you said, is that there's so much shame around it. And I feel like in thinking about all of these challenges,

someone has pain or someone has erectile dysfunction or whatever pain is going on in their genitals or problem, not only is there not anyone to go to with the right answers, but people might not even talk about it because the fear of being shamed and the fear of feeling like, well, something's wrong with them. And so, or even just talking about it to somebody. And so I think that's a huge part of this that people won't come forth and it's

changing people's lives because when you have kind of pain or dysfunction, it really, it's hard to live a normal healthy life. Yeah. Yes. Oh man, I could talk about this topic all day. That shame cycle prevents people from talking about it. And honestly, half of the treatment in any of these diagnosis is just acknowledging that what they're going through is real. It is not in their head.

It is not a figment of their imagination. it is a biologic cause and we're going to find out. And I, that's one thing I've noticed that a lot of people are, are dismissed. They're told, you know, just drink a glass of wine, just relax. Oh, it's supposed to hurt. And we aren't talking to each other. You know, those are, genitals aren't really discussing these issues with each other. No. I've gotten to hear stories of people saying, I finally decided to talk to my friends and turns out a lot of them are also suffering. And that's why I am so one, inappropriate socially, but I'm also trying, I do it for a reason. I do it for a

reason because if you destigmatize this and just make it a normal part of a conversation, it really puts people at ease so that they can start discussing it. And I know this is a really difficult topic to even come into our office to start talking about. And so I have a very much a, um, a, nothing surprises me. Absolutely. Nothing surprises me. I truly just want to make sure that your quality of life is good because as a black woman in medicine, I know what it's like to be dismissed. I know. And I never want people to feel that. And I've always kind of been drawn towards things that are taboo because my existence in medicine is taboo just in general. Right. I know and it hasn't been easy to get where you are. Did you say

you were the first black urologist at your university? Yeah so every space I've inhabited I've always kind of been the first. Not kind of, I've been the first. And with that comes a lot of people telling you that you can't and then I feel like a lot of people having all of these expectations or I carry a lot of these expectations, because I know that being the first, everyone's going to say, well, we let her in. So and look, she didn't do well. And so I'm kind of the gatekeeper for the people coming behind me.

And so there is a lot of pressure, but I'm super competitive and I'm Nigerian. We are cocky. We are tough. You know, I also go to a lot of therapy and I'm not going to pretend like it's not difficult, but at the same time, I am someone that is sees a challenge, especially if someone tells me you can't do that, I will say that let's go. I'm so happy you're in this space right now and that we really need you in this space,

the sexual health space and fighting for it. And I really hadn't heard of many people doing the kind of work that you are doing. So I always hear about like vulvodynia or vaginismus is a very common. And I remember years ago, I was on love line with Dr. Drew and people would call in, I vaginismus, vulvodynia.. And at the time, like I'd finished grad school, but we were still learning too. And it was like, well, it might be because you have sexual trauma. That's why.

And then we started telling people to go to pelvic floor physical therapists. But since those are very common, can we just kind of break these down real quick? What they are or what the cause of them are? Yeah, there are several causes for a female sexual pain disorder. You know, a lot of these conditions does actually take a biopsychosocial approach, meaning that we address biology, but we also address the psychology behind this

and the social stigma behind this, because all of these factors play into each other. Sex is a very complex thing from a scientific standpoint. Although biology is driving this, then comes psychology, then comes pelvic floor dysfunction, all of these things go hand in hand and in order to have a successful sexual health practice, you have to start there and understand that all of these factors play a role into it. And having a sex therapist, physical therapist, it's a team sport. We have to play together. So when thinking about

pain, the DSM-5 defines it, it's called genitopelvic pain penetration disorder or GPPD, persistent or recurrent symptoms for at least six months. So it's either pelvic pain during penetrative intercourse with associated fear, market tensing or tightening of the pelvic floor muscles with any sort of vaginal penetration. And this has to be present for six months. That's the textbook definition. So there are so many causes for it,

but the most common causes are genitourinary syndrome of menopause. So people that are perimenopausal or are going through menopause will have a lot of vaginal pain, pelvic floor dysfunction, STIs. You can also have organ prolapse, vestibulodynia, clitorodynia. And then there's also something called genital pelvic dysesthesia, which is where you're having pain, but it's actually not coming from the genitals itself. It's coming from the spine and the nerves feeding it. And so that's been the most fun part, especially about my fellowship too, is that

we do a lot with spine surgeons and a lot with neurology, that neurology nerves and brain and all of that, that I never thought I would be doing. And so that's been very, very fun. Wow. I mean, there's so many, so there's so many different, so we can't even say like, oh, vaginismus is this or because for every single person with a vulva, there's a different reason why they're diagnosed with it. It could be so many different things.

Yep. And that's why you guys like detectives. Yes. But most places don't have any of that. They don't even just, there's like, oh, well, we don't know what to do with it could be so many different things. Yep. And that's why you guys like detectives. Yes. But most places don't have any of that. They don't even just there's like, oh, well, we don't know what to do. Okay. Yes. That's crazy. Because this is a urologist, if someone with penis came in and they said, you know, my penis hurts and be like, all right, let's take a look.

Versus when people with vulvas come in and say it hurts when I have sex. They're they're literally just like, oh, we tried wine, no exam, no nothing. And I tell my patient, if you were to come into the emergency room with chest pain, not a single ER physician would say, well, have you tried some wine? Just relax a little bit. They would do a workup.

They would examine you because they know that that's important. And that's just not the same energy that's given to the pelvis or vagina. Yeah, because we're not making this up. Like this is what happens every day. We'll be right back after a quick message from our sponsors.

So don't go away. You know how I'm always saying that sexual health is just as important as mental and physical health? Well, now is your chance to help science catch up. The Magic Wand study is here and it's breaking new ground. Literally a first of its kind study analyzing how using a vibrator, specifically the Magic Wand rechargeable, can improve your quality of life. We're talking boosted sexual desire, better sleep, less stress, improved self-confidence, and more intimate relationships. And yes, you heard me right, you can masturbate for science. Here's how it works.

Participants in this three-week study will receive a free magic wand rechargeable. Plus, you'll be entered to win $250. All you need to do is complete a daily survey for 21 days and use the wand for one week of consecutive sessions. Fun homework, right? If you're 18 or older, have a vulva, and live in the US or Canada, visit magicwandstudy.com to sign up before January 5th. That's magicwandstudy.com. Let's make history, one orgasm at a time.

Alright, let's get real for a second. Have you ever felt like life gets so busy that connecting with your partner starts to feel just kind of hard? Whether it's the work or kids or just that daily grind, sometimes we all need just a little help prioritizing our relationships. Well that's why I got to tell you all about paired. It's this amazing app for couples and it's really just all about strengthening your relationship in just five minutes a day which I love. You give me a longer commitment than that, I might not do it. Because paired is fun, it's easy, and it actually works. So here's how it goes. You and your partner download the app. You

pair together and then paired gives you personalized questions and quizzes and games to spark meaningful conversations and help you communicate better and even spice things up. And my favorite part, you can't see your partner's answers until you answer yourself. So it's a safe, honest space to connect. Okay, so the other day I tried this question. What do you remember about the first time we met? And honestly, the conversation that came out was so sweet.

It even brought up things that I'd forgotten about. And moments like that remind me while tools like this are so important. Whether you're just a few dates in or been together a long time, find the time to connect with your partner and nourish your relationship with the Paired app. They just make it so easy and fun and again only a few minutes a day. So just head to paired.com slash SWE to get a seven-day free trial. That's paired.com slash SWE to get a seven day free trial and 25% off if you sign up

for a subscription. Head over to paired.com slash SWE, sign up and nourish your relationship. You got this. So what about the men that come in, the penises that come in? Yeah. I'm wondering if you've seen a rise in younger men dealing with erectile dysfunction. Yes. I tell people that the incidence of erectile dysfunction is essentially is your age. So 20 year olds, 20% of people will have erectile dysfunction, 30 year olds, 30%, 40 year olds, 40. And so one of the, again, I am someone that I hate shame. I hate the shame of sex. A lot

of the men that come to our clinic are full of shame, especially the younger ones of this isn't something that's common. This is something that's supposed to happen to me. And I'm like, okay, true. But also 20% of the population also has this too. So you're not alone. I think telling them that and sharing that with them is so important because there is this And then, you know, the population also has this too. So you're not alone. I think telling them that and sharing that with them is so important because there is this societal pressure that men have of performing. And if they can't perform, they're not fulfilling their duty.

And I'm like, all right, now we're taking that out of the equation. Like, no, that's not gonna work. Again, that biopsychosocial thing, if you're not performing, you're getting in your head, you get performance anxiety. It's just a whole cycle. And I try to approach it from a standpoint of compassion and also like normalizing it. It actually is fairly common. And, you know, in a lot of younger men, why they get ED is either from trauma trauma and that can either be from fractures,

aggressive masturbation team. That's actually a thing. You can actually develop ED from that. How do you know if you're masturbating too aggressively? Yeah. Okay. So there's something called jelking. Yes. Tell us about jelking because I haven't talked about it in a while. Jelking. Yeah. You know, I'm still like, yeah they put like a rod in their penis. Yeah, yeah. The things that people do with their penises, I'm just like, all right, well let's figure it out. Okay, no judgment. No judgment. Okay, and so what happens, so a lot of ED comes from built up of scar tissue. And so any sort

of penile trauma, either microtraumas, whether it's like you get tapped in the penis or you jelt or you... When people think of trauma, they think of a pelvic fracture or a penile fracture. And that's a big, big trauma. But then there's these micro traumas that can happen over time, and that causes scar tissue within the muscle of the penis. And that scar tissue prevents the penis from, it's called hyper relaxation. So fun fact, when you, your penis is actually always flexed when you're flaccid, your penile muscle tissue is flexed. When you have an erection, as blood is getting in that space, what's happening is that that muscle is now hyper relaxing and causing the tissue to become erect.

And so when you have scar tissue, that hyper relaxation doesn't happen because it's a closed chamber. And if you're not hyper relaxing and closing that chamber, blood can leak out. And so that's why people will either get an erection but not able to keep it or not get enough blood in there because it's just seeping right out. So it's the same systematic approach that you do with a penis who comes in. So we're also saying, so that was aggressive masturbation.

You're saying medication can also cause ED. And anything else that we don't, anxiety, true, right? You can be infectious. That's a psychosocial factor. Exactly. Wow. It's hard because sometimes people, I'm not seeing people,

but when they call in, it's like, and then I'm like, we'll go to your urologist, but not your everyday standard urologist isn't probably gonna do the treatment of care that you do at the clinic, right? What we do differently in our clinic is that we spend a lot of time on diagnosis and figuring out

what the degree of scar tissue is present. Are you getting good blood flow to your penis? Are you trapping blood within the penis? And then from there, we can tailor a treatment plan because not all of the treatment options that are out there works for everyone and not everyone wants surgery. And so it's again, the beauty of quality of life is that you have options. And in order to know what the best option for you is you have to know what the degree of erectile dysfunction is.

And that's, so we spend a lot of time on diagnosis with ultrasound, sensation testing. Yeah, it's really, really- That's so amazing. But there's probably some patients go into clinics or they go into their doctors and they're dismissed. So what would a standard urologist in, I'm from Michigan, let's say, so in Michigan perhaps or somewhere might not have this standard of care, right?

They wouldn't have this information. Most would we say that the majority of penises who have erectile dysfunction just take a biagra or they just silently like suffer with it or that's kind of what happens, right? What's the equivalent of the wine of women saying you've pain, have a glass of wine. What are men getting a blue pill? Yeah, men are getting a blue pill

and then when it doesn't work for them, they're stressing. And they're being told that once that doesn't work for you, you have to move on to other things. And the other options work well, but, you know, some people don't like the idea of having to stick a needle in their penis to get an erection. Some people hate the idea of having to do surgery. You know, as long as you're informed about truly what's going on, it's again that the beauty of showing them science, of showing them, okay, this is your degree

of scar tissue, and this explains why you're having these problems. And obviously we have them see our sex therapists too, and it's just such a synergistic relationship between those two of combating the performance anxiety and actually addressing the biology. Cause you know, most men can just go to a urologist and just get a, the pill and it works for them great. Then they'll try the injections and that works for them. They stick with that. And then comes surgery. And if that works for them, great.

But some people, these therapies aren't working. I mean, surgery is always going to work. Prosthetic is always going to work, but some people are just not ready for that. Right. Right. Or, you know, just are so surgically averse. And one thing we also do at our clinic is that we do a lot of regenerative therapy, where we not only like treat the symptoms of ED, but we also try to reverse the scar tissue that is present. So how do we do that? So we use two regenerative therapies, low intermittent shockwave therapy,

which is acoustic sound waves that stimulates stem cells within the penis. And those stem cells then help to regenerate tissue. So another fun fact, everywhere in your body has stem cells. It just matters how active they are. So your skin, eyes, liver, heart, lungs, those metabolically active organ systems, their stem cells are constantly churning things out versus the genitals.

They're kind of a little slower, a little lazier. They're not really doing much. And so what happens is that when you use the shockwave, it stimulates the stem cells to wake up and start doing their job. That's amazing. I've heard about these therapies for men and people always want to ask me if it's safe, but I feel like it makes sense, right? Because it helps stimulate the blood flow. Yeah. Helps stimulate the blood flow, helps with also re-taking away that scar tissue that's preventing the hyper relaxation.

How do they get the scar tissue? The scar tissue comes from an injury or we were saying aggressive masturbation or is it just scar tissue also accumulates over time? It can be broken down into trauma and then it can be broken down into systemic diseases. So one of the reasons why long-term that 60% of people with penises will develop scar tissue at 60 is because most likely they're going to have also systemic diseases like diabetes, hypertension, high cholesterol. And so those things are also causing micro traumas to the penis and that penile tissue

as well. Another plug that I do and I tell every single patient that comes in with a penis and ED is, penile health is heart health. ED is one of the first signs of vascular dysfunction and heart disease. And so unfortunately in this country, men are conditioned that they don't go to the doctor. They don't, you know, they're not, they're not in charge of their healthcare. And but what does drive them to the doctor is erectile dysfunction. And so that's where I captured them and say, all right, if you want this thing to be working

until you're 90 something, go to a doctor. Like let's change, let's talk about lifestyle modifications. Let's talk about changes in your overall health because you're spending all this money and you're hyper-focused on this one thing. This one thing is a cause of a systemic thing. Let's think big picture. Because if your heart's not-

We got you here for your penis. Exactly. You get by the balls, literally. Then you're like, okay, we got to focus on your heart health. Yeah, it's true. What's going on in your heart is going on your genitals, right, your overall health.

We have to look at all of it holistically, which we just don't, because then you're like also making doctor's appointments. You're like, okay, one day I go to the urologist, six months later I go to my general practitioner, but everyone needs to be talking. Exactly. Right?

Yeah, yeah. What are the most common causes of pain during sex? Yeah. Could you say here's like the three most common or is it just? I think what we see the most, it also depends on the age too. So vasibulodynia, you break that down. I like algorithms a lot too. You can break it down into hormonally mediated.

And so this is something that comes from the actually. Oh, I have a puppet. I have that puppet too. Show me, show us. Yeah. So the vestibule is actually mediated or it's kept healthy by testosterone. So those with vulvas actually have quite a bit of testosterone. Testosterone and estrogen go hand in hand. And I think one common misconception is that people with vulvas just have estrogen and

progesterone. But there's never really a discussion about testosterone, but you need testosterone to keep a lot of your genital tissue healthy. And so things like hormonal birth control, a lot of cancer treatments that block hormones will cause what we call hormonally mediated vestibulodynia because it's taking away the testosterone which keeps this tissue healthy. And then there's something called neuroproliferative

which is essentially too many nerves and too many heightened sensation. And that can be either congenital meaning you were born with just too many nerves there, or it can be acquired. So this usually will come after like a yeast infection, or we've had people that will have allergic reaction to like douching or to other topical agents. And that causes this inflammation

and that inflammation causes mast cells. And it's just the whole thing and that just causes significant pain. The other thing is menopause. So it's called genital urinary syndrome of menopause. As people age, people with vulvas age, the ovaries stop producing estrogen, testosterone, progesterone. So it starts that steady decline as people age. What happens then is that, again, all of this tissue is hormonally mediated, meaning that it is all controlled by these hormones.

So when you take away these hormones, that tissue is no longer healthy. So a lot of people will report vaginal dryness, poor lubrication, pain with penetration, and also get a lot of urinary tract infections because all of the healthy bacteria within the vagina and surrounding the urethra also need those hormones. And so if those hormones aren't there, all those good bacteria go away and then all the bad ones kind of

come out and play. Those are the most common ones that we see. And then there's something called clitoridinia too that we see, which fun fact, the clitoris and the penis, same organ, but those are penises are taught if they're uncircumcised, how to pull back the foreskin and clean so that they don't get infections versus, and people with clitorises, that's not talked about. Clitoral anatomy has been, I mean, I'm sure you know, not even addressed. Not even addressed. Exactly. It's just like, don't even look at the clitoral anatomy has been, I mean, I'm sure you know, not even addressed. And so-

Not even addressed. Exactly. Like it's just like, don't even look at the clitoris. It's like, no, we're going to look at the clitoris. And I, one of the things that I love that we do in our clinic is that every single person with a vulva that comes to our clinic gets a bulboscopy where they actually get to see their anatomy on a TV screen. Because when people with penises come in, they get to see their penis. They can always see everything.

And those with vulvas where it's inside and, you know, there's a provider just in your legs saying like, ah, things look fine versus no, I'm walking you through your anatomy. You're going to leave here feeling empowered about yourself, knowing exactly where things are. I don't quiz them. I kind of want to.

That's so cool. Well, my friend called me. She goes, oh my God. After she did this, she goes, I saw my G-spot. They showed me on camera my G-spot. She was like screaming. I'm like, every Volvo owner needs to get in and take a look. I always say take a mirror, take a look, but there's just, yeah, a lot of it's internal

and you can't see it. Yeah. What an incredible service that you are providing. and take a, I always say take a mirror, take a look, but there's just, yeah, a lot of it's internal and you can't see it. What an incredible service that you are providing. Now, I know that you also work with the trans community. So I'm just wondering like what kind of work you're doing right now. My take on comprehensive sexual health also includes transgender and gender reassignment surgery

and just transgender health in general, because I'm just a genital surgeon at this point in time. And so my goal is that everyone is happy with their genitals and have functional genitals that they can be very proud of and that they can celebrate. And that does include transgender care. So that is part of my fellowship that I've just been very, very privileged to just be a part of. You're such an incredible woman. I mean, I love the work you're doing here. What do you think about assigning gender at birth?

Oh, gosh. That is a great question. That's going to be one of those things that's going to be really hard to change. Because that's what everyone thinks about. That's what, you know, what are you having? What is this? Gender reveal party. What would happen to that?

We need to get rid of those. It's a weird party where you, in theory, what we're doing is we're having a huge party for your baby's genitals, which I love a genital. I do. Don't get me wrong, but let's not start forest fires. Right? Of course. Like, I think we should be celebrating genitals, you know, as we're getting older, but that's just me. Yeah. So it is this weird thing. We hyper-focused on this thing called gender when in theory it's a social construct and luckily though the voices of medicine like the upcoming voices in medicine that I'm so

happy about it this there's a whole class of activists that are coming up that are saying no more. You are really gonna be such an incredible force. I just I can't wait to watch your career. You have such a life ahead of you so I can't wait to like watch you and I believe in all the work you're doing. I think it is incredible. Is there anything that you find in sexual health that you feel like you're repeating

with every single patient that you wish that people knew? Yes, oh my gosh. I spend so much time, one, destigmatizing, two, telling people to let go of shame, and then three, telling them there is no normal. There is truly no normal. And I will say this story. So all of the textbooks that you see is just some random dude that was like, that looks like the perfect vagina and that looks like the perfect boobs. Like my best friend's a plastic surgeon and she does boob jobs. And

she, again, I have no shame with my friends or with anyone really. And she told me about the equation for how to make the perfect boobs. And so she measured me and I was just like, I have nothing about it. In my head I was like, oh my God, I have perfect boobs. But in the other reasonable side of me,

it was like, this was just some random guy who's like mistress. He's like, that's, that's the perfect equation for breasts. And that's the same thing for genitals is that there is no perfect genital. There is no normal. There is nothing as normal. And I spend so much time debunking all of that. It's like, that's weird. I'm like, it's not weird. There's only pathology and there's not. If there's no pathology, it's normal. And so let's just debunk that.

But if you're not happy, that's a whole nother conversation. And if it is really, truly causing your problem, that's a whole nother conversation that we can have. But if you're just going through life being like, I think I'm weird. And I you're just going through life being like, I think I'm weird. And I saw some porn and this girl looked like that and that guy looked like this and I don't look like that.

So I'm not normal. I'm like, you're normal. Yeah, it's very normal. Right. Gosh, we have the same job. We really do. I mean, I'm seriously telling everyone it's okay. Like you're normal, you're okay.

And not to have the shame and to talk about it. But you're really, you got hands on, you are changing people's okay. Like you're normal, you're okay, and not to have the shame and to talk about it. But you're really, you got hands on, you are changing people's lives. Dr. Maria Yoloco, I'm so thrilled to have this conversation with you today. I have to ask you now the five quickie questions we ask all of our guests. So they're just quickie, you can just,

you don't have to think about it. So the first thing that comes to your head, what's your biggest turn on? Oh, thoughtfulness. Biggest turn off? Ignorance. What makes good sex? Communication. Something you tell your younger self about sex and relationships? Let go of the shame. What's the number one thing you wish everyone knew about sex? It should be fun. It should be weird. You should just enjoy it and it doesn't

look one way. Make sex whatever you want. Love it. Thank you so much for being here. Please tell us how people can find you. You can find me on several mediums. So on Twitter, my handle is marayulocoMD. I also have an Instagram page where I share little tidbits about information about a certain topic

every couple of weeks, because I'm also still a surgeon. You're awesome. So just again, my biggest thing is educating patients and educating people that they should not be tolerating no care and they should also know that they are normal in the absence of actual pathology. Everybody has to check out Dr. Maria Yuloko.

The work you're doing is incredible. Thank you so much for being here. I appreciate you so much. Thank you so much for this opportunity. Thank you again for de-stigmatizing sex and just in a way that is so inclusive and so shame-free, because that is how people are getting their information. Sorry, I'm going to move. Just thank you. and so shame free because that is how people are getting their information. And sorry,

I'm going to move. Just thank you. Like it, it, it, you're changing lives and just making a topic that everyone does, you know, for the most part, unless you're not, but a lot of people do. Which is fine. Yeah, exactly. Exactly. And you're changing their lives too. And like letting them know that, oh, okay, I might be normal or no, I shouldn't be taking that and accepting that and just sharing information and that is, that changes lives. It really does. Thank you. Thank you. You're so kind.

That's it for today's episode. Thanks for listening to Sex with Emily and be sure to like, subscribe, and give us a review wherever you listen to the podcast and share this with a friend or a partner. You can find me on Instagram, YouTube, TikTok, Twitter, or X and Facebook. It's all at Sex with Emily. Oh, and I've been told I give really good email. So sign up on sexwithemily.com and while you're there, check out my free guides and articles for more ways to prioritize your pleasure.

And if you'd like to ask me about your sex life, dating, or relationships, call my hotline 559-TALK-SEX. That's 559-825-5739, or just go to SexWithEmily.com slash Ask Emily. Was it good for you? Email me, feedback at SexWithEmily.com.