What to do when your brain says, "yes", but your vagina says, "no." Where to find help plus methods for relieving pelvic pain and sexual dysfunction
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Show Notes
Dr. Stoehr, a specialist in pelvic and sexual pain, shares her journey in medicine, the stigmas surrounding pelvic pain, and the importance of comprehensive care and proper diagnosis.
This episode also explores non-surgical treatments, the critical role of psychological elements in pain management, and practical advice for lifestyle-affirming practices in non-monogamous relationships. Discover actionable tips for advocating for your health, navigating difficult conversations, and ensuring a fulfilling sexual health journey.
01:35 Dr. Stoehr's Journey into Pelvic and Sexual Pain
03:10 Misconceptions, Stigmas, and Psychological Impact in Pelvic and Sexual Pain
07:51 When to See a Specialist for Pelvic Pain
12:11 Non-Surgical Treatments for Pelvic Pain
17:37 Advocating for Non-Narcotic Pain Management
19:09 Addressing Shame and Cultural Barriers in Sexual Health
23:37 Navigating Non-Monogamy and Affirming Care
25:48 Finding Lifestyle-Affirming Healthcare Providers
27:03 Discussing Sexual Health and Safety
35:20 Communication and Relationship Dynamics
39:48 Managing Pelvic Pain and Sexual Dysfunction
Dr. Stoehr is a Gynecologist specializing in pelvic and sexual pain and sexual dysfunction. She has additional interests in narcotic free surgery and the intersection of medicine and alternative sexual lifestyles. She is passionate about making sure that people in the LS are able to obtain the highest levels of healthcare without fear of prejudice or bias.
Connect with Dr. Stoehr
https://www.youtube.com/channel/UCYzoek71uQA7YgnG3a2BA1w- YOU Tube Channel
www.swingingsafe.com- Swinging website full of education and helpful videos.
Connect with Paige Bond
Instagram: @paigebondcoaching
Facebook: @paigebondcoaching
TikTok: @paigebondcoaching
Website: https://paigebond.com
Paige Bond is an open relationship coach who specializes in helping individuals, couples, and intentionally non-monogamous relationships with feeling insecure in their relationships. She is also the founder of Sweet Love Counseling providing therapy in CO, FL, SC, and VT. Paige loves educating people about relationships through being the host of the Stubborn Love podcast, hosting workshops, and speaking at conferences.
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http://www.paigebond.com/calm-the-chaos-jealousy-workbook-download
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https://www.paigebond.com/people-pleasing-workbook
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Disclaimer: This podcast and communication through our email are not meant to serve as professional advice or therapy. If you are in need of mental health support, you are encouraged to connect with a licensed mental health professional to receive the support needed.
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Intro music by Coma-Media on pixabay.com
Transcript
(generated by AI - please excuse errors)
[00:00:00] Paige Bond, Relationship Expert: Welcome to the Stubborn Love Podcast. I'm your host, Paige Bond. I'm a Gottman and attachment trained, solution focused marriage and family therapist. I specialize in helping folks design and build their dream relationships through structured therapy and resources. And also use modalities that go beyond traditional talk therapy, like accelerated resolution therapy and psychedelic assisted psychotherapy.
School didn't teach us how to be good at love, so I created the Stubborn Love podcast to help you navigate it. Every episode has actionable tips that will help you create a happier, healthier, and more fulfilling life with the people you love. Join me on this journey of love and learning for the stuff they didn't teach you in relationship school.
I hope you enjoyed this episode. Now let's get ready to rock and roll.
Welcome back to another episode of Stubborn Love. I'm your host, Paige Bond, and today we're focusing on sexual dysfunction and shame that comes along with that, how to look out for it, how to have conversations about this with your partner or with your doctor, and we'll talk about how our special guest today, Dr. Stoehr's work shines at the intersection of medicine and alternative sexual lifestyles. So I'm so excited and thrilled to have you here today. I was recommended to you and listen to your episode on the Sage in Time podcast from my friend, Derek Whitman and loved your episode. Dr. Stoehr, can you tell us a little bit about your journey in specializing in pelvic and sexual pain and how you got started onto this track of medicine?
[00:01:44] Dr. Angela Stoehr, MD: Yeah, sure thing. Thanks so much for having me. I'm super excited to be here. I'm glad you enjoyed the episode with Derek. That was actually a lot of fun to do. So, yeah. So my journey in pelvic and sexual pain, I actually started in residency for OBGYN, knowing that I did not like OB nearly as much as I liked gynecology.
That was not a surprise to me, and it became even more apparent as I was going through my training. My older sister. I have several siblings, but the elder of my two sisters is a physical therapist who at the time was specializing in pelvic physical therapy. And she was constantly bemoaning the fact that there weren't a lot of physicians who kind of knew what to do with the medical aspect of this when she was working with the physiological aspect.
So as I was seeing patients, I kind of developed a. a thing for seeing patients that had pelvic and sexual pain. Nobody else wanted to see them, not even the attendings where I, where I worked. And so I actually really enjoyed seeing those patients and kind of sought out some extra training on my own and developed a niche.
[00:02:46] Paige Bond, Relationship Expert: That's amazing. So needed. And you know, that's kind of not a surprise, unfortunately, to hear that even some of the attendings weren't very interested. I feel like People who are more so like on the up and coming of medicine like bright eyed and bushy tailed are always like the more excited ones to dive into like the things that maybe are a bit more taboo or you know, the like of that.
So I'm kind of curious in terms of your specialty being like in pelvic and sexual pain, like what are some of the misconceptions or like stigmas surrounding pelvic and sexual pain that you encounter in your everyday practice? Oh, gosh, I mean, how much time do we have? So one of the things that you said, not being surprising that other physicians don't really like this.
[00:03:32] Dr. Angela Stoehr, MD: I actually wrote a op ed on this entire topic. And in my opinion, I think the reason that a lot of physicians really hate doing pelvic and sexual pain disorders is because we are not trained to do them. The training is just not out there. We aren't taught to deal with this kind of stuff, or at least very minimally taught to do this kind of stuff in residency programs.
And it's kind of a generational problem and physicians really, really don't like to feel incompetent. And so when there's something that they see that they don't know what to do with, they tend to do the natural thing, which is to blame it on the patient instead of accepting the fact that they don't know what to do with it.
Or even they'll just tell the patient, Hey, I don't know what to do with this and just like send them out the door without any hope, you know? So that's, I mean, I guess the biggest misconception. Within the medical field is that pelvic and sexual pain patients are just crazy and it's all in their head.
Not true. I very rarely Almost never see a patient in my office that I can't find something that's going on something that's wrong And it's not typically just in their head now There's a lot of psychological complications that come along with having chronic pain You can't imagine that if you heard all the time that you would be, you know, just honky dory psychologically.
So it's very common for patients with pelvic and sexual pain issues, especially when they're chronic, to have some psychological components to that. But it's not usually the psychology that's driving the problem. It's the problem driving the psychology. So the constant patients are crazy. Actually, someone just the other day was like, don't you kind of open your door to crazies?
And I was like, well, what other people think are crazies? They're not crazy to me. Most of these patients, I find something going on. I find something wrong when I evaluate them. And then, you know, we actually, we have hope at that point. And the patients, you know, become very hopeful. 100 percent fix all of the problems, but we can significantly improve functioning, significantly improve pain.
And most of my patients are quite happy with outcomes. So yeah, that's just one of the stigmas is that. Women with pelvic pain are crazy, making it up. That happens a lot. I have a lot of patients who have been told by other physicians to just stop complaining about it. You know, there's nothing really wrong with you.
I have partners who think that their spouses are thinking, or they're doing it just for attention. Is that the patriarchy? Is that the patriarchy talking? Yeah, it comes out a little bit. Yeah, it does. I, it's actually kind of funny. I've had several patients that have chosen to leave their significant others in process of being treated with pelvic and sexual pain and oddly enough, they seem to get so much better when they do that.
[00:06:04] Paige Bond, Relationship Expert: Hmm. Hmm. We could go on. I know we could have a whole other episode on that. Oh my gosh. Well, and so it's very clear that there's quite um, a balance between trying to hold space for the emotional pain that the physical pain causes. But when we're not getting that emotional space to feel safe enough, the physical pain just doesn't go away and often in times get worse too.
Yeah. Oh, yeah, absolutely. One of the things that we know about chronic pain, and this does definitely happen in pelvic pain. We've got extensive studies on this. Psychology drives pain signaling. So the way I describe it to my patients, if you are riding on a roller coaster and you bump your knee, you may not notice it.
[00:06:50] Dr. Angela Stoehr, MD: In fact, it could be a day or two later. You're like, where did I get that bruise from? Because you're happy and laughing and having fun. Now, if you're being chased by a bear and you bump your knee, that hurts. It's really bad. So similar or the same injury, completely different perceptions. It's been studied for, let's see, anxiety, depression, loneliness, boredom, fear, anger, and stress have all been studied and significantly increased pain signaling.
So, basically, it tells your brain to sort of turn up the volume on your pain so that you appreciate it more. That's a logical thing for your brain to do. When it assumes that injury is associated with danger, then it's more important for your brain to realize, Oh, something's hurting. You need to do something about this.
But in all actuality, in chronic pain, that volume just gets turned up and left there and it doesn't know how to turn itself back down. So the psychology then kind of becomes a chicken egg cycle where I'm having pain and I'm having depression and anxiety, and then they start driving each other. Yeah, and I imagine, I imagine you probably get quite a few referrals from like therapists experiencing the mental health side of these things and I'm wondering at what point, like, how would someone know when is the right time to go see a specialist?
[00:08:05] Paige Bond, Relationship Expert: When they're experiencing that kind of pain. I do get the occasional referrals from sex therapy. I have a lot of sex therapists that I refer to, so I get referrals from them. I do occasionally get refer referrals from therapists as well. I mostly get referrals from primary care docs and other gynecologists who are like, I don't know what to do with this, and they just hand them over, which is great.
[00:08:24] Dr. Angela Stoehr, MD: That's exactly what they should be doing, is handing it over to a specialist who knows what to do with the kind of more complicated issues related to pain. because again, they're not really trained to do it. Now, as far as like when to go, if you're having pain that's lasting more than three months, technically you're starting to get into that gray zone of, is this going to be chronic?
Is it not? And you've been seen and nobody really knows what's going on, what's causing it. You've already had imaging, you've had some labs done and everything looks okay. That's probably time to look out. for a specialist. And, you know, I'm kind of interested in, because I, I don't have any background or medical knowledge, I don't have any background or medical knowledge on this, but what care do you give to your patients that the other primary care doctor or even other, you know, not specialists and sexual pain, but an OBGYN, what do you give that's different than the care that they are not able to provide?
So it's more just that I'm more trained and I've got more knowledge about what to be looking for. You know, to me, a lot of these things, you know, when I go poking around the patient, like, oh, this is super obvious, this is abnormal, but another gynecologist would be looking at it and thinking, well, it's probably just a normal variant.
There's, there's specific things to be looking for as specific ways to do exams in order to be able to kind of pinpoint. Right. Where pain's coming from and specialized imaging. And then beyond being able to just get a diagnosis, which, you know, is difficult in another office that doesn't specialize in this sort of thing, knowing how to treat it is a completely another beast because I don't just treat the pain where it's coming from.
I have to treat how the brain is associating with it. We treat the psychological disorders that come along with it. And we tend to treat some of the downstream effects of having chronic pain. So it's, it's kind of its own little ball of wax. The other thing is, Pain in the pelvic region of vagina owners is everything from your belly button to your mid thigh.
So people who are trained as gynecologists will know what to do with the labia, the vagina, the uterus, the tubes, and the ovaries, but they don't know what to do with the bladder. They don't know what to do with the muscle. They don't know what to do with the joints. And that's assuming they even know how to look for the disorders that are associated with the gynecological tract.
Same thing with the urologists. They're like, I know what to do with the bladder and the urethra. But I don't know what to do with a vagina. So it, as a comprehensive pelvic pain specialist, I'm trained to evaluate all of those things. Wow. Okay. You're blowing my mind because I didn't even know, like, they could go all the way from your belly button down to your mid thigh.
[00:10:50] Paige Bond, Relationship Expert: Like even Belly button to mid thigh is considered pelvic region. Yep. Wow. I know you probably don't have the answer to, but why isn't this taught as general knowledge as like someone who is living with like someone who is a vagina owner, right? As a vagina owner, you would hope. Again, I think a lot of it's the generational problem.
[00:11:08] Dr. Angela Stoehr, MD: The generation ahead of me didn't know what to do with pelvic pain and didn't seek it out because there was already these predisposed notions that these patients are crazy, which was then passed down to my generation. I was one of the few that stepped out and said, Hey, I don't think they're all crazy.
Maybe we should look into this. And it's getting to be more acceptable. There's more of us that are interested in this than there used to be. I lecture at a handful of universities for the residency programs to teach the gynecologic residents what I do, how I do it. And I think. There's some hope for future generations that they won't just look at these patients and think that they're crazy.
That's, that's the hope. You would assume a problem that affects one out of every eight vagina owners would be something that we would be trained on more intensely, but no. Yeah, way too common of a problem to let just slip by, you would think. Exactly, exactly. Geez, well, I'm glad we have you and I'm glad we have you stepping out of the norm and now other people are starting to follow suit.
[00:12:06] Paige Bond, Relationship Expert: You mentioned approaching things like you kind of go at all different angles. I'm really curious, like, what do the non surgical treatments look like for people coming in and experiencing, you know, these kinds of pain disorders? The vast majority of the treatments I do are non surgical. That may be a little bit of a surprise.
[00:12:25] Dr. Angela Stoehr, MD: Patients that do require surgery are few and far between for chronic pain. Most of those patients would be patients that have stuff like endometriosis and fibroids that are causing their pain or something like adenomyosis, which if you want all the details about what those are, let me know. But a lot of what I treat really is non surgical.
It depends on what it is that's causing the problem. You can. Probably imagine there are a lot of different things that can affect the pelvic region because there's a lot of different organs in the pelvic region. So most of my patients do have pelvic floor muscle problems. In fact, almost all of them do because it's your body's natural reaction to pain to clench and that big muscle at the base of your torso that Has three holes in it when you pee from when you poo from when you have sex with that muscle very much responds to pain in the pelvic region and tends to start tensing up.
And oftentimes that is a big driver for pain. So for those patients, there's a couple of different options. Most of what is in the literature is physical therapy, pelvic floor PT. Hence the reason my sister got me interested in this. There's also Botox and trigger point injections that can be done, but those are kind of.
It really expensive band aids. There's also a near infrared laser called the solar pelvic therapy laser that works really well for that. So those are some of the treatments for pelvic floor muscle. Now, bladder pain is actually quite common and vagina owners. There's something called bladder pain syndrome, formerly known as interstitial cystitis.
The treatments for that are mostly medical. We do bladder installations and we give medications to kind of help regrow the lining of the bladder because that's the problem is the bladder lining is breaking down. And we also give medications to kind of tweak the way that the brain is processing the pain signaling while we're in the process of doing that.
There's also diet and behavior modifications for that. Irritable bowel syndrome is in my range as well. I deal with a lot of patients with IBS. So that's dietary changes and sometimes medications depending on what we see. Endometriosis, a lot of that's medical management. Sometimes it's surgical. Those are probably the biggest things I see.
They're not by any means a comprehensive list, but those are the things I see most often. And a lot of those patients do require some amount of medications to kind of help with the way the brain's processing pain signaling. Sometimes that's psychiatric medications. Oftentimes it's not. Oh, okay. More so instead of psychiatric, is it more just pain management, or?
[00:14:45] Paige Bond, Relationship Expert: No, not pain management. Isn't that interesting? I don't use any narcotics in my practice for my chronic pain patients. There's lots of data to show that that's not effective. In fact, it can actually make pain worse over time. So yeah, you can develop tolerance to pain medications even acutely. So we all know that.
[00:14:59] Dr. Angela Stoehr, MD: Once you start taking a narcotic, you have to start increasing the dose regularly over time in order to get the same effect. So I don't use narcotics in my practice at all. If my patients are potentially needing some type of management like that, I will send them to a pain management doctor. But I don't have that many patients that choose to do that because usually we can control them with other things.
So there's a couple of medications that we use fairly often. Gabapentin is one of them. It is a diabetic nerve pain medication most oftenly used for that. Actually, it was an old antispasmodic seizure medication, but most people, most patients are not on it for seizure medication. In fact, I don't know anybody still using it as a medication for seizures because we've got much better stuff for that now, but it works great for pain control.
And so we use that fairly often. Amitriptyline is a really old antidepressant that nobody uses for depression anymore, but we use it quite often in the pain world. There's Lyrica, which is a medication that's FDA approved for fibromyalgia that works really well in chronic pain patients. Yeah, so we've got lots of different potential options.
[00:15:59] Paige Bond, Relationship Expert: Yeah, I think that's so cool. And honestly, really rare that you don't like a medical practice not using narcotics, but it's like unheard of. So you're really changing the game out here in medical practices. I'm trying to, I don't even use narcotics for my surgery patients. I have a really aggressive protocol to minimize pain and 95 percent of my patients don't require narcotics even after major surgery.
Why are we not doing this more? I, I, I'm working on that. I'm trying to get it out there. Yeah, there's a lot. Yeah, I'm only one person. There's a lots of recovery after surgery protocols. It's an EROS protocol out there. A lot of them, it was originally started, I believe, with colorectal surgery. And then it kind of bled into a lot of other specialties.
[00:16:40] Dr. Angela Stoehr, MD: For some reason, OB GYN has been kind of late to adopt it, but we're getting there. As far as doing ARIS protocols go, I just adopted a really aggressive ARIS protocol about eight years ago. No, about 10 years. Holy cow. I'm getting old. About 10 years ago, I adopted a really aggressive protocol and I've kind of tweaked it over time as more data has come out.
And I've gotten to the point where I just don't need to prescribe narcotics. And that was kind of the goal in the, in the first place. Oh, my gosh. That is so amazing. And I can imagine, like, your patients feel pretty good, you know, not having to wean off narcotics or anything like that after a surgery.
Significantly improves recovery. I actually, I saw a patient this morning who was post op, uh, 13 days and she was up and watching her nephew's basketball game within 12 hours of surgery. She went that night. Yeah, so she felt fine. So yeah, most of my patients do really well. They come back in for their two week post op and other than occasional mild symptoms of like bladder pressure or what have you, they don't typically complain about pain.
[00:17:36] Paige Bond, Relationship Expert: Yeah. Now, how could we advocate for these types of. Needs when maybe they're seeing a doctor that's not really familiar with this protocol or that they prefer to use narcotics with their patients. How do we help like listeners if they're experiencing something like this and they don't want to be on narcotics?
How do we help them advocate? You're probably going to wind up needing to advocate for yourself, and I think that's super important. If your surgeon is like, here's a script for 20 Norcos, just be like, no, I don't really want that. What do you have for protocols to minimize pain for surgery? And if they're like, I'm sorry, what?
[00:18:12] Dr. Angela Stoehr, MD: Find another surgeon. I'm not, I'm not joking. That's probably the best thing to do. I would, I hate to say this because I am one, but a lot of surgeons are kind of old school and They have always done it this way and they will continue doing it this way because that's what they're comfortable with. And they don't like adopting new things unless they're forced to.
And if enough patients come into their office saying, hey, I'm going to find another surgeon because you're not doing an advanced ERIS protocol, eventually they'll fix their practice or they'll lose money. And we're pretty motivated by money, just humans in general, but surgeons definitely, that's where they make a lot of money is doing surgery.
So if their patients are going elsewhere because they're not doing ERIS protocols, it will eventually. Motivate them. Good ideas. All right, listeners. So you heard the drill. Yeah. Ask them if they're doing anything to minimize narcotic use for surgery. And if they don't have an appropriate quick answer to you, then find another surgeon.
[00:19:08] Paige Bond, Relationship Expert: Yeah. I love that. Now, I guess for people, not even at the point where they're discussing surgery, where they're not even sure if they have pain or not, or maybe they're afraid to even bring this up to their doctor, healthcare provider, How do we help people become more comfortable talking about these things?
Because in some cultures, you know, sex is a dirty word or right? So there can be a lot of shame associated with this. So I'll be able to bring this up and start that conversation with the health care provider. Shame is a huge thing around sex, especially in certain cultures and even microcultures within, you know, certain areas, you know, like in the United States, everybody's like, Oh, sex is a big thing.
[00:19:47] Dr. Angela Stoehr, MD: But I'm like, if you were brought up like strict Catholic or really conservative Church of Christ or Muslim, sex may be a topic you are just completely uncomfortable with. I'm trying very hard working on the provider side of things to make the providers more comfortable asking about these things so that their patients don't have to be the ones to bring it up and I know that sounds kind of wild and crazy, but it is very important.
And you would think as a gynecologist, everybody on their normal. Appointments would be asking, do you have any problems with sex, any pain, any desire issues and a lot of gynecologists don't ask because they don't know what to do if the patient says yes. Yeah. So I don't get that question. I was there earlier this year.
[00:20:27] Paige Bond, Relationship Expert: They're like, still with the same partner. And I'm like. That's all I get. That's all the screen. Yeah, you should be a little bit more in depth, but it's partially again. Physicians don't like to feel incompetent. And if they ask a question that they can't fix the answer to, they don't want to ask it. So, I'm, I'm working with providers to try and help them be more comfortable asking the questions by giving them the tools to be able to treat the problems as they come up as far as the patients go.
[00:20:54] Dr. Angela Stoehr, MD: It can be uncomfortable to bring up those types of questions if you bring up something like that at a doctor's office and you get a side eye or a questioning look or an, hey, I don't do that. Find another gynecologist. I know this sounds kind of mean, because I'm like, just drop your dock and go on. But if you're not comfortable enough to talk about sexual problems with somebody who's supposed to be.
A specialist for sexual problems, then you need to find a physician who is, I think it'd be like a lot of therapists and they're telling you, oh, I don't know how to treat you as a couple. Yeah, exactly exactly. That would be that would be problematic and a lot of kind of colleges won't be comfortable with.
Answering the question. They may say, Hey, you know what? If you've got a sexual pain problem, that's not in my specialty, but I know somebody I can refer you to. That's an acceptable answer. My partners do that in my practice. They're like, look, we got a specialist in the office. I could start evaluating this for you, but I got a much better hand.
Like, eight steps down the hallway. Let's just go see her. So, it's an appropriate answer to be like, Look, that's not an area that I'm super comfortable with, but I know somebody who is. Let me refer you. So, if you are brave enough to bring it up, and You get a referral. That's that's great. You're going in the right direction.
[00:22:09] Paige Bond, Relationship Expert: Yeah, I love that. And I think you've highlighted something important to like, there's not only an aspect of shame for the patients or clients bringing this up. There can also be an aspect of shame in the health care provider of their own areas of competency that may need some hard looking at that. So I have compassion for that part, but also.
Go get some education, then. I have compassion for it, too, because honestly, if I hadn't, like, intentionally gotten this training on my own, I probably wouldn't be any more comfortable than anybody else coming out of training. So, I, I feel it. I, I know where it's coming from, and I know that feeling of, like, I don't know what to do with that.
[00:22:51] Dr. Angela Stoehr, MD: And surgeons really like to be fixers, and when they can't fix something, it makes them feel bad about themselves. So, yeah, and then you get the projection problem. So it's, it's a thing. It's a thing. But, yeah, there's a lot of providers that really You're not going to surprise them by saying, Hey, look, you know, when I have sex, doggy style, it hurts.
They're probably going to go, okay, you know what? It's not in my area of specialty. They're not going to look at you and be like, Oh my God, you do doggy style heaven forbid. It's that's not typically going to be the response. Most gynecologists will accept a question like that without giving a weird look.
Now, if you're getting more into lifestyle stuff, up and you're like, hey, you know, I have six sexual partners and I was at a party on Saturday and I'd really like to be checked for STDs. You might kind of get a little bit of a raised eyebrow, but hopefully they won't respond with an, oh my gosh. Yeah. Okay.
[00:23:37] Paige Bond, Relationship Expert: This is a great segue because this is another really great thing I loved about your podcast. And, um, Just another highlight about me is I specialize in helping people navigate non monogamy in the therapy world. So I would really love to open the conversation about, you know, how do we one get, um, the right care or compassionate care for people who are navigating just.
More from the outside, heteronormative, mononormative lifestyles to be able to give them the care that they actually need without feeling that judgment where it is an affirming environment. Okay, another thing, yeah, an affirming environment, you would hope with gynecologists that they would be affirming, but not all of them are.
[00:24:22] Dr. Angela Stoehr, MD: So if I always recommend, like, there's several people you should never lie to. You should never lie to your lawyer. You should never lie to your tax advisor. You should never lie to your. Significant other, and you should never lie to your doctor. So, it feels uncomfortable to bring up stuff like your sexual proclivities, especially when they're not the societal norm with your provider.
Now, there is always a possibility of searching out a provider in your area that you know is in the lifestyle. My husband and I have put out information on one of the, like, major apps, I guess you could call it, for lifestyle patients so that they know if they walk into my office that I'm not going to be judgy.
In fact, all of my patients, every single one of them, always get the same question. Are you, are you sexually active? Are you sexually active just with your spouse? Is there anybody else you're sexually active with? Who do you like? Men, women, both or other? And my patients just know that those questions are coming.
And some of my patients that are in very monogamous relationships and very kind of culturally. More conservative will kind of like borrow their brow, but a lot of my patients are like, I appreciate you asking the question. And if you ask the questions correctly, again, I'm working on health care providers for this.
You should be able to glean that information. And if you're asking the questions, it already gives a sense to the patient that you're not liable to be judgy about it. So I say, Hey, what kind of relationship are you in? It's important for my patients to know that I'm not going to be like, Oh my gosh, I can't believe, you know, it's, it's important.
So you can look for a provider that's lifestyle positive or affirming, not necessarily going to be a ton of those out there that will voluntarily give that information. A lot of people in the lifestyle are very private. My husband and I. I have chosen not to be as private about it because we think it's important for other people to realize.
Number one, there are people in professional degrees with high earning incomes that are in the lifestyle and socially, you know, non normative and also that there are people out there that. You can come and talk to you about your medical problems that aren't going to side eye you when you tell them anything about your sexual proclivities.
Now, I have patients with all sorts of kinks, and it's important for me to know what those kinks are so I can give good care. And patients being able to give that information to me without feeling uncomfortable is super important to me. So as far as. If you know your provider is going to be judgmental or not, usually just a little, you know, like, nudge nudge is going to be enough.
If your provider is like, are you sexually active? You can say, well, yes, I'm sexually active with more than one person. And if they kind of raise their eyebrows, say, well, I'm married, but I'm in a sexually non monogamous situation. And if they're like, oh, okay, click, click, click, click, click. You're probably okay.
If they look at you and you're like, oh God, well, how many patients, how many. Or people are you sleeping with? Maybe you should find another doctor. Yeah. Yeah. Well, do you have any recommendations on how to even find that kind of care? Because I, I don't know. I can't imagine going into Google and typing lifestyle affirming doctor or like, does that work?
[00:27:14] Paige Bond, Relationship Expert: Like how do people find people like you? Honestly, I'm not really sure I one thing I really need to do at some point I need or my husband Reagan probably needs to set up a a list that we can put on my website that has people that I know are affirming physicians. I haven't like. Throwing this out to the entire country by any means, but in the Dallas Fort Worth Metroplex I do have a lot of friends that are quite affirming and would be more than happy to see people in the lifestyle just as Long as they, you know know what to do with them and a lot of them will even ask me questions They'll text me like hey, I've got a patient in the lifestyle.
[00:27:48] Dr. Angela Stoehr, MD: This is what's going on Is there anything additional that I need to be doing and I'm happy to answer those questions Someday, I'll put together a database of physicians in the United States that are lifestyle friendly just hasn't happened yet Yeah, big dreams. Big dreams. Yes, right? Again, I'm only one person.
[00:28:03] Paige Bond, Relationship Expert: Yes, exactly. I really love the kind of like almost like checking social cues to be able to like check in and see if like Provider going to be affirming for me, am I, am I going to be able to tell them, you know, Hey, you know, a scene went wrong this past weekend. Can I tell them about this pain that's been showing up without getting that side eye?
I think that's really important to be having those types of conversations. I'm wondering in terms of like, being able to bring that up, you know, what are some important things as a patient that they should be talking about with their doctor in that sense of lifestyle affirming activities? So the things that are probably most important for your physician to know how many partners you're having, and that doesn't need to necessarily be a number.
[00:28:51] Dr. Angela Stoehr, MD: It can be, I have two partners and we're just the three of us, or it could be, I have multiple partners and that's sufficient. That's all your provider needs to know as far as like screening goes. So STD screening is obviously one of the really important things in the lifestyle. Most of us in the lifestyle are very.
Careful to be screened frequently, but not everybody does that. And so it's important to know kind of what your risks are associated with that. It's important to let your provider know whether or not you're using birth control and what kind that is. It's important not to be just using condoms for your birth control in the lifestyle.
Because as we all know, condoms do break and lifestyle baby who you don't know who the. Potential father is can be a little bit scary. I'm sure. So having really good birth control is super important. So making sure that they know what kind of birth control you're on. What types of sex you're having is also equally important.
If it's just people. Yeah, if it's just PIV, that's one set of, that's penis and vagina. Sorry, there's people listening that may not know what that means. If it's just penis and vagina and the partners that you're with, you're pretty sure aren't with other people in different types of ways. That's one set of risks.
Many, many, many. In fact, most of the people I know in the lifestyle are having oral intercourse and that provides a little bit of a different set of risks. If your provider does not know that you're having regular oral intercourse unprotected with multiple people, they don't know to swab your mouth and throat.
And that is very important. Gonorrhea, chlamydia, trichomonas, HIV, they can all live together. In your throat and they can be completely asymptomatic and pass to everybody else that you give oral sex to so it's yeah super important if you're using that kind of contact to make sure that you're having your mouth and throat swabbed as well.
The other thing is if you are having sex with penis owners that are also having sex with other penis owners, that's somewhat important to know just because there's a slight increased risk of a couple of types of less common sexually transmitted infections, including HIV that probably need to be screened for maybe a little bit more frequently.
[00:30:51] Paige Bond, Relationship Expert: Mm hmm. Now I'm kind of curious in the terms of when we're thinking about people in the lifestyle who are having these situations where they're having multiple different partners and they're wanting to bring up screening and STD testing. I know that in my experience when I've been working with a couple, one partner is wanting to add in more partners into their sexual experience.
They have differences on what they see on how to approach STD screening on Hey, is it, do I have this person show me proof, like a physical paper before, you know, we go and have this experience? Like, how do we have better conversations on approaching STI, STD talks with people that we're interested in having sexual relations with?
[00:31:36] Dr. Angela Stoehr, MD: That's, that's an incredibly good question, and it is a hard subject to bring up in the lifestyle. So there's one group that I'm involved in that I, I love because the person who runs this has these little green bands. And if you have a green band on, then she has seen and confirmed that you've had STD testing in the last three months.
And the only way to get a green band is to provide her your STD screen. So. Not everybody's having to show everybody else. Here's my screen. Here's all of my, you know, important paperwork. They just have to wear a green band. They get to wear a green band and she knows when all of those green bands expire.
She's really good about keeping up with that. And that to me is like an ideal situation, especially if you're walking into a big party or a hotel party, something like that. It's really nice to have that. It is. an uncomfortable conversation to have, and it really is up to you as to what you are willing to risk for your own health.
I know that sounds kind of crazy, but if you're accepting the risk of, hey, I have not seen these people as STD screens. I am going to be using condoms all the time. I use condoms with my oral and my vaginal, et cetera. Then, You can choose to accept the risk associated with that. A lot of people will ask, and you would hope that most people would be honest.
Hey, when was the last time you were screened? You're like, hey, you know, it's been about six months. Okay, have you had a lot of partners in between now and then? And you would hope that they would tell you the truth. That can give you some sense of security. I will say, if we're looking into statistics, and I've actually looked at this fairly recently within the last year, STDs are actually less common within lifestyle patients than they are in patients who are cheating on their spouses.
You are more likely to catch an STD if you are in a relationship cheating on your spouse than if you're in the lifestyle. A lot of people within the lifestyle, because there is open communication about a lot of things, are getting tested regularly themselves and will be open. I have a very good friend in the lifestyle who's HSV2 positive, and she lets everybody know.
She's like, I'm positive for HSV2. I am taking medications to prevent transmission. I need you to know that. And most people are like, okay, that's cool. Glad you're taking the medications. Let's go play. Some people are like, hey, you know what? I'm really not comfortable with that. She's like, okay, I understand.
So I, people are, I think maybe a little bit more forthcoming as well as a little bit more open about who they are as humans, what their kinks are because within the lifestyle, we are very careful to be non judgy.
[00:33:56] Paige Bond, Relationship Expert: Yeah, I mean, none of that surprises me. It makes a lot of sense how it could be more likely with the cheating spouse to be deceptive and hide the fact that maybe they caught something or,
[00:34:10] Dr. Angela Stoehr, MD: or have other partners that they're not telling you about.
[00:34:12] Paige Bond, Relationship Expert: Yeah, exactly. And whereas in the lifestyle, I mean, that's the whole point. We want that honesty. We want that transparency. So I'm not at all surprised. So I love that and I loved how you kind of explained the different ways like to decide where you're at as far as like risk tolerance and how you want to be presented with, you know, do you want actual data? Do you want my word for it for, you know, sexual screening? How can we go and move forward with this?
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Quite a few of my listeners know me and they know that I love talking about non monogamous relationships and different dynamics on the long spectrum that can be of the different types of lifestyles and relations.
Are there any other things, especially from your medical background, that would be really helpful for them to know when it comes to, you know, navigating these kinds of dynamics?
[00:35:44] Dr. Angela Stoehr, MD: The dynamics can be complicated. I'm sure you know that. Anytime you're doing something that's socially non normative, you're going to kind of have to figure out some of it, but there is a decent amount of guidance that you can find online on podcasts.
I always recommend that you have really good communication. If you do not have good communication with your significant other. Your primary, you probably shouldn't be dipping into lifestyle, at least while you're getting help with that, mainly because if your communication isn't good to begin with, it will destroy your relationship.
I've seen it happen many, many times it's because 1 of you wants to be non monogamous and the other 1 doesn't is not a good idea to get into the lifestyle. You have to, you have to communicate without just jumping in there. So having a good, healthy, stable relationship to begin with, I think is super important with your primary.
Now, if you're not in a primary situation, you have somebody that you play with, but you're single on your own, then you kind of get to make your own rules. But I think it's super important for spouses to get together, have a really like in depth chit chat, talk about. This is what I'm comfortable with.
This is what I'm not comfortable with. This is what we need to talk about. You know, all of the, all of the nitty gritty details. And then after each experience, subsequent experience, sitting down and saying, okay, how did you feel? Did you like this? Did you not like this? Are there things that we could have done differently that would have made it more fun for you, for me, for both of us as a couple?
I think it's important to have those communications until you get to the point where. You sort of have settled down. You've had most of the experiences that you think you might have, and you know what to expect, both of yourself and your partner. So being able to communicate really well is important. I think it's also important to discuss as soon as possible with your provider that you're planning on getting into that type of situation so that you can be screened sooner rather than later.
And also, Kind of being, be given some of the details about what to expect, like things about like knowing whether or not swab your throat when you do your STD checks, things like recurrent bacterial vaginosis and vagina owners is super common and people within the lifestyle and sort of some of the tricks in order to be able to avoid that or reduce your chances of having issues like that.
So I think it's, yeah. Some of those
[00:37:53] Paige Bond, Relationship Expert: tricks with them.
[00:37:55] Dr. Angela Stoehr, MD: Oh, yeah, sure. So, bacterial vaginosis, just as a baseline in case some of the people out here haven't had it, it's when the pH of the vagina sort of gets off kilter. And at that point, bacteria that's typically hanging around the vagina but stays at low levels starts to grow.
And then it typically causes a handful of symptoms, most commonly discharge and funny smell. Patients will be like, my vagina just smells weird and I don't know why. And usually that's accompanied by discharge. It can also cause irritation, sometimes spotting, sometimes itching. I have some patients that only have pain with sacks when they've got bacterial vaginosis, but that overgrowth is typically easily treated initially, like right out the gate.
If you start noticing symptoms by something like boric acid, boric acid suppositories are over the counter. They're super cheap. They're easy to get. You can buy them on Amazon and pretty much. Anywhere that sells medications, boric acid up inside the vagina right before you go to bed a couple of nights in a row will usually nip pH issues in the bud.
Boric acid is the pH that your vagina likes, and so it typically will dumb down and overgrowth rather quickly. Now, if you've had the overgrowth for a while, you know, 5, 6, 7 days, and you haven't done anything with it at that point, you may need medications, in which case you're going to have to show up at a PCP or a gynecologist's office in order to get that checked and treated.
The boric acid is probably one of the best things to do. The other thing is avoiding any type of lubricants that taste good, smell good. Those are all no nos. Yeah. Typically, I recommend either really mild water based lubricants or silicone lubricants. Those are the least likely to cause trouble. The other thing is a lot of vagina owners have sensitivities to latex and non latex condoms can be super helpful with that.
So non latex condoms, good lubricant, and boric acid are kind of the biggies.
[00:39:42] Paige Bond, Relationship Expert: I love that. Those bam, bam, bam. You got those right in there. Thank you so much for sharing those. I try, you know, something that I thought of is kind of relating back to the pelvic pain, sexual dysfunction, and then relating it to the lifestyle.
I'm kind of wondering what happens if there's a situation where someone who's a Vagina owner and they have pain free sex with their let's say they're there have a primary partner. They go out. They experienced the lifestyle and they have. pretty bad pain with either PIV or some other type of penetration to them.
I'm kind of curious, like, what would be your evaluation and assessment from a medical perspective on how to treat something like that, where in one situation, there's pain free sex, we're enjoying it, and then in other situations, still penetrative. But now we have pain all of a sudden. How do we approach that?
[00:40:43] Dr. Angela Stoehr, MD: So usually if there is pain in one situation and not another, it's, it's going to be a little bit more on the psychological side. And a lot of that has to do with feeling safe. I know as a therapist, you probably understand this ad nauseum even better than I do, but there is some amount of safety that goes on in being very intimate with somebody.
I think there's probably plays even more intensely in with patients who have been brought up in really religiously conservative environments. Because a lot of times the taboo nature of what they're doing becomes a psychological thing. I always tell my patients with vaginismus, which is the disorder where people have tightening of the vagina without their conscious efforts to do so on attempted penetration.
And that I have actually seen with lifestyle patients. They are fine with their primary partner, but they develop vaginismus with secondary partners. A lot of times that winds up being. Something in that part of our brain that is safety control. I, I tell my patients, it's the part of your brain that you share with, like, crocodiles.
It's the part of your brain that breathes for you all night long, that controls your pelvic floor tension to make sure you don't leak pee and poo. The problem is it's also the part of your body that flinches when something's thrown at your face. So if I was to throw a baseball at your face right now, your natural reaction would be to throw your hands up, blink your eyes, and try and avoid it hitting you, right?
So if your body is anticipating either something dangerous or something morally unacceptable going on, and there's a penis coming at your vagina, your vagina is going to flinch, just like you would with a baseball coming at your face. So, that often winds up being a type of vaginismus that's typically psychologically driven.
Doesn't mean anybody's crazy, it just means that there's a part of them subconsciously that is either concerned, worried, or scared.
[00:42:23] Paige Bond, Relationship Expert: Is the recommendation for treatment Seeing a sex therapist or like, what, what do you recommend when you see that ?
[00:42:30] Dr. Angela Stoehr, MD: If the problem is predominantly with one partner and not other partners or multiple other partners, but not their primary partner, yes, sex therapy, psychology, especially with people who are accepting and affirming of non traditional sexual lifestyles is, is probably the mainstay for that.
There are other things that can be done. But they usually take a lot of physical effort, and you would require a partner who's not your primary to help you with that. I know that sounds kind of weird, but if you have a secondary partner who you're you're wanting to be with regularly somebody that you have.
An intimate emotional relationship with and you're wanting to be sexual, but you're having problems with that, then yes, there's definitely some other treatments that can be done. Usually for vaginismus, we incorporate things like pelvic floor physical therapy as well as using dilators and using dilators with alternative partners can be very helpful.
[00:43:16] Paige Bond, Relationship Expert: Very cool. Can you explain a little bit about dilators just for listeners who may have no idea what the heck that is?
[00:43:22] Dr. Angela Stoehr, MD: Sure, dilators is a misnomer. They, they look like sex toys, but I promise you they're for dilating the vagina. They actually aren't meant to dilate the vagina. They should be called brain trainers, but then nobody would know where to put them.
So, vaginal dilators are used to train the subconscious part of your brain that something going inside your vagina Is not scary. And typically we were recommend doing them once or twice a day with the partner that you're going to be with. Initially, you do it by yourself. If you have primary vaginismus, but if you're having vaginismus just with certain other partners and not your primary, then those certain other partners can help you place the dilators.
Um, so you have some amount of control over that because usually there's a psychological control issue with it as well. Like, that penis doesn't belong to me. I don't have control over it. I can't tell how fast it's going to move or where it's going to go and that. is part of where the fear comes. So having your other partners help you with the dilators can be helpful.
Dilators come in sizes. A size one is about the size of your baby finger. A size two is about the size of your pointer finger, unless you have particularly large hands. And then a size somewhere between six and eight. Yeah, my hands are tiny too. A dilator between like size six and eight is approximately the size of most normal men's erect penises.
[00:44:36] Paige Bond, Relationship Expert: Mm hmm. Yeah. Thank you so much for going into that, just in case people are thinking that maybe that's the direction they need to go. For sure. Yeah. So I feel like we, we got to talk about so many different things today and I really had you go like on a million miles an hour because I had us bouncing all kinds of different topics.
Is there anything that we didn't get a chance to cover today that you think would be really good for the listeners? Pain, sexually alternative lifestyles, anything else?
[00:45:04] Dr. Angela Stoehr, MD: Well, one of the things we did go into that I'm going to reiterate, if you are having pain that is lasting for more than three months, even if it's just in certain situations, like, hey, it's only when I have sex that I have pain, instead of just avoiding sex, which can be very detrimental, I will throw in here that being able to have sex is considered a quality of life marker, so if you're choosing not to have sex because of pain, that's understandable, but if you're wanting to have sex, you really Should be reaching out to somebody who knows what they're doing.
Do not be afraid to look up second opinions on things if you're not getting what you need to out of your primary physician. Doesn't necessarily mean that they can't still do your annuals, but you may not want them dealing with your pelvic and sexual pain problems. And as far as lifestyle stuff goes, I mean, there's, there's lots of information out there.
Information that's coming from legitimate sources is a little bit harder to find. I guest podcast with a lot of other groups and some of them have really good information. I do have a website called swingingsafe. com if you're interested in looking into that. There's a lot of information there about, it collates like all the videos that I've done in other places, things that I've done for other companies, things that I've just thrown up on YouTube.
If you're wanting all of my videos that talk about all of the things, my website has all of that there. And. There's also information about how to talk to your physician about getting into the lifestyle, how to talk to your partner about your kink. That kind of thing is in there.
[00:46:29] Paige Bond, Relationship Expert: I love that. So really a lot of great resources on swingingsafe.
com to help people introduce that part of the lifestyle into, you know, their medical care, introducing it into their own relationships. It sounds like a lot of really good information will be so helpful
[00:46:45] Dr. Angela Stoehr, MD: to people. And I'm trying, I keep adding stuff in there. Anytime I do a new video, I'm like, oh, gotta upload that to my website.
I, I should keep better track of like what I've got on there, but basically like anything that I've ever done as a video anywhere on the internet, it's going to fall. And all of my like blogs and stuff that I've done before, it's all going to fall onto that website. So it's kind of like anything you want to know that Dr.
Stoehr has said is going to be there.
[00:47:04] Paige Bond, Relationship Expert: Perfect. I love that. And if people, let's say are in the area in Texas, or maybe they're wanting to drive. you know, from somewhere else to come find you. Where can people come find you and see you to have you as a really amazing medical provider on their healthcare team?
[00:47:20] Dr. Angela Stoehr, MD: Oh, yeah. So I'm in the Dallas Fort Worth Metroplex. I do have patients that fly to me from literally all over the place, even other countries sometimes because my specialty is a little bit odd. I'm not going to lie. So my office is in Frisco, Texas. And I work with a group called Nurture Women's Health. So you can look that up.
I also have a side company called the Stoehr Center that runs some of my other stuff that's not covered by insurance and that kind of thing. More on the aesthetic side of thing. And also I've written a couple of books that are available on Amazon that all runs through the side company. So you can look up the Stoehr Center, which is my last name, S T O E H R.
I know it's got an H in there that doesn't sound like it should be. And then the Nurture Women's Health is the bigger group that I'm associated with. You can find us there.
[00:48:04] Paige Bond, Relationship Expert: Beautiful. Thank you so much for giving that information to us. And I'll make sure I have all the links in the show notes so people can hop on and find out what they need.
Perfect. Thanks so much. Yeah. Well, thank you for dedicating your time out of your super busy day. I'm going to let you get back to patience and doing your thing. I so appreciate you taking the time to do this episode. Thank you so much. I appreciate you having me. Thank you. Great. All right. Listeners until next time.
And that's a wrap for today's episode of Stubborn Love. I hope you gathered some wisdom to bring into your love life and improve your relationships. If you enjoyed today's chat, don't forget to subscribe and leave a review. That'll help this episode reach even more listeners. If you have any questions or stories you would like me to cover in the future episodes, drop me a message.
I love hearing from you. If you need extra support in your relationships, check out how we might be able to work together by popping on my website at pagebond. com. Until next time, don't let being stubborn keep you from secure love. Catch you in the next episode.
