Meet the Trailblazing Urologists on a Mission to Help Women Have Better Sex

There’s a group of clinicians shining a spotlight on women’s sexual health and pleasure these days, and it’s not the gynecologists or sex therapists you might expect.

It’s a group of female urologists—yes, physicians who specialize in the urinary system and male reproductive system.

In fact, it’s precicely because urologists take care of so many men that puts them in a position to have an especially powerful voice when it comes to female sexual health, says urologist Kelly Casperson, MD, who is also a top podcaster and author of You Are Not Broken.

“Every day, we see the double standard when it comes to how the different sexes are treated regarding their quality of sexual health and hormones,” she says. “Once you see how the men are treated, you can’t help but care for equality for all.”

The Sunday Paper sat down with Dr. Casperson and two other trailblazing urologists—Maria Uloko, MD (an internationally renowned researcher who led the groundbreaking work on defining the number of clitoral nerves in the human clitoris) and Ashley Winter, MD (a sexual medicine specialist and chief medical officer at Odela Health). We talked about the sexism that still exists in medicine, the most helpful medication too many women aren’t being prescribed, why all of us need adult sex education, and so much more.

A CONVERSATION WITH KELLY CASPERSON, MD + MARIA ULOKO, MD + ASHLEY WINTER, MD

Dr. Casperson, you say that urologists are especially well suited to talk about female sexual health and pleasure. Why?

There has always been sexism in medicine. There still is. We care about men’s pleasure and not women’s pleasure. We call women who enjoy sex dirty words. The woman is always the problem when it comes to a desire mismatch: If her desire is too high, that’s her problem. If her desire is too low, that’s her problem. It's always the male default that we’re circling around.

In my office, I'll see two people with low hormones and low sex drive and our health care system cares about one of those patients. Viagra has been around since the late 1990s. It's over the counter in many countries. We do not teach people about the vulva and the vagina, what happens to them as we age, and how simple the fix is if issues surface. And then we give all these 60-year-old men Viagra—90 percent of whom are trying to sleep with a female!

The system is broken, yet most of us are left feeling like we are broken.

Dr. Uloko, you did groundbreaking research on the clitoris and found there’s actually many more nerves in the structure than we previously believed. What inspired you to look at this?

Doing a fellowship in urology really opened my eyes to the huge disparity in care between women's sexual health and men's sexual health. As a urologist, that's what my training is in—yet we specialize predominantly in male sexual health. It’s literally written into our curriculum. We cannot graduate from residency without knowing the penis inside and out. You’d think the same would be true about the vulva. It's not.

Urologists are obnoxiously data driven. Yet when you go to find the research on women, it’s not there. And when it is there, it’s not being translated clinically, in patient care. I believe research is advocacy. Research creates access for people. Research is resistance.

There’s a lot of feelings when it comes to women’s health instead of facts. And those feelings are directly harming patients. I use research to lay down the foundation to combat feelings with facts.

Dr. Winter, you are on a mission to help bust the myth that women’s pelvic health and sexual health concerns are hard to treat. Why?

Traditionally, women's health has been all about pregnancy, how to avoid pregnancy, infections, and cancer—and not about quality of life, whether that's related to pleasure, the absence of pain, or even basic function. What I came to realize as a practicing urologist is how a deep understanding of female physiology and addressing the root causes of any issues women are experiencing can help women have better sex and better lives. And truly, many of these issues are not that hard to treat. Yet for too long, women’s pelvic health concerns have been treated like hard-to-deal-with mystery diseases.

Dr. Winter, what are some of the biggest misconceptions about women’s sexual health you see perpetuated, and the truth you want all of us to know?

One of the biggest things I talk about is vaginal estrogen. Low-dose vaginal estrogen is vaginal rejuvenation. It is overactive bladder treatment. It is UTI prevention. It is vaginal lubrication. And it is safe. It does not cause breast or uterine cancer. It is not considered hormone replacement therapy. You can take it during perimenopause and after menopause. In my mind, vaginal estrogen is the most underutilized drug in the entire world. It’s preventive care.

Dr. Casperson, you are also a huge proponent of vaginal estrogen. I’ve heard you refer to it as essential skin care for vulva owners.

It's so simple. It helps so much. And now, thankfully, it’s cheap. In the early days of prescribing vaginal estrogen, I started wondering, “Why aren't we putting women on vaginal estrogen before the years of suffering? Vaginal estrogen decreases urinary tract infections by 60 percent. It’s as effective as overactive bladder medications for urinary urgency and frequency. Yet it’s insanely underused.

The thing about Western medicine is that we’re very good at treating problems. We’re not very good at preventing problems. I see so many problems all treated with vaginal estrogen. And I started thinking, Well, what if we want women to avoid problems? Can we just start them on vaginal estrogen?

Now, there is not a lot of data on vaginal estrogen as preventative skincare or bladder care. And it would take a long time to do these studies. But why are we waiting for pain with sex? Why are we waiting for a sexless marriage? Why are we waiting for you to be in diapers due to urinary incontinence? Why are we waiting for you to get recurrent UTIs? Why are we waiting for your clitoris to be less sensitive, and for you to lose pleasure with sex? Instead of treating all these problems, could we prevent them with vaginal estrogen?

Dr. Uloko, you say that 70 to 80 percent of the conditions you treat you can diagnose with a story and a basic exam, yet it often takes women years to get the help they need because of a lack of vulvar health training in medicine. What’s it going to take for this to change?

When a male patient comes in with something wrong with his penis, he can look at it and say, “It hurts here, this isn’t normal.” He doesn’t say, “Oh, gross, yuck, I hate my penis.” Women, on the other hand? We have completely given up bodily rights to our genitals to our gynecologists, and our current gynecology training does not actually teach vulvar anatomy. This is a medical crisis.

If someone were to go to the doctor and say, “I have crushing chest pain radiating down my arm,” and the doctor said, “Well, that sounds like a you problem” or “Oh, nothing’s wrong, maybe you should just have a glass of wine,” that’s medical malpractice. But we are not holding that same degree of reverence for vulvar conditions.

We do not learn about vulvar and vaginal pain conditions or think about the vulva as a healthy structure like we do the penis. We don’t understand the health of the vulva. We don't prioritize it. In our standard GYN exam, we put a speculum in and take a look at the cervix. That’s it. But there’s so much more anatomy that we are missing. It is shocking how many structures we just ignore as a medical community.

Dr. Casperson, your recent TedX Talk focused on why we all need adult sex ed. What’s one thing we can all do starting today to help our sex lives?

Get curious. You might ask yourself, Is it true that this is just how my body is—or is it possible that I got no education, I’m doing the best I can, and maybe with a little bit of knowledge and learning how to communicate, could things be different? I think it’s important to question the status quo.

Dr. Casperson, are you hopeful that we’ll see more research focused on women’s health issues in the coming years?

I think it comes down to this: As much as we need to focus on women, we need to remember women are humans. We need equal research on all the humans. Women aren’t a niche. Fifty percent of the population is not a niche. And as long as we keep saying, “The women’s specialists need this, the gynecologists need this…” No. The humans need research. To me, that might be what finally changes things.

Kelly Casperson, MD, is a urologist, sex educator, top international podcaster, and author of You Are Not Broken. To learn more, visit kellycaspersonmd.com.

Maria Uloko, MD, is a urologist and internationally renowned researcher, who led the groundbreaking work on defining the number of clitoral nerves in the human clitoris. To learn more, visit mariaulokomd.com.

Ashley Winter, MD, is a urologist and sexual medicine specialist and chief medical officer at Odela Health. To learn more, follow her X (formerly known as Twitter) @ashleygwinter.