Stacy London (00:00)

Dr. Sophocles, there's just something about saying Dr. Sophocles that makes me so happy. It's like, I know I'm gonna be talking with somebody smart. That's what it feels like. Well, you and I met at the Marvelous Mrs. Menopause event. No, we met before that, but I didn't hear you speak until the Marvelous Mrs. Menopause event, and I lost my mind. Everybody in that audience fell so in love with you.

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Dr Maria Sophocles (00:07)

It fools the best of them, for sure.

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Stacy London (00:27)

You were talking about some of the most difficult things around sex and menopause, and yet you had people laughing and you had people breathing easy. And it's such a joy to have you on the podcast because I'm really hoping that that's the same kind of information that you can impart to our listeners today. We need you on the front lines and you have written this book, The Bedroom Gap. Let's talk a little bit about sort of A, what brought you to writing the book? ⁓ and your experience really with menopause and sexual dysfunction in general.

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Dr Maria Sophocles (00:59)

Yeah, I wrote the book at first for my patients. It ended up being much bigger than that as I finished it and realized, gosh, men need this book too. People need this book as in their twenties and thirties as a guide to what's happening. But initially it came from my patients just having menopausal issues and me feeling comfortable treating hot flashes and all the same stuff we always hear about but they were reluctant to bring up the sexual fallout and their clinicians were reluctant to talk about it. So it's the same thing we know that most clinicians are not trained in menopause, but they're also not trained to talk about sex, combined with the fact that a lot of clinicians bring their own discomfort into an exam room. So if you grew up in a family where sex just wasn't talked about, even if you become the best doctor on the planet,

you might not be comfortable broaching or talking about it. So among all the menopausal stuff, the sexual fallout seems to be the one that's the least talked about and the least addressed. And then when you add onto that people's own prejudice, whether it's sociocultural or religious or homophobia or racism or whatever they feel uncomfortable with, if that person is across from them as a patient, they're even less likely to bring it up. So in the book, we talk about that. We talk about sex in autistic people and we talk about sex in people with chronic illness and why so many doctors say, look, Mrs. Smith, I'm just so happy you made it through your heart attack, like good for you. Or your cancer, we got your cancer out, good for you. Not, gee, you had a mastectomy. You lost a part of your body that you associate with feeling sexual. How might that make you feel? Is it okay to kind of grieve that? And so the book's kind of a lot of the history of how we came to own these roles and they are gendered, even though the book can apply to gay or straight or non-binary, anybody, it's largely written for women, I would say with male partners who bring this expectation that sex is for men and that sex has always been.

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in the big society, you for men or for procreation. So I kind of just call bullshit on that a little bit and say, I think as women, we are so beyond that now. And it's really time to unshackle ourselves from these sort of gender defined roles that ironically, some of our country's going right back into.

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Stacy London (03:42)

We're seeing this cycle. We're seeing the backslide. But I am curious when you say like, what is all of the bullshit that we should be throwing away? Because I know it's really funny as a Gen Xer, right? I thought like, know everything there is to know about sex. Like, it's not a big deal and I don't care about talking about it. It's like, I'm cool.

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Dr Maria Sophocles (03:56)

Yeah. Cool, yeah.

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Stacy London (04:08)

I realize you're absolutely right. I come to this with my own set of prejudices and maybe I'm not as comfortable talking about sex as I thought I would because the minute somebody asked me to start talking about it, I was like, no, I don't want to. I don't want to. This is not, I...

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Dr Maria Sophocles (04:22)

Right, so where's that coming from? And it may be coming from other parts of your upbringing, could be family, could be, you know, in some women's cases, it's history of assault or non-consensual sex that we bury and bury and bury. You know, if we say one in four women on this campus is sexually assaulted, but we think it's much more than that. So it's...

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Stacy London (04:34)

Yes. Yes.

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Dr Maria Sophocles (04:45)

Or it's Sunday school that you long have abandoned, but somehow that stupid Sunday school teacher still saying, nice girls don't do this. So it all lumps together under a term called androcentric sex model or fallocentric sex model. That's the nerdy word. Yeah, it's just that sex is, if we look at the last 4,000 years, which does actually affect us, believe it or not,

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Stacy London (05:02)

Love it. I love it. First of I love the nerdy words, but yeah.

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Dr Maria Sophocles (05:13)

Sex has been for men. Remember women were property. So when you're property, you don't get a vote and your pleasure of course is unimportant. I mean, watch any Game of Thrones episode and you know that. But truly, believe it or not, generation after generation, that still filters down into what happens in a bedroom. And Stacey, my patients, I am so lucky they come from all over the world. They are badass women.

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triple PhDs and CEOs and celebrities and people who by your and my standards really own their world, right? Yet privately they say to me, I don't want to disappoint my partner. I think I'm disappointing my partner because I'm not as into sex as I should be. So that word should is the dangerous word. Where do they get that? I think they get it from Hollywood. I think they get it from porn. I think they get it from history and culture and - And ⁓ often women being pleasers, even badass, successful women in the bedroom are often pleasers. And in same sex couples, we see this too. One is more of a pleaser. So I found that fascinating and I found like that needed to be talked about that.

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Stacy London (06:23)

the dynamic. Absolutely. And I do think it is really interesting. mean, we talk about sort of ⁓ sociobiological, right? We understand that sex is for procreation just solely from a scientific point of view to keep the human race going. But yeah, the human species here and with us, I don't know for how much longer, but we'll see. but exactly.

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Dr Maria Sophocles (06:44)

That's right. We can't solve all of this on the podcast. ⁓

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Stacy London (06:55)

Exactly. We can't solve everything. And we can't solve the idea that this idea of youth, I don't want to talk about children, but certainly the idea of youth as being ⁓ kind of equated with fertility. And that this idea of as we age, we're no longer as attractive biologically because we can no longer reproduce. So there's an understanding that there's like a biological imperative that kind of sits on our cultural understanding of the way that we treat women. But this idea that women have never really had a say about sex, even though we carry children, even though we, you know, we're the ovens about this is where I was going with this. We don't even talk about women's pleasure in the realm of sex really at all. Like, I mean, yes, you know, I know we had the hype report and you know, we've had things in the past that have touched on this.

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Dr Maria Sophocles (07:31)

That's right. And about pleasure, just the concept of pleasure. We've tried over the last 50 years, we've gotten the, you know, the birth control was like, we have the birth control. Let's burn our bras. We're on our way. And so we keep making these little steps forward and I'm grateful for them. I mean, you and I are walking the path more easily because of that. you know, Gloria Steinem's fiery anger, you know, did help, but it's amazing the power of the rest of what I just said in terms of us privately still having a hard time owning it and saying my pleasure counts as much as yours without feeling selfish.

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Stacy London (08:25)

Exactly even feeling selfish or ashamed or embarrassed of wanting pleasure. I I think the shame around this is devastating. And certainly in menopause, one of the things that I found most devastating was like, I feel completely asexual now. I don't feel like I simply don't feel the same way that I felt. I don't feel like I want to show off my body in any particular way. I don't feel particularly sexualized. It just disappeared for me. And it's very hard. Yeah.

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Dr Maria Sophocles (08:58)

Yeah, that's super common. It's very common. But women feel very alone in that. feel, yeah, yeah. And so I want everyone listening to know that if you have that feeling, that's not uncommon. If you feel odd or alone in that feeling, that's not uncommon. But that it is absolutely not the death knell of sex for you and that...

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Stacy London (09:04)

I did, I do.

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Dr Maria Sophocles (09:23)

I would argue, you know, I lecture a lot on health and longevity and the four pillars of health, nutrition, sleep, movement, social connectivity. Everybody knows those. I would argue that sexual health is a fifth pillar because we know that people who keep sex in their life, whether it's with a toy, whether it's with, you know, self-touch, whether it's using the toy with a partner, whether it is multiple partners, you do you, no judgment. But keeping the release of dopamine and endorphins in our lives as long as we can is not a bad thing for your health. The opposite, we know it promotes a feeling of connectivity. We know that developing intimacy with another person has mental health benefits into your 90s. So when we look at longevity and everyone's biohacking and cold plunging and 50 different supplements, know, obviously sleep.

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Well, listen, I mean, if you've never had one, would say work towards having one. And if you haven't had one in a while, I would say try it again. And if you're like, you know what, I don't have a partner right now, or I don't like something going inside me, that is not my idea. And I don't orgasm from anything in my vagina, which by the way, welcome to the world, 80 % of women don't. So please unhook that myth. There are plenty of sex toys like this cute little rose that I just grabbed.

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Stacy London (10:44)

Right.

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Dr Maria Sophocles (10:51)

that just kind of go on the outside or on your upper thighs or your breasts or whatever part of the body feels good for you. So redefine sex for yourself. I know that the other myth is that the people who write all this porn and the people who've done all the, you know, sex acting, the men, the man's world has explained that sex equals penis and vagina. Like, could we please unhook that? and let sex be defined for yourself. And if it's just cuddling, it's cuddling.

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Stacy London (11:25)

I'm sure you're familiar with Cindy Gallup, who started Make Love Not Porn. And one of the things that I found so interesting about the endeavor, it is a website where real people can upload videos of themselves having sex and other people can download them solely because porn is not sex.

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Dr Maria Sophocles (11:30)

Yeah. Yeah.

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Stacy London (11:45)

It's that it's taught a whole generation of young men that your boobs are supposed to look a certain way and that we really want you to ejaculate on our face or whatever. All of these things that just literally kind of go against any common sense in terms of what real intimacy is or could be. And I think that I was curious if you felt that there is something to this idea, that the way that we've learned about sex or a whole generation has learned about sex from porn has stopped us from even asking questions about intimacy and it's just become this kind of performative.

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Dr Maria Sophocles (12:24)

You hit the nail on the head. You're gonna write the second book with me. Yeah, yeah, let's do it. What the problem is that because people watch porn and just imitate, we've seen number one, a huge increase in increasingly violent acts towards women, which women are supposed to enjoy because they enjoy it in the porn video, but in general, it is not enjoyable.

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Stacy London (12:30)

I'm ready with you.

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Dr Maria Sophocles (12:52)

we've seen a complete lack of asking, what do you like? What do you like? Couples who have been together in hookup culture rarely ask that. So when we look at the orgasm gap, it's huge in hookup culture, because there's just no verbal communication. It's better in long-term relationships, because more long-term couples learn what the other likes. But even long-term couples don't actually have like a sexual check-in. They don't really say things like, You know, last week, that was so great for me. And you know why? Blah, blah, blah. And what you did, blah, blah, blah. I love that. And I would love it if we did it more. What a simple thing to say. We say that about a chicken recipe, right? We say that, know, Stacey, I love that chicken you made and I loved how spicy it was, but we can't say that about sex. So we need to get rid of this puritanical like, no, no, don't talk about it thing. Cause just simple communication can buy so much towards mutual pleasure in a relationship. I mean, it's so, so obvious. And I think that's where you were going a little with this is porn is sort of just visualize and copy instead of actual working together to aim for mutual pleasure and or intimacy. There is female friendly porn. We just have to go find it. You have to look for it.

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Stacy London (14:09)

Right, exactly. I mean, exactly. But I guess what I find so interesting is that ⁓ I've heard so many people in menopause. we, I think, even talked about this, that there was that scientific American study that the lowest point of happiness for a woman is 40 to 50, ⁓ and that it's the highest rate of depression, decreased earning potential.

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Dr Maria Sophocles (14:35)

Yeah. and infidelity.

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Stacy London (14:45)

I was like, okay, now menopause could be responsible for any one of those things, right? But when it comes to the divorce, the bedroom gap, I'm so curious as to how you recommend ⁓ building that sense of intimacy and trust and communication. Because I think that when you talk about, hey, why can't we talk about the fact that in last week, that was so great and like what you did. I mean, I'm cringing inside, even hearing you say it, it makes me so anxious because I don't...

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Dr Maria Sophocles (15:17)

No, I know because we've been so conditioned that you don't talk like that.

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Stacy London (15:22)

⁓ So how do we change that? How do we change that, whether we're partnered or not partnered, how do we start to kind of desensitize ourselves to the idea that talking about sex is so dangerous or scary or embarrassing?

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Dr Maria Sophocles (15:36)

Yeah, I often tell my patients, because I'm a sex counselor also, they come in, so we're sort of knee to knee, as I say, and we practice together. So I'm the partner. And we practice things like ⁓ pretending we're on a walk or in a car, so you're looking forward. I mean, this is the beauty of a therapist's couch, right? You don't have to look someone in the eye. And we practice always starting with a compliment, never non-judgmental tone.

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Stacy London (15:44)

Right.

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Dr Maria Sophocles (16:05)

because what you don't want is the person to get defensive. And many people do because, you know why they do? Because we're expected to just know how to do sex. How stupid is that? We're not expected to know how to ski. Everyone knows you put the boots on and you started the bunny slopes and you fall a lot. But you're a cool girl or a cool guy if you automatically are good at sex and know how. It's a litmus test. It is as...

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Stacy London (16:16)

Exactly.

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Dr Maria Sophocles (16:33)

cool and important probably is being beautiful or fashionable or wealthy or whatever other metrics we use. And that sucks because we're not even getting properly taught. So you want to be very careful not to be sound judgmental or disappointed or groans or eye rolls. And even if your partner does do groans or eye rolls, you want to understand that that's because you're

opening a tough conversation at first. So you really do want to, ⁓ I always say, start with a compliment. You know that time we went to the mountains and blah, blah, blah. Think of something that truly gave you kind of goosebumps or you had fun with, and what it was that you loved and speak the truth and speak honestly. And, you know, I think people can sense that and appreciate that. And you can just say, you know, that made me feel so good. I just want to share with you how great I felt. Maybe you say, could I do that could make you feel great? What is it that I'm not doing? In other words, own it a little bit yourself, because all you're trying to do is open up conversation and it's gonna feel like it's in Portuguese for you because it's beginning, but ⁓ eventually it'll feel like your native tongue and pun intended. And...

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Stacy London (17:38)

Yes. Yes, exactly. That's what I'm saying.

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Dr Maria Sophocles (17:54)

And I think you just have to start. It's literally the same as learning a language. The hardest part is starting because you're more likely to stumble. And that's why patients like to stumble with me first. But I think if you don't have a counselor or a therapist, A, you've got a mirror. You could try it with a trusted friend. But you almost want to practice it because, Stacey, I think it's so hard for almost everybody.

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Stacy London (18:03)

I mean, this isn't just hookup culture, right? mean, this is even in people's long-term relationships.

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Dr Maria Sophocles (18:23)

No, I'm talking long-term relationships. And I've had many people say, they come back to see me a month later and I say, how did it go? And they go, I couldn't do it. I couldn't do it because we've been together for so long. I think I'll just deal. It's not that bad. You know what? Like if you made shitty chicken, I wouldn't say that. I'd be like, excuse me. I love coming over for dinner, but you can't just put mayonnaise on it. It's just, killing it. You know, and, and, I, I, or I'd be more polite than that, but you know, it's funny, but it's like this topic and we're so afraid of hurting the other person's feelings, but that here's my suggestion. That other person, that partner actually does want to please you. They actually do he or she. And

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Stacy London (18:54)

That works on fries, not chicken.

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Dr Maria Sophocles (19:14)

If it can't come off as criticism or even constructive criticism, but if it comes off as part of a mutual goal of skiing even better together, you know, I think that takes some creative artistry with how it's delivered. The who, what, when, and we say that in the book, who, what, when, where, how, so that people can...

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Stacy London (19:22)

It’s all so important about the way, I mean, I completely understand that kind of communication needing those factors. But what do you do, I mean, really, what do you do with the fact that like, I have completely, like, I'm on hormones, I actually, don't take testosterone, but I am on hormones. ⁓ And there is a certain point in my life where I could care less about sex. I just,

It's not even, I don't even think about it. I don't even think about pleasure or physical arousal. And it's a little weird for somebody who like went from having like a pretty healthy, you know, normal sex life in all of my relationships to not wanting one. And that doesn't mean.

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Dr Maria Sophocles (20:19)

Yeah. And that's hard on your partner if you have a partner. And if you don't have a partner, it's easy to just keep going without it. And people come to see me and they say, actually, it's been six years, but I've been busy. have a show, I've been writing a book. I now have a travel show I produce. I have all this stuff I'm doing. And I'm like, great. I'm so happy. Your life is so full and great, but you're taking the time to come here and ask me. So you must know that

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Stacy London (20:26)

Keep going. Right. and ask.

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Dr Maria Sophocles (20:46)

there could be this other, like this better thing. And I would say, first of all, part of it is hormonal almost always because even when we take hormone replacement therapy, those are teeny, teeny, teeny doses. And the brain has multiple areas that respond to sexual cues. Multiple areas are estrogen deficient and really testosterone deficient too. And I'm not saying get testosterone and all your troubles will be over. It is more complex than that. We live in a society that prioritizes productivity and sometimes profit over pleasure. And I'm not against productivity or profit. I've got my back-to-back calls today and some are for profit, so I don't want to be a hypocrite, but we prioritize it. And so when you prioritize it, you are no different than the person that says, I am too busy. I can't possibly exercise.

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Stacy London (21:30)

Right, exactly. We all have to live in the real world.

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Dr Maria Sophocles (21:45)

Really? That's the person that probably needs to exercise more than anyone. And so I think when we're busy, we have the perfect excuse. And I would just remind you that you remember how good it feels after you have sex. And you remember, like many people, having said to yourself or a partner, why don't we do this more? Most people say that. Why don't I do this more? Well, whether it's kids or an aging parent in the next room or a 6AM, ⁓recording call or whatever it is, we all have our reasons. But it could even be, don't like my body, my body's not perfect enough, I don't want someone to see my body. There's a lot of reasons. One is being very busy and being in a productivity focused society. But there's another that's really about aging and that we don't allow ourself to age okay. know, Kate Winslet's, I'm okay with my wrinkles. I mean, I...I buy it to a point because I love that she would come out and say it perfectly, but most of what we're fed is that wrinkles are not okay and cellulite is never okay.

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Stacy London (22:49)

Yes, I actually think that's a huge part of it for me. I don't want to, I'm not putting on a bathing suit. Oh please. I don't want to put on a bathing suit ever again after it. Now I'm 57. I'm like, no, no. And maybe that is part of it. Part of it, I do wonder sometimes, this wasn't meant to be a personal therapy session. So I do have other questions, but I do wonder if sometimes if part of it is just that I became

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Dr Maria Sophocles (23:00)

And you're gorgeous! Can you imagine what non-gorgeous people think?

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Stacy London (23:23)

During menopause, I became very insecure about my body and certainly insecure about my looks in the sense that I felt like there was a very long, almost 20 year period of time where my looks didn't really change. From like 25 to 45, I pretty much looked exactly the same. ⁓ Then to actually see physical changes, to really see that your hips spread and your tummy get bigger and your boobs get bigger and your arms get flabbier and things like that. I think if you've already been somebody like me who struggled when I was younger with body dysmorphia and eating disorders, that can make it that much worse. sort of, I'm tracking. Yes, it's like a trigger back. And instead of wanting to feel the confidence that I feel in the rest of my life at 56, that is one area where I have lost all of it.

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Dr Maria Sophocles (24:00)

Yeah, it's like a trigger back to that, honestly. Yeah.

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Stacy London (24:15)

It's, you you'd think that in midlife you can say, now I know what I like now. I'm no longer people pleasing. And so if you are having these healthy conversations, you can be like, this is what gets me off. This is what turns me on. But I think in some cases, particularly like somebody like me, being so self-conscious made that transition even harder.

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Dr Maria Sophocles (24:38)

For sure, for sure. And we know when we talk about that happiness curve, that it's a curve kind of, there's sort of a, so there's a happiness curve and it's actually gets, it goes up after 60, which is great, but it actually splits into a low again and a very high. And the low, the people that do not survive this well in terms of happiness and health are the people who hold on to I hate aging, I hate aging, I hate it, I hate it. Everything's worse, more and more wrinkles, more and more health issues. And they isolate and they're less socially connected. And they go the wrong way. The people that actually go up and 70 is better than 60 for them and 60 is better than 50, those people do the opposite. They embrace, hey, I don't need contraception if they used to. Hey, I don't have to pretend I'm 20 because I'm far enough and I'm beautiful in my own way. And, you know, they kind of embrace the change and say, look, it's happening to all of us. I went to a lecture at Duke two days ago. I was doing a book signing at Duke University and there was a lecture on aging. And the woman said, she was so cute. She worked at the medical center and she said, hot news flash ⁓ on causes of all diseases. The common root factor.

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for the development of everything is aging. And we all laugh just meaning like, as we age shit happens, you know? So once we accept it, we can actually pat ourselves on the back hopefully and say, you know what? I turned 60 this year. I look pretty damn good for 60.

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Stacy London (26:11)

Exactly! It happens! That makes sense to me. You look fabulous. Your skin is amazing.

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Dr Maria Sophocles (26:26)

Thank you. mean, you know, I'm very lucky, like I'm A cup, so there's nowhere South for the boobs to go. So I'm like celebrating that. I'm celebrating my wins. And I think we have to just look at our wins and you know, for some people it's just a scintillating personality, but I would take that. That's going to be there with you for a long time. My dad's 90. He is still so funny and so witty. And as everything else is starting to not work so well. It's amazing that he's holding on to that humor and that wit and it's beautiful. So I say find your beauty and hold it.

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Stacy London (27:02)

But I guess I find your beautiful and hold it is great. And in theory, I love it. Where's the mic coming? Only because I am so incredibly confident in a different way in my 50s than I was in my 20s, my 30s, and my 40s. But this particular topic is the one that really gets me. I don't feel like I'm not confident in my life or capable or anything. But when it comes to this, I feel like I don't know how to explain it. I feel like sex was for my youth. And now it's not that I'm, I feel, it's not that I feel too busy. It's that I feel like it doesn't hold any interest for me. And I find that odd. I find like my brain just turned off one day.

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Dr Maria Sophocles (27:48)

Well, I want to give you grace and give you permission to live your life without it if you want. I don't think anyone's going to be on their death bed going, ⁓ I lived a bad life, but I would also.

But you might be on your deathbed saying, I'm so bummed I didn't sleep with someone. And I think that let's split this into libido and capability. Because the definition of the bedroom gap, the reason I came up with this term and Oprah was very kind to bless it and say, yep, it's a real term. We didn't wait for Merriam-Webster. We just asked Oprah. That's all that matters. So it's a real term. And actually, they use it in psychology classrooms now.

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Stacy London (28:18)

Okay. Yes. And that's all that matters.

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Dr Maria Sophocles (28:35)

The bedroom gap is the difference in expectations and abilities between partners in a bedroom. And it often is exacerbated by menopause because of the estrogen changes, in men erectile dysfunction, ⁓ by health issues. But it actually can close again in the older years, in the 70s and 80s, because couples start to accept- Okay, you might not orgasm ever or your orgasm might be wimpy. I don't care. I just love cuddling with you. I love what I call NST, naked snuggle time. know, I mean, everybody can define sex for themselves at every age. The reason 20 and 30 year olds are unhappy often is that they're defining sex by porn. So they're just failing. They feel they fail every time. At my age and your age, we can, we have the wherewithal because we're confident to define sex and hopefully talk about it a little bit. So.

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Stacy London (29:38)

I mean, this is, but it's so funny listening to you speak. ⁓ It was the first time that I thought, ⁓ I really want to talk about this. I really want to talk about this gap. I really want to talk about the fact that there are issues with communication because I think women are people pleasers and because they're afraid of confrontation in a lot of situations, mostly in heteronormative relationships. But I think it holds true for same sex as well.

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Dr Maria Sophocles (30:00)

It holds true. Yeah. Yeah. There are power dynamics in lots of

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Stacy London (30:03)

There are power dynamics and then there is that just deep shame and right of thinking there's something wrong with me if I don't orgasm every time or if I'm not interested in this the way that I've grown up seeing people have fun having sex. Yeah.

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Dr Maria Sophocles (30:07)

People pleaser of shame. And make no mistake, same-sex couples have the same pressures, right? We were really hot and heavy. now, you know, I had a couple, I wrote about them in the book. One, her parent became very ill and her brain was just so focused on the caregiving and she just had no interest in sex. And she felt so bad that she was letting her partner down. And I actually had an appointment just with the partner and just said, you know,

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Stacy London (30:24)

Of course!

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Dr Maria Sophocles (30:47)

I just want you to know how much she wants to please you sexually, but her brain is really busy now. She's sort of grieving that her mom is dying. And the partner was like, of course, of course she is. But they hadn't communicated that to each other. So sometimes it's just that. But the expectation part needs a minute because what happens when we go through menopause, we actually lose blood vessels in the bottom of the vagina, in the labia, around the clitoris, that blood flow, we've measured the speed of it, it slows. It actually slows. The nerve endings for pleasure get replaced by some for pain. mean, who invented that? But that, right. So some women literally, a man, some women literally don't have orgasm anymore or it's wimpy or anemic or it takes forever. And they just feel like it's not worth it. I don't, this is too much work. It's like, don't, you know, or it hurts. And if something hurts, of course you don't want to do it. So if you're in the pain department, please go find someone who can help you with that. ⁓ If you're in the, yeah.

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Stacy London (31:49)

It hurts, right? mean, that's, my God. You don't want to do it. if you're in the pain department, you're saying, please go see somebody about that. What are some of the, because we like to be action oriented on this podcast. What are some things that we can ask for or look for to at least understand what is happening to us in terms of that pain?

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Dr Maria Sophocles (32:10)

Well, you ask the clinician, are you comfortable treating pain with sex? Because I have pain with sex. You want to be able to tell them, is it with deep penetration? Is it with certain positions? Is it with certain toys? Is it only on the opening? The most common area is the very opening. We call it the vestibule. Just think of the entry to a church. No, that's what it was named after.

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Stacy London (32:43)

Okay, makes sense.

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Dr Maria Sophocles (32:44)

A professor of mine named it. So embarrassing. What a claim to fame. And he was a devout Catholic, so he named it the vestibule. my God. Anyway, whatever. ⁓ I was on NJ Transit the other day and they made an announcement, please don't linger in the vestibule. And I thought, really? Some people would love to linger in the vestibule. Terrible. I know. Awful. Awful. ⁓ But anyway, be prepared to help them help you by saying where the pain is.

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Stacy London (33:00)

And you have my version of the movie.

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Dr Maria Sophocles (33:11)

And then you should absolutely, they should want to examine you and see where the pain is. And they should be able to tell you, there's some scar there from something or other, or no, I don't see anything. If they don't see anything, that's fine. But it means some estrogen cream or testosterone cream or both will probably help make the tissue healthier. It's literally liquid gold. mean.

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Stacy London (33:34)

And it's non-systemic, right? This is like what I love to tell people.

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Dr Maria Sophocles (33:36)

Non-systemic. There is no one for whom I don't care what cancer you had. I don't care if your mom had cancer or your hairdresser had cancer. Nobody with cancer can't take vaginal estrogen. And if you're afraid, then take vaginal testosterone. Comes in a cream. We make it up as a compounded testosterone cream. It's crazy safe. It's really not that expensive either. ⁓ And if you're dismissed.

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Stacy London (34:00)

Well, that's the other thing. We all know that when ED became an issue, or really that it was about, I thought it was about heart health originally, right? ⁓ And we discovered the little blue pill that is ⁓ why I'm having a menopause moment. Thank you. Viagra, Cialis, or any of the others that I've seen commercials for. ⁓ I know that Cindy Eckert came out with Addie.

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Dr Maria Sophocles (34:19)

Viagra, Magic Bullet, yeah.

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Stacy London (34:29)

I don't know if Addie is the only sort of female version of Viagra, but I was going to say, there medications? yeah. I was going to say, are there medications that can help either with pain or just with arousal, know, desire?

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Dr Maria Sophocles (34:33)

It's not. I'll tell you a little more about that. And the book... Go ahead, you ask your question. Tell me your question. So let's quickly go through those so people can have some action items. So estrogen and testosterone can help regenerate cells, make new collagen and make new blood vessels. That's great for pretty much anybody. And you can stay on those forever. Like I'm bringing mine in the casket just in case, you know, they don't have refills wherever I'm going. And, but there are...

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Stacy London (34:52)

Yes. The Greeks said coins, you're bringing estrogen and testosterone. I like it.

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Dr Maria Sophocles (35:15)

Yeah, yeah, there are prescription medications. The first FDA approved for women was Addi, A-D-D-Y-I. I was a researcher on that before it was Addi, before Cindy even bought it. So I knew about it. ⁓ The bummer is that you take it every day. And some people just don't want to take medicine every day. So you don't use it like Viagra. I'll take it. I'll bring it on my hot date or my getaway weekend. You don't use it as needed. You use it every day, just like you would take an antidepressant or a blood pressure lowering medication. So some women just don't want that, but others are like, Hey, I want something. And it works in the brain, not unlike an antidepressant. The second Medicaid, and it's now been approved for menopausal women. Cindy Eckert had to fight and fight and December 15th of last year, she got it approved for. menopausal women, as if we're some freaky species that needed our own approval, you know, even for the near death women. I mean, my God, there's still so much sexism in the FDA. It's unbelievable.

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Stacy London (36:11)

I mean, are there any women on the FDA? That's my question. I'm like, really?

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Dr Maria Sophocles (36:26)

Yes, and they are stunning. I mean, when you hear them say things like, did you see the pink pill yet? The movie you get.

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Stacy London (36:32)

I haven't, and I was so unhappy to miss the premiere with Cindy in New York, but ⁓ nothing but great things. Great.

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Dr Maria Sophocles (36:37)

No worries. Well, I can send it to you. I can send it to you. Yeah. You'll see old footage from the FDA where they're like, I mean, do women even need anything for sex? Sort of like women and sex in the same sentence? What's going on there? So, I mean, I know, and I'm actually working on my own documentary about sex and women and it's funny and irreverent because like Cindy, feel, well, I think Cindy's… film really tells the story of the ridiculousness of the FDA slow to approve thing. And that's actually in my book, The Bedroom Gap. We tell that story because it is stunning when you think of how Viagra was rushed through and it became the fastest selling med on the planet and all that. And if you want Viagra, you don't even have to have a problem. You can just want to better sex.

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Stacy London (37:28)

Exactly!

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Dr Maria Sophocles (37:28)

But if you want Addie, you used to have to demonstrate a severe lack of depression. It's causing marked distress. Like you couldn't just have a down patch in your relationship. So now it's better. So you can take Addie, you get it by prescription. know, good luck finding a doctor who knows about it and is comfortable prescribing it, but hopefully you can. And I say that sarcastically, but also the fact that most physicians literally still don't even know what it is.

The second medication is called Vileci, V-Y-L-E-E-S-I. It's an on-demand injection. Don't be freaked out. We give ourselves a Zempik and, you know, Majaro and all these all the time. It's the same little tiny needle and it releases tons of dopamine. So you're like really wanting to have sex and it lasts for like 15 hours. So neither one is perfect. One's a pill every day. The other's an on-demand injection. The injection The first time you take it can cause some pretty bad nausea. So I tell people the first time no partner just you a Movie near the bathroom. That's it. It's like before your colonoscopy. Just that's your night, you know Seriously, seriously,

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Stacy London (38:43)

Maybe slightly more fun. Maybe there's like a happy ending. Right.

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Dr Maria Sophocles (38:46)

yeah, more fun. Yeah, yeah, more fun. More fun. For sure. I tried it. But then after that, your body gets used to it and people love it. I mean, they call me and they're like, I'm going on a cruise. I want it. But cost is sometimes an issue. Viagra is dirt cheap and available everywhere. The pink pill and Valencia are more expensive. And don't forget that

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Stacy London (39:08)

Is that something that you see coming down? I mean, eventually, like...

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Dr Maria Sophocles (39:12)

Yeah, I think they will. Don't forget that good old boring testosterone, we can use it for libido itself. So we can use it on the clitoris to promote blood flow, but we can use it just through the skin as a gel or a cream to enhance libido. it definitely works, but at the doses that it really works, you may have… oily skin, chin hair, stuff people don't like. for prescri- like I've been prescribing testosterone for 20 years. So for someone like myself, I'm always walking a tightrope of I want to keep it in a fairly safe range, but I want it high enough that my patient comes in and goes, thank you. I watched, I binged something on Netflix and like, I just can't stop thinking about wanting to have sex.

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Stacy London (39:53)

Right.

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Dr Maria Sophocles (40:00)

I love it. I don't want anyone ripping off someone's clothes in a supermarket, but I want people to at least have the oomph, the little desire, like you said, just to think about it at all, you know?

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Stacy London (40:12)

I you know, I joke around all the time now about being dead inside. just, I mean, you know, the irony is not lost on me, but that is a lot of the times what I feel, not this sense of ⁓ being inept or in any way feeling like this kind of ⁓ sense of lack, but the change for me in any case was extraordinary.

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Dr Maria Sophocles (40:41)

Yeah, I hear it every day. Yeah.

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Stacy London (40:44)

go from being sort of this, you know, kind of physically vibrant human to not, to just not. And maybe, you know, like, again, I have like a love-hate relationship with exercise. I think there has something to do with physicality in general, but that's just, you know, me. That's just my story. And the idea that...

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Dr Maria Sophocles (41:03)

No, I think that's a really good one. I think those are really good points. And what I find is a lot of women, remember 80 to 85 % of women our age have dysfunctional sleep. So most, even if they don't really embrace it, even if it's like, just wake up a few times during the night. And we know that when your sleep is disrupted, mood is different, calorie intake is different, interest in sex is different. So even things like sleep can impact our libido.

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Stacy London (41:35)

And when you say sleep, can that be lack of or too much?

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Dr Maria Sophocles (41:42)

Yes, and it can be just being off your rhythm, your rhythm. But the most common thing is that women are age fall asleep, but don't stay deeply asleep. They kind of wake two, three or four a.m. And because they're women, they're like, it's not that big a deal. But actually it is. You are depriving your brain of real restorative sleep. ⁓ And the funny thing is like a lot of my patients who have that, they're like, but my aura ring says I'm getting good sleep.

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Stacy London (41:43)

Because I, Yes. So now Palantir knows that you're getting good sleep.

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Dr Maria Sophocles (42:14)

That's right. I mean, I think these are fun, you you've got to see how do you feel. We all know when we get great sleep. And I would say, same with sex, like sometimes think about when is sex enjoyable for you and when is it for your partner? If your partner's a night owl and you're a morning person, maybe you need to try to initiate at night. And maybe it's binging that thing on Netflix or listening to the app Quinn or you know, reading a book with some steamy scenes. I mean, we know that the female brain stores erotic content, just like a savings account. You know, maybe we don't want to watch porn, but that doesn't mean we don't see an Olympic athlete in the locker room and put something in our brain, you know? So don't be afraid to put erotic content in the brain. And when I give people testosterone, I tell them, this is only part of what I'm doing. The testosterone might be moisturizing the neural pathways of the brain, but I need you to feed it that content any way you like through the ears, through the eyes, you know.

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Stacy London (43:19)

Yes. I love this. Now, you talk a lot about the democratization of this education, which I could not be more ⁓ in favor of. Not everybody can afford to see a doctor like you. Not everybody can afford even to do hormones. How do you see this book helping with that democratization? Does it start with this kind of education?

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Dr Maria Sophocles (43:45)

I think the book, yeah, thank you. Thank you for bringing it up because I started thinking I'm writing this book for menopausal women. And then when I really did the research and thought, learned where do people of our generation, why did we learn not to care about pleasure, that sex was for men and just to shut up and take it or to fake an orgasm, where'd we learn all that? Well, I'll tell you where we didn't learn the right answers was in sex ed. So I think we...

Books like this need to get in the hands of 10th graders and of 23 year olds and of 28 year olds so that men and women can start off having sex be about mutual pleasure right from the beginning. You don't want to be 60 and go, God, yeah, I wish someone had told me that. So I do think that democratization is an age one. And I also think our population's living longer. We're having more and more 80 and 90 year olds. And guess what? When they stay sexually active in whatever way they want, they are less lonely and we have a loneliness epidemic in our country. So we want people to feel like they shouldn't be ashamed because they still want to cuddle or have sex or whatever. So the book talks about upending sex ed. 47 out of 50 states in our country do not teach progressive sex ed, Stacey, 47. So I know, whole other topic, whole other thing, but.

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Stacy London (45:09)

doesn't surprise me.

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Dr Maria Sophocles (45:12)

To me, we're getting a D minus in this country at educating our young people. And the states with the highest recommendations, the most stringent recommendations for sex ed should come from church or home are the highest unplanned pregnancies, the highest teen pregnancies. Not a shocker. So gosh, we have to fix that. We really have to fix that.

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Stacy London (45:27)

You know, it's so amazing to me when I look now at the kind of traditional education, even the education that we saw as higher education for going to college, right? I really am very frustrated when I look back now. I think maybe, maybe algebra came up once in a conversation in the 40 years since I took it. And my real question is, why didn't I learn about emotional regulation? Why didn't I learn about progressive sex education?

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Dr Maria Sophocles (45:59)

Yeah.

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Stacy London (46:02)

Why didn't I learn things that would actually have true life benefits? And I feel like education in a way is so disparate from the lives that we live.

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Dr Maria Sophocles (46:07)

I know, and this is why kids don't, they come out clueless. They don't know what they want to do. They don't even know, should I go to college? And they get to college and they finish college and they still don't know what they want to do. We put them on this treadmill and honestly, the curriculum has not changed much in like 150 years. So I mean, I think it needs a shakeup, but that's, you know, a big, big thing. But for sex ed, that's my little sliver of this. I think

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Stacy London (46:37)

Yes, at least we have your book.

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Dr Maria Sophocles (46:40)

Yeah, we have a book and I talk about sex ed in Holland and if we could incorporate anything like that, we will educate the next generation to be more thoughtful, more understanding of consent, more understanding of mutual pleasure, more understanding of contraception and to have sex when you're ready to own the potential fallout from it. Like we don't talk like that. We talk about putting a condom on a banana.

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Stacy London (46:52)

Exactly. We talk about putting a condiment in a banana, which is hilarious to me and was to everybody in middle school as well. But not even just the idea of mutual pleasure, this idea of generosity. I think about it and I'm like, weren't taught any of that. No wonder nobody's worrying about how the other person feels or whether mutual pleasure is an issue because we're not even.

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Dr Maria Sophocles (47:15)

So when sex-ed fails you in school and in Sunday school, you turn to porn. Like it's really not their fault and it's not men's fault, I don't think. They are turning to porn for answers and there's no way we're going to get the super mega profitable top five porn producers, all male owned, male produced, male funded, male run. Like zero chance we're going to get those guys to change their, you know, just, right.

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Stacy London (47:38)

Yes! Zero. You can only hope that Kristen Stewart's new film company comes out with something amazing.

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Dr Maria Sophocles (48:03)

Yeah, and Erica Lust has tried some, you know, I mean, we have our little things, but wouldn't it be amazing if more clinicians could feel comfortable sharing things like this with patients? So ⁓ we try one at a time.

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Stacy London (48:11)

Well, that's what I was actually going to ask you. What else, aside from the book, are you doing to sort of advance women's health and sexual empowerment? Tell me a little bit about the clinic. there doctors? Do you lecture in places where you can communicate with other clinicians, take the temperature, see what they can learn? I would suggest you are.

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Dr Maria Sophocles (48:28)

I mentor clinicians, but I mentor clinicians, but I think I'm going to try to take that up a level where we could have online stuff so more people can, I do it gratis, but I think I'm going to try to create kind of online courses for clinicians. ⁓ I am not doing enough for sure. I have a clinic in Princeton and I see patients, but I'd love to really brainstorm about how to get the teachings of this book to the masses, I think. I have some women in different cities who are right now buying up tons of copies and bringing them to homeless shelters and women's domestic violence shelters just on their own, which is mind blowing. Like I really want someone to go 60 minutes to go do an episode on that for them, not for me. Like what angels are they? And I think I'd like to start an initiative where when I do an event, if there's a hundred women in the audience, we could ask, people to pay it forward and buy, please buy an extra copy or two copies. And then those will be devoted to going to marginalized groups, to people who couldn't afford a book. Maybe Audible, this just came to me this minute, maybe Audible would do something, because that can't cost them much money to do that. So let's take that through. And if anyone listening has an idea, please do it, because I, please share with me, please find me, mariasophoclesmd.com, so we can find this book in the hands of people who will benefit, whether they're 30 or 60 or 90. I think that'd be fun.

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Stacy London (50:10)

And tell me just a little bit about the clinic. If people wanted to find you, to see you.

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Dr Maria Sophocles (50:16)

mariasophoclesmd.com, is my website and on that website you can link to that.

@MariaSophoclesMD is Instagram. So they can find me. I am working on a clinic in Kenya, speaking of democratizing things. That's just a fun project that for, for women who have nothing, I mean, they're, it's right near where Obama's dad was from. So it's kind of interesting to think when you see the dire health situations there. But the other fun passion project this year is this documentary that I hope will have a ⁓ program where we can bring that into schools and into women's groups, a lot like the Factor, where we'll be able to kind of make it so that women can feel comfortable going, well, yeah, I had breast cancer and I know how she feels. Or my mom told me not to touch myself either. That's why I never masturbated. We want to have storylines. that people can relate to. So that's called HOT, H-O-T exclamation point. ⁓ So I think it'd be fun to have a little QR code to raise some funds and awareness for that. And again, for buying extra copies of the book that guardian angels of this, stewards of this mission ⁓ in San Francisco, they're already doing it. In San Francisco, women are buying extra copies and bringing them to shelters and to YMCAs and places where women might not get to hear podcasts like this or have some access. I think that'll be neat, right?

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Stacy London (51:49)

Absolutely. I think that's wonderful. I think that's wonderful. And I do think that it would be, you know, thinking about the book and about the clinic, I wonder if there is a way to redesign sex ed for middle school. I mean, maybe you're just the person to do it.

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Dr Maria Sophocles (52:06)

Yeah, I already have a name for it. I think it'd be really funny. We call it Guyna College. So I actually trademarked that name because I thought it was kind of funny and cute. But obviously it needs to be culturally sensitive. It needs to be sexually sensitive. It needs to be sensitive to gender expression and identification. ⁓ I think to autism, you know, I have some of the most beautiful patients I have are autistic women who come to me and say, do you know, most doctors think I'm not interested in sex because I'm autistic and I don't understand why. And you get to know them and you realize, of course they want to be sexually expressive. And so we need to also reeducate clinicians, not to judge and not to be, know. So one step at a time, Stacey, but it's been so lovely sharing with you. I hope people enjoyed this. It's great.

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Stacy London (52:36)

I mean, first of all, I would just like to say I think the world of you. I think the book is fantastic. But I also think just what you're trying to do in general is so long overdue. And it's so nice to hear somebody who is so well-versed in this material that there's like a natural sense of trust.

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And I think that in general, lot of patients who are going to see doctors about menopause and sex-related issues are already so self-conscious and anxious and nervous. So knowing that you're out there and knowing that you're there to ⁓ sort of give us permission, really, to talk about this in such ⁓ an easy kind of casual way is really revelatory. And so if you haven't read The Bedroom Gap, please go get your copy. It will make all the difference ⁓ and spread the word because we are here to help Dr. Sophocles with this mission, sex positive mission for midlife and beyond.

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Dr Maria Sophocles (54:01)

Thank you. Thank you. ⁓ for all ages, and I want to say one other thing. I am licensed in 11 states, so people can find me. And if I'm not licensed in a state where you live, I will help you find someone because, you know, there's an American Academy of Sex Educators and Certified Therapists, AASECT.com. And you can go on that and put your zip code in And you can find, it's not that you're gonna find a gynecologist. I'm a little weird because I'm both, but you can find a sex educator and you don't have to be ashamed and you don't have to say, well, I don't have any real sexual problems except this. Just find someone and sit and talk. It's really empowering. It really opens your world up. so anyway, I'm happy to help you find someone. Just DM me on Instagram or something and we'll find you someone in your state. That's fine.

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Stacy London (54:42)

There you go. Dr. Sophocles, thank you so much.

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Dr Maria Sophocles (54:56)

Thank you.

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