Dr. Lauren Streicher: More Sex and Sleep?

Jonathan: Hey everyone, Jonathan Bailor back – and I am so excited about today’s session because we’re going to get a little bit more specific, so it may not apply to every single one of our viewers exactly, but I think there’s going to be nuggets of wisdom and awesome action steps for everyone and if not you personally, certainly people you know. We have with us one of, if not the — top specialists in the world when it comes to talking about the deeper causes and deeper solutions and scientific advancements that have taken place over the past 40 years as we spend more years on this earth maintaining our robustness and vitality because if you think about it — according to conventional wisdom, we have a really sad state on our hands if it’s just about eating less and exercising more because that means the longer we’re on this earth, the less we can eat or the hungrier andhungrier we need to become and the less and less time we can have because the more and more time we would need to spend exercising, according to that conventional dogma — I don’t know about you, but I don’t want to get hungrier and hungrier and more and more time deprived, the longer I’m on this earth. I’ve got more important things to spend my time on, so that’s why I wanted to bring our awesome guest today on the show. She is an Associate Professor of Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University. You’ve seen her frequently all over the media, as well as on the Dr. Oz show, she’s an absolute delight, author of upcoming book called “Love, Sex Again,” (tape mute at 1:40) finally fixes the issues that are sabotaging your sex life. She is a firecracker and I’m a fan of her, Dr. Lauren Streicher, welcome how are you?

Dr. Lauren: I am terrific and I love when guys are fans of the gynecologists. I don’t always hear that and that’s important.

Jonathan: Well, we have a huge amount of incredibly important and passionate women in this world and we make sure that we are living optimally and I feel like so much of the information out there, Dr. Streicher, is fundamentally wrong. We know that from a scientific perspective, but it’s also demeaning. It seems to say that like as we get more experience on this earth, we have to break down and we should just accept that and I don’t think that’s true, do you?

Dr. Lauren: No, and I want to go back to what you were just talking about a minute ago. The idea that we’re living longer and I think that a lot of women say, what’s the deal, my grandmother didn’t do anything special around the time of menopause and she didn’t take hormones or she didn’t worry about how she was eating or how she was living and the answer is you’re right because your grandmother didn’t live as long as you’re going to live and I think that’s such an important point for women to appreciate is that life expectancy is such that women are living almost 40 percent of their lives after the menopause transition and they’re not living these lives sitting home and baking cookies for their grandchildren, they are the CEO of their company, they are surgeons, they are pilots, they are traveling, they are biking, so it’s not just that we are living longer, which we are, but we’re living very differently than our ancestors lived, which is why we have to look at this transition and life completely differently than our great grandmothers did.

Jonathan: Dr. Streicher, that is a fabulous point and it gets to a more meta and macro issue, (?? spelling at 3:31)and it’s really why I wanted to have you on the show to get into some practical tips, because I personally believe that we are all put here to do much more noble and meaningful things than count calories and just like be on the treadmill, right? Like I don’t know if anyone ever on their deathbed is like, man, I wish I would have spent more time running on my treadmill.

Dr. Lauren: Right.

Jonathan: We often say that about work, but I don’t actually know if that’s true. A lot of people get a lot of satisfaction from doing work. I don’t know anyone that gets a lot of satisfaction from doing math at the dinner table instead of just eating food and enjoying their family and their time. So, how do we avoid this treadmill for lack of better terms, where the more time we spend on this earth, the supposedly less we need to eat and the more we need to exercise, because that just seems bleak.

Dr. Lauren: Right. Well, in a perfect world of course, everyone would do the sorts of things you’re suggesting, starting in their 20s, so that there shouldn’t have to be a major change and I think that’s one point that’s very important is a lot of women have it in their heads that the minute they go through menopause, suddenly they have to change everything they’re doing in order to maintain the same weight, the same fitness levels and the truth is, is if you’re doing it right from the get-go, you really don’t have to change anything that dramatically, because everyone thinks that the minute that their ovaries wind down, so does their metabolism and in fact that’s not what’s going on – at midlife, women do gain weight in their life, I mean no question, you and I both know that the average weight gain for a women starting in her middle 40s is about four to five pounds a year and talk about not doing the math. Well, this is one math problem you need to do because if you do the math, you find out that if 4 to 5 pounds a year after 10 to 15 years, you’re going to be up 30 to 40 pounds –

Jonathan: Yeah.

Dr. Lauren: And it gets away from you and I have women all the time who come into my office and say, I’m 30 pounds more than I was when I was 30, is that menopause and I’m like no, you didn’t gain 30 pounds in one year.

Jonathan: Yeah.

Dr. Lauren: This has been something gradual, so you do need to be aware of that and it’s really about being very much aware of activity levels and how you’re eating because what I think would be a good idea to do is go through why do women gain weight at the time of menopause? If it’s not hormones than what is it? And one thing that we know is that while women don’t necessarily gain weight from the lack of estrogen, there is a redistribution of the weight. So, if you take your typical woman who goes through menopause about the age of 51 or 52, and she stops making estrogen and let’s just say she doesn’t gain one single ounce, but she’ll say to me, my clothes don’t fit the same –

Jonathan: Uh-huh.

Dr. Lauren: I don’t look the same. She’s not imagining that. We do know that there is a redistribution of weight. So, that’s one thing. If you were to say, okay, well, what are some practical tips to prevent that from happening? Well, number one is we do know that women that take hormone therapy do not have that same redistribution of weight and we can talk a little bit more about that later, certainly it’s not the only reason that someone should take hormone therapy, but it is something that we have observed and the other thing is that women who may be were not thinking in terms of toning that part of their body earlier in life because they never had an issue need to think in terms of what they can do to tone that area – and if someone who was happy at their weight, they might have to take off a couple of pounds in order to get that midsection back where they wanted it, but there is a reality that there is this redistribution. Interestingly the woman that I’m most interested in is the woman who says to me, truly, I haven’t changed a thing. I eat the same way, I have the same activity level, and I’m gaining weight. Why is that happening? And while every woman is different, I think there is the number one thing that’s causing that weight gain midlife, is sleep disturbance.

Jonathan: Uh-huh.

Dr. Lauren: And when we look at things that are happening around the time of menopause, sleep disturbance is probably the number one thing that has a profound impact on someone’s health and wellbeing, not just their weight, but other things, and this is for a variety of reasons. First of all, we do know that women who were going through peri-menopause and post-menopause have hot flashes, hot flashes tend to keep women up at night. They don’t sleep well, but even women who don’t have hot flashes, we know that estrogen is associated with sleep disturbance and so while low estrogen does not directly cause weight gain, low estrogen does cause sleep disturbance –

Jonathan: Uh-huh.

Dr. Lauren: Either from flashes or just the thermostat in the brain getting reset in the sleep center getting reset, which in turn does cause, number one, the metabolism to slow down. We know that they’re the sleep hormones left in the (Inaudible 00:08:17), which are also very much responsible for not only metabolism, but that hunger center, so the studies have very, very consistent in the last few years that women that don’t sleep enough gain weight even if they’re doing everything the same.

Jonathan: Uh-huh.

Dr. Lauren: The other thing to think about it is what does a woman do when she is not sleeping? She gets up. Where does she go? Well, sadly more times than not, she goes down to the kitchen –

Jonathan: Yeah –

Dr. Lauren: Open up the refrigerator and starts to graze and doesn’t really think of that as having an impact, but it does, we know that nighttime grazing does impact on weight gain and then the other impact that sleep has if you’re not sleeping, you’re not having a lot of energy during the day –

Jonathan: Uh-huh.

Dr. Lauren: And studies have very clearly shown that women that don’t sleep well, if they have a choice between just kind of sitting around or exercising, or just being active – it’s like you said it’s not about getting on the treadmill, it’s about moving all the time and if women have the choice, if they’re tired, they’re not going to want to be active. We know that. The studies have shown that. We also know that women who are tired make poor food choices.

Jonathan: Hm –

Dr. Lauren: We all know that we give ourselves permission to not eat well. I had a bad day, I deserve the cookie. I didn’t sleep well, I’m tired, I’m not going to sit there and steam some vegetables, I’m going to grab the frozen thing off the shelf because it’s easier. So really we know that when we’re looking at the four to five pound weight gain, it’s a combination of all of these factors. The other thing that women really need to focus on is they’re so focused on hormones, but a lot of times they’re thinking in terms of the wrong hormone and we know that one out of ten women do have underactive thyroids and I wish every woman that was gaining weight had a thyroid problem. They don’t. We do a lot of testing for thyroid because we have to just get that out of the way and make sure that’s not the problem and 90 percent of women, their thyroid is just fine, but there are those 10 percent of women midlife who do suddenly have an underactive thyroid, which for those women would explain why is it that they have the same activity level, they’re eating the same and suddenly they’re putting on weight because we know that an underactive thyroid of course slows down the metabolism.

One thing that a woman can kind of look at is as a practical suggestion beyond the blood test, is to see if maybe she does have a thyroid issue is to look at things like your hair, your nails, is there a change? Do you find that you’re maybe kind of constipated, feeling a little sluggish? Those are all things that go along with an underactive thyroid and a lot of women will say, well, I had my blood test a year ago, I was tested and it was fine, sometimes things change and if you feel like something has changed, don’t rely on the blood test that you had two years ago.

Jonathan: Dr. Streicher, it is so important and critical. I’m so thankful for you to uncover these deeper issues, just like identifying the sleep, the hormonal issues because so often we can see this vicious cycle and I’m sure you’ve seen this as well, which is a brilliant woman who has just a massive positive contribution to the world reaches this point in her life and is led to believe that she is probably not trying hard enough because if she would just try harder, this would work out, that causes her to then have even more mental distress –

Dr. Lauren: Yes –

Jonathan: Potentially causing her to need some pharmacological help, which then doesn’t help the weight or sleep issues even more and now you get into this vicious cycle where because you were given improper cause of your initial weight gain, you get depressed and then you go on medication, which causes you even more weight gain and even more sleep disturbance and how can we pool ourselves out of that vicious cycle?

Dr. Lauren: Well, I think the number one thing is to acknowledge that this isn’t a matter of a failure on the part of the woman –

Jonathan: Uh-huh.

Dr. Lauren: So often women will say to me, I’m having hot flashes and I’ll say well, let’s talk about some hot flash solutions and they’ll say, no, no, I’m going to tough it out and that’s because women are tough. They’re told they’re supposed to tough out labor, they’re taught they’re supposed to tough out PMS –

Jonathan: Yeah –

Dr. Lauren: That hot flashes come along and quite frankly most women are blindsided by how bad they are. They think before it hits, I can do this, I’ll exercise, I’ll do a little yoga, I’ll be fine and then all of a sudden, they find they’re ripping off their clothes and can’t sleep at night and then I think the number one thing is for women – for me – my message to women is give yourselves a break for god’s sakes –

Jonathan: Yeah.

Dr. Lauren: This is very, very, very difficult and this is not something that you’re just necessarily just going to tough out and it does have a major impact on your life and I think the number one thing is to acknowledge that and number two is that there’s this idea out there that hot flashes are really short lived and that if you choose not to do anything, that’s it’s all going to be better in six months or a year and what the studies now show us is that the typical amount of time that a woman with severe hot flashes has to deal with it is really in the neighborhood of three to five years –

Jonathan: Wow –

Dr. Lauren: This is not just a five to six month thing and about 15 to 20 percent of women actually have to deal with hot flashes forever – so if you’re in the camp of saying I’m going to do nothing because it’s going to go away, it might – it might – and it maybe that you are able to manage the hot flashes through some lifestyle issues. We know that not smoking, we know that women who are thinner, women who exercise regularly seem to do better with hot flashes, but acknowledging that maybe you do need a little pharmacological help and fortunately, we have a number of options for women to deal with hot flashes that can make an impact and one of course is hormone therapy, which I happen to think is the appropriate thing for most peri-menopause, post-menopause women to do if they are impacted by symptoms and it can be done safely and it can be done appropriately. No, it does not cause weight gain, if anything it causes women to lose weight because they’re sleeping better, they’re feeling better, they’re more active.

The other option that I wanted to talk about because this is new and a lot of women may not be aware of this, is many women of course either are told not take estrogen or they just prefer not to.

Jonathan: Uh-huh.

Dr. Lauren: They just prefer not to take post-menopause estrogen therapy and there is a new product that was just FDA approved a couple of weeks ago and will be available November 1st, and this is the first and only non-hormonal FDA approved product that has been shown to relieve hot flashes and it’s called Brisdelle, and what Brisdelle is, is it’s paroxetine and you have probably heard of paroxetine because this is essentially the generic name for a lot of anti-depressants – Paxil and there’s a number of them – but, what’s different about this is we have known for a long time that women who take anti-depressants like Effexor and Paxil and all that have reduced hot flashes, but the downside is as you said, we can have loss of libido, you can have weight gain issues, so we’re not enthusiastic about giving it for that purpose, but what was done was the study to show that if you give ultra-low doses of paroxetine, very, very low, not the doses you would use to treat depression –

Jonathan: Hm…

Dr. Lauren: But you can actually alleviate hot flashes and there’s no increase in weight and no loss of libido. So, specifically, the typical woman who’s taking paroxetine for depression is taking in the neighborhood of 20, 30, even 40 milligrams a day –

Jonathan: Wow –

Dr. Lauren: Brisdelle is 7.5 milligrams –

Jonathan: Hm…

Dr. Lauren: So, it’s ultra-low, it does not treat depression and that’s really very important for women to appreciate that Brisdelle is not intended to treat depression, it does not treat depression, but it does alleviate hot flashes and it alleviates it to the point that women are able to sleep, they’re able to feel better and I think it’s so important for women to know that there is this non-hormonal option that will give them relief that’s not going to otherwise impact on their life in a negative way.

Jonathan: Absolutely and thinking also you mentioned it can help with sleep. That sleep issue is such a sticky wicket, because if someone for example says, we’re not exercising enough and that is in fact true. It’s pretty easy for us to set aside time to go get on the treadmill or if someone says stop drinking so much soda we can just stop drinking soda, but –

Dr. Lauren: Right.

Jonathan: But the more you tell yourself, self, fall asleep, come on seriously, fall asleep, often that’s counter -productive, so what are some things we can do and I’m curious too. This can apply to anyone.

Dr. Lauren: Yeah –

Jonathan: For those of us that have a hard time falling asleep sometimes and even staying asleep, what have you seen and what does the research show where some of the most effective strategies we can take?

Dr. Lauren: What we find in most peri and post-menopausal women they’re able to fall asleep just fine –

Jonathan: Hm…

Dr. Lauren: They’re waking up –

Jonathan: Ah –

Dr. Lauren: And so when you look at sleep issues of course you have to look at – it’s a very different animal if you’re talking about the person who can’t fall asleep versus the person who falls asleep and wakes up and for most mid-life women, it’s the waking up part. In fact, I always kid around that if the typical post-menopausal women would start emailing at 3 o’clock in the morning, all of her post-menopausal friends would be immediately responding. She wouldn’t have to wait until the next day to get her answers, so there are a few practical things that have been found in the literature that make a difference. Number one, alcohol. We know that alcohol late at night is going to cause a problem with sleep in terms of middle of the night wakefulness. The other thing is interestingly, I was just at a conference about this and there was this study that if you cover the clocks – just put something over your clock, hide your clock, cause we all do it – you wake up at 2 or 3 o’clock in the morning and you see the clock and then you go into the catastrophic sizing, oh, my god, it’s 4:00 a.m., I have to get up in 3 hours, if I don’t fall asleep right this minute, I’m going to be really tired tomorrow –

Jonathan: Yeah.

Dr. Lauren: And this just makes it worse, so the studies have shown, set your alarm for when you need to get up and then cover the darn clocks so that you have absolutely no clue what time it is. The other thing is, is that many studies show that if you can’t sleep, yeah, get out of bed –

Jonathan: Hm…

Dr. Lauren: Because we want to associate bed with someplace that you sleep and you don’t want to lie there tossing and turning. Again it’s somewhat counter-productive, but when you get out of bed, what you want to do is an activity that’s going to make you sleepy. Maybe you read something that’s kind of pick up the paper or something like that. You don’t want to do anything that’s going to be really engrossing or that’s going to be physically demanding, but you do want to actually do something that’s going to be maybe a crossword puzzle or something like that will occupy your mind, but then you’ll start to get sleepy again and as soon as you start to feel that sleepiness, you get right back into bed. The other interesting thing that’s going on mid-life, and if you ask any woman, they will nod and say, yeah, it’s the old going to the bathroom thing. The over active bladder.

Jonathan: Uh-huh.

Dr. Lauren: Because a lot of women say, well the reason I don’t sleep is because I have to get up at night to pee – and then they can’t get back to sleep. What we don’t know in some of these women is, are they not sleeping and when they’re awake they suddenly feel like they have to pee or is it the fact that they have to pee that wakes them up?

Jonathan: Uh-huh.

Dr. Lauren: And both of those can be factors, but we do know that many women do have an overactive bladder, which can contribute to night time wakefulness and while there are drugs that can be used do to help with overactive bladder, I’m not a fan – because we’re looking at a lifelong issue and what we know is that there are some specific things that you can do without drugs to get rid of the overactive bladder and one of the things that causes an overactive bladder is that the bladder actually contracts inappropriately. There’s a muscle in the bladder called the Detrusor muscle and if it starts to contract when it’s not supposed to, that will make a woman feel like she has to go to the bathroom and there’s actually a new device which is incredibly cool, called InTone, which is a pelvic floor strengthening device that a woman uses at home, but it also relaxes this bladder muscle, but the main message though is that if you are getting up to pee this is something that you should address as a separate issue –

Jonathan: Hm…

Dr. Lauren: Because if you don’t have to get up to pee – and what a lot of women do is they fluid restrict. They think okay, I know I’m getting up to pee at night so I’m not going to have anything to drink after 4 o’clock. This is not a good idea. You do not want to fluid restrict. A normal person with a normal bladder should be able to sleep through the night with having a normal amount of fluid. So, stop with the fluid restriction, find out if there is something you can do to strengthen your pelvic floor, to strengthen your bladder and that can go a long way towards getting you to sleep at night, get rid of the hot flashes, cover up the clocks and don’t sit there and toss and turn. The other thing is, is that when we look at mid-life insomnia, a lot of women have sleep apnea.

Jonathan: Hm…

Dr. Lauren: We are looking at as you and I both know, the reason why we’re both here talking is because we have a population which is very overweight and many overweight people do have sleep apnea, which even if they’re not aware of them keeping them up at night, they have a lot of sleep disturbance –

Jonathan: Hm…

Dr. Lauren: With the science has shown more recently, which I think is a great interest is it’s just not overweight and obese men and women that have sleep apnea, we’re seeing it in a lot of thin men and women as well, and it’s really just because of the way – if you will – the shape of their nasal fairings, the back of the throat which can sometimes be obstructed in terms of their ability to breathe freely while they’re sleeping and this is such an important point because a lot of women and men will say, well, I don’t have to worry about sleep apnea because I’m thin, I’m fit and that’s something only fat people have and nothing can be further from the truth. So, I am a believer in sleep studies. Most major universities do have sleep clinics where if you’re not sleeping well, find out, find out is it because you have sleep apnea, is it because you have restless leg syndrome, or is it because you have hot flashes or is it because you have to get up and urinate. I mean there are just so many correctable treatable, medical reasons that really sabotage someone’s ability to have a good night’s sleep and I think they have to put a lot more emphasis on that.

Jonathan: A brilliant distinction, Dr. Streicher because I feel that – I don’t know if this is like a western culture type thing, but if we have a problem getting our work done, we’ll be like okay, gotta go to the doctor, got to figure out what’s happening, because I’m not able to be productive or things like that, but when it comes to restoration and sleep, again, if that’s not working, you want to talk about not being able to get your work done, if you’re not sleeping, you’re not going to be able to get your work done, but we often, again, I don’t know if it’s the puritan work ethic that’s at the root of our culture, but we’re just like well, sleep, it’s optional I can get up early – it’s not optional at all, right?

Dr. Lauren: No, it’s not and it’s funny because as a surgeon, the number one thing a patient says to me when I greet them in the morning before surgery, I walk into the pre-op room to chat with them and pretty much every single patient says to me, so Doc, did you get a good night’s sleep last night because they had to be real sure that the surgeon slept and their pilot slept before they get on the plane. So, why is it that people recognize that this is important for the people in their lives that are doing serious things, but people just count the importance of that for themselves?

Jonathan: Yeah – I don’t know Dr. Streicher, but it is like we’re all guilty of it, right? I mean how often have you and I do this – wake up early to go burn the candle on the separate end. I can only imagine that for decades in your life, you basically had to compromise your sleep schedule.

Dr. Lauren: That’s right and it’s interesting because there has been a lot of research on that on the impact of fatigue on surgeons and quite frankly we see it in obstetricians, gynecologists more than other surgeons –

Jonathan: Hm…

Dr. Lauren: Because most surgeons– you take your typical heart/lung surgeon, yeah, they might have been on call the night before, but more likely than not, they were home in their bed sleeping. You look at the typical OB/GYN, there’s a good chance they might have been up all night delivering a baby –

Jonathan: Hm…

Dr. Lauren: And then they head to the operating room the next day. So it is something that has been just accepted in the old boys’ thing just tough it out and you can do it and I think there’s been a real disservice to patients and I don’t do obstetrics anymore, but I certainly do make it a point – I look at it as a responsibility, if I know I’m doing surgery the next day, I make it a point to get a good night’s sleep the night before – to not burn the candle like you and I both do sometimes. It is important. It’s very important.

Jonathan: And one thing again to highlight – you mentioned when you were going through the wonderful list of things we can do to help with our sleep, you mentioned something which surprised me because my grandmother use to always tell me because my grandmother was a very understated, very small — you would not expect her to say something like this, but one day I was telling her, I was like grandma, I having a hard time falling asleep, this was some time ago, and she said, well, Jonathan, you know, for the past 60 years I take a shot of bourbon and I’m out like a light – like that was her way to sleep, but it sounds like the research is actually showing especially relaxing with a glass of wine, maybe counter-productive?

Dr. Lauren: First of all, grandma’s always right. Never, ever, ever, argue with grandma. There’s a difference between a shot of bourbon and a bottle of bourbon.

Jonathan: Okay, okay.

Dr. Lauren: I think really — that’s the point. The point that your grandmother was making is that that little shot of bourbon helped her fall asleep.

Jonathan: Ah –

Dr. Lauren: And we all agree that alcohol can help us fall asleep, but it’s the excessive amounts of alcohol that are going to wake you up in the middle of the night, so grandma was okay and really the issue with having that one glass of wine every single night to fall asleep is that there’s a lot of calories of course, in the wine, but I don’t think that one little shot of bourbon is a problem. I think I like your grandma, I think that’s –

Jonathan: And have you seen anything Dr. Streicher in terms of more eastern, let’s say eastern approach is like deep breathing, yoga, any sorts of these more holistic approaches being effective or you kind of like, nah, not so much?

Dr. Lauren: Well, I think it depends on why someone is having an issue with sleeping. The one thing that we really didn’t talk about is the oh, my mind is racing, I’m stressed, I’m anxious, I can’t turn it off and this isn’t about hormones or sleep apnea or restless leg or any of the other things we were talking about, this is just someone who cannot make those synapses calm down and go to sleep.

Jonathan: Uh-huh.

Dr. Lauren: And I think meditation has been well shown, has been a very, very good option for some people in terms of helping them go to sleep, certainly anything that helps your body relax, a lot of the yoga practices, all of those can be helpful, the one thing you didn’t ask about Jonathan, was sex.

Jonathan: I literally have it next on my notes.

Dr. Lauren: We think alike. You know when I writing my book of course, when I talk about sexual health and I’m looking at what are the benefits of sex and the question always comes up, is — do people that have sex sleep better and it’s somewhat controversial, but what we do know is that people that have regular sex and particularly if they’re having orgasms, that those relax them and that of course is associated with better sleep. So, we know that anything that’s going to cause relaxation and you can choose your drug, whether it’s yoga, or sex, or meditation, but those things go a long way towards turning off your mind, getting your muscles, getting your body to relax.

I think the other thing also that we didn’t really talk about is physically being comfortable –

Jonathan: Uh-huh.

Dr. Lauren: When someone sleeps and that’s another thing that goes in to the heading we call sleep hygiene. Is the room the right temperature? Those pillows that you’ve been using for maybe 30 years, maybe it’s time to invest in a decent pillow –

Jonathan: Uh-huh.

Dr. Lauren: What is the noise level, what is the light level? I’m a big fan of sleep masks –

Jonathan: Hm…

Dr. Lauren: You know a lot of times it’s just, especially if you live in the city and there’s the flashing lights and the room is not completely dark, it does make a big difference to control your environment and it’s all part of the okay, let’s pay attention. I’m about to go to sleep. What can I do to my environment to make me in that sleep mode. And it really is a matter of okay, time to cover the clocks, put my sleep mask on, get the room to the right temperature — people tend to wear too much to bed.

Jonathan: Hm…

Dr. Lauren: You don’t want to be too warm, especially menopausal women who may flash during the night. That could be a major thing if they are wearing too much to bed, because they might be cold when they get into bed and then they start to have flashes and they get too warm, so you want to be sure that if you are cold, that you’re wearing something or have an extra throw or something that you can easily throw off the bed. What one cute little trick that someone told me the other day if you’re curious about if hot flashes is keeping you up at night because a lot of women don’t really remember. If you said well how many hot flashes did you have last night and it’s kind of hard, you don’t think about it, and one researcher told me that what he did was he told his patients that every time they had a hot flash they throw a piece of Kleenex on the floor, so keep a box of Kleenex next to your bed and when you have a flash just take it and throw it on the floor and the next day if you wake up and you see 15 pieces of Kleenex on the floor that tells you you’ve got a problem you need to correct.

Jonathan: I – I love this. Understanding these principles, these tips and for me at least the importance and the benefits of proper sleep, is so important and this is to your point, we haven’t talked, we covered is sleep optional? Clearly it is not and the more we can understand about the benefits of sleep, the more we can prioritize it and put effort towards it, just like we would to eating and exercise, because we’re capable smart people if we know something is important, we can make it happen. Sleep isn’t optional. Is orgasm optional?

Dr. Lauren: That depends on who you talk to. I think that a typical person they would say that an orgasm is something that they want to have, it’s important to them, sadly a lot of people have given up on that –

Jonathan: Hm…

Dr. Lauren: Because it has become difficult for them, both men and women for variety of reasons – it’s not something that’s required in terms of being able to sleep, in terms of health and wellbeing and in fact, when we look at tantric sex, which is interesting that Buddhists have very large body of work that the orgasm is the smallest part of sexual satisfaction and sometimes, in fact I think we put too much emphasis on orgasm because so many men and women who have difficulty having an orgasm feel like well, if I’m not going to have an orgasm then why bother? I’m not going to go there and I think it’s important to acknowledge that you can have pleasurable sexual activity and intimacy and enjoy sex even if you don’t have an orgasm. Having said that, it’s also I think is nice if you can and I think a lot of people don’t realize that there are things that can facilitate that. Interestingly, one of the things I was talking about before, women that have weak bladders are very often the same women that are not able to have orgasms because we know in order to have a strong healthy orgasm there has to be a contraction of the pelvic floor, that whole muscle group and those are the same muscles that tend to control the bladder and there’s a very high correlation between women who have issues with either an overactive bladder and incontinence and women who are not able to have orgasms or even have pain during sex –

Jonathan: Hm…

Dr. Lauren: And a lot of the work I’ve been doing lately has been focused on strengthening the pelvic floor through a variety of ways not only to help in terms of bladder health, but also to help in terms of sexual function.

Jonathan: And I get so excited when we discover things for example, which traditionally were thought of maybe things to (Inaudible 00:33:33)(tape mute) we actually find out, no, these are things we should go out of our way because they help our health. A good example that is most commonly understood is probably healthy fats, right? Like 40 years ago, all fat was going to kill you, it’s pretty much understood by anyone except the most (Inaudible 00:33:46) (tape mute) that there are absolutely fats that are therapeutic in fact, that are so healthy and sleep. Sleep was maybe one thing that was like oh, you need to power through and not sleep. We’re finding no sleep more and do you feel that while it might not be required, is a sexual experience almost like a vitamin pill for your soul? I mean is it going to have a hormonal impact as positive as proper exercise, proper diet, and proper sleep?

Dr. Lauren: Maybe.

Jonathan: Okay.

Dr. Lauren: A great big maybe on that. One of the things I again talk about in my book is if you Google health benefits of sex, and you will get a list a mile long of the things that sex supposedly does for you, but if you really look at the scientific literature to see what the correlation is, it really hasn’t been scientifically proven, but what has been scientifically proven is that men and women who have healthy sex lives do have increase in dopamine and endorphins which are the feel good hormones, that are increases in such as prolactin, which (Inaudible 00:34:54) (tape mute) a little bit more, so certainly there is a hormonal impact.

Jonathan: Hm…

Dr. Lauren: Are there other ways you can raise these hormones? Sure, sometimes there are through other activities, and sadly some people think food is the way –

Jonathan: Yeah

Dr. Lauren: To feel good, but I think when we look at sexual activity and the health benefits there is no question that there are some health benefits, but they may not be as profound. You know, it’s funny, one of the things that comes up all the time is if you have enough sex you’re going to lose weight and if you do the math for how many calories someone actually normally burns during sexual activity, it’s really disappointing, so don’t do that math.

What you find out is the average couple when they have sex it lasts for about 15 or 20 minutes, especially if it’s an older relationship, and we find that during that time, at best, they might be burning maybe 100 calories, 150 calories, so you can’t depend on sex to lose weight and I always say in the glass of wine you have before sex kind of cancels it all out so you’re not going to lose weight, but you are going to keep your body toned and I really also do believe that people have good body image and feel good about themselves are more likely to have sex, so guess which came first, the chicken or the egg? Do people with good bodies tend to have more sex or does having sex give you a toned, thin body and I happen to think that it’s not the sex that’s the toning and the calorie burning, it goes the opposite way.

Jonathan: Brilliant. Well, again, it’s empowering — I think is the key word for this conversation because for all of those individuals out there who are like, I’m restricting my calories as much as I can and I’m exercising as much as I can and if they’re not getting the results they want, they might think that there’s something wrong with them and they’re broken and what we’ve uncovered here is there is a bunch of things medicinally involving hormones that are still at your disposal, there’s a bunch of things involving sleep and there may even be some things around sex and just knowing that there’s these three big buckets –

Dr. Lauren: Yeah –

Jonathan: That if you haven’t explored it all, don’t give up because, wow, there’s a lot of opportunities and options for things to get better.

Dr. Lauren: That’s right and you know it’s funny because in my practice every day, and I usually see 25 to 30 women a day and pretty much their number one complaint is their inability to lose weight I mean this is of course something that people are obsessed with and just as you said when I say to them, well, what are doing, how are you approaching this, and they’re like, I’m trying not to eat, I try and skip meals — oh, my god, I had this woman yesterday and she was literally 300 lbs. and I said, and it was just like 2:00 in the afternoon, and I said, tell me what you’ve eaten today and she said well, I’m trying to lose weight I haven’t eaten anything, I’ve had some coffee and I said, yeah, and what’s going to happen when you get home from work tonight –

Jonathan: Yeah –

Dr. Lauren: And she said well, I’m going to eat, I’ll be hungry and I said, and what are you going to eat and she said, well, I don’t know I haven’t thought about that yet and I said well, that’s your second problem because you’re so hungry you’ll eat everything in sight –

Jonathan: Yeah –

Dr. Lauren: But this is a very common – and this is a smart woman –

Jonathan: Yeah –

Dr. Lauren: This was not an uneducated woman, this was someone who was really, really smart and she’s sitting there saying, yep, I’m not going to eat, I’m going to starve myself and I don’t know why it’s not working, but I’m going to keep trying and it’s not the approach.

Jonathan: Eating isn’t optional.

Dr. Lauren: No. And it’s funny because yesterday I was filming something all morning and I was rushing to get to the studio where I was doing this filming and I knew it would be about a three to four hour thing and I rarely skip breakfast, but I just had no time and so I grabbed my cup of coffee and my husband, he prepared me my Greek yogurt and fruit and said, eat this and I said I don’t want to eat this, I’m not hungry I’m rushed, I have to review my notes, I have to get there for my hair and makeup and everything and he just looked at me and he said what are you talking about? You’re going to be filming for four hours, eat this. And I ate it because he made me and I gotta tell you, right around 11 o’clock I was really glad –

Jonathan: Yeah –

Dr. Lauren: Because that’s when the film crew, I mean you know you’ve been there – that they always have like the donuts and all this (Inaudible 00:39:20) and had I not eaten my yogurt and fruit, I can guarantee you when they brought out all that junk around that I normally would never have eaten, you bet I would have just said, oh, my god, I’m starving, I gotta eat something, so yeah, even I fall off the wagon sometimes, so it’s nice to have people around you to say no, this is what you’ve got to do.

Jonathan: I love it. Dr. Streicher, this has been an absolute pleasure. So, I know you’ve got a wonderful book coming up that talks about a lot of the things we’ve covered here, what’s next for you (Inaudible 00:39:47)

Dr. Lauren: Well, the main thing I’m working on of course is the book. The book is coming out in a few months, “Love, SexAgain,” this is a book that is for everyone. When I started writing this book, I thought this was book was for men, I mean for women primarily that have sexual problems and what I found is even women that feel like they’re doing okay, it can always be better. There are a lot of things that women can do to make sure that their sexual health is everything it should be and of course for people that have lost that thread, who said I used to have sex, but now I don’t, either because I have no libido or it hurts, or I have cancer or I have diabetes or I have this issue or I have that issue, this book is for them. It’s funny, it’s light, it’s conversational, but it’s got a lot of really good information, so I am focusing very much on that right now and then of course I write blogs. I’m writing for doctoroz.comand I write for everydayhealth.com, and I really use those blogs to get the very latest information out because I think that’s always frustrating for women is to say, but where do I go to get the newest, the new information that’s out there because women go to see their gynecologist at best once a year. I wish I could say that every gynecologist kept up and knew all the latest information, but they don’t necessarily and I think women really need to empower themselves to get good information to make good choices, so that’s what I try and do is through my blogs and my books and getting out there and talking, giving the women information that I hope will really make a difference in their lives.

Jonathan: Brilliant. So, the name of the book is “Love, Sex, Again” and in the meantime, where can we go online to find you? Should we just type your name into Google or what should we do?

Dr. Lauren: You’ll get way too much if you do that. I do have a website Dr. Streicher.com, your best bet is following me on Facebook though, on Facebook/Dr. Streicher because I always post my blogs there and of course, Dr. Streicher on Twitter I always do posts when I am appearing some place or have published something. So, that’s the best way to keep up to date.

Jonathan: Do you ever tweet during surgery?

Dr. Lauren: Are you kidding?

Jonathan: Just kidding –

Dr. Lauren: And as Twitters well know, a lot of these tweets we are able to tweet in advance –

Jonathan: Yes –

Dr. Lauren: So, I remember I had a tweet from President Obama right before he took the oath and I thought wow, that’s great, he tweeted me right before he took the oath, that’s so nice, and then of course you realize that these are prescheduled tweets, so no I do not tweet during surgery, but I do try and keep up with it.

Jonathan: Well, we have to watch out for that next generation of surgeons, I can just imagine we’re going to have a surgeon in there and they’ll have an assistant in there, okay, tweet this to the family, let them know everything is going –

Dr. Lauren: You know what, you’re actually not so far from the truth – I’m in a very high tech operating room and I have the ability to talk to the family while I’m in the operating room and I very often do. If I say the surgery is going to take two hours and it looks like it’s going to be two and a half, and I don’t want them to worry, I can actually get patched to where they’re waiting for me and I can tell them everything is going well –

Jonathan: Wow –

Dr. Lauren: It’s going to be about another 30 or 40 minutes and that’s very reassuring to the family. I have the capability to have someone watch my surgery while I’m doing it, I actually have done a fair amount of surgery on TV and it’s pretty amazing, what technology lets us do now.

Jonathan: And that is true on many levels in terms of what we can do with how we age and how we live, aka, advances in technology offer so many opportunities to us, so Dr. Streicher, again, thank you for sharing some of those opportunities with us today and as always, you are a joy and inspiration, so thank you very much.

Dr. Lauren: Thank you for having me, it’s been a pleasure.

Jonathan: Viewers, again, our wonderful guest today is Dr. Lauren Streicher. Check out her book “Love, Sex, Again,” you will probably be able to pre-order it as soon as this airs, and in the meantime, check her out online and remember, this week, and every week after, eat smarter, exercise smarter and live better. Chat with you soon.