Coming Together for Sexual Health – Details, episodes & analysis

A small leak during a big laugh might hint towards a bigger story. In this episode exploring the pelvic floor, Dr. Olga Ramm and patient Nicole Curutchet answer the age-old question- what's really going on down there? Nicole Curutchet starts off by sharing her experience of developing pelvic floor prolapse, which felt like a “tampon that's halfway coming out.” She tackles the issue of finding the right provider, and shares about her surgery and recovery. On speaking out despite stigma, she says, “this is our bodies and it's the truth, and we don't want people to suffer, so why not talk about it?”  

For many people with vaginas, pelvic floor leakage, pain, and other symptoms, are often dismissed as just a fact of life. Dr. Ramm and Nicole argue that it doesn’t have to be that way. A variety of treatments exist for managing pelvic disorders, including physical therapy, insertable devices, and surgery.  

As Dr. Ramm reveals “birth remains the most common inciting injury to the pelvic floor...It's something that affects a whole lot of us.” Dr. Ramm also discusses research that shows that trauma of all kinds impacts the pelvic floor, “almost like a linear relationship between the number of adverse events that you report and the prevalence of chronic pelvic pain.” 

In a topic often characterized by silence, Dr. Ramm encourages providers to proactively ask about the pelvic floor. She emphasizes the value of informing patients about all the types of care available to them and respecting patient autonomy: “You don't have to follow a specific algorithm. Let the patient make the choice based on their individual values, their goals for themselves and their own personal case scenarios that they want to avoid.”  

• Dr. Olga Ramm’s Website: https://www.ucsfhealth.org/providers/dr-olga-ramm  
• UCSF Center for Urogynecology and Women's Pelvic Health: https://www.ucsfhealth.org/clinics/center-for-urogynecology-and-womens-pelvic-health
• Study That Links Duration of Pushing Phase to Degree of Obstetric Anal Sphincter, Led By Dr. Olga Ramm Injuries: https://pubmed.ncbi.nlm.nih.gov/29324610/
• Chronic Pelvic Pain Society of North America: https://www.pelvicpain.org/public
• The Body Keeps the Score: https://www.besselvanderkolk.com/resources/the-body-keeps-the-score  

Past episodes of

In this episode, Dr. Eleanor Bimla Schwartz and Dr. Kelly Treder discuss misconceptions about tubal sterilization, including debunking notions that is it 100% fool-proof, that the surgery is reversible, that it is more effective than other contraceptive options, or that there is little to no pain post-surgery. “I think we do have fairly widespread misunderstanding of what it means to have your tubes tied. A lot of people seem to have the understanding that that would be something you could easily untie and that it would be a procedure that you could undo,” Dr. Schwartz says. They highlight how important it is for providers to share information with patients about other long-acting contraception options (arm implant, IUD, vasectomy) and their effectiveness with preventing pregnancy, side effects, cost, accessibility, and longevity compared to surgery. Because of this, it is crucial for providers to be informed about the nuances of different contraceptive options. Dr. Schwartz and Dr. Treder provide firsthand insight into what difficult conversations surrounding contraceptives with patients can look like. “I think it's just our obligation to make sure that they know about all available options, that they're not arriving at this decision that they need to have a surgery because they think it's the only thing that's safe for them or the only thing that will work well for them,” says Dr. Schwartz.  

This episode is a follow up to S4 E5 Lesser-Known Forms of Birth Control and Downplayed Side-effects: Providing Empowering Contraceptive Carewith Dr. Karlin and health educator Mariana Horne.

Click here to view the episode transcript. 

Resources recommended in the episode:  

• Bedsider.org is an online resource designed to help individuals explore, compare, and access birth control options. Bedsider offers a comprehensive description of various contraceptive methods, such as IUDs, implants, pills, and sterilization using interactive tools, real-life stories, and educational content.  

• Advancing Access is a UCSF resource that provides clear, evidence-based information on long-acting reversible and non-reversible birth control methods, including costs, benefits, and where to access care.  

• https://www.cdc.gov/nchs/nsfg/index.htm - National Survey of Family Growth  

CAPTC related trainings and resources 

- Shared Decision Making in Contraceptive Counseling  

- Person-Centered Contraception Counseling for Family Pact Clients  

- Same-Day Placement of LARC: Solutions to Common Barriers  

Brief Bio  

Dr. Eleanor Bimla Schwartz Dr. Schwartz, MD is a professor of medicine at UCSF and the chief of the Division of General Internal Medicine at the San Francisco General Hospital. She has a particular interest in identifying ways to

Check out a complilation of three previous episodes on harm reduction. Hear from each of our guests and then go back and listen to one of the full episodes: 

• S4 E1: Narcan Queen Kochina Rude on Drag and Harm Reduction
• S4 E2: Harm Reduction by Heart with Braunz Courtney
• S4 E3: America’s War on Drugs and Harm Reduction Around the World with Tanagra Melgarejo Pulido

In this episode, Rodney McCoy, a Black queer man with over four decades of experience in HIV prevention and education, shares his journey as a Leatherman of color and discusses the intersection of BDSM, kink, and HIV prevention. From his entry into the kink community to becoming a titleholder in the American Leatherman competition, Rodney emphasizes how the kink community provided a safe space for self-discovery and empowerment. The episode explores the link between pleasure, power dynamics, and HIV prevention, highlighting the importance of honest conversations, sex positivity training, and the destigmatization of "risky behavior."  

Rodney, a health educator, program director, adjunct professor, and researcher, emphasizes the partnership between healthcare professionals and patients in promoting sexual health. Rodney says, “I am about encouraging people to embrace all pleasure: sexual pleasure, pleasure that comes from good mental health, from good physical health and from good social connections. I believe as healthcare professionals, regardless of the field we're in, we are arbiters to help assist our clients explore and enhance that pleasure, that good health in their lives.”  Rodney shares personal experiences as an HIV/STI testing specialist, addressing the impact of stigma and the importance of open communication. 

Download the transcript of this episode.

Resources from Rodney:

Beyond the Red Ribbon training & other services: https://rodneymccoy.info/services

Listen to Daddy Podcast on YouTube

Bio:

Rodney “Rod” McCoy, Jr. brings his expertise of nearly four decades in HIV prevention and education, as well as his real-life experience as an African American gay/queer man living with HIV. An Oberlin College graduate with his Bachelors in Sociology and Black Studies, Rod has worked in a variety of capacities in the field of HIV Prevention, from Health Educator and HIV Counselor to Program Director. As an Adjunct Professor at George Mason University, Rod established the “HIV, Culture and Sexuality” course for the school’s Global and Community Health Department. Rod created a sex positivity training for public health professionals called Beyond the Red Ribbon in collaboration with Louis Shackelford of the HIV Vaccine Trials Network. He currently works at Us Helping Us in Washington, DC, as a Research Assistant. 

CW: Mention of abuse, sexual abuse, physical abuse, incest, molestation 

At 24 years old, in the early 90’s, Michelle Lopez was riding a train in New York with her newborn baby and saw an advertisement that spoke to her. It said, “If you’re a woman and you’re enduring substance abuse, homelessness, or battery, call this number.” Michelle picked up a phone and began her new life. Her and her daughter were diagnosed with HIV, and it was her mission to get clean, understand her own trauma, and help others with similar stories. 

Michelle, a bisexual Caribbean woman, realized that women living with HIV continue to be ostracized for both wanting and having sex. Michelle knew she had to combat this and teach herself and others about self-love, pleasure, and intimacy.  She has spent her career advocating for HIV prevention and treatment, women’s health, mental health, sexuality, and how to unlearn feelings of shame. She says, “I recognized getting clean would give me more power to fight against situations and circumstances and stand up for my rights. I had to learn what it is to love Michelle and deal with the trauma that I endured.” Michelle shares how she utilizes her experiences from childhood to the present to educate others through clinical work, research, and advocacy. Her story is one of empowerment, celebration, and making lemonade with the lemons she was given. 

Download the transcript of this episode.

Resources:  

Michelle Lopez LinkedIn

CAPTC World AIDS Day Page

HIV.gov 

Bio:  

Michelle Lopez is a tireless advocate for public health among Black and Latinx communities. Over the last 30 years, Michelle has worked in HIV and AIDS prevention and health care navigation and substance use services. Michelle has served on boards of directors and advised on policy development that impacts the lives of marginalized communities. Michelle is now focusing on research designs methodology to meaningfully engages community members.

Dan Savage is a sex-advice columnist and podcaster, and Ina Park is a sex positive STI researcher, physician, and author. The two come together in this episode to discuss desire, pleasure, and how to communicate about what feels good with partners and providers. Dan delves into discovering kinks, pleasure as we age, and trying new things alone and with partners. Ina reflects on her experiences as a provider, having conversations with patients around sex and pleasure as bodies, needs, and abilities change.  

Dan says that gay people might be better at sex, “not because we're magic...we use the 4 magic words ‘what are you into?’” Ina explains that honest communication with a partner, a physician, a sex columnist, or a therapist knocks down barriers to explore sex and discover pleasure. The two emphasize the importance of both having providers and friends (with a good sense of judgment) with whom you can discuss sex freely.  

This is our first episode of the 3-episode mini-series on pleasure. 

Download the transcript of this episode.

Resources:  

Connect with Dan: https://savage.love/, @dansavage on Instagram, and @fakedansavage on Twitter/X 

Connect with Ina: https://www.inapark.net/ and @InaParkMD on Twitter/X 

Learn how to include pleasure in sexual health history-taking from the National Coalition for Sexual Health: https://nationalcoalitionforsexualhealth.org/tools/for-healthcare-providers/video-series  

Bios:  

Dan Savage is a sex-advice columnist, podcaster and author whose graphic, pragmatic, and humorous advice has changed the cultural conversation about monogamy, gay rights, religion, and politics. “Savage Love,” Dan’s sex-advice column, was first published in 1991 and is now syndicated across the United States and Canada. He also hosts the Savage Lovecast, a weekly, call-in advice podcast that has tens of thousands of paying subscribers for premium Magnum content. Both his podcast and column can be found on his website Savage.Love. 

Ina Park MD, MS, is the author of Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs. She is the Principal Investigator at the California Prevention Training Center. She is a Professor in the Department of Family and Community Medicine at the University of California San Francisco School of Medicine and a Medical Consultant in the Division of STD Prevention at the Centers for Disease Control and Prevention. She is a co-author of the 2021 CDC STD Treatment Guidelines, the country’s premier resource for diagnosis and treatment of sexually transmitted infections.

Director of Gender-Affirming Care for UC Davis Health, Miles Harris, FNP-BC, advocates for the integration of gender-affirming care with primary care and family planning. He shares that “so much of gender affirming care is not about hormones” and that “it is often so easy as a health care provider to do the thing that someone needs that changes their life.” He breaks down misconceptions: hormone therapy and contraception for trans folks is relatively simple, taking testosterone and not having a period does not prevent pregnancy, and there are no contraceptive methods that are contraindicated due to testosterone use.   

He emphasizes the importance of not making assumptions about someone’s body parts or those of their partners, as well as not assuming that people are having types of sex that can result in a pregnancy. In choosing a contraceptive method, he says, “we want to remember that this person is a whole person, more than just their trans or non-binary identity.” This is the last episode in our mini-series on family planning and reproductive justice.  

Download the transcript of this episode. 

Resources: 

Contraception Across the Transmasculine Spectrum Article co-authored by Miles Harris 

Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People UCSF website 

National Transgender Health Summit Biannual conference 

National LGBTQIA+ Health Education Center Online learning from the Fenway Institute 

LGBTQ+ Healthcare Directory Created by GLMA  

Queer Doc & Plume Remote providers of gender affirming care 

CAPTC-Related Training and Resources:  

S3 E9: Abortion and Reproductive Justice Across State Lines  Podcast episode 

S2 E2: Speaking Frankly: Supporting Youths' Choice to Parent with Dr. Aisha May Podcast episode 

Family doctor Jennifer Karlin, MD, PhD, and health educator Mariana Horne, join host Tammy Kremer to talk through forms of birth control that are not as well-known, including self-injectable Depo Provera, internal condoms, and the fertility awareness method. They go into side effects of birth control methods that are not always named, such as changes in mood and blood pressure. Mariana shares how she has supported clients who’ve faced coercive birth control practices in getting the care they want and how her background helps her connect with monolingual Spanish-speaking communities. Meanwhile, Jennifer shares how her family’s experience with healthcare led her to focus on empowering her patients, making the connection between how experiences in the clinic can impact people outside of the clinic: “I want them to take that feeling of autonomy, of like ‘oh, this is my body, I get to make choices about it,’ I want everybody to walk around the world knowing that and feeling that and acting that when they're not in the clinical space.” 

Read the transcript of the episode. 

Resources: 

Plan C Pills 

M&A Hotline 

UCSF New Generation Health Clinic 

CAPTC Related Training and Resources: 

S3 E9: Abortion and Reproductive Justice Across State Lines 

Reproductive and Sexual Health Considerations for Trans and Non-Binary People 

Shared Decision Making in Contraceptive Counseling 

Emergency Contraception 

Prevention and Management of IUD Complications 

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Follow Coming Together for Sexual Health on Instagram and Twitter. 

Welcome to our mini-series on Reproductive Justice and Family Planning! Diana Greene Foster, PhD, author of The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having - or Being Denied - an Abortion, sits down with host Tammy Kremer to advocate for reproductive justice and bodily autonomy. She explains that the Turnaway Study found that, “When people are making the decision about what to do with an unexpected pregnancy and they decide on abortion, all the reasons they give us are exactly those outcomes that we see for people who are denied an abortion.” She envisions a world in which “everyone is an equal partner in sex, in childbearing, in contraception, in pregnancy decision-making.” 

Download the transcript of this episode.

Follow Diana Greene Foster on Twitter.

Resources: 

The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion 

Global Turnaway Study 

ANSIRH: Advancing New Standards in Reproductive Care 

Bixby Center for Global Reproductive Health  

Plan C Pills 

“Black Women’s Lived Experiences of Abortion" 

Girlx Lab

CAPTC-Related Training and Resources:  

S3 E9: Abortion and Reproductive Justice Across State Lines    

S2 E2: Speaking Frankly: Supporting Youths' Choice to Parent with Dr. Aisha May 

Reproductive and Sexual Health Considerations for Trans and Non-Binary People 

Turn on notifications to never miss an episode of Coming Together for Sexual Health.

Follow Coming Together for Sexual Health on Instagram and Twitter.

Diana Greene Foster is a professor at the University of California, San Francisco, in the Department of Obstetrics, Gynecology, and Reproductive Sciences and a researcher at Advancing New Standards in Reproductive Health. She is the principal investigator of the Turnaway Study in the United States and Nepal, a nationwide longitudinal prospective study of the health and well-being of women who seek abortion including both women who do and do not receive abortion.