Why Reproductive Health Is Still Stuck in the 1950s—From Epidurals to Birth Control Methods | Marina Gerner

Dr. Brighten: [00:00:00] Welcome back to the Dr. Brighton Show. I'm your host, Dr. Jolene Brighton. I'm board certified in Naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most UpToDate information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. Dr. Marina Gerner, welcome to the podcast. Thank you so much for having me. I am really excited to talk to you. This is gonna be a fantastic conversation for everybody listening in.

If you know a new mom, you know someone in menopause, if you know a woman, you're gonna wanna share this one with them. Because we are going to be getting into fem tech. We are going to be getting into the nitty gritty of why women are so late to get diagnosed and really get the medical care that they need.

And where I wanna start this conversation is with the fact that medical gender bias is killing women. Heart disease is the leading cause of death among women, not breast cancer. And yet there is a huge discrepancy between not only the awareness that is raised, but also the [00:02:00] research and the way that medicine is practiced.

Can you walk us through this?

Marina: Yeah, absolutely. Let me start by asking you a question. So if I ask you to imagine a person who's having a heart attack, who do you see?

Dr. Brighten: Oh, see, here's the tricky thing. 'cause I wrote, you know a lot. Yes. In multiple books. I have put the presentation of what it looks like for a woman to have a heart attack.

But the classic, so everybody who's listening right now, yes, probably went right away to a, oh, I'm clenching my chest, my left arm. Maybe it's tingly. It's aching. Maybe I'm having jaw pain. But where you're going with this is that it looks very different for the ovary owners in the room. Exactly. So I think

Marina: even for me, even though I know a lot about this topic, the visual that comes into my mind, because that's what we've been trained to see, and that's what we see in movies, is an old white man.

That is just what, what most of us see. And as you said, he's clutching his chest. He [00:03:00] feels pressure radiating down his left hand side. Those are the symptoms we typically think of. But as you said, those are not typical symptoms for women. They're typical for men. And we know much less about how to spot heart health issues and women.

And as a result, women are 50% more likely than men to be given a wrong diagnosis after having a heart attack. And that's because most of our medical research has unfortunately focused on the male body and it's built around the male default. And even today, we haven't reached par, uh, parity in clinical trials.

Um, so one of the innovations that got me into this space of EmTech was a bra. Um, I was really excited. I'm a journalist and I came across this company called Bloomer Tech that's created the coolest thing. They've created a smart bra that uses ECG technology that can help women who are at risk monitor their heart health.

And I was amazed to see this smart bra because I saw, you [00:04:00] know, there's not only a problem that we've just discussed, but there are also people who are working on the solution. And I met the founder, her name is Alicia Chung Rodriguez, at a conference about five years ago. Uh, I was so inspired to hear about this.

So in the lunch break, I. Ran downstairs to ask for her business card, and I knew that I wanted to write about her. So I messaged all those editors who usually say yes to my stories. Now I write for a variety of really big newspapers, magazines, um, but there was only tumbleweed in my inbox. Nobody was interested.

And there was this perception that the topic was a bit niche. And, and that's something unfortunately, that people who work in women's health often encounter this idea that, oh, you know, it's, it's niche when in reality we're talking about over 50% of the global population, right? So how can it be, how can that be niche?

Um, this was before COVID and then COVID happened, and I think a few things shifted during COVID. [00:05:00] Um. So if you think back to the beginning of COVID, you may remember that men had worse symptoms initially. Whereas nowadays women are more likely to have long-term co long-term COVID. And so I think if you wanted to be cynical, you could say suddenly people started paying attention to sex differences in health because men were more affected.

Um, and also a few other things happened. I think some of the power shifted from the doctor's office to the home as people got used to testing themselves for COVID and health professionals, you know, trusted patients to test themselves. And at that time I managed to publish the story of the Smart Bra. I think it's not a coincidence.

I managed to replace it at that time. Uh, and it was published in The Guardian and it did really well. And I think this smart bra is a piece of the puzzle. So it's not on the market yet, but it's in clinical trials and. Once it comes [00:06:00] to the market, uh, it could be used for heart health monitoring and potentially early detection as well of issues.

Dr. Brighten: Yeah. So you said, you know, using a spar, a smart bra for women who are at risk. So what women would be targeted for this, who would be best suited to be wearing a spar, a smart bra to be tracking their cardiovascular health? So that will

Marina: be for the company to decide. Uh, so it's not something I can decide for them, but generally women who are at risk are those who have, uh, family history of cardiovascular issues, for example.

Um, or you know, women with higher blood pressure, higher cholesterol levels. Um, so it's, it's recommended that you monitor those aspects of your health to, to kind of know what your risk factors are. Um, and some risk factors are also higher. For women than they [00:07:00] are for men. So for women, for example, smoking has a higher risk of contributing to a heart attack than if a man was a smoker.

Uh, and in contrast, hypertension is a higher weighted risk in men than in women. And then there are also some sex specific risk factors that only apply to women that are sometimes ignored. So for instance, having, um, gestational diabetes or hypertension in pregnancy is something that can later on lead to heart disease.

Dr. Brighten: I love the idea of you've, most of us are wearing brass every day anyways, and to have something that's part of your daily routine that's also tracking and monitoring you, because as we know, so you said 50% of women, they're getting the wrong diagnosis when it comes to stroke and heart attacks. Women enter the ER and they're often told things like, you know, it's just indigestion.

You have an upset tummy. It's probably anxiety. Oh, you have a headache. Just go home. And that's why I open this with this statement that medical gender bias is, it's literally [00:08:00] killing women because that bias is not only leading to the dismissal of women's symptoms, but even when they have symptoms that are recognized, they get diagnosed, sometimes that pain that they're experiencing is even dismissed and it's diminished.

Or there's the expectation that because you are a woman, you should have a higher pain tolerance. Or if you're a black woman, there's, as we know, that came out during COVID. How many doctors believed that black patients did in fact have higher pain tolerance, that they should be able to tolerate these things more.

So, you know, something that I found interesting in your book is you talked about how it's recognized 50% of the population are women leading cause of death, cardiovascular disease, but how few are actually participating in clinical trials. How many women are in clinical trials when it comes to these innovations in cardiovascular disease?

So the drug trials or even better diagnostic testing.

Marina: So it [00:09:00] really depends on, um, the area you're looking at. According to some estimates, it's only one third of clinical trials focused on cardiovascular health. That's, uh, including women. But it, it depends on whichever area you're looking at. Um, but what's also interesting is that even.

In spaces where women have reached parity. So where we have 50 50, let's say. Oftentimes the data that comes out of that research is still not disaggregated by sex or analyzed by sex. Um, and it also happens earlier when researchers look at mice, for example. Female mice are less likely to be included. And um, that's something I wrote about in the book and some of the reasons that researchers give are really excuses.

There was one team that said, we haven't included female mice because their cages are harder to clean.

Dr. Brighten: [00:10:00] Oh,

Marina: poor you. You'll have to clean a cage. Exactly. And that's something they actually wrote in their paper. They were not ashamed to write that.

Dr. Brighten: Yeah. Yeah. Telling on themselves. You know, in your book you stated that women's health is both underfunded and under researched.

I wanna hear from you in all of your research that you've done in this, how is this playing out when it comes to clinical care?

Marina: Yeah, so women are estimated to make about 80% of healthcare decisions, but only 4% of healthcare research and development focuses on us. And so the upshot of that is that across 770 types of diseases, women are diagnosed an average four years later than men.

Out of 10 medications withdrawn from the market, about eight negatively affected women, and we're nearly twice as likely to experience severe side effects from drugs. Uh, so the dose of the sleep medication of Ambien, for example, was [00:11:00] officially halved. For women. But this only happened after several women were involved in car accidents because they were still drowsy in the morning after taking, uh, the medication.

And I think other drugs would also benefit from a re-analysis, from a sex specific dose adjustment so that women no longer have to suffer these disproportionate side effects. And I think another way of putting how under researched female health is, is by pointing out that there are currently four times more studies focused on erectile dysfunction than PMS, despite the fact that only 19, so one 9% of men have ed, but over 99 0% of women report symptoms of PMS.

Dr. Brighten: Mm-hmm. That's astounding. And I think this is something that anyone who's paying attention to the research and to women's health, it's constantly an issue that's raised. And I find that. There's quite a bit of a [00:12:00] dismissal now where people will say, well, erectile dysfunction has such a major impact on your life, yet we look at conditions like endometriosis, which receives in the United States about $2.

So I have endometriosis. I get allocated $2 of funding for the entire year to research my condition, a systemic condition that impacts every aspect of my life. And being that some women have such extreme pain, they can't even operate and function two weeks outta the month. We're talking six months out of the year, and yet the argument is still made that a flacid penis is much more important than a woman's quality of life.

Marina: Yeah, it's, it's really unbelievable. And something like 10% of women worldwide have endometriosis, which is a similar figure to the number of women who have diabetes. But diabetes research, uh, gets significantly more funding, I think 20 times. 22 times more funding [00:13:00] than endometriosis research. Um, although I think it's changing slowly, uh, we see more and more attention that's going towards endometriosis and there are more conversations about it.

Um, and there's some innovation in this space too.

Dr. Brighten: I think a big part of that is because women are no longer willing to accept that period pain is normal. I think that we have shed a lot of the shame of not talking about our bodies. And I think what's important for everyone to listen is that, and I I wonder if you agree, is that I believe that the change we need in women's medicine will come from the patients demanding better, more so than providers even speaking up and saying that these people deserve better.

Marina: Yes. I, I think it will be a combination of these things, and I think ideally we need to have. Everyone on board, right? The healthcare providers and the patients and those who work in tech and those who [00:14:00] innovate, those who invest in this space. I think ideally it will be a concerted effort among everyone, but patients are absolutely important in driving this change.

Dr. Brighten: Absolutely. You brought up medication side effects. We know that often when women raise concerns about side effects, they're gaslit or they're told things like, well, there's no research to support what you're saying. Therefore, you are lying because I don't have the data that says, without a shadow of a doubt, this could be true.

I feel like birth control is certainly one of those medications that we know in certain populations it can have tremendous benefits. In others, it can do a lot of harm, and yet when women raise these issues, they're often dismissed. I mean, I'm not sure if you are familiar with the JAMA article that came out over a million women and the correlation between depression.

What was astounding to me is [00:15:00] that they showed a strong correlation between new onset of depression was starting birth control. Something women have complained about since the trials, since the birth control trials, and yet the number of providers who lined up to say. Mm-hmm. It's still in your head. This isn't real.

Can you talk us through like what is going on with birth control and especially through the lens of like, why have we had so little innovation?

Marina: Yes. It's

Dr. Brighten: such

Marina: an important topic. Um, and I think, you know, it's worth acknowledging that when the pill came out, when it was introduced, it gave women unprecedented freedom to some extent.

And as you say, it also became a new form of pain medication. And for certain people it's an absolute, um, blessing, but we're also still researching and learning more about the pill. So it's somewhat of a mass experiment, I would say. And I think in 30 years time we will. Think about the pill [00:16:00] differently than we do now, and I think there will be more contraceptive options on the market and, uh, it will no longer be the go-to, uh, recommendation, I would say.

I, I analyze loads of studies in the book around the pill and, you know, some large scale studies, especially in Scandinavia, show that there is a, a link to depression. Others show there's no link, but there's a really good study that shows that it decreases wellbeing overall. Um, and there are clearly so many people who experience side effects.

There's one statistic which says women try an average of three to four different contraceptive methods in our lifetimes. Um, and 90% of us say that there is no contraceptive method that has all the features we find extremely important. So that just shows you how, how shocking. Uh, that space is, and you know, [00:17:00] let me ask you another question.

Why haven't we seen the male pill on the market? Right? There have been trials into the male contraceptive pill. Uh, but those were stalled because men were struggling with symptoms like bloating and mood swings and acne. And they said, stop right there, John. You know, no men should have to suffer through something like that.

But obviously we expect women to suffer the same side effects.

Dr. Brighten: So I spoke about that, um, in my book Beyond the Pill. And when they halted the study the same quarter that they said, we will not accept these side effects for men, they released a new progestin based IUD, which had significantly more, much higher rates of depression than what they were seeing in the Maleo trial.

And they, if that didn't exemplify. The, the fact that I think the perspective really is, is that the burden of an unintended pregnancy falls on women. Therefore, grit your teeth and bear it, and just deal with [00:18:00] the side effects. I also wanna highlight the point that, like, for all intents and purposes, these pharmaceutical companies, they're, they are not altruistic.

They're businesses. They're in it for the profit and nothing more. And so if you consider that men are not going to deal with these side effects, why continue dumping money into a trial? You can never recuperate that cost. That you cannot gain the profit if your target market will not subject themselves to it.

Marina: Yeah. But there is clearly an unmet need. Um, so I write about a company called Contraline that has developed a reversible vasectomy. And that's currently in clinical trials. And, you know, that's nonhormonal and that could be a completely game changing creation. Uh, I've also looked into a, an injection, I think it was a hormonal injection that was done.

It was also discontinued. But there was a really [00:19:00] interesting detail at the end of this study, which is when participants were asked whether they would like to take something like that in the future, most of them said yes. So I, I do think there are many men in heterosexual relationships who really want to do more and who are ready to step up.

So, uh, I think culturally we are making progress on that

Dr. Brighten: front. Absolutely I you, if you pay attention on social media, there are lots of men who say, sign me up. I want to one, maybe shoulder the burden so that it's not all on her. Or two, make sure that I have the best protection so that if I am engaged in sex, I don't have to worry about an unintended pregnancy either from that male clinical trial.

The men actually did say that they would continue it. Despite the side effects, but it was the pharmaceutical company who decided to pull the plug on it. And I think, [00:20:00] you know, it's something that we have to have more dialogue and conversations about this because again, this all shouldn't fall on just women and it shouldn't be just us always, you know, always chasing like the next contraceptive.

I, I wanna hear from you though, you said there are studies that say use of the pill is associated with decreased wellbeing. What does that mean? What does the definition of wellbeing, how did they define that?

Marina: It's a double blind randomized control trial and it included 322 women. It found that those who take the pill have a reduced sense of wellbeing.

And I feel like that's probably not even something they would've defined. They just would've asked, you know, rate your sense of wellbeing on a scale from this to that.

Dr. Brighten: Yeah, I would be so curious. Have you ever used the pill? I have not. Oh, you're a unicorn. My goodness. It's so rare. [00:21:00] It never appealed

Marina: to me, you know?

Dr. Brighten: Yeah. You know, for me, I had extremely painful periods. They were heavy. I would bleed like seven plus days. Um, and my doctor convinced me after several years of that, like, start the pill. Your painful periods will be gone and you know, you don't have an acne, but it'll make your skin even better. And I was like, I will do anything to not have to deal with this.

And 10 years on the pill, I experienced a lot of side effects. So I had, um, extreme depression. I had yeast infections that would never stop. I was just told it was a me problem. Turns out it was a pill problem. I went through a lot of side effects and then it was. 29 years later that I'm diagnosed with endometriosis, 29 years of menstruating and they find stage four endometriosis.

And I actually just recently had excision surgery a few months ago. Um, but it was only after struggling with secondary infertility that this was discovered. My story is in [00:22:00] no way unique. It's a very common story. You're given the pill. No discussion of what is going on. And, you know, I wanna, we'll get into a bit, I wanna talk about delayed diagnosis 'cause I think this, this plays a role.

But why I asked if you ever used the pill is because. And, and I wanted to know about how they defined wellbeing, because overall, when I think about myself and I think about, I had no libido. I was depressed all the time. I cried. Um, some days I couldn't even get out of my house. I had, uh, yeast infections so bad that I became allergic to monsta because I used it so, so often.

And, uh, this is not, like I said, not an uncommon story for me. That's my entire wellbeing. And I, if anyone's listening, if you have a pill story, I'd love you to share it in the comments. What do you think they mean by wellbeing? What is it? I think if you've used the pill, you know what that means, but I was just curious if they had actually defined it and that, and then I was curious if you'd used the pill and could define it, [00:23:00] but you had not.

Uh, is it too personal for me to ask? What has been your contraceptive of choice? I like condoms.

Marina: And I think they work really well if you know how to use them. Mm-hmm. Uh, you know, they're 98% effective with ideal use. Yeah. Uh, and, and the pill, it just never appealed to me. I'm not somebody who's good at remembering to do something every day.

Um, and it always felt like quite an intrusive method of contraception.

Dr. Brighten: Yeah. I mean, it's for people listening who don't know how the pill works, it floods your system with so many hormones that it shuts down brain ovarian communication. It disrupts that entire aspect of your endocrine system. Most of us aren't told that when we're prescribed it.

And yet, you know, you take something like a condom. That's not disrupting anything in the moment. Maybe some people say the sensation, but honestly, condoms have come A, the condoms have come a lot further in terms of their [00:24:00] technology. Um, you wrote about condoms and things that have changed in the book.

Can we just take a little, like, we're, we're still in line with, uh, contraceptives, but I just love to hear about that.

Marina: Yeah, absolutely. I've wrote about condoms, um, that are made by a company called Hanks, and those condoms are biodegradable, which I think is really cool. And they're also very transparent about their ingredients.

So there are some condoms on the market that help men last longer, but those ingredients are actually irritating the walls of a vagina and those ingredients are not disclosed. So I think that's something we generally need more of is disclosure of ingredients, disclosure of potential side effects, and I think the future will hold more.

Non-hormonal contraceptive options. Um, I've included one company, they're based in Denmark. They're called Circle Biomedical, and they've created a contraceptive that it looks like a see-through capsule, uh, like something you would use for your [00:25:00] laundry, you know? But what it does is it works, you dissolve it in your vagina and it works with the properties of your cervical mucus.

And I remember when I was writing this chapter, I told a friend about it and she said, Ew, mucus. But I think, you know, I think mucus is pretty fascinating because it changes throughout your cycle, right? It becomes more, um, liquid at the time of ovulation so that sperm can swim through. And then in pregnancy it turns itself into mucus plug to protect the fetus.

So I think the idea of. Working with mucus and working with the properties of mucus, uh, has a lot of potential. And this is not on the market yet, but if this kind of contraception makes it to the market, I think that would be really fascinating.

Dr. Brighten: I agree. You know, and I hate the word mucus. When we think about, um, semen ejaculate, like they get these like very scientific names for their goods.

Um, and [00:26:00] I wrote about this in my book, is this normal? There's an entire chapter on discharge and understanding that like that egg white consistency that's like a goop in your underwear is like such a sign of health. It's like this naing thing, but the fact that we call it mucus because right, we think of like snot, we think like, I'm sick, I have a cold.

And I think that sometimes translates where women are like, is my vagina sick? Like, what is actually happening here? Because you know, I don't know what it's like in your part of the world. Well, it's probably better than what it is in the United States, but we have 18 states that require medically accurate sex education.

So by far the vast majority of women don't actually understand how their body works. And I love that you speak to leveraging what your body's own wisdom is, right? Because once you pass ovulation and progesterone rises, now the cervical mucus changes and it's much harder for. For the sperm to actually swim past That is how progestin is also designed to work.

So the [00:27:00] synthetic form of progesterone that they put in contraceptives. And yet what if instead of giving you a hormone that has potential side effects, like mood side effects, maybe even potentially, you know, in some people cancer risks, like there's a lot of side effects that we have not studied extensively enough to conclusively say that we know without a shadow of a doubt what these hormones are doing.

What if instead we could just alter what is happening with the cervical mucus there? I would be curious too, to see if they do research on the microbiome because as you were talking about with condoms and disclosure, we know that lubricants, certain lubricants can disrupt the microbiome and we think about the vaginal microbiome being disrupted.

There's bacterial vaginosis, yeast, vaginitis, nobody likes that. But what we haven't studied extensively enough is the disruption of the endometrial microbiome of the entire reproductive tract, which we know can lend itself to implantation issues and [00:28:00] infertility. So I am all about transparency and disclosure because you should always be informed about what you put in your body.

I want you to talk to us about fem tech. Things like natural cycles, how well do they work, and where are we currently at in the industry with women having access to these? Mm-hmm. Yeah, that's

Marina: a great question. So with any form of contraception, you have to ask yourself, what is the pearl index? So to look at how effective a contraceptive is, clinical trials use the PEARL Index to describe the number of pregnancies per 100 women over one year when they use the contraceptive.

And so oftentimes, how effective a contraceptive is depends on how well you use it, right? Whether you use it the way it was intended. And so if you use it the way it was intended, that's described perfect use. And then the other term they use is typical use. So how people actually use [00:29:00] it in the real world.

Um, and so condoms, for example, are 98% effective with perfect use, but only 87% effective with. Typical use. And what's also interesting is that the failure rate tends to be higher in the first year when somebody has started using it, which makes sense, right? They don't necessarily, uh, know what they're doing yet.

Um, and so for natural cycles, the research that they have done, um. Has shown that it's 98% effective with perfect use and 93% effective with typical use. And it's also worth noting that according to a study led by the company itself, fewer than 10% of cycles they recorded on the app or perfect use cycles.

So that means the vast majority of people use it in a typical way where it's 93% effective. So I think you have to, if you're using [00:30:00] natural cycles, you have to ask yourself, you know, what do I need to do to achieve perfect use? And that means tracking your cycle very diligently and using a form of contraception like condoms on your fertile days.

It's also always worth asking yourself, you know. In general with contraception, what are, what are the, the side effects? Uh, what are the risks? And it's good to, what's the best way of putting it? It's good to know yourself. So, natural cycles, uh, is a fertility awareness based. Methods, you know, that that's a whole, that describes a whole range of methods that are basically, that are not new, that work with observing your body, but it's the digitalization of it that's new.

And we know that things like stress can have an impact on how regular your cycle is. So can, uh, long haul travel. So if you're somebody who travels a lot. Then a fertility awareness based [00:31:00] method may not be the perfect method for you. Whereas if you're someone who has a very regular cycle and you can read the signs of your body really well, uh, then that might be a good method for you.

And I've actually met a woman in the course of my research who told me that she can detect ovulation by touching her cervix and seeing whether it feels like the tip of her nose or softer like her lip, and that she got pregnant exactly when she wanted to, and that she never had an unwanted pregnancy.

So, you know, those people exist as well. Um, the thing that's worth noting is that Natural Cycles is the only app that's, um, certified as a digital contraceptive in both the EU and the us. And so all other apps, uh, should not be used in that way.

Dr. Brighten: Yeah, no, that's an important thing to highlight because people will sometimes say, well, I'm just gonna use my period tracker app, [00:32:00] and around day 14 I will, you know, follow the method and that's not how it works.

So this is Athermal method, which means that you're taking your basal biology temperature. What I love about natural cycle, so I've used fertility awareness method for 12 years now, and I've had no pregnancies except for when I plan to get pregnant. And then I got pregnant immediately. So if you are somebody who is trying to conceive, knowing this method is, I think, really, really important, right?

Because we're told this myth, at least we are in the United States, that you can get pregnant any day of your cycle, and as it turns out, you have one day for sperm and egg to meet, and outside of that, you cannot get pregnant. Now the caveat is sperm can live five, maybe six days. They're tricky. They're little loiters just hanging around.

Um, but what I love about Natural Cycles is I'm, I wear an AA ring, so it already takes my body temperature and then it integrates it to natural cycles because I'm like, you like the daily practice of things like having to take the temp? I'm like, oh my God, no. Like, that's so much work. But with my AA ring, I can [00:33:00] even just see my temp there.

But what Natural Cycles does is it converts it, and then it will give you a prediction of. When your fertile window is. Now something else I wanna say about this, 'cause I, I'm a natural cycles user, I do love this app, um, is people will often say, I got pregnant using fertility awareness method. And whenever I dive in deeper and say, okay, tell me more about that.

What were you doing during the fertile window? Oh, during the fertile window, we used the pullout method. Hmm, okay. That is not fertility awareness method because one of the main aspects of fertility awareness method is you must avoid vaginal penetration that will introduce sperm into the vagina. So you can have other kinds of sex or you need to use a barrier.

You need to do something else. But if you're using the pullout method, it can be effective. However, with typical use, which is trusting a man, right? I don't if you don't wanna be pregnant, I'm like, don't [00:34:00] put yourself in the driver's seat and, and be a passenger on this because it can be, you know, one in five or getting pregnant in a year from using the pullout method.

And I think it's really just important to dissect that out because a lot of doctors purposely will use the language of saying, this is just the rhythm method. The rhythm method is very different than the fertility awareness method. And they'll never actually ask their patients, well what did you do during the fertile window?

And when I've asked patients that and they say, well, that's just when we would do the pullout. I'm like. Then you were using the pullout method, you were not using fertility awareness method.

Marina: Yeah, that's a really good point. And I think also highlighting that the egg lifts for up to 24 hours, whereas sperm lifts for five days or even longer.

And that's why you have a fertile window, you know, because as you say, sperm could be loitering, could be around. Um, and, and I think that's something we need to talk about much more because [00:35:00] sperm can essentially always get you pregnant, but the egg is only there, so briefly, and yet we put all the responsibility on women.

Dr. Brighten: Absolutely. That was the shocker moment for me in med school when they were presenting in a fertility clause saying women can only get pregnant one day outta the month. And I was like, I'm on the pill every single day feeling like trash. Like, and I can't even get pregnant like all the time. Um, you know, albeit I, part of it was, you know, for period and how painful they were.

But at that point, after 10 years of symptoms, I was like. You know what? I'd rather go back to painful periods than feeling like, I mean, I feel like I missed out on a decade of my life of like fully living my life. For some women with endometriosis, it gives 'em back their life. And so I just say that because I want you, everyone listening to know that's what's true for me isn't true for you.

And you always have to respect what your truth is about your body.

Marina: Exactly. At the end of the day, it's about having greater choices for women, right? And what might work for one person may not [00:36:00] work for another person. And, and that's okay.

Dr. Brighten: So you presented the data on fem tech and on fertility awareness method in terms of typical use versus the perfect use and, and we're talking pregnancy prevention here.

Can you juxtapose that to the pill and how does it compare?

Marina: Yeah, exactly. So if you use the pill perfectly, it's 99% effective. So you know, really effective, but people aren't perfect and so it's easy to forget or miss taking a pill. And so it's 93% effective with typical use.

Dr. Brighten: Mm-hmm. And fem tech. So for everybody listening, the Fem Tech app, we are talking about natural cycles, which is based on fertility awareness method.

Their typical use is also 93% effective. And so I think that's a really important thing to consider if it is correct for you, if it's the right method for you. Because as you were saying, travel, we've got polycystical variance syndrome, we've got hypothyroidism that's unmanaged, there're gonna be several conditions that lends itself to irregular [00:37:00] cycles that perhaps it won't be the best method for you right now.

But I think it's worth considering because we're all told. Purposely only told the pills 99% effective. And yet when you actually look at how people use it, the vast majority are not getting that 99%. Yeah, exactly. I wanna talk a little bit more about these, uh, femme tech devices, not just for contraceptives, but for women's health overall.

Why do you think it's still so taboo for investors and for the population as a whole to address women's health using fem tech? I have a lot to say on this. Then say it by all means. Say it.

Marina: Where do I start? So I think, okay, what is a taboo? It's something that's hidden, something that is not. Spoken about.

And the origin of the word comes from the Polynesian language, and the word was taboo, which meant both forbidden and [00:38:00] sacred, which I think is quite interesting because that last part of the meaning was somehow lost in translation when it made its way into English. Um, but taboos have always surrounded female bodies.

And I also think not all taboos are equal. Uh, talking about pregnancy loss or urinary incontinence or pelvic organ prolapse is still a much bigger taboo than talking about menopause or menstruation as we have done. And what I have found is that anything that has the word vagina in it is unfortunately still a big taboo.

Mm-hmm. So when I was researching vagina centric startups that focus on, uh, menopause symptoms like vaginal dryness. For example, or on sexual wellbeing. Uh, I heard from entrepreneurs that it's really hard to raise money in this space. Yeah. Because venture capital investors who are predominantly male, uh, are too [00:39:00] embarrassed by the subject.

So I have this one quote from a VC investor in the book who says, I don't wanna talk about vaginas in my Monday morning partner meeting.

Dr. Brighten: But you literally came into this world through a vagina, sir. Like that is literally the gateway to your life. Well, yes, exactly.

Marina: And I think when I, when I heard that, when I figured out that one of the reasons for why we don't get the innovations that we clearly need and want and deserve is because there is a bunch of guys somewhere sitting in a boardroom and they don't wanna talk about vaginas in front of other guys.

Uh, that just. Made me really angry. And so I'm a journalist and I wrote an article for Wired magazine called We Need to Talk About Investors' Problem with Vaginas. And that article went viral and it really hit a nerve. Um, and it led me into the world of EmTech to some extent. Uh, [00:40:00] and I've, it was a very conscious decision to include Regina, you know, on the cover and in the title of my book, because there are lots of discussions about this.

Um, when my agent and I, when we went to sell the book, you know, every publisher said, what a great book, but are you sure about the title? Because there are many reasons. But one was that, you know, the sales teams might be embarrassed and independent bookstores might be embarrassed. So they may not promote the book, they may not put it into their newsletters, they may not put it out.

Into the window. Yeah. So at one point I was asked to come up with 16 alternative titles for my book

Dr. Brighten: 16. Like, oh my God, you're not responsible for other people's emotions. Like, like that was their parents' responsibility to cradle them through the using the word vagina. Yeah. But, but they

Marina: didn't. So here we are.

And so I came out with 16 alternative titles. You know, I asked, uh, two of my best friends were you [00:41:00] brainstorms some titles. And then my publisher tested all of these titles on our target audience. And guess which title one? The vagina business business. Yeah. Because, but people are tired of euphemisms. Um, and I think it really resonated.

But then when the book came out, I still encountered obstacles and I, I continue to encounter obstacles to this, to this day. So, uh, I had a venue tell me they can't host my book launch purely based on the title of the book. You know, they hadn't read the book. I had an author tell me she can't write me an endorsement.

Um, and just a few days

Dr. Brighten: ago, I just wanna say, everybody listening, I would fully endorse this book. It's a fantastic book. So that author, she missed out.

Marina: Thank you very much. Um, and you know, oftentimes I rely on word of mouth and on. People posting about it on LinkedIn or Instagram because they're happy to be associated with the word vagina.

But just two days ago someone messaged me saying, I [00:42:00] was writing a review on Amazon for your book, and I mentioned the word vagina in the review. And so my review didn't go through and I was told I'm, uh, violating community guidelines.

Dr. Brighten: So the same thing happens. Anybody listening who spends any time on social media in women's health knows that we can't say vagina, we can't say vulva, we can't say breast.

We cannot use medically accurate terminology. We can use vulgar terminology if we wanted. And meta meta would let that through. Meta will run erectile dysfunction ads all day every day. And you can talk about a penis, but if you talk about anything using medically accurate description of a woman's body, even saying clitoris, social media doesn't want it out there.

And when I find insane, to me. Is like we just liberated breastfeeding on social media like a handful of years ago. Mm-hmm. And yet I could scroll through and have a girl and a bikini and see, fully see her ola. I can see her labia. I can [00:43:00] see all of that on social media. And it sends a very clear message that as long as we are objectifying women, we shall let it pass.

But the moment that you try to use medically accurate terminology to educate women about their bodies, now, now social media is taking an issue with it and I just find it appalling.

Marina: Yeah, it really is. Um, and the stigma extends to, uh, mainstream media, you know, posters that are not being put up. Uh, and unfortunately there's one study that showed that two thirds of young women between the ages of 18 and 24 are then too embarrassed to use the word vagina at a doctor's office.

Uh, and that's, that's a real problem.

Dr. Brighten: So I wrote about that in my book and the number of sex educators who will not use. So when girls are, so these are, you know, girls who are in sex ed. Um, so like middle school, when they're being taught about their bodies, the [00:44:00] majority of educators are too embarrassed to use the word vagina, that they won't, they won't.

So they, they're not even being taught medically accurate terminology about their body. It's why so many people don't know the vagina is the inside and the vulva is the outside because these conversations are just not being had. You also look at things I talked about the gray's anatomy, how the word penis is like all up in Grey's Anatomy.

They used it all the time. They would not use vagina. They called VA jj, like they used other terms like euphemisms. They would not actually use this to show about doctors and they would not use medically accurate. Uh, terminology and yet saying penis was totally fine.

Marina: Yeah. It just shows the double standard or when you think about doodles in, in bathrooms as well.

Right. We're so used to seeing penises everywhere. It's true. I never thought about that. Mm-hmm. But who can actually draw a clitoris? I've asked many people to draw a clitoris and hardly anyone can do that. [00:45:00]

Dr. Brighten: I should put the, so in my book is this normal? I put, um, there's three diagrams of the clitoris because I was like, they don't even medically accurate representation, like of the anatomical structure of the clitoris doesn't exist in medical textbooks.

Most doctors don't, aren't trained on what a clitoris looks like. So I was like, I will be damned. I'm gonna just put it in my book. I'm gonna give it to people. My son is 12 and somehow the topic of clitoris came up. And I, what I was saying I should put on social media is that I like stuck out my head and then I had my arms to the side and I spread my legs really wide.

And I was like, look at me, I'm a clitoris, like wiggling across house. He's like, mom, you're literally the weirdest. And I was like, yeah, except that you're literally gonna be like the smartest male in every single room if you know this. Yes. But you're right. Most people have no idea. They think the clitoris is just this little tiny pee that just, and a lot of times, uh, you know, people aren't even aware of where it sits or where the urethra sits because, um, I, I, I even [00:46:00] ran into a problem.

So I put out a video on TikTok showing, uh, it was Netter's Anatomy showing the vulva, okay, this is a medical textbook for everybody. This is like what doctors are trained on. And I put that up and I went through and I showed it. Um. You know, the different, um, aspects and gave a little lesson on it. I got community, uh, violation.

I got the video like, you know, they, they took it down. I appealed them and they were, they, I explained to them, I was like, go re-watch the video. And they were like, you know what? You're right. You're right. This is this video stance. We're gonna leave it up, but we will not allow people to comment on it.

People may not comment on your video. I'm like, okay, I'll take the win. I will take the win. Um, TikTok is one of the platforms that I have found is much more open to, if it is a medical provider presenting medical information, we're gonna take that differently than a lot of the other social media companies.

Like as we're talking right now, this is gonna go on YouTube. We'll see you, everybody listening, you gotta help us out. Like you gotta liberate the [00:47:00] vagina because literally I think YouTube is gonna probably be like, Hmm, you said the V word too many times. We are not comfortable with that.

Marina: Yeah, exactly. But as you say, it happens in sex education, in medical settings as well.

Yeah, I remember that after I had given birth, there was a, a nurse who asked me, you know, how's it going down there? And I was like, down there you're a nurse, why are you saying that?

Dr. Brighten: Yeah. Well, I mean, sometimes it's like, I wanna ask you about everything down there. Right. I don't wanna be like, what's your perineum?

Tell me about your vulva. Tell me about your anus. Like you wanna know, right? Yeah. That's but's a the generous

Marina: way of, of seeing it. That's true. Yes.

Dr. Brighten: Yeah. But on social media, I will say things like that and people are like, uh, you need to say the word, like, you're only contributing to the stigma. I'm like, you wouldn't even know I existed if I did say it.

If I said vagina, if I said perineum, if I said anus, you would not know I'm here because they would not show me to you. They would keep me buried. I wanna um, switch gears though, and it's in the same [00:48:00] vein of like the stigma, but I wanna talk about you brought up. Polycystic ovarian syndrome, endometriosis.

We're talking about, you know, some estimates say as as high as 18%. We actually don't know the true estimate of endometriosis because of how underdiagnosed it is. Why is it taking women a decade though, to get these diagnoses?

Marina: Yeah. Well, it's a combination of many, many different factors, but as we've said, women's health has been under researched and underfunded, and it's always important to remember that funding underlies everything.

So if you want to do research, you need funding for that. Um, and as a result, then you have insufficient training for healthcare professionals. You have the stigma that we discussed where many people are still not comfortable talking about, um, menstruation. Also, it's been diagnosed, um, in an invasive way.

You know, it has. Um, it has required laparoscopic surgery for definitive death. This is endometriosis Yes. For everybody [00:49:00] who's ends. Yes. Sorry. And so, uh, that has meant when people were delaying getting that done, um, until symptoms became more severe and

Dr. Brighten: or because they couldn't afford it. Because let's face it, surgery is not cheap.

The downtime of missing work, like as I said, I just went through it, I'm at two months. I still have another month before. I'm considered like having healed from this surgery. It's not insignificant. The impact that it has. Yeah, exactly. And I think

Marina: something that's generally an issue in women's health is that care is really fragmented and it's not very holistic.

So women will go from their primary care doctors to a specialist to another specialist being, um. Sent around and there are not enough people who are connecting the dots.

Dr. Brighten: Absolutely. And for people who are unfamiliar with endometriosis, the [00:50:00] hallmark symptom that comes to mind for most people who are familiar with it is period pain.

And yet we know IBS, many women being diagnosed with IBS, it's actually a missed endometriosis diagnosis. Having chronic fatigue, having anxiety, there's a lot of ways it presents, but as you were saying, this underfunded, you know, area of medicine means that not every provider is getting the most up-to-date information and understanding what endometriosis really is, listening to your patients will get you really far, really far in understanding that endometriosis isn't a reproductive issue alone.

It is affecting the entire body. And the same is true with polycystic ovarian syndrome. That is often called, you know, an an infertility issue. Like it gets just slapped on it that it's a reproductive issue. And yet we know TCOS women as we started this conversation, are very high risk for cardiovascular disease, cardiovascular events, and diabetes.

And that doesn't just go away [00:51:00] once you stop ovulating because that underlying issue, which we don't totally know what it is, um, because we haven't studied it enough to cause the driver of PCS that persists even through menopause. And yet many providers think once you go through menopause, you're not going to have the issues anymore of these anovulatory cycles.

Like we won't have to worry about it. And they negate the fact that many women who enter into menopause become insulin resistant. And those who are living with PCOS are often already living with insulin resistance.

Marina: Yeah, everything is so, so interconnected, uh, in the female body. And unfortunately, medical gaslighting is also still quite common.

And I think what's underlying so many issues is that we've normalized female pain, right? You said, is this normal? Is the title of your book? And I, I think so many times when women say, oh, I have extreme period pain, you know, that's normal, [00:52:00] painful, IUD insertion, that's normal. Or, you know, pain with breastfeeding, just wait a few months, it might get better.

And so unfortunately we have normalized female pain and as a result there are all of these issues. And it's perhaps not surprising, considering we always tell women to, you know, be nice and be agreeable and smile and, and all of that. And so doctors often tell me that women are less likely to, uh, complain about side effects.

Of medication. If you've always told to be nice and agreeable and you'll suck it up and welcome to being a woman, then, then that's where that leads. And I think, uh, we've had enough of that attitude and it's, it's time for change.

Dr. Brighten: Absolutely. I think that the younger generations have seen what the women before them have endured and they are saying no more.

Uh, this actually raises the topic like gynecology is archaic af okay. It is so in so many [00:53:00] ways, archaic and barbaric even. I will say that because the IUD insertion without pain management is an this should have never happened to begin with, and yet it persists with gynecologists defending it. It's the hill they'll die on that.

The cervix has no ear nerve endings that women are just being dramatic about their pain. But I wanna talk about how little innovation we've seen in gynecology and why that is. So the

Marina: speculum, for example, hasn't changed much since the 1870s. The tenaculum is from the 19th century, and it's a pair of, tell, tell everyone what the tenaculum is.

Yeah, it's a pair of scissors with these sharp pointed hooks. Uh, they're used for IED insertion and that can pierce cervical tissue. And it was first developed to remove bullets on a battlefield, which kind of tells you, uh, what that device is like. And now they use it

Dr. Brighten: to pin your cervix. So if people haven't seen an IUD insertion, you can [00:54:00] actually search it on TikTok.

It's pretty easy to find, but that tenaculum is like two little spikes that they're gonna put into your cervix and they're gonna pin it down so that they can then measure the depth of your uterus and then insert the IUD. I had an IUD insertion. I've never, I've had two unmedicated births and I would do an unmedicated birth over an IUD insertion every day, any day.

That was the worst pain I have ever experienced, and yet the female practitioner who was placing it. So for everybody listening, I've very filthy mouth when I am in pain. Um, and research has actually backed up that when you cuss when you're having pain, you actually have a higher pain tolerance. So, um, don't come for me.

Uh, but I was cussing. The pain was so extreme and she actually said to me like she was so uncomfortable by my language that she was like, I'm not gonna proceed unless you stop cussing. And I, at the time, you know, here I am in this vulnerable position, somebody's literally inside my body. But in retrospect, as I became a doctor, I'm like, her [00:55:00] discomfort with my language was put above my discomfort with the medical procedure.

And I still just think like, this is nothing that. That has changed in a lot of ways in medicine. You know, as I say this, I don't want people to think I'm bagging on providers. 'cause I will say there are amazing, amazing providers out there, and there are gynecologists that are sticking their neck out, calling out these practices.

But we, so I wanna go back. I interrupted you and I kind of don't like that I did that because you were talking about when the speculum came about. When the tenaculum came about. I wanna let you keep going. Yeah,

Marina: no, I, I'm glad you brought this up and I'm, I'm really sorry that this happened to you. And it is unfortunately very common.

Um, and I think now that we're becoming more aware of it, you know, we can encourage people to advocate for themselves and to ask more questions and to not accept. Mm-hmm. That form of treatment. Um, but one of the [00:56:00] other things that got me into fem tech in the first place was that I knew I wanted to have children when I started working to this book.

You know, I was in my early thirties and I also knew that nine in ten first time mothers experience a birth injury. Uh, and that's something mm-hmm. That many people don't talk about. And maybe some of your friends might tell you that this happened, you know, in hashed voices. Um, but I, I think it's really important to know what might happen, uh, because power is not even nine in

Dr. Brighten: 10, nine in 10 is huge.

Yeah. And I just, I want you, when you say having an injury, what are you talking about? Because I, I think, um, immediately a lot of people are like, hold up nine in 10, like the, the majority of us. I'm talking about

Marina: vaginal tearing primarily, and [00:57:00] so I was really excited when I came across a company called Maternal Medical in California.

They're working on a birth dilator, so it's a dilator that can be used. In the beginning of labor to pre-stretch the muscles of the vaginal canal so that by the time the baby comes through, uh, they've been pre-stretch and there's less likely to be tearing. And it's important to say it doesn't stretch the cervix, it stretches the muscles of the vaginal canal.

And so this device is not on the market yet, it's in clinical trials. Uh, but I thought that's such a, such a cool innovation, such an interesting idea. And it's actually quite simple. You know, dilators are used in other areas like vaginismus, so it's not a completely new device, but it's something that already exists.

Uh, and it's not invasive, you know, it's quite straightforward. And I thought that was very [00:58:00] promising. And I spoke to the CEO of the company, Tracy McNeil, and I. She told me that the last big innovation in the standard of care of birth was the epidural, which was popularized in the 1950s,

Dr. Brighten: 1950s. Everybody let that sink in.

We have not had innovation in the birth space since the 1950s, and in fact, as you're talking about tearing, app, episiotomies are still being practiced. The American College of Obstetrics and Gynecology have long ago said, you should not do this. And I actually just had a friend recently. That her provider said, oh, when you come in, labor starts, goes through the whole thing.

And then they're like, well, we we're gonna perform the epi episiotomy. And she's like, I don't want that. And he's like, well, I do it with all my patients, you're going to get it. I was like, print out the studies and send the, I was like, I wouldn't birth with anybody who tells me I'm gonna ignore. I'm gonna ignore the research.

I'm gonna ignore your wishes, and I'm gonna do what I, I want. I'm like, I'm not a nice person when I'm in labor. Like, I could still fight you. Um, [00:59:00] so I'm like, I'm never birthed with this person. Yeah. But this is, um, really just one of the many, uh, examples of obstetric violence. So we've had no innovation and we have, we have higher, uh, higher rates of obstetric violence that's even reported, right?

Because we're supposed to smile, we're supposed to grin and bear it. We've got things like a episiotomy, so where they cut you. Not the best intervention. We know a jagged tear is going to heal better than a, you know, straight line, um, cut that's being done there. But you know, we, we also know there's, um, so many incident, uh, instances.

Instances, get that out. We know there's so many instances where. Women have their wishes disregarded by providers. And it isn't following the evidence, it isn't following the science. And so I want you to talk to us a bit about that, because you just had a baby less than a year ago. You've been in that position.

You know, you, you found this diet later. I think that's [01:00:00] awesome. It's also something that midwives for a very long time have taught, uh, perineum stretching. So people, you have to come to YouTube to see this, um, where you actually insert your thumbs into the opening of the vagina, the introitus, and you massage and you, you open things up, um, and you, you stretch the tissue.

It can help immensely with decreasing tearing, also the position you birth in. Um, but you know, to that, why are we not getting updates? Why are we not seeing, not just gynecology, but obstetrics as a whole is not innovating for women? Yeah,

Marina: well there has been some innovation in the birth space that's focused on the fetus and fetal testing, for example.

But when it comes to the mother, that's, that's a whole other stories. And I think episiotomies are a key example of this because they are an outdated medical practice. And as you say, the American College of Obstetricians and Gynecologists issued a [01:01:00] recommendation against the routine use of episiotomies.

Um, but I think the thought behind it mistakenly still is that the precise, when in reality the research suggests that natural tearing is better in most cases. And that episiotomies when they're used in a routine way, can lead to post-surgical infection, deeper tests, long-term discomfort, slower healing, uh, very painful.

Uh, but it's, it's a matter of obstetric violence and, you know, having control. Over that process. Whereas the midwife approach tends to be very different in terms of working with the female body and recommending things like perineal massage and recommending, uh, birth positions where you're not lying on your back.

Right. In most movies, when we see a birth scene, a woman's lying on her back and, uh, screaming and people are like, shouting, push, push, whatever. [01:02:00] Um, and, and that's not actually a, a great scenario because when you're in an active birth position, you're less likely to experience a birth injury. So being on all fours is actually better than

Dr. Brighten: being on your back.

I birthed my first on all fours. So I actually had a home birth that was attended by two doctors. Both my children were home, births with physicians attended it. Um, and I could, they put me in so many positions and I was like, I have to be on all fours. Like that's where my power is. And. That's where I was able to birth my first, and then my second was totally different.

He ended up, the first, I was like, I wanna have this water birth that is not what was in the cards. My second ends up like I was in the bathtub and that was like the only way to, um, you know, get him out of my body was I had to be in the bathtub. And so I, what I think we don't see enough of in. Uh, labor is respecting the [01:03:00] woman's body and her innate wisdom.

I think there is a lot of acting like your body is so dumb and betraying you all the time that only the doctor can know best in some situations. There is a huge movement. I actually just, um, I interviewed a Dr. Dr. Cynthia Dicker, who's in Mexico, who's changing the paradigm in birth. But there's a huge, um, movement towards humanizing birth, to going back to respecting the woman's body, to having less interventions and to honoring that there is a dance, right?

Or this connection between mom and baby that we haven't even began to explore in science and understand. You brought up that there have been innovations in fetal monitoring and testing that I think is actually wonderful that we have that. But also a problem that anytime we talk about childbirth, it is often through the lens of having, you know, baby be healthy and only baby be healthy.

Whereas [01:04:00] mom should be grateful no matter what happens. If she has a healthy baby, then she shouldn't complain about anything. And I will say as somebody who, um, got pregnant at 40 with my second, you're very much treated as if your body is in the way of that baby. And as if your body is at every turn trying to kill that baby.

It is, uh, it is this phenomenon that happened. I don't know if it happens where you're at in the world, but in the United States it's like over 35, you're geriatric, you are old, therefore your body cannot do this anymore. And in fact, it's just going to cause harm to your baby, which is. Not what we see globally.

We see lots of women having babies after 35.

Marina: Yeah, exactly. And it's, it's such a stupid term, geriatric pregnancy. You know, it's not like we say, here's your geriatric pack of Viagra. Right. But for women, we say a geriatric pregnancy or morning sickness, which sounds kind of cute, but it's, it can be quite terrible and it doesn't just happen in the [01:05:00] morning.

So I think those terms that we use are very, um, revealing.

Dr. Brighten: Yeah. And geriatric pregnancy, they did a rebrand of it for advanced maternal age. I still don't think it's, it's, it, it doesn't have the utility to the patient. That medicine, I think, you know, intends and I think that we really have to. We really need to be giving women a lot more respect and dignity in women's medicine as a whole, but certainly in childbirth.

Mm-hmm.

Marina: Absolutely agree. And to respect women's choices as well, you know? Uh, and that includes if somebody wants an elective C-section, you know, that should be. Fine. If that's what they are, sure they want, just say, yes, that's your choice. It's your body. You know, you have the right, uh, to get that if that's your choice.

Um, so I had a very positive birth experience and I, you know, I prepared [01:06:00] for birth, like other people prepared to climb Kilimanjaro. Uh oh, same, same. Yeah. That's a story, that's a conversation for another time. A really long story. Um, but I think there is a lot you can do. And that goes back to my point of not just thinking, oh, you know, I'll go with the flow and we'll see how that goes.

And I think the same goes for conception. When we think about our careers, we plan things, we go for interviews, we write Excel spreadsheets about who we're going to network with or whatever. And then when it comes to conception and birth, it's all like, well, we'll see what happens. I think I. There can be another attitude and you can be much more strategic about those things.

So I had, um, a water birth, which was very empowering and exactly what I wanted. And I had gas and air. So in the US you say laughing gas, which is, uh, common in the uk, which [01:07:00] I thought was fantastic. I was just very high on it and it was absolutely great. And I had, I had such a high from all the hormones that were cruising.

The endorphins are real. Yes. Yeah, the endorphins. It was just, um, an incredible feeling and. I had an amazing midwife, which, you know, makes all the difference in mm-hmm. Low risk pregnancies, uh, continuity of care and having, you know, compassionate and amazing care is, is so, so important. And I had done a lot of research into the particular hospital that I was at, so I was in a birth center led by midwives that is within a hospital.

Uh, and, and there are different configurations you have of that in the uk. So I've researched that particular hospital. I spoke to friends who had given birth at that hospital. I have read hundreds and hundreds of birth [01:08:00] stories as well. Mm-hmm. And like long before I got pregnant, which I think many people would think that's weird, but I was just so curious about what might happen and about all the, uh, potential.

Things that could happen in the process. So I had a birth plan and I had various, I had a flexible birth plan. So if this happens, I would like this. If this happens, I would like that. Yeah. And that was really respected by my midwife. Um,

Dr. Brighten: I love that you brought up though, you said you prepared, like you were gonna like climb the biggest mountain.

And, and let me just say this, like, I think that the expectations postpartum are so ridiculous. If you ran a marathon, everyone's like, you gotta take, you gotta take time off, you gotta recover. Like of course, let's get you like IV hydration, let's do all this stuff for you. And postpartum. Women were often told like, you had a baby.

All right. Get to cooking, get to cleaning. Like, take care of that kid. You're not sleeping. Like, suck it up. It's, we need to have that same respect of like what, what we do for [01:09:00] athletes. But I know that people listening you said that. You gotta give them a little taste. Like what's a couple things that you would recommend considering to prep for birth?

So I

Marina: looked into all the different forms of pain relief, all the different things that are available. You know, I looked into the difference between being on a labor ward and being in a birth center. Um, so the difference between being taken care of by gynecologists and midwives. I looked into what a birthing pool does.

You know, all the studies around what water does when you're giving birth. Um, so I think just knowing what's there so that when you're in the situation and they offer you an option, you already know the option and you can ask more questions about it. Uh, that's really important. I did a lot of, I practiced a lot of breathing techniques as well, because your breath is so powerful and so important in a situation like that.

Um, I did something called the UJA breath. From yoga, uh, you [01:10:00] wanna

Dr. Brighten: explain it for people? Maybe demonstrate it? Yeah. Oh,

Marina: that's probably something you should look up on YouTube. It's sort of a kind of loud, kind of breathing that I found really helpful in the, uh, pushing stage of labor. I also hired a doula, which is an investment, but you know, for me, I would've done so many different things to have a positive birth experience.

So for me that was much more important than, I dunno, going on a big holiday later down the line or something. So I would definitely recommend having a very experienced doula on your team to provide continuity of care and, and because. They have so much insight. Um, and then postpartum, as you've mentioned, there's unfortunately not enough care, and there's something people refer to as the postpartum cliff where there's no [01:11:00] comprehensive follow up.

So issues like, uh, pelvic floor injuries, postpartum depression, or challenges with breastfeeding, you know, can go undetected. So I would look into those issues to be aware they exist so that you can actively, uh, seek help and just get as much support as as you can really. Uh, and, and some of this is a matter of policy, right?

So having good shared parental leave, good parental leave policies in place, uh, does make. All the difference otherwise, um, parents are forced to return to work before they've physically healed, before they're emotionally recovered. So some of it is a matter of policy, of course, but do as much as you can in your circumstances.

Dr. Brighten: Yeah. I wanted to second the doula. I did not have a doula with my first, [01:12:00] um, and then I hired a doula with my second, and it made such a difference. And my team for my second was really wonderful because they just let her take the lead in terms of everything that I needed. And it wasn't until, um, my baby was born that then there was a doctor there and everybody then came in to like, provide the care, but mm-hmm.

For the majority of the time it was just me and her. And then, um. And my husband and he had to get in the bathtub with me. 'cause I was like, I need something to push against and like, you have to be here. Um, but I think what I would love to see. I would love to see, uh, maternity, paternity leave. I would love to see doulas just being part of mm-hmm.

The standard of care that they are there at all times and available to every woman. I would like to see birth plans being respected. There is, um, I was so appalled. I saw this, um, ob gyn on, on social media that was like, you know what we do when we see your birth [01:13:00] plans? We laugh and I'm like, A birth plan is the initiation of a conversation.

And that, I mean, nobody should be of the mindset, you know, like I said, my first one, I was like, had a whole birth hub. I had this whole thing going. I was like, I'm Neva water birth, but every time I got in the water. My contraction slowed. They went away. I didn't progress. And it was like, this is not working.

So if I need to get outta pain and get in the water, but if I wanna have this baby, I gotta get out of the water. Um, I think you make your plans and then you know that like all bets are off the table once you go into labor, because there, there might be things that are needed, but to have a team that respects your wishes, I think is really, really so important.

Yeah. When it comes to advances in terms of technology and in care, you've done a lot of research. What can we learn from what Japan and the UK have been doing? Mm-hmm.

Marina: Yeah. I just had one thought as you, uh, mentioned the birth plan, because I've encountered, yeah. Different attitude. Go back. Yeah. I, [01:14:00] I've encountered different attitudes from, uh, midwives.

I have had one midwife say to me, oh, you know, the birth plan is really for you, not for us. Um, which I didn't think was a great attitude. But then my midwife that I had on the day, and this was a complete coincidence, that I had also met her before in two appointments, which was very, very lucky because usually you always have a different person.

Um, and she said she saw the birth plan and she said, this is brilliant. This is a great birth plan. And she was really familiar with it. She knew what my preferences were. And I think you can't underestimate how important it is to be taken care of and to feel respected in that situation. It really does make.

All the difference, um, mentally, emotionally, physiologically,

Dr. Brighten: it's one of the most vulnerable times of your life. Like anyone listening this who's given birth absolutely knows how vulnerable you feel, but it can also be mentally, emotionally,

Marina: but it can also [01:15:00] be a hugely, the most powerful time of your life.

Yes. Yeah, so that's the thing. Uh, and in terms of looking to other countries, I would actually say we should look to France and Germany for postpartum recovery as that's something we're talking about. I

Dr. Brighten: Korea, man, they got those hotels going on. I'm like, somebody get me there by another baby because that the food alone.

I'm like immediately. Yes.

Marina: Yeah. I dunno if I'd go to a hotel, but I would definitely take the food. Um, and in Germany and in France, what they have is, um, women receive many weeks of pelvic floor rehabilitation therapy, you know, and it's all covered for everybody by the national health insurance system.

And that's really important for things like incontinence and pelvic organ prolapse. Later down the line, postpartum visits are uh, you know, routine and completely normal. Uh, and in Germany [01:16:00] everyone gets a midwife as well, and postpartum that answers. All of their questions and does regular checkups and so on.

So I, I think that should be the norm everywhere.

Dr. Brighten: And I've seen the same in Amsterdam, uh, and um, uh, I don't wanna say Holland, and I'm like, they, they don't really get called that anymore. But we see that in other countries as well where there is a lot more postpartum care. But I think France was the first one that was like, everybody gets pelvic floor therapy.

We see a lot of talk currently because menopause is getting rightly so, a lot more of attention. And I talk about this as well, how important vaginal estrogen therapy is for helping, um, with urinary incontinence and some of these symptoms that women face. And however, what I don't see enough talk about is that it's actually this, this prolapse, this incontinence, all of this that you're experiencing.

This was from 30 years ago, 40 years ago when you gave birth. And nobody caring for you then. And for people to [01:17:00] understand that one of the primary reasons why women enter into nursing homes is due to urinary incontinence. And at that point, you start losing the quality of your life. Like that is how serious urinary incontinence is.

And I actually, it was several years ago, I was on this group hike with like 30 plus, um, women. And we were, everyone's a mom and we were hiking this mountain and this mom said like, she was laughing and she's like, oh, I peed a little bit, and like everybody giggled. And they're like, yeah, everybody does that if you have a baby.

And I was like. Wait, what? And they're like, yeah, once you have a baby, you're gonna pee your pants like every time you laugh or cough. And I was like, this is called stress incontinence and this is not normal. Everybody, my doctor said this is normal. I'm like, your doctor's a liar. Like they're a liar. No, this is not normal now.

Just you. So you guys know, I wouldn't say that to a patient, but these are my friends. And I'm like, absolutely not. Y'all need pelvic floor physical therapy. Let's talk through this because that is not something that will ever get better on its own and you [01:18:00] can't kegel your way out of it. Friends. Um, there's gonna be a whole episode that we have with a pelvic floor physical therapist that we can spend a lot of detail on.

She's actually bringing models and everything, and we're gonna teach everybody about the pelvic floor. That

Marina: sounds excellent.

Dr. Brighten: So the last thing I wanna ask you, so, so to wrap up this conversation, what can women do right now to feel empowered so that we can start creating change in women's medicine? We can start advancing technology, we can get the care that we need.

Marina: I think it always starts with education, right? Because mm-hmm. There's so many things where we don't even know what we don't know. So I would say educate yourself, learn more about your body. And for me, writing the Vagina business was a journey to not only learn about the innovative technology that's out there, but I've learned a huge amount about my own body.

And you kind of think, you know, but there's always so much more [01:19:00] to learn. So I say start with education, with learning more about innovation, learning more about your body, and then have conversations with others. Right? Because some of the most powerful feedback I've received from readers is when people say, oh, I've read your book and you've changed the way I talk to my young daughter, or, mm-hmm.

Or I have finally had a conversation with my mother. Where we no longer use euphemisms is something someone else told me. Or you know, I asked for an additional test because I thought of your book. So that to me is very,

Dr. Brighten: very powerful. That is. And let's I, you know, I just wanna second that. Let's normalize normal conversations about the normal things that our bodies do and when we think things are deviating from what is normal for us.

'cause that's really the only thing that matters, is what is your normal and what the deviation is that we [01:20:00] do advocate for ourselves. And we don't settle for being told you're just a woman, you're just getting old. You're just a mother. You're just, just, just no. You are a human who deserves to have a full quality of life.

Exactly. And the best care in the world. Ah, I love that. Well, thank you so, so much. We're gonna link to your book in the show notes for sure. Um, for everybody listening, um, there's a couple times I asked you to leave comments, but if you do read the book, I would love to hear what your thoughts are about it, because I thought it was an absolutely fantastic book.

I wanna congratulate you so well done and so needed in the world. So thank you again for everything that you are doing on this planet that is helping better women's lives overall. Ah,

Marina: thank you so much. I, I'm very moved by your words. It's, uh, very, very kind of you, and it's been a real pleasure talking to you.

Dr. Brighten: I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out [01:21:00] this.