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.”
Past episodes of Show more...
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
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
Marnina "the Queen" Miller, human rights activist and co-executive director at the Positive Women’s Network (PWN), recounts her journey living with HIV as a young woman in the American South, finding a sense of belonging in the national community of PWN, and spearheading initiatives for HIV advocacy and treatment for people of all backgrounds. Marnina discusses some of the unique challenges that Black women face within their communities as they search for inclusive care and acceptance after HIV diagnosis. She also delves deep into the world of policy, closely examining how political advocacy can impact HIV criminalization and reproductive rights. Marnina highlights the importance of coming together to provide comprehensive sexual health education. She emphasizes moving past equity and towards liberation from HIV stigma: “I want liberation... I don't want equity. I don't want equality. I want liberation. I want to be free of HIV stigma.”
Read the transcript of the episode.
Marnina Miller’s LinkedIn & Instagram
Marnina Miller is a highly accomplished human rights activist, speaker, trainer, and social media strategist with a profound commitment to fostering positive change in society. She is currently the Co-Executive Director of the Positive Women’s Network- a nationwide group that fosters support, care, and community for women living with HIV.
Link to Past Episodes with Similar Content:
In this episode of Coming Together for Sexual Health, host Tammy welcomes Dr. Bethany Golden, a nurse midwife, to discuss the many ways midwives support sexual and reproductive health beyond childbirth. Bethany shares how midwives provide holistic, patient-centered care, including contraception, abortion, STI treatment, gender-affirming care, and primary healthcare for people of all genders and ages. She talks about studies that show that most midwives provide reproductive health services and almost half provide primary care: "...so this is a large portion of what we do. And so the public perception...is that we are doing pregnancy-related care. Again, that is part of what we do, but we spend a lot of time focused on other moments in people's lives."
Bethany also talks about her work with the Reproductive Health Service Corps, which is training more midwives and clinicians in abortion care. Tune in for an insightful conversation on reimagining reproductive healthcare for a more inclusive and equitable future.
Guest Bio:
Bethany Golden, RN, CNM (she/her), is a registered nurse and a certified-nurse midwife with deep clinical experience and knowledge of comprehensive reproductive health including abortion. As a clinician, consultant, and lecturer, and as part of research teams, she has worked in clinics, hospitals, universities, and villages in New York City, SF Bay Area, Chicago, Fiji, and Nicaragua. Most recently, as a member of the Future of Abortion Council's workforce committee and the policy advisor at Training in Early Abortion for Comprehensive Healthcare (TEACH), she initiated, co-developed, and advocated for the successful passage of bill AB1918. The law created the CA Reproductive Health Service Corps to train and diversify the entire health care team, which she currently co-directs at TEACH with Megan Kumar. Since 2002, she co-founded and continues to operate ICAS/Juntos Adelante, a not-for-profit that focuses on health and human rights in Nicaragua.
Read the transcript of the episode.
Check out Bethany Golden’s website
Bethany’s Publication: Emerging approaches to redressing multi-level racism and reproductive health disparities
Related episodes of Coming Together for Sexual Health: Trauma-Informed Pregnancy Care with Becca Schwartz, LCSW & Abortion and Reproductive Justice Across State Lines
Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu
Don’t forget to leave us a review on Spotify, or wherever you get your podcasts.
Monica Gandhi, MD, reflects on her decades-long work in HIV care, from providing care early in the epidemic to leading implementation of today’s groundbreaking medical advances. She discusses the science behind HIV (including how 7 people have been cured), the groundbreaking shift from complex pill regimes to long-acting injectable therapies, and how these innovations help patients facing medication challenges. Monica also draws parallels to COVID-19 as she underscores the importance of harm reduction; encourages bipartisan support while talking about policy and funding; addresses social determinants of health that impact HIV prevention and treatment. For her, HIV is not just an infection, but a movement driving healthcare and equity forward.
Monica Gandhi, MD, MPH, is a Professor of Medicine and an Associate Chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco. She is the director of the UCSF Center for AIDS Research and the Medical Director of the HIV clinic (Ward 86) at SF General Hospital. Dr. Gandhi also serves as the Associate Program Director of the Infectious Diseases Fellowship at UCSF. Her research focuses on HIV treatment and prevention optimization, HIV in women, adherence measurements in HIV and tuberculosis, adherence interventions, and optimizing the use of long-acting antiretroviral therapy. Dr. Gandhi has been in the HIV workforce since 1996 and brings an extremely important level of expertise to the field. Her book, Endemic, illustrates the lessons to be learned and applied to future epidemics from the HIV epidemic.
Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu
Don’t forget to leave us a review on Spotify, or wherever you get your podcasts.
Ina Park, MD, is back again for a focused look at her (second) favorite sexually transmitted infection: syphilis (favorite because it’s fascinating). She says, “it’s one of the most challenging conditions to diagnose in clinical medicine because it literally can look like anything.” Join Ina and Tammy as they explore how syphilis was almost eliminated around 2000 and then surged again to current rates of infection in the US. Ina spotlights how a rise in congenital syphilis has fueled a mobilization in public health efforts, even while she celebrates declines in rates of the most infectious types of syphilis. As national syphilis screening guidelines are adapted to increase screening, including in emergency departments, Ina is optimistic for a reduction in future syphilis rates. But here’s the takeaway for healthcare providers and patients alike: keep syphilis on your radar. A quick shot of penicillin early-on can save everyone a lot of trouble.
Links:
Connect with Dr. Ina Park on her website, LinkedIn, X, and Instagram
Resources mentioned in episode
CAPTC related training and resources
Previous episodes with Dr. Ina Park
Check out a compilation of three previous episodes on reproductive justice and family planning. After you hear what each of our guests has to share, take a listen to one (or all!) of the full episodes:
Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu
Don’t forget to leave us a review on Spotify, or wherever you get your podcasts.
Did you know the visible part of the clitoris is less than one-third of its actual size? Cliterally just the tip of the iceberg! In this second part of our series with Rachel Gross, Rachel and Tammy’s excitement sparks an important conversation about this understudied organ and its friends--the vagina, vulva, and pelvic floor. Afterall, it is not common knowledge that (gasp) all sexual organs differentiate from the same embryonic root, or that close to 10,280 nerve endings were counted in one clitoris. By taking an interdisciplinary approach to sexual health, Rachel reveals how pleasure is impacted by menopause, vulvodynia, and pelvic pain. She calls attention to the whole-person approach of gender-affirming care doctors, and the importance of addressing a person’s overall experience of their bodies and pleasure. There is much to explore about pleasure and sexual health in this episode.
Links:
Check out Rachel Gross’s website
S4 E8: Intimacy Starts with I: Women, Self-Love, and HIV with Michelle Lopez
Rachel Gross has been a science reporter for over 10 years, determined to share educational resources and information with the public. Rachel’s work has been published in The New York Times, The Guardian, BBC Future, National Geographic, and more. Rachel is also the author of Vagina Obscura: An Anatomical Voyage, a novel dedicated to re-mapping the female body based on meticulous research and exploration. Rachel is a committed sexual health educator, having lectured at various organizations and top universities in the nation.
Read the transcript of the episode here.
Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu.
CDC’s 2023 STI Report is in, and for the first time in years, there’s good news. Tune in to our latest episode with Dr. Ina Park, a nationally recognized expert on STIs, to learn why she is cautiously optimistic about the new data trends in chlamydia, gonorrhea, and syphilis. Dr. Park expertly navigates the report with our host, Tammy Kremer, explaining how the previous surge in STIs has begun to slow, while prevalence continues to be high in certain “STI microclimates." Dr. Park stresses the importance of maintaining momentum through increased testing, focused prevention efforts for disproportionately impacted communities, and reducing stigma around STIs. Listen in to discover how disease intervention specialists are battling syphilis on Native American reservations with plenty of penicillin, a trusty car, and heroic determination. Overall, Dr. Park envisions a world where discussing infections is as routine and stigma-free as talking about the common cold.
Read the transcript of the episode.
Links:
Connect with Dr. Ina Park on her website, LinkedIn, and Instagram
Resources mentioned in episode
CAPTC-related training and resources
Previous episodes with Dr. Ina Park
Meet Rachel E. Gross, science journalist and author of Vagina Obscura: An Anatomical Voyage. In this first part of a two–part conversation, Rachel shares how her personal experience with bacterial vaginosis inspired her to write a book that investigates what we know about different parts of female anatomy and how that knowledge (and lack thereof) has been developed. Vagina Obscura is Tammy's favorite read of the year! Rachel highlights the often-overlooked clitoris and vagina, exploring how these body parts are still unfamiliar or awkward for many, including healthcare professionals. We also delve into the systemic marginalization of female and LGBTQ+ voices in science, and how this has influenced society's understanding of the female sexual and reproductive system. Our discussion covers topics like vaginal pH balance and why it varies across different racial groups, and the use of boric acid—a common rat poison—as a treatment for bacterial vaginosis. Rachel also shares the story behind her book's title, Vagina Obscura.
Part two of the episode with Rachel is all about the clitoris. Stay tuned!
Guest Bio:
Rachel Gross has been a science reporter for over 10 years, determined to share educational resources and information with the public. Rachel’s work has been published in The New York Times, The Guardian, BBC Future, National Geographic, and more. Rachel is also the author of Vagina Obscura: An Anatomical Voyage, a novel dedicated to re-mapping the female body based on meticulous research and exploration. Rachel is a committed sexual health educator, having lectured at various organizations and top universities in the nation.
Links:
Check out Rachel Gross’s website
Rachel’s book: Vagina Obscura: An Anatomical Voyage
CAPTC related training and resources:
Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at captc@ucsf.edu.
Don’t forget to leave us a review on Spotify, or wherever you get your podcasts.
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:
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
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.
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. Show more...
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.
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
CAPTC-Related Training and Resources:
S3 E9: Abortion and Reproductive Justice Across State Lines 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:
CAPTC Related Training and Resources:
Turn on notifications to never miss an episode of Coming Together for Sexual Health.
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.”
Follow Diana Greene Foster on Twitter.
Resources:
CAPTC-Related Training and Resources:
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.
Tanagra Melgarejo Pulido, Director of Capacity Building at the National Harm Reduction Coalition, speaks with host Tammy Kremer about the landscape of harm reduction programs and policies around the world and in the US, with a focus on the impacts of racism and colonization. She explains how harm reduction began with “communities of people who used drugs looking at each other, saying wait a minute, ‘We love each other, we care for each other. We need to build power and we need to work together.'”
Download the transcript of this episode.
Resources:
National Harm Reduction Coalition
Harm Reduction International Conference
CAPTC-Related Training and Resources:
S3 E2: Sex, Drugs, and Rock & Roll: Harm Reduction Strategies with Jen Jackson
Turn on notifications to never miss an episode of Coming Together for Sexual Health.
Follow Coming Together for Sexual Health on Instagram and Twitter.
Tanagra Melgarejo Pulido was born and raised in Puerto Rico and is a daughter of immigrants from Mexico and Cuba. She leads the National Harm Reduction Coalition's capacity, building, and technical assistance efforts across the United States and its territories.
CW: Substance Abuse
Braunz Courtney speaks with host Tammy Kremer about he practiced strategies of harm reduction at the age of 11 before he knew what the term meant. He went from dancing shirtless to raise awareness of the prevalence of HIV/AIDS in queer Black communities to serving as the Executive Director of the HIV Education Prevention Project of Alameda County. He touches upon the importance of organizations that understand the lived experiences of the populations they serve.
Resources:
CAPTC-Related Training and Resources:
Turn on notifications to never miss an episode of Coming Together for Sexual Health.
Follow Coming Together for Sexual Health on Instagram and Twitter.
Braunz Courtney is the Executive Director of the HIV Education Prevention Project of Alameda County. He serves PWUDs, the unhoused homeless, LGBTQ+, youth, and the recently released/reentry of the Alameda, Contra Costa, and Solano Counties. He creates, implements, and markets culturally appropriate programs that provide services in non-clinical settings to BIPOC communities throughout Northern California East Bay with a goal of having long-lasting public health impacts.