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

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

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

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

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

Past episodes of

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

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

Click here to view the episode transcript. 

Resources recommended in the episode:  

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

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

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

CAPTC related trainings and resources 

- Shared Decision Making in Contraceptive Counseling  

- Person-Centered Contraception Counseling for Family Pact Clients  

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

Brief Bio  

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

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.

About Positive Women’s Network 

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: 

Monica Gandhi, MD: HIV as a Movement, Not Just an Infection 

The Clitoris and Its Friends: The Anatomy of Pleasure with Rachel Gross   

Intimacy Starts with I: Women, Self Love, and HIV with Michelle Lopez 

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 

• Connect with Bethany Golden on LinkedIn and Instagram 

• 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 [email protected]  

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. 

• Read the transcript of the episode.
• Connect with Dr. Monica Gandhi on Twitter and LinkedIn 

• Endemic, by Monica Gandhi 

• CAPTC HIV & PrEP Resources 

• Long-Acting Injectable PrEP 

• Previous episode with Dr. Monica Gandhi: S1 E7: How Effective Are COVID-19 Vaccines? with Dr. Monica Gandhi 

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 [email protected] 

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 

• • CDC Geographic Risk Calculator 

• • Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs 

• CAPTC related training and resources 

• • STI Clinical Update Webinar – Introduction to Syphilis and Congenital Syphilis

  • CAPTC Disease Intervention Trainings 

• Previous episodes with Dr. Ina Park 

• • Dr. Ina Park Unwraps the CDC’s New 2023 STI Report 

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: 

• S4 E4: When People Have or Are Denied Abortions: The Turnaway Study with Dr. Diana Greene Foster 

• S4 E5 Lesser-Known Forms of Birth Control and Downplayed Side-effects: Providing Empowering Contraceptive Care 

• S4 E6 Family Planning as Gender Affirming Care with Trans and Nonbinary Patients 

Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at [email protected] 

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 

• Connect with Rachel Gross on LinkedIn,  X, and Instagram 

• Scientific American Glowing Clitoris Video 

• Sophia Wallace Artwork 

• S3 E13: Centering Pleasure, Problems, and Pride in Sexual Healthcare with Jenn Rogers & Bryce Furness 

• S4 E8: Intimacy Starts with I: Women, Self-Love, and HIV with Michelle Lopez 
  

• Taking a Sexual Health History 

• Sexual Health Educator Training Program 

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 [email protected]. 

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 

• • CDC 2023 Sexually Transmitted Infections Report 

• • Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs 

• CAPTC-related training and resources 

• • CAPTC Disease Intervention Trainings 

• • CAPTC STI Clinical Training 

• Previous episodes with Dr. Ina Park 

• • S4 E7 Dan Savage on the Magic Question “What are you into?” & Dr. Ina Park on How Providers Can Help 

• • S3 E7: Breaking Down STI Stigma with Dr. Ina Park & Courtney Brame  

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!

Check out the transcript of the episode. 

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 

• Connect with Rachel Gross on LinkedIn, X, and Instagram 

• Rachel’s book: Vagina Obscura: An Anatomical Voyage 

CAPTC related training and resources: 

• S3 E13: Centering Pleasure, Problems, and Pride in Sexual Healthcare with Jenn Rogers & Bryce Furness 

• S4 E8: Intimacy Starts with I: Women, Self-Love, and HIV with Michelle Lopez 

• Taking a Sexual Health History 

• Sexual Health Educator Training Program 

Have any questions, concerns, or love letters? Send us a message on Instagram @comingtogetherpod or email us at [email protected]. 

Don’t forget to leave us a review on Spotify, or wherever you get your podcasts.