The Vagina Doctor Podcast w/ Duncan Turner M.D.

Nurse Practitioner Sophie Mengele at TMA discusses Lexapro (escitalopram) for women’s health, explaining it as an SSRI that increases serotonin to help stabilize mood and reduce anxiety. She describes using Lexapro for younger patients and for premenopausal/menopausal patients, either continuously through the menstrual cycle or only during the luteal phase (after ovulation, about 12–14 days before a period) for recurring premenstrual symptoms like mood fluctuations, anxiety, depression, and sleeplessness. She notes standard dosing is 10–20 mg but often starts at 5 mg to see if a lower dose helps. She also uses Lexapro in menopause for similar symptoms and says it can help with hot flashes, offering an option for those not ready for or not candidates for hormone therapy.

00:00 Lexapro Overview

00:26 How SSRIs Work

00:51 Cycle Based Dosing

01:17 PMDD Like Symptoms

01:32 Starting Dose Tips

01:43 Menopause Benefits

02:08 Who It Helps Most

Episode Resources

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Oculoplastic Surgeon Linden Doss on PDRN, Microneedling, Lasers, Exosomes, and the Future of Surgery

Duncan Turner, MD interviews Santa Barbara oculoplastic surgeon Dr. Linden Doss about modern shifts from traditional cutting-and-lifting surgery toward regenerative approaches, including injectable PDRN (“salmon sperm”), placenta extract, microneedling, and selective laser resurfacing. Doss explains causes and treatment differences for under-eye dark circles, emphasizing thin skin and the roles of collagen versus elastin, and contrasts cold microneedling and pico lasers with heat-based devices that can damage elastin and promote scarring. They discuss scar-minimizing protocols after brow lifts, surgical precision in blepharoplasty, and why laser blepharoplasty is inferior to blades and needle-tip cautery. The conversation covers skepticism about fillers and “biostimulators,” evolving canthoplasty techniques, concerns and possibilities for robotic surgery, fat grafting challenges and nano-fat, the regulatory uncertainty around exosomes, and longevity/skin topics including rapamycin and antioxidants.

00:00 Welcome and Introductions

01:06 Why Eyes Matter in Menopause

01:48 Regenerative Shift in Surgery

04:15 Surgeon Culture and Cutting

07:57 PDRN for Dark Circles

13:20 Microneedling and Scar Blending

16:21 Elastin Versus Heat Devices

19:05 Pico Lasers and Resurfacing

21:46 Placenta Extract Aftercare

22:52 Robots and Surgical Tactile Skill

31:24 Laser Bleph Limits

34:00 Filler Fatigue and Healing

37:41 Biostimulators and Muscle Devices

41:56 Collagen and Elastin Supplements

42:47 Marine Collagen Night Routine

43:15 Elastin Supplements and Sourcing

43:45 Heavy Metals in Supplements

44:32 Peptides Versus Proteins

44:53 EGF Myths and Wound Healing

49:08 Placenta Extract for Healing

50:28 Exosomes Basics and FDA Issues

53:33 Exosomes in Real World Healing

54:51 Fat Grafting Challenges and Cysts

01:02:44 Nano Fat and Stem Cell Boost

01:04:19 Measuring Eye Rejuvenation Outcomes

01:05:45 Canthopexy and Fox Eye Surgery

01:10:19 Rapamycin for Skin Longevity

01:13:36 Eye Aging and Facial Hollowing

01:15:39 Antioxidants for Retinal Health

01:17:11 IV NAD and Glutathione Skepticism

01:18:13 Closing Thoughts and Thanks

Painful Intercourse Across the Lifespan: Estrogen, Vaginal Atrophy, and Rejuvenation Options

Dr. Duncan Turner and nurse practitioner Sophie Mengele discuss painful intercourse across life stages and how low estrogen affects vaginal tissues. They note symptoms can be multifaceted and occur in teens through geriatrics, including patients on oral birth control who may have suppressed estrogen peaks and benefit from vaginal estrogen or vaginal rejuvenation treatments, which may also help reduce recurrent vaginal infections. They cover postpartum discomfort related to lactation, low estrogen, and healing after lacerations, describing gentle laser options like MonaLisa and Forna V and the use of estriol or weak estradiol cream. For perimenopausal and menopausal patients, they explain that systemic HRT may not fully address pelvic needs and encourage local vaginal estriol/estradiol and DHEA. They describe low-estrogen changes (thinner mucosa, reduced blood supply, collagen, and elasticity) and how fractional CO2 laser and radiofrequency create micro-injury to stimulate healing and potentially improve symptoms including urinary issues.

00:00 Podcast Welcome

00:21 Infections Can Overlap

00:41 Painful Intercourse Overview

01:04 Young Patients on Birth Control

02:06 Postpartum Low Estrogen

02:48 Perimenopause and Menopause Care

03:53 How Low Estrogen Changes Tissue

04:46 Laser and Radiofrequency Explained

05:52 Real Life Impact and Options

06:56 Atrophy Analogy and Wrap Up

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The Vagina Doctor Podcast with Duncan Turner MD

Should Ovaries Be Removed During Gynecologic Surgery? Menopause, Risks, and Hormone Therapy

This episode explains how the decision to remove ovaries during gynecologic surgery depends on whether a patient is premenopausal, perimenopausal, or postmenopausal. Postmenopausally, ovaries produce little measurable estrogen or progesterone, so removal during pelvic surgery can reduce future risks like cysts or malignancy, regardless of hormone replacement therapy. For younger or perimenopausal patients, the choice is more individualized: if menopause is more than five years away, keeping functioning ovaries may preserve hormonal benefits, while removing active ovaries can cause sudden, symptomatic surgical menopause requiring hormone replacement. The script also addresses concerns about faster aging, noting symptoms are largely estrogen-related (vaginal dryness, atrophic vaginitis, urinary frequency/incontinence, pelvic floor issues) and may be mitigated with hormone therapy.

00:00 Ovary Decisions in Surgery

00:35 Postmenopause Remove Ovaries

01:45 Perimenopause Weigh Options

02:13 Keeping Ovaries Benefits

02:28 Surgical Menopause and HRT

02:47 Aging Concerns Explained

03:51 Estrogen Loss Symptoms

04:28 Personalized Summary

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Sleep Specialist Explains Sleep Apnea, Wearables, Ferritin, REM Behavior Disorder & Why Pills Aren’t Real Sleep

A sleep-medicine and neurology specialist joins the podcast to discuss his path from art school to medicine, his own sleep apnea diagnosis, and how sleep medicine overlaps with neurology. He explains common sleep disorders he treats, why women are often underdiagnosed for sleep apnea, and the limitations and risks of over-relying on wearables, emphasizing trend tracking and age-appropriate interpretation. The episode compares sleep-testing options, outlining polysomnography as the gold standard and home sleep testing as a practical first step, and highlights restless leg syndrome and ferritin targets as potentially life-changing when addressed. They cover REM behavior disorder, its causes, safety strategies, and treatments like melatonin and clonazepam. The conversation reviews sleep apnea risk factors, CPAP alternatives, hormone effects on sleep, and argues that sleep reflects overall mental and physical health, warning against long-term use of sedative “sleeping pills.”

00:00 Meet Dr Shien Young

00:43 From Art to Medicine

03:50 Neurology and Sleep Apnea

06:05 How Patients Get Diagnosed

08:34 Wearables and Sleep Data

14:42 Best Sleep Testing Options

17:43 Beyond Apnea Restless Legs

19:23 Micro Arousals and Mindset

21:42 REM Behavior Disorder Explained

28:02 Treating REM Behavior Disorder

30:04 Sleep Apnea Risk Factors

32:24 Anatomy Behind Apnea

33:51 Women Underdiagnosed

34:24 Hormones And Sleep

38:10 Ferritin And Dopamine

39:43 Who Needs Testing

40:37 Home Study Basics

42:46 Beyond CPAP Options

44:20 CPAP Comfort Mindset

47:53 Wellness Simplified

53:24 Pill Mill Medicine

55:24 Cialis And Off Label

58:15 Sedatives Not Sleep

01:01:42 Two Week Rule

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GLP-1 Weight Loss, Muscle Loss & Bone Health in Menopause: What Women Need to Know

Dr. Duncan Turner and nurse practitioner Sophie Mengele discuss the impact of GLP-1 weight loss medications on muscle mass and bone health, especially for women undergoing hormonal changes and menopause. They note that while weight management and exercise are proven to support longevity, weight loss commonly leads to reduced muscle strength, and diminished appetite on medication may worsen inadequate protein intake and low activity. They emphasize that muscle mass and physical strength are associated with longevity, while visceral fat is tied to metabolic disease, and thinning can be particularly risky for osteoporosis. The episode highlights monitoring tools such as DEXA scans, bone scores, and body composition assessments, plus the importance of strength training, supplements, and considering hormones such as estrogen and possibly testosterone under medical oversight.

00:00 Podcast Welcome

00:24 Today’s Topic Overview

00:45 GLP One Risks

01:09 Protein and Diet Reality

02:09 Muscle Loss Matters

02:33 Longevity Metrics

02:49 Testing and Hormones

03:47 Osteoporosis in Midlife

04:26 Monitoring and Safety

04:44 Wrap Up Thanks

Episode Resources

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HPV, Stigma, and Abnormal Pap Smears: What Patients Need to Know

Duncan Turner, MD discusses how stigma often becomes the lasting burden of HPV (human papillomavirus) infection, a common sexually transmitted virus linked to increased risk of cervical, vaginal, and vulvar cancers. He explains why immunization is recommended for children of both sexes and shares a patient story involving an abnormal Pap smear, HPV DNA detection, and cervical surgery for a precancerous lesion, followed by inappropriate judgment from a physician. He emphasizes reassurance: most HPV-related abnormal Pap findings can be treated and the vast majority of patients can be cured and ultimately be free of disease. He also outlines testing practices, noting HPV is typically not tested for before age 30 unless the Pap is abnormal because many younger patients clear it naturally, while older patients may need both Pap cytology and HPV DNA screening.

00:00 HPV Stigma and Risk

00:35 Vaccination for Everyone

00:54 Patient Story After Divorce

01:38 Reassurance and Treatment

02:05 Why Doctors Don't Test Early

02:28 Pap Smear Plus HPV DNA

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The Vagina Doctor Podcast with Duncan Turner MD

Estrogen & Progesterone in Menopause: Safety, Symptoms, and Treatment Options

Dr. Duncan Turner and nurse practitioner Sophie Mengel discuss how estrogen drops sharply in menopause and how estrogen replacement can relieve significant symptoms, while progesterone is often added for safety to protect the uterine lining and reduce the increased risk of uterine cancer from estrogen alone. They clarify that progesterone isn’t needed without a uterus, address daily vs cyclical progesterone use and patient preferences, and emphasize individualized plans and follow-up. They compare transdermal versus oral hormones, noting oral estrogen’s liver pathway can increase clot and stroke risk, and explain monitoring with annual pelvic ultrasound to assess endometrial thickness. They discuss limitations of patches, the role of compounding pharmacies for dose customization, preference for bioidentical options, and selective use of a progesterone IUD to control bleeding, protect the endometrium, and provide contraception in perimenopause amid fluctuating hormones and misleading public information.

00:00 Welcome to the Podcast

00:21 Why Estrogen Matters

01:15 Progesterone for Safety

02:12 Myths and Progesterone Only

03:39 Who Needs Progesterone

04:17 Daily vs Cyclical Dosing

05:49 HRT Benefits and Timing

07:28 Patches and Their Limits

08:18 Compounding and Delivery Options

09:17 Transdermal vs Oral Risks

10:09 Progesterone Absorption and Monitoring

11:59 Bioidentical vs Synthetic and IUDs

13:44 Perimenopause Bleeding and Insurance

16:21 Perimenopause Hormone Testing Confusion

17:58 Education and Closing Thoughts

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Bladder Infection Symptoms vs Menopause Irritation: When to Treat and When to Test

Duncan Turner MD The Vagina Doctor Podcast

Bladder infection symptoms are a common urgent call, with pelvic discomfort, frequent urination, burning, and sometimes blood in the urine, and patients often want immediate treatment. Because confirming infection via urinalysis and waiting for culture and sensitivity results can take time, the episode emphasizes listening closely to symptoms, obtaining a urine specimen before starting antibiotics, and using urinalysis for accurate initial assessment while the culture guides antibiotic choice within 48 hours. It also explains that many patients begin having bladder-infection-like symptoms around perimenopause or menopause due to low estrogen, which weakens tissues and can cause irritation and inflammation, sometimes after sexual intercourse, even when urinalysis is normal and cultures are negative. The approach recommended is thorough, patient, and focused on accurate diagnosis and appropriate treatment.

00:00 Why UTIs Prompt Calls

00:11 Classic UTI Symptoms

01:02 Menopause and Estrogen Link

01:25 When to Start Antibiotics

01:46 Urinalysis and Culture Plan

02:30 When Tests Are Negative

03:03 Be Thorough and Patient

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The Vagina Doctor Podcast with Duncan Turner MD

Sophie, a nurse practitioner at Turner Medical Arts, explains two main GLP-1 medications—semaglutide and tirzepatide—and how they differ. She describes semaglutide (Ozempic) as a GLP-1–only medication that slows gastric emptying to help people feel full faster, can cause constipation and nausea, and improves metabolic function by lowering blood sugars gradually, making it helpful for people with diabetes and weight to lose. She then outlines why tirzepatide (Zepbound) is her preferred option: it combines GLP-1 and GIP, with GIP receptors on fat cells that help target abdominal and visceral fat, leading to better weight loss and improved blood-sugar management, and it is better tolerated with fewer side effects.

00:00 Welcome to the Channel

00:30 GLP-1s Overview

00:58 Semaglutide Basics

01:31 Side Effects and Tolerance

01:44 Blood Sugar Benefits

02:26 Why Tirzepatide Wins

02:43 GIP and Fat Loss

03:19 Final Takeaways