You are currently viewing Episode 486: “Fixing Sexual Pain with Dr. Polly Watson”

Episode 486: “Fixing Sexual Pain with Dr. Polly Watson”

In today’s episode, our hosts interview Dr. Polly Watson. Dr. Watson is an expert on menopause and focuses on holistic treatment methods, creating life changing results for her patients. Join us for this fascinating conversation on the causes and solutions of sexual pain.

Did you know that during the transition to menopause 75% of women experience discomfort during sex due to hormonal changes? We discuss all things regarding hormone replacement therapy, pelvic floor therapy and how male partners can support their spouses better. There is no shame in this transitional time, yet too many women struggle in silence and we are sharing this message today. You are not alone, there is hope and treatment that can improve conditions. Sex should be enjoyable, not painful! \

You, along with George will learn so much in this episode and will feel empowered about the pathway forward. To learn more about Dr. Watson visit her website here: https://hormonewellnessmd.com/  You can also get great insights from her podcast, Menopause Rescue.

Check out this episode’s sponsor (and thereby support the pod!):

Uberlube.com — Laurie’s long-time favorite personal lubricant to Keep It Hot!

Transcript

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George Faller [00:01:49]:
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George Faller [00:01:51]:
The following content is not.

Laurie Watson [00:01:53]:
…we have doctor Laurie Watson who is the founder of hormone wellness maryland it’s a petite practice focusing on optimizing midlife health for women she’s a gynecologist as well as a certified menopause society practitioner and is also certified in functional medicine from the institute of functional medicine she’s the host of menopause rescue a podcast that seeks to elevate the conversation on menopause transition and she is my dear friend so thank you Laurie for being with us i.

Dr. Polly Watson [00:02:30]:
Always tell people when i send my patients to Laurie i say she’s not my sister but i sure wish she.

Laurie Watson [00:02:36]:
Was yeah we’re kind of found sisters.

George Faller [00:02:39]:
Double doctor watson what a treat what.

Dr. Polly Watson [00:02:42]:
A treat.

Laurie Watson [00:02:46]:
Welcome to foreplay sex therapy I’m Doctor Laurie Watson your sex therapist.

George Faller [00:02:50]:
And I’m George Faller your couples therapist.

Laurie Watson [00:02:53]:
We are here to talk about sex.

George Faller [00:02:54]:
And we have a little bit of fun doing it right g listen and.

Laurie Watson [00:03:03]:
And we have a little bit of fun doing it right g listen and.

George Faller [00:03:06]:
Let’S change some relationships so fun so.

Laurie Watson [00:03:09]:
Fun to be here so polly is i always say polly is smarter than god because she is one of the smartest physicians that i know she is so gracious and so good with my people i sent her everybody who comes and i just want to do a shout out that if you live in north carolina you can see polly if you’re coming to visit me on an intensive you can make an appointment with polly right she needs to see people in person and then once they live in north carolina you can see them by zoom yeah otherwise if they don’t live here then they need to see you in person right yeah but that.

Dr. Polly Watson [00:03:47]:
Actually that may change soon we may get licensed in the compact where we have licenses in more than one state so we’ll keep you posted but change is a flutter so that could be really exciting because we could go from north carolina to over twenty different states pretty quickly so that would be fun.

Laurie Watson [00:04:05]:
So great and the other thing is is polly and george and i on foreplay we have a podcast episode in the museum of sex in new york city yeehaw we are famous woohoo to.

Dr. Polly Watson [00:04:20]:
Get on an airplane right yeah for.

Laurie Watson [00:04:22]:
Sure have you been there to see.

Dr. Polly Watson [00:04:25]:
Yourself i have not i have a friend who lives in brooklyn that i would really like to see so i have a son who’s going to be starting college at rochester institute of technology so maybe we’ll stop over in the city before we head up to rochester.

Laurie Watson [00:04:40]:
Yay that would be fun well you are bringing us good news today about menopause and i encourage you to reach out to polly because she has the podcast and she does all kinds of outreach on her site we will put all that on our post when we post this so polly let’s see we’re going to start tell me what’s exciting to talk about today well i want.

Dr. Polly Watson [00:05:05]:
To say that sexual pain often has an easy fix and there’s so many women that are walking around with sexual pain and unfortunately their healthcare provider who’s trying to do the best they can in their twelve minute visit didn’t get sexual medicine training or didn’t get adequate menopausal medicine training and so maybe they were put on first line vaginal estrogen maybe they were put on hyaluronic acid or were just told to use ky jelly and it didn’t work right and they think because that didn’t work there’s nothing else that they can do meanwhile their relationships are imploding the way they see themselves is imploding their ability to have that fantastic orgasmic release for stress management is imploding right and i just want to say there are so many things we can do to help you.

Laurie Watson [00:06:03]:
Absolutely absolutely and don’t like ky jelly just for the record we love uber lube is uber lube is our favorite.

Dr. Polly Watson [00:06:13]:
Here but yeah and uber lube is fantastic and i’m one of lori and i’s jokes together is that i’m a huge nerd and so we don’t want to use a lubricant that is not osmotically balanced so uber lube is not going to run into problems with that.

Laurie Watson [00:06:31]:
So yeah oftentimes that’s what no osmatic imbalance use right can you help me.

George Faller [00:06:37]:
Just with a number are there any numbers out there what percentage of women actually experience pain because i think most men are clueless and most women don’t talk about it so how common is.

Dr. Polly Watson [00:06:46]:
It i would say and i’m pulling this out of my backside so i’m trying to be really honest about that but sexual pain we don’t call it urogenital atrophy anymore we call it genitourinary symptom of menopause and people are like what the heck do you mean by that right but what we’re trying to encompass with that as women go through menopause you lose elasticity in the vagina but you also lose the thickness of the anterior vaginal wall so you may also experience urinary frequency increased urinary tract infections you may have pain in the vestibule the little opening so not the cylinder on the inside but that sort of junction space space between the outside and the inside so we’re kind of talking about discomfort in that entire area but it is i would say in my clinical experience seventy five percent of women at least in menopause transition are.

Laurie Watson [00:07:44]:
Having some discomfort wow not fun not.

Dr. Polly Watson [00:07:48]:
Fun no not not fun and unnecessary right usually a really pretty easy fix i think the other thing that i would really emphasize is that absolutely our first step is to make sure we’re not having painful sex but we don’t want to stop there everybody deserves to have a sexual experience worth having that they enjoy right and so i also think that if you’re not in pain that’s fantastic but if you’re not experiencing orgasm the way you want to experience orgasm there’s still resources for for that.

Laurie Watson [00:08:23]:
Also you bet oh you are going to be a wealth of knowledge what were you going to say g i.

George Faller [00:08:28]:
Was she’s speaking lori’s love language all these big turns and body parts and like lori’s lighting up my brain’s like i don’t even know it’s tough to keep up with but a lot of little moving parts down there so anyway.

Laurie Watson [00:08:41]:
A lot of little moving parts down.

Dr. Polly Watson [00:08:43]:
There george i hear you i hear.

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Dr. Polly Watson [00:10:04]:
Hard to get amazing new gifts into stores right up to the last minute like a designer perfume for that friend who never rsvp’d wishlist topping toys for her kids who came too mm belgian.

Laurie Watson [00:10:16]:
Chocolates for the neighbor a cozy scarf.

Dr. Polly Watson [00:10:18]:
For your boss and a wool jacket for your husband that you definitely did.

Laurie Watson [00:10:22]:
Not almost forget marshalls we get the deals you give the good stuff even.

Dr. Polly Watson [00:10:28]:
At the last minute phew find a.

Laurie Watson [00:10:30]:
Marshalls near you okay so tell us the most common reasons that women do.

Dr. Polly Watson [00:10:36]:
Have sexual pain.

Dr. Polly Watson [00:10:38]:
So in women who are in midlife common things being common it’s the change in estrogen levels so we have less estrogen the tissues get less stretchy i think another really important thing to mention is we so we have estrogen receptors right so george women make testosterone too right we have estrogen receptors and we have testosterone receptors in this tissue and when we go through menopause and both of those hormone levels fall the tissue can get brittle it can get fragile there’s less blood flow to the tissue and it doesn’t stretch as well so oftentimes you’ll hear women say i used let’s say they’ve used the right lubricant they used uber lube they used something reliable they got through the sexual part and then they have this burning stinging pain afterwards because they have these little microscopic tears where the tissue didn’t stretch it had microscopic tears so that’s a really common reason another really common thing that no one is talking about and i wish they did is that let’s say i go into my gp or into the dermatologist and i’m complaining of hair loss what is a really common midlife prescription is to get some spironolactone which is a testosterone blocker so i may be blocking testosterone at my scalp for my hair or maybe my face if i’m having some periorbital acne or sorry hormonally related acne okay but i’m also blocking it in my genitals and so that can be another reason why women are not connecting the dots and maybe their health care team maybe their dermatologist doesn’t know a lot about sexual medicine and isn’t realizing we traded one problem but we created another and there’s a fix right we can use either topical testosterone in the vestibule we can use vaginal dhea which metabolizes the testosterone in the vestibule so this is an easy fix but i can’t tell you how many women come into my office because they got a prescription for spironolactone and no one told them wait a minute we can block it in your scalp and on your face we need to add it to your genitals because no one’s thinking about their sexual wellness and then they may not feel comfortable coming to their dermatologist and saying oh by the way sex hurts now right like absolutely i was.

Laurie Watson [00:13:00]:
Prescribed that when i was premenopausal because i had polycystic ovaries and i was you know kind of with it enough to look it up and look at the side effects and i’m like whoa whoa whoa whoa whoa this is going to block my testosterone i do not want that so yeah i knew about.

Dr. Polly Watson [00:13:17]:
That one yeah and then i think women have had surgery right we may have had an ovarian cyst rupture we may have had a cesarean section we may have had some sort of surgical scarring that can cause pain and we often don’t talk patients through about a year after surgery is when the scar tissue really develops so if you’re thinking about needing a hysterectomy or you’ve recovered from a c section it’s a really good time to go ahead and get folks in pelvic floor physical therapy presumptively let’s not wait until they have pain let’s say hey you’re going to have scar tissue develop we’re going to get ahead of that before you have a problem and then i think another piece that’s often missed is this whole pelvic floor health right so laurie knows this about me i am wound up tighter than a banjo string i’m a little bit of a type a kind of girl and so maybe other people relate to this we grind our teeth we don’t breathe diaphragmatically and it’s not intentional that we’re holding our pelvic floor super tight but i do it’s not under my conscious control and so a lot of women will come in my office and they’ve got pain and and the first thing i’m asking is do you grind your teeth at night because a lot of times there’s a connection there and so we see this this can translate to pain the pelvic floor is so tight that the muscle encircling the vaginal opening is like this right and if you’re trying to put anything into the vagina you’ve got to go over that speed bump when when if there’s a penis or a toy or whatever it is that’s hitting that speed bump the body’s response is i’m going to shut down more i’m going to keep you out so we want to really work with pelvic floor physical therapists to.

George Faller [00:15:10]:
Address this it’s the opposite also true a lot of women have weak pelvic floor muscles where it’s not tight it’s.

Dr. Polly Watson [00:15:20]:
You know i guess i meet so many warm women that are too tight than too loose and i think another maybe analogy that’s helpful is if we’re thinking about women that say you know my orgasm used to be this big juicy mama orgasm and now i’m having this little squeak like eee that’s it and you’re like really seriously that’s all you got right i’m going to start.

Laurie Watson [00:15:45]:
Using that the big mama juicy orgasm.

Dr. Polly Watson [00:15:47]:
Or the squeak so if your muscle started like ninety percent contracted and you need to have a thirty big muscle contraction to have an orgasm there’s just nowhere for it to go the other thing is if your pelvic floor is so tight are you really engorging your genitals no everything is bound up so almost like if your neck was really tight and you start having tingling going down your arm you can’t get blood flow to the area so like when that fat came through or everybody wanted to stick a little green egg in their vagina i’m like this is a terrible idea everybody i know is too tight not too lo.

Dr. Polly Watson [00:16:29]:
We gotta chill.

Laurie Watson [00:16:30]:
Out it can it can happen there can be laxities though that impact functioning but you’re right the vast majority too.

George Faller [00:16:38]:
Tight can we take a quick break because i think a lot of our listeners want to know more about this pelvic floor stuff because i know most men they don’t even know there is a pelvic floor and we have one too so a little insight into that might help them from before we move on to the next thing okay.

Laurie Watson [00:16:59]:
I love uber lube it is my go to lubricant for the last twenty five years i’ve recommended it highly i’ve used it myself there’s no taste no smell there’s nothing to interfere with your intimate moments it washes off easy with soap and water listen it doesn’t contain any water it doesn’t have a ph your vagina will be happy it doesn’t disturb your delicate balance you can use it for sex in the shower go ahead and explore all those mermaid fantasies seriously you can use it with condoms it’s okay with latex you can even use uber lube for chafe protection against sports i’m serious you can buy little travel packets so that you can have sex whenever you’re away and it’s easy peasy it is in the classiest glass bottle with beautiful writing you can keep it on your bedstand honestly nobody would even think that it’s lubed they would think it’s like a perfume bottle it is beautiful trust me go to uber lube dot com use the code foreplay uberlube dot com foreplay get your ten percent off i’m telling you it is skin friendly it is quality it is my favorite.

Laurie Watson [00:18:07]:
So one hundred one on pelvic.

Dr. Polly Watson [00:18:09]:
Floor tell us okay so this is really easy we have this sort of hammock of muscles in the base of our pelvis and they are used in balance they’re used to help us remain continent of both urine and stool and it can be so important to just think about this is a stability muscle so that can get either too tight or too loose depending on let’s say you broke your ankle and you were in an ankle boot and you had an asymmetric gait that’s going to throw off your pelvic floor you could have had a tailbone injury when you were a little kid that could have thrown off your pelvic floor certainly pregnancy and childbirth are going to throw off your pelvic floor if you’re like me and you’re a midlife woman and you’re trying to lift heavy right and if you don’t have good form at the gym and you’re not recruiting your glutes correctly or maybe you’re doing single leg work you’re going to imbalance your pelvic floor so this group of muscles is so important because all of the blood supply and the nerves that go to our genitals have to go through this pelvic floor so you kind of think about if the pelvic floor is too tight it’s almost like putting a tourniquet where you’re trying to get engorgement and you just can’t get there it just isn’t going to work as well.

Dr. Polly Watson [00:19:33]:
How is.

George Faller [00:19:33]:
That that’s not good.

George Faller [00:19:36]:
I’M scared to ask more questions bring it on george.

Dr. Polly Watson [00:19:39]:
Come on we can do it so.

George Faller [00:19:41]:
How does this play out with men.

Dr. Polly Watson [00:19:43]:
Oh don’t ask me anything about men i’m a gynecologist all right yeah i mean i think that men can see pelvic floor physical therapists too for pain i don’t know a lot about like erectile dysfunction and those kind of things but i’m sure that pelvic floor pt can be helpful for them too i.

Laurie Watson [00:20:02]:
Have sent men to pelvic floor pts and i know that sometimes too tight of a pelvic floor does create ed so sometimes before you kind of throw in the towel and just take viagra you know if you’re a tense stressed out type a person you know and you do clench your teeth it might be a good evaluation to talk to your physician about that get a referral to a pt or just go to a pt and they’ll do an exam on you to see if they can figure that out too so i have some really great pts in the area who have told me about that and talked about that.

George Faller [00:20:40]:
How do you relax your pelvic floor if you’re too tense.

Dr. Polly Watson [00:20:45]:
I just kind of want to give a shout out to herman and wallace because they do a lot of pelvic floor pt training so you don’t want just any pt you need a pt who’s trained in pelvic floor and if you go on the herman and wallace website you can do the find a practitioner and find somebody in your area.

Dr. Polly Watson [00:21:03]:
How do you relax your pelvic floor you learn how to breathe diaphragmatically right so if i’m holding everything in if i’m inhaling kind of think belly button to spine i’m pulling my pelvic floor up and in and if i’m exhaling i’m allowing that diaphragm to fall my pelvic floor should fall so there’s a lot of breath work involved and women we will often use little wands i like the intimate rose wand a lot you can get them that vibrate and so just like george if you and i went to the mall in the eighties what would we do we would go to the sharper image and you would put those little vibrating things on your shoulders right so if you put something that vibrates on a sore muscle it can kind of let it relax so intimate rose makes this little for women a little wand that you can put in the vagina and you’re just putting this very little like almost like you’re seeing if a peach is ripe just this barely little gentle amount of pressure kind of oh i can let go and so there’s some really nice.

Laurie Watson [00:22:10]:
Tools available very nice george is going to run out and get the rose.

Dr. Polly Watson [00:22:17]:
Try it out well what are other.

George Faller [00:22:20]:
Ways of addressing pain because i i i’m so happy we’re talking about this because again i don’t think anybody really talks about this they just try to grunt through it and think it’s going to be fine but we know that trains your body not to want to have sex so you know if you can get help and i don’t think most people know the resources out there to get help so this pelvic floor is a really important one what else what else you got for us so.

Dr. Polly Watson [00:22:44]:
If part of the problem is hormonal right and we want to also just include this is not just perimenopausal postmenopausal women pregnancy postpartum nursing that can be a time when the vaginal tissues get very fragile especially with nursing so it may not be just sometimes women on really low dose birth control pills can have the same symptom because the pills are blocking their own normal hormone production and so they’re really not making very much so i think the first question is is it hormonal or is it musculoskeletal or is it both right is it scar tissue like trying to kind of go through what is it and then usually we start with replacing with estradiol i like to use vaginal dhea a lot there’s a commercially available fda approved product it’s called enterosa it’s in food grade fat it doesn’t have anything that’s like a paraben or any bad chemicals in it you can also compound an estrogen and testosterone topically sometimes if someone has a lot of pain you can also compound a little bit of lidocaine in there so i want to really emphasize we’re not suggesting putting lidocaine on the clitoris right we don’t want to numb the clitoris but the part in sexual pain that hurts the most if your vagina is like a clock at the six o’ clock position at the bottom that’s the part where we have the most pain so they’ve actually done studies in breast cancer survivors where if you just put a little bit of lidocaine jelly at the opening of the vagina leave it there for about five minutes before penetration that alone can also really help and so we want to address the hormonal piece we can do that with topical vaginal hormones topical vaginal hormones are very safe they’re not going to give you breast cancer they’re not going to give you a stroke don’t read the black box warning it’s just not enough hormone to cause harm so we have physician statements from acog from menopause society even if you are a breast cancer survivor undergoing treatment you can still use vaginal hormones so i think that’s also something to really shout out because that’s a community that is suffering unbelievably and explain who acog is.

Laurie Watson [00:25:07]:
And why you can say that with authority about especially cancer victims and yeah.

Dr. Polly Watson [00:25:13]:
So acog is american college of obstetrics and gynecology so they’re sort of when you’re board certified they’re your sort of mothership organization if you’re an obgyn okay and so acog basically represents the medical standard of care and so they release position statements and so there’s a position statement on the use of vaginal hormones in breast cancer survivors and i actually have a lot of these that i’m glad to share with you so if if you’ve got if people in your community are survivors and they’re trying to navigate a conversation but their healthcare provider that may not be as up to speed on sexual medicine and they’re feeling scared right they don’t want to do anything to harm this cancer survivor’s outcome i can i’ll be glad to provide that list so we’ve got great there.

Laurie Watson [00:26:05]:
That would be great do you have a link on your site that we can send people to for that list.

Dr. Polly Watson [00:26:10]:
I can make one i don’t have.

Laurie Watson [00:26:12]:
One right now or you can send us the reference but that might be a way to get people to come see all the offerings that you have.

Dr. Polly Watson [00:26:19]:
Yeah that’s a great idea just to.

George Faller [00:26:22]:
Show off a little bit just to show off that i listened to laurie i’m just trying to integrate the material so that’s six o’ clock space that’s the perennium that you’re talking about perennial perineum is that where most of it.

Dr. Polly Watson [00:26:34]:
Is george we’re going to get really particular okay so when i think about the perineum i’m thinking about the skin skin between the vaginal opening and the anal opening that kind of that space part i’m talking about is almost at the opening of the introitus which is just medical speak for the vaginal opening so if you sort of open the labia minora and you’re just getting to that pink mucosal surface right where we get to more mucosal skin that looks like the inside of someone’s mouth not like skin that looks like the inside of someone’s arm does that make sense.

George Faller [00:27:10]:
So that’s right above it you’re saying.

Dr. Polly Watson [00:27:12]:
Yeah right above the perineum kind of right at that vaginal opening would be where we’d want to put lidocaine or hormones et cetera and then again like you know folks can also work with pelvic floor pt can be really so helpful and.

Laurie Watson [00:27:30]:
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Dr. Polly Watson [00:27:45]:
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Laurie Watson [00:27:46]:
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Dr. Polly Watson [00:27:52]:
Bean casserole there’s no wrong way to.

Laurie Watson [00:27:54]:
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Dr. Polly Watson [00:28:28]:
Drink responsibly if i could say a little bit more about that can we talk about that for a minute that’d.

Laurie Watson [00:28:34]:
Be great i just wanna say one thing before you go there about pt is you know i talked to so many women who are menopausal and they’re terrified of using vaginal estrogen they’re not breast cancer survivors they’re not you know i mean they’re just terrified of using estrogen lest it cause cancer but vaginal estrogen is like safe for breast cancer survivors and it’s basically right it’s local.

Dr. Polly Watson [00:29:00]:
It’S not systemic absolutely and it’s it’s really a fallacy that the fda sticks the same label on vaginal estrogen that it does on systemic estrogen so i have a little analogy that might help people with this let’s say you have a bug bite or you got poison ivy you may put hydrocortisone cream on your itchy spot on your arm right and you’re not really going to get diabetes rage fatigue weight gain from using a little bit of hydrocortisone cream if you were to take systemic oral prednisone right that can really screw up your blood sugar it can make you gain weight it can affect your mood all these things so the delivery system and the dose really determine what’s happening with the medicine so vaginal estrogen is very very safe and in my opinion anybody can use it safely.

Dr. Polly Watson [00:29:58]:
Estrogen alone wasn’t what bumped up people’s breast cancer risk even in the whi and kind of these more conservative studies it was adding the synthetic progestogen to it so we have nurses health study we have whi data we have lots of studies that estrogen alone didn’t bump up breast cancer risk so i think it’s really important to just try to everybody take a big deep breath and.

Dr. Polly Watson [00:30:24]:
Quality of life is so important and i just see people suffering unnecessarily because of these walls we have right because of the fear and it just is.

Dr. Polly Watson [00:30:37]:
I always want to respect where people are coming from like if they’re coming from a place of fear and i’m not meeting them where they’re at and i know that this is safe i have to get them to trust me and help them feel like it’s safe so i don’t want to disregard somebody’s fear but.

Dr. Polly Watson [00:30:55]:
Vaginal estrogen doesn’t increase cancer risk period or dementia risk or blood clotting risk or any of the risk it’s sort of like putting hydrocortisone on a bug bite.

Laurie Watson [00:31:06]:
Nice nice that is such good news and i feel like we need to keep saying that and saying that okay what do you want to leave women with today what’s the message there’s hope.

Dr. Polly Watson [00:31:17]:
There’S so much hope and this isn’t a quick fix some folks have had a lot of pain for many years so partners if you’re listening just because your partner gets some vaginal hormones you need to know that this is the vaginal hormones are going to take at least a month to notice the difference full stop if there are musculoskeletal things that are involved most folks will start turning a corner around eight to twelve sessions okay so we don’t yes like weeks of physical therapy exactly and so we want to make sure that people have kind of realistic expectations that they’re not going to like put on the estrogen cream once and expect it to work the other thing that makes me a little crazy people are like oh my god i got my vagina fixed it’s awesome and then it stopped working and i’m like well are you still taking that they’re like no i was fixed i stopped and i’m like you gotta be kidding me i said it was working why did you stop well it was fixed i’m like you’re still in menopause your body is not gonna make these hormones so we also if it’s working that’s fantastic let’s let it keep working and we need to keep.

Laurie Watson [00:32:36]:
Taking it yep exactly but this is.

Dr. Polly Watson [00:32:39]:
Such a fixable problem do not suffer.

Laurie Watson [00:32:42]:
In silence that that is good and polly thank you so much for coming on foreplay we’re so grateful tell us again where we can find you so.

Dr. Polly Watson [00:32:52]:
My practice is called hormone wellness md and we’re out of raleigh north carolina and my podcast is menopause rescue so i’d love to see you either place.

George Faller [00:33:03]:
Yay this episode’s gonna join the other one in the new york museum right so here we go yep that would.

Dr. Polly Watson [00:33:09]:
Be great we’re gonna be double double trouble double trouble the watson trouble here.

Laurie Watson [00:33:15]:
They come that’s right okay polly my dear friend love you girl love you.

George Faller [00:33:21]:
Too lessons you got it bye bye call in your questions to the four play question voicemail dial eight three three my four play that’s eight three three my the number four play and we’ll use the questions for our mailbag episodes all content is for entertainment purposes only and should not be considered as a substitute for therapy by a licensed clinician or as medical advice from a doctor this podcast is copyrighted by foreplay media.

Laurie Watson [00:33:46]:
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