The Science Of Estrogen, Orgasm And Sex Drive

Felice Gersh, MD

Well, it’s my pleasure. We’re going to talk about such a fun topic. I can’t wait to dive into it.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I’m looking forward to learning from you because this is something you know so well. I’m ready to soak up all the information. We’re going to talk about the role of estrogen. First of all, I just wanted to start by saying that we think of estrogen as a woman’s hormone, but it’s just that it’s so much more than just that. What is it that we need to know about estrogen?

Felice Gersh, MD

The first thing is the fundamental of life, and that is that whether we want to have babies or not, that’s a personal choice, which I support. But the prime directive of life is the creation of new life and our bodies as women and men, too. But I do focus on women. Our bodies are designed for that purpose. Now it turns out that to be fertile and have successful pregnancies, you need a functioning body. In every single organ system—your neurological system, your connective tissue, muscles, bones, and arteries—you need to have a functioning intestinal tract so you can digest, absorb, and excrete toxins. You need to have great, functioning, and beautiful skin. You can go through every organ system, and everything has to be working well because, for successful reproduction, you also need to ovulate and then impregnate. get an embryo that implants and all of that, and get through the pregnancy. But humans have to raise their offspring, and they have to raise them until they reach sexual maturity. You have to do this multiple times. You have to be healthy, not just to be fertile and have a successful pregnancy, but to raise the offspring. I don’t call it a sex hormone any longer, but it is very important for that. We’ll talk much more about that. But think of it more as a life hormone. It’s the hormone that is the foundation of life itself. To that end, it has to be in the right amount and the right rhythm. It is essential since it’s essential for every organ system. It is also essential for sexual desire and a sexual response because nature wants fertility and wants people to conceive. To that end, you need to have the desire and the proper response so that, hopefully, when it’s the peak time for fertilization, that’s part of the built-in system that we can talk about in the beautiful menstrual cycle. that is going to improve and optimize sexual function as well. Think of estrogen not just as having a period but as the support for life itself.

Betsy Greenleaf, DO, FACOOG (Distinguished)

That is fascinating. and I’m always finding out more and more, even in my traditional OBGYN training. It’s like we weren’t taught this stuff, and I’m always surprised to find out these other functions of estrogen. and you were saying that there’s a connection between estrogen and orgasm.

Felice Gersh, MD

If we look at it, let’s start with the basic menstrual cycle. In the menstrual cycle, the first day of bleeding would be the first day of your period. That is called day one. Now, at that time, estrogen levels are at their lowest. They’re very low. The body is in a more inflammatory state because that’s when your uterine lining is dying. It needs to come out, and you can have a little bit of uterine contraction. It shouldn’t be over the top. You’re in agony. But just a little bit to push out the dying and dead uterine lining tissue and also to contract so that you constrict the blood vessels so you don’t hemorrhage. All of these things are finely tuned in a healthy woman. At that time, sex drive would be at its lowest because it turns out that for testosterone receptors to work optimally, you need to have a higher amount of estrogen being produced. Nature doesn’t care about women having sex or having an interest in having any sexual activity when they’re on their period because you’re not going to get pregnant and remember, the prime directive is fertility and to conceive. At that particular time, humans can certainly have sex any time they want, but you’re not going to have a big libido or drive. It may be a little harder to achieve an orgasm at that time because your estradiol level—the estrogen produced by the ovaries—will be at its lowest. That means that your testosterone receptors will have at least some efficacy. They’re going to be less effective in terms of binding the testosterone and then creating the effects as well.

Even testosterone production is going to be slightly lower at that particular time of the menstrual cycle. Now, as estrogen levels increase during the first half of the cycle, which is called the follicular phase, or it can also be called the proliferative phase, whether you’re talking about the ovary part of the cycle or the uterine lining part of the cycle, they have like little separate names, but those are the two names for the first half of the menstrual cycle. As that’s happening, you’re setting up your progesterone receptors, and you’re starting to upregulate your testosterone receptors. Then, just a little before you ovulate, you get this giant spike of estradiol production. It’s like a giant spike, and that sets your testosterone receptors to be optimized at that time. It also optimizes your estrogen receptors because estrogen increases the function of its receptors. That’s when you’re setting up your progesterone receptors for the second half of the cycle. At that time, when you ovulate, you have a little blip in the production of testosterone. You are also the most anti-inflammatory because higher levels of estradiol lower inflammation in the body. It numbs your immune cells, which are the attack system of the body. Why would that be important? Because you don’t want your immune system to attack and kill the sperm or an embryo, because that’s like an alien. Also, it has proteins that would not exist in the female because they’re coming from the fetus. that includes genetic material from the male, which is alien. The immune system is quieted at that time, resulting in less inflammation and more receptivity of the receptors for estrogen and testosterone. Libido goes up, sex drive goes up, and fertility is optimized so that you’re more likely to have conception. implantation, and so on. Then progesterone starts to be produced, and progesterone then down-regulates the testosterone receptors and the estrogen receptors, and you have less libido, and it may be harder to have an orgasm in the luteal phase. The second half of the menstrual cycle is important because it’s all designed around sexual responses for the optimization of fertility.

If a woman is very aware of her body, her cues, and just how she feels, she has a natural cycle, and this means she’s not on birth control pills, which, by the way, is a libido killer in most women and can affect how a woman has a sexual response. Well, we’ll get a little bit more into that because that’s one of the mechanisms. But they don’t talk about a birth control pill. Is it like lowering your libido in response, but when you have a natural hormonal cycle, you are going to be naturally the most fertile? Of course, when you ovulate and also feel the most sexually-like sensation, you’re going to respond the best. You’ll have the best orgasms, and you’ll have the biggest libido at that time. But humans, unlike some animal species, can have sex any time we want because a lot of it is up in our heads like we just want to do it, but we have the capability. But if you went with the natural rhythms of the body, nature did give us the tools to be the most sexually active and responsive when our estrogen levels are the highest, our testosterone levels are the highest, and our testosterone is the most functional because the receptors for estrogen and testosterone are working at their peak capabilities right at the time of optimal fertility, which is at the time of ovulation.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I’m thinking about this, and I’ve been there for years on birth control. I remember that this is not fair. I’m doing something so I don’t get pregnant, but then I don’t have a sex drive to have sex, and then fast forward. I’m like, this is now making a lot of sense because my father, myself personally, did years and years of birth control, had my kids, and then very soon after that, I had a hysterectomy and was in menopause. Then I’m going, “Oh my gosh, are we just screwed in menopause? Then, like, what do we do? What do we do about that?”

Felice Gersh, MD

Oh, well, we are screwed into menopause if we don’t get on hormone therapy, because if we look at what these hormones do, I talked a little bit about increasing sexual drive. But if we get down to a little bit more of a nitty-gritty level, if we look at the estradiol, that’s the estrogen. Remember, estrogen is not a hormone. It’s a family of hormones. That’s also very confusing because people use the word estrogen, and that would be a little bit like using the word fat. Well, we know now that there are good fats. There are bad fats, saturated fats, polyunsaturated fats, and omega-3 fatty acids. Omega-6 fatty acids: it’s a family of fats. The same thing happens with estrogen. When you use the word estrogen, I say, “What is estrogen? Is it the one that the ovaries make into the one of life, which is estradiol, or is it estriol? That’s also a hormone of life.” That’s the dominant hormone produced by the placenta; that’s the estrogen of pregnancy, or is it estrogen, also known as E1, which only works on a different type of receptor, the alpha? that if you have too much of that, that can be pro-inflammatory. Estradiol works on all the different estrogen receptors in a balanced way. It’s estradiol that we would want to give to a woman in menopause. What does estradiol do in any woman pre- and post-menopause in terms of sexual function? Well, because it works on all the organ systems.

It keeps our vascular system healthy. Now, we know that for a man, when he has erectile dysfunction, that is often a sign. Like now, that’s like a big red flag that he has vascular disease because for a man to have an erection, he needs to have good blood flow to the penis so that he can get the congestion to get the erection. Well, women need the same thing. We just don’t talk about it enough. Women need great blood flow to their genital tissues, including the clitoris and all the surrounding tissues, because there are nerves in the labia minora as well. So for all the surrounding tissues, you need to have proper blood flow. Now, sometimes I use the word estrogen, and then I say, Why am I using that word? It’s fat, but if I say it, I want to say I’m talking about estradiol. So estradiol maintains vascular health, and this is critical for proper sexual function because you need to have blood flow to the normal structures of the clitoris. You need to have blood flow to the entire area. that keeps it healthy. Part of the way that it does it, and there are multiple ways, is by increasing this magical gas called nitric oxide, which maintains the health of the lining, which is the endothelium. It also maintains the health of the arteries from the beginning to the end—the whole thing. So you need to have that nitric oxide, and the enzyme that helps to produce it is supported by estradiol. Men make estradiol in their arteries through a conversion.

The enzyme aromatase that converts testosterone into estradiol exists in arteries to convert testosterone into estradiol, which then activates the enzyme endothelial nitric oxide synthase to make this magic gas, nitric oxide, which maintains the health of the artery. Viagra works to increase nitric oxide. It works through different pathways to increase nitric oxide. Some women use very small doses. It’s off-label, but they use smaller doses of Viagra, and sometimes for them, it helps, so it’s an individual thing. because it’s increasing blood flow. That’s an important thing to understand. Estradiol is essential. Not only that, it maintains the health of the tissues directly because it supports skin and connective tissue and all of those things are vital for proper sexual function. That’s why, on birth control pills, many women have vaginal atrophy or dryness because they don’t have the proper hormones. These are not the same hormones. You have to recognize that we have to try to control our reproductive destiny because we don’t want to just have babies when we don’t want to. But birth control pills are what they are. They’re endocrine disruptors. They’re chemicals designed to interfere with the normal production and function of our beautiful natural hormones. Their primary function is to kill fertility temporarily, so you can’t get pregnant. When they first came out, nobody understood any of the things we were talking about.

Nobody understood that these are vital life hormones for the entire body, for every organ system, and, of course, for the support of the genital and sexual organs and libido. Nobody knew any of that. This is going back to 1960, and nobody knew any of these things. Now, fast forward to today; it’s too big to fail. I just want people to understand so that they can have informed consent so that they can look at all their options and decide at that time in their lives what they are willing to put as their priority and what they are willing to put down so that they have choices that are informed. But when you have proper estradiol, you’re going to maintain the health of the vagina, and without that, you’re going to have a dry vagina. You’re also going to have an altered microbiome of the vagina, which is the microbial life in the vagina. It’s the most fascinating thing. We know that the gut microbiome is so important, and how do we feed the microbes in our gut with the food we eat, like the fiber we eat, the polyphenols from vegetables and fruits, and so on? Well, how do we feed the microbes—the good guys that are living in the vagina—that support proper PH acid-base balance, maintain health, and keep out pathogens? The good guys—we call them the commensal bacteria. Fight off the bad guys, okay? Those are the pathogens. Well, it’s like a war going on between our good bacteria and the bad ones trying to invade us. It’s a fascinating thing.

But how do you support the good guys in the vagina? Well, the vaginal lining cells themselves make the food. It’s like a starchy material. They make the food that is secreted into the lumen, the vaginal canal, which is fermented by the good bacteria, creating lactic acid, which then creates a more acidic environment that promotes the health of the vagina and is also hostile to the pathogens, which usually like a more alkaline or base type of environment. These are all supported by estradiol. It’s so amazing. When you don’t have it, you cannot have an optimally healthy vaginal canal in the tissues and then all the surrounding tissues and the connective tissue as well. That is the fascia and all this connective tissue. That’s why, as women get older, when they don’t have estradiol production from their ovaries, they can prolapse, like their bladders falling into the vagina. That’s called a cystocele, or the rectum; that’s called a rectocele, or you have a dropping of the cervix in the uterus. 

That’s a uterine prolapse that interferes with sexual function. Because when you have all these organs, like prolapse and falling out of your vagina, and the vagina is all thin, it doesn’t make sex pleasant. It’s also caused more incontinence. Women do not like to pee when they’re having sex. But that happens because of a lack of estradiol. You can see that there are so many different aspects to having a wonderful sexual life that requires estradiol. Then, when you look at what we call peptides and neurotransmitters, they are heavily supported in terms of their receptor function because you can’t have anything work properly if it doesn’t have the receptors that work properly and also their production. These are key neurotransmitters and peptides, like oxytocin. Oxytocin is on the border between a peptide and a hormone because it’s just based on the length of the amino acid chain. We can call it whichever, but it is key to having orgasms, and estradiol helps with the production of oxytocin and the receptor function of oxytocin.

when you have optimal oxytocin, you have optimal orgasms that require not just testosterone but estradiol. That’s why I say testosterone is very important for sexual function, but testosterone won’t even work properly without estradiol and estradiol doesn’t,  get it,  do like,  achievement recognition for maintaining proper sexual function. oxytocin will not be produced or work properly without adequate When you have optimal oxytocin, you have optimal orgasms that require not just testosterone but also estradiol. That’s why I say testosterone is very important for sexual function, but testosterone won’t even work properly without estradiol, and estradiol doesn’t do the job of maintaining proper sexual function. Oxytocin will not be produced or work properly without adequate estradiol. Then there are other peptides, like VIP, a vasoactive intestinal peptide. These are also important. They have different functions. Nothing is a single function in the body; everything is multitasking. That’s also very important for sexual function. What’s interesting about oxytocin is that when it drives up sexual, libido, and sex drives, it does that as well. It drops your appetite. That’s why some people use oxytocin as an appetite suppressant because no one is going to be like, You don’t want to have different cues coming in like, “Gee, I’m hungry, I want a sandwich.” At the same time, “I want to have sex now.” The body wants you to reproduce. You don’t care about that sandwich; you don’t want to eat; you just want to have sex right now. 

That’s why when you have a lot of oxytocin, it drives up your sex drive and it drives down your appetite. You don’t get distracted by wanting to go eat when you’re supposed to have sex and have a baby. That’s so interesting. Then, oxytocin is also known as the bonding hormone, so it makes you feel warm and loving. Estradiol. then there are other peptides like VIP and vasoactive intestinal peptides. These are also important. They have different functions. Nothing is a single function in the body, everything is multitasked. Okay, but that’s also very important for sexual function. what’s interesting about oxytocin is that when it drives up sexual, also,  libido and sex drive, it does that as well. It drops your appetite. That’s why some people use oxytocin as an appetite suppressant because no one is going to be like you don’t want to have different cues coming in like, gee, I’m hungry, I want a sandwich. at the same time, I want to have sex now. The body wants you to reproduce. it’s like you don’t care about that sandwich, you don’t want to eat, you just want to have sex right now. that’s why when you have a lot of oxytocin, it drives up your sex drive and it drives down your appetite. you don’t get distracted by wanting to go eat when you’re supposed to have sex and have,  make a baby. that’s like so interesting. Oxytocin is also known as the bonding hormone,  so it makes you feel warm and loving.

Because that’s how women are; they want women’s nature. Nature wants women to love and cherish their partners and take care of them. then, of course, when they have babies, enable that oxytocin to bond with their babies. But it’s all about the same thing: successful reproduction. You want your moms to love their babies. You want the women to love their partners. You want them to want to have sex and stop eating when they’re having sex. It’s all built into this system. It’s fascinating when you put all this together with other neurotransmitters like serotonin and dopamine, and even acetylcholine, which helps you have memory and cognition. All of these are heavily involved with estradiol, so you feel good sleeping because from serotonin comes melatonin. All of these are critically essential neurotransmitters for the body. If you don’t have estradiol, they’re not going to work properly, and then when you look at acetylcholine, not only is it about making memories, but it is also the neurotransmitter of the vagus nerve. That’s the part of the autonomic nervous system that is calming and makes you feel less stressed. When you have enough estradiol, you’re going to have what? There’s less anxiety, you’re going to be calmer, your organs are going to be working more properly, and you’re going to have better digestion. But when you don’t have enough estradiol, you go into the default, which is sympathetic activation, which is stress. That’s why, after menopause, women have a double-to-four times increased risk of anxiety and depression, loss of estradiol, and, of course, libido, which goes plummeting. When you put it all together, you see the beauty of how nature designed women for their prime directive, which is to make babies.

But we want to control it, to make it. But we need to understand how we’re designed, and then we have to modify as we wish, understanding the pros and cons of our choices. But we are designed for optimal fertility and health through our estradiol. It’s just such a beautiful thing to understand that progesterone downregulates estradiol receptors. That’s why, in pregnancy, you have a high level of progesterone. A woman is going to have a lesser sex drive, because what’s the point? Nature wants you to conceive. You already did it, so you can conceive again. When and in the second half of the luteal phase of the menstrual cycle, when you have high progesterone, it’s downregulating your estrogen and your and your testosterone receptors, so you’ll have less sex drive because nature doesn’t care if you have sex when you can’t conceive anymore, either you did or you didn’t conceive during that cycle. But that moment has come and gone. Recognizing this will help women who have their natural hormones or are in menopause understand why their sex drive may have ups and downs and why things are not working well, and then they can take positive steps to just live with their rhythms and understand that this is how they’re designed.

In menopause, it is important to get on hormones and physiologic doses so that they have optimal function. You don’t want to smoke and mirror-like a little, tiny, little dose. you, and then you take progesterone every day because that’s going to downregulate your estrogen receptors, your libido, and your sexual response. You have to, and there’s—oh, it drives me crazy. There are so many people out there doing hormone therapy who took some course for a weekend or something, and they don’t understand the interplay of these hormones and the dosing and how that matters. That’s how women don’t do so well on hormones in menopause because they’re getting the wrong doses in the wrong forms, often the wrong regimens. Of course, things are not going to work optimally. They’re going to do something, but it’s not going to be what you might dream of.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I was thinking about, and I’ve seen, too, where they’re just placed on one hormone, and just like, “Okay, you’re in menopause here; we’re just going to give you one hormone, and now you’re going to be amazing.” It’s like you’re now especially understanding this interplay with the hormones. It’s more like a symphony.

Felice Gersh, MD

Some doctors out there just put women on hormones like progesterone and testosterone, and they’re leaving out estradiol. It’s like, Why would you give just testosterone? Unless you’re trying to do a gender change, this is like you’re transitioning. That’s not making any sense. Testosterone is a key player. Testosterone matters, but it doesn’t work properly in the absence of estradiol. It’s important to understand what progesterone does. Progesterone is wonderful. Progesterone is very anti-inflammatory. That is very important because you don’t want to have a lot of inflammation when you’re trying to grow a pregnancy. After all, you don’t want the immune system to kill that. That is a problem for some people right there.

Their immune systems keep causing miscarriages because they kill the little embryo. Progesterone in a healthy, properly functioning female body downregulates the immune system. it’s anti-inflammatory. that has the very purpose of preventing the immune system from killing and attacking the little embryo and then the fetus. But, of course, there’s a price to be paid. There’s always a price and a compromise. That’s why women who are pregnant have a higher risk of an adverse outcome if they get certain infections, like COVID, the flu, or chickenpox, because their immune system is in some ways hampered. But that’s also why women who have multiple sclerosis and some other autoimmune diseases often go into remission when they’re pregnant because it’s like progesterone acts like a biologic. 

It downregulates, as does estriol, which is the dominant estrogen of pregnancy, by predominantly acting on the beta receptor, which is anti-inflammatory in terms of downregulating the innate immune cells, which first attack the immune cells of the body. So that’s why women who often have these autoimmune conditions, like multiple sclerosis, will go into remission during pregnancy. When you understand the purpose of the hormones and what they’re trying to accomplish, then it’ll be logical about how to use them in replacement situations and what they do when you like. For example, when you go on birth control pills, that turns into predominantly estrone because it gets metabolized in your liver, and then it goes into the bloodstream as an estrone and activates the innate immune cells, the attack animals of the immune system.

That’s why birth control pills increase the risk of blood clots because blood clotting is part of the immune response and can be life-saving because the immune system is activated. For example, if you have trauma or pathogens like bacteria or viruses, if you’re bleeding, you will hopefully not bleed to death because your blood will be more clotting. You get more pro-inflammatory when you go into labor because, when you pass the placenta, you don’t want to bleed to death. That’s when you want to be more pro-clotting. That’s why women tend to have activation around the time of labor, for things like pre-eclampsia. When you understand how these hormones work, not only do you understand the sexual response and sex drive, but suddenly everything falls into place. You understand why women who have pregnancies have certain increased risks, why women who are on birth control pills have certain increased risks, and so on. That’s why you would never give birth control pills to a woman who has uncontrolled high blood pressure or just had a heart attack because birth control pills are pro-inflammatory. It’s just a fascinating thing that, when you go into the second part of pregnancy, that’s when you have a more pro-inflammatory state, and women are more likely to get things like pre-eclampsia, gestational hypertension, gestational diabetes, blood clots, and all those things.

It all comes together, and it all fits when you understand that the prime directive of life is fertility and conception. but we can use this to our advantage as well by giving proper hormones to women in menopause. Because if nature cared about a sex drive in a post-menopausal woman, what’s that going to accomplish for nature? But we think, we feel, and we decide, so we manipulate nature. I’m all for it. I know that it’s not natural to go on hormones after menopause, but I don’t care. A lot of women have gray hair, and they color it. what? That’s not natural. They don’t care. People put on makeup that they don’t, so I manipulate the unnatural when I want it, but I try to do it most naturally, like, I’m going to give hormones that are human bioidentical. I’m going to allow them to replicate the hormone rhythms and levels as closely as I can. I can’t give you, like, the equivalent of a new set of ovaries, but I can come closer, and I can do the best I can to try to give a woman who’s, say, 55, the same environment in her body as a woman who’s, say 21. what? Every cell in your body is a different age.

You have very few cells in your body that were there the day you were born. That’s why you have stem cells. Birth control pills do not help. They are like pro-aging. Estradiol helps maintain your stem cell pool. They are anti-aging. If I can help to mimic the hormonal environment of a young woman, I can help to maintain the functioning of every cell, no matter what their age in the body, to do what they’re genetically programmed to do by foundationally giving them the information, because that’s what hormones do. They’re like the information delivery system. Then you add in all the other important things, like the proper nutrients; you want to keep out the toxicants and poisons; you want to get adequate sleep and fitness; and everything else to support all the organ systems of your body. But foundationally, like the building of a house, you need the foundation to have a healthy female body. You need to have the hormones, and the prime hormone is estradiol. Every woman should know this, love and embrace estrogen, and not fear it because the Women’s Health Initiative created tremendous fear. But it was based on the wrong thing. It’s like I always use this analogy: if you do a study like they did with the equivalent of strawberry-flavored jellybeans and then you find it’s not that great for you, the conclusion should be, don’t eat strawberry-flavored jellybeans.

It shouldn’t be: Don’t eat vine-ripened organic strawberries. But that’s what they did. Estradiol was not what they tested in the Women’s Health Initiative, and none of the data applies to estradiol, so we need to just get over it. That was strawberry-flavored jellybeans, so don’t eat what they gave in the Women’s Health Initiative. That’s not the same as the beautiful natural human bioidentical hormones that we can give women because of brilliant scientists. We can give women in the menopausal years to come reasonably close, not identical, but reasonably close to the environment of a younger woman to help women at any age, to not only have a better sex drive and libido, which will happen, and we can give testosterone and DHEA, that’s the adrenal androgen. We can give those as well. I’m not just saying all, and we always have to give progesterone. Estradiol is just like the leader, but we need to pack. If you need thyroid, you get thyroid. We have to give the array of hormones, like you said, the symphony of hormones, but the conductor of the master hormone—I call it the master—is estradiol.

You would never give the other hormones and not give estradiol if you’re in a situation where you’re not making it because you’re menopausal. So we need to just recognize it and stop being afraid of estradiol. It’s your best friend. Estradiol, the hormone of life, is the hormone of sex, libido, cardiovascular health, musculoskeletal health, and neurological health. Because I didn’t mention that you have a clitoris, you have that whole neural system that is maintained by estradiol. You’re not going to have a proper neural function; like, all the neurotransmitters are supported by estradiol, and the blood flow to the neural tissue is all supported by estradiol. You’re not going to have healthy neurological tissues from the brain all through the peripheral nerves if you don’t have adequate estradiol. That’s just how it is, ladies.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Oh, my God. Felice, this is brilliant. I wish I had known this in medical school. This was such a big difference. Where can people find out more information about you because they need to be following your stuff?

Felice Gersh, MD

Well, I’m old-fashioned, doctor. I have a brick-and-mortar practice in Irvine, California, where I see patients every single day, Monday through Friday, and work with them one-on-one. I can also do some telemedicine as well. I have a book. My book on menopause was rated. I am so proud. The number-one menopause book by Good Housekeeping magazine is called Menopause: 50 Things You Need to Know. I have some books out on polycystic ovary syndrome, which is a whole different topic, but they have their own set of problems. Those are my PCOS SOS books, and I’m trying to get more active on Instagram. I’m going to be doing lots more on my Instagram, and I hope you’ll be on my Instagram live. I’m going to try to do many more of those, and so I hope that people will Google me and follow me. I do lots of webinars, and though I’m trying to get out there and do a lot more and write more books, I’m also primarily a doctor who sees patients. I still believe that you need that one-on-one. People come to me from other parts of the world and other parts of the country, and we have a whole program for healthy aging for women in menopause. Of course, it includes sexual function.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Oh, my goodness. Thank you so much, Dr. Felice, for being with us. This has been amazing. I’m going to just make sure you go check out Dr. Felice and stick around because we have more great sessions coming up.