So, How Are Your Orgasms? w/ Dr. Karen Toubi

We’re back from the break, and this week’s episode of Don’t F*ck this Up is right on time for Valentine's Day, because it's all about pleasure. Lauren is joined by board-certified gynecologist, sex medicine and menopause expert, Dr. Karen Toubi.

From vivid memories in 7th grade, where she declared her future as a gynecologist, to her unwavering commitment to revolutionizing women’s health, Dr. Toubi shares her heart-first decision to pursue a career dedicated to the most intimate parts of her patients' lives.

We tackle topics like the orgasm gap, the failures of sex ed, innovative treatments like vaginal Botox and PRP, and the pain points of insurance. Tune in for an educational, exciting and much-needed conversation we hope will empower you to advocate for your own sexual health - and to maybe even have some fun in the process.

“There’s a huge disparity in our sexual health, and no one is talking about it, but I’m talking about it.” - Dr. Karen Toubi

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Book an Appt with Dr. Toubi: www.drkarentoubi.com

Email the show at advice@dontfckthisup.com for your questions to be answered on an upcoming episode!

Transcript

Karen Toubi (00:01)
Thank you so much. Thank you for having me. I'm really excited to be here excited to just spend time with you and chat I feel like that you're always a lot of fun to talk to

Lauren Alvarez (00:08)
Yes.

Oh my gosh, well, I will do my best to keep it fun. And I feel like there's a lot of things I wanna talk to you about. I mean, being an expert in sex medicine, menopause, there's a lot of topics, I think that we haven't had a chance to get into on the show yet. So I'm really happy you're here. Before we get into all that, how are you?

Karen Toubi (00:29)
I'm doing good. Thank you for asking. Finally, some sun over the last couple rainy days. Californians, Angelinos can really, we appreciate the sun after all that rain, but doing great. Thank you.

Lauren Alvarez (00:37)
Yes.

Yeah, oh, I'm so happy to hear that. I mean, it's really interesting because I'm not a native Californian, but being out here, I feel like we're so allergic to any weather that isn't sunny, that everything shuts down, we're not built for rain, our houses aren't built for rain, any of it. So yeah, we'll take the sunny weather any day of the week.

Karen Toubi (01:05)
Yeah, for sure. For sure. Yeah.

Lauren Alvarez (01:07)
I mean, I'd love to kind of talk about like, how does one even go along a path to becoming a gynecologist? I mean, yes, I know there's a lot of school, but did you know that this was something you were interested in from an early age? I mean, how early did you know that you wanted to get into gynecology and being an OB, sex medicine, all of it?

Karen Toubi (01:24)
Oh, good question. I mean, I think as far as like becoming a gynecologist, I have a very vivid memory. Being in the seventh grade, I was walking to the library and I told this girl, one of my friends that was standing right next to me, I said, I'm going to be a gynecologist. And it's like, it's a very weird thing for a seventh grader to say.

Lauren Alvarez (01:47)
Yeah, I could see that.

Karen Toubi (01:48)
Yeah, I have a seventh grader now and she's like, definitely not wanting to be a gynecologist. But I just thought it was cool, like to take care of women and to be someone important, like deliver babies. I thought that was cool. And just be like involved in just taking in the women's space. And then it was really a journey.

you do four years of college, you go through four years of medical school, and in medical school, you have to really know what you want to do quite early because you apply to certain rotations in your third year.

You apply to residency at the start of your fourth year. So you really kind of have to know without really experiencing everything that there is to know. And so I was really interested in women's health, wanted to be a gynecologist. Really I think I made that choice with my heart.

and not so much with my head, knowing that you have to wake up at two o'clock in the morning and you're dealing with very, very extreme emergencies and the whole gamut of life itself from like being born to even like death with like ovarian cancer and different gynecologic cancers. But for me it was,

It didn't feel like I was going to work when I was coming in and just taking care of women. It doesn't matter. And you're so intimately involved in every single aspect of her life. Is she having sex? Is she going to choose a birth control? Does she want to have a baby? Is she happy in her life? These are all things that you're talking to women about on a daily basis.

Lauren Alvarez (03:42)
Hmm.

Karen Toubi (03:42)
Is she healthy? And so, yeah, so then naturally I went to residency, which is another four years of training where you learn how to operate and you learn how to take care of women all day long, like 80 hours a week. Wild. Yeah, so I did that. And then when I graduated, I kind of, so I continued taking care of

Lauren Alvarez (03:59)
That's wild. So much time.

Karen Toubi (04:11)
the whole gamut of women's health. And I realized like what really was exciting to me is taking care of women in the sexual capacity. So in our lives, like in healthcare in general, everything is about trying to prevent pregnancy, trying to prevent STDs, and then trying to help people get pregnant. There isn't this like...

Oh, well, are you enjoying sex? Is that pleasurable for you? Are you able to get an orgasm? Nobody talks about that. And it really like in caring for women, I was like, wait a second. Like we talk to men about their erections all the time. Like that's a very normal thing. Nobody talks to women about whether she is aroused, whether she enjoys sex. It's kind of just like

Lauren Alvarez (04:40)
Mm.

Karen Toubi (05:03)
Well, I'm having sex, let's prevent pregnancy. Or I'm having sex because I want to have a baby. No one really talked to women about how their sexual health is going. So.

Lauren Alvarez (05:06)
Yeah.

And I think there's like education, right? For all of us and depending on the kind of household and culture that you grow up in, some people don't have those conversations at home. I mean, I remember my parents were so tight-lipped about it. I mean, you'd think that they didn't even have sex to bring us into the world, you know? They were like, absolutely not, versus my in-laws who are like little cheeky, like, you know, making little comments. And may we all be so blessed as to like having sex well into our seventies. That would be fantastic. But it's just not the environment that I grew up in. So...

Karen Toubi (05:41)
Oh yeah.

Lauren Alvarez (05:45)
I kind of thought it was like, you're not supposed to talk about it. And, you know, one thing I think that's so interesting is with your approach is that you are so open and I'm sure you're often prompting people maybe for the first time to have these conversations in, you know, in this setting.

Karen Toubi (05:59)
Oh, for sure. Well, number one, our culture definitely has a big influence in how we view sexual health. Sexual health is health, but definitely our culture has a huge influence, like how we grew up, what kind of schools we went to, our religion, everything plays a role in how we view sexual health. But...

In every single annual exam that I perform, I ask like a whole slew of questions. I ask about their family history. I ask about their personal medical history. Are they on any medications? And then I always ask, are you having orgasms? And I can't tell you how many people just like take a minute and they're like, wait a second. No one's ever asked me that. Or some people will say, well, no.

Lauren Alvarez (06:48)
Right.

Karen Toubi (06:51)
I'm not getting orgasms or I've never had one before. And then like you ask more questions and you're like, holy fuck, you've been married for six years and you've never had an orgasm? Like, so there is a huge orgasm gap. And I know like men, 95% of the time in every encounter that they have will have an orgasm and only 60% of women do. And so there is, it's a real stack.

Lauren Alvarez (07:15)
Wow, that's a real stat. That's the separation. That's the gap. That's a lot. That's a huge gap. Yeah.

Karen Toubi (07:20)
Yeah, there's a huge gap. There's huge, huge gap. And it's different between whether it's a one night stand or whether it's with a long term partner, there's there are differences. And, and that really is a testament to like, how comfortable you are with your partner. How you know, so with a one night stand, is our women comfortable with their partners? I don't know. Or women who have sex with women have a much higher orgasm rate compared to women who have sex with men. Right?

Lauren Alvarez (07:37)
short.

Hmm, I wonder why. Yeah, because they're actually, they've both experienced perhaps a gap and they're like, hold on, let me make sure we don't have a gap here. Yeah.

Karen Toubi (07:56)
Exactly. So, so yeah, there is a huge disparity in our sexual health. And nobody's, nobody's talking about it. But I'm talking about it. I think it's Yeah, talking about it.

Lauren Alvarez (08:05)
Yeah, you are talking about it. Yeah, and I think breaking down the stigma around, it shouldn't be a taboo conversation. It shouldn't be something that there's barriers, but even our healthcare system, I feel like, doesn't focus on that. I saw that you posted recently about the healthcare system.

kind of not even having you bill insurance for certain things that men are reimbursed for all the time. Insurance, there's even kind of that gap there, which I definitely want to get into. But I mean, thinking about when you're having conversations in your office with widely undiscussed topics, how often would you say that people are coming back to you after they've come to you for an appointment? They go off, they have their own time, they come back for another appointment.

Have they done their homework? Have they done their research? And I don't just mean having an orgasm, I mean have they gone on? Because I think one thing about you is that you're so good at educating your patients. You're so keen to like give information, but then you're like go try this out, go see how this works for you. So are people doing the work?

Karen Toubi (09:05)
Yes, they are. So people, once they know that there's like solutions, they're like, oh, like, let's try this. Let's see if it works. And they are definitely doing their homework. I think that it is, it is our time. It is time for women to really experience pleasure in just their sexual health. It's not only about satisfying their partner. It is definitely about making sure

whether or not they even have a partner. So I have women who I see like, and then during a regular general exam, I'm like, Oh, like your clitoris is completely like covered, like, let's take care of that for you. And then they're using a vibrator to take care of themselves and to achieve their pleasure on their own. And they're like, Oh, wow, like, that's a difference, you know? And so, no, you don't even have a partner. Like everything needs to be working well on your own.

Lauren Alvarez (09:57)
Yeah.

Mmm.

Karen Toubi (10:06)
And then you can add a partner into it. And I feel like...

Lauren Alvarez (10:09)
Yeah, that's like so many things, right? Like if you're unhappy, how could you possibly be happy with somebody else? And same with your physical pleasure, there is a lot of mental connection too, right, to that. But if you aren't able to even understand what you need from your own body to feel satisfied, how could you possibly ask for that from a partner, communicate that accordingly? You're just like receiving? That's not how that should work, you know? And I think that most people are not really having those conversations.

early on, you know, with family members like a parent or somebody who's giving you kind of what we'll call the talk, or definitely not in health class. I mean, that was absolutely not a conversation that they're having in health class. And the videos and everything was very much from the, you know, cis hetero male lens. That was really how they projected it.

Karen Toubi (10:57)
Right. Or sex ed in high school was really like, this is how you wear a condom, like don't get pregnant. Right? No STDs, no pregnancy. That is sexual education as we know it. There is nothing about pleasure in our like high school sex ed class.

Lauren Alvarez (11:05)
Right.

Yeah.

Well, I mean, you have five children, which is amazing. First of all, just shout out to you for that. And I also feel like that also brings your lens of, being someone who's bringing babies into this world, the fact that you've done it, you have the track record yourself to have said, not only have I delivered them for other people, I've also had my own children. But as a parent, how does that look for you as somebody who works in this space? What is, and maybe advice that you'd give to other parents who have kids who are

How, what does that look like nowadays with the landscape of social media and internet? It's so different than when I was younger.

Karen Toubi (11:54)
Yeah, so good questions, really interesting. I will say I am pretty unique in what, I'm very open in talking to my kids about everything and anything. So if they ask me a question, I am 100% willing to talk to them about exactly what it is and will explain everything. But at the same time, I don't.

Lauren Alvarez (12:08)
Yeah.

Karen Toubi (12:19)
let my kids have free reign of their computer and social media. My kids don't have social media. And I really try to I don't want to say the word shelter because that's not a good word. Limit I try to limit their exposure to social media. So my oldest is 13. And I have like 13, I have a 13 year old boy and a 12 year old girl who are really are like

Lauren Alvarez (12:24)
Mm-hmm.

limit perhaps? Yeah.

Hmm.

Karen Toubi (12:49)
listening to music and it you know they have great friends and they know a lot of things. It's a fun age and they know that they can just talk to me and ask me questions. I think I remember like we were driving carpool and my son asked me what's 69 and he must have been like 11 and I just matter of factly talk about it and then they're like oh okay sounds good and then just move on.

Lauren Alvarez (12:55)
Yeah, that's a fun age too.

Yeah.

Karen Toubi (13:19)
So I think it's important to be the one to talk to our kids about all of these things, talk to our kids about, give them a real sexual education. So it's not only about preventing pregnancy, preventing STDs, but really giving a whole, giving the whole gamut of a sexual education and talking about pleasure and talking about who you wanna share these experiences with.

Um, and, and I think that probably for worse, our media does a poor job of talking about sex and the lens that sex is portrayed with in the media is not real. And I kind of want to just not expose my kids that to that right away when they're first encountering like what sex is all about.

Lauren Alvarez (14:05)
Yeah.

Yeah. And I think that if there's so much more information out there that if you're told, oh, this is bad, it doesn't mean that they're not going to do it. It means that they're going to go get that information from somewhere else and you don't control what that information is or where they're getting it specifically. So I think you're right. Like start at home, be open, have that dialogue and also just show that you're comfortable and confident with that. I mean, I think that is something that you don't always see in nuclear families. And so the more you can

they can be that way with their kids. And, you know, you're actually kind of starting a revolution. I don't know if you realize that. Yeah, totally. I mean, thinking about, you know, we went through a global pandemic, obviously, which was such a wild time. And it was a huge time for people to look inward on their careers themselves, their health, their families. Do you feel like this gave people a different perspective or lens to focus on their sexual health in a different way? Did you have other conversations that were coming up?

Karen Toubi (14:47)
Thanks.

Lauren Alvarez (15:09)
were people ignoring it all together? Because it definitely was such a unique time to live through, especially, I'm sure, as a health care professional.

Karen Toubi (15:16)
Yeah, for sure. I think that, you know, it's funny, when the pandemic started, we thought that like, nobody would be having babies. And then, right. And then we have this big boom, like people were just spending a lot of time with each other. And there was nowhere to go and not much to do. And so they were exploring at home.

Lauren Alvarez (15:29)
funny how that happened.

Yeah.

Karen Toubi (15:44)
And people came in with all sorts of problems, issues that they were having before that they never really addressed. And now that they were at home and they were actually being intimate with their partners or having this time, because our lives were so crazy. I don't think we realized how crazy our lives were pre-pandemic.

Lauren Alvarez (15:53)
Mm.

Karen Toubi (16:11)
And when they were at home and they had a minute to slow down, they realized like, Oh, like, I actually, it's hard for me to reach orgasm, or it's painful for me to have an orgasm or this is, you know, it's, it's painful to have sex, it didn't, doesn't feel like it used to feel or all sorts of things that maybe were left on the back burner or things that have developed over time.

Lauren Alvarez (16:27)
Mm-hmm.

Karen Toubi (16:37)
I think definitely came out of the woodwork and we were seeing lots of those type of questions answered. Yeah.

Lauren Alvarez (16:43)
Yeah, definitely. And then people having pregnancies perhaps that they weren't expected to have through such a unique time. I mean, you were going through a pandemic for the first time too. How did you coach people through that of just like, yeah, it is totally unprecedented, but people have been having babies forever. Was that the approach?

Karen Toubi (17:02)
Yeah, you know, it was terrifying. I was actually pregnant at the same time through the pandemic. I was pregnant with my patients. I got pregnant, I think I found out I was pregnant like March of maybe it was the first week of March I found out I was pregnant. And I was pregnant. Yeah, right in the beginning. And I

Lauren Alvarez (17:07)
Oh wow. Oh my gosh.

Oh my gosh, so really right in the beginning.

Karen Toubi (17:29)
was pregnant alongside of my patients. And so we didn't know anything. So like everything we know now was completely different back then. Everyone was terrified. I think we just really just, it was a hard time. We were just, we stayed home. That's what it was. Like we didn't go to the grocery store. We had delivery services. It was really tough. I think I just,

Lauren Alvarez (17:38)
Totally.

Yeah.

Karen Toubi (17:59)
Um, people isolated.

If you ask me today whether you should get your COVID vaccine, I'd say, I don't know, do you? But back then, it was a very different time. I was vaccinated four times. I was one of the first people to get a COVID vaccine when it was available to healthcare workers, recommended it to my patients, recommended that they stay home, wear a double mask. It was just really tough.

Lauren Alvarez (18:07)
You too, you.

Karen Toubi (18:30)
And we didn't know what the virus, like what COVID did to pregnant women. And we had no idea. So it was a very, very scary time. Yeah. So glad it's over.

Lauren Alvarez (18:37)
Yeah. And now being on, yeah, I was gonna say now being on the other side of it, it's like the learnings. I mean, I remember even early days, it was like so much misinformation because we just didn't know anything. It was like, I mean, I remember thinking like, oh, like, you know, we'll be back to work in a couple of weeks. And then I remember it became very real for my husband when like the NBA shut down. He was like, oh my God, this is like, this is really bad, you know, but it was hard to imagine kind of the global scale. But yeah, I mean, I can't imagine having a baby for the first time is, you know,

I'll say scary enough, just like all the unknowns, but then you add in like a first ever global pandemic and a virus and I can only imagine just kind of the fear building for that. And as a healthcare professional, being honest in saying I just don't know is probably really hard to hear, although I'd rather hear that than you make something up that's just to make somebody feel better, right? I think, yeah, I mean, there's so many.

Karen Toubi (19:27)
Yeah.

Lauren Alvarez (19:31)
Um, kind of lessons that come from that. I mean, for you, like, do you have kind of thoughts on like who your biggest mentors were or any of like the invaluable advice or lessons that maybe you learned from, from them or learned what not to do maybe?

Karen Toubi (19:44)
Wow, so many. And you know, each stage of life has different mentors. And so in med school, I have a mentor, Dr. Safaoui. She taught growth anatomy. She is a surgeon who in her last year of residency had a terrible accident and then was never able to actually practice general surgery.

And she had a really interesting perspective on life. So you can imagine doing all of this training, general surgery residency is seven years. And then, you know, four years of med school, four years of college, and then getting to the end of where you want it to be and then not being able to do anything that you wanted to and having to change direction. And she is definitely

Lauren Alvarez (20:25)
Wow.

Karen Toubi (20:44)
the first of many mentors who has shown me that changing direction is not always a bad thing and how meaningful the new direction could be. So she has mentored hundreds of students throughout the years in ways and I don't think she'll really understand the impact. So she was my real first mentor of medicine in med school.

Um, and well, you know, my first mentor is probably my dad. Um, so my dad is a physician and I grew up going to work with him on the weekends. Like he'd take me to the hospital when he rounded and I'd like sit in the nursing station and like ask him about his patients or I'd go to the office with him and I'd see him take care of people.

Lauren Alvarez (21:19)
Oh.

Oh, that's amazing.

Karen Toubi (21:40)
where I'd see like neighbors come to the house to ask him questions and he'd take a look and he was definitely the first mentor, like just taking care of people. Like the real physician of yesteryear where like complete selflessness and just like such a veracity for knowledge and just like, just.

care, just like a care person, just like always caring about someone else and what do they need and how can I help and what can I do and what, you know, so that was my first, I grew up with that. Never talked to me about sex, but you know, but right. Yeah. So that was my first mentor. And that's what I saw. That's what I thought.

Lauren Alvarez (22:20)
incredible.

I mean, hey, we can't get everything from everyone, okay?

Karen Toubi (22:33)
I saw of medicine. So that's what I knew medicine was. That's, is just care, the way he cared for people is what I saw medicine to be. And that's what I wanted. But I wanted to care for women, which was unique, like, you know, not very many people only take care of women. So, so yeah, so then, you know, Dr. Safaoui in medical school, and then through residency, I've had multiple

Lauren Alvarez (22:51)
Yeah.

Karen Toubi (23:01)
physicians attending physicians who I would see operate and see talk to patients and you just like pick little things up little nuggets up from every single person to become who I am today. So I had Dr. Elizabeth Speed who's like

Lauren Alvarez (23:13)
Yeah.

Karen Toubi (23:23)
my gosh, such a badass and Dr. McAvoy, such a badass. Like really, I was lucky to be surrounded by such wonderful women who were my mentors and taught me how to be a doctor, how to talk to patients, how to like touch a patient's thigh before I start an exam. Like these are all little things that you like pick up along the way from just watching someone else and learning how to talk to people.

Lauren Alvarez (23:47)
Yeah.

Karen Toubi (23:49)
Dr. Amir Marashi, who's a cosmetic gynecologist and like sexual medicine, like guru. He also was someone that I learned a lot from.

Rachel Rubin, Dr. Rachel Rubin, who's a urologist and sex medicine specialist. Like I inhale everything that she says, really, such a wonderful person. But you know, the funny thing is, is a lot of these people don't even realize the impact that they're making in, in everyone that they touch. They kind of just like are doing their work. And which is a big lesson, right?

Lauren Alvarez (24:11)
Amazing.

Yeah.

Yeah.

Karen Toubi (24:32)
everyone really has such a big impact in what they do.

Lauren Alvarez (24:36)
Yeah.

And I think also like moving through these conversations that you're having with patients or that you're having these small interactions, they end up becoming these really transformative moments for them oftentimes and the impact of your work and perhaps having experienced that from other people who you consider as mentors who had no idea that they were mentoring you in those moments, really kind of transformed for you the opportunity and hopefully you realize the impact of your work that you're doing. I mean, you're speaking up about things that are often ignored

and you're informing your patients and you're making sure that people feel like they have an advocate for their sexual health. I mean that is transformative. It really is. And so I hope that people feel that same mentorship from you. I mean you know whether they're your patient or someone who gets to do you know rotations or a midwife that gets to work with you during a delivery. I mean all of that is pretty magical.

Karen Toubi (25:29)
Yeah, thank you. I'm incredibly lucky to be able to do what I do. I don't take it for granted. To be able to talk to women, to people about their most intimate moments of their life is pretty magical and it doesn't get lost on me.

Yeah, it's pretty incredible. And yeah, so.

Lauren Alvarez (25:56)
It really is. I mean, when you think about the doctors that you, when you're a doctor of osteopathy, is that right? A D.O. And so can you share with our listeners a little bit about the major differences? Because one thing that I observed is that, you know, you for one, like I said, work with midwives instead of, you know, RNs, you know, in the hospital setting for deliveries, things like that. But what are the other major differences in this method of study and practice and perhaps even why you chose to go in that direction if you're open to talking about it?

Karen Toubi (26:06)
Mm-hmm. Yeah. Good to you.

Yeah, so there are two different licenses in the United States that are able to practice medicine, there are MDs and DOs. The truth is they really aren't that different. So the four years of medical school are very similar. Osteopathic physicians have this like extra component.

of treating people with their hands and kind of like understanding the musculature a little bit more intimately understanding what things feel like having like a deeper understanding of where different nerve fibers are leaving the body and coming into the body and having just a deeper understanding of like the musculature. But at the end of the day, we take the same board exams.

Lauren Alvarez (27:16)
Mm.

Karen Toubi (27:21)
And then really go to the same residencies. So the residencies for both MVs and DOs are now combined. And so like I went to New York Presbyterian, which is a residency program out.

like out of New York City that's like affiliated with Cornell. And so really they're the same. And so my treatment, and an MDs treatment, like I was in a class of, in my residency class, we had all MDs besides for me. So really our training is the same. I would say that as a DO, we also had this like,

Lauren Alvarez (27:43)
Yeah.

Karen Toubi (28:02)
woven in to our training, there is this extra like philosophy that like really patients treat themselves like our bodies are incredible and have the ability to heal on their own.

and to allow the, you know, to really listen and understand like what is actually going on in this problem. So when you're talking to someone, you're not just giving them like a bandaid for whatever, like their blood pressure, but really understand like, well, why is their blood pressure high? Where, why are they not able to have an orgasm and just like, listen to the story, listen to the whole story, like what is their relationship like? What, um, what was their childhood like? What

Lauren Alvarez (28:27)
Hmm.

Karen Toubi (28:49)
what is their physical anatomy like, you know, and you do like a full comprehensive exam and social history and just listen to the patient in front of you. And then you can get to the root of the problem instead of just like, you know, giving the patient a band-aid and moving on. So that is really the osteopathic philosophy is that you're getting to the root of the problem and understanding. So, but I will say that I don't

Lauren Alvarez (29:09)
Yeah.

Karen Toubi (29:19)
in a good like MD physician, I think that they have the same. I think that should be the same philosophy for every good physician. So there's that, yeah.

Lauren Alvarez (29:29)
Yeah.

Yeah. How would you advise someone who, because I often hear people, and I talked about this also on a different episode with Dr. Stolberg, but how do you recommend that people approach finding a new gynecologist or finding an OB? They know that they want to get pregnant. Maybe they already are and they've moved to a new city. What are some of the guidelines that you would recommend that someone go through this checklist? Because I'm sure after this episode, everybody's going to want to come to you. If you're in LA, maybe you can make that happen.

And if they're not, then what advice would you give them to make sure that they feel like they're being seen in a way that is comfortable, but also helping them in kind of the full picture of their health, versus just like come in, you know, okay, we're gonna do an exam, okay, goodbye, like that kind of thing. Because you're offering something much more 360.

Karen Toubi (30:14)
Right.

Yeah, I think that the most important thing when finding the right gynecologist or right obstetrician is to find someone that you're comfortable with, where you can ask them any question, right? Where your doctor doesn't feel like you're asking stupid questions. Because the most important thing is to have a good relationship with your doctor so that if...

you know, something happens in the course of your pregnancy, you trust them. And if they're telling you like, hey, you need a C-section or hey, you need to be delivered early or hey, this is what I think we should do. You have this trust relationship where you feel comfortable listening to them. There is

Lauren Alvarez (30:49)
Yeah.

Karen Toubi (31:06)
you know, there are a few specialties where it's normal to just come in and like expose your genitals after meeting someone for three minutes, right? So I think that when I get to know people, like they come in like, Hey, what's going on? What are you doing today? Like what brings you in? And you really have to have this connection where you're comfortable asking anything. And that's

Lauren Alvarez (31:17)
Yeah.

Yeah.

Karen Toubi (31:34)
That's what I feel. I think that most gynecologists are pretty smart and have gone through the same type of training. And I would say most people are able to give good care, but I think excellent care happens when your gynecologist is able to really listen and where you feel comfortable. And that's where excellence happens.

Lauren Alvarez (31:45)
Yeah.

Yeah.

I love that. And I think, you know, also thinking about people who feel apprehensive, talking, approaching those topics of, you know, that are a little bit more intimate or that they've never said out loud before. And I think having that trust really establishes, you know, opportunity for them to connect with you and feel like you're listening and not one foot out the door of the room. And I certainly had those experiences, you know, in my, you know, medical history of going somewhere and having someone like I felt like they just couldn't wait to leave the room. So I felt so pressured to ask.

every question I could think of, or maybe not ask all the questions, because I felt like, oh, I'm keeping you, versus being able to actually have a conversation and a dialogue and feel like I was heard and listened to and answered, and even a pause and being like, is there anything else? And I'm like, I don't think so, but gosh, nobody ever asked me that. And I think that's just a really tremendous, like you said, excellence, versus just like, okay, you're a good doctor. Do I feel like you could give me an IUD and take it out if I need to? Great, that's good, but like.

What about an excellent doctor who's gonna put me at ease when we're having really serious conversations? And I think that is a special, special skill that you have for sure.

Karen Toubi (33:03)
Thank you. I will say that our health system is kind of broken. So, in so many different ways, but I will say like it's hard for doctors to spend the time that they necessarily want because like insurance companies, either they work at like a big corporation. So like I worked at Kaiser when I first came out of training and I had 15 minutes to see my patient and

Lauren Alvarez (33:09)
Let's talk about that.

Yeah.

Sure.

Karen Toubi (33:32)
where the next one was coming through and I couldn't make my own decisions on like how long I wanted to spend with patients and it was just kind of miserable. And so really it's not necessarily the doctor's fault because they're not able to spend that time and they have so much paperwork to get through and they're you know but that's what I liked about private practice and why I got out of Kaiser was because I wanted

Lauren Alvarez (33:45)
Yeah.

Karen Toubi (34:00)
I wanted to spend, I went into medicine because I enjoy talking to people. I enjoy really helping people and having a 15 minute visit where you're not able to get into any problems or actually help people was not making me happy and not making my patients happy and was just like overall feel like pretty miserable. So it was really like super glad to go into private practice and to be able to spend more time with people.

Lauren Alvarez (34:04)
Yes.

Karen Toubi (34:29)
Um, people will complain that there's a long, like, you know, they wait a long time in the waiting room. But I will say like, it's people need more time, like it's impossible to, you know, our health insurances don't reimburse. And that's like a whole like a whole, you know, a whole ball of God, like I like to say, but um,

Lauren Alvarez (34:45)
Yeah.

Yeah. It's also like if you're waiting, if you're waiting in the waiting room, that means that you're able to give that excellence to somebody. And then on the other side of it, knowing that you might be the person who needs that extra time or like coming in for an appointment. I remember during my pregnancy and you had gone to a delivery and I was like, well, that could be me in a few months. Of course I want you to go. And you also sent in another doctor who provided

Karen Toubi (35:17)
Yeah.

Lauren Alvarez (35:25)
of remembering that if you're on the other side of it, you're gonna want those extra 10 minutes with Dr. Tooby because you need them, and that you're gonna give them to your patient because you know that they need them. And I think you mentioned the insurance model, and I think that is something that, I mean, I had an episode with Dr. Wilson who specializes in men's health and longevity, and he moved from actually Kaiser into concierge practice because...

Karen Toubi (35:32)
Right.

Right.

Lauren Alvarez (35:47)
he felt that there was so many limitations from insurance, you know, and also from people not being able to get, I mean, he told me a very specific story in the episode about wanting to prescribe a medication to somebody that you know is gonna really help their life. And also knowing in the same breath that insurance is not gonna cover it. And is this something that you're seeing a lot? Yeah.

Karen Toubi (36:05)
Yeah, that happens to me all the time, all the time. There are certain vaginal hormones that work better than others. And I like to prescribe them and nine times out of 10, insurance will not cover it. And I end up becoming this like, this like researcher, like, where can the patient get a better deal? Do you have a Costco membership? And like, you and then

what'll happen is like I have to prescribe like four other vaginal hormones before they're able to use the vaginal hormone that I wanted. And I mean, so many limitations to care. I have patients that have like a very tight pelvic floor where intercourse or penetrative intercourse becomes very painful in a condition called vaginismus. And

Vaginal Botox is actually very helpful for that condition. It's really almost curative. Insurance makes you fly through so many hoops in order to get that covered. I spend hours trying to get that covered sometimes. I would say that I completely understand why people leave the insurance model because you can't take...

Lauren Alvarez (37:04)
Wow.

Yeah.

Karen Toubi (37:26)
care of people the way you want to. And, and people should realize that you do get different care when you go outside of the insurance model, because people are able to spend the time with you, without worrying that you have like seven people in the waiting room waiting for you. And you're able they're able to spend the time and get to know like the whole story and the whole picture and they're able to just Yeah.

Lauren Alvarez (37:29)
Yeah.

Karen Toubi (37:55)
offer all of the options without being limited in what's covered or not covered.

Lauren Alvarez (38:00)
sort of that relationship based medicine like your dad practiced, right? Of like of yesteryear where it's like a home visit. Or I mean, I know people who have concierge medicine, they had things that went undetected with regular medicine through insurance. They went to a concierge practice and found out that they had significant health problems that needed to be addressed immediately. And this is things that when you're not taking the time that they're definitely missing. I mean, you mentioned vaginal botox, which I've admittedly never heard of.

procedures like have you seen the increase in patients either requesting in recent years or new treatments that you're excited to educate more patients on? Because I feel like especially social media, there's so much out there, but what's the good stuff and also what are people asking for?

Karen Toubi (38:40)
Yeah.

Yeah, so the truth is people don't know what to ask for, right? Like nobody really knows, but there are so many innovative treatments that are now available. So in my office, we offer shockwave therapy, so cleovana, which is radial shockwaves that increase the intensity and frequency of orgasm. And really, this has been around for such a long time. We've been using it for erectile dysfunction.

Lauren Alvarez (38:49)
Right.

Karen Toubi (39:16)
We use it to help with like blood flow in certain joints. We use it in musculature. Like, and someone was like, hey, if we're using it for men on their penis, like the clitoris is literally the penis. It's the same organ. It's the same. Like why wouldn't it work for the clitoris? And so now we use it for women and it really helps women of all ages, like 20 to however old you are.

Lauren Alvarez (39:33)
Yeah.

Karen Toubi (39:46)
It helps with bringing blood flow to the area, helping with nerve neurogenesis, so helping stimulate the nerve growth in the area, and it helps with the intensity and frequency of orgasm. And so that's pretty awesome. Who would have thought such a thing exists, right? Very non-invasive. It kind of feels like a tapping. It's like a gentle tapping. And

Lauren Alvarez (40:02)
That is awesome. Yeah.

Karen Toubi (40:12)
So that's great, no needles or it's not a dangerous procedure at all. There are no negative side effects to that. So really, yeah, only positive ones. And so, yeah, if we've been using it for men for years, like, you know, thank God we started using things for women, right? Like we did, you know, why not? Um, and then there's like the laser therapies, there's the CO2 laser we have in our office, the Mona Lisa.

Lauren Alvarez (40:20)
Only positive ones, as you said, yeah.

Yeah. Why not?

Karen Toubi (40:42)
That is a laser that helps also regenerate tissue. So in a lot of postmenopausal women, after menopause, the tissue just becomes thin and dry and the urethra gapes open and sex becomes painful. You have less lubrication. There's increased risk of urinary tract infections, increased like waking up in the middle of the night to pee, like all these really fun things. And so...

The laser helps regenerate that tissue and helps heal the tissue and make that less of a problem. Of course, vaginal hormones are like number one. Everyone 45 plus should be best friends with either vaginal estrogen or vaginal DHEA. Intrarosa is like my favorite and of course almost never covered.

So yeah, you know, so there's that, but definitely like vaginal lasers are very helpful as well. So you don't have to like constantly be putting creams in the vagina. And then we have radio frequency too. We have the Thermiva in our office and that really helps with like tightening the tissue. So it helps with incontinence, postpartum, people have a lot of laxity in their vagina. People have issues with holding in their urine when they cough or sneeze. I know for me, I took my kids to this like,

jumping place and there's like little puddles everywhere. I mean like this, the Thermiva, we'll be quiet with that answer. But yeah, the Thermiva was wonderful. Thermiva is really great because it helps like tighten everything, helps the tissue in the vagina, really tighten up, helps with laxity, helps with like people queef. So that's just like air that goes into the vagina because there's a lot more.

Lauren Alvarez (42:05)
Mm-hmm.

From you or from the kids, to be fair. Yeah.

Amazing.

Karen Toubi (42:33)
laxity. So the thermiva is really helpful with that. Thermiva was helpful with the incontinence. And so that's like a radio frequency in the vagina that is, we use that all the time post partum and really as people age, menopause, perimenopause, postmenopause. And it really helps with the tissue integrity and also helps with neurogenesis. So it can help make orgasm feel better.

else. And then the thermiva also really does some like cosmetic things on the outside too. So like some people feel like their labia majora is like wrinkled as they either lose a significant amount of weight or as they age, there's just like less fullness in that area. And the thermiva is really great at kind of just like snatching everything up and making everything look youthful. We do

Lauren Alvarez (43:28)
Wow.

Like the same thing they do in facials, like skin care.

Karen Toubi (43:34)
Yeah, so like vampire facial, you can get like, you know, vampire vagina, but essentially, so really PRP is just you draw your blood, you spin it down and you take out the platelets and like all the growth factors in your own blood that promote healing. So let's say you cut your hand, your hand has like a scab, all of that is really like the platelets and all those growth factors, the healing factors that help, you know, heal the hand.

Lauren Alvarez (43:39)
Ha ha ha!

Karen Toubi (44:03)
So you're removing those from your own blood and then re-injecting them into your body, into the area of problem. So it first came, we started using PRP in orthopedics into people's joints, and that helped with regeneration in the joints. We started using, and then from there, they realized like, hey, this is just like regenerating tissue. So like...

Lauren Alvarez (44:11)
Wow.

Mm-hmm.

Karen Toubi (44:28)
Let's put it in people's faces to help with wrinkles and collagen and just like anti-aging. And then from there, people are like, well, you can do it anywhere. Let's put it into mastectomy scars. So people that get like have mastectomies or top surgery, they have like a pretty big scar that goes along their chest. PRP has been shown to be very helpful in reducing those scars just because it's a lot of.

Lauren Alvarez (44:49)
Mm-hmm.

amazing.

Karen Toubi (44:55)
regenerative properties, healing properties, and then you can put it into the vagina, put it into the clitoris to help with intensity and frequency of orgasms, put it into the vagina to help with the tissue integrity, to help with laxity, to help with healing. I use PRP a lot for patients that have lichen sclerosis. So lichen sclerosis is a autoimmune skin condition that many women have on the vulva that can cause like,

significant itching and pain within her course. 4% of lichen sclerosis can turn into vulvar cancer. And I use like PRP into the vulva and into the area of the lichen to really help with healing. And it's shown significant promise. So there's lots of different ways you can use PRP and lots of ways you can use all of these treatment modalities. It's...

It's not all about your pap smears anymore. There's so much.

Lauren Alvarez (45:55)
Yeah, that's incredible. I mean, and also just so empowering to have that information available of just like, there are options if you're dissatisfied with something, whether it's the appearance or actually how something feels and like, there are solutions. And I think that right there is just the conversation that I think so many healthcare professionals aren't able to have or they're not willing to have. Hopefully it's just not that they're not able and it's insurance pushing them out the door in 15 minutes. But I mean, I just think that it shows like how limitless like the possibilities of

a gynecologist, what you do in your day to day really are. I mean, another thing too that I definitely want to talk about is like originally we were supposed to record a different day and you had like a gynecological emergency case that came up, you had a scheduled surgery and you said, okay, this isn't gonna happen. And you said, hold on though, we have to talk about, this is like one other way that women's healthcare is at the bottom of the totem pole, I think was like your exact words.

Karen Toubi (46:28)
Yeah.

Oh yeah. I remember I was like pissed that day. Okay. So this is what happened. I had a scheduled surgery that was supposed to go, like, I don't remember what time it was. And then I had scheduled with you to record this podcast, like at a later time that day. And I was like, oh, for sure. I'll make it like I'll finish the surgery and then I'll have this podcast. But then I was bumped by another case from the emergency room.

which is totally appropriate. Like an emergency came in, this woman had something called a torsion, ovarian torsion, where her ovary was twisting on itself and it's a big emergency because she could lose the blood supply to the ovary. So it definitely needs to be done and quickly. But what pissed me off was that the gynecology,

OR only had one room for gynecologic surgeries. So this is at Cedars-Sinai in this world-class hospital with tons of operating rooms, like rooms and rooms and rooms and rooms of operating rooms. And they were bumping me, so I was a gynecologic surgeon, so that means a surgeon that takes care of women exclusively.

They bumped me out of my room to take care of this other patient, which again, I had not upset that they took care of the patient. But what I'm upset about is that if this, if, if this scenario was flipped, let's say there was a man who was having testicular torsion. So his testicles were like, you know, had the danger of losing their blood supply. There is an available operating room for him where no surgeon would be like bumped.

Lauren Alvarez (48:26)
Really?

Karen Toubi (48:30)
So that means they don't value people who take care of women. They don't value my time. They're bumping me to take care of this woman, which is totally appropriate. But they should have a room available for gynecologic surgeries that come from the emergency room. There are lots of different emergencies that come from the ER.

Lauren Alvarez (48:41)
Right.

Yeah.

Karen Toubi (48:59)
And so, like there are ectopic pregnancies, there's bleeding, there's like, you know, lots of different hemorrhages scenarios and like there should be a designated operating room for those type of procedures and emergencies where they don't have to bump a scheduled gynecologic surgery.

Lauren Alvarez (49:14)
Yeah.

Yeah, because it becomes like an either or situation versus like both things are of importance. It's not like this person who has a scheduled surgery is less important. And also there's a big mental hurdle for the person who's having surgery that like you're fasting before your surgery, you're hyping yourself up that you're gonna be able to do this and then it's changing or you have hours that are delayed or maybe it's the next day. That's a really big shift. Yeah.

Karen Toubi (49:25)
Right.

Right. Yeah. So, yeah, that was like crazy to me. Like, are you kidding? Like, there's a million ORs here. They're bumping my OR. They don't have a designated operating room for like a woman, but they do for a man. Which is like a whole other thing. Like medicine in general is all about like.

Lauren Alvarez (50:00)
I'm in.

Right.

Karen Toubi (50:08)
Viagra is a very popular drug to help men have an erection. Doctors prescribe Viagra without really asking about who are they having sex with? Is their wife or their partner?

Is she ready to have sex? Is her vagina ready to have sex? Is she having pain with this mega erection? It's all through a very male lens, all of medicine. We talk about men who have prostate cancer, we talk to them about their sexual function after surgery. We don't talk to women.

Lauren Alvarez (50:32)
Yeah.

Yeah.

Karen Toubi (50:56)
I mean, I do, but this is something I recently started doing and not because I was trained to do this. We don't necessarily talk to women about what their sexual function is going to be like after getting a hysterectomy or after removing her ovaries. And this is something we really need to talk to people about. Will you be able to have an orgasm after you remove your uterus? Not everyone is able to. After a leap, which is like a surgical...

Lauren Alvarez (51:14)
Yeah.

Karen Toubi (51:23)
procedure on the cervix where people have abnormal cells, we don't really talk to women about, like, hey, maybe your ability to have an orgasm will change. And whether or not, like, some people will say, well, hey, you're preventing cancer. Well, yes, I'm not saying not to do the procedure. I'm just saying to have that conversation. And I think that it's a very, it's a very.

Lauren Alvarez (51:43)
Right. Yeah.

Karen Toubi (51:50)
different way of talking to people. Where like, we're not talking at people about like, hey, this is what you need and let's do it, but like, hey, this is what you need, these are the consequences and like, you deserve to be able to understand like the whole picture and make your own decision on how you wanna proceed.

Lauren Alvarez (51:53)
Yeah.

I mean, also known as informed consent, which I think is a whole huge topic in healthcare where there's a lot of healthcare providers that are not giving you that full picture about what are your alternatives? What are the risks? What are the benefits? I mean, yes, it's like remove cancer cells, but also you deserve to know the whole picture. And I'm not just gonna tell you the highlight reel, because I think that that's like, that could be a huge problem for somebody, not that they would hopefully decide not to have that procedure, but that they would understand the implications and what options they have following that to.

Karen Toubi (52:12)
Yeah.

Lauren Alvarez (52:38)
have the best possible results, right? Yeah.

Karen Toubi (52:41)
For sure. And then even with hormones. So 20 years ago, there was a women's health initiative that came out with this false news.

out like media outlet saying that hormones caused breast cancer. And there was this huge pendulum switch. Women came off of estrogen, stopped estrogen hormone replacement therapy. And for like the last 20 years, the way most OBGYNs were trained was like, no, don't people don't put people on estrogen. And if you are going to put them on estrogen, put them on like a really low dose for the shortest amount of time possible, and make sure they come off by 60. Versus like

for men, like no one's gonna tell a man to get off of his testosterone. It's just not the same conversation. And really like when you look at the data, like this women's health initiative study was amazing, but when we actually looked at the data instead of having this like false headline that everyone kind of listened to, you realize that like actually estrogen is really important for your brain and your bones and your heart and...

Lauren Alvarez (53:27)
Oh yeah.

Karen Toubi (53:50)
talk to people about risk of breast cancer and hey, the risk of breast cancer is probably not what we thought it was and it may actually be protective against breast cancer and testosterone is actually really important for women. That's like another thing. Testosterone is not FDA approved for women in the United States and so when I prescribe testosterone to women, I have to prescribe it as if they're a man.

and then tell the woman to take it a little differently. So like, you know, when you have a little, a little instruction on your prescription, it says like, take one daily. Well, I have to write it as if they're a man. I say, take, you know, apply a whole tube daily. But really I have to like tell the woman, hey, you're going to use a pea size amount, that whole tube will last you about 10 days. And I can't write that on the prescription, otherwise her insurance won't cover it and the pharmacy won't fill it.

Lauren Alvarez (54:23)
Yeah.

That's wild. Yeah.

Karen Toubi (54:44)
So isn't that crazy? I've had like pharmacists call me when I've written the instructions like as I want it to be taken, the pharmacist calls me and like, hey, I can't fill it this way. Like, please change the instructions. And then you have like this secret like conversation with the patient like, hey, this is what it says. But like, I really want you to take it this way. Like, that's so backwards. And in other countries like Australia, there's a dose for women and in the

Even Canada, like why are we so behind? It's because no one really cares that much about women's care. And so we have to be our own advocates and be super loud and change things because otherwise nobody else will.

Lauren Alvarez (55:25)
Yeah.

Yeah, like this whisper network of like healthcare guidance, you know, shouldn't have to be like the way that your doctor approaches it. It should be like you should be able to have like a megaphone and tell people what they need to do. And I do feel like you've done a really good job of that, like through social media. I've seen that you've been on several panels, you know, you know, even recently you celebrated National Orgasm Day, which is amazing. I didn't know that was a holiday, but everyone should be celebrating it. Yeah. But I think that, you know, it is really refreshing to hear that. I mean,

Karen Toubi (55:51)
Yeah!

Lauren Alvarez (55:57)
Are there any books or learnings recently that have shaped you in kind of your pursuit forward with medicine and how you want to really live out loud with information?

Karen Toubi (56:09)
Yeah, wow. Okay, so the first book that I think like, I read it a couple years ago was really mind blowing for me and changed the way I like thought about hormones in general is called estrogen matters. And it's a book by Dr. Avram blooming, who's an oncologist. And he like just goes through all the data and talks about

like how estrogen does not cause breast cancer or all the other bad things they say estrogen causes and talks about like how important it is to women's health, how we don't tell men to just like deal with it. We, and so really it changed my perspective because in training, that's exactly how we were taught to just like have women deal with it.

And I was like, hey, oh my God, like I was thinking like that. Like it just changed my, I was like, oh my God, like really? I thought like that. So it changed the way I started thinking. And then Come As You Are by Gaskin is really good.

Lauren Alvarez (57:09)
That's amazing. That's so powerful.

Karen Toubi (57:17)
And she just came out with a new book, I forget the name of it, but it was just recently like in the last week. But that's just like, in terms of sexual health and like confidence and just like being who you are and comfortable in, in your sexual in your sexual being, you know, that was a really good. Yeah.

Lauren Alvarez (57:38)
Here, here, may we all be more comfortable in our sexual beings, right? I mean, I can't believe we're coming up on time. I feel like I could have you for like a whole day. We can make like eight episodes because I feel like people are just gonna gobble this up. I mean, where can folks go to learn more about you and your practice and your thoughts? I mean, I know your social is great. Where would you like to send people?

Karen Toubi (57:59)
Well, you can go to my website, www.DrKarentoubi.com. So 2B is T-O-U-B-I. You can come to my Instagram, Beverly Hills Gyno, and then of course, I'd love to see you in my office in Beverly Hills. So just call and schedule an appointment.

Lauren Alvarez (58:19)
I love that. I mean, what is one final thought you wanna leave our listeners with today?

Karen Toubi (58:24)
There are no stupid questions. If the only stupid question is the one that you don't ask. And so when you are wondering something, when you're not sure about something, just ask. Because there is an explanation, whether simple or not, somebody can walk you through it, and it could make your life significantly better. So don't hold back, just ask.

Lauren Alvarez (58:52)
I love that. Dr. Tooby, thank you so much for joining me today. This has been so special.

Karen Toubi (58:54)
Yeah.

Thank you so much for having me. I love talking to you. This is great. Thank you.

Lauren Alvarez (59:02)
And I love talking to you. Thank you so much. This has been another episode of Don't Fuck This Up, the podcast answering the ultimate question. How the fuck did you land that cool job? I'm your host, Lauren Alvarez, and I'll talk to you next week.

Karen Toubi (59:04)
Thank you.