What No One Tells Women About Painful Sex, Orgasm Issues, & Low Libido (Part 2)

[SPEAKER_01]: Organisms are pretty complex. [SPEAKER_01]: You need a lot of things working right and healthy for an orgasm to have fun. [SPEAKER_01]: You're brain, your nerves, your blood flow, your hormones, your spinal cord, your attention, your safety, your stimulation, a skill partner, and a knowledge of your anatomy. [SPEAKER_01]: There are a lot of options for problems with orgasm, but you need the appropriate diagnosis. [SPEAKER_01]: Why does sex hurt? [SPEAKER_01]: This is your body's way of telling you that something is wrong. [SPEAKER_01]: Pain with sex is very common. [SPEAKER_01]: The problem is that we have normalized it. [SPEAKER_01]: When I talk to patients about pain with sex, I like to break it down into three areas.

[SPEAKER_01]: The first area was the... [SPEAKER_00]: content of the disruptor podcast is for informational purposes only and does not constitute medical advice please consult your health care provider for personalized guidance regarding hormone therapy and all your medical decisions. [SPEAKER_01]: Miracle melts for play around deeply hydrating the hormone free inserts powered by hyaluronic acid. [SPEAKER_01]: He's worked with your body to suit and relieve painful sex and vaginal discomfort from vaginal dryness. [SPEAKER_01]: This isn't about masking symptoms. [SPEAKER_01]: It's about real relief. [SPEAKER_01]: New up on melts are brought to you by playground, co-founded by Christina Aguilera and a team of lovers, mothers, entrepreneurs, and a true sex dinosaur. [SPEAKER_01]: Their mission to normalize conversations about sex,

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So if a doctor tells you to testosterone is a male hormone, why are you asking for it? [SPEAKER_01]: Once again, run. [SPEAKER_01]: Why does sex hurt? [SPEAKER_01]: So I want you to hear me when I say, this is your body's way of telling you that something is wrong. [SPEAKER_01]: Pain with sex is very, very common. [SPEAKER_01]: The problem is that we have normalized it. [SPEAKER_01]: And when we normalize it or dismiss it, I can't tell you how many delays and diagnosis that leads to. [SPEAKER_01]: I've had women that I've presented with fibroids. [SPEAKER_01]: And I asked the question, you know, have you been struggling with pain with your periods? [SPEAKER_01]: And they're like, for years,

I'm like, why didn't you seek out help? [SPEAKER_01]: And they're like, well, every woman in my family, [SPEAKER_01]: has painful periods, so I thought that that's just the way we had to live. [SPEAKER_01]: So we need to stop being our own barrier. [SPEAKER_01]: There's enough barriers to healthcare as women. [SPEAKER_01]: We need to stop being our own barriers to healthcare. [SPEAKER_01]: So pain with sex is common, but it's treatable. [SPEAKER_01]: So you don't have to live with it, and it's not normal. [SPEAKER_01]: And when I talk to patients about pain with sex, I like to break it down into three areas. [SPEAKER_01]: And so we can figure out together where the pain is, and then

we can hone in on any diagnostic tests that we need to do, any examination that we need to do, any imaging that we need to do, maps that we may need to do. [SPEAKER_01]: This is why you guys really need to see an expert and not just buy something on the internet that says, [SPEAKER_01]: And so the first area of pain that women have is the outside, or what we call the vulva. [SPEAKER_01]: A lot of women mistake this is the vagina, but the outside is the vulva. [SPEAKER_01]: And the vulva includes your labia mnora, your labia mnora, and the vestibule, which is the area inside the labia mnora, right around the opening of the

vagina. [SPEAKER_01]: And this can feel like a burning, a stigging, a tearing, or oh my gosh, I can't even stand wiping anymore, [SPEAKER_01]: There are multiple contributors to this. [SPEAKER_01]: It can be hormonal changes from perimenopause or menopause, postpartum, breastfeeding. [SPEAKER_01]: There can be skin conditions like like in sclerosis. [SPEAKER_01]: There can be infection or inflammation or even irritation from products. [SPEAKER_01]: treatment obviously can include removing any of the irritate irritating agents, optimizing bald-barcair, using topical hormones or pain medications or using moisturizers. [SPEAKER_01]: We may also prescribe localized hormone therapies, pelvic floor apizzosis. [SPEAKER_01]: physical therapy, if we feel like it's a tone issue. [SPEAKER_01]: So that is why an exam, labs, diagnosis, all of

that is so, so important so that you are given the right treatment option. [SPEAKER_01]: There is a vaginal pain, and our vagina is the actual tube, and this patient's will describe [SPEAKER_01]: menopause called genital urinary syndrome of menopause, our hormones change. [SPEAKER_01]: The vaginal walls normally have these folds called rugae and act like an accordion and our thick and pink. [SPEAKER_01]: And as we go into parymenopause and menopause, we start to have this collective umbrella of symptoms of vaginal dryness, irritation, more likely to have infection, both [SPEAKER_01]: And it's because of the declining estrogen levels that the walls are getting thinner, we start to that tissue becomes paler less pink we start to lose those

folds and our pH also starts to change the pH starts to increase because microbiome of the vagina also starts to change. [SPEAKER_01]: And treatments can include lubricants, moisturizers, and obviously localized hormone therapy. [SPEAKER_01]: There are two types of localized hormone therapy. [SPEAKER_01]: A lot of people know about estrogens. [SPEAKER_01]: They can come in its positivity form. [SPEAKER_01]: They can come in cream form. [SPEAKER_01]: There's actually a ring that delivers estrogen locally. [SPEAKER_01]: One of my personal favorites is [SPEAKER_01]: It breaks down into estrogen and testosterone, so it's a duality. [SPEAKER_01]: It actually helps with all the symptoms of vaginal dryness and GSM and preventing your inner tract infection, but it actually helps with some of

those domains of sexuality that I was talking about, so it's almost like a two per one. [SPEAKER_01]: And so if you have a choice, [SPEAKER_01]: between intarosa and localized estrogen for some patients if you're struggling with sexual function, I will tell them, hey, intarosa may be a really good option. [SPEAKER_01]: And if it's now covered by your insurance, your doctor can always compound DHA from a compounding reputable pharmacy. [SPEAKER_01]: Deep pelvic pain. [SPEAKER_01]: This can feel like a sharp pain when I'm having sex, you know, it feels like he's hitting something or gets worse when I'm going to the bathroom, this can be pelvic floor dysfunction endometriosis, that's when tissue that looks like the inside

lining of the uterus kind of ends up outside, whether it's on the ovaries, the lining of our intestines inside the pelvis and the abdomen, [SPEAKER_01]: And that tissue doesn't realize it's not where it should be, and so it responds to the normal hormonal changes of our cycle, and this can be very, very painful and it can lead to scar tissue and adhesions, [SPEAKER_01]: in the uterine cavity in the muscular layer or hanging off of the uterus. [SPEAKER_01]: I think I explained to patients, think about the uterus like an orange and the inside part where you can like, when you peel off the top of the orange, you can look in the middle of that little

cavity that space, that's like the endometrium. [SPEAKER_01]: the fruit of the orange is the myometrium or the muscular layer of what causes cramping or contractions. [SPEAKER_01]: And then the outside peel is like the serosa. [SPEAKER_01]: And so fibroids can grow kind of [SPEAKER_01]: in any of those areas. [SPEAKER_01]: Ovarian cysts or masses or tumors, there are a multitude of things that can be going around in the pelvis. [SPEAKER_01]: Previous surgery, previous infection can all leave scar tissue. [SPEAKER_01]: So oftentimes we will do an examination. [SPEAKER_01]: The gold standard of imaging is initially just getting a pelvic ultrasound. [SPEAKER_01]: That's typically covered by insurance, [SPEAKER_01]: And treatments can be public floor physical therapy, it can be

medications, it can be surgery just really depending on what the diagnosis is. [SPEAKER_01]: There are some practical tools that can help with sexual function beyond medications. [SPEAKER_01]: There's an o-net, so for anyone who has baby sat for a child or had a child to be around the special price rings, this is meant for couples that want to insert in the vagina. [SPEAKER_01]: Whether it is a tool or a penis, but these are stacked rings that you can place on a male partner or a tool. [SPEAKER_01]: And they are medical grade rings that basically control the depth of penetration, my patients. [SPEAKER_01]: love these because they're like, oh my god, when we first started trying to

have sex, you know, we used to need four rings and now we're down to two rings and so super cost effective. [SPEAKER_01]: One, it's kind of design awards. [SPEAKER_01]: The founder has an amazing story. [SPEAKER_01]: She struggled with sexual pain and basically was told you're going to have to live this way. [SPEAKER_01]: the rest of your life and she includes this beautiful note that is very encouraging and empowering to women about their sexual health care so that device is called the ONAT and then there is a device called Kiwi which is a vibrates but it vibrates not in the typical way that you think to be used for a vibrator and an orgasm it can

be but we know in medicine that vibration [SPEAKER_01]: can be a treatment so that our brain is thinking about vibration rather than the pain signals. [SPEAKER_01]: And so you can use that around the opening of the vagina before or after intercourse to help. [SPEAKER_01]: It also increases blood flow and reduces, you know, the pain signals. [SPEAKER_01]: It's not a lifetime sentence. [SPEAKER_01]: There are so many evidence-based treatment options. [SPEAKER_01]: Why am I having problems with orgasm? [SPEAKER_01]: So many women are so hesitant to come forward and talk about this, or they don't even know that there are actually treatment options for this. [SPEAKER_01]: And so, orgasms are pretty complex. [SPEAKER_01]: You need a lot of

things working right and healthy for an orgasm to occur. [SPEAKER_01]: You're brain, your nerves, your blood flow, your hormones, your spinal cord, your attention, your safety, your stimulation, and a skill partner are all required and a knowledge of your anatomy. [SPEAKER_01]: It's very interesting to me that women, we have the sole organ dedicated to pleasure, the clitoris. [SPEAKER_01]: It has thousands and thousands of nerve endings, and that is why you need to make sure that there's not a skin condition. [SPEAKER_01]: causing the clitoris to be covered because the majority of the clitoris is internal anyways, but there are major category problems of orgasm. [SPEAKER_01]: So number one is timing. [SPEAKER_01]: It all of a sudden

takes a lot longer than it used to or longer than your partner expects and then you kind of get into your head and you're thinking about, oh my God, this is taking forever. [SPEAKER_01]: This is embarrassing and guess what? [SPEAKER_01]: When we get into that mindset, [SPEAKER_01]: complete absence. [SPEAKER_01]: There are women that have never had orgasm or there are women that used to be able to announce gone and or there are women that can by themselves been out with their partner. [SPEAKER_01]: So there's a lot of dynamics in play there. [SPEAKER_01]: So timing issue number one, complete absence number two, diminished, meaning you or I can ask them, but you're like, wow, damn, it's

not like it used to be, it's a lot weaker, but satisfying or just, you know, I had a woman tell me one time, she's like [SPEAKER_01]: And this is usually a public floor issue. [SPEAKER_01]: And then there is a very, very interesting type of orgasm. [SPEAKER_01]: It's the one that I've seen least often in my clinical practice, but I've been doing this for two decades. [SPEAKER_01]: And it's something called Anne Haddonic orgasm. [SPEAKER_01]: Meaning you have the physical contractions [SPEAKER_01]: but you don't get any of the euphoria, none. [SPEAKER_01]: But there are treatment options. [SPEAKER_01]: And so I want to tell you one of the biggest killers of an orgasm. [SPEAKER_01]: So this is your

take home message. [SPEAKER_01]: Is attention. [SPEAKER_01]: We are so busy as women. [SPEAKER_01]: We are paying attention to our children and what we didn't do at work and the car line and the grocery list and meal planning. [SPEAKER_01]: And we can't focus on pleasure. [SPEAKER_01]: And if we cannot focus on pleasure, we are not going to be able to orgasm. [SPEAKER_01]: In the intention is not a great thing, but orgasm requires a specific type of intention to be present and body non-gender mental and if your brain is so busy doing performance reviews and to do lists or self-criticism, your nervous system can't drop in and relax enough for you to be. [SPEAKER_01]: present in the

orgasm. [SPEAKER_01]: So what are treatment options? [SPEAKER_01]: There are topical medications. [SPEAKER_01]: There is hormone therapy. [SPEAKER_01]: There is pelvic floor physical therapy. [SPEAKER_01]: We use [SPEAKER_01]: specifically for those that have problems with attention. [SPEAKER_01]: There are clitoral pumps. [SPEAKER_01]: There are vibrators. [SPEAKER_01]: Some of the medications that we talked about for low desire actually show that they help with orgasm as well. [SPEAKER_01]: There are topical creams that increase blood flow that contain testosterone, so there are a lot of options for problems with orgasm, but you need the appropriate diagnosis and the disgust [SPEAKER_01]: Yes. [SPEAKER_01]: Women can use Viagra. [SPEAKER_01]: It is not at the approved for women, but this question comes up all

the time. [SPEAKER_01]: It just depends on what problem we're trying to solve. [SPEAKER_01]: Biograph works by increasing blood flow. [SPEAKER_01]: So where there may be a blood flow issue to the clitoris because both the penis and the clitoris, they engorge with blood and then fill up and then release the blood when we're having an orgasm. [SPEAKER_01]: So it's a pressure issue, it's a valve issue. [SPEAKER_01]: And so if we think that blood flow is the issue, [SPEAKER_01]: then, you know, topical Viagra, and we can compound it for women. [SPEAKER_01]: It can work. [SPEAKER_01]: But we have to remember the whole biosychosocial approach. [SPEAKER_01]: We have to remember to address all the domains of sexuality. [SPEAKER_01]:

We have to remember to address low desire, stress, burnout, relationship. [SPEAKER_01]: So if we just treat the blood flow and don't address anything else, [SPEAKER_01]: It's not going to be a magic bullet for everyone. [SPEAKER_01]: So you have to think about it. [SPEAKER_01]: It's one of the tools in the toolbox that we use, but it's not just, oh yeah, I just give her some topical Viagra and everything will be fine. [SPEAKER_01]: Can viagrators offer a medical benefit? [SPEAKER_01]: Yes, I love this question because it reframes vibrators as what they are. [SPEAKER_01]: I call them sexual help tools and not toys. [SPEAKER_01]: And the vibrators are evidence-based. [SPEAKER_01]: They help with arousal. [SPEAKER_01]: They can increase

blood flow. [SPEAKER_01]: They can increase stimulation. [SPEAKER_01]: They can help with orgasm. [SPEAKER_01]: They can help with pelvic floor strength and rehab and make those muscles around our pelvic floor stronger. [SPEAKER_01]: They can help with pain and vaginism. [SPEAKER_01]: A vaginism is the involuntary contraction of the muscles surrounding the vaginal opening. [SPEAKER_01]: And so for some patients, we can use them for graded stimulation and can help support desensitization. [SPEAKER_01]: or even fear or guarding because they are self-used. [SPEAKER_01]: So you have control of it. [SPEAKER_01]: And for patients with vagin nismiss, oftentimes, pelvic floor physical therapy, vaginal valium, [SPEAKER_01]: medical grade dilators that slowly will help relax or open the vaginal opening. [SPEAKER_01]: One of

my favorites is milly because it is actually adjustable and you only have to insert it once and then you dial it accordingly. [SPEAKER_01]: How do we formally diagnose or gas initiatives? [SPEAKER_01]: So a great evaluation can involve a detailed history. [SPEAKER_01]: When did it start? [SPEAKER_01]: Has it always been that way? [SPEAKER_01]: The context is it only when you are by yourself or is it with a partner or are the opposite? [SPEAKER_01]: Is there pain involved? [SPEAKER_01]: Are there medication changes? [SPEAKER_01]: Are there issues going on with mental health? [SPEAKER_01]: Is there any change in the relationship or the relationship [SPEAKER_01]: a focus pelvic exam, both looking at the anatomy, but also the tone of

the pelvic floor. [SPEAKER_01]: Labs want appropriate looking at things like hormones and thyroid, and then treatment options are removing a medication that may be causing it, hormone therapy, localized hormone therapy, topicals for either discomfort or to increase blood flow. [SPEAKER_01]: public four physical therapy, there's some great company that's available in all 50 states called origin, vibrators, and devices like we've talked about, and then mind-body approaches. [SPEAKER_01]: So since it focus, guided aerotics, therapy, [SPEAKER_01]: And in select cases and under clinician guidance medications, they can help support attention or arousal issues. [SPEAKER_01]: And that's where Adderall is, you know, can be considered. [SPEAKER_01]: Bonus questions. [SPEAKER_01]: What are the best localized hormones and what do they

do? [SPEAKER_01]: for my sexual health care. [SPEAKER_01]: So localized hormone therapy, whether it's a topical, whether it's a ring, whether it's a suppository that comes in so many different forms and really depending upon lifestyle and symptoms, they can be a gaining change or. [SPEAKER_01]: If you'd think about it, sometimes the patient says, I don't want to have sex anymore, because every come I do, I get a urinary tract infection. [SPEAKER_01]: And for those of you ladies who have had a urinary tract [SPEAKER_01]: I don't blame you because I've had one, two, and it every time you have sex, you get a bladder infection. [SPEAKER_01]: Of course, your desire is going to disappear and you're not

going to want to be into it. [SPEAKER_01]: And so, vocalized hormone therapy can help prevent those infections. [SPEAKER_01]: So, when we're treating this umbrella and syndrome, genital urinary syndrome of menopause, when it starts to creep up in this hairy menopausal menopausal years, [SPEAKER_01]: Perry menopause can be seven to 10 years before menopause menopause occurs the average age in the United States is 51 51 years young I like to say being 50 myself. [SPEAKER_01]: But you are going to treat genital urinary syndrome of menopause with moisturizers and lubricants with them localized hormones. [SPEAKER_01]: And localized hormones not only restore the anatomy, so I talked about the thinning of the walls and the loss of collagen, elastin,

and de-resplenclow, but I also talked about the pH changes. [SPEAKER_01]: When our vagina is more acidic, [SPEAKER_01]: Um, but tends to find up infection better. [SPEAKER_01]: Um, that's why things die in our, in our stomach, too, because of the, um, acidity. [SPEAKER_01]: And so when the pH increases as we go into permanent positive menopause, it renda sense more likely to have infection, not only of the bladder or urinary tract infection, but also of the vagina. [SPEAKER_01]: And so vocalized hormone therapy. [SPEAKER_01]: restores the pH helps with tissue quality elasticity and restoring some of the anatomy reducing the recurrent urinary tract infections and just overall improvement of vaginal health. [SPEAKER_01]: And so the options that you

will hear a lot about are localized, estrogen-prime, ester dial, an estrogen-containing ring, but I really want to break down [SPEAKER_01]: And it now only helps with GSM, like we've talked about with the tone, the texture, the decrease in the urinary tract infections and vaginal infections, but also helps to improve some of those domains of sexuality that we talked about earlier of the FSFI. [SPEAKER_01]: I get asked this question all the time, I think, because I'm a sexual health expert and also because I'm a woman and I'm also in the demographic that a lot of my patients are in, [SPEAKER_01]: I like Dr. Javade, what are some of your favorites, and I love them tech. [SPEAKER_01]:

It's not just a catchy word, it's technology that is improving the healthcare for women by reducing barriers, by increasing access, by increasing innovation. [SPEAKER_01]: by bringing health care to patients and in different ways and meeting them where they are at. [SPEAKER_01]: And so some of my favorite favorite lubricant brands playground. [SPEAKER_01]: What I love about playground lubricants is that they have worked with the FDA on clearance for some of their products. [SPEAKER_01]: So you know that they're safe and they do what they say. [SPEAKER_01]: Because that's what the EPA is there for to make sure that things are safe and that there's not a lot of adverse events and that that products and medications do

what they say they're going to do. [SPEAKER_01]: But I also like it because they've curated products for like phases and so really individualized their products stripes amazing brands by Naomi Watts. [SPEAKER_01]: They have a couple of great not only lubricants, but also boulevard moisturizers, so really tackling the issue of dryness and pain. [SPEAKER_01]: Foria is a CBD infused and so one of my favorites because it's a little bit different and contains a unique ingredient and a lot of patients who've tried it. [SPEAKER_01]: Like it, you can also use the oil for massage and then also for intimacy. [SPEAKER_01]: favorite vibrators. [SPEAKER_01]: There are so many vibrators on the market now and what I love about

them is back in the day they all looked like purple penises and now I love them because they are designed with women's bodies in mind, they are discrete, they are elegant and so some of my favorite vibrators [SPEAKER_01]: hands free. [SPEAKER_01]: So it can be used during intercourse. [SPEAKER_01]: Their vibrators can also be used for solo play. [SPEAKER_01]: Plus one has so many different vibrator types and their designs are also elegant. [SPEAKER_01]: There's a smart vibrator called Lyonus that actually can track your orgasms and [SPEAKER_01]: Folor sexual health is called vipsy. [SPEAKER_01]: It's audio overodica. [SPEAKER_01]: So what you to think about it as romance meets mindfulness. [SPEAKER_01]: So a lot of times there can

be a discord between partners and one partner may have a lot of spontaneous desire and yet a partner may have responsive desire. [SPEAKER_01]: And so, a lot of my patients will listen to these sexy stories. [SPEAKER_01]: Pick your characters, you pick how saucy or sexy you want the story to be. [SPEAKER_01]: You can really tailor it to you and what turns you on. [SPEAKER_01]: But a lot of women who may opt for medications or hormones may add this as an adjunct, or may say, hey, listen, I'm not quite ready yet. [SPEAKER_01]: To go to therapy or to take a prescription communication or to start a hormone, but I do want to try something and this

is kind of be done from the privacy of your own palm. [SPEAKER_01]: So I love this once again, it's called dipsy. [SPEAKER_01]: There are other some great tech companies to know taboo, so taboo is a sexual wellness brand and what it does is chooses intimacy essentials designed to support women through their like changes and they combine products and education and they deliver it to you. [SPEAKER_01]: And then a really personal favorite that I am actually a customer of is called Aria. [SPEAKER_01]: This is a couple's focus into Missy platform and it acts like an intimacy concierge. [SPEAKER_01]: And so you fill out and I've had so many people think me and know I do not

work this company, I do not consult for them, but I'm really fascinated with their approach to sexual [SPEAKER_01]: But you fill out your goals. [SPEAKER_01]: Are you struggling? [SPEAKER_01]: Are you wanting to be more playful? [SPEAKER_01]: Are you wanting to investigate? [SPEAKER_01]: Are you trying to fix a problem? [SPEAKER_01]: Are you trying to just explore? [SPEAKER_01]: sexual tools that will help you then recreate the scene or take part of the scene in your own way and for a lot of couples who have shared that they put sex in the back burner was no longer in the forefront or they didn't even know how to start addressing it. [SPEAKER_01]: um, by having a scene or an

app or a tool, it took some of the pressure off and it brought the fun back into the bedroom. [SPEAKER_01]: What I really want you to take away from today was so much fun having all the time I needed to answer a lot of your questions that you send my way that you [SPEAKER_01]: and you don't have to live with pain. [SPEAKER_01]: It's very treatable and the video is not a character flaw. [SPEAKER_01]: It's not your fault. [SPEAKER_01]: Organisms are actually obtainable and trainable and supported by the right tools. [SPEAKER_01]: You are allowed to ask for help and I want to end with this. [SPEAKER_01]: The World Health [SPEAKER_01]: And that sexual health is connected

to basic human friends. [SPEAKER_01]: So here in me again, sexual health is connected to basic human rights. [SPEAKER_01]: So if you have ever felt like you were too much because you were asking questions about sex, or for bid pleasure, pain, or desire, this is your permission slip. [SPEAKER_01]: You're not asking for something. [SPEAKER_01]: you're asking for much needed health care and that this episode hits home. [SPEAKER_01]: I want you to share it with a friend who needs to take her pleasure seriously. [SPEAKER_01]: And if you want a deeper dive, I can turn even more of these questions. [SPEAKER_01]: into a second episode. [SPEAKER_01]: So reach out to me if you would love that. [SPEAKER_01]: Thank

you so much for tuning into this episode of the Disruptor. [SPEAKER_01]: It today's episode resonated with you. [SPEAKER_01]: If you heard your experience reflected and validated or even better relieved, remember this suffering and silence is not inevitable. [SPEAKER_01]: We all deserve solutions that work, that honor our bodies, and that restore comfort without compromise. [SPEAKER_01]: That's why we've highlighted miracle melts by playground, products design not just to hydrate, but to truly relieve painful symptoms. [SPEAKER_01]: So you can move beyond just enduring. [SPEAKER_01]: Don't forget to subscribe to our listeners get 20% off their first order with Code Dr. Sony. [SPEAKER_01]: That's DR, SOMI. [SPEAKER_01]: And if you're looking for a little extra comfort, try one of

Playground's FDA-grade lubricants for dual action relief. [SPEAKER_01]: You're not alone and you deserve to feel good. [SPEAKER_00]: This is more than a conversation. [SPEAKER_00]: It's a call. [SPEAKER_00]: A call to build something better. [SPEAKER_00]: Subscribe, share, and bring more disruptors into this room. [SPEAKER_00]: For unfiltered insights and bold ideas, go to drsomee.com to sign up for the monthly disruptor newsletter. [SPEAKER_00]: And follow us on social at drsomee. [SPEAKER_00]: We're not waiting for a seat at the table. [SPEAKER_00]: We're building our own table.