On today’s show we welcome Dr. Lori Brotto, a Professor in the department for Obstetrics and Gynecology at the University of British Columbia and the Canada Research Chair in Women’s Sexual Health.
Quick Warning: While this woman's story & subsequent BJ tutorial video is quite distressing, it will teach you how to make your man scream with pleasure and become sexually addicted to you. If you are interested in having your guy completely obsessed with you and only you, then check out her story & (explicit!) blow job tutorial video here.
Lori has also the author of the book, Better Sex Through Mindfulness: How Women Can Cultivate Desire. In this episode we are discussing sexual desire, and how a low desire or lack of interest in sex is by far the most common sexual concern, not only in women but in men as well. Many people struggle for different reasons, both psychologically and socially. Lori helps us today to uncover those struggles and those reasons and step beyond our negative beliefs to reignite our sexual desires through mindfulness. For an incredibly insightful conversation, be sure to tune in to today’s episode!
Key Points From This Episode
- Hear more about Lori and how she became a sex researcher and sex therapist.
- Researcher’s findings on reasons why women experience low sexual desire.
- Why low sexual desire is often confused.
- Understanding how mood and depression suppresses desire.
- How your beliefs can impact your desire.
- Cognitive behavioral therapy and how it can effectively treat sexual complaints.
- Physical conditions people can have that may interfere with sexual function.
- A female Viagra solution to fix female sexual arousal disorder, how terrible can it be?
- Struggling to reach orgasm during sex: whether you’re lacking desire or full of it.
- How mindfulness can help women and man be more present and reignite desire.
- Lori share some stories from her book on how mindfulness can be useful.
- Adopting a regular mindfulness practice and engaging the muscle of the mind.
- And so much more!
“Low desire or lack of interest in sex is by far the most common sexual concern, not only in women but in men as well.” — @DrLoriBrotto [0:04:01]
“Negative beliefs in the brain can also stimulate certain brain path ways that interfere with desire and arousal.” — @DrLoriBrotto [0:11:21]
“Pretty much anything that impacts hormones has the potential to impact sexual response.” — @DrLoriBrotto [0:14:35]
Related: If you want to give your man back-arching, toe-curling, screaming orgasms that will keep him sexually addicted to you, then you'll find them in my private and discreet newsletter. You'll also learn the 5 dangerous & "dumb" sex mistakes that turn him off and how to avoid them. Get it here.
“If you are going to have sex, you may as well show up for it.” — @DrLoriBrotto [0:27:30]
Resources, extended show notes and Lori’s details can be accessed by clicking here.
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[0:01:20.3] Sean Jameson: Today, I’m talking to professor Lori Brotto, she is professor in the department for obstetrics and gynecology at the University of British Columbia and the Canada Research chair in women’s sexual health. Lori has also written a book, Better Sex Through Mindfulness: How Women Can Cultivate Desire. Lori, thanks so much for coming on The Bad Girls Bible Podcast.
[0:01:43.6] Dr. Lori Brotto: Thanks so much for having me Sean.
[0:01:45.2] Sean Jameson: I’d love to start off with a little bit about your background and how you came to study sexual health and then, how you came to teach it.
[0:01:55.3] Dr. Lori Brotto: Sure. Well, I’ll start by saying I never imagined being a sex researcher or a sex therapist, it was one of those serendipitous things. I had always had a long standing interest in research and actually my primary interest was in understanding treatments for depression. I had the opportunity to volunteer in a research laboratory quite early on during my undergraduate university training and the focus of that research lab was on understanding sexual dysfunction using animal models. Essentially, I would inject different medications in the rats or expose them to chronic stressors and then measure the effects on their sexual activity.
I actually continued that for the next six years after that and increasingly became really interested in understanding some of the environmental causes of sexual problems. Of course because rats are – give you only a narrow window into the human sexual experience. It was the year that Viagra was approved in Canada, which was 1999 that I made the switch over to human research and it was a combination of Viagra being approved so suddenly we have this effective and easily available, low side effect, low risk medication to treat male sexual dysfunction and yet, in that same year, there was quite a large publication that found that almost half of women have sexual concerns.
There was not kind of corresponding pharmacological treatment to address the large populations of women with sexual problems. It was really that year that I made the switch to studying women instead.
[0:03:42.7] Sean Jameson: Awesome. Could you talk a little bit then about your findings and maybe the findings of the scientific community and researchers about some of the reasons why women can experience low sexual desire or you know, sexual desire disorder?
[0:04:01.7] Dr. Lori Brotto: Yeah, low desire or lack of interest in sex is by far the most common sexual concern, not only in women but in men as well. People are often surprised to hear that because they just assume that erection problems is the most common concerns but it’s actually lack of interest in sex. There’s been a lot of research trying to understand why do we lose desire, why are some folks maybe born with a very low level of sexual desire and buy and large, that research suggest that although there could be a multitude of different reasons, for a lot of people, those reasons tend to be psychological and social or sociocultural.
Some of the big key players are mood. Low mood or depression is highly associated with loss of desire as is stress and anxiety. There’s lots of other belief related reasons so if you believe that you’re destined to have a bad sex life or if you believe that you’re not capable of having satisfying sex, those beliefs can actually play a pretty significant role in determining whether you’re going to have low desire or not.
The research is not meant to say that biology and hormones and physiological function aren’t important, they are, they absolutely are. In fact, they’re critical. The leading causes tend to be more psychological and social.
[0:05:23.8] Sean Jameson: I’d love to talk about these psychological reasons in a minute but could you talk about why maybe some women confuse having low sexual desire or with actually just understanding how their bodies react, perhaps even more of a responsive arousal pattern? Where initiation needs to take place before they actually, some sort of physical initiation needs to take place before they actually feel desire. Could you talk a little bit about that?
[0:05:52.7] Dr. Lori Brotto: Yeah, you’re absolutely right Sean and I’m glad you pointed that out because I think that there is a prevailing myth that we have sex because we have desire, right? You suddenly are struck by feeling in the mood or horny or have a craving for sex and that then leaves a person to seek out a sexual encounter. Yet, much of their research, in particular for women, though not only. But especially for folks in long term relationships, it is much more common for people to start engaging in sexual activity and then the desire for the sex that they’re already having starts to emerge once their body starts to show signs of arousal, they notice pleasure.
They start becoming in tune with what’s happening, they’re focused on the act and on their partner. It’s very much more common to have a picture where first, the person might become aroused phalli aroused and then that gives rise to sexual desire.
It’s important that listeners in the public understand that because we don’t want a person who doesn’t feel desire at the outset to think that there’s necessarily anything wrong with them.
[0:07:03.0] Sean Jameson: Yeah, that makes absolute sense. Maybe some people listening should have to think about that, might be nothing wrong, whatsoever but they may need something to happen first before they actually start feeling desire.
[0:07:15.6] Dr. Lori Brotto: That’s right.
[0:07:17.0] Sean Jameson: Could you talk then a little bit about how these things say you mentioned mood and depression, how do they work on someone to suppress their desire?
[0:07:29.1] Dr. Lori Brotto: Well, when you think about depression, one of the Hallmarks signs of depression is apathy or no longer being interested in the things that used to bring you pleasure or interest. Maybe it’s a certain activity or a certain type of food that the person just says, don’t enjoy that anymore. That same symptom extends to sex. Even if a person previously really enjoyed sex, if their mood is down or if they have, even a diagnosis of a major depression, they’re going to have a reduced interest in all the things that previously gave them pleasure and sex being just one of them.
That’s really how depression and desire are linked. Stress and anxiety works through probably a slightly different mechanism. We know stress has kind of two parts to it, one is the effects on the body so you have the fight or flight system that’s engaged or the sympathetic nervous system response and that system directly counters the sexual arousal system.
If a person is engaged in fight or flight, say they’ve encountered, you know, something they need to run away from or an intruder or someone who is going to mug them. The fight or flight system’s going to be engaged and it’s going to block the sexual arousal system and that makes sense because we want to be mobilized to run or to fight.
[0:08:47.5] Sean Jameson: Maybe not have sex in that situation.
[0:08:49.4] Dr. Lori Brotto: Not have sex, that would not help you in that moment if there’s an intruder in your house.
[0:08:53.2] Sean Jameson: If it’s clear then.
[0:08:56.3] Dr. Lori Brotto: Then there’s the other part of stress, which is the psychological part, right? When we’re stressed, we might be preoccupied on certain thoughts, we might be distracted, we would be very much thinking about what’s about to happen, what’s going to happen in the future and so all of those things directly interfere again with our ability to become subjectively or emotionally aroused in the moment.
[0:09:17.8] Sean Jameson: That’s good to know and so anxiety is the same as what you’re saying.
[0:09:21.5] Dr. Lori Brotto: Yeah, anxiety is probably a more extreme version of stress, I mean, the reality is that a lot of people in kind of contemporary society will say that they’re stressed and it’s just from the daily to do list, right? We’re walking around with chronic and almost epidemic levels of stress.
Anxiety would be a more extreme version of that where you might have a very specific anxiety about a situation or an object or you might have anxious thoughts or worries about your health or the future. They’re very related but slightly different.
[0:09:58.3] Sean Jameson: You also mentioned beliefs, could you talk about that Lori? How that impacts someone’s desire.
[0:10:06.8] Dr. Lori Brotto: Yeah, this has been a really fascinating part of the research that shows just how impactful beliefs can be in either boosting desire or shutting it down altogether. You know, we’ve known for a long time since the days of masters and Johnson that folks who are prone to sexual difficulties might have, especially negative or even catastrophic beliefs about sex.
Things such as if I don’t reach an orgasm, my partner will leave me or I’m certain I’m not going to get aroused because you know, everything is wrong. Those beliefs are pretty pertinent when it comes to arousal and desire. There’s newer research actually that shows that more general sex related belief.
Things such as believing that your sex life ends at a certain age or for women, believing that sex ends with menopause or believing that it’ s inappropriate to engage in masturbation, all of those kind of negative sex related beliefs can impact sexual desire and there’s again, probably a different variety of different mechanisms by which that happens but ultimately, you know, negative beliefs in the brain can also stimulate certain brain path ways that interfere with desire and arousal.
[0:11:29.5] Sean Jameson: What you’re saying is maybe even someone grew up in an environment a long time ago where maybe sex wasn’t discussed or if it was discussed, the idea of maybe getting pleasure from sex wasn’t positively, wasn’t associated with positive emotions?
[0:11:47.1] Dr. Lori Brotto: As sexual beings, we’re the byproduct of a lifetime of experiences as well as what’s happening in the here and now. In my clinical practice, I see plenty of individuals who will say, you know, “I’m an adult, mature, empowered, educated person and yet, I’m still holding on to these negative beliefs from my childhood where I was exposed to an environment that was very ambisexual” or “I was told that masturbation was a sin or that engaging in premarital sexual activity would mean that I would never find a long term partner.”
Sometimes people find those beliefs that become engrained at a young age really difficult to shake, even though as an adult, they’ve got real evidence to the contrary.
[0:12:33.7] Sean Jameson: I’m just wondering then, can beliefs work in a sort of in the opposite direction, almost could you give some placebo and tell them “Hey, this is going to fix your sex life, could it work almost in that way?” I know it’s a bit of a random question.
[0:12:50.0] Dr. Lori Brotto: Yeah, well, we call that cognitive behavioral therapy. There’s an entire system of therapy that involves identifying problematic beliefs and challenging them and replacing them with more accurate beliefs and CBT is a well-known treatment for lots of different conditions and depression, anxiety, et cetera.
It can also be a really effective treatment for sexual complaints. I think one of the other aspects that I think you’re getting at is you know, “can we have people adopt some maybe overly optimistic beliefs. Even if they’re unrealistic and can that actually help them?” That’s actually been done in an experimental setting in the lab where women with low desire were brought in and threw a mood induction paradigm, they listened to these audio clips that delivered messages such as I like my sexuality. I’m an empowered woman.
I’m a fully sensual sexual woman. Then they showed the women erotic films and they measured both their physical response, their self-reported sexual response. The beliefs had an impact so even experimentally, trying on these beliefs, even just for a short term can actually boost sexual arousal. That’s been something we’ve been trying to take advantage of in the clinical settings.
Can people benefit from trying on these positive beliefs. Say, before or during a sexual encounter.
[0:14:16.2] Sean Jameson: Awesome, good to know there can work perhaps in the opposite direction. We talked about these kind of psychological issues, are there also maybe kind of physical conditions people can have that may interfere with woman or a man’s sexual function?
[0:14:32.5] Dr. Lori Brotto: Yeah, lots of physical condition. Pretty much anything that impacts hormones has the potential to impact sexual response. Diabetes or thyroid disease or polycystic ovarian syndrome or medications for that matter that can impact hormonal response and then of course, there’s a whole host of medications like antidepressants or even some of the chronic pain medications or neural leptins can also interfere with ability to reach orgasm. Then you know, chronic health conditions in general.
All of the large surveys have shown that folks who have chronic health conditions are far more likely to also experience low sexual desire than those without chronic health conditions. Or even just poor self-reported health. They also can act as a vulnerability factor. Now, the exact mechanisms, how some of these chronic health conditions make someone vulnerable to developing low desire or sexual dysfunction, that, we don’t totally understand because maybe there’s some other explanation that is accounting for both the low desire as well as the chronic health condition.
That’s a place where the science I think still has a way to go.
[0:15:51.8] Sean Jameson: Okay, I just guessed so many conditions like the ones you mentioned, drugs to treat them, even the aging like as your hormones change and maybe it’s something people should talk to their own doctor about.
[0:16:07.0] Dr. Lori Brotto: Absolutely. You know, I think it’s important to at least, at the outset, rule out whether there could be an easier, a low hanging fruit factor that’s contributing. You know, if it is a medication that’s getting in the way, can that be swapped out for a different medication and that happens all the time with antidepressants. A lot of the antidepressant are major culprits for getting a way of workouts.
[0:16:30.7] Sean Jameson: SSRI’s I think?
[0:16:31.7] Dr. Lori Brotto: Exactly, yup. SSRI’s and so can those be swapped out for one of the more sex friendly antidepressants. I think your point about talking to your primary care providers is a really important first step. Unfortunately, there’s lots of evidence, scientific evidence that not all primary healthcare providers themselves feel comfortable talking about sexuality or may not feel equipped with the appropriate knowledge to answer sex related questions. So I always say to people, if you are not happy with the first health care provider you talked to regarding your sexual function then ask for referral to someone else.
[0:17:10.7] Sean Jameson: Awesome great advice. So you mentioned Viagra came out in 1999. It is 20 years later is there a female Viagra solution to fix female sexual arousal disorder?
[0:17:24.9] Dr. Lori Brotto: There is, it is finally here and it’s terrible. So in North America at least well in the United States and in Canada, there is medication called Flibanserin. So it was approved in 2015 in the USA and just last year in Canada and it is a bit of a misnomer to call it female Viagra because it is so different in so many ways. First of all it acts on the brain unlike Viagra, which acts on the genitals. The other thing is it has to be taken every day in order to see some of the benefits of Flibanserin.
So unlike Viagra, which is taken right before planned sexual activity and pretty much clears from the blood stream within a few hours afterwards, Flibanserin because of how it works on the brain to up regulate and down regulate some of the neurotransmitter systems that are involved in desire, it needs to be taken daily. So I was a bit facetious in saying that it is terrible but there is truth to that because the research studies have found that it works only a very, very small sample of women with low desire.
About 30% of them had side effects like fainting or light headedness and the kicker is that it’s completely contraindicated with alcohol. So while women are using it, they cannot be consuming alcohol at all.
[0:18:49.7] Sean Jameson: Okay, so do you think then we’re quite far away from there being a drove that’s as universally as effective as male Viagra, as Cialis or whatever those?
[0:19:02.7] Dr. Lori Brotto: Yeah, so you know I think we might get there one day. There has been – you know Flibanserin was just the first one to cross the finish line but there’s several others still in the race that are hoping to be the second and third to cross the finish line and the other medications have different mechanisms of action. So I think that there will likely be others that are available. You know my own view is that given that the majority of causes of low desire really relate to personal and psychological and socio cultural factors.
I am highly doubtful that any of those medications will be able to fill the gap among all the women who have low desire. So I think they will have a place to play among a very, very small sub sample only.
[0:19:51.4] Sean Jameson: Why do you think it will only cover a small sub sample?
[0:19:55.6] Dr. Lori Brotto: So in the studies that led to Flibanserin’s approval, the women who participated, the 11,000 or so women who participated were they had a long list of exclusion criteria. They had to already be sexually active. They already have to have no difficulties with arousal or orgasm. They couldn’t be using certain medications. They have to have no relationship or conflict issues with their partner and so that just simply doesn’t represent the majority of women that we see in clinical practice.
Who have difficulties with sexual desire, I think among those women who look like the women that participated in the research studies, yeah the Flibanserin might have a place to play there.
[0:20:39.1] Sean Jameson: Okay, well hopefully we’ll see things unfold positively in the next five, 10, 20 years.
[0:20:47.8] Dr. Lori Brotto: Maybe.
[0:20:49.7] Sean Jameson: Women that struggle to reach orgasm during sex is it always connected to a lack of desire or could a woman feel desire and want to have sex every day every night but also struggle with orgasm?
[0:21:06.9] Dr. Lori Brotto: The latter is very true. So there are lots of women who have lots of desire, no difficulties with arousal and then just have difficulty reaching orgasm and of course when we ask questions of women, it is important to tease those apart. So is this someone who has both? You know is it that their difficulties with orgasm is because she doesn’t have desire. Maybe she’s distracted and not present or is it the case that no, no, no she’s really present. She is really in tuned and she just has this very specific difficulty with reaching orgasm.
[0:21:44.1] Sean Jameson: Speaking of being present, you have written a book, Better Sex Through Mindfulness: How Women Can Cultivate Desire. Could you talk about how mindfulness can help women and man be more present and then maybe also help with the problems of low sexual desire or even loss of arousal?
[0:22:03.8] Dr. Lori Brotto: Yeah, I mean mindfulness is nothing new, it has existed in eastern Buddhist practice for close to 4,000 years or so but it is really been the last 40 or so years that’s made its way into western health care mostly through the avenue of addressing chronic pain and increasing the anxiety and depression and just general wellbeing. I became interested in mindfulness when I first learned about it in 2002 when I was working in Seattle at the University of Washington Medical Center.
And I just had a bit of a light bulb moment. I was doing research with women with sexual difficulties after cancer and a lot of those women talked about being disconnected with their bodies. So lack of pleasure, didn’t feel anything, couldn’t even tell if their partners were touching their genitals and everything that I had been learning about mindfulness and also practicing mindfulness myself as I was learning it suggested that, “Hmm I wonder if this could maybe help this women to tune into whatever is there even if it is reduced from what it was before.”
So it really started out as a big experiment and as I was learning the mindfulness, I was teaching the women that I saw in that research setting and then we carried out a first pilot study and low and behold, we found that this women who were convinced that their bodies were no longer capable of producing pleasure or them feeling arousal during sex they suddenly started to feel those sensations again and they also reported an improvement in their desire.
So that was really the first study and then from there, it launched a whole series of much larger studies with different populations of women with sexual concerns.
[0:23:50.7] Sean Jameson: So I mean some skeptical people they might wonder if mindful is the reserve of hippies. It is all woo-woo. From what I am hearing, I am guessing those further large scale studies back up the pair of mindfulness in relation to cultivating desire.
[0:24:10.9] Dr. Lori Brotto: Yeah and you know I think it is a good point that you are making because mindfulness becomes so popular and it feels like everyone is talking about mindful like it is some universal panacea but it doesn’t tail a really specific kind of practice. It is just not paying attention but it is about paying attention non-judgmentally and moment and in our research, we actually looked at whether it was only those women who kind of bought into mindfulness.
Or drank the mindfulness cool aid so to speak where they are the ones that benefited and it turns out they weren’t that regardless of how much they’ve believed it or not, all of the women improved to the same degree. So I think a take home message from that is that this is a practice that could be useful really to anyone regardless of whether you have a history of practicing mindfulness or yoga or regardless of your religious affiliation. It is about practicing a very specific skill for cultivating desire.
[0:25:15.4] Sean Jameson: Awesome, well would you have any stories maybe from your book you can share on how a patient or someone use mindfulness.
[0:25:23.6] Dr. Lori Brotto: Yeah, so many. You know maybe I will present a really typical one because again this certainly represents a lot of women that I see in my practice and it is the story of a woman who prides herself on being able to do it all. You know she’s got a great job that is very rewarding. She is a high level executive, manages a large team, she volunteers in her community, sits on various boards, on different foundations and on her strata where she lives.
Has kids that are in various activities that require parent involvement and participation and it is the story of the person with the chronic to do list, the never ending to-do list and she is in a relationship and loves her partner and used to really love and enjoy sex and overtime what has happened is that sex has been relegated to late in the evenings after the 11 PM news. It’s become something – yet another thing on her to-do list and overtime, she would forego the very things that gave her pleasure.
So things like touching and kissing and maybe receiving oral sex and she would just go through the motions of quickly getting to intercourse because of a belief that’s all that really counts anyways.
[0:26:44.8] Sean Jameson: We can cross it off the list.
[0:26:46.9] Dr. Lori Brotto: Cross it off the list just like doing laundry and buying groceries.
[0:26:50.7] Sean Jameson: So romantic.
[0:26:52.2] Dr. Lori Brotto: The sad part is that there’s so many people’s reality and so for this woman, mindfulness has so many different and unique benefits to her. So one is about can she bring her awareness to what she is doing including to sex. So because she is a chronic multi tasker it means that when she is engaging in sexual activity, she’s not really there. She is elsewhere. She is planning her talk for tomorrow. She’s planning what has to be on the grocery list, etcetera.
And so mindfulness for her is one way of being there and I often say to people, if you are going to have sex, you may as well show up for it, right? Meaning that if you are going to go through the trouble so to speak of engaging in sex at least be there, at least be present and use this opportunity to really connect. So that is one way that mindfulness could be helpful for her. I think another way is just in managing general stress levels.
And as we talked about earlier in our conversations, stress can wreak havoc on sexual response. So mindfulness, which has been found to help regulate the stress response system can start to do that for her in a way that will hopefully reduce the negative effects of stress on her ability to become aroused and on her ability to cultivate desire and then I think a third and really, really important component of why mindfulness is helpful for her is the compassion and training.
So you know are there things on her list that she can start to let go of, she can delegate to someone else and you’ve got to be awfully compassionate with yourself to say, “You know what? I just can’t do that and I am okay with it. I am okay with saying no. I am okay with delegating this to someone else so that I can free up a bit more time and schedule sex during that time. So that’s I think a really common presentation and I describe a case like that in my book.
There is a lot of other different presentations of why and how desire expresses itself but certainly that one is a lot of people can relate to.
[0:29:03.5] Sean Jameson: How can people then if someone is listening and want to get started with mindfulness, would you have any exercises or books, maybe your book they should read for?
[0:29:13.1] Dr. Lori Brotto: Of course, yes. The first step is to get my book, Better Sex Through Mindfulness but to be honest, I mean that is why I wrote it. You know I am an academic researcher and we have been documenting the effects of mindfulness treatment in research studies for quite a long time but the problem is that research studies stay buried in medical studies and most of the public don’t read them. So I decided to write the book so that it was all located in one place.
But you know in general what I would recommend is it is a good thing for your brain. It is a good thing for your health to adopt a regular mindfulness practice and so whether it is 10 or 15 minutes a day every single day or slightly longer practices a couple of times a week but starting to engage that muscle of the mind so that you can start to be much more aware of just how quickly the mind takes off and gets distracted unknowingly.
So having a solid foundation of general mindfulness practice is really, really helpful and then from there, you can gradually start to bring those skills into sexual encounters with either alone, right? So you could imagine an exercise where a person is touching themselves all over. They could do that mindfully, right? They could tune into what do the sensations feel like, where in my body do I feel these and then progressively from there, integrate those skills while having sex with a partner.
[0:30:41.0] Sean Jameson: Lori, this has been fantastic. I have learned a lot personally, I think a lot of our listeners are going to take a lot away from. So if people want to find out more about you, if they want to find out more about better sex through mindfulness or they could get in touch with you, what is the best way for them to do that?
[0:30:58.4] Dr. Lori Brotto: So I am pretty available and responsive on Twitter. So my handle is Dr. Lori Brotto, the doctor is just Dr. that is probably the fastest way to reach me. We also have a research website. So the URL is brottolab.com and there, we have links to all of our publications. We’ve got about a 150 publications. We also have links to all of our ongoing studies and there we also link to any recent media that I or some of our lab members have engaged with.
The book, Better Sex through Mindfulness is available through Amazon. It is also available through Chapters, chapters.ca or chapters.com and very, very recently there has been an audio version that was released just within the last month. So there is a soft cover copy as well as an audio version available.
[0:31:51.2] Sean Jameson: Awesome, I will include all of those in the show notes. Lori, thanks so much for coming on The Bad Girls Bible Podcast.
[0:31:57.2] Dr. Lori Brotto: Thank you so much for having me Sean. It was great to have this conversation with you.