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What happens when you get a herpes diagnosis? And more importantly, what happens if you begin hiding that you have herpes?
Dr. Sheila Loanzon, an OBGYN who gives amazing PAP smears, is here to talk about her very personal story and new book, “Yes, I Have Herpes.”
From advice on how to deal to details about what herpes really is, Dr. Sheila has practical advice as well as powerful personal stories about why she didn’t tell her partners about her herpes for many years and what it was like to go back and tell them the truth.
We also talk about why it’s so important to work on ourselves if we want healthy relationships, how to set yourself up for a successful PAP smear, tips for trauma survivors and trans folks to find a good doctor, why ALL vulvas are beautiful, and the strangest question Dr. Sheila has ever had from a patient.
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In this episode, Dr. Sheila and I talk about:
- Why Dr. Sheila wanted to write about her journey in coming out about having herpes. Putting a face to a virus that so many people have but simultaneously vilify is critical to reducing stigma.
- Herpes being basically a skin condition. We don’t shame folks for colds or flus, and we know how to navigate acne and eczema, so why is herpes treated so differently? Only because of sex.
- Her shift from hiding her herpes and feeling unlovable, which led to relationships with cheating and lying and stealing, to working on herself, finding self-acceptance, opening up about her herpes, and how that totally shifted her experience with love.
- Scarcity in dating and love versus abundance in dating and love, and how knowing your value can totally shift the kinds of people who show up for you.
- The actual screenshots of conversations Dr. Sheila had with past lovers when she finally disclosed her herpes status. It’s an amazing part of her book that I so appreciated.
- How you’re still lovable and deserving even if you make terrible mistakes. The key is to own those mistakes, to do your best to move forward, and learn from it. Powerful lessons from Dr. Sheila’s mistakes for all of us to learn from.
- The pain of lying and hiding aspects of ourselves, even if they’re parts of ourselves we’re scared of or ashamed of. Self-forgiveness is so important.
- Why Dr. Sheila’s sex life improved after she started disclosing her herpes status with partners.
- What to do if you receive a positive diagnosis for an STI, like herpes.
- Vulva diversity and what an OBGYN has to say about the variety of ways vulvas and labia actually look.
- What makes Dr. Sheila’s PAP smears so great and tips for making your next PAP smear a little better.
- How to empower yourself around medical care, PAP smears, and having agency as a trauma survivor or trans/NB person.
Resources from this episode
Interested in Dr. Sheila’s book? Check it out here: “Yes, I Have Herpes”
About Dr. Sheila Loanzon
Dr. Sheila Loanzon, also known as the “Compassionate Gynecologist,” is a board certified obstetrician and gynecologist with over 15 years of patient and personal experience with the diagnosis of herpes. Dr. Loanzon offers women specific tools to shift their perspective, gain insight, and move forward confidently and in self-love. Dr. Loanzon received her BA in biochemistry at Vassar College and completed medical school at the College of Osteopathic Medicine of the Pacific. She currently works at a large multispeciality practice in California. You can find her on Twitter @DrSheilaGyn.
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Episode Transcript
Dawn Serra: You’re listening to (You’re listening) (You’re listening) You’re listening to Sex Gets Real (Sex Get Real) (Sex Gets Real) Sex Gets Real with Dawn Serra (with Dawn Serra). Thanks, bye!
Hello, lovely listeners. I am recording this little hello from Washington. I’m in Seattle for the Seattle Erotic Film Festival, which means for three days, I am watching porn in a theater with a whole bunch of other people. Its variety of erotic film, some of it includes sex, some of it is just erotic. To be honest, the first one that I saw was pretty disappointing to sit through an entire film of stereotypical male gaze of young white, also only wearing white, virginal, thin, women just frolicking through fields is an old trope. But there is so much for me to see and learn. Hopefully, I’ll connect with some local film makers, since you all know I went through erotic film school and I’m interested in moving into that space at some point.
Dawn Serra: This week, I have Dr. Sheila Loanzon, who is an OBGYN and she recently put out a book called, Yes, I have Herpes. She has a very personal story of acquiring her herpes in college, and then hiding that fact from partners for over 10 years before she started doing some work with a coach, and decided it was time to be honest with herself and with others. There’s wonderful conversations in the book that she has with past partners where she finally discloses her status. She has all kinds of medical information about the herpes virus and what it actually is, how we can be more compassionate to ourselves around things like STIs. We also have some fun talking about the ways that vulva and labia look and smell, since I tend to get emails from people who are worried about the way that they look pretty frequently. Then we also talk about what makes for a great pap smear, and what trauma survivors and trans folks can do to help find better care.
So let me tell you a little bit about Dr. Sheila and then we will jump in. Of course, next week, I will give you a full rundown of all of the films that I saw at this weekend’s Erotic Film Festival. So Dr. Sheila Loanzon, also known as the compassionate gynecologist is a Board Certified obstetrician and gynecologist with over 15 years of patient and personal experience with the diagnosis of herpes. Dr. Loanzon offers women’s specific tools to shift their perspective, gain insight, and move forward confidently and in self-love. Dr. Loanzon received her BA in biochemistry at Vassar College, and completed medical school at the College of Osteopathic Medicine of the Pacific. She currently works at a large multi-specialty practice in California. Also, don’t forget, if you love the show, and you want to support it, you can go to patreon.com/sgrpodcast – $1 a month, $2 a month $5 a month. Every single dollar helps me to keep doing this show. So thank you so much for listening and here is my chat with Dr. Loanzon all about herpes.
Dawn Serra: Welcome to Sex Gets Real, Dr. Sheila. I love that we’re going to be talking about herpes today.
Dr. Sheila Loanzon: Thank you so much for having me.
Dawn Serra: You’re so welcome. So we were talking a little bit before we got on air and I mentioned that last year I had someone on the show talking about sexual health research, and herpes, and the stigma that’s kind of associated with it. So I love that we’re talking about this today, because I think the more that we talk about it, the less stigma we have and the more permission slips we write for folks out there. So I want everyone to know first that you wrote a book called Yes, I have Herpes.
I’d love to know for you, what’s that been like to have this big coming out process that’s beyond conversations with partners, but announcing to the world like, “Hey, here I am.”?
Dr. Sheila Loanzon: Yeah, it’s been definitely a wonderful journey. So the book came out about a year ago, and I think it’s been phenomenal and the reason why I ended up coming out with the book is because I wanted to put a face to the virus; that number one, that my friends knew, that my patients knew, and give that support to people who may not normally see it from their physician, from their friends, from their community. It’s been great. I think that my medical colleagues have thought it was a wonderful support to give to people out there because we see how the virus can change people. I think it’s helpful for patients to see that there is somebody out there advocating for them, and really trying to educate the community, to hopefully change that stigma – that was my biggest thing. Then also educating the community that it’s not a typical stereotype. There is a face behind this virus and it really isn’t something that should be stigmatized or that we should be ashamed of.
So I just really wanted to normalize the conversation and throughout all of my interviews and my micro-blogs on Facebook. I’m really trying to educate everybody and give that emotional support that patients don’t always get even from their physicians in the office, just because it’s such a limited amount of time.
Dawn Serra: Yeah, I’m so glad you mentioned that because I know that because of how the medical system is set up in the West, specifically, I can’t speak to a lot of other places. But, doctors often have very little time with patients. I also just finished doing a six-month training with medical students to help them get six months of sexual health and sex education. I know that’s a little unusual. So a lot of physicians also don’t typically get lots of sex education around how do we talk about kink? How do we talk about multiple sexual partners without shaming folks? I think a lot of people get a diagnosis like this and then end up feeling very alone or the delivery was really cold, and now they’re swimming without direction.
Dr. Sheila Loanzon: Yeah, I recently, this month, had a patient who came – who was recently diagnosed by one of my colleagues, and had found out where I worked and said, “Is it okay if I come to you?” And I spoke to her for like an hour. I mean, I could talk about this for hours and hours. So it was important to give the information and the emotional support because there’s a lot of confusion out there. A lot of times, physicians don’t have time in a 15-20 minute appointment where we’re trying to do various other things like pap smears and education and vaccinations. It’s really hard to add that on top of everything else.
Dawn Serra: Yeah. So one of the things that you’ve said, which I really love, and I want to reiterate this, is herpes is a virus and we don’t shame people for colds and flus, and a bajillion other viruses. You’ve said that herpes is basically a skin condition. So when we think about it that way, there’s so many different skin conditions all of us either have or will have eczema and rashes and who knows what.
Dr. Sheila Loanzon: Zits.
Dawn Serra: Zits! Exactly. So it’s literally not the lesions and the management of having herpes that people are scared of. It’s the social stigma that we recently saw with the big Usher mess that’s going on. Unfortunately, that stigma drives people to then hide or lie or just not get tested because then they can claim ignorance of not knowing, which I think for a lot of people seems easier because it’s a lot less vulnerable.
Dr. Sheila Loanzon: Yeah, we’re certainly in a community where the conversation has gone by the wayside. We text so readily and email. The art of communicating a thought, I think, from one person to another has changed. So out on top of that, this social pressure that we get and situations like the Usher news outbreak, which really – I was excited. I was like, “Yes, a celebrity.” Then by paying off those women without really knowing the full medical history, and as a physician, I want to know the full medical history and the course of this history – this presentation that she had. We really can’t say exactly what judgments we can pass on someone. So I almost feel worse. I was like, “Come on, Usher. Come on, out. Let’s do this. Let’s work together.” But not everybody is in that space, and we have to respect that.
Dawn Serra: So one of the things that I get very regularly on the show is people who, for a variety of reasons, are avoiding a tough conversation. Whether it’s divorce, or “I think I might be kinky”, or “I think I might be gay” or whatever it is. It’s this fear that comes with being left and being rejected and being humiliated. I know that there are people listening who know that they have some type of STI and have not communicated that with partners, because of the shame. I know a big part of your story was that you didn’t disclose to partners for 10 years after you found out.
Dr. Sheila Loanzon: Yeah. I think it ultimately with any situation, it comes down to self-love and self-confidence. For myself, I think the reason why I had a very tough time disclosing is because I really wanted to have that love from a partner. I thought that if I could manipulate a situation and look a specific way, and act a specific way, and be “clean” as I can be, that I would be so lovable and worth it. It was actually really focusing inward and building that self-confidence on my own, was I able to say, “You know what, this is part of who I am. I accept this, I love this.” Then I can go forward and get essentially what I wanted. That was what was so ironic is because I was in these situations where I was with partners who were cheating on me, lying, taking my money, and I was willingly giving it in hope for the exchange of love. There’s some common thread, and in the end, it’s me. So there’s got to be something that I’m putting out subconsciously and consciously.
When I started working with my executive coach, it was like, “Do you think it’s the fact that I’ve never told anyone I have herpes?” He’s like, “Oh my gosh, this is so huge!” Because if you’re looking in a mirror every day and you’re thinking, “I’m not worthy.” “I can’t be loved.” “I deserve to feel dirty.” “I should feel alone.” Of course, it’s going to end up attracting that same thought. So it was once I started to identify that, and my book covers how I went through that process, could I actually realize, “You know what, I can stand on my own. If I disclose and someone doesn’t like me, then that’s okay. Go ahead and move on. You weren’t the right partner for me. On to the next.” I found that it actually attracted better people to me. I got better partners. Then I finally got the chance to choose. It wasn’t like, “Oh my gosh, here’s someone here. Let me attach right on because of scarcity. This may never happen again.” It was actually like, Do I even like this person? Do I see a future with this person?” So everything shifted and that’s what I would encourage listeners out there and the people that, hopefully lives that I touch, can see.
Dawn Serra: I love so much what you said about being able to actually choose rather than feeling like “I’d better grasp this because it might be my only chance,” and then settling for terrible things and feeling worse, and not knowing why everything feels like it’s falling apart. I’ve told listeners this so many times, but I’m in a fat body and for me I found the exact same thing of, when I disclose up front – I’m in a fat body which by society is seen certainly a very specific way, that people were able to self select out of even giving me their time and energy. So that the people who remained were people who I could really truly have great conversations with and not be carrying this shame of, “How long can I hide this?” So I love that you – you even wrote in the book that having herpes was a natural filter for partners. I adore that you were able to get to a place where you saw like, “This gives me a chance to be living in my truth constantly,” to not have to apologize for who I am. So now I actually can be very abundant in, “I get to choose who deserves me.”
Dr. Sheila Loanzon: That was the difficulty that I was having. Because here I am Dr. Loanzon, the professional, educating these patients on how to practice safe sex. Then here I am, the patient, not doing that. There was this huge disconnect of my professional life and my personal life. It’s exhausting. It’s exhausting to have to try to make all those things match. So I realized that if I could just marry these two things together, I could live so much more in my truth. In the end, I was looking for a partner that was open and educated, and wanting to get to know me, and that was what was coming through down the line. Because I had invested in myself. I mean, it definitely took some work. But I mean, it’s so worth it to make yourself a priority.
Dawn Serra: I love that so much. I think that’s so important, especially for people who are parents or for folks who are super busy and always caring for other people of, we have to find ways even in the smallest ways to care for ourselves. I think so many of us are so stuck in, “If I just keep doing and performing, and trying to be enough and be perfect,” that we forget how to even trust ourselves or listen to ourselves. I think what’s so interesting about your story was that by working with your coach, it gave you an opportunity to actually do these really beautiful self-care practices and to actually realize, “I have a lot to offer and I deserve this.” And to start prioritizing time for yourself every day. I mean, that’s something all of us need to be doing, especially people that tend to give too much of themselves.
Dr. Sheila Loanzon: I think, my practice is an OBGYN practice, so often I see women in their 40s and 50s, who are really displaying all of that hard work. So they’re coming in anxious, insomnia, depressed, trying to figure out what. I’m like, “If we could just dial it back to that time, where you were vulnerable and just own some of the things that perhaps we swept under the rug. I think maybe you’d have a larger emotional release and things would end up falling into place.”
Dawn Serra: Yeah. So you did this beautiful thing in your book where you actually included the conversations that you had when you disclosed to your previous partners that you hadn’t disclosed to at the time. I felt so distressed for you when I was reading those. You actually, for the most part, had some really lovely responses and conversations with people. But I’m wondering, what was it for you to actually write those messages and say those things, and then to wait for the blow almost like, “Oh god, what are they going to say back?”
Dr. Sheila Loanzon: Yeah, it was nerve racking. It was nerve racking, but in those experiences I had felt before I had disclosed, I had always felt like the waves kept crashing over me. I kept feeling knocked down and knocked down and, “When is the rug going to be pulled out?” I felt very unstable. When I decided to disclose to these partners, I had to really think, “Okay, remember who you are. Remember the work that you’ve put in, remember the person that you know you want to be. Then whatever falls, falls.”
Because in the end, I had to have ownership of it. I had to realize I put myself in this situation, I put these people in this situation, I have to deal with the repercussions. So I wanted to include those stories because you could also see the transition of the partners through the history, and know that everybody have their own experience and they’re completely entitled to it. I can’t fault them because it’s their experience and I wanted to be very honest. The book was coming out and I wanted to share what space I was in – some were great and some were not. People are in different spaces and I have to respect that.
Dawn Serra: I think that’s something that’s so important for all of us to remember whenever we’re doing any kind of act that’s really vulnerable, where we could potentially get really hurt or rejected of – if we’re sharing something really big, especially if it impacts somebody else’s health potentially or their life – they’re allowed to feel angry and betrayed and to have big emotional responses. We can hope that it’s a nice, easy thing, but I love how you left a space of like, “All I can do is the best I can do. Then if they need to be angry at me and say things, they’re allowed to do that.” I think that’s such an emotionally mature way to handle that that shows a lot of the work you’ve done.
Dr. Sheila Loanzon: I think that I really wanted to respond to their concerns and not react, because the emotional reaction is usually where a lot of us come from – that palpitations, sweating, shaking, perspective. I really wanted to come from a space of responding if they had questions that they had concerns, if they were wondering what their health was going to be like. So it was emotionally trying. But in the end, everybody was really wonderful. They’re all great people and some of the relationships without some of them didn’t, and that’s okay.
Dawn Serra: Yeah. It’s not safe for everyone to disclose certain things. It’s not safe for everyone to come out. It’s not always safe for someone to disclose something if they’re in a potentially violent situation. But barring those situations, I think what’s so beautiful, and I’ve experienced this too in my life, of one we’re constantly trying to pretend or hide, it takes up so much energy and it takes up so much of our resources that we’re not really showing up for ourselves or anyone else in how you can feel in your story – like when you surrender to like, “Okay, this is who I am and I get to live in this truth, and whether people like it or not, I can’t control that. But this was me.” It felt like all of this space came into your story.
Dr. Sheila Loanzon: It was very cathartic. It’s interesting – before I’ve actually written the book – First of all, to build the confidence to write that book, I remember when my executive coach had said, “I think you should write a book.” I said, “You are crazy town. No one is going to pay attention to this. I am going to be out there standing on a ledge and no one will understand.” My perspective ended up changing because I realized that if I could use this book to even help just one person out there, then I did my job. I do my best in my daily practice to help patients and give reassurance, and open up perspective because that’s a lot of what medicine is. If I could extend that even further to a larger community, that’s really what I wanted to do. And the responses have been really wonderful.
Dawn Serra: Yeah, I love the vulnerability of you. Because I think too often, the stories that we hear are, “Here’s all the things you should do and if you don’t do those things, you’re a bad person.” Or “Here’s all the things that you can do and I’ve done them perfectly.” I love that you just made it very clear like, “I had to go on my own journey and I made some mistakes. It was kind of ugly for a while. But here’s where I’ve come to.” So this story of you can mess up and still be worthy, and lovable and powerful, and have wonderful relationships. Even if you’ve made mistakes.
Dr. Sheila Loanzon: People can change. I think that’s the thing. I mean, if I was judged on the person that I was when I was 20 years old, oh my goodness, could you imagine if we were judged on the way that we were when we were in college? We can make mistakes and people can change, and there has to be some type of forgiveness in there. Forgiveness for ourselves first. I had to really address that portion of myself that realized that I was making mistakes and that I knew better. But I also was in a coping mechanism at the time, and that’s how I was trying to survive. But at the same time, too, it wasn’t jiving with the person that I was. It’s hard because if you’re open about everything, except for just one thing, it’s so incongruent that it’s like you’re stuck in a wall in a corner, and I didn’t want to feel that way anymore. So even when I wrote this book, there were portions of it where I was sobbing – writing these chapters, but it was so helpful. I encourage people out there to write, even if it’s just for yourself – even if you write it and burn it. I mean, I think getting those emotions out, even when people email me – one email all of a sudden, I can see them release all this emotion and that is really important for people not to keep bottled up.
Dawn Serra: Yeah, I agree. So let’s talk about the mechanics a little bit for people who kind of know what herpes is, but don’t really know a lot of the specifics. So herpes is super common. I know that you’ve written that it’s estimated that 80% of the U.S. population has either herpes simplex one, or two, and isn’t unaware. So let’s talk about the ways that you can transmit or acquire herpes and start there.
Dr. Sheila Loanzon: Yeah, so the difficulty, I think, with estimating how many people have herpes is because it’s not a reportable disease. It’s different than HIV or syphilis or even gonorrhea and chlamydia. So the CDC’s current recommendation is not to be screening in a routine screening test. So when people come in and say, “Oh, hey. I’d like STD screening.” They’re not checking for herpes unless you specifically asked for it. Even then when you specifically asked for it, some providers may not do it because the CDC recommendation is to not. The thought process way back when was that herpes type one was the oral cold sores on the mouth. People usually get it when they’re skiing out in the sun, changes in diet, stress, things like that. Then type two – herpes type two was considered genital. But now with the advent of oral sex and anal sex, and different holes going everywhere, it’s gotten a little bit blurry about which goes where. So certainly someone can test positive for herpes type one from oral sex on the genital area.
The difficulty, too, is that the transmission can be very difficult to detect because someone can transmit herpes to the genitalia, even if they have a history of cold sores and don’t have an outbreak. That’s actually the majority that I’m seeing, currently, of infections that are happening. First, usually it’s people who are exploring their sexuality. So it’s around the early 20s, late teens is when I’m seeing it. The culture comes back positive for type one, and then they say, “Oh, I had oral sex at one point or another.” So it’s getting very blurry. People out there say, “If you’re sexually active, it’s likely that you possibly have it, and just don’t know it.” So it’s hard to shame people because you don’t know what their current status is.
Dawn Serra: Yeah. It’s transmitted via mucous membranes and then open sores, cuts, those kinds of things. Right?
Dr. Sheila Loanzon: Right. Exactly. So you think mucous membranes – mucous membranes are essentially the skin that’s like in your mouth. So your eyes, your mouth, your genitalia has that sensitive skin that can lubricate – that’s the skin. Even if you are sexually active using condoms, it really doesn’t end up protecting all the skin that’s down there. So it’s not uncommon for people to end up even with rectal outbreaks.
Dawn Serra: Also, quickly so people are aware, we talked about this a little bit on the last one, but just to touch on it that even if you don’t have visible lesions, because of the shedding that can happen, you can transmit it even between outbreaks.
Dr. Sheila Loanzon: Correct. Yeah. So first off, the transmission from unprotected intercourse is actually fairly low. So it’s not 100% if you’re sexually active with someone who has herpes, you will absolutely hundred percent get it. So I think that that’s an important thing to know. The most important thing is to avoid sex when you’re when you have an active outbreak, using antiviral medications, and then using condoms, having an open conversation about your sexual history is important too.
Dawn Serra: Fans of the show know that one of my very favorite sex tools is gloves. So let’s also use gloves when we’re having different various types of sex, if we want to help protect ourselves, especially if we have cuts in our hands, or we’ve touched ourselves – those kind of things. There’s lots of different ways to have super fun sex that don’t have to involve genitals. One of the things that I just love, too, about your story is knowing the information isn’t about scaring you out of having a wonderful, delicious sex life. It’s about being informed so that everyone can choose for themselves what they want to engage in, and then you can have super hot sex from there.
Dr. Sheila Loanzon: Absolutely. In fact, I think it actually increases intimacy. Because to show a vulnerable part of yourself to your partner, and to have them respect that and reciprocate it, I think elevates everything. I actually found that my sex life improved by being honest. I mean, I will be very blatant – I did not enjoy oral sex and I’ve triggered it back and thought, “Well, maybe it was because I acquired this virus from oral sex,” and until I actually disclosed it. Good times, good times.
Dawn Serra: Yup. There you go. So if someone does get a positive diagnosis, what do you think is one of the first things that they should do? Especially if it wasn’t with a doctor that was particularly prepared to hold that emotional space and be there with you?
Dr. Sheila Loanzon: Yeah, that’s very, very common. First thing I always say with anything that you’re just shocked and floored with is take a deep breath. I encourage people not to drive at that time. Don’t go binge drinking. Don’t go binge shopping. Just take a moment and process what’s going on. Because I do think that there’s a grieving process that has to happen and an education process that has to happen.
So when patients, of course, we have the internet now, I’m always very cautious of the websites that people refer back to, because there can be a lot of mom and pop websites out there with inaccurate or different information. So it’s important to research that. If they would like, they can always schedule another appointment to talk to their physician. I think that that is always an open door. If they don’t feel comfortable with that one, perhaps they could seek out somebody else that they would feel comfortable. But I do find that when there is someone who has spent their whole life focused on medical training, and then the herpes positive person goes to them, there’s just a little bit of reassurance that seems to be transmitted.
Dawn Serra: Yeah. Just a reminder, too, that so much of why we have these big fear and anger feelings come up is because of the social stigma attached to it. It’s kind of – we assume that it means we’re going to be ostracized, never have sex again, nobody’s going to want to touch us, we’re going to be unlovable. So I think it’s so important to let ourselves feel angry and sad. Then to also seek out folks who are doing really rad work in herpes like yourself or Ella Dawson and her amazing TED Talk, or you mentioned an organization called Herpes Opportunity.
Dr. Sheila Loanzon: Yeah, there’s actually quite several places and there’s even a few underground Facebook groups that do exist. There’s some people when they get to that point of dating,there’s a lot of dating websites that are out there for patients who are STD positive, sex positive places. So I think that there’s a lot of options than we probably had 20-30 years ago. So it’s just seeking them out. Even just confiding in one other person, I think, is so huge whether it’s a therapist, a best friend, a partner, a mom. It’s not uncommon for people to contact me or even the moms to contact me asking for how to support someone. Just by unleashing the top of the kettle, all that hot air goes out. I think that there is some reassurance in there.
But I will say, there’s some people out there, granted, it took me 10-15 years to get where I am. So I still had to go through that grieving process, 13 years later. So that process has to happen. I would love for people to respect that natural thing, because eventually it ends up being time.
Dawn Serra: Yeah. So something else that was interesting that I actually didn’t know as I was reading your book, and so I love learning all the things and reading all the facts to my husband. It was you were talking about how over the course of time, outbreaks tend to decrease over the years and decades. I think also, that finding this support has been such an important part of how a lot of the people you’ve worked with have gotten through this. So I’d love it if you could talk a little bit about over the course of time, I think a lot of people are scared of the knowledge in those conversations. What does it look like 10, 15, 20 years after you’ve gotten the diagnosis?
Dr. Sheila Loanzon: So I will say that the diagnosis and the outbreaks do not look like the internet pictures. Those are sensationalized dramatic, rare occurrences. Most of the times when patients come in, it’s maybe one or two little spots. Sometimes I see a little bit more after that, and that’s perhaps someone who thought that they had a urinary tract infection or yeast. infection that wouldn’t go away, or something like that. So, if you catch it early enough, it actually doesn’t do this big explosion that’s on the internet. I mean, those are just dramatic. I wish we could anatomically put pictures that are more appropriate. But usually, the first year of an outbreak is the worst because the body is trying to figure out and build its immune system to the virus. So it’s not uncommon for people to have 6, 8, 10 outbreaks the first year. Generally after that, I have found that it decreases for people as life goes on. I will say, I very rarely, at this point ever get an outbreak. I’ve taken better care of myself, which I always think is very important for mind, body spirit. So it could be that in which case, I’m managing my stress level, which can be a trigger.
Sometimes people can figure out what their triggers are. Some people find that it’s with waxing, some people find it’s with a new sexual partner. So figuring it out and perhaps avoiding it can be helpful. Some people that I’ve spoken with, if they feel like they’re starting to get an outbreak and whether for them that means an itching or a tingling, or even a cut, or some people even were first diagnosed with genital outbreaks, but now have more rectal outbreaks. They’ll just take the antiviral medication and it decreases the length of time, the pain, the outbreak, in general. So it’s a wonderful medication. People have not become resilient to it like things like penicillin or other antibiotics out there. So it’s benign, I think it’s helpful and in the end, it’s just learning how to understand the triggers of your body, and try to avoid them and maximize your health the best that you can.
Dawn Serra: So the one thing I want to say to everybody listening who either has herpes or has genital warts or has HIV or… For many of us will have, at some point in our lives, that you are beautiful and lovable and there is nothing wrong with you, whether you have a virus or not. I’d love to know for you, what’s the one thing that you still want people to understand about living with some type of STI?
Dr. Sheila Loanzon: I think in the end, we all have things in our lives that we have to overcome. The mind is by far the most powerful organ in our whole body. And with all those little synapses and neurotransmitters that transfer back and forth, I really think that there’s an emotional investment that we should have to move forward from anything. My story and my platform started with herpes, but I think that it transfers into issues of childhood abuse, trauma, infertility, pelvic pain. It’s such a wide variety and we all, even from the outside, the most perfect person you could ever think of is battling something on the inside. Because we have layers of pressures and stories layered upon us, and I’m really just trying to get down to my naked self and really be exactly who I am. I think we can all get there if we put in the work and develop the self-love that we all deserve.
Dawn Serra: So I’d love to shift gears a little bit. I get emails somewhat periodically from folks who are experiencing a great deal of shame over how their vulvas look, usually because their vulvas doesn’t look like the vulvas that they’re seeing in porn, which is pretty much the only place that we ever see vulvas in this world. I know you, because of what you do, have seen thousands and thousands and thousands of vulvas in all states and all ages. I would love it if you could talk a little bit about the variety of vulvas out there and what you’ve experienced, and what you would like to say to someone who feels maybe they’re different.
Dr. Sheila Loanzon: For the same reason that we all have different hair, hair types, hair oiliness, noses, and everything. The vulva is exactly the same. I think it is actually very unique and beautiful, that we’re all different. I mean, if we all look the same, how boring would that be? There’s a wonderful book that one of my colleagues has. It actually, I think, has 200 vulvas in there. Because a lot of times patients will come and say, “I want to look like this. You need to trim this, trim that. Make it go together. Forget the five babies I just had and make it look like I was when I was 16 years old.” The reality of it is that you had five children, beautiful children, that you delivered vaginally and that is absolutely something to be proud of. Our anatomy is created for a reason – it really protects the sensitive skin on the inside.
A lot of patients come to me and say, “I’d like surgery,” but at the same time, too, that is generally at the expense of changing into symmetry, into pelvic pain, into vaginal strictures. It’s not always worth it. It always comes back down to that self-love, self-confidence thing. But I will say that everybody is different, everybody is unique. Some patients like to say, “Oh, my goodness, I’m so embarrassed. The last time you saw me this, that, and the other.” I was like, “I barely remember the vulva I just checked right before you.” So nobody remembers, nobody remembers. If it’s something that’s coming from a partner, I think it’s important to say that number one, are they the judge? Are they the expert? Number two, does it function for you? If it’s functioning, fantastic. Number three, if they’re looking at it, hopefully that means that you’re getting sex, in which case – Great job. Keep going. Don’t worry about it.
Dawn Serra: Yeah, yeah. I love the question like, “Should they be the judge?” Because I think you’re so right. If you’re not experiencing pain or some type of medical issue, and if you can experience pleasure with the genitals that you have, unless you want to change your genitals because of a gender identity type of thing. I used to have a co-host and she always talked about how her wife at the time had great big meat curtain labias, and she loved that. Because she had so much more to put in her mouth. So I think it just comes with that – if someone is commenting on your genitals, no matter what genitals you have, I think the response needs to be like, “They give me pleasure and this is mine, and you don’t get to comment on them.”
Dr. Sheila Loanzon: Right. Or if you have an issue with it, good. Go ahead and move along. Because in the end, you want someone who accepts you for everything that you are – everything that you are. It’s for the same reason that a lot of patients come to me wanting to be evaluated for vaginal discharge, because their partner says that they have an odor. I will tell you that area has a scent in general and that is sexy. That is something to be applauded for and not be evaluated.
Dawn Serra: Yeah, that’s something else that I personally find a little bit bothersome is this trend that I’ve seen off and on over the years of wanting to make your vulva smell like lavender or like roses. Because the unspoken rule is that pussies smell bad. So we don’t want that smell. We want to introduce a different smell. I think that really comes down to fear of women’s pleasure and fear of the unknown. So I love that you brought that up because like They should smell like vulva. I mean, it’s a vulva so it should smell like a vulva.
Dr. Sheila Loanzon: Exactly. I have patients who apologize, “Oh my gosh, I’m so sorry. I didn’t shower before I came in,” or “Oh my goodness, I didn’t wax or shave.” I’m like, “You are in your natural state. That is fine.” If there’s something wrong, if there is an infection, it will come through; regardless of if it is prim and proper, and ready for presentation.
Dawn Serra: Rolling out the red carpet.
Dr. Sheila Loanzon: Yes, we don’t even notice. As an OBGYN, we don’t even breathe through our noses anymore. It’s fine.
Dawn Serra: Trick of the trade. So one of the things that delighted me when I was researching you was, you were very proudly sharing that recently, you’ve had so many people tell you that they rave about your pap smears. I think that’s fantastic, because that’s usually a great point of concern for folks who have a vulva. So I would love it if you could talk through a little bit why you think you’re so great at them.
Dr. Sheila Loanzon: Yeah. One of the reasons why I went into OBGYN in the first place is, and I think most OBGYN, is because you have to make people feel comfortable, right from the get go. You maybe only have 5-10 minutes to talk to someone for you’re like, “All right, let’s go. Let’s do this.” Most people need four dates and a lot of talking. So I only have 15 minutes. So I think building that comfort level is really important. I’ve discovered that when I also take the tone of the patient and talk a little bit slower and a little bit calmer, all of the anxiety that I see in them j relaxes a little bit. A lot of it is really getting to know, “Well tell me about your family history,” or “Tell me about your social history.” It just mellows down a little bit.
One of the important things I think, too, when doing an exam is I know people think it’s very funny when OBGYNs are like, “Okay, keep scooting down, keep scooting down.” I promise you, you don’t fall off the bed, it just doesn’t happen. People don’t fall off the other end. So I find that when you can literally bring your butt cheeks, probably about halfway down until they’re falling off, it actually tilts the cervix and makes it a little bit more comfortable for me to see it. Then one of the other things that I do, too, is that I just tell the patients where I am.
Dr. Sheila Loanzon: So they usually actually send people to me who have either never been sexually active or have been abused in the past, whether it’s my technique, whether it’s my demeanor, I’m not sure. But just letting them know, “Okay, I’m here by your knee and I’m tracking all the way down. Okay, I’m right here. I’m right here. I’m right here.” I generally use the smallest speculum that I have. But I find my trick is yoga breathing. That’s actually something that I try to impart on my medical students because nobody wants something jammed in without knowing. I think it’s important, especially in a clinical situation, that’s medical and intimate. So really, I usually do it in a few breaths and if I can feel the patient tensing up, I wait. In their own space, they end up relaxing. Because with yoga breathing, breathing in and breathing out, the pelvic floor actually relaxes and allows that speculum to go in. I’m just following the patient’s lead. I find that when I end up doing that, and then I just do – pap – HPV. It’s done. It’s done. I mean, everybody survives a pap smear. Everybody survives a pap smear, everybody leaves smiling. So knowing that you have that end point, you can get there.
Dawn Serra: Yeah. I have a lot of listeners, myself included, who are rape and assault survivors, people who have PTSD and trauma. I also have a lot of listeners who are trans and non-binary, and they have very different feelings and expectations and needs. So I’m wondering if you can give some advice to folks who either have trauma or who are in some type of marginalized body for finding doctors who could be a good fit for them, and also ways they can advocate for themselves to ensure they have the least traumatic and stressful experience possible.
Dr. Sheila Loanzon: Absolutely. I will say that every physician is different. Some of us have great days, some of us have really bad days, so even someone who is very open and communicative on some day, may not. It’s unfortunate because I know this is a very delicate meeting for this patient. So what I actually encourage is, you can either do the research ahead of time, find out who’s in your network who carries your insurance or whatever, and you can try yelping, you can talk to other people. Essentially, you’re looking for someone that’s open, honest, educated. If you end up finding those characteristics, you can always go and interview them. There’s no harm in going and talking to someone. You can feel their demeanor when they walk into a room or when they sit and talk to you. So, there’s a lot of different providers. It can be a nurse practitioner, it could be a physician, whether it’s an M.D. or a D.O. like my degree. So, there are going to be people who are a wide variety.
Essentially, you’re just looking for someone who’s open and willing to listen. Then you can kind of see where you go, I really do believe in following the gut instinct. If this physician enters into a room and you feel already guarded, just normal guarded of a new person, but are feeling some type of tension or emotional reaction may not be the best. Because you’re looking for an environment that’s warm, so that you can confide, because in the end, your physician has the knowledge that can hopefully help you with whatever is happening medically. So it might take a little bit of searching, and that’s okay. But hopefully when you find that right person and that home, then then things will just fall into place moving forward.
Dr. Sheila Loanzon: I will say that my company specifically, which I’m very proud to work for, has really stepped forward in terms of working on transgender, non-binary – the community. We’ve integrated that community into our healthcare with specific support systems and education for the physicians. I actually just finished diversity training for the physicians and the staff. Because this is a huge new community that’s coming up. I think support is of the utmost importance, and we really put a stress on the providers to build that knowledge because we know that it’s coming.
Dawn Serra: First of all, thank you for all of that, that’s so helpful. I think it’s something that doesn’t get talked about a lot. I also want to reiterate what you said about trusting your gut of, you don’t have to follow through on anything, unless you’re in an emergency situation and you have to get the care for some type of really, really urgent reason. Your choices may be more limited, but for routine care and for small things – I think it’s so important to remember that if you get a feeling of, “Oh, I’m feeling really uncomfortable or something about this isn’t working,” you’re allowed to put a stop to what’s happening to say, “Okay, I don’t want to do this. I’m going to find somebody else.” It might be an uncomfortable conversation to have but you’re allowed to choose yourself ahead of their feelings.
Dr. Sheila Loanzon: You can be a power to your medical care. You do not have to do anything that you don’t want to do. I mean, I’m assuming that most of the listeners are adults. If you are an adult, you can make an informed decision. At any point, if you feel uncomfortable, you can just stop. I mean, even with everything that I’ve done – I’ve had patients come in who were survivors, who had the best intent of doing a pap smear, but just could not – just the thought of putting the legs into the stirrups was terrifying. I could see it, her sister could see it. There’s no reason to force anything. In the end, if something’s going to be happening and something goes wrong, you can evaluate it at that time. I do think that preventative health is extremely important, but not at the expense of crippling you for the next month because it was just so traumatizing. There’s no need for that at all – at all.
Dawn Serra: Yeah, yeah. Thank you for that permission slip because I think so many of us need to be reminded that we do have power in these situations, even if they feel very exposed and powerless.
Dr. Sheila Loanzon: Yeah, I think a physician will let them know, will let you know, if it’s not right. I think that there’s a huge patient autonomy that can happen. But if at any point, like, for instance, when I’m on labor and delivery, patients can go through things to a certain extent. I want them to have their experience, but if at any point that there’s jeopardy of life, I will directly say, “Listen, not okay. This is the situation. We have to make something more definitive.” But if it’s a situation that someone is struggling with – a pap smear or a breast exam or something like that, not necessary. I think that there can be other ways to evaluate and that would be okay.
Dawn Serra: So I’d love to end with one last thing. We were talking ahead of time and, and I was curious about your experience with kink and pregnancy. You mentioned that at one point, a couple of years ago, you did have someone ask you if they could engage in fisting while pregnant. I know lots of listeners are very into fisting. So I would love it if you could let us know what was the final verdict on that?
Dr. Sheila Loanzon: So, it was when I was in residency and I think she was maybe even 16 or 17 years old. So I was still in residency. So I had my attending there and we both went, “That’s a question we don’t get asked often.” I guess we both kind of looked at each other. We thought, “Well, if you’re okay with it, I think we’re okay with it too.” I mean, as long as there isn’t any medical problems. There are people who prefer to have anal sex in pregnancy. There are some people who prefer to do fisting or anything like that. I think it’s fine as long as there isn’t any risk of preterm labor. There isn’t really any risk, I think, to the baby. However, it can cause vaginal soreness which can be confused as labor. So it have to be in the right situation and, of course, you know, make sure that you’re well lubricated. The difficulty is that the baby is right there, that cervix is right there and you really don’t want to introduce preterm labor and to explain it, “Oh, because we were fisting.” You kind of want to make sure you’re doing it in the right situation.
For the same reason that I had someone – she kept coming in with recurrent bacterial infections and I kept thinking, “What is going on? What are you doing?” So eventually she said something, “If I have anal sex, can I go back to oral or vaginal?” I’m like, “Whoa, whoa! Anal sex is the final stop. You don’t go anywhere else, because that’s going to introduce bacteria that you just don’t want.” You have to be very logical about it.
Dawn Serra: Yeah, yeah. Just use a little bit of information gathering and proceed with caution sounds to be the wisdom of the day.
Dr. Sheila Loanzon: Yes. Always check with your provider because every pregnancy can develop a little bit differently, and some things that may be appropriate at some times may not be in other times. So it’s important for us to know where you’re at.
Dawn Serra: Thank you for all of that information. That was amazing.
Dr. Sheila Loanzon: That was very fun.
Dawn Serra: So I would love it if you could share with listeners how they can get your book and stay in touch with you and find you online.
Dr. Sheila Loanzon: Absolutely. So I have a few venues to be reached. The place that I usually am working off of is actually off of Facebook. So if you go to facebook.com/DrSheilaGYN – I generally try to post about once a week about something, whether it’s something that moved me whether it’s something I was doing for myself, whether it’s some type of interview that I did. I’ll refer to other herpes advocates that are out there. So that’s a really great way to reach me and you can send messages there if you’re looking for more support. My book is on Amazon and you can search my name is Sheila, My last name is Loanzon – LOANZON. And you can purchase that. You can see my journey and all the fun stories that we talked about here. Lastly, I do have my website and that’s at drsheilaloanzon.com.
Dawn Serra: Awesome. I will have all of those links on Sex Gets Real for this episode and in the show notes so you can just click through really easily. I also want to remind you ask your libraries to carry this book, if you’ve got people in your life who need to learn about herpes, or even if you want your kids to learn more because they’re teenagers and they’re becoming sexually active – let’s get ahead of the stigma and the bad information and get that book for them. I want to thank you so much for being on the show and being so lovely and warm and open with us. It was wonderful.
Dr. Sheila Loanzon: Thank you, Dawn. It was super fun. I love this kind of stuff.
Dawn Serra: Me too. To everybody who listened, thank you so much for tuning in. If you have questions or thoughts about this episode you can use the contact form at dawnserra.com. Of course there’s an anonymous option. If you have any questions or comments you want to share with me for a future episode, you can go there as well. Until next time, I’m Dawn Serra. Bye.