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Sexual Health and Medicine Access: A Roundtable Discussion
Episode 626th July 2022 • So Curious! • The Franklin Institute
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In this episode, Kirstin and Bey are joined by associate professor of anatomy and neurobiology Dr. Jonathan Wisco and a few of his students. We will be hearing about what the next generation is focusing on in terms of providing equal care for people with different gender and sexual identities. Please note: This episode was recorded prior to the overturning of Roe v Wade.

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Transcripts

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Hello and welcome to So Curious, presented by the Franklin Institute.

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We are your hosts.

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I am Kirsten "Go Birds!" Michelle Cills.

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I am The Bul Bey.

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Kirsten and I are so excited to bring you this season that talks all about the

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science behind love, sex, and relationships, everything from your brain

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on love to why we obsess over our favorite television characters, to how science and

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tech are changing our relationships with each other.

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For this episode, we are going to join Dr.

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Jonathan Wisco and his students for a

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roundtable discussion about people's access to sexual health and medicine.

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This topic is super important to me, not

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only as a woman in the year 2022, but also as someone who was raised by a mom who was

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a high school sex ed teacher for most of my childhood.

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And talking about sexual health is so

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important, but it makes people real uncomfy sometimes.

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And that's tricky, because if it's not

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something we talk about, that's when things start to get bad.

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We have to have this conversation.

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I'm really excited to be talking to Dr.

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Wisco and his students.

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But uncomfortable or not, we have to talk about it.

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Because sexual health is an important part

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of being healthy. Living through a pandemic, obviously, we've seen how people

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don't [all] have the same kind of access to healthcare and medicine.

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Definitely. And when it comes to sexual health, we are

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seeing in real time how different values around sex and reproductive health care

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and all of that in different parts of the country add all of these layers of

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complexity to who can have access and who can't.

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Right? So let's get some experts to help us make

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sense of all these questions and curiosities that we have.

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Yeah.

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So on that note, let's jump right on into our conversation with Dr.

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Jonathan Wisco and a few emerging minds in the field.

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Dr.

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Wisco, can you introduce yourself and tell us what you do?

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Sure, absolutely. My name is Dr.

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Jonathan Wisco.

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I am an associate professor at Boston

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University School of Medicine, in the Department of Anatomy and Neurobiology,

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and I am interested in lifespan medicine and life access medicine.

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Which I think brings me here, because we're really interested in taking a look

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at sexual medicine as it's related to our health.

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Right. Amazing.

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And let's just go around the horn and figure out who's all here with us.

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We got a nice, lively group today of

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Masters, undergrads, studying all kinds of fun things.

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Let's introduce everyone.

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Hi My name is Anya.

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I am a second year Masters student in the Department of Anatomy and Neurobiology at

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Boston University School of Medicine, and my research with Dr.

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Wisco focuses on identifying health

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disparities amongst pelvic cancer patients.

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Awesome. Thank you. I'm Estefenia Rivera.

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I'm currently in Cornell.

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My major is Human Biology, Health and Society.

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And I work with Dr.

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Wisco on a project entitled "Sex and

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Gender." But it was, like, on the field of athletics, so just basically studying the

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health disparities that affect athletes due to their gender.

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And last, but certainly not least... .

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My name is Alexandra Gates.

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I'm a fourth-year undergraduate student at Elizabethown College.

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And my research with Dr.

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Wisco is about overviewing sexual

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differentiation and determination with the current literature, and then comparing

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that to what we currently teach in healthcare programs, as well as how that

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applies to the standards of care set for transgender and non-binary people.

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Incredible. Yeah.

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So, yeah, let's just right into it.

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What kind of access disparities exist when it comes to sexual health medicine?

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Let's go with you, Dr. Wisco.

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I'll just give you a quick overview.

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We are really interested in this problem

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of why people, particularly of different sexual orientations and different gender

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preferences, have such a difficult time accessing care.

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I'm going to turn this over to Anya

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because she's done an incredible amount of work in this particular space as an

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overview, so she might have a better perspective.

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But that's the question we were trying to answer.

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And what Estefenia and Alex are looking at our nuances underneath that umbrella.

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So why don't we start with Anya? Go ahead, Anya.

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Yeah. So Dr.

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Wisco and I started this project with

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prostate cancer research, and we focused our research question on an alternative

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way to diagnose prostate cancer without using an MRI.

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So I'll researching how patient access to

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insurance could hinder their ability to proceed with their diagnostic imaging.

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We found a lot of barriers that patients face when it comes to health care access.

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So by assessing all the barriers to

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healthcare access, we were able to discover, like, when a patient may

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completely stop care due to specific circumstances or situations which

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ultimately impacts their cancer diagnosis and treatment.

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Wonderful.

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So do you have any possible solutions that you have come across?

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As far I know, that's what most of your work is.

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Do you have anything that has stuck out to you?

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Yeah, so we basically found

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many barriers to healthcare access in terms of physician education.

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And amongst these topics is the idea of

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sociocultural bias and absence of patient navigation that

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play huge roles in the delay or absence of healthcare access.

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I found a really good paper to talk about this, and it refers to Dykes & White's

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2009 paper about physician education playing a big role in disparities. It q

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uotes, "recent studies suggest physicians prejudices substantially influence their

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feelings about patients and their treatment decisions.

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And as a result, such prejudices appear to

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be major contributing factors to healthcare disparities.

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" So just in terms of education and improving, that could help overcome.

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And, really quickly, how could you explain all of this to a child?

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How can this be stripped down?

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That's a good question.

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I think some of the things that Anya discovered, if I might interject any, is

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actual, also, barriers that the patients face, which you alluded to.

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So, transportation barriers, insurance

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barriers, comfortability barriers with a particular caregiver, racism barriers.

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There's all sorts of other barriers.

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And I think if we were to boil this down to explaining this to a child, I would

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probably say if you wanted to play in the sandbox with a friend, but you couldn't

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get to the sandbox, you wouldn't be able to play with your friend.

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What are all the barriers that are preventing you from playing in the

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sandbox -- or even just getting to the sandbox, let alone playing in the sandbox

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-- that prevents you from having a fun time with your friend?

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I think it's important that we have Alex

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and Estefenia chime in because they did a lot of work in terms of identities.

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And so a big barrier that we are

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discovering is just...Anya has alluded to physician bias and physician education.

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Even the individual identities and how

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caregivers perceive those identities has been a major barrier.

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So why don't we start with education?

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Why don't we start with Alex, and then

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we'll get into a more specific realm of athletics.

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So when it comes to barriers of care,

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specifically, transgender people have a huge number of them.

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One of the big ones is money, because,

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likely due to higher levels of workplace discrimination and harassment, transgender

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people are much more likely to be unemployed or live in poverty.

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There's also a lot of barriers trying to

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get quality insurance to cover things like pelvic exams.

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So from that aspect, it's difficult to seek treatment when you can't pay for it.

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A second barrier that's really important

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is just a general level of distrust in the healthcare system.

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And it is totally valid because there's a

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long history of transgender people being discriminated against in healthcare.

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A lot of this is due to a lack of knowledgeable providers.

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And this is just, also, reflects back on the educational things that are taught

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. A lot of the educational standards, even though our literature has continued to

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evolve and our knowledge of how to treat people on a more inclusive level has

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continued to grow, what we teach in schools hasn't really reflected that.

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It's stayed fairly stagnant.

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And even beyond the lack of good guidelines set to treat people that maybe

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don't fall into this binary system of sex, we've got the idea of discrimination.

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Sometimes it's intentional.

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There's, like, intentional malpractice.

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People are being discriminated against due

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to their identity, and sometimes it's not necessarily even intentional.

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There's this phenomenon called "Trans Broken Arm Syndrome," where

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basically the story goes, a transgender person will walk into a hospital with a

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broken arm, and they're like, I have a broken arm.

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Please help me.

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And instead of actually treating a broken arm, the physicians are so curious about

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the fact that they're transgender that they don't treat the problem at hand.

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So then we get unintended discrimination.

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That is so...

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Have you heard of this before?

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No. No. It's heartbreaking.

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I definitely want to have a moment for Estefenia to chime in.

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But I certainly would love to respond to that.

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And everything that you guys have been

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bringing into this conversation, it's really mind-blowing.

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Yeah, for sure.

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And going off the topic of transgender individual, and not only how medicine is

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affecting them and they're not able to getting the treatment that they deserve,

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but also you have the societal aspect of it.

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So, for example, transgender individuals want to compete in a sport and right now

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they can, but this is a very controversial topic, because we don't even fully

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understand what's going on in this individual's body.

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And this is why many physicians are

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intrigued and they fail to give them the right treatment.

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So right now there's this situation in

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Congress and people don't actually understand what's going on.

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They don't know what to do. They think just because a person is born a

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man and then becomes a transgender woman, she would always have the benefit of being

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bigger and having bigger bones, having bigger muscle.

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But people don't actually understand what's going on.

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And there's nothing wrong with that.

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It's just there's this narrative of people not being educated and this misinformation

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being spread in [such] huge platforms as the government.

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So there's this need for education.

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And that's what my research focused on, on understanding what has been studied

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specifically in the transgender field regarding sports.

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And that conclusion was pretty standard and pretty obvious.

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It's just like this is understudied and if

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we want to make laws that affect these athletes, more needs to be done.

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These people can't suffer just because we haven't studied the effects of hormone

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therapy on their bodies and the implications of this.

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And we have a lot of examples with athletes that are transgender and that

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succeed and both not succeed in their new field of competition.

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There was a swimmer, and I think a lot of people are familiar with her, Lia Thomas.

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And there's this other weightlifter (I

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forgot her name right now), but she competed in the Olympics.

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And in both cases you have one athlete that succeeded and she was able to win.

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And in the other case, you have one

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athlete that was eliminated in the first round of the Olympics.

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So there's this narrative of what's

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actually going on and we don't fully understand this.

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And in order for us to move forward, there's a need for more scientific

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research to be done on these specific people.

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They shouldn't keep suffering.

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So you all have given Kirsten and I a great deal to chew on, to think about.

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I'm going to attempt to say it back to you

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and you let me know if I'm completely off base or absolutely accurate.

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healthy looks different for everybody.

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That's principle number one.

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I got it right, I got it right!

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So healthy looks different for everybody, and our systems and institutions are

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structured very rigidly where it can't serve everyone's health needs.

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Is that it? Did I get it right?

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I like how you worded that. Health,

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particularly sexual medicine health, is different for everyone.

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We've been highlighting transgender health

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because that has the highest disparity and lack of attention.

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But even if we talked about cisgender health and if we actually added in the

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concepts of race or socioeconomics, the bottom line that you mention is the key.

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Health is different for everyone.

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How we address it, how we consider it, how we approach it.

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And that, I think, is the problem, is that

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we try to use a "one size fits all" type of environment and approach to everything.

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And that just doesn't work anymore because

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we're now recognizing that people need individualized attention.

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Yeah! And anyone who knows me personally

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knows how passionate I am about the first point you brought up about how looking

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different to everyone because I'm terminally ill, I have cystic

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fibrosis and I'm not on oxygen right now, but I often am.

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And it's so insanely different the way I'm

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treated versus when I'm on oxygen and when I'm not.

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I'm so passionate about the fact that you never know what's going on with someone.

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So I love that you all are fighting this

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good fight, especially when it comes to reproductive health and sexual health.

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They are for sharing that.

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Yeah, absolutely.

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I'm just curious because we were talking about misinformation.

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And obviously there is a disconnect,

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particularly when we are teaching in the classroom, things about sex and gender and

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what it is that we know and what we're teaching any age group in the classroom.

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Do you have any ideas as to -- this is kind of two-part -- but why does this

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disconnect exist and kind of how can we bridge that gap?

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So in schools, we teach a lot of things that are very simplified.

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We teach this idea that sex is part of a binary system and that sex and gender are

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the same thing, when neither of those are really true.

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That exists, just first of all, because at the time these educational standards

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were set, maybe that was what we knew to be true.

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Since then, we know that it's not.

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So our understanding through literature

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has increased, but our education hasn't gone with it to close that gap.

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And I think a lot of that there's this excuse of tradition and the idea of

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keeping things simple so that people can understand them.

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But it's really not super difficult.

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At the end of the day, the idea that sex is on a spectrum and that gender is

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independent from sex, these are things that we can teach.

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And I think it's important to go back to those educational standards and the

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curriculum to completely reform them, to make them A, up to date, and B inclusive

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for all the kind of identities that people have and existences that they're living.

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100%. I'm kind of riding on a high.

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I feel like I got an A. Just kinda throwing that out there!

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And I also just want to add, I think it's

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really interesting, because we've been talking to many people who work in the

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fields, in any sort, of sex, love and relationships on this podcast.

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And I feel like I've seen a pretty big thread when it comes to education about...

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It's actually amazing how much easier it

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is to teach this stuff to little kids than it is to teach to adults.

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That's actually the best case when people are like, "well, what age?

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They really shouldn't be learning about this before a certain age," and it's like,

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no, that's exactly when they should be learning about it.

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Yeah. Sorry to cut you off, Bey, whaddya got?

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No worries. I would actually love for Dr.

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Wisco to respond to that, maybe, because

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what age would you recommend talking about sex?

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Well, I remember I was very nervous talking about sex to even my own kids.

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And so we decided as a family that the right age to talk about sex to kids was

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when they were conscious of their own body.

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So that was very early, for us.

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Now, that's because you have two parents, one is a clinical anatomist and one is a

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psychotherapist, that decided that that would be the appropriate time.

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But we recognize that different parents

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have a different idea of when that is an appropriate conversation.

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We don't want to argue with that, but the conversation needs to happen, and I think

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all three of us would advocate as early as possible to have that conversation.

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School districts tend to want to control that.

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We teach anatomy and physiology, nutrition, through Anatomy Academy to

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elementary school kids, and Anya has taken part of that project.

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But we don't teach anything about sexual

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medicine or sexual health because the school districts have asked us

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purposefully to not do that since they want to control that information.

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I understand why they want to do that.

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I get it, because, again, parents have

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different ideas of when that should be taught.

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But I think from a research standpoint,

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earlier is better. And it's not to try to influence anyone.

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It's so that knowledge is there for the students to consider.

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And how parents want to help their kids understand that, totally up to them.

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So that's perfectly understandable.

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But if we just talk about kids as

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students, as pre-professional students ,that are learning this information,

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there's no question that college is too late.

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There's no question that high school is almost too late, because that has

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significant ramifications on how people approach this from a career track.

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I don't know. Anya, if you want to chime in on here,

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because you and Estefenia have looked at this in terms of how we perceive

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healthcare, how we perceive sports, and these kinds of frames of mind, and I think

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you would probably both agree that the education can't happen early enough.

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I mean, if I can touch on Anatomy Academy as well, I think that'd be great, because

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as a mentor for Anatomy Academy, first of all, it's a very rewarding

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experience working with kids and teaching them about human physiology and nutrition,

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but it's also about trying to incorporate storytelling, and...

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Really quickly, what is Anatomy Academy?

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Anatomy Academy is a program that we started at UCLA to inspire kids to adopt

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healthy lifestyles as an educational way to fight the obesity epidemic.

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And at the same time, we were trying to

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provide our medical students at the David Geffen School of Medicine the opportunity

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to teach complex medical information before they got to the clinics.

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service learning, but

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also an educational intervention program at the same time.

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Since then, we have expanded to a number of states across the country.

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But primarily, our goal is to teach

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anatomy, physiology, and nutrition to help kids adopt healthy lifestyles.

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So we have a seven-week curriculum where we teach different aspects, different

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systems of the body, to help kids understand how their bodies work.

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I mean, of all the things that we educate our kids on, bodies are really important.

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You carry your body throughout your entire lifetime.

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Right? And so knowing how it works, what causes

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it to not work, are things that we try to convey in Anatomy Academy.

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Anya, I want to come back to you.

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Why is it important that there's more interaction and connection between the

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classroom and the lab, especially when it comes to sexual health?

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If I can touch on my research a little bit more with Dr.

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Wisco.

And so it's dual:

When we were doing our search for all of the health disparities in pelvic cancer,

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we only got 348 papers that pertain to the topics.

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And if you break down the papers that we found, only 35 were on physician

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education, 22 on LGBTQIA+, 15 on sex and gender, 11 on transgender.

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The numbers just keep getting smaller the more specific you get.

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So I think having a more open conversation, especially for medical

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education, is so important to foster growth and just understanding your

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community that you're going to be working with.

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And this also starts small. Right.

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So just recognizing that when you're

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teaching younger students, you really want to be very inclusive and teaching as well

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in the lab to medical students, it's also important to bring that awareness, the

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self-awareness, that is so important in healthcare that we need today.

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Yes, to all of that.

And so it's dual:

Yeah, I think that's an incredible place to kind of close the conversation.

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I want to certainly open it up to any final thoughts from everyone?

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I guess my final thought would be more

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open to getting educated by people that actually know what's going on with the

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literature and having that respect for the people that actually conduct the research.

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I feel like that's something that not only

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this topic has taught us, but also COVID in general, being more open to respecting

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the people that have PhDs, that have MDS, the people that know their stuff.

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So I think that would be my final thought.

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It's a great final thought.

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Don't listen to a comedian and a rapper.

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Yeah, we don't know anything.

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From my perspective, I think it's just really important to remember that sexual

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health is just as important as any other type of health.

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There's a big stigma around it.

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It's very taboo to talk about sexual

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health, but it's super duper important, as much as anything else.

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And the idea that

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it is not a conversation that should be talked about, it should be kept behind

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closed doors, that's not conducive to healthy living.

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If you want to be healthy, you have to respect your body, all parts of it, and

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that means not being shy about your health regardless of where you're talking about.

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Everything that Alex and Estefenia said was great.

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And I just want to add that sexual health is a part of your overall health, like

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Alex said, and it's part of patient centered care, and there is a need for

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inclusive healthcare and integrating more open-minded approaches to medicine.

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Thank you for that.

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And Jonathan, do you have any final thoughts for us?

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First of all, thanks for the opportunity to let us be a group here.

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I love my students and I want to give them

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the opportunity to express their thoughts based on what they've learned.

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And it would have been unfair for me not

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to invite them because they did all the work, so I appreciate that they're here.

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I think my final thought here is that knowledge is incredibly important.

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Knowledge is power. We've heard that, right?

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But what kind of power does it give us?

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Knowledge gives us the power to change systems.

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And when we have incorrect knowledge or even an incorrect perception of that

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knowledge, that can lead down very incorrect pathways.

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And in this context, it can lead to biased

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decisions for even the very people that we trust -- let alone our own perceptions of

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who we are, from a perspective of sex and as a perspective of gender.

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So I think we need more knowledge.

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We don't have enough knowledge on the topic.

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And so I don't blame people for being fearful of wanting to change and wanting

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to be more inclusive, because we simply don't have enough knowledge on the topic.

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But we have an intuition of what should be correct and what should not be correct.

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So we need to find more knowledge.

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But even if we find more knowledge,

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scientifically controlled knowledge that we have gone through a process of, and we

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can trust the information, quick scientific fixes are not the answer.

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We need good studies to find out what is really the truth out there.

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But once we have the truth, it's not

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enough to just say, "this is it." It's really important to have a good,

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welcoming, inclusive space where we can have a difficult conversation, where we

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can have an inviting space and say, "this is how we've grown up to know something,

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but in reality, it's this." And allow people to have the safe space to realize,

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"wow, that's really different!" Even the term

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cisgender and transgender are completely foreign to even my generation.

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We have to acknowledge that this is a difficult thing to talk about and people

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will put up the walls when they feel unsafe in engaging in that conversation.

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So even though we have more knowledge, we

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need to have safe spaces to be able to consider that new knowledge.

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And allow people the opportunity and the choice through that invitation of learning

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something new, to decide for themselves what they're going to do with that.

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I think regardless of where you're at and

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what you believe, we have to allow people the choice to take

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that information and apply it to their own lives.

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And over time, as the knowledge gets

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better, as the conversations get safer, we will change the world in terms of

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understanding because we're all in this together.

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It's not like our bodies are going to go anywhere, right?

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So we need to be able to have safe spaces and conversations for that, to improve the

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health for everybody, not just any one group.

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Beautifully said.

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And talking about sex is definitely hard.

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I couldn't agree more.

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That's why we're doing this with Radio

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Kismet and with Philadelphia's Franklin Institute.

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That's why we're bringing in people like you all who know so much more about it

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than a stand up comic and a rapper who are just excited to hear about it.

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We are so happy you all were here with us.

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Thank you so much for your insight.

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I learned a whole bunch.

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Bey, did you?

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Yeah. And like I said, I got an A, as far as I'm concerned.

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[Laughter]

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Bey passed, yep! Thank you all so much for joining us.

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This was super awesome. Thank you.

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Thank you so much.

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Yeah, so that was a really cool discussion.

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I really appreciate it.

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Just kind of like the nimbleness of the field of study because it's developing and

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everyone's sexual health looks different and functions differently, and then you

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have the access point part of the conversation.

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It was something that just kind of kept me on my toes as a listener.

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Yeah, and I think it's really cool as a

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young woman in her 20s, knowing that these people that we just talked to are the ones

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who are like, going to graduate, going to go into this field and freaking rock it.

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I feel like I have a lot more hope than I did this morning when I woke up.

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So thank you so much to Dr.

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Jonathan Wisco and the crew for being here with us today.

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I think that's all for this episode.

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Yeah. And next week, we're going to look at one of the major factors that influence

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our cultural norms around relationships, which is the media.

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We'll talk about how it shapes our most

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important relationship, which is the one we have with ourselves.

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And also next week, we're going to talk

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about a topic that is very near and dear to my heart, which is why we mourn, laugh,

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cry and smile with our favorite TV characters.

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You're going to get this and more coming

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up next week, so please subscribe to this podcast wherever you listen.

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And I am Kirsten Michelle Cills.

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And I am The Bul Bey.

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Thanks for listening.

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So Curious! is presented by the Franklin Institute.

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And special thanks to the Franklin institute producers Joy Montefusco and Dr.

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Jayatri Das.

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This podcast is produced by Radio Kismet.

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Radio Kismet is Philadelphia's premier podcast production studio.

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The managing producer is Emily Charish.

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The producer is Liliana Green.

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The lead audio engineer and editor is Christian Cedarlund.

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The editors are Lauren DeLuca and Justin Berger.

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Head of operations is Christopher Plant.

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The science writer is Kira Vallette.