Earlier this year, I went to my first ISSWSH conference — the International Society for the Study of Women’s Sexual Health. I lovingly call it the Super Bowl for women’s sexual medicine.
I’d been a sex therapist for 17 years before I attended. For a long time, I had my professional homes in other organizations. But this one, ISSWSH — the one founded by Dr. Irwin Goldstein and Sue Goldstein — is where the medical side of this field actually lives. The researchers. The urologists. The gynecologists. The people figuring out, at a cellular level, why our bodies do what they do during sex.
I had the ultimate honor of sitting on a panel with Dr. Irwin Goldstein. With standing room only, we shared a stage (with Dr. Rachel Rubin and Dr. Emily Morse) to discuss the bio-psycho-social aspects of low desire, and the new FDA injectable to boost it. When it was over, I asked him and his wife Sue if they would come on the podcast.
They said yes!
A pioneer who almost wasn’t
If you don’t know Dr. Irwin Goldstein’s name, you know his work. He was the first author on the New England Journal of Medicine paper that introduced Viagra to the medical community in 1998. He co-discovered the role of nitric oxide in erections. He has more than 380 peer-reviewed publications. He founded ISSWSH. He runs San Diego Sexual Medicine alongside Sue, where they’ve built one of the most innovative bio-psycho-social sexual health clinics in the world.
Ironically, he started as a biomedical engineer turned urology resident. And the moment that changed his career — and changed the field — happened in a 1976 operating room when he turned to the surgeon performing a penile implant and asked, “Could you explain the physiology of erection to me?”
The surgeon shrugged.
“I have no idea. Who cares. We put it in.”
Irwin cared. He spent the next decade figuring it out.
The other half of the story
Sue Goldstein is the part of this story that most articles miss.
Sue and Irwin met in college outside Boston. He was an engineer who came back from spring break as a pre-med. She supported him through medical school in Montreal, then through his residency, then through their family’s move to San Diego in 2007. She raised their kids while (not so) quietly absorbing every research idea Irwin brought home. As she tells it, “the family story was that when Viagra came out, I knew more about erectile dysfunction than the average urologist in private practice — and I probably still do.”
Today, Sue is an AASECT-certified sexuality educator, a certified clinical researcher, a published author, and one of the most outspoken patient advocates I have ever met. She is also seventy-six years old and, in her own words, “feels like she’s in her fifties.”
What she said about her own journey through perimenopause and HSDD genuinely stopped me.
“Duty sex” and the desire that came back
Sue has been married to Irwin for fifty years. They have great sex. They’ve never had a marriage where “sex” wasn’t happening — except for one period, in her words, when she had hypoactive sexual desire disorder. “I had duty sex,” she said. “Because I love my husband. And once we were having sex, sex was good. But if you had asked me the next day if I wanted to have sex tomorrow, I would have said no.”
Then, she started on testosterone. When Addyi came on the market, she became one of the first women in the country to take it. And what came back wasn’t just her libido — it was a playfulness in her relationship she hadn’t realized had gone missing.
“Sex today is as good as it was when I was twenty,” she said. “Except now, I can’t have it every day.”
The hormone prison
The conversation that hit me hardest was about menopause.
Sue is on a 5-part hormone management protocol. Systemic estradiol. Systemic progesterone. Testosterone. Vaginal DHEA. A compounded testosterone-estradiol cream for the vestibule. She is, in her own description, “on all five — and proud of it.”
When I asked her about the women I see in my practice — women who have been told for decades that hormones are dangerous, women who recovered from low-stage breast cancer and were told they could never take hormones again — she was direct.
“They’re in hormone prison for no reason.”
The Women’s Health Initiative — the study that scared a generation of women off hormones — has been extensively re-examined. The conclusions most patients are still living under are, in many cases, no longer supported by the evidence. “It’s not too late to start,” Sue said. “Even if you’re seventy-six. Even if you’ve never been on hormones. Wherever you are, today is the day.”
I thought about all the women in my practice who have quietly accepted the loss of their libido, their pleasure, their bone density, and their cognitive sharpness — because someone, somewhere along the way, told them their suffering was just aging.
It isn’t.
Two episodes worth of wisdom
Daniel and I split this conversation into two parts because there was simply too much to fit into one. Part 1 is about the field — how the Goldsteins built it, why so many patients still get failed by mainstream medicine, and the cutting-edge research that's transforming the way we treat painful intercourse. Part 2 is about the marriage — fifty years of staying together, staying functional, and staying in love.
If you’ve ever felt unheard by a clinician, dismissed by your own body, or convinced you were the problem — these episodes are for you. You’re not the problem. You just haven’t been to the right office yet.
Have you been told it was “too late” to start hormone management — or that there was nothing else to be done? I’d love to hear your story in the comments.
Warmly,
Dr. Jenni
P.S. If this resonated, please share it with someone who might need it. Substack grows entirely through readers passing it along — and I’m grateful every time you do.
Dr. Jenni Skyler, PhD, LMFT, P-CSTSex and Relationship Therapist | Sex Expert for Adam & Eve | Founder, The Intimacy Institute | Host, Sex and the Psyche podcast | Brand Ambassador, Vyleesi
