Full Transcript Podcast Intro and Guest Introduction 0:00 always thought this vaginal dryness and pain with intercourse is something we see as the women are longer in postmenopause. 0:06 But it's really not true clinically. 0:08 It's some of the earliest signs to start to get urinary tract infections. 0:13 And they don't even have that pain-with-intercourse yet, but this is often for me the early sign. 0:18 Out of blue, they get Urinary Tract Infections where they didn't use to have them. 0:23 You're listening to the Lifestyle Medicine podcast with Dr. 0:26 Ivan Rusilko, brought to you by Access Lab, where we explore new perspectives at the forefront of personalized healthcare. 0:36 Welcome back to the Lifestyle Medicine Podcast. 0:38 I'm Dr. 0:39 Ivan Rosilke, your host, and we're powered by Access Labs. 0:41 If your doctor's not checking your labs, they're not a doctor. 0:44 And today, do I have a treat for you. 0:46 We have Dr Christina Ensman, who is fabulous. 0:49 She's coming to us from Germany. 0:50 she's awesome. 0:51 we are talking about GSM, something that's super, super unique. 0:54 i'll let her get into it. 0:55 Uh, she does have book coming out called, Nobody Told Me. 0:57 It's about nutrition during perimenopause. 1:00 So I am super excited to hear about that as well. 1:03 uh, so Dr Kristina, thank you so much for coming by today. 1:05 Well, thanks, Ivan. 1:06 I'm very excited too. 1:07 Thanks for letting me talk about the vagina. 1:09 This is going to be fun. 1:11 Definitely. 1:11 So, I am very curious. 1:13 What kind of got you started on the whole GSM angle? 1:17 And again, that's genitourinary syndrome and menopause, correct? 1:20 Just want to make sure I get it right. 1:23 That is correct. 1:24 Genitourinary syndrome of menopause. 1:25 Yes. 1:26 So, you know, I was a young gynecologist. 1:29 I'm originally from Germany, as everyone can hear. 1:31 In the U.S. 1:32 since 20 years, however, but that just doesn't go away. 1:38 As we all, actually I know the story when I was really, you know, I started out and I realized everyone, trips over this very strong accent. 1:45 I asked my boss, and was like, should I take a class to get rid of this accent? 1:49 And he looked at me and he was, like why would you want that? 1:54 I made peace with it. 1:55 Well, he wasn't a New England guy. 1:56 He felt this was a bonus, that accent, so he. 2:01 My goodness. 2:04 So anyhow, so I was a young gynecologist, you know, trained in the U.S., first in Germany, then I, family reasons ended up in U S.
What GSM Is and Why It Matters 2:12 And as many of us gynaecologists, we don't really learn much about, not about menopause, and we learn about the vaginal conditions in depth. 2:21 We know about okay, this is yeast and this VV and be treated every time with antibiotics. 2:25 However, I actually have in Germany, a PhD on my doctoral thesis was actually in dermatology. 2:32 So I was really used to looking at skin very closely, like I would love to just take out my microscope and look at it. 2:39 And so I, you know, skin and the microbials, it took this very, very serious. 2:46 This was my natural inclination. 2:49 actually that doctoral thesis was, it was dermatology, but actually the microbiome. 2:54 So here's how everything really started, right? 2:56 So it wasn't about bacteria, about skin, how important that is. 3:01 When these patients came early on with first these dysbacteriosis, so infections of the vagina, not STDs, vaccine symptoms no one could treat, 3:12 and pain with intercourse, many of my midlife women. 3:16 This was immediately, I was like, there needs to be a better answer than we give you more antibiotics or sex has to painful. 3:24 So both of these were just not good answers for me and that's how it started. 3:28 Okay. 3:28 Very, very unique. 3:29 And again, so is this a very prevalent issue when it comes to women of this age or is it something that you've seen on the uprise over the past 10 years? 3:39 No. 3:39 So this genitourinary syndrome of menopause, we used to call it vaginal atrophy, right? 3:45 So it was a typical disease. 3:48 Let's think about diagnosis codes from the postmenopausal women. 3:53 Usually it's still in the textbooks that it is something that happens later on in post-menopus like several years in. 4:00 And it basically happens because vaginal tissue thrives on estrogen, has estrogen receptors. 4:05 And as you know, the tissue gets longer and longer not exposed to estrogen. 4:10 As we are longer in postmenopause, many women get symptoms, you which are associated with vagina dryness, then the vagina, 4:18 however, also gets I mean, you know, usually it has this big folds, this you see these pinkish moist folds so the vagina can stretch. 4:27 When the penis goes in, it can't stretch for the baby. 4:30 That's how it's made. 4:31 But it becomes like more a stiff tube under estrogen, under estrogens lack. 4:36 And that's when women become, many of them. 4:39 Not all, and we get to that, but many, you know, get like this pain with intercourse or, so again, initially we called it vaginal atrophy, 4:48 just saying, well, this is just problem with sex. 4:51 But then we realized, oh no. 4:53 And then it came this new name because we realize, part of the bladder actually also have estrogen receptors. 4:59 So the same syndrome is actually when the women now start to have urinary frequency, urinery urgency, or a stress incontinence. 5:07 So we have to pee, you have two pee. 5:09 This is part of that estrogen lack and can be treated with the intervention. 5:15 That's when this new name came, genitourinary syndrome on menopause. 5:19 To make clear, no, this is not just a sex problem because that's what many general physicians just don't feel this was worthwhile intervening. 5:26 But no it's actually genito-urinary. 5:29 problem, and I like that. 5:31 Okay. 5:31 Very, very unique. 5:32 Now, so when it comes to, obviously hormones play a gigantic role. 5:34 Estrogen, I'm guessing, being probably one of the most important ones there. 5:38 When it come to like, let's say a woman comes in, you know, obvious symptoms of it, are you testing for things like estradiol, 5:45 estriol esterone, all the different types of estrogens, as well as progesterones, testosterone, free in total and things that? 5:51 Are you just focusing specifically on estrdiol? 5:53 The big one. 5:56 No. 5:56 So it depends what the woman comes in for. 6:00 If she, if you're talking, you know, in terms of genital urination, the menopause if she's like six years into postmenopausal and doesn't want to be on 6:11 hormones and systemic hormones, I don't need to check a hormone level.
Hormone Testing and Vaginal Estrogen Treatment 6:14 I know they're going to below and I'm not pushing hormones systemic, hormones on anyone. 6:19 However, this lady in that case, I would give her vaginal estrogen and we can talk about that later, which is not systemic estrogen. 6:26 It's just local giving estrogen, however, women in perimenopause with all kinds of symptoms, yes. 6:33 I do depending progesterone to be honest, don't test a lot in my permenopausal woman because it's not, you know, whenever you test it, 6:41 it is going to, be wherever, but I, and it you, know it doesn't matter if she's 45 I know she is in, peri-menopus. 6:49 estradiol, testosterone, sex hormone binding, clobolin, DHEA. 6:53 So this is when I do regular labs, it's in an insurance-based frame. 6:58 If we talk about someone really wants functional medicine services and we really want to dig deep, we want know how do people metabolize their estrogens, 7:06 I like to do, you know. 7:08 tests, so dried urine tests of comprehensive hormones based on urine metabolites. 7:13 And then we look at all these things. 7:15 Then I want to know how do we metabolize these estrogens so I can give a patient a risk assessment or explain how simple. 7:22 Okay, it makes total sense. 7:23 When it comes to the actual estrogen itself, or I should say the difference between estriol, estrone and estradiol. 7:30 when you're saying it's more of a systemic versus a localized one, are you using estrdiol or estrriole once you start to treat somebody vaginal? 7:40 So for treating someone vaginally, I really do not need no estrogen levels. 7:45 So that's what I'm trying to say. 7:48 Because again, these people are going to be in periopostmenopause and I do check hormone levels if we are talking about hormone replacement therapy. 7:59 If someone has hot flashes, then of course I want to check these levels, But for treating the vaginal symptoms, that's when I look at the vagina and I 8:08 can tell this is a vagina that lacks estrogen. 8:11 And then, you know, we don't want to make care more complicated. 8:14 Particularly in that for the genitourinary syndrome of menopause, I keep it simple. 8:20 This is also mostly my insurance-based practice. 8:23 So I don' t overcomplicate things. 8:25 Estrogen levels don t help me because I'm not trying to get the estrogen level anywhere. 8:30 I m trying get as much estrogen or DHEA that vaginal mucosa and it's barely absorbed, there are some formulations for the vagina that act like systemic hormones. 8:41 So, you know, we have to be careful. 8:43 There are different preparations out there, like the fem ring, just saying it is a ring that goes in the vagina that helps the version atrophy, 8:50 but it has enough hormones to actually help with vasomotor symptoms and we can actually measure the estrogen levels in blood. 8:57 These are always two things that really have to be very carefully distinguished and causes lots of confusion. 9:03 Also, in my colleagues, I literally sometimes have my gynecologist colleagues like, no, this is not a systemic hormone. 9:08 This is just vaginal estrogen. 9:10 And that woman can take that, really, until the end of her days. 9:12 Makes total sense. 9:14 When it comes to environmental factors like UTIs and things like that changes in pH balance, does that accelerate the process of vaginotrophy much faster? 9:23 And if so, how do you kind of treat that with patients? 9:28 Okay. 9:29 So here's what I see, what are really contributing factors. 9:33 And I want to distinguish between the premenopausal women and the older women. 9:40 As I said, traditionally, we always thought this vaginal dryness and pain with intercourse is something we see as the women are longer in postmenopus, 9:49 but it's really not true clinically. 9:51 It's really some of the earliest signs, particularly suddenly women in their early 40s or mid 40's start to get urinary tract infections. 9:59 And they don't even have that pain with intercourse yet, but this is often for me the early sign. 10:05 Out of blue, they get Urinary Tract Infections where they didn't use to them. 10:10 and then women who never had their vagina stretched. 10:13 And I just have it to say this way. 10:14 So basically they never have born a baby vaginally, either because they have no children or they had C-sections. 10:21 These women actually feel that effect of the vaginal tightness much earlier than other women. 10:26 Women who had vagin babies, we kind of feel this tight-ness effect a little later, but the women had the C section or no-children, 10:34 this is also often interestingly the first sign. 10:37 even before they get hot flashes, they often suddenly have pain with intercourse. 10:42 So this is something what I want to clarify. 10:45 And then they tell, oh, no, you're fine. 10:48 Often they read and they bring it up to their doctor and the doctor dismisses them because they're too young. 10:53 That is actually not true. 10:54 This can indeed be an early sign. 10:57 What is, I also would like to tell our listeners because many people don't know that. 11:02 And now I'm talking about the young women. 11:04 If you have been a long time on oral contraceptive pills, and I have nothing against that, you know, they have their place in medicine. 11:12 However, many women are started very early because they've painful cycles or endometriosis, whatever the reason is. 11:20 In my observation, when these women started early, let's say around 14 to 16 years old, often once they reach in their mid 20s,
Early Symptoms, UTIs, and Oral Contraceptives 11:30 they literally start to get pain with intercourse and no one can figure it out. 11:34 And what it is, it's genitourinary syndrome of not menopause, but estrogen deficiency. 11:40 People throw all kinds of things at these women and they get all kind of treatments. 11:45 While the only treatment would be just stop that birth control pill, at least for a while to prove the concept because that tissue estrogenizes really 11:54 fast again and they're going to feel better. 11:56 So this is what I really want everyone to know. 11:59 The other thing that is really important, so, you know, apart from yes, we can give estrogen and that that's really going help that vaginal discomfort, 12:09 the tissue is going up estrogenize again. 12:13 And many women now say, well, I have got an estrogen for my doctor. 12:16 I didn't do a thing. 12:17 This is really because usually they don't get enough. 12:20 So often they're told, you know, take a pea-full amount and just put it a little bit outside. 12:25 That's not going to do nothing if you have severe vaginal atrophy or severe syndromes. 12:31 You really need to use whatever they give you. 12:34 Usually it's cream or a tablet. 12:36 I usually say three weeks every night. 12:39 that is really to up estrogenize these tissues. 12:42 And then, you know, then you can taper down to two to three times a week and then see how much that individual woman is going to need. 12:53 Some things are cellular genetics. 12:55 You know, you mentioned earlier, estradiol, estriol and estrone on the DHEA on vaginal tissue levels. 13:03 No one has examined that, but I do know and trust this is also important to know. 13:07 Not every woman gets skinny to urinary syndrome of menopause or pain with intercourse. 13:12 You know, because we always say, oh, everyone gets it. 13:14 It's not true. 13:15 And I've seen plenty of very, you know vaginas, I would call atrophic, like the mucosa looks thin and pale. 13:22 These women look at me and like, no problems with intercourse. 13:25 So they are, also having regular inter course helps to stretch these tissues. 13:30 Even if there is not much estrogen, they have good blood supply. 13:35 Just for everyone to know. 13:36 We get this everyone, we are still very individual. 13:41 Just many of us are going to, you know, it's likely that there are some type of symptoms from it. 13:47 What is super important is that I see my practice is. 13:52 Feminine hygiene products. 13:55 This is also, you know, we are bombarded at all ages, young and old with, these colorful products in our supermarket. 14:04 And, the feeling is conveyed like this vagina needs to smell like roses, is dirty, needs, to be cleaned, it needs be sanitized. 14:15 Maybe we also if something itches, would give you like local anesthetic. 14:19 This is, so my practice is really full of patients that have literally chronic irritation from over the counter cleansing and feminine hygiene products. 14:32 Okay. 14:33 My number one is really talking about vaginal microbiome, bath soaps. 14:38 And this is something, I don't know, in Germany, we don' use much bath soap for body hygiene. 14:44 I'm very American, that's what I had to find. 14:47 So, you know this foaming three times a day. 14:50 The soap scum really disrupts the microbiome, not just from the vaginal skin or the vulva skin, from entire body. 14:59 And what it really does, it feeds, particularly for women who have recurrent BV, chiral vaginosis. 15:05 Everyone who has had that knows exactly what I'm talking about. 15:09 So the soap scum is going to accumulate on the skin and feed the wrong bacteria. 15:14 So exactly this anaerobic bacteria that love that soap's scums, and that's what's then going cause this reinfection or recolonization of the vagina. 15:23 And that causes this fishy, gray odor, smell, irritation. 15:30 Then the patient comes back and says, yeah, Dr. 15:32 Anspann, I have stopped using it vaginally. 15:34 I just use it for the rest of my body. 15:36 And then I'm looking and I was like, yes, no, that's not going to help because our body is a continuum. 15:42 And it, you know, then they're trying to explain me, but no it doesn't run down there. 15:46 I like it. 15:46 Doesn't matter. 15:47 So SOPSCOM is very bad, really bacterial disruptor. 15:52 If we can't stop that, I literally can get rid of bacterial vaginosis. 15:57 This is an important thing. 15:59 What's the right way to clean it then? 16:01 I am curious. 16:03 Yeah. 16:03 So basically, I was just going to say also disrupt cell to cell adhesion barriers. 16:08 If you're really like a vigorous scrubber, you have a rag and you clean yourself very well in your private area, it's you also going be more prone to yeast 16:19 infections because you literally, will weaken the defense of your cells in the genital area. 16:23 Yeah, so what do you use? 16:26 I always say, just to be generic, an organic shower gel. 16:31 So first, no bar soap. 16:32 Go for gel, don't go for an Organic bar Soap. 16:36 Don't come in with, you know, the, what is it called? 16:39 Like the Castile soap, like I'm like, Hey, in Germany, we clean our floors with that. 16:44 Literally. 16:45 This is very organic, but it's not for your skin. 16:49 Organic shower gel that's paraben and sulfate free. 16:52 I'm not saying it's enough. 16:53 If it has some essential oils in there for some subtle nice fragrance, I don't think that is bad as long as it is not an artificial fragrance with phthalates.
Hygiene Habits, Microbiome, and Irritation 17:04 That is good. 17:05 Personally, the company Good Clean Love. 17:11 They helped me a lot starting to support me to look closely at these things. 17:17 We're doing studies together. 17:19 So they have a product that is a pH balancer. 17:23 But again, none of this is supposed to be applied in big amounts on a wash rack. 17:27 It's all gentle on your fingertips, applied outside, rinsed off. 17:33 This is how you maintain that balance. 17:37 But again, if you want one product, just get an organic shower gel that you can apply. 17:41 Then also just to the stinky areas, your armpits and where else you wanted. 17:46 And very sparingly, no wash rack needed. 17:48 That's really all we need. 17:50 I always say, well, sure, our grandparents, they were working hard all day. 17:55 They were maybe on the fields. 17:57 Yes, they would take like a shower or bath with real soap, you know, bath soap once a week. 18:03 Well, that was okay. 18:04 Our skin would recover. 18:06 But now that we like, all of us, well, how often do you take a show? 18:10 Like two to three times a day. 18:12 That's what my patients are telling me. 18:14 And then every time you do this foaming soap scum ritual, this is what you get. 18:19 You're going to get chronic skin irritation and other bacteria are going take advantage of that. 18:27 There were studies that showed basically the bath soap use is really associated with a pre-selection of propionibacteria, 18:35 which are associated was boils and acne. 18:38 So more is not more if it comes to... 18:43 to our washing hygiene in 2026. Okay. 18:46 It might've been different like a hundred years ago. 18:49 Now here we are. 18:51 How important when it comes to, because whenever I'm testing anything, cause I also deal a lot with perimenopause, menopausal, 18:56 things like that. 18:56 how important are androgens when I, when, it, comes with the actual vaginal, I guess, pH and how everything works lubrication wise. 19:02 I mean, thanks like testosterone, DHEA, even cortisol. 19:05 Even though that's not an androgen, are these things also playing into like the vagal floor and everything else that goes on? 19:14 You know, I'm sure they do. 19:17 I don't think we have really big data on it. 19:19 So we do know some women, if they don t respond to estrogen, vaginal estrogen. 19:24 We do give them testosterone compounded in creams. 19:27 And for some vulva vagin pain symptoms, that can actually be helpful. 19:37 If you're talking about DHEA, we have been using that a long time in the functional medicine space for more libido, but also vaginal sensation. 19:48 And it was actually FDA approved. 19:50 I would say like 10 years ago, the product is called IntraRosa. 19:54 So the doctor can prescribe that. 19:56 It's one of my favorite ones. 19:57 it's a very nice formulation, if you ask me. 20:01 It's a suppository on a paraffin base, which I like because it doesn't irritate the vagina at all and you use it every night. 20:10 What I liked about it, it causes very nice moisture. 20:14 And then the nice thing about, if a woman asked me, so what about if I have sex? 20:18 So how do I, let's say they want to take estrogen, and it's like, when do i place this in my vagina? 20:23 You know, I'm like, yeah, you don't necessarily want to get estrogen cream on your partner's penis on a regular basis. 20:30 But that's where I really like then the intravaginal DHEA, which is a type of testosterone. 20:36 And you can actually use it as a lubricant. 20:38 You can insert it prior to bedtime or to intercourse. 20:41 It dissolves really quickly. 20:43 it gives, very nice moisture. 20:53 All insurances are paying for it, so it's not my first line, but I like to offer it to patients. 21:00 What is usually covered by insurance, which I always say is dirt cheap and this is perfectly fine, is the vaginal estrogen tablets. 21:08 Okay. 21:09 There are some women who are really sensitive to ingredients in pharmaceuticals. 21:15 So let's say a cream, they're like, Oh, I can't do estrogen cream. 21:18 And I'm like I I mean, allergic to estrogen. 21:20 I was like no, no I don't think you're allergic estrogen, you are allergic something in that preparation and you know, and then it can irritate them and 21:28 we just don' know what it's or they just on like moisture from it. 21:32 so for these patients that very. 21:35 very cheap, small, dry estrogen tablet that you insert with an applicator is fantastic. 21:41 Usually I'm like, well, it doesn't really create so much moisture, but it does matter. 21:45 This is just very boiled down formulation of estradiol, nothing else to irritate the vagina. 21:52 So it really depends always a lot on the patient, what they need, and what is their situation. 21:58 But there are lots of products out there. 22:01 So it's always good to have a physician who is willing to explore the different option with someone and not just give up if one of them doesn't work. 22:10 Now, are there any other types of issues or diseases or symptoms that can mask what this is or actually be confused with it? 22:17 So somebody might say, oh, this might be this, but it is actually this. 22:22 Well, yeah, you're talking about the genitourinary syndrome of menopause, which can cause pelvic pain or pain with endocourses, 22:30 urinary frequency, all of that. 22:32 However, we always, when someone has suddenly pained with an endocrine, often I see pelvic floor muscular disorders. 22:40 People often don't think about that. 22:41 If there was, you know, even from childbirth, muscles were always a little tighter after that, and now comes the postmenopause and things just get a bit tighter. 22:50 And now suddenly, maybe there were a couple of uncomfortable intercourses and there is a muscle spasm reflex. 22:58 Now these muscles in the pelvic area become even tighter and suddenly intercourse is painful.
Androgens, DHEA, and Treatment Options 23:04 Then people are saying, well you have vaginismus. 23:07 Yes, but this is just a term, right? 23:10 But the underlying problem is really that the muscles are too tight. 23:14 And for this, we have a perfect profession. 23:16 There are the physical therapists, they are specialized in pelvic floor physical therapy. 23:22 I mean, there are really miracle workers, if you ask me. 23:26 They are like so good in figuring out, does this woman need pelvic force strengthening or does she need help with, how do I relax my pelvic floor? 23:36 Because you know, we always hear Kegel exercise. 23:38 So someone tells you, you have something wrong with your pelvic, floor muscles. 23:41 Then they start to do Kekel exercises, which is all the wrong thing because they actually need to learn. 23:47 Someone needs to teach them relaxation exercises. 23:50 Yes. 23:51 Pelvic floor disorders, then we have vestibulotinia. 23:55 This is now something that It's an area in the vagina, right, where the penis goes in, that is the vestibule, so the entry hall, 24:04 if you want so, and that can be chronically irritated. 24:08 And as a gynecologist, we can't even see nothing, but it's really when we touch that area, there is a pain sensation or a sensation that's disproportionate 24:19 to what we do. 24:20 Basically, I put my finger there very gently and the patient feels severe burning. 24:25 So this is what's called like a dysesthesia. 24:28 So the nerves are feeling something that is really not there. 24:33 Why does that happen? 24:34 I think chronic irritants, sometimes we see it after repeated STD treatment or treatment of like BV, like, you know, the things like which, 24:46 bacterial vaginosis and yeast infections are not STDS. 24:50 overgrowth of other bacteria in the vagina. 24:55 So this was often mindlessly treated repeatedly without thinking what might be underlying, or if it's even that. 25:03 People get irritation again, they go to the urgent care center, and they just want to get rid of you fast, so they give you the same prescription like 25:10 to 10th time. 25:11 And this is when I then often see these, I call it the post-treatment inflammatory mucosa. 25:18 We don't really see much, but it adds like the skin in the vagina is angry. 25:24 Is that a term yet? 25:27 I called it leaky vagina. 25:28 It's a terrible term. 25:29 Like we know from leaki gut. 25:31 I'm like trying to tell you. 25:33 the same symptom exists in the vagina. 25:35 It's not about bacteria only, it's about the mucous layer, the salt content. 25:41 So suddenly this protective layer is breaking down and everything we put now in there or touch it is reacting out of proportion. 25:50 Okay, so this was the vestibulotinia. 25:53 There is, you know, I probably have a different approach than other people to treat that. 25:58 That's when I actually, pack out my functional medicine toolbox. 26:02 And that's what I would actually do a gut health test, right? 26:05 I also do then food sensitivity testing because, yeah, because I'm like, now look, what's going on in your gut is going in the vagina probably too and 26:15 vice versa. 26:16 So let's just have look. 26:18 So I do that usually, you know, and there are certainly some compounded creams that help, like a band-aid solution to let this area rest. 26:28 There are some old fashioned surgical procedures, but again, that's where I become very, I put my functional medicine hat on when I'm really like, 26:36 no, not just going to put for like band aid solution. 26:39 That must be a reason that is happening. 26:41 And so I have seen indeed women with just food sensitivities. 26:46 You know, and they get, you know histamine reaction. 26:48 They are often sensitive to, to oxalates to histamines. 26:53 So I try to talk to them about the things that they're eating. 26:56 We do have something that I think is often related. 26:59 It's the painful bladder syndrome, right?
Other Conditions That Mimic GSM 27:02 interstitial cystitis. 27:04 I think that's also something you always have to keep in mind when someone comes with vaginal and urinary symptoms, like something hurts, 27:12 the bladder hurts maybe, pain, sex hurts. 27:16 Definitely something to be, you know, has to considered. 27:19 And what else? 27:20 Yes, there are a couple of other definitely vaginals symptoms. 27:24 STDs, please, Mike. 27:28 I just assume we are testing you for STDs, please, right? 27:31 We want to make sure. 27:33 But sometimes, you know, we get, again, it was, often when the women are older, they didn't really expect that. 27:41 And now, when we treat the STDS, and that's often, some of these more vaccine symptoms start. 27:47 We are just more fragile. 27:50 as a system, as the body system. 27:52 I think as we get older, then when we do, you know, multiple antibiotic treatments, sometimes the vagina reacts in an unexpected way. 28:00 That makes total sense. 28:01 So I'm curious, if you could give the advice to any two women out there, I am sorry, to, any woman out right now, the two most important things that they 28:08 could do on their own at home to kind of perfect their vaginal perfection, If you will, what were the top two things a woman could just to make sure that 28:16 she's in tip top shape? 28:18 All right, remove bar soaps. 28:20 They may have a very simple feminine hygiene procedure. 28:24 Please don't annoy your vagina. 28:26 Less is really more. 28:27 And then if you are in midlife and you have pain with intercourse, dryness, all of this, go to your gynecologist. 28:34 Everyone can prescribe vaginal estrogen. 28:36 So this is for the mid-life woman. 28:38 For the younger one, I really want to say whatever you see or read on TikTok or social media, don´t put it in your vagina. 28:46 That's really my first recommendation. 28:49 I think that's the quote of lifestyle medicine right there. 28:52 That was a great, great one. 28:55 Really, that is, I mean, really I could have a whole business just from fixing these women. 29:00 And so, and then vaginas are not supposed to smell like roses. 29:04 So there is just, you know, penis don't smell roses either. 29:07 so this is not necessary. 29:09 You did no spray, none of these, colorful things you should really buy. 29:13 Then many things, You can even buy in the supermarket, like the antifungals and the anti-itch with lidocaine. 29:20 This is the most. 29:22 common topical allergy that I really see is really from lidocaine from these creams. 29:28 And the other thing, sorry, for the young woman, you need to know perineal pads. 29:33 So I'm not sure if I am allowed to mention some brands, but there are some that really stand out causing like a severe allergic reaction in the perinatal area. 29:49 What? 29:50 So that's definitely not an area that needs to be inflamed. 29:52 That's for sure. 29:54 Yes. 29:54 So, you know, some of the big brands out there who cause, perineal pads, very fancy. 30:00 This is like the most common toxic skin eruptions I see. 30:05 If you feel after you've had your mensis, your peroneum is inflamed, look at the pad you're using and go for something simple, 30:14 organic, plastic-free, perfume- free. 30:18 Many brands actually, they emit toxic fumes and you have no idea what kind of rashes I They are blistering, they are red. 30:26 So, you know, ask me what to use. 30:28 Use something else, use something more organic. 30:31 I personally like menstrual cups. 30:33 There's nothing wrong with them. 30:35 They're made of silicone. 30:36 You can put them in the dishwasher if you like. 30:40 Anyhow, so yes. 30:42 So really, I think many things we see are really caused by modern feelings about how we have to clean and to wash and how things to have, 30:54 to look like, or what we to do. 30:57 So a follow up to that question, because I always like to ask two questions at the end. 31:00 If you're a physician who's speaking to a patient who has these actual type of symptoms, what's the best way you can kind of approach that, 31:08 bring it up and kind, you know, the, best, I guess, formulation of action to actually treat this for a woman who is painful sex? 31:17 Okay, so for the mid-life woman with painful sex, and if we really, I would always do a good trial, enough of estrogen, because even if you have other 31:28 things underlying and there are some other diseases that can happen, i always treat that vagina first with estrogen because everything, 31:35 every treatment you're going to do is going work better once the vagina has enough estrogen. 31:39 What's common is a lot. 31:42 condition called lichen sclerosis, that is an autoimmune condition of the vulva skin that can also come with itching, irritation, 31:49 pain with intercourse. 31:51 But also these women, you know, there's always a double therapy. 31:54 We do some cortisone if we need to, but at the same time, estrogen. 31:59 And for the younger women Here you have to really advocate for yourself, get rid of all the unnecessary feminine hygiene products.
At-Home Tips and Clinical Advice 32:08 And then if you to be treated for BV, which sometimes is necessary, here I really recommend try to go with a vaginal treatment. 32:16 So there is always the oral treatment, clindamycin or metronidazole, with which many women are like, I just want to take it orally because I don't want 32:24 deal with my vagina. 32:25 However, I really don't want you guys to do that because that's really disrupting every time the entire microbiome of your entire body, 32:32 right? 32:33 And you swallow this tablet, it's going to disrupt the gut, It's gonna disrupt your microbiomes in your ears and in you nose, 32:39 everywhere. 32:39 So you don' want that, because BV is not an infection. 32:42 It's a bacterial overgrowth. 32:46 So that's where I'm a big fan. 32:47 If your vagina is otherwise okay and it's not complaining about topical products, I like the gel form for the vagina and this you can also do repeatedly. 32:57 Sometimes I call it an eradication protocol. 33:01 while you basically change your feminine hygiene habits, we actually give you like a brief course of this vaginal gel every month. 33:09 I always say to bump the bad bacteria away, but then in the meantime, you have to give this vagina a chance to regrow the healthy bacteria. 33:17 Then in between, use a lactic acid gel to see if you can get the vagina back in balance. 33:25 And the same applies for yeast infections. 33:28 Sometimes, you know, the vagina is very irritated. 33:30 I'm like, take an oral tablet. 33:32 It's okay. 33:33 However, if there are chronic vaginal yeast colonization, some of them are kind of resistant to normal doses of the oral antifungals, 33:43 then often vaginotreatments work actually much better. 33:46 And sometimes you have to do them longer, but they are still, good at in controlling the vaginally yeast overgrowth. 33:55 Yeast is okay. 33:57 It's our microbiome. 33:59 So it's really the fungium. 34:03 Okay. 34:03 We all have bacteria in our vagina and our gut. 34:07 Just, it is a problem when the guys take over the place because we have cost balance. 34:13 Not like I have to eradicate every single yeast. 34:15 No, It is part of our micro biome make up really. 34:20 Makes total sense. 34:21 Well, Dr. 34:21 Christine, I got to say, you've never made me more relieved that I'm a man for certain reasons. 34:26 Not going to lie. 34:26 That seems like there's a lot of women got a deal with. 34:29 So God bless you guys, but it's been an absolute treat. 34:31 You know, so for everybody who would like to learn more about you and everything else that you do, how can they find you? 34:37 Where are they going get a hold of you. 34:40 Well, I have a website, drchristinaentzmann.com, where I do most of my functional medicine work. 34:45 I actually have the microbiome program there too. 34:48 So I've found actually many things I can fix without really seeing the vagina. 34:54 If you are in Maryland, you do have an office here. 34:57 But if you have other vaccine vaginal microbiomes issues that you really would like someone to have looked at, who really have dealt a lot with it, 35:05 check out my website. 35:06 Fantastic. 35:07 Well, again, thank you so much. 35:08 It's been a very informative day for me, at least, so I can't appreciate that much I'm Dr. 35:13 Ivan Russoco. 35:14 This is the Lifestyle Medicine Podcast. 35:15 We're powered by Access Labs. 35:17 If your doctor's not checking your labs, they're not a doctor. 35:19 Dr Christina, Thank you. 35:20 So much for everything. 35:29 Every innovation we pursue is driven by one bold purpose, making personalized medicine more practical and accessible for patients and providers. 35:38 If this episode sparked new ideas or challenged how you think about patient care, awesome. 35:43 Follow the show and share it with a colleague who's ready to level up their practice. 35:47 Head over to our website at accesslabs.com and register your practitioner account today. 35:52 You'll get access to over a thousand routine and advanced biomarkers. 35:58 with 24-hour results. 36:00 When signing up, select Lifestyle Medicine Podcast as how you heard about us and score 10% off your first invoice. 36:08 Oh, and don't forget, drop us a review. 36:11 It helps more practitioners like you find us. 36:14 We'll see you next time.
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