The Unseen Bond: Your Brain, Gut, And Vagina

Introduction to Vaginal Health 0:00

Hi everyone. Welcome back to Mastering The Menopause Transition Summit. I'm your host, Dr. Sharon Stills. I've got another redhead here with me today. And we are going to have a talk about vaginal health. And so that is not something you hear talked about often, but it is super important. And so we're here to take away the stigma of it and just let you understand how the health of your vagina is really important, but also how it connects to your brain and your gut. And like this is a whole body thing we're talking about here.

And so I have my dear friend and colleague, Dr. Betsy Greenleaf with me. She's a premier women's health expert. She's a bestselling author and entrepreneur and inventor, business leader, specialized in female pelvic health and reconstructive surgery for over 20 years. She's a trailblazer as the first female in the United States to become board certified in Europe gynecology, she possesses a professional reputation that has led to being sought after by medical societies, associations and corporations to provide lectures, teaching, advanced training.

She is she's got just a laundry list of accolades. And I'll let you tell I'll let her tell you about herself. And she's also funny. So we're probably going to talk a little in this talk, too. So welcome, Betsy. I am. I'm thrilled you're here and we finally got this to work through all our technical difficulties. Oh, I'm so excited to be here. So thank you so much, Sharon, for inviting me. I always love talking this. This is a fun topic, even though I know a lot of people are like, what? You know?

So is there anything else about you before we dove in that you want the ladies to know your story, how you ended up doing what you're doing? You know, I mean, they can always read that stuff online, but, you know, I definitely did not, like want to grow up and be a gynecologist. That was definitely not on my list of things to do as a five year old. You know, we joke about that. And in fact, when I went to medical school, I was like, Oh my God, why would anybody look at that all day long? And patients always ask me that.

And I actually, in fact, one of my good friends, she's such a diarist and I remember during residency were sitting across the table from each other eating lunch, and I was like, You, how do you look at people's nasty feet all day long? And she, like, almost choked on her sandwich and she's like, Are you serious? And I was like, Oh, yeah, yeah. You know what? You just become desensitized. You know, when you go into the medical field about what you're looking at added. And really it was just that I wanted to help women in women's health. So the vagina is is such a beautiful part of our anatomy and so unique and has so many magical qualities and, you know, so let's like let's dove in because you are like America's vagina doctor.

And, you know, I think the biggest thing is really tough is that there was a study that came out not too long ago that said that 65% of women are uncomfortable saying the word vagina. And I really think that that's kind of sad. But I realize that there's a lot of shame and embarrassment.

Normalizing the Word and Anatomy 3:25

But if we can't talk about it, then how if we're having problems with that area of our body, how do we ask for help? And 80% of women will have a pelvic health condition at some point in their lives. So I think that we just need to get used to saying the words that go with the parts. And and even though I say vagina all the time, vagina is actually just the tube inner tube, when really the vulva is the outer outer part of the labia with the outer lives. But I'm just happy that people say the word vagina.

And if you use vagina, just refer to everything down there. I'm perfectly happy that with that. So as long as we're talking about that area, I'm happy. And I think eventually we'll get to the point where we can use that word and people won't like it. Kicked off Instagram like somebody I know or or, you know, get blocked by social media, you know, because vagina goes against community standards as well. And so if you're, you're listening and you want to say the word vagina with us, do it on three.

One, two, three vaginas. Aina. And if any of you feel triggered by that word, then you know there's a little exploration to do there. We're not trying to make you feel bad or anything, but it's just a name for a body part. And somehow it got so, like you said, censored. You know, we can say elbow, we can say lung, we can say heart, but vagina is not okay to say. And so it's just part of your body. Yeah. If you're if you're a woman listening, you have one. There's a lot that goes on down there. A lot of good stuff, too.

A lot of, you know, pleasure can happen there. Ribs come through there. You know, there's a lot there's a lot going on there. So it's an important part of our anatomy. And I know in my practice, especially when I had my brick and mortar, I was so surprised at how many of my patients had never seen their vagina. And I had my handy dandy mirror where I could actually show them their vagina and get them intimate with it because I guess it's not the easiest thing to see or we don't think about seeing it.

But like having a relationship with our vagina is is important. Yeah, I think a lot of people don't even think about that area until they have a problem. And then when you have a problem, that's all you think about. That is, oh, that's kind of they see my job is not only just normalizing the conversation, but I want to get you to the point where you kind of forget about it but not forget about it. Like ignore it, forget about it where it's not running your life so that you can just get on with your life and live your life.

Not have to think about itching, burning, pain, or whatever is the problem. So and I agree with that with the mirror, that is key. I always tell patients like your body parts are with you all the time and so you're going to trust your doctor to just look at something once a year. And now some of the recommendations, pap smears especially, are not even to do pap smears until like every three years. And then even after the age of 70, they're saying you don't need to do that anymore. And so in our interpreting this, like, oh, I just don't need to go to the gynecologist or to see women.

They go because they're having babies and then they add their babies and then they just stop going. And so, first of all, you need to have those areas checked. And second of all, what better way to check it to like look at it yourself? You know, I say vaginal exams of mirrors and make sure things look, you know, figure out what it looks like normally so that something's a little out of whack. You can be like, Oh, wait, that's something different. Same thing. I tell people seeing their breasts and my breasts are with you all the time.

You know, you're more likely to find lumps and bumps than your doctor. That's just checking once a year. Exactly. I was just thinking the same things. They took the words right out of my mouth. Exactly. We we check our breasts, we get to know them. We we need to know our vagina. Because what you said, I mean, we are we need guides and doctors and teams, but we are with ourselves 24 seven and we should know ourselves the best. And by inspecting and getting acquainted, that's a good way to start. So so gosh, there's a lot to talk about.

Where do we start? Let's talk about first how the vagina is connected to the brain, to the gut, so we can kind of get this holistic perspective and then we can go into issues that are happening. This is just fascinating. And I think being like as an osteopathic physician and, you know, also like a natural path,

Vaginal Microbiome and Brain-Gut Connection 8:14

we coming from a natural world, we tend to like connect everything. And so this is nice to realize that actually traditional medicine is actually catching up with this idea. And we're starting to see more studies where everything is connected. I think the biggest thing that they're finding out is that we have a microbiome and you haven't heard about what a microbiome is. It's just the whole kind of universe. The bacteria that live on our body and within our body and each of our areas have different microbiomes.

Our skin has different bacteria living on it that our mouth and our gut than our vagina. And so it's when that bacteria goes out of balance that we tend to have problems. So starting well, this is where when you get the brain, the getting the vagina connected, we can actually start from any one of those organs and connect it to each other. So a lot of times we'll start with the vagina since we're talking about the vagina. So if the microbiome of the vagina is off, it usually because we have we should have lactobacillus, which is a type of bacteria that lives within our vagina that keeps us healthy, fit there because what it does is when it's there and it's growing, it produces hydrogen peroxide and the hydrogen peroxide chases away the bad bacteria, chases away the yeast.

And the reason why the lactobacillus wants to live there is when we're younger and our tissue isn't thick and healthy, it's it's actively growing. And as it's actively growing, those old cells are sloughing off. And there's old self contained glycogen and glycogen is the food source for the lactobacillus. So our old cells are lactobacillus and then return the lactobacillus produces hydroxide. It signifies our vagina. The vagina is pretty at a like like acid level. It's like 3.5 to 4.5 as a normal acidity for the vagina like water is seven.

So a on the scale. So when everything's imbalanced, that is great. What happens is many things throw off that peach balance and basically kill off our healthy bacteria. Anything from stress to being on antibiotics, too, as we get older, that tissue starts to thinned out and we're not actively producing new cells. So basically the bacteria starts to starve to death unless we do things to rejuvenate or regenerate the agile tissue. And so when the balance of that bacteria is off now, now, because the way we're built as women, you have the rectum and the vagina so close together, bacteria from the rectum can now get into the vagina.

So this is gut bacteria. At the gut bacteria is off. Now, we also have bacteria or yeast from the gut getting the vagina and causing these issues. And I think one of the things that's super I find super interesting is, you know, in the past in medicine, we're like, oh, that's just a yeast infection or that's B bacterial vaginosis. And we're like, Oh, that's just an infection. And didn't think it had any other connection to anything else in our bodies. But now they're finding out that it's the microbiome of the vagina is off.

There's a feedback loop to the brain telling the brain that this is not an ideal time to be reproducing because the body, you know, as humans, we're supposed to be reproducing and making more humans. And if our systems are not perfectly imbalanced, the body's going to be like, Oh, that's not a great time to be reproducing, or the body's going to sense it as a stress. And so the brain is going to then shut down our hormones, which may show up in some people that are younger having babies. It doesn't fertility and in anybody at any age, it actually can show up as a decrease in sex drive.

So when a lot of women and including myself, you know, at points in my life before I knew any better about this this information thinking like, oh, I'm having a low sex drive, I must need more hormones. So then you go to the doctor and you ask for hormones when the hormones aren't are just a tool. They're not always the answer. It could be that there's something going on in the vagina and your brain is telling everything like, okay, let's shut everything down because we're sending that things aren't right.

So I think that then science, the scientists are actually studying this now and it's just incredibly fascinating. Really puts it all together. It's like one big circuit and we are always feeding back to each other on our different systems in our bodies. So. So a big thing we see is vaginal dryness. So can you speak to that? Because so many women, I mean, having sex is such a beautiful part of being a human being, alive and so many women I see come to me who just stopped having sex because it hurt and which is so sad to me.

So can you speak to that? Yeah. So unfortunately, you know, as we get older, our estrogen levels start going down and what happens is the estrogen is one of the hormones that feeds the vaginal tissue and tells it to grow thicker and in, you know, very full and actively growing. And you know what who said before it's feeding the lactobacillus. But the other thing is, when we start, when that does, you start to thin out. It also loses its elasticity. And so we start losing our college in in our last.

And these are the these are the chemicals in our skin or in our in our vaginal tissue that makes things like stretchy. So what happens is not only is the vagina very becomes very dry, but also when it stretches, you actually can get cracks and tears in the tissue. And this is why some people will complain it feels like cut glass when they're having sex because basically the tissue is stretching and ripping. And so this is true. And some women will come in and say, like, I feel like I'm getting ripped open.

And it is kind of true. Like the tissue is tearing and, you know, becomes very, very uncomfortable. We also start losing the blood vessels that feed that to you, start to retract. So this is another reason why if women are on systemic hormones like they're taking hormone replacement, whether it's a pill or a patch or palate, and they're like, well, it's not helping my vagina. Yeah, because you don't have the blood vessels that are you can take those hormones to the vagina to feed that tissue, to grow nice and thick and healthy.

So, you know, it's kind of like trying to grow a plant, but not having any fertilizer or any nutrients in soil like nothing's going to grow. So then there are tons and tons of different things now to help rejuvenate the vagina. And I mean, just ten years ago, all we had were topical hormone and some of the and the ones that we had on them that were prescription on the market weren't always the best options because a lot of the prescription ones and I'm going to throw some under the bus here, but things like Premarin and ashtrays, if you look at the ingredients of those creams, a lot of them contain propylene glycol as a filler agent, as a thickening agent.

Well, unfortunately, propylene glycol can be irritating to mucosal membranes, so they can actually be using it and actually causing more irritation. Or women will use vaginal lubricants. I'll use lubricants like K-Y jelly when they're having sex again. That's going to make things better. Well, they've done a lot of research on the balance of the K-Y and something called Osmolarity. And osmolarity has to do with them to get scientific evidence like the solute concentration is basically how moisturizing or how drying something is to a tissue, to tissue.

And K-Y almost gets to a point where it's almost like pouring salt on your tissue. You know, like, imagine pairing salt on a slug and it shrivels up. So you're using K-Y because you want the lubrication, but it's actually drying out your tissue more. So you need to use more. So the science behind lubrication has gotten so much better. I mean, now there are lubricants that just come to mind and I know there's more. So the companies that I haven't mentioned, I apologize if I'm forgetting them, but companies like Good Clean Love or Uber Lube, those are some really good companies that are really put invested in doing the research and finding lubricants that are paged and osmolarity balanced for the vagina so that it doesn't affect your page.

It also doesn't dry you out like a like a slight salt on a slug. So

Dryness, Atrophy, and Rejuvenation Options 17:28

and then now from rejuvenation standpoint, we have so many more options. I mean, anywhere from like, look, there's bio, you know, there's bioidentical or I like to call them bio equivalent because I think bioidentical has gotten a little bit of a bad rap just that term. It's the same thing, but bioequivalent meaning like what's in your body? So there's Bioequivalent hormones that can be compounded. There is a prescription bioidentical obviously that can be purchased called in. Vecsey There are DHEA prescription suppositories, which is a precursor hormone to estrogen and testosterone.

And so we have also testosterone receptors in the vaginal area. So when you apply that topically, it can it can help. And then I think what's fascinating is from an esthetic standpoint, from so from the beauty world, they've been doing things to rejuvenate our face and our skin elsewhere in our bodies for years, like lasers. And then of 1980s, they used lasers for skin rejuvenation. And then all of a sudden, in about the late like like 2014, the first laser came to the United States has been used in Europe for a lot longer.

All of a sudden they're like, Well, wait a minute, we can do it to the face. Why can't we do it to the vagina? And then that just explains coded the world of vaginal rejuvenation because they realized, wait a minute, anything that we can rejuvenate skin with by doing like a cosmetic treatment, we can just now apply it to the vagina. So then you have laser and you have radio frequency. So just to go back, why does laser work? So laser uses light energy to penetrate the tissue and it makes a microscopic injury, which sounds terrible, but it's it's actually the ultimate in biohacking because if we make a tiny microscopic injury, the body goes, Oh, wait, I need to fix that.

And so what will happen is your cells will come in and flood that area of growth factors to heal the injury. But in turn it turns on your tissue to regrow. So now we can regrow vaginal tissue without having to use topical hormones. So this is really important for people who have breast cancer, who are like nervous about using hormones or just anybody who's nervous about using hormones. So then they were like, okay, well, what other things can do? That radio frequency, which is using sound wave to generate heat, and that heat causes an injury that then is perceived by the body and causes regeneration.

Then we have red light therapy and red light therapy, something that you can actually do at home with these red light wands that you can buy. She plug off my website, the pelvic floor store, but other places do, and then things like something called carboxyl therapy. So carboxyl therapy is using carbon dioxide too, which is a gas. But they were able to figure out how to put it in a gel form. And you're like women. We breathe out carbon dioxide. How does that regenerate the vagina? Well, when you apply it or inject it into tissues like in this instance of applied non injected, it attracts oxygen into that tissue.

And so that attraction of the oxygen will actually help stimulate growth of blood vessels. So now you get more blood vessels in the tissue and the more it can grow and I think that's about it that I know of right now. They're working on tons of things, but it's so exciting that there's so many different options for people, anything from things that can be done at home to things that, you know, you can go to a doctor and have done or even actually in some states I would warn people against going to just anybody to have some of these laser treatments done.

I mean, you got to look at actually some of the laws are kind of scary. And for example, in New York State, anybody that has enough money to buy a laser can own and operate a laser. Beam. That I think is a little, you know, a little scary. But, yeah, you have to make sure you go to somebody who's been trained and been doing it for a while. Oh, I know something else. PRP, platelet rich plasma. So that's something. Where would you take your own blood and they spin it down and they pull off the platelet rich plasma, which has growth factors and that can be injected into around the vagina and some people have heard it called the O-Shot.

That's that's actually a license, a name that people can get trained in. But it may be cause called other things elsewhere that's injecting your own blood back into your body with growth factors to trigger that the vagina to regrow. So so that's that's a very extensive list. I know there's a lot of stuff which is amazing. So for someone listening, like how do they navigate? How do they know, am I, I'm dry, can I just use some estriol or DHEA internally or do I need lasers? How do how do we know how to navigate?

Yeah, you know, I think on your own sometimes it's not that easy to tell yourself. I think it's also comfort level. I think it's comfort level how how much you want to get involved with doing things because some of these procedures can be slightly uncomfortable. Not not very much. They just that day. And it also is going to be budget because some of the therapies run anywhere from, you know, you can buy a bottle of lubricant for 12 bucks all the way. You can spend a couple thousand dollars for laser treatments.

So I think one of the things that we're looking at now is in the past or up until recently, everybody was waiting and letting that tissue age and then treating it well. Once you treat something that's already kind of gone through the process, it takes more effort to try to get it back to where it needs to be. So I would actually challenge women to start thinking in maybe late thirties, 40 years, to actually start doing these treatments almost as preventative. Mm. I know because if we can keep it the way it's supposed to be or the way it's healthy, keep it that way all the time.

It's less effort and in the long run it's less money that you're going to have to do. And so when you're younger, you might just want to do like get a red light wand, which I'm surprised I don't have one here and usually have them like handy like next to me, like show and tell, but I don't right now. And these are just, well, little wand. They almost they almost look vibrators and just you put them in the vagina like 20 minutes, two or three times a week just to keep that tissue healthy. And then people are like, why red light?

What is a red light that works? They found that the wavelength of the red light actually stimulates our mitochondria, which are basically the powerhouse and the portion of our cells that that support aging. So all of our aging is happening in our mitochondria and we can keep our mitochondria healthy. Our tissue doesn't age. So that would be like an easy thing. Now if you're finding that you're having a little bit more dryness or even it doesn't even have to be a woman or a menopausal summer to menopausal.

But even women who've been on birth control, well, experiences issues or someone who's pregnant, breastfeeding the pregnancy, don't don't be messing with any lasers or anything. But but if you've already kind of gone through some changes and are having a lot of symptoms, then laser is probably your better option because it's going to be one of the quicker things that's going to get back to where it needs to be. And then in combination, you can add either topical hormones or red light or or you know, what or your your budget may just be like.

All right, well, let me just I just want to do the topical hormones and put some creams in there, you know, kind of like we put creams on our face all the time. That's the thing. I always laugh that people will be like putting like tons and tons of creams on their face, yet you have them put a cream in the vagina and they're like You. I don't want to do that. I'm like, You're just like, you're moisturizing your vagina. We're just doing the same thing, just trying to keep things healthy. There you go.

And can you just speak to because you mentioned lubrication, but lubrication doesn't fix the solution. So just to end the problems, if you could just speak to that for the. Women, that's when we use like lubricant. It's a lot of that. A lot of times people are using that sex during sex. Sometimes people are using them daily, almost to try to keep the tissue moist. It's really just going to kind of put like like a layer of moisture on. It's not going to actually go into the tissue and actually fix it.

But I know that there are a lot of companies that sell like hyaluronic acid and actually hyaluronic acid vaginal suppositories. And that's going to be I mean, that's good, but it's no more good than just putting a moisturizer on things that are actually going to change. That's not going to get the tissue to regrow. But using a lubricant during sex is great. Just make sure it's a make sure it's one that's compatible with the vagina, like a good clean love or uber lube. You know, there is a portion of the population that I've talked to that looks at vaginal lubrication almost as a sign of their sexual arousal, and they judge themselves if they're not wet enough.

And I always say like, that's like that's it's a physiological thing. It's going to dry up as we get older. It's just it doesn't mean that you're like less of a woman if you're not getting as wet or there's a lot of things that play into the factors of why the vagina gets self lubricated. And and one of the things is some people think that that's like it's like mucus coming out. It's actually blood. So our natural lubrication is actually from blood. It's what's called a trans due date. So when we become sexually aroused, the idea is that our genital areas gets blood and engorged with blood, just like a man or blood, but he gets an erection when the blood comes of that area.

The pressure of the blood coming in, well, actually, like some some of what the fluid from that blood will actually leak through the vagina.

Lubricants, Hormones, and Regenerative Treatments 28:38

And that's what causes the lubrication. It's what's called a transition. So once again, we've talked about as we get older, we lose a lot of the blood vessels in that area. So if we lose blood vessels, we can't get as much blood in the area. So this is actually really important because if you don't use it, you lose it. And so this is where if you want to actually continue to have sex, so it's kind of a catch 22 because it hurts have sex, but the more you have sex, the healthier vagina will be. So it's important that I think, you know, getting it health, getting it to the point where it's healthy from all these rejuvenating things.

But also the more blood flow you can get into an area, the better that whether that be having sex with a partner or even just self satisfying masturbation. Because I think of it as your physical therapy for your vagina, because the more you can get blood flow in there, the more you keep those blood vessel healthy, the more blood vessels you make, the better it'll be over time. So, you know, so whatever you got to do is AFC women. Unfortunately, over time, like, maybe their partners have died and they're no longer sexually active or they, they think that, you know, that that's a part that it's over in their life.

No, you got to keep using it because that no joke I've seen women to the vagina will shrink if you don't use it. Nobody will dry, but it'll shrink. I've had women where you can barely get a pinky inside of it because it will it will shrink up, but doesn't mean you can't reverse it. Because just think of B babies can come out of there. So if we can pass a baby through, the vagina can stretch back out, it just sometimes takes a little bit of physical therapy and sometimes actually that's something you need to do is actually go for physical therapy.

There are pelvic physical therapists whose sole job is to help you keep your vagina healthy. You know, whether that's just, you know, from an aging standpoint or unfortunately, you develop some sort of, you know, condition or pelvic pain kind of issue with the vagina. There are pelvic physical therapists. You know. I always think of orgasms as good medicines, so. Yes and yeah. And then you are also the wonderful hormones and the oxytocin and all these hormones that are released during an orgasm.

So, yes, you exercise, think about it as your regular activity, which actually brings up another subject about exercise. So we start losing 8% of our muscle mass every year of our life or every decade of our life starting at age 30. And people think about working out and like, you know, doing things for our arms or legs. Nobody ever thinks about the vagina. And so we have pelvic muscles that basically are in charge of our whole pelvic floor that keeps everything in our body. And so that's like doing your key goals.

And if we don't do that, we can lose our muscles and atrophy. And now we're at much higher risk for leaking of urine, having difficulty holding and bowel movements and gas, and then even losing the ability to have strong orgasms because those muscles are just floppy. So strengthening those muscles and doing those exercises are going to help keep our pelvic organs in place. To a degree. There's some other conditions where ligaments get damaged, but that's a whole other story. But keeping our pelvic organs in place, helping us with leaking of urine, helping with strength in the pelvis and helping with orgasms.

So we've got to think about working out there, too. Good. Good point. So key girls is bad enough and how should the what should the listeners should they start doing them now? Yeah. You always hear your key goals at the red lights, right, or at the stop signs. So what do. You you know what the one problem with key causes is? There's a good number of people who don't do them properly. So it's hard to figure out where those muscles are. And I'll hear a lot of women that'll come in and they'll say, Well, I do them every time I urinate because it was like printed someplace to do these.

Why urinate? Tighten up those muscles? Well, you don't want to be doing it while you're urinating because you're going to stop the flow of your urine and your bladder is going to keep pushing and the urine is going to go where the least amount of pressure is going to be back up to your kidneys and then increase your risk of kidney infection. Now, the reason they say to do it when you're urinating is just so you can figure out where those muscles are. So they are the muscles that help you stop your urine flow.

Just figure out what those muscles are. And then once you know where they are, then you can do that anywhere that you need to. But I've had other people explain it to like it tightening those muscles is similar to like the muscles you'd be using if you're trying to hold in your gas or holding in stool. Or some people like said, well, it's like if you were trying to pick up and stacked something into your vagina, like your picture, your vagina, like a straw, and you're trying to suck up a drink through a straw and you're going to like lift.

So those are great. Those are what a lot of people think of with pelvic floor, but also exercise where you could just be sitting in a chair with your legs on the floor and stick a ball between your right, between your knees and just squeeze your knees together or take a pillow and put it between you and squeeze together. That active squeezing legs together will also strengthen the pelvic floor. Or if you go to a gym, they have those abductor adductor add adding your legs together doctor machines that will also strengthen the pelvic floor.

So those are things that you can do. So awesome. So what about you mentioned of bacterial vaginosis. So what what about infections and women having urinary tract and post-menopausal? Can you speak to that? So unfortunately, after menopause, our risk of vaginal infections and bladder infection skyrockets. And it all has to do with the microbiome of the vagina. So it's a microbiome, the vagina is off. Then we're more likely to get yeast infections or bacterial infections. And a lot of times people automatically go and it's your burner discharge.

The first thing that a lot of women will do is reach for the over-the-counter yeast medication, when in fact only 12% of itching, burning discharge is yeast and 80 something percent is actually bacteria. So I always tell people you're better off reaching for boric acid work acid. You can get over the counter and there's many different companies out there. My favorite is pee Feminine, how they make one that you can find in most most supermarkets

Pelvic Floor Strength and Sexual Health 35:48

or chain pharmacies and doing a boric acid. It depends on the symptoms you can. If you really want to clear things out and rebalance the vagina, it's one suppository twice a day for two weeks and that'll really that'll really just take care of things. But sometimes people just need to put one in just if they just kind of feel a little off and helps with odor. But basically it's going to help balance out. So whether it's used or bacteria, it's going to help either way. Now the other thing is because the vagina is so close to the urethra, which is a two week throw, that bacteria can easily get up into the bladder and cause urinary tract infections.

So if you're traditional medicine, if you get a urinary tract infection, the treatment is 3 to 5 day course of antibiotics. But let's say you're a person who's getting them over and over and over again. Then it's a matter of there's an issue with the vaginal microbiome. And then even further, it may be a problem with the gut microbiome, because I've seen that especially with yeast, where women have yeast, they get treated, the yeast in the vagina goes away and it comes back and then they get treated and it goes away.

They come back. Well, I can tell you with no uncertainty that a majority of those cases are people that are having yeast in their gut. And then we look back on like what causes yeast that diets high in sugar and even inflammatory food with a gluten and dairy can throw off the microbiome of our gut, which then causes an overgrowth of yeast. And then if we remember the gut and it gets giant in and becomes this whole circular thing and like we talked before, now you don't have any sex drive because you've thrown off the microbiome with the vagina that's going back to the brain.

So it's all connected and I could do that circulating for hours. So the nibble is connected to the shinbone. Exactly. Exactly. Oh, wow. Such amazing and important information. What is there anything else that I didn't ask that you think's important to share for just overall vaginal health? You know, I think when it comes to just health in general, I always tell people that total health is like a three legged stool with body, mind and spirit. And if all three legs are not even that stool tips over.

So when we talk about vaginal, we can't just look at vaginal health. We need to look at what is your diet because that's affecting your gut health, that's affecting your vagina. What is your stress level if you are stressed because of, you know, work or life or family or just you know, anything that's going to throw off not only your hormones, but that can throw off and start making too much cortisol that makes you more susceptible to infection, especially with yeast. So we really need to be looking at what can we do for the brain, what can we do for the spirit?

I mean, that may be just, you know, spending time with family and friends. So we need to look at all aspects, not just for total wellness, but also for for pelvic and imaginal wellness. And then I think other than decreasing stress levels and eating healthy and being healthy, the two things we always forget are sleep and hydration. 75% of Americans are chronically dehydrated. If we don't drink enough fluids, then that affects our bladder health. And also, well, if we're having issues of dryness, we're dehydrated, then our tissues not getting moisturized from basically the inside.

So we need to be drinking a lot more fluid. And, you know, you're drinking enough when your pee is clear, pee clear, because everyone's always asking how much water. I'm like, pee clear, you're drinking enough. So and sleep. You know, as Americans, we don't get enough sleep and anything under 8 hours of sleep only decreases lifespan, increases our risk of obesity, and also increases our risk of not not healing and affecting our immune system. So we got to put all those things together, not only to keep our vagina healthy, but to keep everything healthy.

And sometimes the vagina is the first sign that something more serious is going on. And it may be the vagina having problems because it's your body screaming for help, saying like you're not feeding me right. You're not sleeping right. You're too stressed. You might not show up anywhere else and the vagina may be the first place that shows up. And then we ignore it. And then next thing you know, we're having other health problems. So basically, listen to your vagina is trying to tell you something.

Your vagina is speaking during that period. So I also want to just ask because you mentioned and it's a very important point about the vagina being acidic because a lot of times we think we need to alkaline to be healthy. And there are important parts of the body that like the stomach and so and the vagina. So how could someone figure out if their vagina is the right age gas? So interestingly enough, you can get p, h, p four and actually tests. And so we actually go over this and I have a vagina reboot course and we go over how to test this and how to evaluate it.

But it's really simple. I mean, you could even just take a tiny Q-Tip and just put it into the vagina and you want to get p p for a specific range. It's usually a range of 3.5 to 5.5. So we have it on our website. You can find it elsewhere because any the normal peer to the vagina should be between 3.5 and 4.5. So anything higher than that is there's something out of balance. Now, the only thing that gets a little tricky about that is yeast can survive in lower, lower acid environments. So like more it can be in a low I mean, a lower and more acidic environment.

So having symptoms on the beach is normal. Doesn't mean that things are fine. You need to always check, you know, check out what the symptoms are. And, you know, from a standpoint of at home, you can always try because I know some of these things always happen on a Friday night at 5:00 when all your doctors are closed. And then you've got to wait until Monday to again see what I know. It happens all the time. So I would reach more for the boric acid before you go for anything else. And important thing is stay away from Duchenne.

A lot of people want to feel fresh and you know, first of all, the washing

Infections, pH Balance, and Daily Care 42:58

and the soaps, you know, our vagina wasn't ever meant to smell like roses. We don't need, you know, floral spring scented vaginas because a lot of the products do contain irritants to the tissue that can further throw off the page and the microbiome inducing that we have an open system. So the vagina is connected to the cervix in the uterus. And then we have the university of the fallopian tube. The fallopian tubes are open to our abdominal cavity. So the problem with doing that, when you you squeeze this water and this fluid into the vagina, if we're squeezing too hard and we don't know how hard we're squeezing, we could be flushing things back into our abdominal cavity.

You don't want to be flushing yeast and bacteria that shouldn't be there into our abdominal cavity and you get really sick. So stay away from the in the the thing there. And honestly water is your best friend when it comes to washing without using anything else though I have to say I am actually really excited. So I said about the feminine health company that I love. They just came out with a boric acid wash there. Now I find that that one is more is more balanced. If you feel like you need some kind of like soap out of the boric acid wash, but in general, water, all you really need.

Well, a lot of the soaps in detergents are more irritating than they're than they're worth now, which actually also is one of the problems in some people with toilet paper, because toilet paper is often bleached, make it white. And so some people that bleached toilet paper can be very irritating. So nowadays you can find unbleached if you're finding problems, especially with as we get into menopause that it's is more dry, can be more sensitive. There are companies that make unbleached toilet paper, bamboo toilet paper.

So those are some things if you're having a problem, you're not having a problem, you can use those. But you know, things you got to think about. Like if you're irritated, what could be causing it with the detergent you wash your clothes in. I always tell people, especially underwear wash in like dye free and fragrance, not unscented scented because unscented laundry detergents actually contained scents to cover up the chemical sense of the the soap or the detergent you want, like on fragrance, on dyed soaps to wash your underwear, anything that's touching that skin is going to make you irritated.

This is why if you're using any kind of pads or even like pads for incontinence, you're getting little leaking. You want to put those pads are bleached. So lots of different things that can be causing irritation down there. Yeah, I'm glad we I'm glad we went there because that's super important. And I'm you know, I'm a fan of bamboo, organic, natural, whether you're struggling or not. Like, you know, prevention, you were saying is is the best cure. And so. You let it breathe to at night. Like either.

Don't wear. Anything or wear very thin. Things that are very loose because, you know, when we're wearing lightweight and constricted clothing where it's holding in moisture and yeast especially likes a warm, wet, dark environment, well, that's the vagina, especially in clothing. So let her. Out. Yeah, I tell you, I'm wearing a dress right now, and I got no underwear on. Yeah. Yeah, actually, I'm wearing sweatpants with no underwear at nighttime. When I come home, I, like. Fell in fashion from the doctors here, too.

So it's all. Underwear? Absolutely. Yeah. Let it breathe. That was. That was fantastic. I think we covered a lot of ground and ended on it and some important good notes. So thank you for you know, it's funny, as you're talking for a minute, I was thinking about like the mouse and how we we've so been taught that the mouse and oral health and the teeth are separate from our body and we just go to the dentist for cleaning. And our mouth is such a breeding ground for disease processes that we experience.

And so it's kind of like the forgotten mouth, the forgotten vagina, like these orifices are are part, part of full body health. And so I hope that from being here and listening to Dr.

Whole-Body Wellness and Where to Find Dr. Betsy 47:48

Betsy's wisdom, you can bring your vagina home to being part of your body and embracing it and not being not buying into any of the weird stick by it. It's part of your body. It needs TLC, it needs love, it needs attention, it needs prevention, it needs treatments. And so I hope that you you have a lot to take away from this talk that's super important as you are mastering your transition and your hormonal journey and aging and growing and being a woman and being a sexual being and all of these wonderful things that we get experience.

So thank you for for bringing the juice and bringing the conversation and for all that you do. And where can people find you or so? First of all, I'm all over social media. As long as I don't get kicked off again using the word vagina. But come follow me, especially on Instagram at Dr. Betsy Greenleaf. Currently is Dr. Betsy Greenleaf underscore. But if you look me up at anywhere in Dr. Greenleaf or Dr. Greenleaf underscore Dr., I think it's Dr. B Greenleaf on Twitter. You can find me there. I have a website drbetsygreenleaf.com and there's also the pelvicfloorstore.com And so we'll be putting some information on those sites about different courses and programs we're doing so you can find me there.

So again, her Instagram videos are a lot of fun. So I highly recommend. Yeah. And I'm working on Tiktok that's my name. My next thing I'm trying that I got I got so many ideas for videos up here and not enough time to do them. I just look forward to that. So thank you for for being here and sharing with us and to all of you and left a lot to integrate and think about that really, really important. That's why I wanted it to be a part of the summit. So be well. See you soon.