The Unseen Bond: Your Brain, Gut, And Vagina

Sharon Stills, ND

Hi, everyone. Welcome back to Mastering the Menopause Transition Summit. I’m your host, Dr. Sharon Stills. I got another redhead here with me today and we are gonna have a talk about vaginal health. 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 this is a whole body thing we’re talking about here. I have my dear friend and colleague Dr. Betsy Greenleaf with me. She’s a premier woman’s health expert. She’s a bestselling author, an entrepreneur, an inventor, business leader, specializing 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 neuro-gynecology. She possesses a professional reputation that has led to being sought after biomedical societies, associations, and corporations to provide lectures, teaching, advanced training. She’s got just a laundry list of accolades and I’ll let her tell you about herself. And she’s also funny. So we’re probably gonna chuckle a little in this talk too. So welcome Betsy, I’m thrilled you’re here. And we finally got this to work through all our technical difficulties.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Oh, I’m so excited to be here. So thank you so much Sharon, for inviting me. I always love talking to you. This is a fun topic, even though I know a lot of people are like, “What?”

Sharon Stills, ND

So is there anything else about you before we dive in that you want the ladies to know your story, how you ended up doing what you’re doing?

Betsy Greenleaf, DO, FACOOG (Distinguished)

They can always read that stuff online, but I definitely did not wanna grow up and be a gynecologist that was definitely not on my list of things to do as a five-year-old. I always joke about that. In fact, when I went to medical school, I was like, “Oh my God, why would anybody look at that all day long?” Patients always asked me that. Actually in fact, one of my good friends, she’s a podiatrist. Iremember during residency, we were sitting across the table from each other eating lunch, and I was like, “Ew, how do you look at people’s nasty feet all day long?” And she almost choked on her sandwich and she’s like, “Are you serious?” I was like, “Oh, yeah, yeah.” You know what? You just become desensitized when you’re going to the medical field about what you’re looking at. Really it was just that I wanted to help women and women’s health so.

Sharon Stills, ND

Well, and the vagina is such a beautiful part of our anatomy and so unique and has so many magical qualities. So, let’s dive in, because you are like America’s vagina doctor.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, I think that the biggest thing that’s 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. I really think that that’s kind of sad. But I realize that there’s a lot of shame and embarrassment, 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? 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. Even though I say vagina all the time, vagina is actually just the tube, the inner tube, when really the vulva is the outer part, and the labia, which are the outer lips, but I’m just happy if people say the word vagina. If you use vagina just to refer to everything down there, I’m perfectly happy with that. So as long as we’re talking about that area, I’m happy. I think eventually, we’ll get to the point where we can use that word and people won’t get kicked off Instagram, like somebody I know, or get blocked by social media, because vagina goes against community standards.

Sharon Stills, ND

So, well, and so, if you’re listening and you wanna say the word vagina with us, we’ll do it on 3. 1, 2, 3 vagina.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Vagina.

Sharon Stills, ND

If you feel triggered by that word, then 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 body part. Somehow, it got so like you said, censored. We can say elbow. We can say lung, we can say heart, but vagina is not okay to say. So, it’s just part of your body. 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 pleasure can happen there, babies come through there, there’s a lot going on there. So it’s an important part of our anatomy. 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. 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 having a relationship with our vagina is important.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, I think a lot of people don’t even think about that area until they have a problem. Then when you have a problem, that’s all you think about.

Sharon Stills, ND

That is true.

Betsy Greenleaf, DO, FACOOG (Distinguished)

So that’s how I kinda see my job is not only just normalizing the conversation, but I wanna get you to the point where you kind of forget about it, but not forget about it, ignore it, but 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 the mirror, that is key, because I always tell patients your body parts are with you all the time. So, you’re gonna trust your doctor to just look at something once a year. Now some of the recommendations with Pap smears especially, are not even to do Pap smears until every three years. Then even after the age of 70, they’re saying you don’t need to do them anymore. 

So, women are interpreting this like, “Oh, I just don’t need to go to the gynecologist,” or you see women, they go, because they’re having babies and then they’ve had their babies and then they just stop going. First of all, you need to have those areas checked. Second of all, what better way to check it is to look at it yourself. I say vaginal exams with mirrors to see, make sure things look… Figure out what it looks like normally, so that if something’s a little outta whack you can be like, “Oh wait, that’s something different.” The same thing I tell people say in their breasts, I’m like, “Breast are with you all the time.” You’re more likely to find lumps and bumps than your doctor that’s just checking once a year.

Sharon Stills, ND

Exactly, I was just thinking the same thing. So you took the words right out of my mouth. Exactly, we check our breasts, we get to know them. We need to know our vagina, because what you said, I mean, we need guides and doctors and teams, but we are with ourselves 24/7, and we should know ourselves the best. By inspecting and getting acquainted, that’s a good way to start. So, there’s a lot to talk about. Where do we start? Let’s talk about first, how the vagina’s 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.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, this is just fascinating. I think being like as an osteopathic physician, and you would know also as a like a naturopath, we, coming from a natural world, we tend to connect everything. 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. If you haven’t heard about what a microbiome is, it’s just the little kind of universes of bacteria that live on our body and within our body and each of our areas have different microbiomes. So our skin has different bacteria living on it than our mouth, than our gut, than our vagina. So, it’s when that bacteria goes out of balance that we tend to have problems. So starting, this is where, when you get the brain, the gut and 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’s usually, because we should have lactobacillus, which is a type of bacteria that lives within our vagina that keeps us healthy, we need it there, ’cause 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. 

The reason why the lactobacillus wants to live there is when we’re younger and our tissue is nice and thick and healthy, it’s actively growing. As it’s actively growing, those old cells are sloughing off. Those old cells contain glycogen. Glycogen is the food source for the lactobacillus. So our old cells are feeding the lactobacillus and in return, the lactobacillus produces hydrogen peroxide. It acidifies our vagina. The vagina’s pretty, like acid level. It’s like 3.5 to 4.5 is a normal acidity for the vagina. Water is seven, so on the pH scale. So when everything’s in balance, that is great. What happens is many things throw off that pH balance and basically kill off our healthy bacteria. Anything from stress to being on antibiotics, to as we get older, that tissue starts to thin 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 vaginal tissue. 

So, when the balance of that bacteria is off 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. So if the gut bacteria is off, now, we also have bacteria or yeast from the gut getting to the vagina and causing these issues. I think, one of the things I find super-interesting is, in the past, traditional medicine we’d be like, “Oh, that’s just a yeast infection,” or, “That’s BV, bacterial vaginosis.” We’re like, “Oh, that’s just an infection.” Didn’t think it had any other connection to anything else in our bodies. But now they’re finding out that if the microbiome with a 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 as humans, we’re supposed to be reproducing and making more humans. If our systems are not perfectly in balance, the body’s gonna be like, oh, that’s not a great time to be reproducing, or the body’s gonna sense it as a stress. So, that the brain is gonna then shut down our hormones, which may show up in some people that are younger having babies, it may show up as infertility 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, at points in my life before I knew any better about this information thinking like, “Oh, well, having a low sex drive, I must need more hormones.” Then you go to the doctor and you ask for hormones when hormones 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 sensing that things aren’t right.” So I think that in science, the scientists are actually studying this now and it’s just incredibly fascinating.

Sharon Stills, ND

So it 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, 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. Many women I see come to me who just stopped having sex because it hurt, which is so sad to me. So can you speak to that?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, so unfortunately, 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 very full and actively growing. Like we said before, it’s feeding the lactobacillus. But the other thing is when we start, when that tissue starts to thin out, it also loses its elasticity. So, we start losing our collagen and our elastin. These are the chemicals and our skin or in our vaginal tissue, that makes things stretchy. So what happens is not only is the vagina 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 complete, it feels like cut glass when they’re having sex, ’cause basically, the tissue is stretching and ripping. This is true. Some women will come in and say like, “I feel like I’m getting ripped open,” and it is kind of true. 

The tissue is tearing and becomes very uncomfortable. We also start losing the blood vessels that feed that tissue, start to retract. So this is another reason why if women are on systemic hormones, they’re taking hormone replacement, whether it’s a pill or a patch or a palette and they’re like, “Well, it’s not still not helping my vagina.” Well, yeah, ’cause you don’t have the blood vessels that you can take those hormones to the vagina to feed that tissue, to make it grow nice and thick and healthy. So, it’s kind of like trying to grow a plant, but not having any fertilizer or any nutrients in your soil, nothing’s gonna grow. So then there are tons and tons of different things now, to help rejuvenate the vagina. I mean, just 10 years ago, all we had were topical hormones 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 gonna throw some under the bus here, but things like Premarin and Estrace, 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 you can actually be using it and actually causing more irritation or women will use vaginal lubricants or use lubricants like KY jelly when they’re having sex and you go, “Well, that’s gonna make things better.” Well, they’ve done a lot of research on the pH balance of the KY and something called osmolarity. Osmolarity has to do with to get scientific, it’s like the solute concentration. It’s basically, how moisturizing or how drying something is to tissue. KY almost gets to the point where it’s almost like pouring salt on your tissue. You imagine pouring salt on a slug and it shrivels up. So you’re using KY, because you want the lubrication, but it’s actually drying at 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, two 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 Uberlube. Those are, there are some really good companies that have really put, invested in doing the research and finding lubricants that are pH and osmolarity balanced for the vagina so that it doesn’t affect your pH, it also doesn’t dry you out like a salt on a slug. So, and then now from a rejuvenation standpoint, we have so many more options. I mean, anywhere from let’s look at there’s bioidentical, or I like to call them ‘bioequivalent,’ cause I think bioidentical has gotten a little bit of a bad rap. Just that term. It’s the same thing, but bioequivalent meaning what’s in your body. So there’s bioequivalent hormones that can be compounded. There’s a prescription bioidentical ovule that can be purchased called IMVEXXY. There are DHEA prescription suppositories, which DHEA is a precursor hormone to estrogen testosterone. We have also testosterone receptors in the vaginal area. So when you apply that topically, it can help. I think what’s fascinating is from an aesthetic standpoint, 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. I mean, since the 1980s, they’ve used lasers for skin rejuvenation, and then all of a sudden in about the late 2014, the first laser came to the United States. 

It’s been used in Europe a lot longer, all of a sudden they’re like, “Well, wait a minute, if we can do it to the face, why can’t we do it to the vagina?” Then that just exploded the world of vaginal rejuvenation, because they realized, wait a minute, anything that we can rejuvenate skin with by doing to like a cosmetic treatment, we can just now apply that to the vagina. So then you have laser and you have radiofrequency. So just to go back a look, 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 actually the ultimate in bio-hacking, because if we make a tiny microscopic injury, the body goes, “Oh wait, I need to fix that.” So, what’ll happen is your cells will come in and flood that area with 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 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?” Radiofrequency, 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. Red light therapy’s something that you can actually do at home with these red light wands that you can buy, cheap plug off my website, The Pelvic Floor Store, but there are other places too. Then things like something called carboxy therapy. So carboxy therapy is using carbon dioxide to which is a gas, but they we’re able to figure out how to put it in a gel form.  You’re like, “Wait a minute, 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, it’s applied, not injected, it attracts oxygen into that tissue. 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. Yeah, I think that’s about it that I know of right now. They’re still working on tons of things, but it’s just so exciting that there’s so many different options for people, anything from things that could be done at home to things that 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 gotta look, some of the laws are kinda scary. Like for example, in New York State, anybody that has enough money to buy a laser can own and operate a laser. That I think is a little scary, but yeah, I wanna 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 you take your own blood and they split it down and they pull off the platelet-rich plasma, which has growth factors. That can be injected into around the vagina. Some people have heard it called the O shot. That’s actually a licensable name that people can get trained in, but it maybe called other things elsewhere. But that’s injecting your own blood back into your body with growth factors to trigger the vagina to regrow.

Sharon Stills, ND

So that’s a very extensive list.

Betsy Greenleaf, DO, FACOOG (Distinguished)

I know there’s a lot of stuff.

Sharon Stills, ND

Which is amazing. So for someone listening, like how do they navigate? How do they know? I’m dry, can I just use some Estriol or DHEA internally, or do I need lasers? How do we know how to navigate that?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, 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 much you wanna get involved with doing things, ’cause some of these procedures can be slightly uncomfortable. Not very much, usually just that day. It also, is gonna be budget, because some of the therapies run anywhere from, you can buy a bottle of lubricant for $12 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, forties to actually start doing these treatments almost as preventative.

Sharon Stills, ND

I love that.

Betsy Greenleaf, DO, FACOOG (Distinguished)

So, because if we can keep it the way it’s supposed to be or the way it’s healthy and just keep it that way all the time, it’s less effort, and in the long run, it’s less money than you’re gonna have to do. And so when you’re younger, you might just wanna do, get a red light wand, which I’m surprised I don’t have one to hand. Usually, I have them handy, next to me, like show and tell, but I don’t right now. These are just the little wands. They almost look like vibrators and just, you put them in the vagina 20 minutes, two, three times a week just to keep that tissue healthy. They found and people are like, “Well, why red light? What is it about 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 ourselves that support aging. So all of our aging is happening in our mitochondria. If we can keep our mitochondria healthy, our tissue doesn’t age. So that would be like an easier thing. Now, if you’re finding that you’re having a little bit more dryness or even it doesn’t even have to be women who are menopausal. 

Some are menopausal, but even women who’ve been on birth control will experience these issues or someone who’s pregnant and breastfeeding. Though pregnancy, don’t be messing with any lasers or anything. But if you’ve already kind of gone through some changes and are having a lot of symptoms, then a laser is probably your better option, ’cause it’s gonna be one of the quicker things that’s gonna get things back to where it needs to be. Then in combination you can add either topical hormones or red light. Or you know what? Or your budget may just be like, all right, well, let me just, I just wanna do the topical hormones and put some creams in there. Kinda like we put creams on our face all the time. That’s the thing I always laugh at. People will be putting tons and tons of creams on their face, yet you have them put a cream in the vagina and they’re like, “Ew, I don’t wanna 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.

Sharon Stills, ND

There you go. Can you just speak to ’cause you mentioned lubrication, but lubrication doesn’t fix the solution. So just to fix the problem. So if you could just speak to that for the women.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, so when we use lubricants, a lot of times people are using SAC during sex. Sometimes people are using them daily almost to try to keep the tissue moist. It’s really just gonna kind of put a layer of moisture on it. It’s not gonna actually go into the tissue and actually fix it. But I know that there are a lot of companies that sell hyaluronic acid. Actually hyaluronic acid, vaginal suppositories. That’s gonna be, I mean, that’s good, but it’s no more good than just putting a moisturizer on things. It’s not actually gonna change the tissue. It’s not gonna get the tissue to regrow, but using the lubricant during sex is great. Just make sure it’s one that’s compatible with the vagina, like a Good Clean Love or Uberlube. 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. I always say it’s a physiological thing. It’s gonna dry up as we get older. It doesn’t mean that you’re 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. One of the things is some people think that that’s like mucus coming out. It’s actually blood. So our natural lubrication is actually from blood it’s what’s called a transudate. So when we become sexually aroused, the idea is that our genital areas gets flooded and engorged with blood, just like a man gets engorged with blood, but he gets an erection. 

When the blood comes into that area, the pressure of the blood coming in, some of what the fluid from that blood will actually leak through the vagina, and that’s what causes the lubrication. It’s what’s called a transudate. So once again, we’ve talked about it. 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. This is where if you want to actually continue to have sex. So it’s kind of, it’s catch-22, because it hurts to have sex, but the more you have sex, the healthier your vagina will be. So it’s important that I think, getting it to the point where it’s healthy from all these rejuvenating things, but also, the more blood flow you can get into the area, the better, and whether that be having sex with a partner or even just self-satisfying, masturbation, because 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 vessels healthy, the more blood vessels you make and the better it’ll be over time. 

So, do whatever you gotta do. I’ve seen women, unfortunately over time, who’ve maybe their partners have died and they’re no longer sexually active or they think that that’s a part, that that’s over in their life. No, you gotta keep using it, because no joke. I have seen women too. The vagina will shrink if you don’t use it, not only will it dry, but it’ll shrink. I’ve had women where you can barely get a pinky inside of it, because it will shrink up. But doesn’t mean you can’t reverse it, because just think, babies can come out of there. So if we can pass a baby through this 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, whether that’s just from an aging standpoint or unfortunately, if you develop some sort of condition or pelvic pain kind of issue with the vagina, there are pelvic physical therapists.

Sharon Stills, ND

I always think of orgasms as good medicine.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Well then, yeah. Then you got also the wonderful hormones and oxytocin and all these hormones that are released during an orgasm. So yes, exercise. They think about it as your regular exercise, which actually brings up another subject about exercise. So we start losing eight percent of our muscle mass every year of our life or every decade of our life, starting at age 30. People think about working out and doing things for our arms and our legs. Nobody ever thinks about the vagina. We have pelvic muscles that basically are in charge of our whole pelvic floor that keeps everything in our body. That’s like doing your kegels. If we don’t do that, we can lose, our muscles can thin out in atrophy. Now we’re at much higher risk for leaking of urine, having difficulty holding in 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 kegel exercises are gonna help with keeping our pelvic organs in place to a degree. There’s some other conditions where ligaments get damaged, but that’s a whole nother story, but keeping our pelvic organs in place, helping us with leaking of urine, helping with strengthen the pelvis and even helping with orgasms. So we gotta think about working out there too.

Sharon Stills, ND

Good, good point. So kegels is that enough? What should the listeners, should they start doing ’em now? You always hear, “Do your kegels at the red lights, or at the stop sign.” So what do you-

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, you know what the one problem with kegels is? Is there’s a good number of people who don’t do them properly. So sometimes 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 some place to do these while you urinate, tighten up those muscles. Well, you don’t wanna be doing it while you’re urinating, because you’re gonna stop the flow of your urine and your bladder’s gonna keep pushing, and the urine’s gonna go where the least amount of pressure is. It could 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 where those muscles are, and then what you know where they are then you can do that anywhere that you need to, but I’ve had other people explain it too. Tightening those muscles is similar to the muscles you’d be using if you’re trying to hold in your gas or holding in stool, or some people have said, “Well, it’s like, if you were trying to pick up and suck something into your vagina.” Picture your vagina like a straw and you’re trying to suck up a drink through a straw and you’re gonna lift. So kegels are great, those are what a lot of people think of with pelvic floor, but also there’s exercises where you could just be sitting in a chair with your legs on the floor and stick a ball right between your knees and just squeeze your knees together, or take a pillow and put it between your knees and squeeze together. That act of squeezing the legs together will also strengthen the pelvic floor. Or if you go to a gym, they have those adductors, adding your legs together, adductor machines that will also strengthen the pelvic floor. So those are things that you can do.

Sharon Stills, ND

Awesome. So what about, you mentioned BV, bacterial vaginosis. So what about infections and women having urinary tract and postmenopausal, can you speak to that?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, so unfortunately after menopause, our risk of vaginal infections and bladder infections, skyrockets, and it all has to do with the microbiome of the vagina. So if a microbiome of the vagina is off, then we’re more likely to get yeast infections, the bacterial infections. A lot of times, people automatically go reach, anytime they itch or burn or 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. 80-something percent is actually bacteria. So I always tell people you’re better off reaching for boric acid. Boric acid you can get over the counter and there’s many different companies out there. My favorite is pH-D Feminine Health. They make one that you can find in most supermarkets or chain pharmacies. Doing a boric acid, it depends on the symptoms. You can if you really wanna clear things out and rebalance the vagina. It’s one suppository twice a day for two weeks. That’ll really just take care of things. But sometimes people just need to put one in just if they just kind of feeling a little off, it helps with odor, but basically, it’s gonna help balance the pH. 

So whether it’s yeast or bacteria, it’s gonna help either way. Now, the other thing is because the vagina is so close to the urethra, which is a two-way pee through that bacteria can easily get up into the bladder and cause urinary tract infections. So traditional medicine, if you get a urinary tract infection, the treatment is three to five 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, ’cause I’ve seen that, especially with yeast where women have yeast, they get treated, the yeast and the vagina goes away and it comes back and then they get treated and it goes away and it comes back. Well, I can tell you with no uncertainty that a majority of those cases are people that are having yeast in their gut. Then we look back at what causes yeast in the gut, diets high in sugar and even inflammatory foods and gluten and dairy can throw off the microbiome of our gut, which then causes an overgrowth of yeast. Then, if we have over-rid the yeast in the gut, then it gets near the vagina and then becomes this whole circular thing. We talked before, and 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, yeah, it’s all connected, but I could do that circularly for hours.

Sharon Stills, ND

The knee bone’s connected to the shin bone.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Exactly, exactly.

Sharon Stills, ND

Oh, wow. Such amazing and important information. Is there anything else that I didn’t ask that you think is important to share for just overall vaginal health?

Betsy Greenleaf, DO, FACOOG (Distinguished)

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. If all three legs are not even, that stool tips over. So when we talk about vaginal health, we can’t just look at vaginal health. We need to look at what is your diet, because if that’s affecting your gut health, that’s affecting your vagina. What is your stress level? If you are stressed, because of work or life or family, or just anything, that’s gonna throw off, not only your hormones, but that can throw off and you start making too much cortisol, that makes you more susceptible to infections, especially with yeast. So we really need to be looking at what we can do for the brain? What can we do for the spirit? I mean, that may be just spending time with family and friends. So we need to look at all aspects, not just for total wellness, but also for pelvic and vaginal wellness. Then, I think that 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, don’t drink enough fluids, then that affects our bladder health. Also we’ll, if we’re having issues with vaginal dryness, if we’re dehydrated, then our tissue’s 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 you’re pee is clear. 

So pee clear, ’cause always everyone’s always asking, well, how much water? I’m like, “Pee clear, you’re drinking enough.” Sleep, as Americans, we don’t get enough sleep and anything under eight hours of sleep, not only decreases lifespan, but increases our risk of obesity and also increases our risk of not healing and affecting our immune system. So we gotta put all those things together not only to keep our vagina healthy, but to keep everything healthy. Sometimes the vagina is the first sign that something more serious is going on and it may be the vagina is having problems ’cause it’s your body screaming for help saying like, “You’re not feeding me right. You’re not sleeping right. You’re too stressed.” It might not show up anywhere else. The vagina may be the first place it shows up and then we ignore it and then next thing you know we’re having other health problems. So basically, listen to your vaginas, trying to tell you something.

Sharon Stills, ND

Your vagina is speaking. Don’t ignore it. So I also wanna just ask, ’cause you mentioned, and it’s a very important point about the vagina being acidic, because a lot of times we think we need to be 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 pH?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, so interestingly enough, you can get pH paper and actually test. 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 wanna get pH paper in 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 the normal pH of 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 acid environment. So it can be in a, I mean, a lower pH, a more acidic environment. So if you’re still having symptoms and the pH is normal, doesn’t mean that things are fine. You need to always check out what the symptoms are. And from a standpoint of, at home, you could always try, ’cause I know sometimes these things always happen on a Friday night at five o’clock when all your doctors are closed and then you gotta wait until Monday to get, see the doc. I know it happens all the time. So I would reach more for the boric acid before you go for anything else. 

An important thing is stay away from douching. A lot of people wanna feel fresh and first of all, the douching and the soaps, a vagina wasn’t ever meant to smell like roses, we don’t need floral spring scented vaginas, because a lot of these products do contain irritants to the tissue that can further throw off the pH of the microbiome. We have an open system. So the vagina is connected through to the cervix and the uterus. Then coming out of the uterus, you have the fallopian tubes and the fallopian tubes are open to our abdominal cavity. So the problem with douching is that when 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 abdominal cavity. You don’t wanna be flushing yeast and bacteria that shouldn’t be there into abdominal cavity and you get really sick. So stay away from the douching altogether. 

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 pH-D Feminine Health company that I love. They just came out with a boric acid wash. So I find that that one is more balanced. So if you feel like you need some kind of soap, I would go for more of the boric acid wash, but in general, water is all you really need. Well, a lot of the soaps and detergents are more irritating than they’re worth. So, which actually also is one of the problems, some people with toilet paper, because toilet paper is often bleached to make it white. To some people, the bleached toilet paper can be very irritating. So nowadays, you can find… If you’re finding problems, especially, as we get into menopause that tissues 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. If you’re not having a problem, you can use those. But things you gotta think about like if you’re irritated, okay, what could be causing it? The detergents you washed your clothes in, I always tell people, especially the underwear wash ’em in dye-free unfragranced, not unscented, because unscented laundry detergents actually contain scents to cover up the chemical scents of the soap or the detergent you want unfragranced, undyed soaps to wash your underwear, ’cause anything that’s touching that skin is gonna make you irritated. This is why if you’re using any kind of pads or even pads for incontinence, if you’re getting a little leaking, you want it, sometimes those pads are bleached. So lots of different things that can be causing irritation down there.

Sharon Stills, ND

Yeah, I’m glad we went there ’cause that’s super-important. I’m a fan of bamboo, organic, natural, whether you’re struggling or not. Prevention you were saying is the best cure.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Let it breathe too. At night, either don’t wear anything or wear very thin things that are very loose, because when we’re wearing tight and constrictive clothing, we’re holding in moisture and yeast, especially likes a warm, wet, dark environment. Well, that’s the vagina, especially in clothing. So let her out.

Sharon Stills, ND

Yeah, I’ll tell ya, I’m wearing a dress right now and I got no underwear on.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, I’m wearing blue sweatpants with no underwear. ’cause at nighttime when I come home, I like from-

Sharon Stills, ND

Full confession from the doctors here.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yes.

Sharon Stills, ND

You have permission to-

Betsy Greenleaf, DO, FACOOG (Distinguished)

It’s all off.

Sharon Stills, ND

Take off you underwear, absolutely.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, let it breathe.

Sharon Stills, ND

Well, that was fantastic. I think we covered a lot of ground and ended on some important, good notes. So thank you for… It’s funny as you were talking for a minute, I was thinking about the mouth and how we’ve so been taught that the mouth and oral health and the teeth are separate from our body and we just go to the dentist for a cleaning and our mouth is such a breeding ground for disease processes that we experience. It’s kind of like the forgotten mouth, the forgotten vagina, these orifices are part of full body health.  I hope that from being here and listening to Dr 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 stigma. It’s part of your body. It needs TLC, it needs love, it needs attention, it needs prevention, it needs treatments. I hope that 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 to experience. So thank you for bringing the juice and bringing the conversation and for all that you do and where can people find you?

Betsy Greenleaf, DO, FACOOG (Distinguished)

Sure, so first of all, I’m all over social media as long as I don’t get kicked off again, for saying the word vagina, but come follow me, especially on Instagram @drbetsygreenleaf. Currently, is Dr. Betsy Greenleaf underscore. But if you look me up at anywhere in Dr. Greenleaf or Dr. Greenleaf underscore or I think it’s Dr. B Greenleaf on Twitter, you can find me in there. I have a website drbetsygreenleaf.com and there’s also the pelvicfloorstore.com. We’ll be putting some information on those sites about different courses and programs we’re doing. So yeah, come find me there.

Sharon Stills, ND

Awesome. Her Instagram videos are a lot of fun. So highly recommended.

Betsy Greenleaf, DO, FACOOG (Distinguished)

Yeah, and I’m working on TikTok, that’s my next thing I’m trying. I got so many ideas for videos up here and not enough time to do ’em.

Sharon Stills, ND

I agree.

Betsy Greenleaf, DO, FACOOG (Distinguished)

They’ll keep coming.

Sharon Stills, ND

I’ll look forward to that. So thank you for being here and sharing with us and to all of you, lot’s of, lot’s of integrate and think about, but really, really important. That’s why I wanted it to be a part of the summit. So, be well.