The Vaginal Microbiome: Restoring Intimacy and Health in Menopause

Introduction to Vaginal Health in Menopause 0:00

Today's conversation is about one of the most important, yet least talked about aspects of menopause. I'm talking about vaginal health and intimacy, and many women believe that vaginal dryness, discomfort, recurrent infections, painful intercourse, or a loss of intimacy are simply things they have to accept as they age. But the truth is, these changes are often connected to shifts in menopause, connected to the vaginal microbiome and even the health of the surrounding tissues, and there are effective ways to support them.

My guest today is Doctor Anna Cabeca, better known as the Girlfriend Doctor. She's a triple board certified ob gyn. She's a bestselling author and international speaker, and one of the leading experts in women's hormones, sexual health, and healthy aging. And through decades of clinical experience and her research in integrative and functional medicine, she's helped thousands of women restore confidence, intimacy, and quality of life during perimenopause and menopause. Welcome, doctor Anna Cabeca.

We're so happy to have you here today. I am thrilled to be here with you and with your audience. This is such an important topic. I'm passionate about talking about it. I know you are. And there's nobody I trust more to come in and talk about this. We're going to have a conversation that more women need to hear today about the vaginal microbiome, intimacy, hormones, and the practical solutions that can help women thrive during this next chapter in their life. So thank you for being such an open book and supporting women.

I want to jump right in to the vaginal microbiome because, you know, this is a really important topic. But when we think about microbiome, I think a lot of people's brains just go straight to the gut. I mean, we're so familiar with the gut microbiome, not the vagina and the vaginal microbiome. So why is this microbiome so important during Perry and menopause and why? You know, I think what's even more important is why are we just hearing about it now? Why has it been overlooked for so long in conversations about women's health and intimacy?

Yeah, no, it's a really good question. I would tell you in general, women's health research is and it's positive. And so it's been it's so important in the obstetric world as a ob gyn, you know, the conversations about vaginal seeding in babies with C-section, in other words, to take some of the vaginal fluid at the time of a C-section to get it into the baby's nose and oral passageways that would make a difference in their immune system and everything. So we started talking about these things.

Why the Vaginal Microbiome Matters 2:26

But really, you know, we think about it always. The gut microbiome comes to the forefront, but there's specific differences and not just the gut microbiome. You know we have a skin microbiome oral health microbiome eye microbiome vaginal and bladder microbiome. So all over it really this like these these these neighborhoods of organisms living together and and supporting each other. But what's really interesting is we're in the gut microbiome. There's the diversity that we need in the vaginal microbiome.

There's the uniformity that we need less diversity. And that's really important. In 2015, there was a publication by in the Journal of Microbiology. This is why most people don't know about it, because you know who besides me is reading the Journal of Microbiology as an object? Nobody. You know. Who is doctors. I was really interested. In the vaginal microbiome and understanding it, and also for the vaginal seeding aspects. But, you know, it was really to prove the point that when we're looking at the vagina, it's not merely a passageway for sperm and menses and, you know, and babies it it is so important to our overall health.

And we started over the really more so after the, you know, after the DNA code was broke, so to speak. And we were like, okay, well, it's not the DNA that's making all these decisions. It's got to be something else. And hence the microbiome. And then looking at women's health research at the microbiome and how it relates to risks of disease, what changes over menstrual cycle, a pregnancy, a life span. And these these factors have become so critically important and really honestly, as just in the last few years starting to get some traction.

I feel the same. You know, I was recently at the IFM conference practitioner conference, and I feel like every company that has focused on gut health is now getting into the vaginal space. Now they have vaginal testing, they've got vaginal supplements. I just saw it everywhere. I was like, wow, this is a transition from what we saw a couple of years ago. It's, you know, good that women's health is is actually becoming really important and a really important conversation. Now I want to I mean, did you see that too?

I'm sure you have. You've seen it everywhere. Well, yes. Yeah. There's competition among companies to come up with testing. And then also with vaginal probiotics, like there's specific strains that I want and I look for in a vagina targeted probiotic. So because it makes it really makes a difference. But what's not talked about Laura. And I'm really fascinating because I was reading a Harvard paper recently that was looking at the Euro biome. I'm learning these words to. Like, oh, you're, you're you're you're you're.

The urine system. Euro. Yes. Euro biome. So the, the bladder of the urethra and the, you know, the microbiome of the bladder and the urethra and how in women it's very it's the same as in the vagina. But when we start to get that dysbiosis like you do in the gut, you have incontinence, you have urgency symptoms. But has that been addressed? No. But now we can start advocating for ourselves and do targeted, targeted therapies and pay attention to these things because we can test for it. We can also, you know, the nutrition and lifestyle mechanisms that the habits that we create can all make a really big difference to.

And then topical solutions. Oh my gosh, we're going to get into all that I have to disclose to you and tell you I bought a whole bunch of vaginal microbiome tests from different companies, because my plan is to do them all on the same day and. Turn. Them all in and see what happens. And I want to compare notes because I did that over the last two years. And and so I would love to I would love to see which one you come. Which. Decide on. I know, and I obviously have to come to you because I'm going to get all this data and then I'm going to be like,

UTIs, Dryness, and Hormonal Changes 6:32

Anna. What is all this mean? And is it accurate? And which one can I trust? So trust me, there'll be a follow up conversation to this. I was already thinking, like, who do I know that could actually help me sort this out? And it's you. So happy to. Absolutely. Yeah. So, you know, let's talk about some of those. I know, I know, our women want to know about solutions. So so many women are noticing vaginal dryness, irritation, discomfort, recurrent urinary tract infections. I've suffered from that for such a long time in my 20s and 30s.

It was just terrible. And the amount of times I took antibiotics in my life is is unbelievable for urinary tract infections. And, you know, they're also experiencing changes in intimacy during menopause, but they assume it's just low estrogen. So we've been told that right now, obviously I don't think that was my problem when I was 25 years old. But what's actually happening in the vaginal microbiome during this transition, and how does it contribute? And what are some of the solutions that you have for this?

Yeah, this is so important because also like the recurrent antibiotics, we know that in women now in menopause are being told, oh, just take an antibiotic after sex or just take, you know, prophylactic antibiotic. And we know how destructive I mean, you can speak to how destructive that is to. The. Track, right? It's so destructive. It's destructive to the bladder to it's destructive to the vagina. And the bacteria is protective the the vaginal bacteria. So the predominant in the, in the euro biome at the urethra and the bladder and the vagina, the vaginal microbiome are predominantly Lactobacillus species.

So Lactobacillus Chris badass anus, Jensen I and Gasser, as well as Rhamnus, these are really protective lactobacilli. And I would add in lactobacilli it's one of my favorite bacterias. So these are very protective and restorative and in healthy amounts. And again no other like other bacterial species. So low diversity we see these predominantly Lactobacillus species. Then we have no urinary track infections, reduced urinary urgency, healthy vaginal P.H., which is part of it. Now, I've been in the hormone space for a long time using hormones to help with vaginal health.

And, you know, the anecdotal okay, you know, we had nothing else as far as vaginal probiotics taking oral lactobacillus, probiotics or yogurt or whatever it. Would be totally. Repopulate the vaginal, the health of the vagina because it made a huge difference. But in the hormone space, it was focused on typically, you know, for the extent of my career, predominantly DHEA, clitoris to anus to keep that tissue healthy, to help the bulbar vestibule, to help your body support the natural secretions. And so that I'm assuming I was assuming for many years.

So we were really able to test the healthy bacteria. We've only been able to test the like sexually transmitted diseases for so many years until the last couple. And so that didn't give us an idea. Okay, we know there's no chlamydia, but there was no lactobacilli either. So now that I've been testing and if a person's been on antibiotics, if they've had a history of HPV, if they're doing or whatever, the, you know, and just eating out regular food that's contaminated with pesticides or besides and antibiotics, they've killed off their natural.

So now I've been testing and seeing the very reduced, very reduced to negligible to zero lactobacilli. So I'm like, okay, now everyone needs to get on into this vaginal microbiota support. And in addition to the hormones, because what we know from research, there was a research study published a couple of years ago that looked at the HP. Right. We think about HPV, abnormal pap smears, cervical cancer, and looked at the HP risk that higher levels of HPV are associated of pathologic HPV with vaginal for and with the vaginal bacteria.

So the more diverse species, the higher the vaginal. In other words, more alkaline because the vaginal H is supposed to be acidic, like to fight off buggers. And. The and when. So you have alkaline environment, diverse vaginal microbiome, and you have high risk HPV, you have an increased risk of cervical cancer. And that's a huge pet peeve of mine because so many women are told they don't need pap smears. I just had a 72 year old, I did a pap on and she had high risk HPV.

Testing, Probiotics, and Targeted Support 11:16

So we're repopulating the good bacteria to prevent cervical cancer from ever happening. Hopefully I. Still remember when those Acog changed, when those Acog recommendations changed. I was still working in Western medicine at the time, doing a lot of women's health at the time. And I, I remember when it went from yearly to every three years and then every five years. It was crazy. Well, yeah. And then and. Then and then what happens is you disconnect the woman from the practitioners all full body assessment.

Because what happens when you do a pap smear, you also do a full body assessment. We're checking their thyroid. You know, we're Palpatine, we're checking their breasts. We're doing a manual breast exam. We're doing an abdominal exam. We're talking to them. We're finding out what's going on in their life. And some women are in a in abused relationships. And maybe you could intervene there and give them support, resources and help. And I just think that Acog making that five year recommendation was so much more damaging even than just separating, you know, a woman from a pap smear.

It was. The whole body that we separated her from, from her practitioner being able to help. I just don't even get me started on. On that. I know. Please continue. Because that is it is a pet peeve of mine because, you know, had a, you know, diagnosed a 72 year old with stage four cervical cancer that never should have happened. She was told, you know, she didn't need hormone, she didn't need a pap smear after menopause. And she was on hormones. She had an enviable sex life. God bless her. Right.

And no one dared ask or examine her. And that is I mean, that's a crime. And our medical society is are partly to blame. But we should never as individuals who are showing up here and listening to us today and listening to your summit, they're getting that empowerment piece, that important information. Totally. And you know, something else that I remember as I'm remembering this, something else that comes to mind is I can't tell you how many skin cancers I diagnosed off of doing just full body assessment of women every year, how many melanomas, basal cells and squamous cells we saw and sent them to dermatology to have it treated.

It's just unbelievable. I don't I'm just so frustrated with the medical system. But I want to clarify one question, something that you mentioned a few moments ago, and it was taking those lactobacillus strains and you mentioned the Lactobacillus ruder. I, I was really happy. My senses perked up because I have a probiotic like that in my bathroom right now. But my question for our audience is, should those probiotics be given vaginal or orally, and how often should they be taking them? Because you mentioned that it should be a routine part of supporting the vaginal microbiome.

Yeah, absolutely. So that's a really good question. So there are certain there's different ways you can take it. There's the vaginal probiotic inserts that's by seed VSO one and it's a scheduled and then a maintenance schedule. And those are vaginal. And then there's that. You have my VB balance my VB probiotic which are the strains with a little bit of cranberry because in my age group the urinary urgencies and infections. But these strains at high concentration you take it orally and through transference.

And I have studied this, Laura, you know, like how does it go from the gut to the vagina? I mean. How does that happen? Transference. Magical process. It's fascinating. Right? This community. But but that's how it's described in the literature. And so you actually get seeding. And I have tested this with the oral probiotics to see an improvement over time. The benefit to is adding to the gut microbial diversity, increasing the vaginal micro diversity. The lactobacilli kills off the other things that we're seeing in the vagina.

And it also helps with that, restoring that like layer, that mucosal layer of the vagina. That's really key because even like hormones, even using DHEA and or estrogen, adding the probiotic, the vaginal targeted probiotic, whether it's vaginal, oral or alternating between them, that really makes a difference for people. It really has made a difference. Decrease urgency, decreased incontinence, not getting up at night to pee, feeling just that that next step. And it's been a missing piece for so long.

And and so it's like everyone needs to know about this. It's so important. And I would add too because we were talking about dysplasia and pap smears, but that vaginal itch symptom or that urinary urgency symptom that you're treated with antibiotics or antifungals for, you have to evaluate it first with your own mirror look. Does it look like it look normal, look, inspect, you know, and then be evaluated because there's like and sclerosis we diagnose we abnormal skin lesions cancers things. You know it's never normal and don't like.

You know you don't like to treat without a diagnosis. Absolutely. So you've. Created quite a few products that actually support women in in intimacy in helping prevent your recurrent infections, urinary tract infections I'm sure recurrent bacterial vaginosis all of these kind of overgrowth of bacteria. So can you talk a little bit about kind of what got you into formulating. And I'm sure I'm sure it has something to do with there was nothing good out there. Right? I want to solve this problem. Yeah.

It's I never intended it to be a formulator. But you know way back when I was diagnosed with you know in 2006 with infertility and early menopause post-traumatic I had taken I you know I was told I would never be able to have another child. And so I took a sabbatical from my practice and traveled around the world, you know, essentially looking for answers.

Formulating Solutions for Intimacy and Tissue Health 16:58

My daughters were seven and ten at the time, and serendipitously, I met healers. I would say it's like, you know, it was God's hand in every step of the way. And and I learned about yeah, I learned about mocha. I learned about adaptogens, foods and different medicinal foods that were used in different parts of the world. And I started incorporating that. And I always say that learning about the medicinal, traditional foods, because modern medicine had failed me. I mean, it had my I failed six rounds of fertility treatments.

I was told I just needed Xanax and antidepressant. And you know, what could I expect otherwise? And, you know, like it was it was devastating. Learned so much in these in these last many, many years. And so the part of that was creating my mighty mocha formulation. So I would say it's God's formula, not mine, but it is amazing. And I naturally conceived a child at 41 that I was told I would never be able to have. So now I'm 60 and she's off to college this year, so the whole nother thing. But then with that.

You started your family at 40? No, I had my my youngest daughter at 41. Oh, they. Were told. You were told you couldn't have any. More children. Have their children. Wow. I was saying you have a. You have a big family. Wow. You were busy in your 40s. If you had all those. Oh, yeah. No, no. Like it was. Yeah. Years before. But being diagnosed, I had failed six rounds of infertility treatments and then after that diagnosed as early menopausal. And so by my, you know, some of the best reproductive endocrinologist at Emory.

And so like I was I didn't think I could reverse this. And now I'm passionate about doing that. Then I finally went through menopause really at 56 years old. So was really able to with these these nutrition, lifestyle medicine, understanding all these aspects, we're able to do so much. This is the empowerment piece that I want all women to understand. So but my formulation started with Mighty Maca and then Joe and which is my topical vulva product to anus. And it has data and plant stem cells of the alpine rose in it.

It's a beautiful formula. And what does it do. Why would you want to put that clitoris to anus. Why would this be important for women? Yeah, because as we age we get clitoral atrophy and the clitoris has like 10,000 nerve endings and blood supply. And those will it will get desensitized and devalued and lose blood vessel and blood flow and sensation, just like men get erectile dysfunction. So by adding back data in the plant stem cells, we get that rejuvenation experience. And also the labia will shrink.

And the labia is very sensitive. It's a sensitive sexual organ. And and most of the dryness comes from the vaginal vestibule area. So the opening of the vagina versus within. And so we want to replenish the nutrients. And data works at the intrinsic cellular level to convert to testosterone and estrogen without increasing any systemic levels. And with pelvic floor exercises, I will say how to do this. So we die with pelvic floor exercises done. Well. We I just did it when you said that. I know right to me, to everyone listening your key goals now and.

You did I just like tensed everything up and I was like, squeeze Lori squeeze. That's it. That's right. Like we can't. Yeah we have muscle is magic. Muscle is magic in menopause. So those muscles are so important. And that helps with blood flow and sensation too. So the combination works really well. And that was a solution for myself and my patients. And it's also key to support the vaginal microbiome. Now if you have zero good bacteria to begin with you need to replenish it. And that makes a difference.

And even my 18 year old, because she eats out, she's on the rodeo circuit. So she eats out sometimes not healthy food. I am like, okay, you've got to take we've got to keep the vaginal health and relates to our menstrual health and, you know, risks of endometriosis and all these things. But here are some vaginal probiotics. Just mix it in with everything else I got her on. She has she takes the mighty mocha the bedroom probiotic and happy with that at this point. Yeah, I I've also heard that the joke is for the lips up there and the lips down there, so people like it to use it on your lips.

On your face as well, right? Yeah. The ingredients are clean. I mean, ingredient snob, you can see that from all my ingredients and topical products. Like there are no chemicals, no endocrine disruptors. Everything has been vetted, studied and evaluated by me. And so you can use it. And we say we take care of the lips above and below your hips. So job, you know, helps those fine lines and wrinkles around your mouth. And it helps under the eyes to. Oh my gosh, I have some I'm going to put it under my eyes.

I'm going to try that. Try it and let me know. Especially if people are dealing with dry eyes I mean glandular secretions. There's been some research to show that data helps with glandular secretions, and that's what it's doing in the vaginal boulevard and urethral area too. So again the urethra, we want to keep that tissue healthy and strong. And also the key bacteria, the key lactobacilli that are important to keep us from struggling later on. It just makes so much sense. Right. Like we've missed it in women's health conversations for for way too long.

We have. And I wish I would have known you earlier in my life. I had my very first urinary tract infection before I was ever sexually active. I was 16 and then they were chronic from there. And then I had chronic yeast infections. It was a nightmare.

Gut Health, Hope, and Where to Find Dr. Cabeca 22:48

I remember just being miserable mostly in all of my 20s, and I bet you I could have avoided all the antibiotics and the antifungals and all the treatments. If I would have known, if I would have known then what I know now, and would have had somebody like you in my corner. So, you know, I think a lot of our women right now listening today are wondering, where do I start? They're beginning to notice changes. Maybe we have some perimenopause women. Maybe we have more advanced women in menopause here and they're not sure where to start.

And what are the most important things that our listener can do right now to support a healthy vaginal microbiome, so she can protect her intimacy in her relationships and feel confident in her body as she ages. Yeah, yeah. First and foremost, I want to I want to touch on that recurrent UTIs, because I learned this from a urologist, Doctor Neil Galloway at Emory. But vitamin C 2000 to 4000mg a day. And now add in. So if you're having those recurrent UTIs, vitamin C 2000 to 4000mg a day, at that point we only had like Lactobacillus acidophilus.

But now we have the targeted specific vigilant and bladder microbiome bacteria. So add in a probiotic and use, you know, in that tissue to keep the tissue healthy. And so because as we lose elasticity, as we lose blood flow, as we lose use that glandular secretions, we we need to add that back. And again of course the exercise hydration nutrition avoid you know, avoid any chemicals and watch what you're using on underwear. What clothing. Synthetics pads, liners I just have I bought my girls linen panty liners now to like, we're not even going to go with the organic pad.

Let's try at least try this when you can, to avoid the amount of chemical exposure from even the organic pads. So one, because what I've been seeing over the years is as both our diseases and and bladder issues. So removing the chemicals, keeping things healthy inside out makes all the difference. So I say it's like my intimacy bundle which is and velvet which is my new lubricant, and add in the VB probiotic. And that's a good place to get started. Oh so good, so good. Are there some things that she can do?

You know, I remember when I, when I finally solved this, it was decades later that I finally put an end to the chronic UTIs. And it really was because I focused on my gut health. That's really what I did. And so do you have some time to chat between the connection between the gut and the vaginal microbiome? I know there's a connection there. And for me, that was everything. Yeah. No, absolutely. It's key. I would say to, you know, I'm a gynecologist, so I can say I, I can see the health of an individual from their vagina if their vagina is unhealthy, if it's inflamed, they're having issues.

I know their guts messed up, Laura. Right. Like we know it. And so you've got to you have to address that. I can't heal someone's hormones without healing their gut. Mean there's an incredible connection. And you have we know about leaky gut, leaky membrane. Right. And so we can see that, you know, same thing, the asymptomatic or aseptic vaginitis that so many people get diagnosed with the vagina. Also adding in there. But we want to we have to address gut health first and foremost. It's so important from a functional medicine standpoint for women's health from before pregnancy all the way to our final breath, we have like that's so important for me is addressing these issues and low, you know, again, low inflammatory good fermented foods my microbial support but also like understanding your own unique diversity.

Could you do this for us as we wrap up today, could you give a message of hope that you would want every woman to leave this conversation with about her body, her relationships, what's possible for her during and after menopause? Oh my gosh, yes, absolutely. First of all, menopause is natural. And, you know, a blessing really for old enough to go through it. And suffering is optional and your diagnosis is not your destiny. It's not a disease process that we're suffering with. It's an opportunity for transformation and higher awareness and spiritual enlightenment and passion.

I'm sitting here at 60 today. I'm like, what am I going to do for my next 60 years? So there's such an opportunity to tap into our passion. And when it comes to vaginal health, dry, you know, sexual pain with sex, intimacy after an exam. And, you know, things look normal. Advocate for yourself. So these are tools I found where where I created where none have existed. And it's so important. And I've seen situations from licensed grocers and UTI, recurrent UTIs and, you know, patients unable to tolerate, you know, a vaginal exam to reversing the hands of times 20, 20, 30 years and enjoying life.

Have this beautiful video on, you know, a of a 75 year old who was celebrating her 52nd wedding anniversary. And she's a lovely client and she says sex is better now since we address things down there then it's been in the last 50 years and I'm like, what an inspiration to me. So that is yeah, I think there's never you never give up hope, but know that it is. You have good intuition, good energy. Your body is constantly trying to help you repair itself and just addressing it with the right nutrients and the right amount of time it can be we can be healthier tomorrow than today.

That is a that is a sign of hope for our for our listeners, I know that people are wondering how do I become a patient of Doctor Anna Cabeca? How do I get access to these, you know, Mighty Mocha and Joe? And how do I get that? So can you tell our audience where they can find you? Yeah, absolutely. So my website is dranna.com dranna.com. I currently have a wait list for my patients, but I have my online programs and my products. And we give your audience, your listeners, a special code. Laura Summit 2026 code for your audience to get 20% off your first order.

So we do that, and I thank you guys for showing up and advocate for yourself. You can also find me on the Girlfriend Doctor podcast and social media at The Girlfriend Doctor. Amazing. Thank you so much, Doctor Anna, we're so blessed to have you here today to speak with us. Until next time everybody take good care. Bye now.