939: The Brain, Gut, Vagina Connection With Dr. Betsy Greenleaf

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Katie: Hello and welcome to the Wellness Mama podcast. I’m Katie from barbaraoneill.online and this episode goes into a new topic that you might not know a ton about. I know I didn’t, which is the brain, gut, and vagina connection and we go deep on the vaginal microbiome.

I knew of this in the context of the birth environment. And how it seeds a baby’s microbiome, but we went so much deeper than that. In this episode, I’m here with Dr. Betsy Greenleaf, who is a leader in women’s health. She’s triple board certified and dedicated to empowering busy people with pelvic peace, hormone harmony, and irresistible confidence.

She has over two decades of experience in female pelvic medicine and reconstructive surgery, and she’s also a renowned best selling author and award winning speaker and an expert on the topic we dive into today, which is how your vaginal microbiome might be connected to your libido, to your fertility, to your stress levels, to your diet, to so many things.

Above and beyond what I understood before this episode. So I learned a lot. She has a lot of practical tips and also gives her opinion on things like, um, laser therapy, red light therapy, boric acid suppositories, um, things we can do to support vaginal microbiome and things to avoid and so much more. So let’s learn from Dr. Betsy Greenleaf.

Dr. Betsy, welcome. Thank you so much for being here.

Betsy: I’m so excited and so grateful for you having me here, Katie.

Katie: Well, I’m so excited for this conversation because 900 episodes in, it’s not often I get to go into an entirely new topic that I have not even touched on in the past. And I’m really excited to learn from you today. And the topic we’re going to deep dive into is the brain gut vagina connection. I would guess most people are at least aware of the gut brain connection, and I’ve gotten to talk about that before, but I, until researching for this podcast with you, had no idea that there were other connections.

I knew the oral microbiome was connected, but I feel like even, you know, having been a woman my whole life, I do not, I’ve not understood this. So I know this is a broad topic, but maybe introduce us to the concept of the vaginal microbiome and how all of these work kind of in interplay.

Betsy: Yeah, you know, this is something too that myself as a gynecologist… first of all, we were never taught about the microbiome, which, I guess if people have been following you, they realize is the bacteria that grows on our skin and in our bodies and every part of our body has a different environment where the bacteria is supposed to be optimized to keep us healthy.

And that’s the microbiome. It’s what’s in those areas. And so not even being taught that as a gynecologist and then on my own kind of discovering the microbiome with the gut brain connection, and in my going down this rabbit hole of that research, all of a sudden I found out, wait a minute, there’s something also going on with the vagina.

And I knew that for years I was always testing people’s microbiome, but not realizing I was doing that. Back as far as I can think of, since 2009, I would send off swabs on people to look at what kind of bacterias and yeasts were there and never really knowing that that was called the microbiome.

And I kept on thinking, how is this connected to other things I was seeing with people? And it kind of developed over time. And then, even when I was kind of getting into this, there was no research connecting the vagina to this. And it was like one day, as I was getting kind of further and further into the gut brain connection, that I found some research and I’m like, wait a minute.

Now this makes sense. Cause people are going to go, wait a minute. The brain is up here, the gut is like in the middle and the vagina is in the bottom. Like how in the world are these areas talking to each other? And I think that’s what’s incredibly exciting, is that the body is so interconnected and it’s so much smarter than we are. Which I think is really exciting. But basically to kind of make it super simple and being like, okay, like how’s this all connected?

I’m going to mention the gut brain connection first, because I think that was fascinating. And I actually stumbled upon that because I was having my own problems. I was 40, I was starting to have some depression and anxiety. And my doctors are like, that’s perimenopause. Everything just got blamed on perimenopause and menopause, which I find too often happens with women.

And so they were putting me on antidepressants and they weren’t working. And I just thought, okay, well, this is the way life is. And all right, I’m going to just kind of be the good patient and take the antidepressants and that’s all that can happen. And then all of a sudden I was getting sick all the time.

And lo and behold, somebody says to me, when my doctor says to me, we’re going to send you to an immunologist and try to figure out why you’re getting sick all the time. And they told me I had this primary immune deficiency, which is a hereditary condition that just starts showing up in your forties.

And I’m like, I started asking my family members, is there anybody that’s getting sick all the time? And everybody was like, no, we don’t know what you’re talking about, it’s just you. We did kind of chalk it up to, okay, it’s just crazy Betsy and whatever. And then as I was going down trying to solve my own problems, I came across this whole gut brain connection and a little light bulb went off in my head once I was reading the research.

And it’s like 90 percent of your happy hormone is made in your gut. And I’m like, aha. And then it was 80 percent of your immune system is made in your gut. And I’m like, aha. So I’m like, well, if I fix my gut, maybe at the same time, this is going to get rid of my depression, my immune system issues.

And it did. So, you know, months later, my immunologist said to me, uh, I got good news and bad news. The good news is your labs look all normal. The bad news is we don’t know why. And I’m thinking, well, I know why. Cause I had this bad gut and I, you know, from standard American diet, my microbiome was thrown off.

And around the same time, I kept… I was also getting a lot of yeast infections. So this is like the great thing when a doctor has problems because they’re like, okay let’s go down that rabbit hole and try to fix myself. So I was getting a lot of yeast infections and I was connecting it to like, every time I ate like sugary things, I would get a yeast infection.

My scalp would break out and I would get like really bad dandruff. My dermatologist was like, that’s not connected. But now we do know that sugary foods will stimulate these sugars that yeasts like to live on. And so when I cleared up my gut for the depression and the immune issue things, my yeast infections kind of started going away.

And that’s when I started applying it more to my patients. And we were like, wait a minute. Okay, we’re starting to see that if we fix their gut, we got rid of their recurrent vaginal infections. We fixed their gut, we got rid of their recurrent urinary tract infections. But then something really strange happened in that I had one of my nurses who had seen me talking about this stuff with patients and she was like, you know, I want…she wasn’t having any symptoms, wasn’t having any problems, but she’s like, I want you to check my microbiome. So we did a swab on her, sent it off. And of course, everything was completely shifted. And we fixed it. Now, her backstory was, and we didn’t really make the connection until after the fact, but her backstory was she had been with the same guy for six years.

They were having unprotected sex. They were not trying to have a baby, but they were like if it happened, it happened. And so they weren’t trying not to have a baby. And so she just assumed after six years of unprotected sex that she couldn’t have children and didn’t think much of it. Fast forward, she ends up breaking up with the boyfriend. I fixed her microbiome. She gets a new boyfriend and we know that the first boyfriend was actually fine. Cause he had fathered other children from his previous wife, but, the new boyfriend, she’s with the new boyfriend and same thing. They weren’t being careful.

And lo and behold, she gets pregnant like right away. And she was like, what the hell? And then that’s when I went down this rabbit hole of, well, wait a minute. Did it have to do with me fixing her microbiome? And that’s when we found this whole brain, gut, vagina connection. And this is where I say the body is super, super smart because if for whatever reason, the bacteria in the vagina are off, they have found the research that there’s a feedback loop through the vagus nerve, which is one of the main nerves in the body. And it goes back to the brain and it tells the brain, Hey, now is not an ideal time to reproduce. So the brain goes, let’s dampen everything that has to do with reproduction.

So this is now going to affect fertility. This is now going to affect sex drive. This is also going to affect hormones. And so actually having the microbiome in the vagina being off, we can then have these issues with sex drive and libido and hormones. And so just by fixing the vagina, we can actually improve libido. And then we also found out that, and I kind of already knew that the gut, if the gut was off, men and women, we know that the vagina and the rectum is so close together and that often there’s bacteria that gets spread back and forth no matter how clean you are. So then we made this other connection that if the gut is off, this could also be affecting sex drive and fertility and libido and hormones.

There’s this whole connection that happens with this and I know I’m kind of… I want to make sure if you have any questions because I can go off on tangents and talk about this for hours because I get so excited about it.

Katie: Well this is so fascinating to me. And I would guess it’s so relatable, many women probably had a similar experience at some point of being told their labs are normal or having been blamed on hormones. I know I’ve had both of those experiences, and I also had to kind of do my own detective work to eventually figure out what was going on and then help my body work through it. ButI feel like we still hear that way more than I wish we did, especially from women when it comes to conventional medical approaches. So I love that you asked the deeper questions and kind of discovered this whole new world that is seemingly so helpful to women. And previous to this, I had only heard of and really researched the vaginal microbiome in the context of birth because my third was born via emergency C section due to placenta previa.

I was not expecting to have a C section. And so he had eczema and all kinds of skin issues, which we thankfully resolved. But it really piqued my interest and I got really curious about you know, the whole process through which babies are sort of introduced to this microbial environment during birth and how that’s a normal, healthy, physiological process. And as you were explaining this, it made me think, I bet this work that you’re doing for women especially who are in the kind of era of having children is so important because seemingly if they are getting their initial introduction into the microbial world through the birth process, then understanding and being really aware of our vaginal microbiome probably is also important for them.

And I don’t want that to be the whole conversation, but I would love to hear your take on, especially for women who are in the childbearing phase, how does this come into play and like what can be going on in vaginal bacteria that might be either beneficial or not as helpful?

Betsy: Yeah, so a couple things. We definitely know that there’s connections between this and fertility. And so in the women who are actually having difficulty getting pregnant, that in traditional medicine, they’re not really looking at the microbiome or thinking about testing that. And this is something that I talk to my reproductive endocrinologist to all the time.

I’m like, that should be like one of the standard things. That we should be testing the microbiome before we’re starting to get into all these crazy fertility treatments, because it could be something as simple as just fixing that area to restore fertility. But you’re right. Also with vaginal births, and this was something that I am guilty unfortunately, I had two planned C sections because as a urogynecologist, I know what can happen to the pelvic floor. And I was thinking I was being so incredibly smart. Like I am not going to ruin my pelvic floor, I’m going to have C sections.

But not realizing that I didn’t expose my children to vaginal bacteria, because that’s the first exposure to bacteria that babies have is through the birth canal and through the vagina. And that’s where they actually start getting their microbes in and on their body. So now some people just can’t have vaginal births and we understand that. And luckily a lot of the…there’s now probiotics for babies or if people are not breastfeeding, there’s probiotics put into the formula.

So we know it’s important to expose children to that bacteria. But even then a baby’s microbiome isn’t even set for until a full year. So we know that typically it’s through that exposure through the vagina that they pick up that bacteria and now that kind of gets them on their way to be healthy.

And we also know that, I mean, there’s so much interesting things with the microbiome that’s even beyond the hormones and our health and our immune system. But we do know there’s a great connection between the microbiome and obesity. And so that women who are obese or people who are obese, they have a completely different microbiome than those people that are normal weighted.

And so that could also, you know, in women who are obese and exposing the babies to a different microbiome that could actually, this is why sometimes we see obesity run in families. It’s not just a genetic issue. It can also be a microbiome issue. And I think a lot of science now is being geared towards, well, let’s see, how can we fix the microbiome to help people with their body composition?

Not just for, you know, I want to look good purposes, but for being healthy. Because I know when I look back at my patients that are a little bit on the heavier side, a lot of times people will say, I’m not eating that much. Like, I don’t understand why I can’t lose weight.

We might not be able to lose weight because of what the microbes are doing. The microbes a lot of times, especially in the gut, they’re causing this inflammation and inflammation makes us hold onto weight. And so this can actually be a struggle that people are dealing with, with that connection, with weight and obesity. And I get so excited about the microbiome, like I could just like… I wish there was almost a specialty of just, I mean, there are microbiologists, but we don’t have like a medical specialty where you just come in and have your microbiome treated because we’re finding that even… so with babies, here’s a really exciting, interesting thing of how the microbes affect our behavior in even babies.

So babies that are colicky are very low in something called Bacillus Infidus. So Bacillus Infidus is very low in colicky babies. And so when the bacteria is low in their gut, the bacteria wants to survive and proliferate like everybody does, every being on the earth. And so it’s able to actually hijack some of the behaviors.

They’re finding that bacterias have like D. N. A. for human genes. So they could actually, like our puppet masters, control our behavior. So when backs Bacillus impetus is low, it makes the baby very irritable and cranky. And so what happens when a baby is crying and we don’t know what to do as a parent?

We’re like, I don’t know. I’ve changed you. You’ve just slept. I don’t know what else to do. Let me feed you. So when you feed the baby, the Bacillus Infantus is excited because it goes, Oh, now I’m being fed and I can now replicate and make more of my fellow bacteria. And then when that level of bacteria comes up to a normal level, the baby is no longer irritable.

So the fact that a bacteria can not only control the behavior of a baby, but actually then control the behavior of a parent is crazy. So, because it really just comes down to in the past we thought, Oh, maybe these babies are more gassy, but it’s really has to do with the bacteria level and the bacteria itself wanting to bring itself up to a higher level in the baby.

Katie: That’s so interesting. And as a doula, I’ve gotten to be present actually at several C-section births where now we know about swabbing. And that was my kind of my hands on duty was to help swab the baby immediately and then get the baby on dad’s chest in a blanket as soon as possible, even in the OR.

And so I love that as we’re understanding this more, even for women who, for whatever reason, do have a C-section, there’s things we can do. Like all is not lost. You can still do so many. And like you said, there’s now probiotics and we know all these ways to support the baby. But as you were saying that, I thought like, obviously this also of course benefits the woman and her vaginal bacteria being really optimal is going to have benefits for her body.

And of course, also for her baby. Which brings me to the question of, it seems like now we have the ability to test this, but if we’re able to test it, what do women need to know and understand kind of like before testing? And then with their results to be able to effectively optimize our vaginal microbiome?

Betsy: Yeah, the testing becomes a little tricky because we have tests that are covered by insurance and we have tests that are not. And even then your practitioner might not completely know what type of testing to do. And there’s two big tests and one is called PCR testing and the other one is called next generation sequencing. And I kind of compare PCR testing to if you walked into a room and you had a list of people you were looking for and there’s a crowd of people and you’re like, I need to find Bob and Susie and Sarah and you walk around the room and you’re like, are you Bob, Susie, or Sarah?

And that person’s like, no. Then you’re like, I don’t know who that is, I don’t care, let me go. I’m just looking for Bob, Susie or Sarah, and I’m walking around. And so there might be a lot of other people, but I only identify who’s Bob, Susie or Sarah. So PCR testing will only tell you, the results will only tell you what you’re actually looking for. Which is good when we know that certain bacteria can cause vaginitis, we know certain bacteria can cause urinary tract infections, and if we’re looking for those specific bacteria. Great.

They’re either there or they’re not there. Then came along next generation sequencing. And next generation sequencing is like I walk into a crowded room of like a hundred people, let’s say, and I walk up to each person and I’m like, who are you?

And you’re like, Tom. And who are you? All right, Katie, we’ll use your name. And who are you? And you’re like, Oh boy, so now I have a list of maybe even a hundred different people. And then I have to look at those results and go, Oh my God, well, what does this mean? So next generation sequencing will tell you everybody that’s there.

But because it’s so advanced and it’s been on the market now since probably about 2015. So gosh, that’s like 10 years now. We still don’t know what the significance of some of these bacteria are. So I remember when I first got these tests…I like that test because I like to know what everything is there.

But I would get those results back on patients. And it’s almost overwhelming because you’re like, okay, here’s a bacteria I’ve never heard of. And you go to look in the research and they don’t even, there’s no research on it because In the past, the only way we could identify bacteria or yeast was growing it out in a culture. And culture testing is pretty much… not many people are doing culture testing anymore because culture testing misses a lot of things.

So culture testing is where we take a swab, we put that swab on a Petri dish, and then we wait to see what grows and then we identify it. And the problem with culture testing is there’s so many things that can happen to that specimen from the time it leaves your body to the time it travels in the car to get to the laboratory to then grow on a petri dish.

Some of those bacteria could die or maybe they just don’t grow on that type of petri dish. So culture testing, we’re like, okay, no. PCR testing, great, but we’re only identifying the things that we’re looking for. Next generation sequencing, we’re identifying everything, but we might not know what those things mean.

So we’re just finding out that, all right, maybe some of these bacteria are normal, maybe they’re not. Some of them, we don’t even know what the significance are. Some of them aren’t even named. Like there are two bacteria that they know are associated with recurrent vaginitis. And they’ve been named like bacterial vaginosis associated bacteria number one and two.

Like they haven’t even named them because they’re trying to figure out how they fit into this grand scheme. So the biggest problem is now that when people get these results and many doctors have portals, or labs have portals, where you can see your results ahead of time and people get their results and they see all this crazy bacteria, they panic and they’re like, Oh my God, I’m sick.

Well, you may or may not be. Sometimes like a lot of that stuff is normal. Some of it we don’t really even need to treat. So I always tell people with the next generation sequencing, there’s kind of an art to how to interpret it and don’t go crazy when you see those results. So, yeah.

Katie: Well, that’s a great point. And it seems like just like in the gut microbiome, obviously, bacteria is supposed to be there. So I know that often in society, we can think of bacteria as bad, but actually in your body, bacteria is really good and important. And is it similar with the gut microbiome that there’s obviously many, many types of bacteria and it’s not that any are good or bad?

It’s more about the balance and which ones are opportunistic and making sure that like the good strains are strong enough? And is there more nuance than that when it comes to the vaginal microbiome?

Betsy: No, it’s in fact, it’s actually just like the gut microbiome. Though we do happen to know that lactobacillus species tend to be the healthier bacteria in the vagina. And so there are multiple different types of Lactobacillus. A lot of times people have heard of acidophilus, Lactobacillus acidophilus, but there’s Lactobacillus crispetus and Lactobacillus rhamnosus and Lactobacillus…there’s a whole list of them.

But here’s actually the interesting thing is we have to also ask ourselves, why are those healthy bacteria there? And in the gut microbiome, we know that we support healthy microbes when we eat more vegetables and fruits because healthy bacteria like to live off of fiber.

So one of the ways to support our gut health is we eat more fiber containing foods and we eat more fermented foods which have the bacteria in it that we’re kind of replacing in our system. In the vagina, a lot of that bacteria has actually come there, number one, because it’s come from the gut because of the rectum and the vagina being so close together.

That’s how there’s like the vagina is almost like a reservoir for gut microbes. But the other thing is when we’re young and we’re healthy, and we have all our hormones, the vaginal tissue will actively grow and it’s multiple cell layers thick. And so as the tissue is growing, the old cells are getting pushed out and then they eventually slough off.

Those old cells contain a chemical called glycogen, which is the food source of lactobacillus. So as long as our hormones are healthy and we’re in our reproductive phases, that vaginal tissue will actively grow, slough off, feed the lactobacillus. In return, the lactobacillus is so grateful that we’re feeding it, it in turn protects us by producing hydrogen peroxide. This is why some women will notice that when they wear underwear and especially dark colored underwear that they get like almost like a bleaching of their underwear because of the hydrogen peroxide that’s produced by this lactobacillus in their discharge. So that what ends up happening is that lactobacillus produces that hydrogen peroxide.

It actually makes the vagina very acidic and it keeps away the bad guys. So it keeps away the other bacteria and yeasts because they just don’t want to grow there because the environment is so acidic. A healthy vagina should be between the pH of 3. 5 to 4. 5. And that’s actually a really easy home way to test if your bacteria in your vagina is normal, is actually just get pH paper in that range. And if your pH of your vagina is higher than 4. 5, then there’s something off with the microbiome. But if it’s within the 3. 5 to 4. 5, it typically tends to be more healthy. Now the problem happens is when we’re pregnant, we don’t produce estrogen, which is making that vaginal tissue grow.

So the microbiome in pregnancy can change. If we’re on birth control, the vaginal tissue can thin out and affect, you know, we basically starve that bacteria to death. And when we’re in menopause or perimenopause, we’re also not actively growing that vaginal tissue. And now the lactobacillus doesn’t have a food source.

So this is where there are tons of things that people can do, and there’s so many products on the market now to kind of normalize the vagina. One of my favorites is using boric acid. So boric acid suppositories are capsules in the vagina. What it will do is it actually makes the vagina more acidic, and it encourages the bad bacteria to kind of not be there anymore and it makes more of an environment for the good bacteria.

But if we don’t have that glycogen from our healthy tissues growing and sloughing off to feed the bacteria, all the boric acid in the world is not going to work. So that’s where it gets a little bit more complicated. You know, in pregnancy and in breastfeeding, there’s not a lot we can do from treatment standpoints to the vagina.

But in patients that are either on birth control or perimenopausal or menopausal, there’s a whole host of things that can be done to the vagina to keep that tissue actively growing so that it can feed the bacteria so that it’ll want to stay there. And that is anywhere from using topical hormones in the vagina, whether they’re prescription or there’s some that are over the counter. And this is where life got really interesting. Back in 2014, the first vaginal laser came on the market and we started hearing about vaginal rejuvenation and we’re like, okay, well, how does that work? So lasers have been around since the 1980s. And it’s basically, it’s kind of like biohacking, which we didn’t call biohacking at the time, it was just lasers.

But lasers use light energy and they penetrate the tissue and they make a microscopic injury. And when that happens, the body floods that area to heal with growth factors. And so it’s a way to stimulate the vaginal tissue to regrow without having to use hormones. It’s like basically we’re biohacking our tissue to get it to do what we want it to do.

And once the first vaginal laser came out on the market, which I was like, that was brilliant. Why didn’t I come up with that? Cause lasers have been around forever. They use the same thing for skin. Then everyone started going, wait, what other aesthetic procedures can we apply to the vagina?

And that’s where the floodgates opened up. That’s where we have now radio frequency treatments, which is using sound waves to generate heat. And we know that heat will stimulate tissue regrowth and collagen regeneration. And PRP using our own blood and the growth factors in our own blood to make platelet rich plasma that can then be injected in and around the vaginal tissue to stimulate rejuvenation.

And then during the pandemic… so those treatments, people actually had to go to doctors or practitioners to have them done. And then during the pandemic, nobody was leaving their houses. So this is where we saw innovation in home treatments and I’m sure maybe you’ve talked about red light therapy, and we know that the wavelength of red light stimulates our mitochondria, which are the anti aging, basically powerhouses of our cell that kind of reverse the aging process. And so somebody came up with a red light wand for the vagina. So they’re like, okay, well let’s rejuvenate the vagina like that. And then there was another company that came out with something called carboxy therapy. Which is really big in Europe, not that big in the United States. But carboxy therapy is where they actually inject carbon dioxide into the skin and it stimulates and attracts oxygen to the area. And in response to that carbon dioxide being there and that excess oxygenation of that tissue will cause the tissue to rejuvenate. Well, there was a woman who created a product because she wanted it for herself and she knew about carboxy therapy, but she’s like, I don’t want to have needles stuck in my vagina.

Let’s see if there’s another way to do this. And she worked with scientists that came up with a gel version of carbon dioxide that could be applied to the skin or applied to the vagina to do the same thing as an injectable. So now we have this crazy range and I’m sure there’s new things still coming out on the market to rejuvenate the vagina.

So it’s not just.. I mean, it’s definitely about comfort that can happen with either low hormones or menopause or perimenopause or childbirth. But the other thing is it’s also about keeping the microbiome healthy and intact.

So basically just wrapping up all the different ways of vaginal rejuvenation is not just about it looking good and feeling good, but it’s also about keeping a healthy microbiome. So we would be able to give that tissue, be able to have a food source for the microbes. So.

Katie: That makes so much sense. And I want to definitely dive deeper on ways we can learn to support our vaginal microbiome and/or if there are any things to avoid on that. But I’m so glad you also brought up pH because that was one of the questions I had as well. And seemingly like that comes into play. One thing I want to make sure we touch on and maybe this will relate to the kind of good and bad things for our vaginal microbiome. But just like in the gut, and the analogy I even use more so is the oral microbiome, bacteria is meant to be there. It’s about the balance. We’re not trying to ever get rid of bacteria.

I think the mouth is a good way to illustrate that because we often will see, I’ve done a lot of research in this realm with my toothpaste brand, but we see like strep mutants getting out of balance and leading to cavities, or we see other strains getting out of balance leading to gingivitis.

And because they’re both opportunistic, we actually don’t usually see them at the same time because they’re competing and the solution is not destroy all bacteria. The solution is, how do we support the good bacteria so that it can kind of deal with the bad bacteria? And I would guess something similar is going along in the vagina, but I want to make sure we highlight seemingly the correct answer is not to kill all bacteria in the vagina. That would be counterproductive. But what do we need to know about sort of keeping that optimal balance?

Betsy: Yeah. Well, you know, one of the things I’m going to start off with is about with the killing of the bacteria, because I think that is really important. And, you know, I think back to just when we talk with kids and I used to be the mom that ran behind my kids with the hand sanitizer all the time. And I realized now I probably cause more harm than good because it is exposure to bacteria and even bad bacteria.

And I say bad, it’s just not ideal. We don’t really want it. There’s nothing’s really ever bad, but it is sometimes exposure to those less ideal bacteria that helps support our immune system. But you know, I see too many products, it drives me crazy, on the market that are geared towards odor.

And I think there’s been a whole market that has been created to make women’s super self conscious about their odor. And this is where I’m like, listen, your vagina was not meant to smell like roses or creamsicles. And then those products are out there with all the vaginal douching and the soaps and the deodorants that can be applied down there. Typically, if there is an odor, it usually means that there’s been a shift in the microbiome. And we need to look at, okay, how do we shift it back, as opposed to let’s make it worse with these soaps and detergents and things.

With that also being said, one of my my social media posts people kind of went a little crazy and I talked about not washing with soaps and detergents and just using water. And people kind of lost their minds. Now I do have to say to people that if they are using soaps and you’ve never had a problem with the soaps or the body washes or if you’ve never had a problem with that, like you’re fine. You can keep using them. But where they can cause a problem is they’re going to strip the tissue and the skin of the healthy oils, which are protective.

And then that can open you up to more of this bad bacteria coming in. It can throw off the pH of the vagina, which can now invite some bad guys in. We do know that once the bad guys are there, it can affect fertility. But the other thing I didn’t talk about is the inflammation that’s caused by these bad bacteria that can be there actually can increase your risk of STDs.

So we know… or even exposure to viruses, because HPV, human papilloma virus, is associated with cervical and vaginal cancer. And If things are off, the inflammation that ensues can affect our immune system in that area and make it less likely that we’re going to be able to fight it off. So the other thing with the soaps and the detergents is they tend to have a lot of artificial chemicals in it, that through the vaginal mucosa are really super easily absorbed. So we’re exposing our body to toxins that we don’t really need to be doing in those, with the dyes and the fragrances and all this. So when people get like freaked out when I tell them just washing with water. Water is a universal solvent, meaning that it will dissolve most things.

And even if it doesn’t, It will wash off most of what we need. So when we tend to start using all these perfumes, things to actually help the odor down there, we actually can worsen the odor because we’re throwing off that healthy microbiome. So, and things that we can do, you know, it’s interesting that to keep the vagina healthy, there are things that we can do specifically. But even more so it’s going back to general health, because if we’re getting enough sleep, that’s going to support the microbiome of the gut and the vaginal microbiome. If we’re drinking enough fluids, because they say that 75 percent of Americans are chronically dehydrated, so we need to make sure we’re drinking enough fluids to actually even get a proper lubrication of the vagina.

And the vagina will kind of make a discharge that will wash things out that aren’t supposed to be there. And let me actually go on a tangent for that for a minute. So, you may ask, why when I have a yeast infection or a bacterial infection or whatever, why do I get this heavy discharge?

If you think about it, it’s like getting an eyelash in your eye. If you’ve ever gotten an eyelash or a piece of sand or something, you know, piece of dust in your eye, what does your eye do? It waters to flush it out. So, the discharge that’s happening with these microbiome shifts with yeast or bad bacteria are happening because the vagina is trying to make a heavy discharge to flush everything out.

Going back, we want to eat healthy, unfortunately, the standard American diet, which is very high in sugar and processed foods can actually affect the vagina. So we tend to see more yeast in people that are eating processed foods and especially sugary foods.

And if we’re not getting enough probiotics to replenish our gut, which would then help replenish the vagina, then that can actually affect the vaginal health. They even say taking probiotics… there’s been a couple of studies that show that if you take a probiotic, it can take anywhere from a week to a month, depending on the type of probiotic, for it to repopulate the vagina.

But also, it’s only going to repopulate the vagina if the vagina has the proper food source for that bacteria. But eating fermented foods, they say you should get at least one to two servings of fermented foods in a day. So, that may be anything from yogurt, or kimchi, or kombucha or sauerkraut, but it’s not just the probiotics. You need to be eating some sort of fiber to feed those probiotics.

So this is where either taking a fiber supplement or eating more, really eating more vegetables is probably the key. Will actually help support it. And I know some people are like, I don’t like the fermented foods. Well, the good news… you’re better off with the fermented foods, but there are so many different probiotics out there.

I always tell people, look for one that’s specifically made for women because usually the ones that are made for women will have the different type of lactobacillus ingredients in them. So that’s always a good thing to definitely try and add a lactobacillus into it. Stress. Stress actually can affect our vaginal microbiome because we know it will throw off our gut microbiome.

So we, unfortunately, we’re living in a very stressful times. And so incorporating more connection with other people and, and actually relaxation or meditation. Those are things that also will support the microbiome in general and the vagina. Specifically when we’re… there are some treatments that we can specifically target the vagina, but the key is really going to be supporting overall body health.

But the things that specifically target the vagina are either boric acid suppositories. I think everybody on the face of the earth sells them now over the counter. Back in the day, we used to have to have them compounded by pharmacies, but luckily you can now get them over the counter.

Just, I always have people look at the ingredients and make sure it’s really just having boric acid. Sometimes the capsules will have some fillers in there, but you don’t need a lot of other fancy ingredients with the boric acid. There are some specific vaginal probiotics that can actually be placed specifically in the vagina that are sold on the market and that’s actually pretty good.

Sometimes if you want to kind of give a little boost, especially if you’ve, let’s say you’ve been on antibiotics, unfortunately, antibiotics will throw off the gut, which that’s why we get yeast infections when we had to get antibiotics because the gut gets thrown off and then the vagina gets thrown off.

So, but you can actually boost that process a little quicker by using some of the vaginal probiotics that we actually take a capsule or a suppository and put it in the vagina for about a week. But typically, you know, those targeted therapies aren’t something that you need to use chronically, they’re going to be from time to time. Another good time to potentially use either a boric acid or a vaginal probiotic is during the summer months because we’re hot, we’re sweaty, especially yeast likes to grow in a dark, warm environment, which happens more when we’re in a bathing suit all day long. Or let’s say we’re like exercising and we’re not getting out of those Lululemons quick enough, so.

Because the vagina does need to kind of breathe and kind of be open to the air. We don’t want to kind of keep it constricted and not let air get to those areas. I will often tell people, especially at night, try sleeping without underwear, wearing something very loose. Because we don’t want to hold in heat and moisture, which can then lead to typically more yeast issues.

But even like when we’re in, let’s say in the summer times, we’re in a bathing suit. Well, the quicker you can get out of a wet bathing suit, the better, but sometimes it just doesn’t happen. I know that I personally will often travel with my boric acid and I will if I’m going to be in a bathing suit all day, sometimes I’ll just throw one in to kind of keep, you know, as a preventative. Now I will tell you anytime you use things like the Boric acid or the vaginal probiotics, you’re going to make a discharge with it because the body’s going to sense that there’s something that you put there that shouldn’t be and it’s going to want to flush it out.

So sometimes there’s like a little balance between, All right, well now I’m going to have a discharge in my bathing suit versus treating a yeast, if I get like something itchy or burning later. You can always use something like that. So, yeah.

Katie: That’s so helpful. And it sounds like the pH aspect, that’s something you said women can test at home and that like boric acid can be helpful if that’s out of balance. And is that something you would recommend women just kind of like keeping an eye on and or using occasionally as needed? Obviously not like probably a daily practice.

Yeah. And I wouldn’t do it as daily. It’s more like as needed. And the other thing is, you know, a lot of times if something’s gone and it’s like Now five to seven days and you’re not getting better, then you really need to get into a doctor. But I find for a lot of women, especially when it comes to having problems down there, these problems all of a sudden tend to happen on Friday night at like six o’clock at night when the doctor’s office is closed.

So I don’t necessarily see a problem as long as you’re not having severe pain or any kind of bleeding, just kind of using a boric acid. Suppository to just kind of like pop in there until you try to get you through the weekend or get you to the point where you can be seen by, by a doctor. So, but if, if any of the symptoms are lasting longer than seven days, that is like the sign that you, or if things are getting worse.

Or if there’s some kind of associated bleeding or any kind of pain, then you just need to go see a doctor, urgent care, emergency room, whatever, you know, you need to, but cause you don’t want to ignore that. But if it’s something where it’s like, okay, well, we don’t know what’s going on. And the nice thing about boric acid here. Statistically, when people get itching and burning down there, majority of people think that it’s yeast. And so what do they do? They head to their 24 hour pharmacy and they go by like a monastat or whatever yeast medicine there is that they’re selling. But I will tell you the majority of those cases are not yeast.

They can be bacterial. And boric acid is it usually takes care of the problem. Either way, so I always tell people you’re better off reaching for the boric acid than you are the yeast medicines. So,

That’s great to know, and I want to circle back to something we talked about briefly in the beginning and make sure we get to go a little deeper on that, which is the fertility or connection, because this especially from seemingly women approaching menopause or after is that like libido can often take a hit. And I think a lot of women I operated under this assumption was that it was kind of a hormones first problem and it sounds like this is a whole area that like we might not have ever thought to consider. So for anyone who’s in that experience of perimenopause or menopause, what are some ways that we can specifically support our microbiome that are also helpful for libido?

Betsy: You know, it’s interesting because usually that’s the thing that gets people in the office asking for hormones is the libido. And so it is, most people will think that, okay, I just need hormones and that’s going to make everything better. And then you have people that go on hormones and they’re like, okay, my libido is still not good.

And so the hormones are definitely a tool in our toolbox and they can help with libido. However, if the bacteria in the gut and the bacteria in the vagina are off, that’s also going to suppress libido. They’ve actually even done studies in men and men who have gut microbes that are off, they will report lower libido and potentially even erectile inflammation issues. So this is also once again, going back to the basis, making sure you’re getting enough sleep, like 7-8 hours of sleep. Making sure you’re drinking enough fluids. And I didn’t really mention how much fluid, you know, people always like want a number and it used to be like eight cups a day.

But now they’re saying it should be more like 11 to 12, 8 ounce cups of day. So, and that also depends on how much you’re actually, you know, exercising or how hot it is. I usually tell people that as you’re drinking fluids, and it doesn’t always have to be water. It can be anything that’s not caffeinated, not alcoholic, or usually fit into the fluid category.

And usually as you’re drinking through the day, as long as your urine is clear, that’s usually a sign that you’re pretty well hydrated, but you want to kind of shoot for closer to 10 to 12, you know, eight ounce cups, all about 80 ounces of fluids a day, which is not always easy. And I’m telling people to do that all day long.

And I end up looking back at the end of the day and I’m like, Oh my God, did I drink anything? So I always tell people carry around a container with you. You know, eating healthy foods.n Ad here’s actually, you know, this is really interesting about the microbiome. Eating healthy, we see this happen all the time around New Year’s is people eat kind of crappy during the holidays and then all of a sudden around January, their New Year’s resolutions come into effect and they go, I’m going to eat healthy and then they start eating all these kale salads or salads and all these vegetables.

And then they end up getting gastrointestinal disturbances. And they end up getting bloating or gas or constipation or diarrhea. And then they are like, wait, what is going on? I’m eating healthy. Why do I feel so terrible? Well, there’ve actually been studies that show that you don’t have the microbiome when you’ve been eating those bad foods for so long.

You don’t have the microbiome to actually process all that fiber in the vegetables and that it takes about 8 to 12 weeks and they’re not exactly sure the exact number, but they’ve rounded to about 8 to 12 weeks for you to shift your microbiome to a healthier one that can process those type of foods. So they actually did a study when they did it with rats, but where they took rats that they put them on a bad quote, bad diet, and then automatically switched them to a healthy diet.

And then they took rats where they did a bad diet and gradually kept them on the bad diet but started introducing healthy foods and then gradually switched them over to the healthy diet. And the ones that did the gradual switch over actually ended up having a better microbiome in the end and a more diverse microbiome, meaning more healthy bacteria, than the ones who went straight to the healthy diet.

So, this is something, if you’ve been eating, McDonald’s and Burger King and whatever, and now all of a sudden you want to eat salads, yes, we want you to stop eating those inflammatory foods, but try to just start introducing those vegetables over a 6 to 8,12 week period and just see how you do and then gradually switch over.

You tend to do a lot better. So eating healthy, sleeping, drinking, exercise is really, really good for libido. So exercise can boost testosterone, which men and women both need to help support a sex drive. The thing with exercise though, is too much of a good thing is not a good thing because they’ve actually found that too much exercise actually is a stressor on the body and it can actually affect not only your microbiome, but your cortisol levels, which can throw off your hormones.

And so this is another thing is that, stress and sex can’t coexist. So, when we’re looking at libido, we go, okay, where are the stressors in that person’s life? And the stressor can be mental stress, could be financial stress, could be work stress. And so, we need to lower those stressors, but it could also be the stress on the body from inflammation.

And that inflammation could be coming from food. Foods could be coming from toxins that we’re being exposed to, could be coming from too much exercise, which is actually kind of crazy when you think of, you’re like, I’m trying to be healthy and like actually too much it can be a problem.

There actually was a study that was done where they found that like, 30 to 45 minutes of exercise a day kind of fell in intense exercise a day that kind of fell in that that good period that didn’t boost that cortisol, which would then throw you into a stress reaction. But then when you start going into, like, an hour or 2 hours or whatever of exercise, it actually had more detrimental effects on the body than just doing about 30 minutes of exercise. So…

Katie: Well, that’s great to know. I feel like that gradual shift from a dietary perspective is also easier from a mindset perspective and like adding in more beneficial things versus restriction probably is also psychologically helpful. And I love the exercise tip as well. I’ve been doing a lot more walks with a weighted vest and then just weightlifting sessions versus anything super strenuous.

And I feel really good doing that. So I loved that’s sort of evidence backed as well. And as we get close to the end of our time, last questions would be for one, where can people find you and keep learning about this? I’ll make sure I link to these in the show notes. And then any last vaginal health tips you want to leave us with today or action steps people can start with.

Betsy: So, you can find me on, I’m on every single social media out there. If you just look up Dr. Betsy Greenleaf or Dr. B. Greenleaf, that’s where you can find me. Also, I am at the pelvic floor store, which is a site where I put a lot of the pelvic health products that I recommend. And in fact, we have a discount for your listeners that they put in WELLNESSMAMA, all uppercase, You get 10 percent off any purchase on that site. And then I’m in the process of actually opening a menopause clinic, and that will be the International Pause Institute, P A U S E. And then you can find me at pauseinstitute.com. And then just, you know, wrapping it up, I think the biggest things when it comes to vaginal health is really focusing on overall wellness because wellness is a combination of body, mind, spirit.

It’s like a three legged stool. We can do everything for the body. And that’s why as practitioners and doctors, we can give you treatments for the body. But if you don’t have that balance of mind and spirit, that three legged stool is going to fall over. And so, connecting all of that and doing something, we’re connecting with other people for a sense of community connecting, you’re doing something for relaxation, whether it’s a hobby or meditation, that’s all going to add to not only your libido, but also your vaginal health and your overall wellness.

So if the whole body is connected, we got to look at it as one giant unit and not just its parts. So…

Katie: I love that. I think that’s a perfect place to wrap up for today. I know I learned so much and this was so fascinating. Hopefully we will get to do another round someday. Maybe we can answer some FAQs that come up as a result of this episode, but for today, Dr. Betsy, thank you so much for your time, for your obvious passion about this topic and for helping women and for everything that you’ve shared.

I’m so grateful.

Betsy: I’m so grateful to be here. Thank you, Katie, and for everything that you do.

Katie: And thank you as always for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of the wellness mama podcast.