It’s time we normalize talking about pelvic and vaginal health. In today’s episode, my friend Dr. Betsy Greenleaf and I attempt to do that. She is one of the first Board Certified Female Urogynecologists in the United States. She is also a Distinguished Fellow of the American College of Osteopathic Obstetrics & Gynecology, a Premiere Women’s Health Expert, and a Motivational Speaker.

Dr. Betsy was in private practice for almost 20 years and now she’s building online experiences for women to heal themselves in the urogynecological area. 

Urogynecology is the area of medicine that covers the diagnosis and treatment of conditions that affect the bladder, reproductive system, and rectum, including pelvic floor disorders. Urogynecologists can be urologists or gynecologists trained in female pelvic medicine and reconstructive surgery.

So let’s talk about about pelvic and vaginal health. In this conversation you’ll learn what Dr. Greenleaf and I believe EVERY woman should know to correct and protect your vaginal health.

What Is a Pelvic Organ Prolapse? 

A uterine prolapse occurs when the muscles and tissue in your pelvis weaken. This allows your uterus to drop down into your vagina.

Our pelvic organs are open to gravity because we don’t have bone structures at the bottom of the pelvic floor. All we have is muscles and ligaments, and those ligaments are not even that strong, so anything that causes a lot of pressure can rip and tear those ligaments.

Then the uterus may not stay up where it’s supposed to be, or the bladder, or the rectum, and then those three organs, which are very close to each other and lean on each other, can end up pushing each other out.

Most commonly women who’ve had long and difficult pregnancies or have given birth to a large baby, or multiple babies, are at risk of a prolapse. Also, women who are chronically constipated, or do effort constantly like lifting heavy objects or gymnastics, or even people with asthma attacks or chronic bronchitis where they’re coughing hard all the time – all these things are going to put a lot of pressure on the pelvic floor.

How Is a Pelvic Prolapse Treated?

Surgery is an option that has been around for a long time, using the mesh as in hernia surgery, but they found out overtime that when you put mesh in the pelvic floor, it doesn’t work as well as it does when you put it in for a hernia and there were some women who ended up developing problems over the years, so unfortunately that’s currently not a great surgery for prolapse. 

Furthermore, these surgeries have shown to not be permanent, so once you’ve had one surgery, you’re at higher risk of it dropping again and having to get another surgery. Some non-surgical options that are available include a device called a pessary which folds up inside the vagina and they just wedge in place so they can hold all the organs. 

Another option is prevention by strengthening the pelvic floor. Kegels, which involve tightening and then releasing the muscles in your pelvic floor, work to strengthen and prevent prolapse. 

We start losing 8 to 10% muscle mass every decade of our lives so if you don’t start strengthening those muscles it’s definitely going to be a risk factor for prolapse. Other exercises include sitting down and putting a ball or pillow between your legs and squeezing your knees together. 

Physical therapy can help too. It is important to start this therapy as soon as possible. For example, in France, when women give birth, they automatically get put into a physical therapy program after birth and not surprisingly France has the lowest rate of incontinence and prolapse. 

There are now regenerative medicine approaches that can help with prolapse. We’ll cover that later in the interview.

What Is the Vaginal Microbiome? What Is the Gut-Vagina-Brain Connection?

There’s now something called “next generation DNA sequencing” where we can swab the vagina and we can identify exactly which microbes are present and so we’re getting a better understanding of what’s going on with the microbiome of the vagina. This testing is available through my office.

With this advanced testing we’re discovering other bacteria and so the exciting part about this is that women can now understand why some conventional treatments are not working for some issues. What we’re finding out with these newer tests is that there’s many more bacteria that are interacting in our bodies. 

In Dr. Betsy’s case what happened was she was getting chronic yeast infections and the yeast medicines were not working. Then she started looking into the gut microbiome testing and finally found out that her gut was filled with yeast. So, a lot of times when you’re getting vaginal symptoms, it’s really a symptom of a larger problem going on with the microbiome of the gut. So, in this case we need to address the gut in order to get the vagina healthy. Learn more in a prior HHH episode about the gut-vagina connection.

What’s even more interesting is that scientists are finding that there’s a microbiome connection between the vagina and the brain through the vagus nerve. So, if the bacteria in the vagina are off balance, that is going to dampen our sex drive. A lot of women are going to their doctors thinking if they don’t have a sex drive it must be hormonal, but it may be a microbiome issue. 

We have also seen evidence of problems with fertility when the microbiome in the vagina is not optimal. Learn more in this blog post.

It really is exciting because it gives more treatment possibilities so women don’t have to be struggling with fertility issues, low libido, or chronic infections, when we can actually be detectives and identify the imbalances both in the urovaginal area and the gut.

There are also natural ways to rebalance the microbiome in the vagina. We want the healthy bacteria to stay there and get the bad bacteria out. One way of doing this is balancing the pH in the vagina. The vagina is naturally very acidic and so in a very high acidic (3.5 to 4.5 acidity range) the healthy bacteria thrives, and the bad bacteria doesn’t.

One of the products that’s available to support a healthy pH is Boric Acid. Boric Acid effectively treats vaginal infections (microbiome imbalances) in the vagina – whether it’s yeast or bacteria. 

These options save women from getting stuck in the repetitive cycle of vaginal cultures, antibiotics and antifungal medications. It also helps to prevent HPV because HPV is more likely to occur in an imbalanced vaginal biome. Learn more in this HHH episode about HPV.

Are There Good and Bad Products to Use Vaginally?

When it comes to cleaning, plain water is the best option. If we want to use soaps or other products, we should definitely look at the ingredients and stay away from sodium lauryl sulfate which can be very irritating and polypropylene glycol, which is a mucosal irritant. And avoid fragrances, dyes and detergents. Also, it’s a good idea to avoid the use of lubricants because they can throw off the pH balance in the vagina. 

There are also some products out there that promote acidity in the vagina like lactic acid products, the only thing is if you have a milk allergy you likely want to stay away from lactic acid. Also, there are some vaginal probiotics that come in suppositories that promote healthy bacterial growth. 

When it comes to vaginal douching, we have to be careful because if you have a bacterial infection, douching can spread that bacteria into the uterus, the fallopian tubes and into the abdominal cavity, and that can make you really sick. 

The best thing to do to promote vaginal health is to also address your gut health as there is evidence that these systems are connected. The more you improve your gut health, drop inflammation, and get your digestion working and your gut bacteria optimized, the more you’re going to see a positive impact in your vaginal microbiome and overall health.

I (Dr. Doni) also find that gut health is related to HPV. When helping patients with persistent HPV, one of the first things I do is to address your gut health and gut bacteria. This will in turn improve your vaginal acidity and microbiome and make it harder for the HPV virus to thrive. Learn more in this FREE HPV Masterclass.

What About Regenerative Medicine for Pelvic Health? 

This is something that’s changing every day. We’re coming up with new options and treatments that could be done at home or at practitioner’s offices. 

There’s PRP which is when platelet-rich plasma (from your own blood) is injected vaginally. Platelet-rich plasma contains stem cells which can promote the growth of healthier vaginal tissue. So PRP can regenerate the vaginal tissue. 

There’s also laser therapy to rejuvenate tissue using devices in the vagina that work using light energy, which penetrates the tissue, causing microscopic irritation that stimulates growth. The body reacts to heal that irritation, flooding it with growth factors. The red light therapy device Dr. Betsy mentions in the interview is the vFit.

There’s also radio frequency therapy using sound waves to generate heat to cause the tissue to regenerate. We’re kind of entering this world where anything that’s being done for rejuvenation purposes cosmetically is now being applied to the vagina and other areas of the pelvic floor too.

Doing all these things in combination can give people better results because they work on the tissue in different ways. 

If you want to reach out to Dr. Betsy and learn more about how she can help you, please make sure to check out her website or her Instagram @drbetsygreenleaf_.

You can also check her upcoming Happy Vagina Rally which is an online women’s summit with 40 speakers (including me, Dr. Doni) will be talking about vaginal health, general pelvic health, HPV, hormones, hair loss, gut health, bladder health, energy levels, etc. This event is sure to change your life simply by helping you understand your body and how to heal it.

If you’re interested in learning more about my approach to healing HPV you can find my new HPV Recovery Guide here.

If you are tired of this virus and are really committed to erasing it from your life forever, you can sign up for my Say Goodbye to HPV 12-Week Program here.

If you want to work on your gut health and microbiome you may want to sing up for my Heal Leaky Gut Program where I teach you how to heal leaky gut with my proven protocol. Keep in mind that 50% of people with leaky gut, have zero symptoms, so the only way to know for sure is to do the food sensitivity panel I recommend.

For the most comprehensive support, even with the most difficult health issues (physical or mental), it is best to meet with me one-on-one, which is available to you no matter where you are in the world (via phone or zoom). You can set up a one-on-one appointment with me here.

We’re here to help you! 

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