#168 MATURE CONTENT - Improving Your Pelvic and Vaginal Health with Dr. Betsy Greenleaf

In today’s episode I get to introduce you to my friend Dr. Betsy Greenleaf. She is the First Board Certified Female Urogynecologist 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.

Today we talk about urogynecology and general pelvic and 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, and the pelvis 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 that 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 hard coughing 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 long, 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 hernia and there were some women who ended up developing problems over the years, so unfortunately there's not great surgery for this. 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. Here is where Kegels which involve tightening and then releasing the muscles in your pelvic floor to strengthen them. 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 factor of prolapse risk. 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.

What About the Relationship Between the Pelvis and the Microbiome?

There’s now something called next generation sequencing where we can swap the vagina and we can see everything that's there and so we're getting a better understanding of what's going on with the microbiome of the vagina. 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 they'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 someone 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 balance the gut out to get the vagina healthy.

What’s even more interesting is that scientists are finding that there's this like microbiome connection between the vagina and the brain through the vagus nerve. So, if the bacteria in the vagina is off that is going to dampen our sex drive and 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 more problems with infertility when the microbiome in the vagina is off.

It really is exciting because it gives more treatment possibilities, it helps us to see and so women don't have to be just struggling with infertility, 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 out there is Boric Acid. Boric Acid will balance out the vagina whether it's yeast or bacteria.

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 that is in a lot of woman's products that 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 kind of want to stay away from lactic acid. Also, there are some vaginal probiotics that come in suppositories that are over the counter that promote healthy bacteria 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 as well as your gut bacteria the more you’re going to see a positive impact in your vaginal microbiome and overall health.

We can also see how the gut health is related to HPV, when you have a persistent HPV case one of the first things to do is to get your gut health and gut bacteria on point, this will in turn improve your vaginal acidity and microbiome and make it harder for the HPV virus to thrive.

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 is injected where stem cells multiply and grow new younger tissue. PRP can regenerate the vaginal tissue. This procedure works by stimulating stem cells to grow healthier vaginal tissue. There’s also laser or light therapy to rejuvenate tissue using devices in the vagina that work on light energy, penetrating the tissue and making a little hole. Then the body reacts to heal that hole and it floods it with growth factors. There’s 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 where 40 speakers will be talking about vaginal health, general pelvic health, HPV, hormones, hair loss, gut health, bladder health, energy levels, etc.

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.

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