Breaking the Silence: A Deep Dive into Vaginal Health with Dr. Cheri Ong

The pudendal nerve, which supplies the clitoris. The word pudendal in Latin actually means shame. So I think way back in time there's this something about the clitoris that people feel ashamed of, which should not be. We should celebrate the clitoris. All we're trying to do is replace what your body used to have that we didn't have, we don't have anymore as we age. So this is almost anti aging medicine because we're restoring some of this stuff to allow us to continue to live our lives functionally.

There may be a lot of things taken away from you, but there are definitely things that we can maintain or bring back and support. It doesn't have to be a complete loss.

Don't give up on finding solutions, because the solution might be there.

Welcome to Metabolic Matters podcast. Let's meet today's guest. Hello everybody. This is going to be an amazing conversation I have with us today. I mean, first of all, this is a topic I was talking with Dr. Cherib a couple months back before we set up this discussion together. But this is probably one of the least discussed and most important conversations my patients want to have. And so I'm really looking forward to having this discussion today. We're going to kind of talk about things that are possibly thought as somewhat taboo and yet it is so a part of our natural being. And I really am excited to bring in a world renowned expert and even innovator in this field. A board certified plastic surgeon with coming on two decades of experience in this field. My gosh, Dr. Cherie Ong out of the Ong Institute in Arizona is here today to talk everything vagina. And so welcome, welcome, welcome. Thank you for being here.

Thank you, Nasha. I appreciate it. I'm excited. We have lots to talk about. Things are super important that you know that people are afraid or shy bring up. So let's chat.

Exactly. And I think that, you know, it's something I don't understand why it's. I mean, we all have one. At least half the population has one. Like why, why is this such a taboo topic? And what got you interested in applying various tools from high tech surgeries to high tech kind of modalities and even combination of therapies to really bring this concept of vaginal rejuvenation and sexual health to the forefront.

So this is actually pretty new. When you say new. It's only been present for about 10 years or so, so surprisingly wow. And I fell into it just accidentally. I was a plastic surgeon. We're doing all sorts of different surgeries, breast reconstruction, breasts, you know, all sorts of cosmetic surgeries. And I think the biggest thing I realized is women are shy to talk about this because this is a very intimate area.

Yeah.

It's not something we tell everyone. We're very private. It's a private area. And so one of the things that I realized when I was doing lots of cancer reconstruction for women who have breast cancer is that, you know, some of the side effects that they had with cancer therapy were really affecting their daily lives, you know, their relationships with their partner and not being able to find solutions for this. So it was really interesting. When I started working with these types of technology way back in 2014, I realized that what an impact it had on women and are now able to, you know, have sexual relationships again or able to go to the bathroom, you know, leaky urine, things like that. I did not realize what a big problem it was until I start working with this technology.

This is amazing. And, you know, one of the things that folks go to your website, which will have this linked in the show notes here today, but you're known for someone who is expert in dealing with people's vaginal insecurities. And so you've alluded to a few of those. I mean, we're kind of in this community a bit cancer centric. But this is agnostic. Right. It's. It's affecting women of all ages, of all backgrounds. I mean, perhaps the cancer side of things brings together another complexity to the situation. But what do you mean about vaginal insecurities? And how do you kind of diagnose this? How does someone show up in your office?

Interesting. So we do know that the word clitoris, the actual word clitoris. So clitoris actually comes from the Latin word that associate with the word shame. The pudendal nerve resupplies the clitoris. The word pudendal in Latin actually means shame. So I think way back in time, there's something about the clitoris that people feel ashamed of, which should not be, we should celebrate declaration. But one of the things that I realized too, that I've had patients wait years and just afraid to pick up the phone and call me or call an office and say, hey, I want to talk about this thing. Because I feel like it's really on my mind. It's causing me to lose sleep, but I'm afraid. I don't know who to talk to. I can't really talk to my husband. I have a few girlfriends, some gynecologists that will do your regular exam. Your Pap smear, but really having someone have a conversation about. And when I realized that that was one of the things I try to make it as easy as possible for women to express that this is something that's bothering them. And people want to have good sexual life till they are 50, 60 and 70. And so that's one of the things that we just realized we have more to live for, you know, we have more to do. And this is something that, yeah, it has become, the good thing has become more and more women are more aware of it. And so now there is a lot more in the space or in social media and things that people are talking about. And so my, my specialty or what I talk to women about is both. You know, as a plastic surgeon, we do the surgery, but we also have non surgical treatment treatments to help people with dryness and urine incontinence and things like that, and giving them the permission to really bring that up as something that is bothering them and something they can do something about.

I think that's really interesting. You both take care of the external genitalia as well as internal changes to the system. And so I never, you know, looking at your website was very intriguing to me. It was. First of all, it's a very, it's beautifully done. It's normalizing a conversation that again, like, like we started out here, if you're a woman, you have one of these. So this is the, the part about this conversation that's just like, why is this not normal to have this? One of the things you and I talked about when we met up a couple months back was we can appreciate the variation and the, the differences among us, but there are some situations where it goes beyond just this, not, you know, just being differentiation or someone just not feeling good or comfortable in their own skin. And so you are meeting people in a very vulnerable place and you are offering solutions that are like you said, nothing short of life changing. And so what are. You've alluded to some of them, but what are some of the most common, I guess sort of issues that bring somebody to you. So you've mentioned that you do external work and internal work. Perhaps. Start with the external discussion and then let's talk about the internal of what brings somebody in specifically for this kind of care.

I think you nailed it right on the head. You know, you're talking about self confidence and I think that's basically what it means is it's nothing about the way the partner feels about the way it looks. It's really an internal feeling that women has that they just don't feel good in their own skin, as you mentioned. So a lot of it is self identity, self confidence of how they feel. And in terms of what, some of the common reasons why people seek some sort of solution for this is the fact that people are super active. So exercising, you know, trying to wear tights and clothing, bathing suits, things like that. And they're very uncomfortable with exercise. So trying to ride the peloton or certain exercise bikes, they get uncomfortable. And they also get issues with sex. Sometimes sex is uncomfortable for them. And basically we have a lot of surgeries, a lot of plastic surgeries for women wanting to have their facelifts and they want to have breast augmentations or breast lifts. But I think about this as just another aspect of the body that we could actually improve on. We can actually lift it up, we can make it look better and end of the day is making it look more beautiful, but also something that makes them confident of themselves. And I want to reiterate like you don't have to have this procedure just to gain the confidence. Right. But I think it for someone who is healthy and they're feeling good about themselves, it can make a difference of how they show up in their lives and you know, and with, with your relationships.

And I think about, you know, where I'm now across the menopause bridge. But I have a lot of my younger friends are in that post, post child rearing era and the conversations we have among us about women saying it doesn't quite look and feel the same that it did and going to a lot of great lengths of various exercises and physical therapy and pelvic floor specialties. I have a couple of friends who've had extreme, extreme, extreme changes where surgery was a good option, as you mentioned, like in someone who's in a healthy state. You know, this is probably not something we want to rush in and do a surgery like this for someone coming out of cancer treatment. But for women who've had backgrounds of abuse or trauma or injury or a lot of changes that happen after child rearing, that to your point, it's uncomfortable to wear certain clothing or to do certain activities or just to feel comfortable with your partner in the most sensual and intimate experience they can have, this is a really powerful tool. But what I also love that Dr. Sheree as to offer are a lot of non surgical, non invasive therapies that can really, and I love the word, rejuvenate the whole sexual sensual experience. And I would love for you to speak to us about some of those tools and more specifically like what, what women might be coming into you for those. And so you've kind of mentioned a few in our discussion, but maybe line, give us a little line item of what they might be coming into to work your rejuvenation.

That's. There's a new word that is coming more and more popular. I like that word. I think the most common concerns women have are dryness, so not having enough lubrication as we go through menopause and the need to use lubrication during sex or just having very painful sex. So that's the first one. And the second one could be leaky urine. So having few children, coughing, laughing, sneezing, doing exercises and be able to control the bladder. The third one, which is a little bit more complex because, you know, it involves several things, but orgasms. So not being able to. Taking longer to achieve orgasm and not getting as powerful orgasms, those are the main ones in terms of non surgical solutions that women have. And the last one is things that could be treated as medical like coronary, coronary, chronic urinary tract infections or yeast infections because the lining of the vagina is not healthy and so there's overgrowth of bacteria and just being on antibiotics for a long period of time.

Exactly. Reasons there's a lot. And you know, another one you and I mentioned last time, and I see this a lot, especially in women, I think, who've come through cancer treatment if they didn't have autoimmunity prior to the treatment itself, can elicit some autoimmune changes which can lead to the condition known as lichen planus. And a lot of your therapeutic interventions, I would expect, would have great utility in supporting that because that can become increasingly difficult over time as well. So I don't know if that's something you want to. We might touch on today for some of your therapeutic interventions as well.

Sure. I mean, are you mentioning about lichen sclerosis?

Oh, sorry, yeah, exactly. Lichen sclerosis and lichen.

Yeah, Lichen sclerosis is a chronic problem that many women have and it's painful, it's autoimmune and is usually a dysfunction of the immune system. And it's very hard to treat because a lot of people treat it with steroids. That's a traditional way of treating it. And the way I would approach it is, you know, we want to improve the immune system so we do different treatments in terms of that. But ultimately what we want to create is a healthy environment where there's good blood flow. We can treat it with some of our treatments to increase blood flow, regenerate the lining and then really allowing for those areas to reduce the inflammation area. So we use things like injection of exosomes and things like that. And combined we can avoid long term steroids. And this is super, super painful. If someone has it, they know how debilitating it is. And it's been really nice to see that we have a solution that can help these women with this chronic. This. It was chronic pain.

I love this. And you know, here's another thing that's very unique and specific to the oncology community is many of the women who work with somebody like myself or someone that I trained, they have estrogen positive cancer types. And there's a hesitancy and a concern about using more exogenous hormones to, to work on this. Plus they've literally been on drugs to block that. So it's kind of like peeing in the wind to bring in a hormone that you're also then trying to block. And so they're always trying to look for meaningful, supportive ways to deal with the juiciness, to deal with the pain, to deal with the arousal issue, the blood flow issues, the, the. A good quality orgasm sensitivity there, as well as some of these other more chronic conditions that you mentioned, the UTIs, et cetera. So what is so extraordinary about what you offer is you're offering non hormonal solutions. And so maybe start to walk us through many. I mean, first of all, I want folks to know that Dr. Sri also does integrative medicine in her practice as well. So it's not just surgically related or even some of these specialty tools. She does take into consideration the entirety of the patient, which I think is really beautiful here. But perhaps speak to some of these particular modalities and where they might be most effective.

Sure. Now, the estrogen, which, which is, which is one of the most important things for our vaginas is one of the things that affect so many parts of the vagina. We lose strength in our pelvic muscles because we lose estrogen and as you mentioned, the loss of lubrication. What happens is when we lose estrogen, which the vagina tissue loves estrogen, the lining gets thinner and thinner. So what we want to do is we have an option. Now that was one of the things that really got me into doing this treatment because I've been doing it for over 10 years, over thousands of procedures. And one of the things that really allow. Pushed me forward to continuous treatments is the fact that these women who have estrogen blockage with tamoxifen or drugs like that, they were, they had so much issues with pain and painful sex and these treatments. The treatment I like to use is a radiofrequency treatment. There are other lasers out there, but I feel like when women have very, very little estrogen, the radio frequency energy is very gentle. It's a very small device, it doesn't hurt. And we are creating energy to improve the blood flow, burst blood, blood circulation to the area. And as a result of that, there is more blood flow to allow for the cells to get thicker. And the cells can produce more lubrication on its own. So now they're naturally able to produce natural lubrication. It can also stimulate new blood flow, new angiogenesis, which is creation of blood vessels. And we can actually do. We actually have studies to show those changes in the microscope so we can see microscopic changes of that. There's new production and lay down of collagen and elastin. So with collagen and elastin there's more elasticity because you just don't want something that's stiff, you want something that's pliable, something that's healthy. And so these radio frequency energies are truly regenerative because it restores the lining again. And so when, when someone comes in for like cancer therapy, we will start with, you know, we would probably need several treatments. We go slow and we build up, you know, treatment for treatment, and we get them to a place where now their vaginas are healthy, which leads to ornal lubrication, less risk of yeast infections, you know, UTIs, things like that. And overall they, they have better pelvic strength as well. So all of those things are super important when someone doesn't have any estrogen.

Wow, that's so interesting. And what I hear you saying is this radio frequency treatment that you're talking about, this energy input that you're describing here is more about restoring our body's innate endogenous function versus something externally replacing it. That's really, really unique.

Yes, truly, truly regenerative. It really helps restores the own. I love a lot of the treatments that I do. I love allowing the body to do its work like it's naturally intended to do those things. We're just using a tool to help that happen. We're just reversing some of the changes that has happened to atrophy, which is thinning of the lining and all those things. We're just allowing the body to do what it can do. And the radio frequency energy and other tools that we use are just facilitators.

Amazing. Amazing. And so what does, what does a radio frequency treatment look like and feel like? Could you walk us through that? Just for people to get their mind around this?

So it's a non invasive procedure. So it's not very painful. There's no specific preparation for it and all that. The device is actually, if you think about ultrasound. So ultrasound is a good analogy because ultrasound, you just, you know, there is no needles, there's no, there's no cutting and it's just a, the energy goes through your skin. And so the size of the device is probably as big as my fingertip right here. It's very small, it's not very large, it's very gentle. And it's shaped as the S shape. So it's very, it follows the shape of the vagina. And what happens is someone would come in and we'll do a treatment and last about 30 minutes. And what we're doing is every couple of seconds there's a pulse of energy. And that pulse of energy creates the changes. So the treatment is about 30 minutes or so. And depending on where the woman is, we can decide how much temperature we want to give. So it's customized to them and we treat the whole vagina and restores it and then really no downtime. There is no, you know, activities you need to avoid. People can go back to normal activities. So it's very, very nice to do that. And a lot of women do it proactively too. So they come in again not even having any symptoms, but they want to proactively, you know, improve the health of the vaginal lighting. They can do that. So this is something that, you know, can be done by most women. Yeah.

And so I like the idea, like if they start to note changes on their annual exams or whatnot to, to head this off at the pass. There's options here. Or instead of jumping onto the estrogen bandwagon, if they especially have a particular history of cancer, strong, strong family history or things that make hormones a little sketchy to use, these are really good tools to keep that, that vibrancy. Just like you would exercise other muscles of your body and how your needs change over time as you age. For instance, women need to be doing more weight bearing exercise, more weight training. You're kind of offering the same type of thing. Your body needs different things at different phases of its life. Yes.

And though you are, if a person doesn't have cancer and they're on hormone replacement, it can amplify that, you get better results. So unlike actually for women who are able to do a hormone replacement therapy for various reasons, there are many reasons to do hrt. Doing the vaginal treatments will just allow the results to be even better. So they get better orgasms. If women that do the HRT get better results just because they have the environment.

Double whammy.

Whammy, Triple whammy.

There you go, the potentiation of it all. Yeah, well, you do a couple other really innovative therapies. And one of the things we talked about here was the lichen sclerosis, which can be a pretty debilitating condition. But you and I were kind of kicking around ideas of how to help. I've got a couple patients in mind I want to send your way. And you talked about using things like prp, which is also known as the ose. Maybe tell us a little bit about a famous O shot as well as hyaluronic acid. So these do involve a needle, but they're still, you know, way less invasive and not perceived as painful from women I know who've had these procedures. So tell us maybe a little bit about some of these other tools and where, what utility they may have.

Sure. So I always think about the analogy of growing a plant. So if you want to grow a plant, you need water, you need sunshine, you need fertilizer. So I like to stack a lot of these treatments because it all works together. So the more more tools you have, the better results you're going to get. And they all feed off each other. So when you think about radio frequency as giving the water, giving the energy and giving the blood flow, now you have the blood flow going and that's great. Now we want to have better orgasms, so we want some fertilizer. So we want some extra growth factors. And the growth factors that tradition, traditionally the word is called, the name of the procedure is called the O shot. It was actually invented by a good friend of mine, Dr. Runnels. And the PRP is actually growth factors from your own blood, from your own platelets, platelet rich plasma. And I've used PRP for a very long time. There are other products now that I'm using that is a little bit more potent, so we can use that as well. But basically what we're trying to do is add more fertilizer and growth factors. And these growth factors, what they are a signaling molecules to bring your own stem cells into the area. Say, hey, that's the area that I need to heal I need to regenerate the nerves. In areas of lichen sclerosis, there's certain areas where in postmenopausal women, the, the, the entrance of the vagina is super thin. Usually at the entrance, the lining is really thin. And so we want to restore that tissue because this, where is the most friction when you have sex. And so by adding hyaluronic acid. Think about hyaluronic hyaluronic acid as a filler that you put in your face. But basically what it is, it absorbs whatever is in there. So we can inject the product into areas where it's thin. Guess what? It allows the body to pull in moisture into that area and allow it to heal again. And if you inject the product like PRP or in my case, I use a lot of exosomes in my practice, it allows the growth factors to stay where it needs to stay and rebuild the tissues. So I really love the fact of using different things depending on where it is to help reverse or restore some of the changes that has happened.

I love it. It's, you know, we talk about, you know, kind of the biohacker world. They talk about stacking hacks. You are absolutely stacking hacks here with regards to the whole pelvic floor, which is really powerful. And it's not just changing things, I think. Very interesting, interesting that it's changing things like structurally with some of the therapies you're bringing on physiologically with others. And, and I, I would imagine psychologically is impacted as well.

Yeah, you talk about stacking. We, we also, I, I love stacking because one plus one plus one equals five in my, in my mind. But we have, you know, we do the radio frequency, we do the O shot, we do the ha. All these treatments are down the office. And then we give patients or women stuff to do things that they can use at home as well. So we can compound arousal creams, you know, we, we have a sexual peptide for women and men, but now women have opportunity for sexual peptides. And all we're trying to do is replace what your body used to have that we didn't have, we don't have anymore as we age. So this is almost anti aging medicine because we're restoring some of this stuff to allow us to continue to live our lives functionally well.

And it's interesting because in the population that we serve, we have a lot of women who had their fountain of youth taken away earlier than expected. It's especially today with the rates of cancer going higher and higher. In people younger and younger, we are impacting a lot of pre menopausal women and a lot of pre fertile women or women of fertility age in a way that we've just never seen in my 30 plus years in practice. And so I cannot even tell you the number of conversations I've had with couple and with women about will I ever be able to have the same intimacy with my partner again? The emotional crush of that, in addition to the big C diagnosis. It, it just, it, it, it's something just we shouldn't have to be worrying about. And I think that what you bring to the table is, you know what, there may be a lot of things taken away from you, but there are definitely things that we can maintain or bring back in support. It doesn't have to be a complete loss.

Yeah, I agree. I mean, when I was doing breast cancer reconstruction, I had young women, 20, 30 years old, they had double mastectomies. They lost their, the confidence with themselves. They lost a big part of the, their, their breast. Right. They don't have their breasts. And so I realized at that time that there was, you know, we can't, we can reconstruct the breast, we can put implants, we can make, you know, breasts, new breasts, but it's not the same. They don't feel the same, they don't look the same. Women don't feel the same. So much of this is internal. And that's when I started working with them with the no concerns. I ended up, you know, taking over some of their vaginal concerns. And I realized there was something that they still had that they could, you know, rely on to feel sexy again and to feel like they can show up and be the person they were. Because so much as you said, the toxicities of all the treatments, at least that's something they could, you know, have and move forward with. And that's really, really important.

It's huge. It's huge. And though I know you do not specifically address trauma or some of the other things that could have led to some sexual dysfunction, even above and beyond cancer, or, you know, all these other pieces, I know that you recognize it as a contributing factor to this. So how do you address this with your patients and do you have resources for them when you are meeting someone who's really had some sexual trauma?

That's a really good question, because I feel like that was something I did not learn in medical school. I, I kind of learned through experiences that I had with women. And so I'm very, very particular on the women I take on for surgery because we want to make sure we're doing the surgery and you can heal. The surgery is not going to do that. And one thing I realized was that when we go ahead and do surgery, we actually pull a band aid off and all the women actually relive some of the emotional trauma, like in real time, without true giving birth trauma to giving birth sexual trauma. So I'm very particular, in fact, I turn away at least 20% of women seeking cosmetic vaginal surgery because, like, there are more important things that need to be addressed first. And so most of them have seek therapy in the past. I would encourage them to go back. I'm actually very excited because I actually found a lady now that I'm working with and I am going to find out from her how we can incorporate this into our interview process because there's so much of that that needs to be addressed. But this time, I would highly recommend them to work with their therapist and address those things before they actually have the surgery. So, yeah, it's very, very important because there's this thing that people talk about, the gut brain connection. I believe there's a very strong, even stronger vagina brain connection. And if we don't address that, the A will not heal from the surgery properly. And it may evoke emotions that they didn't realize was going to be evoked from the actual surgical trauma itself. You know, so that's one of the biggest things I've learned in the last, you know, five years or so is this one thing. And so I'm very, very aware of it now. And I definitely talk to women very ask those questions upfront in a way that they feel comfortable sharing. And if they do, I would allow them to seek, you know, more therapy first to make sure that they can move forward.

I love it. Just kind of women supporting women.

Yes.

In that and that arena, which is huge because it's like this is an opportunity for deepening their healing. But they need the tools and the resources there so it doesn't backfire. Because I can imagine it, like you said, it kind of surprised you when it started just showing up in so many different ways. So I love that. I can't wait to hear how this goes with this new addition into your practice or into a referral source for your patients. So you have been involved, and we're hoping to do more of this in the future. But you've definitely been involved in research. You've helped bring some of these amazing tools to the masses. So I want to know, kind of what is exciting you on the horizon right now? Are there any emerging technologies or opportunities that you see that are, you know, maybe you're already playing with, maybe doing some research in or, you know, is on the horizon?

So a lot of the stuff that I'm excited about is really in the face of immune health, integrative health, and being able to combine that. So not just treating. If you talk about vaginas right now, how can we incorporate other modalities that treat the body, particularly in immune system, into our practice? So we do already a lot of ozone therapies and, you know, things like that. I love the stacking part. I love, like, adding treatments upon treatment, really understanding the cell cycle and what we can do. I can nerd out about this. It's like my. So we are combining a lot of things now, so I really want to understand how can we maximize cellular efficiency? One of the big things we've brought into the practice for the last several years Is a type of ozone therapy that helps with detox. So we're really seeing a lot of people detox their toxins, their chemicals, their mold and stuff like that. So we can speed. Speed up the process of getting rid of that. So ultimately, over time, all these toxins cause issues like, you know, and so if we can combine those things, then we can allow people to have. Maybe prevent bad things from happening from them, like cancer, things like that. But we also can extend their energy levels and their overall longevity. So those are the things I'm super excited about.

It occurs to me just, you know, when we have. When we have a patient coming to us for the first time, those patients are like, bringing together their board of advisors. You know, they're. And it's like, I just see you as such an important advisor on this journey that you don't have to wait until there's a problem. This could be something of. Have a conversation of what can I be doing now to prepare my body for the changes to come? You know, what. What tools can I be doing at home? What are some things I could be doing preemptively with you? What can I know, be aware of in case there are side effects from, say, my radiation or my hysterectomy or my endocrine disrupting therapies or endocrine blockade therapies, or even just the trauma itself that just locked the whole body down of not recognizing self anymore? I just. I feel like you should be showing up earlier on Instead of waiting for there to be a problem.

My, My. My big thing is you know, I would do the same thing I'm doing now if. If I had cancer tomorrow, if I've. I had a diagnosis of cancer, I would be the same thing I'm doing now if I didn't have cancer. Because ultimately, if you get a strong immune system, we can get rid of all the. I'm doing the same thing I'm doing now as if I cancer, I'm going to eat well, drink well, exercise, do all those things at home. But I also went to, you know, take care of my total toxin burden. I'm going to, like, do things to remove those things and detox regularly. I would do those things to improve my immune system. Simple things like is, you know, vitamin D and things like that. But I would. I would do those things and I do treatments of ozone, you know, several times a year. That would be what I would do if I had cancer. So for me, proactive is just preventing those things from happening. And we can do that. We can really, first of all, feel better. And we're doing the things for. To prevent bad things from happening. So I love your analogy because I feel like if I have cancer, I'll do the same thing right now. So I'm treating myself as if I have cancer right now. I'll do the. I won't eat sugar. Right. Do all those things.

Yeah, I love it. I love it. So you're really talking terrain, you know, addressing the terrain. It's like the. The vagina is just part of that terrain. It's like the bull, you know, where all. Everything settles. So if you aren't taking out that garbage and dealing with the things, it will eventually settle in right to that part of your body and being, from the physical to the emotional to the biochemical, all of it. So it's a very underserved part of our being. And I just think it's really amazing. There's an entire field, entire expertise in this. And so what I would love for kind of final thoughts from you is how can clinicians better support their patients? How can they be open to having these conversations?

I think the first thing is awareness, and hopefully with this conversation, because you don't know what you don't know. And I think just being able to be open to. Being able to be open to options that are out there that are not traditional. So that's number one. And knowing there are things that you may not know. So first of all is that awareness. And then secondarily being able to have a conversation and listening to the patient and really listening like you know, what are the things that are bothering you? What are the things that are really affecting you that you have not mentioned before and finding, you know, maybe referrals or solutions for, for other people that are doing those things because they are out there. If you don't know about it, you can't look for them. But yeah, my goal here is, with this conversation is just first of all, the awareness that something like this exists. Then we can go deeper into what are the things that exist and then we can, you know, help more women.

I love it. And Dr. Shree, I know one of the things you're passionate about is educating future practitioners. And so we, we hope that more, you know, even a clinician listening to this thinks this is a tool I need to bring into my office. Like, clearly, especially someone who sees so many women, this is like such an important tool. So I know that you offer trainings or will and hope to do more so in the future, but you also do take referrals from all over the world. I know you're not just limited to the United States. Can you tell us how folks can find you and even if a clinician's listening, where to look for possible future education opportunities with you? Sure.

They can definitely contact me through my website and the website is oninstitute.com we do have training opportunities for sure, but I think just the ability to be aware of these things and being able to find sources of options that are out there. So definitely the best way to contact me is my. Through my website. Or I can also provide you my email that I can. You can put in the notes, but you can send me an email as well. Happy to answer any questions.

So good. And if you could offer one tool that a listener today could start incorporating at home, what would it be? One tool.

That's a good question. I think the big. The one tool I can offer is be proactive. Take, take, take, take, take command of your health because no one will. And just being able to listen to your body and don't give up on finding solutions because the solution might be there. And I think that is just being able to have. Advocate for your own health. And yeah, and then you will find the solutions and the answers will come.

Amazing. First of all, I am so glad I know you exist out there for myself and other women in the future to be of support here. I feel like you can go back to our retreats, go back to my clinician trainings and offer this tool, these recommendations because it is something I cannot express it enough. How often this is a concern and is not being addressed. And so you offer hope for so many. So, Dr. Cherie, I'm incredibly grateful to have you here today. Thank you for being such an advocate of women. And thank you for being an incredible resource for clinicians as well.

Thank you so much, Dr. Winters. I appreciate it. I really enjoyed the conversation. Thank you for allowing me to share.

Absolutely.

Thank you. Sam.