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

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions.

Dr. Donnie Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself. And in doing so, she discovered the Dr. Donnie stress recovery Protocol. On this show, you're going to hear from doctors, nutritionists, and Experts along with Dr. Donnie, who will give practical advice and wisdom to help heal your body. This is how humans heal.

Hi and welcome to how humans heal. I'm Dr. Donnie Wilson, and today I get to introduce you to my friend, Dr. Betsy Greenleaf. She is a urogynecologist and really a women's health specialist. And I'm so happy to have you here with me today, Betsy. Thank you.

Oh, thank you so much, Dr. Donny. I'm so excited to be here.

So Dr. Betsy Greenleaf, she originally is trained as a, like, OBGYN, what you would usually think of as an OBGYN. She's board certified as an OB GYN, and she's also the first female certified in urogynecology, which is specifically the area of women's bodies that. That overlaps with the urinary system and the vaginal system area. Right. So this whole pelvic area for women, and it's so exciting. And Dr. Betsy was in private practice for almost 20 years, and now she's really building online experiences for women to heal themselves in that urogynecological area with online programs. So. Oh, my gosh, it's so exciting what you're doing. I just love your passion for women's health and helping women with this. So thank you again for what you do. This was my explanation, but please, like, how do you explain it?

Yeah, no, I think you did a great, great job. And it's funny because, you know, a lot of people when they hear Eurogynecology, they're like, what is that? My. My mom, when she first heard it was like, you're going to do what? She's like, is that like, fancy gynecology? Like, European?

Like, like eur.

Yeah, like you. Yeah, like Euro Disney. And I'm like, no, no, it's like you're Euro. Having to do with urology. It's kind of combination of urology having to do with the bladder and the urinary system and gynecology. So we get even more specialized on, like, the pelvic organs. So we have to do. We treat people for, like, incontinence, leaking.

Prolapse, unfortunately, sometimes the uterus or the bladder or the rectum, Like, Droops and drops. And nobody ever tells you about that when you're younger and all of a sudden like something's kind of bulging and you're like, what in the world is that? Well, urogynecologists are the type of doctors that handle that type of medicine. So.

Oh my gosh, my, my 20 year old daughter just asked me about that. She's like, mom, is that a thing that the, the uterus can pro, can prolapse out of the body? And, and she was trying to conceptualize it, she's like, how's that even possible? So it is like, it isn't something they tell you about, but it's like, hey, this is the truth of women's bodies and how to help prevent some of these things that can happen with aging. But sometimes it's happening even at younger ages, right? Yeah.

I've seen, no, the youngest I've seen people having prolapse or like even high school kids. And surprisingly it tended to be women who did gymnastics. And I think the problem, so like back up for a minute is like our pelvic organs are open to gravity because all we have, our hip bones, there's nothing like bone. There's no bunny structures on the bottom of us keeping things in place. All we have is muscles and ligaments. And those ligaments are really not even the strongest thing in the world. So anything that causes a lot of pressure on the pelvis can rip and tear those ligaments. And now the uterus doesn't stay up where it's supposed to be, or the bladder doesn't stay where it's supposed to be, or the rectum and those three organs are very close to each other and they kind of lean on each other and they can push each other out. So all of a sudden like the vagina can start turning inside out like a sock. And then next thing you know, things are bulging outside of the body. People are like, what? So most commonly women who've had pregnancies or childbirth are usually at the highest at risk for this. And actually 50% of all women will develop a prolapse at some point in their lives. But then we see women who are chronically constipated. You know, the bearing down of bowel movements can damage those ligaments. I said, like women who did gymnastics, sometimes that landing, that hard landing put a lot of force on the pelvic floor. I've seen women who've never had children develop prolapse from lifting heavy objects or like, or even people who get like asthma attacks. Or chronic bronchitis where they're really like hard coughing all the time. All these things are going to put a lot of pressure on the pelvic floor and they can.

Now a lot of us solution. Is it, is it to some degree surgical? And that's what you were doing before was really surgical interventions.

Yeah. And it's funny because when I, when I trained the surgery is all when the vaginal mesh had just come out. And so before we had those 1-800-bad-drug commercials about vaginal mesh is this was going to be like the next great thing because it was less invasive and it basically we use mesh for hernia surgery since the 80s and so it's just the same type of product. But they found out over time 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 there's not a great surgery. And that's the other thing is that we used to think when you did surgery like, oh, you just have surgery once and that's it. Well, they're now realizing that these surgeries are not permanent. So once you've had one surgery, you're at higher risk of it dropping again and having to get another surgery. So. But dating back is interesting. Dating back all the way to ancient Egypt, there's been some non surgical options that are available as a device called a pessary. And pessaries come in all kind of crazy shapes and sizes and they're just usually today, day and age. They're usually made out of silicone and they, they fold up and insert in the vagina and they just wedge in place so they can hold all the organs up. But it's interesting looking back at ancient Egypt, they used to use rocks or pomegranates, which I don't advise, or even like in, in ancient Rome they used to use potatoes. Yeah, don't do that.

Well, that's not, that's not going to last very long either because it's bad. But that's interesting. This is not a recent issue for women and women have been trying to solve it. And so yeah, pessary is like, was considered like the old option, but now it's back as like, hey, maybe this is better solution than repeated surgeries. Yeah.

And I think that there's so many, there's just so many options for people and they, I remember when I first came out of training, it was like, you Had a prolapse, you got a surgery. You had a prolapse, you got a surgery. And then as I went on in my career, I started going, wait a minute. Why fix something with all the risks and complications that can happen with surgery if it wasn't bothering the person in the first place? Like, they just happened to find it on an exam? And so I started treating my patients like that, where we were. We started going from surgery being your first option to surgery being, well, if nothing else works. And this is bothering you enough that it's affecting either your physical quality of life or your mental quality of life. That's when it's time to have surgery. So, yeah, but there's.

There's so much, because it also can be a lot of just awareness and prevention. What can we do to help women be strengthening their pelvic floor before it gets to that point?

Exactly. That's definitely where key goals come into play. Because, you know, it's funny, it's something that's like a board examination question, like, answer, like, what should you do? What's the first thing you should do when somebody has a prolapse? They should be strengthening their pelvic floor. But we should all be strengthening our pelvic floor, doing our kegels all the way along the way to give as much muscle support to. To the pelvis and all our organs that are sitting on top of that, you know, to help prevent some of these or even help alleviate some of these problems. But we don't think about it. We think, you know, when we think about working out, we're working out our arms and our legs, and not many people are thinking about working out of your pelvic floor. But 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. If you don't use it, you'll lose it. So we want to make sure. And it gets harder and harder. Not that you can, but it gets harder and harder to strengthen those muscles over time. So it's definitely something you want to keep up with. And unfortunately, I find that a majority of women don't do kegels properly. We hear it and we go, okay, I'm tightening my pelvic floor. But a lot of women, it's. It's not a natural thing to try to think about tightening that area. So sometimes many women, like, bear down, and if you're bearing down and pushing down, you're going to actually cause more damage to those muscles. So I, you know, there's a couple of different ways to do the Kegel. Number one, there's pelvic physical therapists, and they're, they're amazing. Find a pelvic physical therapist who can teach you how to do exercises. And, and sometimes there's other exercises just like sitting, sitting down and putting like a ball between your legs or putting like a pillow between your legs and squeezing your legs, your knees together. That will also strengthen your pelvic floor. So you don't have to be doing like traditional Kegels. But when I try to explain people how to do the Kegels, it's like, all right, well, think about the muscles you'd use if you were trying to hold a gas. Like, you know, say you're someplace you're in public and you, you know, you need to fart. Well, like, what are those muscles that you would be holding in your gas? That's. Those are the muscles. Or think about, you have a straw in your vagina and you're trying to like, suck up fluid. It's going to be like a more of a lifting type of movement, so, Than a bearing down. So.

So that's such an important distinction. And I am with you. I love the pelvic physical therapist. Like anyone who has his having issues and didn't know that that's a specialty in physical therapy is all about the pelvic floor for men and women. And it can be life changing. Especially women who like after pregnancy and birth and if you're having continued pain and, and even before it becomes prolapse, that's such a. They have so many options with physical therapy to help the healing of the pelvic floor.

Yeah. And it's funny, there's been like, when I first came out of training, there was like one in the area and now I look there, you can find the pelvic physical therapist almost anywhere. Even if you just go look up pelvic, Pelvic physical therapy or even a lot of the physical therapy websites will now have a separate link to who does pelvic physical therapy. And you know what, it's kind of a shame if you think about it. In France, when women give birth, they automatically get put into a physical therapy program after birth. And we don't do that here in the United States. And you think like, birth is a. Whether you're having a C section or a vaginal delivery, either way it's a trauma to the pelvis. And what do we do for all our other surgeries? If you have orthopedic Surgery, you're going to physical therapy afterwards. And not surprisingly, France has the lowest rate of incontinence and prolapse because these women are addressing it right when it's happening instead of years down the road when we're seeing, you know, things are starting to show up.

Wow, that. That really is. That is really interesting. And I want to also shift the conversation slightly, because here we are talking about anatomy and these anatomical structures that we can, you know, that are, like, present. But another part I know of your research and your passion is to understand the microbiome. You know, like, what's the microbiome that. The microbes that live in this area and how do we optimize them? Tell us more about that.

This is an area that I just completely geek out on because every time I turn, there's more and more information. And it kind of. It's interesting. It kind of started for myself because of years having issues, suffering from yeast infections. And so, like, yeast became like my arch nemesis. Like, I used to think like yeast like Darth Vader. And he. I was going to be, you know.

Like, I'm sure a lot of women listening feel the same way, because you do. You feel like you're in a battle with these microbes that want to take over your body. Right.

And I couldn't figure it out, and it was driving me crazy. And then as the more and more I looked into the research, the more I found more information on microbes. And as the science progressed and we went from doing cultures to now they're able to do something called next generation sequencing, where we can swab 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. Because unfortunately, you know, it's the scariest thing is in medical schools today, they're still teaching, like 1950s these cultures, right? Cultures or something called a whiff test. So, like in the past, the way, like in the 1950s, and this is how I was also taught in medical school, and this is what they're still teaching nowadays. And you would do. You would do a swab and you would put it under a microscope and you would look at the cells, and if you saw a yeast, you'd like, see. And if you saw like something called a clue cell, which is a skin cell with bacteria stuck on it, you're like, oh, it's bacteria. And then you would do something called a whiff test, where you'd put a little Hydrogen peroxide or potassium hydroxide on the slide. And if it smelled like fish, you know, many women who have had bacterial infections know what that means. They'd be like, oh, this is bacteria. And that's all. That's the only way that we knew how to diagnose. And so I was always taught there was a bacteria called gardnerella, which was the main cause of bacteria vaginosis, which gives you that fishy odor, and it gives you a heavy discharge and gives you, you know, itching, burning. It's a pain, you know, it's not fun. Well, now with this advanced testing, we're discovering other bacteria. And so usually when you get these women who, like, they're going on these creams and treatments, and then it's not. And they're not getting better. They may be getting partially better. We may be killing off some of the bacteria, but we're not killing it all off. There may be other strains that are contributing to things. So this has been really exciting. And then I think even more so as we're finding out what's normal in the vagina. And we're able to identify the type of Lactobacillus, which is, a lot of people have heard about Lactobacillus acidophilus. That's just one of many different strains of Lactobacillus that are naturally found in the vagina. And then even taking that research event further. So in my case, what happened was I was getting chronic yeast, and I'd, you know, go on the yeast medicines, and I. I would. Wasn't getting any better, and I didn't know why. Well, then I started looking into the other microbiome testing, and I started looking into gut testing, and when I finally did my gut microbiome, I found that my gut was filled with yeast. So a lot of times when you're someone's getting vaginal symptoms, it's really a symptom of a larger problem going on with the microbiome of the gut. And then the microbiome of the gut is really the root cause, and we need to balance the gut out to get the vagina healthy.

So I'm so glad you're mentioning this. And I've seen this too, you know, like in over practicing the past couple decades, because I learned the same. The same cultures I learned how to do. And I've seen so many times my patients come in and they're like, I keep on getting the yeast or bv, and every time they do the culture, it's the same thing. And then they keep. So the treatment's not really solving anything. These, I mean, it's so I feel so frustrated for women for having to go through that and not get anywhere. And then you have to go back into the doctor's office, wait for the culture. It's like, it's like a broken record. It's like we have to come up with a better solution for this. And the fact that luckily now this genetic testing is allowing us to see actually who's living in there. Right. Like, exactly. And two will say, I'm sure you've heard this too, where women say, I've been getting this discharge and maybe it doesn't even show yeast or bv. And they're like, I swear I have a discharge, I want to know what it is. And it doesn't show on the culture, so the doctors can't diagnose it. But this genetic testing can finally identify what the imbalance is.

And it's crazy. We're finding bacteria that they don't even have names for. So they're calling them like bacterial vaginosis associated bacteria number one and bacterial vaginosis associated bacteria number two. And then there's even other ones that they, they find and they're like, whoa, wait a minute, we didn't know this was in the vagina and we don't know how to treat this. So some of the science is evolving, but it's definitely, it's giving us so much more information. And I, and you have to really ask your doctor specifically to do next generation sequencing testing because unfortunately some of the insurance companies are still not covering it. Sometimes they do, sometimes they don't. But.

So it might be an out of pocket test, but it's worth it if you've been in this torturous repeated pattern to finally identify it and break the pattern. And as you were saying, it comes back to gut health because of course the vaginal area and the gut are not that far from each other and the Microsoft be related. Right.

And that's the thing is, so if the, you know, we have the anus and there's, if those bacteria are like in that area are imbalanced, then they get into the vagina and then the vagina becomes imbalanced and then that's even closer to your urethra where you pee through. And then that also sets you up for recurrent bladder infections. So see the, all these areas are, are really connected when it comes to the microbiome. And then the research that really got me incredibly excited is when we start connecting this okay, to the gut. That makes sense. Where it's connected to the gut, but where it's connected to the brain was even crazier that scientists are finding that there's this, like, loop between the vagina, through the vagus nerve to the brain. And so that if the bacteria in the vagina is off, that's going to dampen our sex drive. So a lot of women are coming to their doctor singing like, all right, I don't have a sex drive. It must be hormonal. Just give me hormones. And then they're not seeing the results they want with the hormones, because it may not be completely a hormone issue. It may be a microbiome issue. And even in women who have infertility, we've seen this where if the microbiome of the vagina is off, then they may have more problems with infertility. So it's just. It's all the body's way of protecting itself and going like, okay, you know what? Things down there aren't quite right. So I'm going to dampen everything that has to do with reproduction. And so it shuts it down. So it's amazing, you know, how, you know, you go the brains up here, the vaginas down here, how are they interacting? But it's been, you know, it's so exciting to see all this research that's coming out.

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 fertility, low libido, chronic infections, or recurrent infections, when we can actually be detectives and say, hey, what do we. And not only identifying the imbalances both in the vaginal uro, vaginal area, and the gut area, but then being innovative about how we can get it all back on track again. Because it says to me, and this is what I see in practice, but I'm so curious about your opinion, is that the treatment is not just antibiotics. Right. Like, so much of the time, it's like, women go to the gynecologist and it's like, okay, either you're going to get an antifungal or an antibiotic, and it's. This is not solving it. Yeah.

You know, it's funny. It's one of my favorite things is if we think about. When we talk about microbes, it's. You want to really make the environment that the microbe is living in, like, inhospitable. So if it's. If it's a bacteria or yeast that we don't want there well, let's make it so it wants to move out. Like, let's make it so it won't live there. And at the same time, let's take the microbes we want to live there and encourage them to live there. And one of the ways of doing that is the vagina is naturally very acidic. And so in a very high acidic, like 3.5 to 4.5 acidity range, the healthy bacteria thrives and the bad bacteria doesn't want to be there. So there are easy ways that we can actually balance the PH of the vagina to help encourage healthy bacteria being there. And. And one of my favorite products on the market is something that's been around forever, which is boric acid. So boric acid, it's.

I think everyone. I'm so glad we're bringing this up because everyone should know about it and even have it in your house. Tell us more. Tell us more.

Yeah. So, you know, I remember when it. When I was practicing at one point and I had those patients that we just really couldn't get their infections cleared up. And you're, like, digging through the literature. There was some old, old literature that was like, okay, use balboic acid in the vagina to rebalance the pe. And I was like, okay. But at that point in time, I used to have to have the compounding pharmacies, like, mix it up and make the suppositories. And then what became really excited was the first. The first company that actually came on the market that sold this over the counter was a company called Ph.D. feminine Health. And they make. You can find that everywhere. And then that kind of exploded. A lot of other companies jumped on, but I still stick with them because they're the first. And I just, you know, a little loyal to them. But I. I mean, I carry a bottle with me all the time. Like, I have it when I'm travel, because I find sometimes if you're sitting on an airplane for hours and you're sweaty, that like, kind of the yeast likes dark, wet, you know, environment vagina. You know, if. If you're in a bathing suit all day, sometimes using a boric acid suppository is prevention. And what I love about boric acid, which gets the yeast medicine companies really, really mad, is that boric acid will balance out the vagina, whether it's yeast or bacteria. And there's been a study that showed that, like, when. When women get an itching or a burning or discharge, everyone automatically thinks it's yeast when there's only a small percentage of the time that it is actually yeast. So some of the studies have said, like, even as low as 20, 12% of the time it's yeast, and the other times it's bacteria. So the nice thing is boric acid is something you can use. You know, I wouldn't say yeah either way, but I will. You know, I also want to preface that. If you're pregnant, I would talk to your doctor, but, you know, or if you have any other medical conditions, always check with your health care practitioner. But for me, I always, like, tell people, just go for that first. And then if, you know, you're putting one in every night, say for like five to seven nights, and you're not better, then at least that gives you some time to kind of like, get into the doctor's office. Because I don't know, I'm a doctor and I can't even get into my doctor's office.

I try to pull the doctor card. You can't get in. It's really hard to get in.

Having vaginal symptoms, it's very urgent because these symptoms can be like, it's hard to function in your day. And it's, you know, what are you gonna say? Oh, I, I don't feel well, I can't work today because it's burning and you're like, you can barely stand it. You know, like, you're like, what else can I do? So, yeah, it's like, to be. And I agree with you, like, Boric has saved so many women because instead of having to, like, wait out for this culture, and then the cultures may not even be correct, and then it doesn't even matter anyway because Boric will treat whether it's yeast or bacteria. So it's like you already have a head start on it. And not only that, but I'm seeing it where we can finally break the pattern. Because as you're saying, it's resetting the pH, it's resetting the environment. So now it's not so easy for this yeast or bacteria to jump right back in again. It's like we're saying we're creating this protective, you know, barrier to say, no, this is. You got to go somewhere else. This is not the place to hang out anymore.

Exactly.

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You know, the interesting thing is that there's so many things that we do that throw off our ph and that's something that we need to be aware of. Now number one is vaginal lubricants. I mean that's something that's been really interesting to see the science behind that because up until I don't know how long they've been on the market, but maybe since 2015 or a little bit before that up into, you know, we just picked the, whatever lube was on the market and most people thought about KY or, or Astroglide and, and unfortunately especially ky. It's not PH balanced for the vagina and it's not osmolarity balance, which just means it doesn't have the right salt solution like balance. And so it's almost like pouring salt on a slug. Like it dries up the vaginal tissue. Oh my God. So you end up having to use more and more. So there was a woman that developed a lube company that I also love, good clean love. She was having her own problems and then she ended up, you know, being very inventive and was like, I want to figure this out myself next, you know, she starts a loot company and their lubes are specifically ph balance, specifically salt balance. And you know, I think it's opened a whole new world for, for, you know, us understanding the vaginal microbiome and the products that we use in the vagina. I mean you also like look at all the soaps that are on the market when. And people get so funny. We, I had a video on, I think it was on TikTok that went a little crazy when people were talking about how to properly wash down there. And everyone's like, yeah, no one's really ever talked about that. Like you don't really get taught. And you know, as gynecologists we usually say just water, that water is really all you need. And then some people are like ew, just water. And I'm like, well in some. Then some people were responding like, well, I've used This soap for years and never had a problem. Well, I'm like, if you never had a problem, you don't need all of a sudden just to go to just water. But if you're somebody who's having a lot of problems, you want to look at the ingredients in your soap and stay away thing with things with fragrances and dyes and Turgens and maybe just do a water or maybe there's some boric acid washes out there now. Then there's, you know, there's some other companies are making more PH balance for the, for the vulva that are support the microbiome. So you might want to look at some of those other specific washes. But even then, I would definitely caution you to look at the ingredients because often I see sodium lauryl sulfate as a big ingredient that's a sensing ingredient and that can be very irritating. And polypropylene glycol is another thing you find in a lot of women's products. That is a mucosal irritant. It's going to, you know, irritate the, the delicate tissue of the vulva and the vagina. So this is why we often say just, you know, just water and water. Water is a universal solvent. Like it dissolves everything. So like water is not a problem.

It's so drew. It's sometimes just doing some extra showers can do so much good for handling some of these. These when it gets to be to a symptomatic infection. I want to ask your take on vaginal steams and douches, what do you think of them?

Yes, the steaming thing drives me crazy. You know why? Only because.

As a gynecologist, why it drives me crazy is when you are just sitting still, yes, your vagina is a tube, but it's a collapsed tube. So I don't care how much steam you're sitting on top of it is not traveling up the vagina to the uterus and steaming out the uterus. It's. It's just not.

It's not going so far in.

It's probably just getting the outer tissue. So like, maybe you're getting a nice steam to the vulva. That's probably all it's doing. And then you kind of worry about the steam. Like I always worried about people getting burns. But, you know, I know people that swear by it. Now, if it's helping you to relax, that's probably doing a lot more than the actual steam. So, you know, if you believe it's working and you believe it's helping relaxation, we Know that stress is going to affect all your pelvic health. It's stress going to affect fertility. So if doing a yoni steaming is going to get you to relax, then you're going to probably still get benefits. But it's not that the steam is going up the vagina and cleaning out everything.

Thank you so much for coming out on commenting on that because I, yeah, it's like it's kind of this trending thing and like I'm always like, okay. Like I tend to be very careful about what we would introduce vaginally anyway. And here we are talking about, you know, sometimes we would introduce like say boric to. But boric. While it sounds scary, I mean whenever you say the word acid that sounds scary. But the vagina. But actually. And so sometimes I just call it boric and I leave off the word acid.

I like that. I like that burn.

There's no. It doesn't tend to have side effects of burning. It's just very gentle to the vaginal area. So. And we know it's not going to cause harm. Whereas. And sometimes we'll use. I mean, I'm curious anything else that you would say is okay to use vaginally versus how do you know when it's not okay to use vaginally?

Yeah, there's, there's actually lack. They're looking into some lactic acid products for the vagina too because they're looking into other things to acidify the vagina. There's actually a non hormonal birth control called.

Or frexy. Always get the name mixed up. It's a acidic gel that goes into the vagina and it has a little lactic acid, a little citric acid. The only thing is if you have a milk allergy, you kind of want to stay away from lactic acid. But they're looking at, into other. These acids to balance out the vagina. I know a lot of people always ask about putting yogurt in the vagina. The only thing I, the only issues I have with yogurt is we don't really need milk sugar in the vagina now. Have I had people take probiotics? There are some vaginal probiotics that come in suppositories that are over the counter. You can use those. Have I people have. I had people take a probiotic and it has to be one that's geared more towards vaginal health. I've had them open it up and make a paste and then kind of put that into the vagina. Yes. You asked about the douching before, not a big fan. There are times when it's appropriate, but for the most time, most part, people think of douching because they're doing it because there's an odor. Well, usually there's an odor because there's a bacterial imbalance which I term like unbalanced vagina syndrome. So, so that's really. If there's an odor, if you're doing it for odor, then there's an imbalance and that needs to looked into and all the douching in the world is just going to make it worse. And as women were an open system so that if you're flushing water in the vagina, it's going to go up the uterus like out the fallopian tubes into the abdominal cavity and you could be washing bacteria and yeast into your abdominal cavity and that can make you really, really sick. There are, I will say though, as a gynecologist, there have been times where as a doctor I have administered douching, but we've done it more with like hydrogen peroxide and in like different concentrations of peroxide and water.

And now like I would say don't go home now and be like, well, now she's going to tell me to do it. Okay. To do peroxide.

Because profitable setting. Yeah.

Because it can be very irritating. But at the same time, lactobacillus, that healthy bacteria in the vagina, one of the ways it keeps us healthy is it makes hydrogen peroxide. So that's why sometimes we will use it medically to kind of like wash and clean out the vagina. But like, yeah, right in, in the.

Appropriate.

Condition.

Really comes back to what you were saying before, which is let's get your body and your gut health healthy. The more you improve your like drop inflammation and get your gut, your digestion working well and your gut bacteria then already the. It's going to make. Promote a healthy environment for vaginal bacteria. So. And like how do you now in your. Because I know you offer online programs and ways that people can access information from you. You know, tell us more. Like how are you guiding people in that way to really create a healthy environment overall to promote healthy microbiome.

Yeah. So right now we're just, we're building it out on actually by time this airs, it'll be all built out. There's a course we're putting together on a website called femversity.com and pen versity is going to be where it's going to hold all our women's health Courses for both individuals and for practitioners to kind of teach them how to do this and deal with the microbiome. Right now we have a vagina refresh reboot, which is like a two week program on how to just bring your vaginal ph back to normal, learn how to test it yourself at home and then how to adjust it and then also using probiotics to balance out the good, the gut bacteria. But then what we're planning on doing is expanding that into more of a. Because if so, usually when you rebalance the vaginal bacteria, it, if you do the pH, it gets you back to normal within two weeks. But if you're still having problems, and that's usually there's a gut, there's a gut underlying gut issue too. So we're putting some other courses and protocols together where you can balance out the gut bacteria so that we can then affect the vagina and the pelvic health all together. So that's, those are some of the things we're working on. And, and then in August we, we have right around the corner and you're going to be part of this. We have the Happy Vagina rally, which is an online women's summit that I'm really excited about. We have. I keep losing track with how many speakers. We have a lot. There's one, we're supposed to have 30. I think we're up to 40 speakers talking about all things vagina, but not just that. We have people talking about hormones and other women's conditions. We have somebody talking about hair loss because that's the thing with the gut health is gut health affects every one of your systems. So there's a big kind of focus on gut health and how it's affecting our hormones, affecting our, like hair affecting our vagina, affecting our bladder, our energy levels. So it's. Yeah, it's all connected.

That's amazing. I'm so excited to be part of it. I'm going to be talking about HPV and that's how common that is and, and how we can. And I use some of these same concepts with address, same microbiome balancing and gut balancing because what I just, I mean, it just so happened that I over the years was helping people with their gut health and helping women with hpv. And I started to see every time I helped their God heal, the HPV went to negative and stopped. So I'm like there how I could see it clinically. And then it started coming out in the research, you know, this research you're referring to, you know, like we're like, of course the gut health affects the vaginal health, but still, in the conventional medical world. And when you go to your regular gynecologist, they're probably not going to talk about this much.

Yeah, yeah, now. And that's something, too. That's why I wanted to develop some courses for practitioners, because people would hear me speak, and the practitioners would come up afterwards. They're like, where can we learn about this? And I'm like, well, I kind of taught myself over the years. And they're like, you teach me. I'm like, all right, you know what? I hear you. I'm going to start putting these courses together for you, too.

I love it. I love the name Femmiversity. That's so cool. Yeah. Brilliant ideas. You must. I think, Betsy, you must just have your mind flooding with ideas all the time. And you're just like, how do I get this all contained into one place?

I know my. The problem is I need, like, multiples of me, because on top of femversity and doing the summit, I also have a website called the Pelvic Floor Store that I've had since 2018, and that's a store that sells online products for pelvic health. Because that came out of necessity, because I'd recommend products for patients, and they have a hard time finding them online. And a lot of the companies that make some of these products won't sell through Amazon, So people couldn't get it on Amazon. So I was like, all right, well, let me start putting the products that I recommend on one website. So it started off as something for my patients, and then it keeps growing, and then. And then I can. Now we keep finding more products. And so I'm always, like, trying to add things to. To it because I'm like, oh, wait, that seems cool. Let's add that one.

So awesome. I mean, I'm so happy for people to get to know you and all of these resources, because this is also a lot of times things that women just aren't talking about necessarily, maybe don't feel comfortable talking about, and you just sort of break the ice and say, okay, we're talking about this now.

Yeah, that's my goal is really to get people, like, normalizing the conversation about your pelvis. Because you're right. When you were talking about earlier, if you're at work and you don't feel well, that's going to affect your work performance. And you can't be like, my vagina is bothering me today, but, like, it was your elbow or Even if you had a stomach ache, people don't have a problem saying they have a stomach ache or whatever. But you're not going to go around telling people like, oh, my vagina is bothering me. So. In fact, there was a study that came out that said 65% of women are uncomfortable saying the word vagina. And I'm like, but 80% of us will have a pelvic health problem at some point in our lives. So if we just normalize the conversation, like, it just should be coming, like, just normal part of conversation. Because these, these problems are frequent, they exist, and women don't know about it, they don't talk about it. They certainly don't talk about with their friends. You know, sometimes they do something they don't, but, you know, depends on the.

Friend and the personality. Right. But I just love that it's, I mean, it's part of our bodies, it's part of our reality. It's normal. These are normal things that happen. So, like, we might as well be talking about it and helping each other with it so that each person doesn't have to figure it out on their own. And, and, and it also kind of breaks some of the isolation because I think women can feel isolated with these situations and then there can be shame. Right. Like feeling ashamed of it. But once you realize that we're all women and have some of these same issues, it drops the shame, would you say?

Yeah, definitely, Definitely. And these problems, these problems are so common. So, like, there's help. Like so many women will just like, I can't tell you over my career how many times I, multiple times a day I walk into a room, see a patient, and they would be like, oh, have you ever heard this before? Like, I must be the only one that this has ever happened to. And I'm like, nope. You and everybody like before, you know, you know, they don't realize that these are things that are happen all the time, just normal part of life. But at the same time, you don't have to put up with it and be like, oh, this is just normal part of being a woman. Because there's so many different things that can be done. And even though I talked about like mesh being bad, there's, there's constant, like, innovation happening in this field. You know, we're starting to get into a lot more of the regenerative medicine for pelvic health, which is becoming fascinating too.

Yeah. Have you, have you done some training in that area in terms of say, like a PRP stem cell use in.

Yeah, yeah, so yeah, prp, which is great. Stem cells, exosomes, all these things are just like using to heal, like generate your own tissue. Even doing things like, like some of the vaginal rejuvenation therapies that have been only around in the United States since 2014, but using laser therapy to rejuvenate, using light therapy, using like, it's actually red light therapy devices that can be used in the vagina to help rejuvenate the vagina.

Oh, gosh, I'm trying to think what others. There's so many radio frequencies, radio frequency, using sound waves to generate heat to cause the tissue to regenerate. So 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, you know, other. Other areas of the pelvic floor. So that's.

Yeah, thank goodness. Because we really need it. It's such a. It's. I mean it. When it comes down to it, this is also an area for sexual activity. And that's one. Would you say that's one of the main reasons women. Women find you. Is like, it. You know, if it's affecting their sex life, that might be a big motivation, I would think.

Yeah. And you know what? Up until I would say until the late first laser came out on the market, there was too many women that were just kind of grinning and bearing it. And then, and then when Viagra came out, I was starting to get complaints from my patients because they were like, they were almost. Not that they were happy to give up their sex lives, but they were like, okay, like it was painful to have sex because after menopause that tissue doesn't. Is not as stretchy. But because their husbands were having, you know, if they were having sex with a male partner, their male partners were having issues. And then all of a sudden, Viagra came out on the market. Now their male partners were. Were okay, but they weren't. And so they would be get really frustrated, like, well, where's our pill? Where's our pill? And you know, one of the things I will tell you about Viagra, is it on? Honestly, there's no such thing unfortunately, as a horny pill. We don't have one of those. And so Viagra doesn't make a guy like, in the mood. It all does increase blood flow to the pelvis. It actually works on women too. It works in the same way as that if once the brain becomes excited, it'll increase blood flow to the pelvis, which Helps with sensitivity and lubrication. So but we still needed other things because the vaginal creams that were on the market, like the estrogen creams, just weren't doing the job for many women that were postmenopausal. And a lot of those creams contained propylene glycol, which are irritating, or some women are worried about using hormones because of cancer.

So that's when we started. You know, they brought out laser technology, which was brilliant. I'm like, why didn't I come up with this? Because they've been using lasers since the 80s to rejuvenate tissue. And so how it works in the vagina is that it basically just causes a microscopic little injury to the tissue, which sounds terrible, but it's just the light energy penetrates the tissue, makes a little hole, and then the body goes, oh, I have to heal that hole. And it floods it with growth factors. And so not only is it healing, but those growth factors are getting that tissue to regrow again without having hormones there. And you can return the vagina back to the way it was before menopause with just using light energy, which is crazy. So again, now we have so many more options. I mean, and this is, this is what PRP does. This is what red light therapy does. I actually show and tell. I have a red light therapy device here. These, this is a home device. This is called the V fit. And it's funny, I haven't charged this in a while and it's still, still working, hasn't died yet all the times I've showed it. But it's very bright. But red light actually has been shown the wavelength of red light penetrates tissue and stimulates your mitochondria, which are the powerhouse of the cell and is very anti aging. So they make that now for the vagina. So, so now there's doing all these things in combination. So that's the other thing. And some people are like, well, I'm going to go with the laser, I'm going to do the radio frequency or I'm going to do the prp. Well, actually you get better results the more you do together because they're different dalities and they work on the tissue in different ways. So you can combine them in any way you want. And a lot of times I'll tell people, if you're going to do it, get a red light therapy home device. If you don't want to do a laser or if you do a laser, get one because it'll make your treatment last longer.

So amazing. Oh, my gosh. And it's. It is. It's so important to know this because, you know, ultimately, like, this is an important part of our body that we're going to have. Even if you have a hysterectomy, you still have a vagina. So you, you know, it's like how to take care of this area whether you're sexually active or not, but especially if you are sexually active, like, to be able to not be in pain. And I think, well, sexually active or not.

Right.

Women don't. When it comes down to it. Right. We should not have to be in pain and constantly having infections and constantly feeling like we can't live our lives because of some of this. Because as you're saying, there are solutions.

Yes. Yeah, definitely. And what's great is that this is something that's changing every day. We're coming up newer, new options and things that could be done at home, things that could be done in practitioners offices. So. And there's more options that, like, where you don't have to necessarily use hormones, we're using. It's almost like biohacking. You know, we're using all these therapies to kind of trick the body into regenerating itself. And I kind of like that idea.

Yeah. Yeah. Vagina biohacking.

I love that. Vagina hacking. No, maybe not. I gotta come up with a better one for that.

I love how you're. Yeah. You're always coming up with good ways to talk about this, that that's honoring women and yet also honoring that it's possible to heal. Oh, my gosh. Thank you so much for joining me today, Dr. Betsias. Thank you.

I love talking with you, Dr. Donnie.

And I'm so excited for the summit. I'll make sure to share links to your website to the Happy Vagina Rally is what it's called.

So people can sign up and be able to learn more from you and from all of your speakers in the summit. And yeah, stay in touch with you for the future. So thanks again so much. I appreciate it.

Thank you.

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