23: The Impact Breast Cancer Can Have on Your Vaginal Health with Dr. Betsy Greenleaf

Hello and welcome to the Kidney breasts podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools, and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breast, I mean, best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being.

You know what I say?

Breast health is health.

So no matter who you are, a.

Breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode.

Hello and welcome back to beyond the Cancer. You guys are in for a treat because we have America's down there doctor to talk about sex. And this is really an area that everyone who has a breast cancer diagnosis struggles with because not only are they dealing with issues that can sacrifice their life, so issues of mortality, but on top of it, it embodies sexuality. And there are so many questions of are you still a woman and what kind of woman are you? And so there's all that psychological part that's, that's deeply, deeply tied into a breast cancer diagnosis. And then most of the treatments for breast cancer have profound effects on estrogen, which have profound effects on our down there place. Right. And so between the psychological part of it and that effect on our libido and then the estrogenic effect on our libido, people are really left afterwards struggling with their sexuality. And I hope that after our talk today, people can look at it with renewed hope. So welcome. Dr. Betsy. I'm so happy that you're here.

Oh, thank you so much for having me, Dr. Jen. I'm so looking forward to talking with you.

So why don't you just give us a little bit of background into. Because I know that you kind of came to be America's down there doctor on a very unique path. So can you talk to us about how you came to do what you do?

Yeah. So I always knew I was interested in medicine, but I just wasn't quite sure what I wanted to do. And you know, in fact, actually in college, it was between veterinary medicine or human medicine. So I applied to both schools and then I ended up. Wow. In medical school. And then I was like, well, maybe I'll do pediatrics, because that's kind of like veterinary medicine. So talk of zay. They, they agree.

You mentioned veterinary medicine, and they joined right in.

Yeah. Yeah. So, but then as I went through my rotations in medical school, school, I realized that, you know, pediatrics, you had to deal with what parents, and sometimes the parents were very difficult to deal with. And gynecology was the furthest from what I was wanting to do because I was like, who wants to look at that all day long? But, you know, you become desensitized to things in medical school and you know, next thing I know, I really, you know, I was very attracted to the surgical subspecialties. And so I had a hard time with both, you know, with choosing between general surgery or, or ob gyn. And so I ended up actually starting out in general surgery.

And then we share that, we share that in common.

And you know, the funny thing with the general surgery is I found that, you know, the general surgeons who are very, very good, but a good number of them are like body mechanics and they just wanted to get in there, get their stuff done and they didn't really want to form those relationships with the patient. So I was the one on Jen.

It's very true. I, you know, most surgeons become surgeons very intentionally because their patients are asleep.

Yes.

Right.

And I really wanted that relationship with the patients. Yeah, I was the one who was walking around during like our rounds and someone just had their appendix out and I'm like, feel now that your appendix is out. And like, you know, and I was worried more about their emotional feelings. And so I made halfway through that and then I was like, you know, and then next thing I know, I was like, all right, you know what? OB GYN it is. And, and though I love, you know, delivering babies and everything, I like sleeping and babies come on at all times of the night. And I really, really like the surgical aspect of things. So I didn't even find out about urogynecology until the very end of my training. And so urogynecology is a profession that or specialty that really is pretty new in medicine. It hasn't even really been started until the 1970s and only became a board certified specialty in the. I think it was like, I can't remember if it's 2012 or 2014. So around that time. And so I was lucky enough to become the first board certified female urogynecologist in the United States. States.

So that is an accomplishment. Can you, can you explain to people in case they don't know what that means, what a urogynecologist does. And you know what, what, who would go to you and what your patient population looked like.

Yeah, I remember when I came home and told my mom I was going to be studying urogynecology. She thought it was like fancy gynecology, like Euro Disney Euro.

As opposed to uro?

Yeah, urogynecology is uro and then gynecology. So it's a. It's a mixture of urology and gynecology. And so urology has to do with the bladder, the kidneys, the whole urinary tract system, and where gynecology tends to deal with the female parts. So it was a nice combination because as women, we have a lot of things going down in the pelvis. So the pelvis is our area, like a blood of our thighs and below our belly button. And so there is like, the bladder and the urinary system. Your is the genital system. There is the rectum and the end of the colon. So there's a lot of things that are going on in that area. So typically, somebody sees a urogynecologist if they're having issues with incontinence, like leaking when they cough, laugh, sneeze, if things are kind of drooping and dropping, which is a scary thought because some people haven't even heard of that. Something called a pro. Prolapse. And a prolapse is basically the ligaments that hold up our organs start to fail, and now the uterus starts to droop out through the vagina, or the bladder starts to droop out through the vagina or the rectum. And 50% of women will actually experience that at some point in their lives. So other things I did specifically was I like to do pelvic pain, recurrent vaginitis or recurrent itching, burning down there, or even recurrent bladder infections. So it covers a whole area of what's going on in those pelvic organs.

Yeah. And really when a lot of the issues that happen in those pelvic organs happen as a result of hormonal imbalance.

Right. Yes.

So estrogen withdrawal is a big problem.

Oh, sure, definitely. You know, one of the things, if we think about what happens naturally in the body as you're going through menopause. So let me back it up. Like when we're young and we have all our hormones, the vaginal tissue is nice and thick and healthy because it's thick. That also provides some structural support to the pelvic organs. So it helps to hold things in. But also when it's nice and thick and healthy, it's constantly growing. And as it's constantly growing, those old cells slough off, and new cells are made. So the cells are putting out the old cells. Those sloughed off cells contain glycogen, which is the food source for Lactobacillus, which is the healthy bacteria that lives in our vagina. And without it, we'd be sick. So we need this healthy body bacteria to live inside our bodies. So it helps prevent us from getting vaginal infections, and it helps prevent us from getting STDs, it helps prevent us from getting urinary tract infections. But as we go through menopause, we naturally start losing that estrogen. That tissue starts to thin out. And basically now the Lactobacillus has lost its food source and it starves to death. And now we're at risk for all these other conditions. And now throw on top of that, you're a woman who has breast cancer. Cancer. And now you've been through chemotherapy, or now you're on medications like Tamoxifen or Arimidex. Those things are just gonna totally, like, strip away all your estrogen. And whether you were in menopause or not, your estrogen levels are just going to bottom out. And now you're gonna have more problems with loss of that bacteria. And so we tend to see in that population, you know, there are the issues of vaginal dryness, and I'll get into that in a minute. But with this, what we call vaginal dysbiosis, where it's a shift in the bacteria, now we get problems with odor, itching, burning, discharge, recurrent vaginal infections, recurrent bladder infections, worsening of incontinence, all because of these shifts in bacteria. And the other thing that their scientists are just finding out now, which is fascinating, is that the brain and the vagina are connected. And you're like, wait, how? They're a little far from each other. How does that happen? But there's this feedback loop in the vagina through the vagus nerve that tells the brain when the vagina is healthy. And when the vagina is not healthy, the brain goes, okay, I'm going to squelch all the processes of reproduction. And your brain doesn't know the difference between you're trying to have a baby or you just want to get a little sexy with a partner or with yourself. And so libido, sex drive tends to tank when the bacteria in the vagina is off, too. So we say that there's they're really finding out that these little microorganisms have such an important impact on our health and our lives.

Yeah, it's astounding what the microbiome does. Right. And what it's responsible for and its influence in case people don't know what we're talking about. The microbiome is the collection of organisms that lives in and on us. And it actually lines every single space that has communication with the outside world. So we're talking about all along our gut, but I mean, our nose has a microbiome, our ears have a microbiome, our anus has a microbiome, our vagina, the low lungs, you know, everything that, that has contact with the outside world. And that, that collection of organisms makes up a lot. It, it makes up a lot of our genetic material. I mean, we are only 10% human from a genetic standpoint. And 90% of our genetic information is coming from our microbiome. And it is having a profound effect on what we think, how we feel, how we do, how healthy we are if we're thin, if we're fat, if we're all of these things. It's having a profound effect on that. I wonder, have you done any research into the vaginal microbiome and what shifts the vaginal microbiome and what we might be able to do in order to improve the health of our vaginal microbiome.

Or, you know, especially for women that have had a history of breast cancer and they are now, you know, suffering from these, the low estrogen. One of the things that we tend to use in people who are not in that category can be topical estrogens to rebuild that tissue. But there's always this fear. You know, I get into this, I leave it up to the oncologist, but then you get some oncologists are like, hey, no problem. You can use the hormones in the vagina. And then I guess oncologists are like, no, you can't. But here's the great thing. There are so many non hormonal options to rejuvenate that tissue. So the first thing that we want to do is rejuvenate that tissue so that it will keep making new cells and making this glycogen that'll feed the healthy bacteria. If the healthy bacteria is there, it will fight off and scare away the bad bacteria. So there are. It started out in the United States and even sooner in Europe, was using laser therapy to rejuvenate tissue. And people are like, well, how does laser rejuvenate the vagina. Well, lasers have been used since the 1980s for skin. These are on the face all the time to rejuvenate the skin. And somebody, and I wish it was me, goes, wait, why don't we just turn that into a probe for the vagina and use it for the same reason. And I'm like, wow, that was brilliant. Why didn't I think of that? So in 2020, actually 2016, it came out here in the United States. It uses light energy to penetrate the tissue, causes a microscopic injury, which, that sounds bad, but you don't feel that. But the body triggers, goes, oh, wait, something has injured us, we got to heal. And it starts flooding that tissue with growth factors. So it's a kind of way of biohacking the body. It floods the area with growth factors and that triggers the tissue to start regrowing on its own without using hormones. And so once lasers were introduced in the United States, it kind of opened the floodgates for other rejuvenation therapies because which were all really stolen or taken from the aesthetic world, the cosmetic world, because then they're like, oh, well, if lasers work, let's use radio frequency. Radio frequency is using sound waves to generate heat. And we know if we heat tissue at a certain level that that will trigger, trigger it to grow. Using platelet rich plasma, that's taking blood from your own body, processing it and getting the growth factors out of it, and then injecting it into the areas where you need rejuvenation so that can be injected into the vagina. And then during COVID there were companies that were like, wait a minute though, all a lot of those treatments had to be done in a doctor's office or in a healthcare practitioner's office. Well, now everyone's home during the quarantine, like, what do we do now? And so there were other companies that then revolutionized things by coming out with some home therapies using red light. We know that red light, the wavelength of red light, is very stimulating to the tissue and causes tissue regeneration. So there's a number of companies that make red light wands for the vagina and even something called carboxytherapy. Carboxy therapy is using carbon dioxide, which is what gas we breathe out. But when they, when, when it was applied or injected into tissue, it attracts oxygen. And when we oxygenate tissue now, we can cause that tissue to regrow. So there was a woman who discovered a way to put that carbon dioxide into a topical gel so it didn't have to be injected. And so now that's used as a home treatment to rejuvenate the vagina so that that addresses all like let's get the tissue healthier. And so fortunately, without the tissue being healthy, some of the other treatments don't always work. But then the question becomes, well, even once you have the tissue healthy, you could still have bad bacteria there. And so one. So some of the other options specifically for the vagina would be rebalancing the ph. So the acid level of the vagina. The vagina is very acidic and that's actually something you can easily test. You can get ph paper as long as your vagina is between 3.5 and 4.5, that's in the right acid level. And that also is indication of healthy bacteria. But naturally as we age, because of the shifts in bacteria, that ph will shift. So something as using boric acid suppositories, those work amazing for rebalancing the PH of the vagina. They're also great for preventative treatment. So I always used to tell people especially like during the summer, if you're like in bathing suits all day, which, you know, yeast likes wet, warm, damp environment. Well, that's sitting around in a bathing suit. So I tell people in the summertime throw in like, you know, a boric acid suppository to help, you know, keep the vagina healthy or even using there's other acids that can be used.

Do you, do you need to worry about anything with long term boric acid?

Nope. But it has to be placed in the vagina. It's not taken orally. So that's a big disclaimer because I'm always worried because the package comes and it looks like pills. There's many companies out there.

I know, I never understood why the manufacturers didn't change that because it seems really dangerous.

Yeah, you don't want to take it orally. Some people go like, oh, you're putting rat poison in the vagina. Well, boric acid has been used for hundreds of years and it does have a lot of different ranges of use, including actually bruh killer dilute.

Boric acid is used to treat some medical ailments.

Yeah, it definitely and has been for you. That's used for eyes. It's used as eyewash. It's used to rebalance the vagina in.

A very dilute solution. It is being used orally for any number of conditions. It smells, it actually doesn't smell, but it tastes God awful. But it does work for many conditions. But you're specifically Talking about boric acid suppositories for the vagina.

Yeah.

And I just wanted to. To go back through that list of things that you can do to improve vaginal health before we get into the vaginal microbiome, because many of those things that you're recommending can be done at home. They don't require a doctor's office.

Yes.

So you talked about the whole micro injury, and you know that, for lack of a better word, technology has been used across the board. And I hope that people are as accepting of this and trusting of this process with regard to their vagina as they are for their face, because I feel like people will line up and do anything to improve the quality of the skin of their face. And then you tell them that you're going to do that to their vagina, and they're like, what?

Right. And if you don't use it, you lose it. So you have to keep that area healthy. So it's easier to prevent vaginal atrophy, like thinning of the vagina, than it is to try to reverse it when it's gone. Years down the road, like, people are.

Doing these skin lasers prophylactically. Are these treatments that you talked about, the red light? I guess carboxy therapy has to be done in a doctor's office that could be bought.

That spot can be bought online.

Oh, yeah. So all these therapies, these are things that you recommend doing prophylactically?

Yes, definitely.

And is it something that you would start when you're perimenopausal? Is it something that. And anyone with a breast cancer diagnosis should, from the start be thinking about the health of their vagina?

Oh, yeah. In fact, I just had a friend of mine who, she made it through one round of chemotherapy, got rid of her breast cancers, was gone for five years. She then spent a lot of time and energy rejuvenating her vagina. And unfortunately, she was just diagnosed with a recurrence. And so the first thing she did after finally getting that diagnosis was called me up and was like, okay, I'm going through this again. What do I got to do to keep my vagina healthy? And we were like, okay, let's get you, you know, let's get you a red light wand, you know, and these things in combination work even better. Better. So depending on your budget, like, my idea would be laser to get the tissue healthy, and then the red light wand to keep it healthy. Okay.

So laser is a little more intense, I'm guessing.

Yeah.

And so that really, like, gets the process going and then you can maintain it with red light therapy.

Yeah, yeah. But, you know, some people use red light and then that's it. It just takes a little bit longer. So like lasers like that jumpstart and then. But the red light. The red light works perfectly well. It just can take a little bit longer. But it's great if you're perimenopausal and you're really using it for prophylaxis. Like, you haven't even started to get that thinning yet. Like really, you know, menopause, natural menopause can occur as early as 38. So really, women in age 35, you know, breast cancer or not, should be thinking about rejuvenating their vaginas.

Yeah, I agree with you. We need to think about the prevention across the board and across our body as we should be thinking about everything. Right. Because breast health isn't breast health. Breast health is health.

Yes, right.

Breast health is heart health. It's vaginal health, it's gastrointestinal health.

It's just health. Yeah, oh, definitely.

And so, you know, we're not just eating well to take care of our heart. We're eating well to take care of our whole body. We're thinking well to take care of our whole body. We're loving well. We're living well to take care of our whole body. And this is no different.

100%. Yes, definitely.

Let's talk about the vaginal microbiome, because I think it's so interesting. Are there things that adversely affect the vaginal microbiome? Are there things that we should be universally avoiding? On the flip side, are there things that we should be doing to enhance the health of our microbiome?

You know, it's funny, and I think all health to support the vaginal microbiome, we really got to look at healthy lifestyle. And so it's really a lot of basics that are not. That are outside of the pelvis. Number one thing, diet. So because your gut microbiome is what influences your vaginal microbiome. Because let's say you do lose your healthy bacteria. Well, the only bad bacteria that's going to get in there is the bad bacteria that you're allowing in your gut. And when I say like allowing in your gut is this is coming from a poor diet. So this is your standard American diet, will throw off your gut microbiome. So foods high in sugar, so get rid of the sugars. You know, dairy can be inflammatory. Wheat products can be inflammatory, processed foods. So I always tell people that, you know, you want to eat something that either grows, walks, swims, or flies. So those are your natural foods. And then, you know, refrigeration has really not helped us out as humans because, you know, back in cave person days, we weren't, like, going across the, like, savannah and to go to our refrigerator and open up, you know, our nice cold food. So back then, we were eating more foods that were laden with bacteria. And so this is how we were getting healthy bacteria into our guts. So how we can do that now is eat fermented foods. So this may be. Now everyone gets me on the yogurt because you're like, you just said not to eat dairy, but, like, I give yogurt a pass. As long as you don't have a lactose problem, milk, sugar, or a casein problem.

Which is which. Which I would say is more significant, especially when we're talking about yogurt, because I think with yogurt, most of the lactose is digested.

Yes.

In the fermentation process. But if you have a casein allergy, which is the protein in milk, that is going to be a problem whether or not it's fermented.

Yeah, yeah. So if you can tolerate and you don't have any sensitivities, then the yolk and yogurt and the kefir.

And what about those yogurts that are made from, like, almond milk or coconut milk? Or is that. Is it the same?

If you look at the ingredients, a good number of them don't contain a lot of healthy bacteria. A lot of times they're using gelatinized products to make it have that, like.

Oh, so it's the consistency without really being yogurt.

Yeah. And then you also have to look at, like, man, the yogurt aisle, and the supermarket is gigantic. And everyone's like, oh, it's yogurt, it's healthy.

Most of it's garbage.

A lot of them are just basically glorified desserts. I mean, like, because there's so much sugar. Well, that totally negates all the benefits of the yogurt. So yogurt is very easy to make at home. And so that's something that you can look into if you're going to be eating yogurt, but then also, like, sauerkraut, kimchi, kombucha. So you're fermented, but with kombucha, you.

Do have to be mindful of the sugar in that.

Yeah, yeah. And then also, too, if a whole nother category of people are people who have histamine intolerances. And there are some bacteria that are from fermented foods that can trigger histamine inflammatory actions, and they tend to be high.

Histamine foods.

Yes.

When you ferment foods, it tends to raise the histamine levels.

But there's so many probiotics now that are out there that are for women, like women only, which are nice. But you got to, you got to kind of look at the ingredients. I tend to stay away from any ones that contain Lactobacillus caseye, because that's a histamine producer, so that's good to know.

So in terms of things that affect the microbiome and when I say effect, there are lots of things that deplete it.

Right.

Chemotherapy, obviously, being one of the greatest antibiotics. And we need to be really mindful of the hidden antibiotics.

Right.

Not the ones that we're necessarily taking, but the ones that we were taking that we don't even know we're taking and know why we're taking them.

Right.

Because I forget what this statistic is, but is it 60 or 70% of the antibiotics in this country are actually not consumed by humans, they're consumed by our livestock?

Yes. Yeah. That is a big.

It's a big problem.

And it's funny, before I got into functional integrative medicine, there was an article that came out years ago connecting chickens in eating chicken to increasing your risk of bladder infections. And so from my traditional medicine brain, I was like, that's crazy. That doesn't make any sense. But now I look back from a functional integrative standpoint and I go, wait a minute. These were chickens that were fed antibiotics. In their feed, they contained probably a lot of antibiotic resistant bacteria on their bodies. And then also whatever antibiotics were actually got into their meat. And now you're eating that. That's throwing off your microbiome, maybe potentially causing an overgrowth of some of these commonly caused bacteria that cause UTIs. And now if we increase those bacteria in the gut, and now it's coming out the anus, and no matter how clean you are, it's very easy for this bacteria to get from the anus to the vagina and the vagina into the urethra and then the bladder. So, yeah, so being mindful of your food sources and yeah, finding food. So food is a big source.

Products are a big source too, because we put antibacterial things in our hand cream and lotion and toothpaste and all of these places because they don't want them to grow bacteria while they're. You know, because generally, I mean, how long does it take for you to use a tube of toothpaste? You know, quite some time. So they don't want it to grow bacteria in it. So they put triclosan or one of the. One of the antibacterials in there. And then, you know, you're taking antibiotics, and you don't even know you're taking antibiotics, you know, and the other.

The other thing I always think about it with bodily products that we use, too, is the hidden endocrine disruptors. So these are chemicals that actually trick our body into thinking they're hormones, and when they're not. I had a case with a woman who had breast cancer, and she was having pelvic pain. High levels of estrogen can actually trace trigger pain receptors. So she was a postmenopausal woman who was having pelvic pain, had breast cancer. And I'm like. We checked her hormone levels, and her estrogen was through the roof. And we're like, what is going on? She was on tamoxifen. We're like, what is happening? And then I was like, it kind of felt like that TV show house. We're like, okay, what products are you using at home? And it really was coming from. From, you know, she had, like, water bottles that were being stored in, like, a hot garage, and then. Or she would leave them in her car and then drink out of the. This plastic and then some of the body creams that she was using. And so once we were able to kind of figure out what these products were, getting her changed to, like, healthier products, her estrogen levels came down, and she did not get better from her standpoint. And then that helped her pelvic health, which then helps support her sexual life. So. Yeah.

Yeah. And, you know, listen, you can't avoid everything. I mean, you and I know we have to live in this world, and you can avoid everything. And there are other factors at play in that. Some people are just great detoxifiers. So no matter how much estrogen, they come in contact, both their own estrogen. But then those. Those xenoestrogens, all those estrogens out there in their environment, they do fine, right? Because they're really good detoxifiers. And there are just some people that are not good detoxifiers. And so for those people, the plastic water bottles, the K cups that they're making their coffee in every day, those things where they're not thinking about they're ingesting plastics, but they're ingesting plastic. And the microplastic burden is tremendous. So in as much as people can help. Well, I think everyone should learn what kind of detoxifier they are. Like, I think that that's an important thing because I think we need to know what line we need to walk. Right? Like, I'm a lousy detoxifier. I know that I need to walk a tight line. But there's someone else who, you know, they may be a good detoxifier, and they can be a little less. I'll refer to myself as neurotic. Right.

Okay.

So we know that there are endocrine disruptors that will have profound effects on the pelvis and the pelvic organs. The chemotherapy is going to have an effect. What about antidepressants? Because I find that there are so many people like, that is so readily prescribed for anyone who is going through a difficult time and transition. And listen, I get it. Like, no one wants to be in pain, and no one wants to have their patient suffer more pain than they need to have. Like, I get it why they're put on, but I do have concerns that they have an effect on the microbiome.

Yeah, definitely. So, you know, pretty much many of the medications that we take will throw off the gut. And then you got to almost ask, why is the depression there in the first place? Now, of course, people go through rough times, especially with a breast cancer diagnosis. That's a trauma. That's a tough thing to deal with emotionally. But 95% of our happy hormone serotonin is made in the gut. So this becomes like, okay, well, maybe the gut is off first. If you have a tendency towards anxiety and depression, maybe we need to get the gut healthy. But then we go, okay, wait, this is kind of a catch 22, because, you know, if there's chemotherapy involved, that's killing and sloughing off your gut cells. If you're on antidepressants, that's affecting your microbiome. So that's going to add to those serotonin levels going, like, lower and lower. Because unfortunately, from a prescription standpoint, we don't have these antidepressants. Don't raise your serotonin. Like, it's not like we're giving you serotonin to make you feel happier. What they're doing is they're blocking those receptors so that it just makes. It. Makes it appear like you have more serotonin than you do. So it basically is taking up spots so that whatever's floating around in your body, it appears to your body that there's more than there really is. So now if you keep taking those, it's just going to keep lowering the actual serial serotonin levels. And now you're, you know, you have poor gut health and that's lowering it. Or when you're anxious and depressed and then you go for those comfort foods. And what are those comfort foods do? They're just going to be lowering and affecting that gut even more. So.

So, yeah, and I think the data is starting to really reflect the ineffectiveness of all of the SSRIs in terms of what they're actually doing, because they're doing what we originally thought they were doing, and their efficacy is not what we originally thought. And, you know, there is. There is a lot of truth in placebo. Yes. Right. So a lot of people felt better because they got a pill, but not because of what the pill did.

And forget about the fact that most of the pretty much every antidepressant really affects sex drive. Like, now you have, like, no interest.

It's almost. It's almost guaranteed that if you're on one of those SSRIs, you're going to have a low libido.

Yeah, definitely.

Okay, so are there any other, like, common things that we should be thinking about that that affect our microbiome?

You know, so some of the other things we're talking about, gut health is fiber. Most Americans don't get enough fiber in their diet. And we're supposed to be eating about 25 grams of fiber daily.

And I think that number's low.

I know. I think it should.

You know, our ancestors really ate way more than that. I think the number really should be closer to 60.

I agree with you. And we need it not just only for healthy bowel movements, but also that's what's feeding the microbiome in our gut. So you need those fiber and those fiber products to kind of as like, prebiotics. So, you know, increasing the amounts of fiber, whether it's through vegetables or taking fiber supplements or whatever, that's going to help, too. But then I look at other things that kind of affect outside of diet, that affect our life, and then also our hormone levels and our sex drive, and it all has to do with stress. And so if we're under too much stress, the process by which cholesterol, which everyone goes, cholesterol is bad. Cholesterol is not bad. We need cholesterol to make all our hormones. So cholesterol is not the problem. Inflammation is. But let's say in your, like, in A nice relaxed state. Cholesterol will come down and be made into your sex hormones. Testosterone, estrogen, progesterone. Everything's happy. Well, if you're stressed and whether that's like, you know, you're worried about something or you're physically stressed from an illness, those hormones will all be diverted towards cortisol and cortisone. So those are now your stress hormones which are going to affect your healing. And so that's a system that we need that helps us stay alive in times of acute stress. Like you got to be running away from a lion, but that's not something that you want elevated all the time. And so we stress our bodies out, you know, through illness, through, you know, a lot of people aren't getting downtimes or have too much on their plate.

Yeah, way too much stimulation.

Like, unfortunately, we were supposed to go to bed when the lights, you know, when the sun goes down. And we blame it a lot on our tablets and our phones, which are bad. But even just using, you know, artificial light is keeping us up a lot longer. And so that's gonna.

And I think that is probably directly having an effect on our microbiome.

Oh, yeah. Yeah. It's all. It's amazing me how it's all connected. And you could just sit here and talk in circles because we can connect all of it. You know, 75% of Americans are also chronically dehydrated. So as, you know, as you're drinking, like, I timed that perfectly, but we're not drinking enough. We're not drinking enough fluids. And so that's a stressor on the body. And then it's also affecting the microbiome. You know, it's also drying out the vagina. So like some people, when they do become sexually excited and they're like, well, I'm not as wet as I used to be. Well, that's not a reflection of how excited you are. That could be a reflection of. Of that you're dehydrated. It could be a reflection of. There could be some underlying blood flow issues. So it could be one of the first signs of cardiovascular disease. And, you know, also some people are just produce more lubricant than others. So, you know, this is all connected. And you're not going to do that if you're stressed too.

Yeah. So the idea is with cortisol and our. And our fight or flight hormone, like, if you're fleeing from a tiger, that is not the time to procreate.

Right.

And so. And those hormones are always checking in with each other. Right. So you have to be safe in order to bring another child into this world. And so that's not going to happen if you are in danger. Right. But you, you brought up the word lubricant. And so I think that this is a really important thing for us to talk about. And people can have issues with enough vaginal lubricant if they are dehydrated. That's a great point. So people should make sure that they're consuming filtered water every single day. Half of your weight in ounces of filtered water every single day. But please make sure that it's filtered water and that you're drinking out of glass or stainless steel and not out of plastic. But some people still need more help than that. And I do think that you should look into it in that if you are drinking enough. Like, do you have small vessel disease? And is this one of the first signs of heart disease? Which, incidentally, the majority of women who get a diagnosis of breast cancer don't die of breast cancer. They die of cardiovascular disease because it's the same root cause, it's the same inflammation that leads to breast cancer that also leads to cardiovascular disease. So unless you somehow shift out of that inflammatory state into a more balanced state, you still have that stimulus. So, but, you know, if you've kind of worked through those things and you're still having issues, what can we do to improve lubrication? And are there some products that you like and recommend?

You know, first of all, products came right to my mind because there are so many on the market. And so they're not.

And many of them are quite toxic.

Yeah, they're not all. Let's just say that, yeah, one of many of them contain something called propylene glycol, which is used as a preservative. It's also a thickening agent, but it's also very irritating to mucosal membranes. So you can actually be causing more damage than good.

And then tissues of the vagina, they're very, very thin, right?

Very thin.

And you're readily absorbing that.

Oh, yeah. And so, yeah. And a lot of these contain some toxins. You know, I'm going to throw KY Jelly under the bus. But because that's one everyone thinks of. KY Jelly. KY Jelly. Well, they have brand recognition, but we know for a fact it's not PH balanced for the vagina. And it also is not osmolarity. The osmolarity is not correct. So what is osmolarity? Osmolarity has to do with the amount of particles in this solution. And so it basically, it's. The osmolarity is very high, which means it's very drying to the tissue.

So it's going to pull fluid into it because we always want to balance.

Right. It's just.

So it's. It's going to actually do more harm than good. Right.

Think of pouring salt on a slug. Exactly. That's exactly what is happening. You know, slug is going to like dry up. And so we know that lubricants like KY Jelly are going to like throw off the ph, which is going to throw off the microbiome, and it's going to dry the tissue. And it also can cause microscopic tears in the tissue because it's actually kind of rough on the tissue. And so there are a couple companies.

That it's being used in every hospital and every doctor's office across this country.

Yeah. Without.

Without a thought.

When I found this out, we switched all the lubricants in our office. And I recommend women take your own lubricant with you when you have an exam. That is gynecologist.

Fabulous idea. And I just be like, I'm sensitive saying that.

Yeah, just tell them, you know, I'm sensitive to what you use. Can you please use this when you do an exam? And like some of the ones that have actually done the research to. To show that they're healthy for the tissue is companies like Good Clean Love or something called Uber Lube. And Uber Lube is a funny one because it's also used as a hair product, so you can use it twice. Like, wow, that's so funny. Yeah, yeah. So but they are the ones that. Those are some of the few that are PH balanced for the vagina. There is another one that I like that contains glycogen. So glycogen, once again, is that food source for the healthy bacteria. My only problem is I'm not 100% in love with them because it does have some propylene glycol in. I still sell it through my online store, but I caution people that it's use it as long as you don't have a propylene glycol sensitivity. The levels in this one are very low. But if you're trying to kind of build up the microbiome of the vagina, you can use it in combination with vaginal probiotic suppositories so that you're putting the suppository and it has the healthy bacteria, but if you got to also feed the healthy bacteria. So you have to put something that contains glycogen. And right now there's only one product, it's called Luvina, that has that in it. So I keep trying to talk to the company. I'm like, can you just get one ingredient out and I'll be happy.

Can't America's down there, Dr. Get them to pull the harmful ingredient.

Yeah, I know. I'm actually trying to find someplace where I can have it made myself and just like sell it as well. You should.

I look forward to your, to your product.

Yeah.

I've heard repeatedly people saying that they use coconut oil. What are your feelings about that?

I have a love hate relationship with coconut oil and I find that the patients that come in that love it are very passionate about how it's worked and they've never had problems. My issue with coconut oil is it can be irritating to the tissue, it can cause scratching, and it has a lot of antibacterial properties to it. So it's not like on paper, I don't like it. But this is what I tell patients. Like, I don't promote it. But if they come in and they say like, I've been using a coconut oil for years and if we test their microbiome and it's fine and they're not having issues, then I go, you know what, let's not, let's, let's not fix what's not broke if it's working for you. But the other problem with coconut oil is a lot of times it's coming in a jar that people are having to put their fingers and scoop it out. And every time you're doing that, you're introducing bacteria into that coconut oil even though it's antibacterial. So, you know, I tell people if they're going to use it, like get a spoon or something that they can wash off in between or, or something. But I rather them use some of these ones that have been shown to be balancing for the vagina.

Interesting.

Yeah.

I think that most people don't know the fact that coconut oil is very antibacterial, that it does have antibacterial properties, which is why it's used as a substitute in things like toothpaste and body products because then you don't have to add additional antibiotics into it.

There's a new oil that we're adding onto our website that is interesting. It's being sold as a massage oil, but it's called the company that makes C60. And so C60 is this carbon molecule that is very anti Aging and rejuvenating to the tissue. And they made it into a massage oil that can actually be used in the vagina, too. So they have a product called sex. I think it's sexy. Sexy C60. And so we're having people try that and see if that works, because other than having this carbon molecule in, does usually contain some other healthy oils. It's usually like avocado or one of those other oils.

So I'm just drawing a blank on the guy who did all of the research here, Mohammed. I'll think of his last name eventually, with the DNA company. He said that olive oil is actually the best thing to use because it is not antibacterial and it doesn't change the vaginal physical. So I thought that that was very interesting. So for my people that said that they were using coconut oil, I actually told them to change it up. And it's definitely messy for sure. So, like, put it in a pump bottle, or if you put it in the refrigerator, it actually will become a little more solid.

That's one of the problems with the oils. It tends to stain the sheets where, like, some of these other specifically made lubricants tend to wash out. So that is something to take into.

Consideration because they're being modified so that they're water soluble.

Yeah.

Whereas the oils are not.

Yes, right.

The oils are all fat soluble.

Yeah.

Okay. You said something before about testing their microbiome. So what are you doing to test people's microbiome?

Yeah. So, you know, interesting enough, this technology has been around for about 15 years, and even the regular traditional gynecologists are still not using it, which I don't understand because usually it takes a long time for mainstream medicine to jump into this. But there are a number of companies that test the microbiome of the vagina. I will tell you, there was. There was a process that I was using in the past was something called PCR testing, where basically they would analyze the DNA presence of bacteria. And so this is so much more accurate than getting a culture of the bladder or getting a culture of the vagina. Because anytime, like, you think you go to the doctor and you give them a urine sample, there's not for a culture. And so there's so many things that could happen to that sample from the time it leaves your body to the assignment, sitting on a counter at the doctor's offices for a couple hours, and then it may be sitting in a box outside for the laboratory to pick up, and it might be 90 degrees out. And then it's in a hotel car. And then it gets the laboratory and then they put it on a petri dish and nothing grows out. And they go, oh, look, there's nothing here. And so we miss a lot of things in traditional and culturing, whether it's the vagina or the bladder. So about 15 years ago, they started doing this PCR testing. Yes.

It should never be that there's nothing here because it's supposed to have bacteria. It's supposed to be teeming with bacteria.

Exactly. And so this is what's been exciting about the new testing. So PC, PCR testing in the past, which was great, and it was all we had, looked at the DNA presence of bacteria, but it only looked for what we were asking for it to look. So it was like basically like walking into a room and being like, I want to find Bob and going up to everybody and going, are you Bob? No. Well, I don't know who you are. Go away. Are you Bob? Nope. Okay, go away. And then you find Bob and you're like, oh, look, Bob is here. But you don't know who everybody else is because you didn't ask their names. Well, now we have something called next generation sequencing. And it's like walking into a crowded room and going, okay, what's your name? And you're like, oh, Sue, Sally, Shonda, Johnny. Oh my God, look, now I have all these things. So now we're able to find everything through next generation sequencing. But it's so advanced that medicine hasn't caught up yet. Some of the bacteria we're finding on people, nobody's ever even. They've had to invent names. Like they have two, that's like bacterial associated bacterial vaginosis associated bacteria number one and two, because they haven't even been named yet. They know it's associated with vaginitis. There's other bacteria where like it's named, but they don't know what the clinical significance of finding it in the vaginal vagina. So we're just figuring this stuff out. So it's great. And there's a number of companies that do it. I say Microgen happens to be one of my favorite because it's one of the few that insurance companies will cover. So. And that's something that if your doctor is not already doing, you can ask them to do it. You can contact the company and they will actually hook your doctor up with. There are some direct to pay patient companies that are out there like Juno Bio or Evie. And I think Evie has two Vs. The only problems with those testing is that's for information purposes only. So you swab yourself at home, you send in this result, you get it and they're like, okay, here's what you got. You're like, okay, well I don't know what this means. Right. So yeah, so that's. We're hope. We're actually hopefully in the process of kind of creating some kind of program to help people interpret those results and what they actually mean.

Yeah. Which would be awesome. Right?

Yeah.

Okay, so let's just summarize for people that there are lots of things that you can do to both ignite and maintain your vaginal health and that you don't have to forget about sex and sexuality even after a breast cancer treatment. And there are both things that you will do in your doctor's office, but also lots and lots and lots of things that you can do at home.

Definitely.

And take care of your microbiome. Anything I forgot.

I think the biggest thing is just be kind to yourself because we do put a lot of stress on ourselves and you know, being self critical can really affect your health. And so I always tell people health is like a three legged stool. You know, body, mind, spirit. You could be working out perfectly, eating the perfect diet, but if you don't have that balance of mind and spirit, your health is just going to topple over. So yeah, so definitely take the time and relax and be kind to yourself.

Yeah, that's excellent, excellent advice from America's down there. Dr. Dr. Betsy. Where can everyone find you?

Sure. So you can find me at the pelvic floor store. We search out pelvic health products that are that you can trust. Find me anywhere on social media. Please follow me. Message me. I'm in one or many different ways. Just if you look up Dr. Betsy Greenleaf, you should be able to find me. I can't give you specific names because I every once in a while the word vagina is a trigger and it gets me kicked off of social media. So. So my names are always changing. But if you go Dr. Betsy Greenleaf, you'll be able to find me. And there's also Dr. Betsy greenleaf.com so excellent, excellent.

Dr. Betsy Greenleaf, thank you so much for being here. It's Dr. Jen Simmons. Bye for now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health. So by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode episode, please subscribe to our podcast and leave us a review.

Your feedback and support mean the world.

To us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Rjensimmons and remember, MyGen has two answers, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.