Episode 41: The Happy Vagina, with Dr. Betsy Greenleaf

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi friends. So today we are talking about vaginal health. This applies to all of us, definitely. We all have issues every now and then. And it's really important to just be aware of vaginal health in general because if something does come up, then you're not freaking out and, you know, calling the gynecologist necessarily or not getting the answers that you need. What I have seen many times over the years is patients complaining of chronic infections. They get treated for a yeast infection or bacterial vaginosis, and it keeps coming back, or they have symptoms, but they keep being told there's no infection. They keep getting checked and there's nothing wrong. So today I'm talking to an amazing OBGYN who specializes in vaginal health. We're going to talk about the reasons for all of that. So your vagina has bacteria living in it, keeping it healthy. That's the normal flora in your vagina. Just like our gut has a normal microbiome or ecosystem keeping things balanced, so does our skin, so does our respiratory tract, and so does our vagina. So it's really important for you to understand that you need to keep a balanced microbiome in the vagina and you need to understand what influences that and shifts it out of balance. I will tell you that conventional doctors still don't know or understand this information. Even though the science has been here for over a decade, it is very slow to be adopted and, and be taught to the masses. So if you're not seeing a functional medicine doctor or someone who's staying really current on the scientific literature, you're probably gonna get treated the same old way with the same old couple, you know, medications, and not really get any answers. So even if you're not struggling personally, it's good information for you to listen to because my guess is, you know, a friend or a sister or somebody else who's having these struggles. So if you could think of someone, definitely share this episode with them because this kind of information can help women reclaim their daily life. Like some women struggle to participate in life and enjoy life or have intimate relationships because of this, it can really interfere with their daily life. So don't hesitate to share this episode. It's really important. And thank you for spending your time with me. I really appreciate it and I'm just so grateful to be able to do this for you. So let me tell you about my amazing, impressive guest. Her name is Dr. Betsy Greenleaf. She is the premier women's health expert, entrepreneur, inventor, business leader, and she specializes in female pelvic medicine and reconstructive surgery. For over 20 years now, Dr. Greenleaf is a trailblazer. She was the first female in the United States to become board certified in urogynecology. So that is a gynecologist who went on and specialized in the bladder and pelvic health of females and it's a surgical specialty. So she possesses a professional reputation that has led to being sought after by medical societies, associations and corporations to provide lectures, teaching and advanced training. In 2018, she was honored with the title of Distinguished Fellow of the American College of Osteopathic Obstetrics and Gynecology for her service and dedication to the field. She holds committee positions on many national women's health organizations. She's a board examiner for the American Osteopathic Board of Obstetrics and Gynecology and she serves as a spokeswoman for the American Osteopathic association with her quotes appearing in major media outlets. So Dr. Greenleaf is the CEO of the Pelvic Floor Store, which is an online store dedicated to finding reliable products for for pelvic health. She manages a blog at Dr.betsy greenleaf.com and she is the host of Some of your parts podcast. So definitely check her out over there. That podcast is dedicated to women's wellness and the notion that you are greater than the sum of your parts, which so she and I are completely aligned. If you haven't realized it already. We have the same ideals and beliefs and passion for helping you guys to live your best lives and to be educated in the latest up to date science so that you know what questions to ask, where to look for answers and to live your best life. So I'm super excited to talk to Dr. Greenleaf. You're gonna love her. She's like real down to earth person that I just enjoy talking to. We could talk for hours. So here we go talking about pelvic health. Well welcome Dr. Betsy to the Functional Gynecologist podcast.

Thank you so much for having me here. I'm so honored. This is so exciting.

Oh, my gosh. I'm the one who's honored. You are the first female urogynecologist in the United States. Such an honor. Oh, my goodness. So I secretly wanted to do a urogynecology fellowship after residency, but unfortunately I had kids and I couldn't really move to the state where I needed to be able to do that. So I just did a lot of urogyne surgery in my office. It was actually my favorite surgery to do. So how did you get into urogynecology?

You know, it's funny because just the whole going back into medicine was kind of like, you know, it's a long story. Hopefully you have time. But I was always interested in medicine as a. Even as a kid, though, I didn't know I wanted to be a doctor, let alone a gynecologist. But I remember I was around five years old when my mom was pregnant with my sister. And I was obsessed with everything about that pregnancy. And my mom had books. I remember, like a five year old, I'm sitting there looking through books, and I remember like pictures of the uterus and the baby, like upside down and the woman. And so I had an interest in that. But then, you know, that kind of went away. And then as I went through college, I went to college and I didn't know, you know, I went to college because you were supposed to go to college after high school, you know.

Right.

I didn't know what else to do. So I actually still didn't know exactly. I mean, I was graduating college and still didn't quite know what I was going to do. I applied to veterinary school. I applied to medical school because I knew I had an interest in medicine. And I actually didn't get into veterinary school. That was my number one thing I wanted to do. And they said it was easier to get into medical school than veterinary school because there's only so many veterinary schools in the country. And I was from New Jersey. We didn't have a school. So medicine was my backup plan. It sounds obnoxious. So I went to my. I went to medical school. I still didn't even know what I want to do. I remember the people that came in, they're like, oh, I want to be an orthopedic. Orthopedic surgeon. And I was like, I don't even know if I would be here. But yeah, I was so interested in the subjects. And still gynecology was the last thing on my mind. I'm like, who wants to stare at that all Day long. And then, you know, you go through your rotations and you just become desensitized. And, you know, you don't realize that you're looking at someone's vagina all day long.

Yeah. I tell my patients it's like looking in an ear. That's how I feel.

I remember I had lunch with a friend of mine, and we were in residency, and she was a podiatrist. And I said, how do you look at people's nasty feet all day long? And she, like, looked at me and she's like, are you serious? But, you know, it's interesting. I didn't even start off in gynecology because, you know, all of a sudden, medical school ended and you had to decide. And. Yeah, at that time in my training, I was osteopathic. I am an osteopathic physician. I did. We had to do a year of internship. So that extra year kind of gave you more of experience trying to figure out what you wanted to be when you grew up.

Right, right.

Which I still don't know today to this day, but. So I found myself really drawn to the surgical specialties. I like general surgery. I like urology. I like obgyn. They're like, you know, you're going along, and they're like, well, now you have to decide. And I couldn't just. I couldn't decide. I really liked urology, but there were no feet. I didn't have any female role models for urology. And I thought, you know, who. What man would want to see me for those kind of problems? Which now there's tons of female urologists and men see them. But at the time, I couldn't see that working my own obvious sexism. But so then I was stuck between general surgery and ob gyn. So I applied to both. And going to an osteopathic residency, we didn't have the MATCH program like the mds, where you, like, kind of like, they match you to the schools. You just apply and you wait to hear. And I actually heard from general surgery first. So I was like, all right, well, that's a sign. They told me first, I'm going with them. So I actually started doing general surgery. And I loved it. It was fun. But what was starting to happen was, I mean, this was like, I start going, oh, this is how old I am. This was before they had the work hour restrictions. So there was a week that I had worked 125 hours straight. And I remember sitting there praying that I would pass out. Like, I remember, God, please let Me pass out, because it's the only way I'll get some sleep. Because if I go to sleep on my own, I'm gonna get in trouble. So if I pass out, it won't be my fault, and I can actually get some sleep. And so then I started looking at all the general surgeons who I respected, and I'm like, they lived, breathed, died, general surgery. And I was like, I want to have a life. And around that time, I met my future husband. And I was like, oh, there's no way that I'm going to be able to do general surgery and have a family. On top of the fact I was the who. This was funny. I was a person who really wanted to get to know my patients. Nothing to say badly against general surgeons, but a good general surgeon is a body mechanic. They get in, they get the job done, they're out of there. See you later. That is not a bad thing. That's what you need to be in that. In that profession where I was the one who wanted to get attached to my patients. And I'd go into my rounds. It took me forever to do it because I'd be like, so how are you feeling now that your gallbladder's out? Like, how are things going? That's the work of general surgery.

Exactly.

I got halfway through general surgery, and I'm like, yeah, no, this isn't for me. But I almost kept pushing it because I was like, I don't want to not finish what I started. And then I realized, well, you know what? I'm not quitting. My perspectives changing, just letting go of what wasn't serving me well. So then I was like, well, you know, I still wanted ob gyn, but I kind of played around with maybe er, maybe radiology, because those are better lifestyles. But then I was like, no, I really like the obgyn. So then I did my ob GYN residency, and I found it was very heavy on obstetrics, that there wasn't a lot of surgery, and I missed the surgery. And it wasn't until my very last rotation as a resident that I found. I mean, I knew urogynecology existed, but I didn't do my rotation until my very last. My very last rotation of residency. And by then, it was too late to apply for fellowship, so I got a job. And we were in negotiations, contract negotiations, and contract negotiations fell through. All of a sudden, I found myself graduating and not having a job, nothing. And panicked, like, what do I do now? And I actually went back to the doctor who ran the urogynecology program. And I said, hey, I'm really interested in the urogynecology. I'll apply for next year. What can I do in the meantime? And I just got lucky because what happened was the person who had applied and had gotten the position didn't pass part three of his boards. And that was one of the requirements to get into. So he's like, well, turns out I have a spot open. You want it? I was like, yes. So then I did neurogynecology. And that's how it happened now. Interesting enough. So some people are like, what's Eurogynecology? My mom thought it was like Euro Disney, like it was European, like some kind of fancy gynecology. And I'm like, no, it's urology. It's a combination of urology and gynecology. It came first, full circle. I really like the urology, but now I can combine it with the gynecology and you can have those relationships with your patients. And it was wonderful. But it's only been a specialty that's existed since the 1970s up until. And I really should get the year on this. I want to say it was six years ago, so maybe 2014, 2015. I don't remember. I gotta find the actual dates. But it wasn't a board certified specialty until a few years ago. And so I got lucky. As soon as I came out of Fellowship in 2006, I was asked to be a part of a board that was creating the examination process.

That's awesome.

That was, that was awesome. And then there was a little bit of battle between the osteopathic world and allopathic world. So the dos and the MDs about how the exam was going to be given and who was going to give the exam. And it ended up splintering into two different exams and the osteopathic world. We were able to give our examination first. So that's how I became the first female board certified urogynecologist in the United States. So we, I got my exam done and we beat out, sorry, mds. Nothing against mds. We just beat out their examination process. So we got it done a little bit quicker than they did.

Well, that's super impressive because I secretly did love urogynecology. I mean, and I was like, you. During residency, I liked my urology rotations, right? But too many male patients, number one and number two, they didn't really take care of women. I saw this huge gap. Like they, they just saw men. And so women would have to suffer with their Bladder issues and their prolapse issues and nobody was taking care of them. Not the gynecologist, not the urologist. And so, you know, your specialty really did fill a necessary gap. And I was blessed enough to have extra training in that so that when I came out as a gynecologist, I felt comfortable doing those surgeries. But that's really uncommon for most gynecologists. And I think that patients don't understand that, you know, why can't my gynecologist fix this? And really there's a huge lack of training in that area. So I'm glad that it's starting to close. But it takes a lot of time to learn those, you know, difficult surgeries or to become experienced with pessary care and things, you know, like I was the pessary Queen for about 10 years of my practice. I mean, I had so many 70, 89 year old, 90 year old women. They take the bus every three months, they'd come get their pessary check, you know, because it was needed. They weren't good surgical candidates. They didn't want surgery or whatever. And so, so there's other options. But everybody came to see me because I was the only guy in a college just doing it. Even my partners were like, that stuff's scary. Like, how do you do that?

And so it is scary in that, you know, I remember we got one lecture in residency.

Exactly. One lecture, exactly.

And like, here are pessaries. So for people who don't know what a pessary is, it's just a device that can be placed into the vagina that like wedges in and holds up any organs that are falling out. Because the vagina, the bladder and the rectum lean on the vagina. And if the walls of the vagina, the ligaments in there are not holding things up the way they're supposed to, everything kind of just collapses in on itself. You know, unfortunately, gravity affects all parts of our body over time.

It does.

And you know, and it's. Well, having a prolapse is scary. I mean, I have had women where things, you know, it may be, can be something happened gradually, but it could be something where you lift something heavy one day and all of a sudden a ligament gives way and now you have something bulging out of your body and people are, you know, freak out that they have a tumor. They're like, oh my God, I'm dying, I have a tumor. And we have these simple devices that have been around here's. Oh, this is amazing. They've been around since ancient Egypt.

Yeah. Tell us what they used to use.

They used to use everything from pomegranates, which I do not recommend stones. You know, rocks. In Roman times, they used to. You also used to use, like, shaped stones. They used to use potatoes, which I definitely don't recommend potatoes. And I'm sure you've heard of the story where there's a more recent story where somebody used up a potato and it sprouted and grew into their uterus and had to be surgically removed. So do not recommend any of those. But it's such an old and simple and easy and really very little risk associated with it. And I remember the first time we didn't even do them in residency. It wasn't until I was in fellowship. And I remember the first time I had take one out. I was terrified. Even though they told me how to take it out, it wasn't like it wasn't crumpling up the way it should to come out easily. And then sometimes if you don't know what you're doing, it can be uncomfortable. And I just remember the woman, she's post menopausal, and you lose the elasticity to your tissue, and your tissue is dry. Now you're trying to yank something out of their vagina. And obviously she. It was not very comfortable for her. And I think I was more traumatized than she was. Like, I'm not doing this again. I hate this. But it wasn't until really that I got into practice that I really started to use them more and more. And I had actually a nurse practitioner during my training who really spent a lot of time with me and how to put them in and how to take them out. And even some of the ones that you get, other, you know, other gynecologists will look at you crazy. You put these ones in that look like a donut or a cube, and there's tricks to get. Getting those in and out. And they're like, what?

Yeah, exactly. It takes some time to teach yourself on all of that. And you can't be scared of it, you know, but it's such a good way to treat prolapse without surgery, you know, And I think it's really important. So you did all the surgeries, you do the pessaries, but you have a passion for, like, the ph balance and the bacterial flora of the vagina. Right. Like, talk about vaginal health and what you know now as it relates to gut health and all of that, because it's so important. Women have recurrent BV or recurrent yeast infections. Recurrent UTIs. Why is that happening?

You know what? It's so funny because it's like, I go on in my medical practice. I realize every day about what I didn't know yesterday. You think you know everything. And all we were taught in training was, okay, the normal pH of the vagina should be between 3.5 and 4.5. And if it's, you know, if there's a fishy odor, it's bacteria. You know, if you look under a microscope and you see yeast, it's yeast. You know, like, we weren't told, you know, anything other than that. And we certainly weren't told to connect it to the gut. And, you know, somebody like myself who suffered for years and years of chronic yeast infections from the time I went through puberty, had chronic yeast infections. I think. I think it really started with me trying to heal myself and finding that. Wait a minute. And in discovering things about functional medicine and, you know, I don't know where all of a sudden the light switch went on, but once I know these things, you can't go back, right? I think it goes. I think what amazes me is that Hippocrates is my favorite saying. Hippocrates said, let food be thy medicine. And I started realizing after looking at that quote, that it's not just food. Like, there are so many things that we can do to keep ourselves healthy. I can tell you what I was doing that was causing all these recurrent, like, vaginitis, recurrent urinary tract infections. I was eating a very high carbohydrate diet because especially during medical school, that's when the American Heart association diet was out and everybody was like, low fat meats are bad. So I've been healthy and eating. I was eating bagels, like, multiple times a day. Oh, yeah, hey, look, it's low fat. I'm being healthy, not knowing I was wreaking havoc on my body. I mean, I look back just for fun, one day we were in the radiology department, and we were letting one of the radiologist students practice doing ultrasound. She ultrasound my liver. And she's like, you have fatty liver. And I'm thinking to myself, like, I don't drink, right? Like, you don't eat fat. Well, because I was eating a ridiculous amount of carbs. And so, you know, and I think now we find too, is as we've gone on, probably about 10 or so years ago, there was this swab that came out that tested the DNA of bacteria in the vagina. So I Started out of curiosity, doing it on everybody, because I wanted to see what was there, and I wanted to know if it was, like, if it was affecting. At the time we were implanting a lot of mesh, and I was trying to figure out if the bacteria had anything to do with what we were seeing as mesh erosions, where the mesh was wearing through the vagina. And I started to see some patterns in what was the bacteria in the. That was occurring in the vagina. And then, you know, fast forward to, you know, probably about five or so years ago, we start hearing a lot more about the microbiome. The microbiome. Then we started hearing about microbiome of gut. And so we know that there's healthy bacteria in the gut that helps us with a lot of our functioning. We know that 90% of our serotonin is made in our gut. We know our immune system is made in our gut. And if we don't have a healthy gut, then that's going to affect our other systems. I think also being trained as an osteopathic physician, we try to interconnect everything now with functional meds in the same way. So I'm like, okay, gut health, pelvic health. What is going on? And it kind of started like I was seeing people with yeast, recurrent yeast, were having a lot of yeast in their gut. Why are they having yeast in their gut? Well, okay, because they're stressed and their hormones are off, and now we're creating systems in their bodies where the yeast is going to flourish because of a bad diet. And so it just. It all started coming together. So, you know, and I've started to see more and more of that happening. I started seeing more women with recurrent vaginitis, where their general gynecologists were like, well, I gave them the medicine for bv. We did the five days of the metro gel, and it's not going away. And we did the, you know, seven days of terconazole, terazole, or the diphther. You know, one day a die flu can. And I'm like, you know what? These issues that we're seeing in the vagina are just the symptoms of a larger problem. Yes, that this yeast and bacteria is there because we've lost our healthy biome. So the healthy bacteria, the lactobacillus, that should normally be in a. In the vagina is no longer there. And that's really the problem. Then you got to go back. Why isn't there? Well, it's not there because we're eating crappy diets, we're not drinking enough fluids or not, you know, we're stressed. And so we're affecting the PH of the vagina. And so you can treat these bacterial and yeast infections, which to me, vaginal infection and urinary tract infections are the same thing in that the vagina is so close to your urethra and the rectum. And so you have the gastrointestinal tract with the rectum, you have the vagina and you have the bladder. And if there's something wrong in one of those areas, it's going to affect the others. So usually if I find recurrent urinary tract infections in somebody, it's because their vaginal health is not good. Well, and if their vaginal health is not good, it's because their gut's not good. So to me, they don't separate. So it just, it's where that person is getting those symptoms. And so we start looking at, for example, why is Lactobacillus good? So Lactobacillus are a group of bacteria that keeps the vagina healthy and it does so by producing peroxide. So it likes to eat the sloughed off tissue of the body, which in the cells of the sloughed off tissue is glycogen. And that's the food source for the lactobacillus. So the Lactobacillus then makes hydrogen peroxide, which basically keeps away the other bacteria or keeps it in balance because they may be some, what we say bad bacteria in the vagina, but if it's low, we don't really care about it. If it's gets off balance and creates symptoms, then you care about it. Now, when women are in their menstruating years, typically what should be happening is the estrogen that affects the vaginal tissue is going to keep that tissue thick and healthy and the tissue is going to grow and grow and slough off and then feed your Lactobacillus. But in that age group, you're looking at more of things that can throw off that stress diet maybe lubricants that people are using. I mean, there's a whole, and I can even do a whole talk on that itself. But there's a lot of science behind lubricants now. And hope I don't get sued by ky, but KY jelly is what people normally think of as a lubricant. That is usually one that comes top of mind. But that's probably one of the worst ones you can use for the vagina because it's not ph. Balanced. And not only that, but we look at, they're now looking at things called osmolality and osmolality and osmolarity. And those have to do with kind of like the harshness of it on the tissue. And so we know that KY jelly is very drying to the tissue. In fact, actually it's purposely drying to the tissue because if it dries your tissue and you have to use more, you need more and more and more.

Yeah. Isn't that sad?

You know, so now there's these great companies that are out there that are making ones that are so much healthier for the vagina where they're balanced so that they're not sucking out your moisture, they're not causing microscopic scratches in the tissue and they're not affecting the ph. So, you know, also being on antibiotics, you know, if you're on, if you've got a colon, you're on antibiotics, that's going to throw off your microbiome of the vagina. Why? Well, it's going to partially kill it on its own, but also it's going to throw off your gut. And they know one, one course of the Cipro, which is usually the top of the line thing that people would go to for urinary tract infections, it can take sometimes over a year for your gut health to return back to normal after just one course of that. And we're talking like maybe like a three day course, you know, I mean.

Right. You think of women who are on it all the time. Yeah. I mean, that's crazy. And I. It's so important for women to realize like the bacteria in their gut and in their vagina and on their skin and everywhere else, like they rely on what we're eating for their nourishment. So if we are eating what the bad bacteria, like, they're just gonna flourish, right?

Oh yeah. Sugars, carbs, you're just, you're just feeding that bad bacteria everywhere in the body. Inflammation and yeast. Yeah, yeah. And we know like now, unfortunately, perimenopausal and menopausal women have additional issues where you're losing a lot of the estrogen and you're getting the hormonal changes of those times of the life and the vaginal tissue starts to thin out. So those times it's even more important to try to create a vaginal environment that's going to support these bacteria. Because if you still have the stress and they're not eating right, and then you add on this thinning tissue that's not sloughing off, you're going to have poor lactobacillus that are going to feed me, feed me. And if you don't feed them, they're going to go away and other things are going to take over. So that's why, especially in perimenopausal years in menopause, you see the rates of bacterial infections, the vagina and of the bladder, just skyrocket during that time. But yeah, tons of different things to do for that.

Talk about that, will you? Because I get that all the time. So many women are like, I am just tired of always having a bladder infection, a yeast infection, like, what is going on? What can I do about that?

I think number one, you got to get your gut healthy because you can do all you want to the vagina, but if the gut is not healthy, nothing else is going to follow. So there's so much different information out there. On anti inflammatory diets, I think the biggest things are stay away from sugars, stay away from simple carbs like white breads. Bagels in general. Yeah, bagels do not go on the bagel, do not go on the Betsy bagel diet from the 1990s does not work. So drink lots of fluids. Fermented foods, that's one thing. Prior to refrigeration, humans were a lot healthier because we ate a lot more fermented foods. People are like, ooh, what's fermented foods? I mean, you're talking to yogurt now. Dairy's iffy. Because sometimes we say in general dairy's inflammatory, but yogurt might not be. I think with yogurt you got to kind of just see how your system responds to it. I do fine with yogurt and I make my own homemade yogurt. It's so easy. You go in the stores now, you can find kombucha anywhere. And so kombucha is a fermented tea. And surprisingly, it's easy to make at home. I've started making a lot of this stuff at home because it's actually cheaper and easier. I just last week for the first time made my first ever sauerkraut, which was really easy. I was surprised. Kimchi. A lot of the pickled foods that are not pasteurized. You want things that have live bacteria, even just for your immune system. They say, here we are, we're so worried about germs. We became the, the generation of hand cleaner and you know, a lot of times we're killing off some of that healthy, you know, antibacterial soap is probably not the best thing to be doing to your body. You want that healthy bacteria, you want to get outside. You know, I remember, you know, when my kids were younger, I was that person. I was the one who they were outside. I was like slathering them with hand clean, you know, a hand cleaner, like, oh, I don't want you getting germs when I probably did them a disservice. Kids need to be out playing in the dirt. We need to be out in nature and getting that soil bacteria on our body. There are studies that actually show that people with pets and pets that go outside in nature are healthier. The theory behind that is because those pets are out playing in the dirt, your dog comes in, you're kissing and hugging your dog or cat or whatever, and now you're getting that healthy bacteria. And so as a pet owner, you actually can have a healthier immune system because of that. So I think getting healthy bacteria in your body, working on the gut is where to start. Now for the vagina. I have had patients who've gotten a little nutty with this, and I don't blame them. It's easy to get obsessed with things, but you can test it. The PH of the vagina easily, get pH strips. But I think focusing too much on those numbers, you can get a little nutty. But there are tons of things. If you want to try to get the microbiome of the vagina healthier, we have to look at, well, are you perimenopausal, menopausal? Because if your tissues thin from lack of estrogen, there's tons of things we can do for that. So I really like. And I know you do these. I really like the lasers. I like the vaginal lasers because it's non hormonal. You know, here we have an easy way we're using light or heat energy, depending on the device that your physician has, to basically cause a microscopic injury to your tissue. Which sounds terrible, but, you know, microscopic injuries trigger your body to heal. And when your body's healing, it's going to regenerate that. That tissue. And this is. These are theories that we knew about light energy and lasers that go back to the 1980s. That all of a sudden, why didn't I think of this? Somebody goes, oh, let's put this into a vaginal probe. And now we'll make the vagina laser. And that didn't come out in the United States until 2016. That we've been doing it to people's faces since the, you know, for cosmetic purposes. Since the 1980s. So I love it. It is costly, but actually I figured out the numbers. If you look at the numbers of having a vaginal laser versus a lifetime of paying CO pays for vaginal estrogen, you're actually ahead. And it's cheaper to do the vaginal laser and do the yearly or twice a year maintenance because, yes, it's a bigger upfront cost, but over a lifetime it's actually a lot cheaper. So if it was up to me and if everybody could afford it or if insurance covered it, I would have everybody who was menopausal or perimenopausal laser their vagina, because it's going to get that tissue thicker, healthier. And now we took care of that component.

Yeah, it's amazing, you know, then you don't have to worry about this cream every couple nights and the mess of that and interfering with intercourse and half the time it doesn't work right. So. And it does have a high CO pay, like you said.

And people are not using it because the CO pays on these, on these tubes of cream. They're so hot, high. And so people are trying to make it last longer so they're using less and less or not using it as often. And it's not doing anything right.

They're not even getting the effect dose.

To go the completely natural way to rebalance the PH of the vagina and try to get that lactobacillus back into the body. There are some good products I like. There's one called Louvina. Though patients don't always like Louvina because Luvina is a gel that can go into the body. It has some of those, like, it has prebiotics in it. So it basically has the food for the lactobacillus. And the only complaint I get from it is because it's this gel. It goes in, it melts and it gets drippy. So some people find that problematic. Some people love it. Some people use it as a lubricant. I think that especially if you're dealing with recurrent urinary tract infections or recurrent vaginal infections, use it as a way to try to help rebalance things. Maybe not use it all the time, but same thing with boric acid suppositories. And there's a number of them out there to help. It's more rebalancing the phone, you know, I know there's stories about people putting yogurt in the vagina. I don't really, I don't like that idea. I'm like, you don't really need the milk sugars, but I have put, have had people put like a probiotic. You know, either make, open up a probiotic, make a little paste out of it with some distilled water, put it on your finger, try to put it in the vagina. The problem is it's not going to stay there and not going to take hold unless everything else in your body is healthy. There have been actual studies that taking an oral probiotic, it takes about a month of taking oral probiotics for it to repopulate the vagina, for it to kind of get where it needs to go. But I think you can, a lot of times you can combine all these things to really get things the way they are. But really I think the biggest focus is the diet, that if we don't fix the, the gut, nothing else is going to work. You can put everything else you want, you can laser it, you can put yogurt in it, and nothing's going to work unless we get back that healthy and work on more healthy lifestyles.

Exactly. It's so true. I think that's where functional medicine shines. So if you feel like you are just struggling with these recurrent infections, find someone to help you look at your gut health. Maybe do some advanced stool testing that can look at what's living in your gut. Do you have yeast overgrowth? What's your immune system doing? Are you making toxins? All of that. And work with a nutritionist to get your diet up to par. Right. I do see a lot of women use a probiotic with lactobacillus in it with some success. But you have to be feeding that bacteria the right food. You know, if you're on the Betsy bagel diet, it's not gonna work. It's not. Bagels are the devil. So I'm so glad that you also use the vaginal laser because I think that has been just such a tremendous advancement for women to free them from this daily chronic usage of estrogen and louvina and replens and all these over the counter things. You know, intercourse doesn't have to be painful just because you're menopausal. You don't have to be peeing your pants. You don't have to be constantly irritated and uncomfortable. That's not normal way to live. And you don't need to. Right. You should have a healthy vagina. So you are creating a summit. Right? Happy vagina.

Yes. I'm so excited because, you know, I realize that there's only so much I can do with seeing patients in my office. But there's a whole world out there where people don't know this information. And I'm always so shocked, you know, because I know things doesn't mean the rest of the world knows things. But I'm always so shocked about how women come in with public issues, vaginal issues, especially in the perimenopausal period and menopausal period, and they're embarrassed to talk about it, even though they're sitting in a gynecologist office or urogynecologist because they think they're the only one this is happening to. And I realize that nobody talks about, about perimenopause or menopause. We all know about menarche, which is the medical term for getting your period. Everybody knows about preg. You know, there's a lot more that's known about that and pregnancy. But nobody talks about the other changes other than they're like, I'm going through the change. That's it. That's all you hear if that. It's not something. I mean, I think the conversation is starting to happen more, but I'm like, you know what? That's it. It's got to happen a lot more than it is. Because until I get people coming in the office that are like, all right, I've heard something about it, and they realize that they're not the only one, that this is common and there are changes that can happen to the vagina and there's things that happen during this time period that cause us to have health problems and that there's things that can be done. I figured I need to get the word out there. And so we're doing it with a three day summit in November, November 13th through 15th of 2020. And it's going to be about 30 experts talking about vaginal health for three days. We're going to tell you all you need to know about vaginal health. And it's called the happy vagina rally. And I think my goal in life is I want to save a million vaginas. Now I'm trying to figure out how to put that on a T shirt. You know, they were like, you know, save the whale. I'm all about save the vagina.

So glad you're doing that.

I want the word vagina to be something that you can say without cringing. Yes. I mean, like, my kids hear me say it though. You know, they call mommy the vagina doctor, but, you know, they don't. They won't say it in school, but you Know what? Like, you talk about your little pinky, you talk about your foot. If you go to the doctor for your heart, your stomach, you talk about it. You're like, oh, I'm seeing the doctor from my bad knee. No one ever talks about the pelvic organs or use the proper terminology. So my goal of goal in life is to get people to use the proper terminology and to be able to say it like it's no big deal because the more you say it, the less shocking it becomes.

Yes. I love that. So important.

So vagina, vagina, vagina.

So important. Oh, my gosh. So three days on vaginal health. That is incredible. That it. There's that much to learn. But there is, right? So I hope everybody tunes into that because that's going to be amazing. You got to reclaim your health, and you can't ignore that part because it affects your intimate relationships. It affects your ability to exercise and do things right. I mean, it affects so many aspects of your life.

Confidence.

Yes.

You know, I want people, I want them to be aware of their pelvis and their pelvic organs and their vagina, but I don't want them to be aware. So, you know, the people that have the problems, one of the things they complain about is, I'm just so aware of my vagina. I don't want you to be aware of it in a bad sense. I want your vagina to be happy. I want you to forget about it. I want you to be able to get on with your own life so that you're not constantly worried about what's going on with my vagina.

Exactly. Exactly. Well, thank you so much for doing that because that is so needed. I am looking forward to it. I'm super excited. So cool. I will have links in the show notes. And where should people follow you and find you?

Well, they can find me on social media. Instagram, Facebook, all the social medias. I also have Dr. Betsy Greenleaf.com they can find my information there. Though I have to say, probably the social media is more up to date than the website. But also on the website, we'll have the information about the Happy vagina rally. And also I have a podcast too called Some of youf Parts where we focus on that you are greater than the some of your parts. So the title is Some of your parts S o m E, but the tagline is S u n. Yes, yes.

So good. You covered tons of amazing topics. So important for women's health. So definitely check that out, guys. Well, thank you, Dr. Betsy. You're awesome. Love you.

Great. Thank you so much.

Oh my gosh. Didn't you love her? I just could talk to Dr. Betsy for hours. She and I are so much alike and I just know that she is doing all of this extensive work for the right reasons. She cares about you. She wants you to live your best life. So she's one of those amazing, selfless people that just gives, gives, gives. So definitely follow her on Facebook, check out her website, her pelvic floor store, and when her summit comes out, I will share that on my social media for sure because I'm going to be on theirs and she's gonna have amazing guests and it's going to be great information. So thank you so much for taking the time to hang out with me today and for taking the time for yourself. Self care is imperative. We need think of ourselves as women. We can't keep giving, giving, giving without giving back to ourselves. So if you want to be amazing, you have to treat yourself like you're amazing. Right? So I hope that you can find one golden nugget in today's episode that will help you reclaim your health and take your amazingness to the next level. So please hit the subscribe button if you're enjoying this. Share it with your friends, share it on your social media tag me and I will send you a cool gift and I would love it if you would leave me a review that would be so amazing to give me five stars and leave me a review. Because itunes needs to know that you guys want to hear more about women's health and we need to keep supporting this kind of information getting out to the masses because it's super important. So if you did that, that would just make my week. So go out, have a kick ass week, support each other and support yourself. It's not selfish, I promise. It's life changing. So I love you guys. Bye.