It's time to talk about our happy places - our vaginas! On this episode of The Hormone Prescription Podcast, host Dr. Kyrin Dunston is joined by special guest Dr. Betsy Greenleaf, an OBGYN and pelvic floor physical therapist, premier womens health expert, a best-selling author, entrepreneur, inventor, and business leader specializing in female pelvic medicine and reconstructive surgery for over 20 years, to talk all things vagina. Dr. Greenleaf, is a trailblazer as the first female in the United States to become board certified in Urogynecology, CEO of The Pelvic Floor Store, a blog at drbetsygreenleaf.com, and she is the host of Some Of Your Parts Podcast, and host of the happy vagina rally summit.
She dedicated to women's wellness and the notion that you are greater than the sum of your parts. and BODY MIND SPIRIT podcast that focuses on the trinity of total health. She is the best-selling co-author of You Were Made To Be Unstoppable.
In this episode you will learn:
-How your vagina changes throughout your life
-Pelvic floor physical therapy and how it can help with things like incontinence, pain during intercourse, and more
-The importance of self-care for your vagina
-And much more!
So whether you're dealing with the changes that come with menopause, are concerned about your pelvic health, or just want to learn more about taking care of your vagina, this episode is for you! Tune in now and let's get started on having a happy vagina for a happy life.
[01:15] Hey everybody. Welcome back to another episode of the hormone prescription with Dr. Kyrin. Thank you so much for joining me today. Today. We are gonna talk about vaginas. Yes, I know this is probably something that you don't hear talked about that much, but the truth is you have one, you take it with you everywhere, and it's a big part of what makes you a healthy woman. And my expert today knows this better than anyone. She is an expert in vagina house. She has a great event coming up. We're gonna tell you about, and she has a voice and she's not gonna be silent. And you shouldn't be silent either about what's going on for you. I'm gonna tell you a little bit about her and then we will get started. Premier women's health expert, a bestselling author, entrepreneur inventor, and business leader, specializing in female, pelvic medicine and reconstructive surgery for over 20 years.
[02:14] Dr. Betsy Greenleaf is a trailblazer as the first female in the us to become a board certified Euro gynecologist. Yay, Betsy. She is the CEO of the pelvic floor store. She has a blog at Dr. Betsy greenleaf.com. She's the host of some of your parts podcast, and also she hosts the happy vagina rally summit. We're gonna tell you about she's dedicated to women's wellness and the notion that you are greater than the sum of your parts and body mind spirit podcast that focuses on the Trinity of total health. She's the best selling co-author of you are made to be unstoppable. Welcome Dr. Betsy Greenleaf.
[02:55] You so much, Dr. Kirin for having me here. I'm so excited. I love talking to you. So this is gonna be great.
[03:00] <laugh> yes. Betsy is so much fun. Not only is she brilliant, uh, when it comes to women's health and special, especially vaginal ecology and pelvic floor things, but just such a free thinker and out very outspoken. She shared the quote from Alan Albright with me before this episode, and I said this so speaks to who she is in the world. And I think who I am too, right. It took me quite a long time to develop a voice. And now that I have it, I am not going to be silent. So did you used to, to not have a voice on important matters?
[03:37] You know, I, unfortunately I think I've always just kind of not had a filter, just spoke my mind, but I did find very quickly that especially in traditional medicine, especially in, in, unfortunately the time that I did my training being in a male dominant field, that people did not wanna hear me. And it did get me in trouble, especially my first, my actually very first job. I came out in the early two thousands thinking, come on, it's two thousands. Like, you know, this is crazy. Like how bad can, you know, medicine be? And I'm going into a hospital where it was like stuck in the 1950s. And so they were not used to having somebody that spoke up.
[04:42] Later on, I spoke to some of my family colleagues and they're like, you, what is the doctor's lounge? And I was like, uh, last time I looked, I do have a degree. They're like, oh, we don't go in there. Only the men go in there. So yeah. So unfortunately I kind of learned the hard way that people don't always wanna hear what you have to say. So I do have a tendency to rock the boat, but I just, you know, as much as they've tried to squelch me over the years, I still haven't learned to shut up and I'm just gonna keep talking.
[05:12] oh my gosh. You just brought back so many memories from when I first came out of residency and went to work in this hospital and the doctor's lounge. Oh my gosh. Yes. You were like an anomaly. You were like a rare bird walking into the Seren Getty <laugh> and they would look at you like they were like lions you're doing here. And do you know what? I even remember that in the, so in the surgical suite, they didn't even have a female doctor's locker room. Yes. The only doctor's locker room, they said, this is the doctor's locker room was for males and females. So they would tell us, you have to go in there and change. I'm just remembering this. And of course, none of us wanted to, so we didn't.
[06:05] I think it's still like that in some of the hospitals I go to, it says like doctors' locker room and then there's the nurses' locker room. And I'm like, but there's a lot of male nurses. And obviously there's a lot of female doctors. So, but you know, the, the men go into the doctors when the female go into the nurses.
[06:21] and God forbid, you would, you would raise your hand or say something at the, you know, the OB GYN staff meeting. They really would look at you like with these daggers, like, are you real? Like, it's enough that we gave you a seat at the table, but you're gonna open your mouth and say something <laugh> really
[06:38] It's actually, you know, it's funny too. Cause I actually even started out in general surgery before I switched to OB G a N. And I remember walking into the operating rooms and like the doctors would look up and they'd be like, uh, you, what am I gonna talk to you about? And I would go home and study the sports page. Everybody else was study like surgery, textbooks. I was studying the sports page. So I had something I could walk in and talk to them about.
[07:04] Maybe I should have done that. I didn't think of that. And I think it's important thatm in listening know kind of what the environment was like for us and still is in the hospital environment, because it will help you to understand a lot of why you're not getting what you need from medicine. Because if this is the oppressive environment that the doctors are living in, when it, it comes to women, this is what is being translated to you, without words in the care that you're receiving or not receiving, and the attention to your vagina and lady parts that you're probably not getting to the level that you need it. So that's why I think it's important to know. So let's dive into talking about, well, first you're the first certified urogynecologist female in the us. That's amazing. Yeah. What prompted you to want to go into urogynecology?
[08:06] You know, what's interesting. So I told you I started out in general surgery and I was the person who I wanted more of a relationship with my patients and listen, general surgeons are amazing people, but I found for me, they were too much like body mechanics, you know, get in, get the job done, get out, but I, and not have a relationship with the patients. And so I wanted a relationship with, with the patients I was going around on general surgery and I was the one who was rounding and being.
[08:56] I didn't necessarily wanna deliver the babies partially. Cause I like to sleep at night <laugh> babies come at all hours of the day. And so they told me that doesn't exist. It doesn't exist. And it wasn't until my very last rotation as a OB GYN resident that I did Euro guide. And I'm like, this is amazing. I mean, this is what I've been telling people. I wanna do, you know, I was being told before, like, that's blasphemous, you can't just do the surgical aspect. And so, yeah. So I found that and uh, I got really lucky because I was a month from graduation and most fellowships have already accepted their fellows into the program.
[09:59] Yeah. Amazing. And so you've had this really deep dive into pelvic floor disorder. I know you're very passionate about the VA biome and you're holding this event, uh, the puppy vagina rally, that's coming up soon. We will have a link in the show notes for you guys to sign up. And what are some of the most interesting things that you learned doing the interviews for this event about the vagina that you would like to share with.
[10:32] Everyone? You know, it's been so much fun cuz every time I interview people, I think like all of us as we talk to people, it's not just the conversation, but then it's an exchange and we're learning so much from each other. I think, you know, part of it was being traditionally trained. We didn't get a lot of training in sexuality. In fact, actually they took it out of the curriculum when I was in medical school. And I think even when it was in the curriculum, it was only like a week long. So we have a couple speakers that talk about sexuality that like from Susan Bratton to, I have a woman who is the erotic massage coach.
[11:31] And I'm like bringing in this woman, who's the tic massage coach, like talking to her, first of all, she is just so much fun. I'm like, wow, I never even thought about that as like an option. And when you first hear about it, she does these classes on like how to like kind of, you know, get your partner aroused. But I was like, well, that doesn't sound fun for, for me or the woman, but it is super empowering.
[12:27] So it has been really enlightening along the way. And of course we have you talking about menopause on the summit too. So a lot of fun little tidbits from Dr. Karen. So it is just, it was a lot of fun making it. And I mean, I can't, I could go off on hours for all the different speakers that we had. We actually had to kind of hold it down to 30 speakers. Cause that was the other thing at first, it was turning into this week long summit. And my, I really wanted to address busy women because I don't know about you, but I don't really have a lot of time to sit there and watch a lot of videos. So I wanted, we decided to par it down, make it 30, 30 different speakers over a four day period. So in like short half hour session. So you could just kind of get in, get the information and get back on, you know, with your life.
[13:18] Yeah, I am super excited to hear it. Definitely wanna hear about that massage therapist you talked about. So why is the vagina so important? I know some women here get it. Any woman who's had recurrent Vitis. Oh my gosh. That's probably one of the most frustrating things for women. And if you've had that, you probably know what a big deal the vagina is. But I think that most people don't get the importance of the vagina. Just like they don't get the importance of their mouth. People are like, yeah, my mouth, what do you, what about it? I chew food. I swallow it. I go to the dentist, I brush my teeth big deal. And I'm like, no, your mouth is everything. So why is the vagina so important when it comes to women's health?
[14:05] And it it's been fascinating over the years to find the connections between the gut, the brain and the vagina. And even if you're talking about the mouth, when we talk about microbiome, so microbiome are the small microorganisms that live in different areas of our body. So our microbiome of our mouth is different than that of our gut is different than the vagina, but they all interact. So, you know, starting with the mouth, we're 75% of us are chronically dehydrated. So if you're dehydrated, you're gonna actually throw off the healthy bacteria in the mouth and that's where your digestion begins. And if your digestion isn't good or the bacteria in your mouth, isn't good.
[14:56] That's gonna throw off your gut health and your stomach health. And we know that the gut health, 95% of our happy hormones are made in our gut. And 80% of our immune system is made in our gut. So if our gut is off, that can lead to inflammatory conditions, autoimmune conditions, probably 90% of the medical conditions out there today are either caused by or aggravated by things in the gut. And then things like anxiety and depression are aggravated by our gut. And then if the gut is off, that throws off the microbiome of the vagina, and then we're more susceptible to recurrent geese and recurrent vaginal infections.
[15:57] And so it will dampen sex drive and fertility. And because the brain doesn't know the difference between wanting to have a baby wanting to have fun. So now a lot of times we, you know, women, especially postmenopausal women would come in that like I have no sex drive, gimme hormones and hormones are a great tool and they are amazing and they work, but in some women, it doesn't completely fix the problem. And then we gotta go look at the, the microbiome because if the microbiome of the vagina is off, the brain is going okay, it shouldn't be reproducing right now. Let's dampen everything.
[16:46] I think that's so important. So thank you for highlighting that is that, you know, with the modern age birth control, we have uncoupled sex from reproduction and we just wanna have it because we enjoy it. It improves intimacy or for whatever reason your body doesn't see it that way, it still sees it. As you get, you're rewarded with a sex drive when you are optimally healthy, cuz then it thinks you'll make a healthy baby and you'll be around to take care of it for 18 years. But how interesting that there's data that if you, your vaginal environment is off, that it's gonna feed back into your brain to be a kill switch on your sex drive.
[17:50] Yeah. And then it feeds into, you know, hormones do play a part because if we're not getting estrogen well and there's other receptors in the vagina, if we're not getting hormones to the vagina, the vaginal tissue thins out and our healthy bacteria, the lactobacillus lives in like the symbiotic relationship with us. Like it lives off our, off of our dead tissues, which sounds kind of gross, but it eats something called glycogen and it survives on that. And in return, the healthy bacteria produces hydro peroxide, which keeps the vagina very acidic, which fights all the yeast and the bacteria.
[18:40] Everything connects to everything else, thing else <laugh> everything's related. Um, and I love how I love when women see that light bulb go off and no longer is it like, oh, I just have a recurrent vaginitis problem. And they get it that, oh my gut micro flora is off. Oh my mouth, my hormones. Right? All these things. And so we're gonna have a link to the happy vagina rally. I'm wondering, they're gonna get lots of great information there. There's so many women I find in their forties and fifties who start having problems with their pelvic floor. And I find I'm amazed by this. You're probably used to this. They don't even wanna talk about it, but to their providers, cuz they're so embarrassed, I've had women, uh, and I'll ask them, are you having a problem with, you know, something protruding from your vagina you're notch for what it is and they'll go yes. And I say, well, why don't you say something?
[19:59] Sure. You know, this is, I can't tell you. I mean, being a gynecologist is what I did every single day of my life. And yet every single day I would have a woman in the office that goes, oh, I'm the only one this has ever happened to. Right. <laugh> and I'm like, no, in fact, actually 50% of women will have a pelvic floor support problem. And so the way we're built, unfortunately gravity takes over everything. I mean, you know, everything starts heading south, you know, from our boobs to like ear lobes to our vaginas and some women who've had babies are a little higher risk of things, drooping and dropping though.
[20:52] I mean, we're just, everything's going to gravity. And so inside our pelvis, you have your bladder, you have the vagina, you have the rectum and these things can start drooping and dropping and falling out. And part of it's from ligament damage, not, you know, you know, whether it's having a baby or being constipated and straining too much or maybe coughing or lifting something too heavy. And then the problem is we start losing muscle mass. We lose about 8% muscle mass for every decade that we live.
[21:42] But what lot of times they'll say like, well, sometimes people come in, they think they have a tumor. Cause all of a sudden something's hanging between their legs. Mm-hmm <affirmative> and usually it's the vagina that's bulging. You're seeing the mucosa, like the skin of the vagina that's protruding. And well, sometimes we refer like the bladders falling out, the vagina is falling out. The uterus is falling out the rectum falling out. Like nothing's gonna be falling and dropping on the floor.
[22:27] Or the rectum's gonna start leaning on the vagina and push it out. And basically everything's just kind of flopping and collapsing and stage four prolapse is actually where the vagina can fall down and turn inside out and hang between the legs. So that is possible. So if you're experiencing anything that's dripping or dropping, you know, get it checked out. Uh, at the same time, I know it's kind of shocking. If so that happens, cuz it can be a gradual process or somebody could lift something heavy. And if they're not lifting properly, you gotta blow out as you're lifting. But if you hold your breath and all of a sudden pop there goes something and you're finding it between your legs, it is not a surgical emergency.
[23:31] Yeah, it is shocking cuz nobody talks about it, but we're talking about it and I'm glad you're here. So now if it happens to you or your BFF send texts, you what is this photo? And you can be like, no problem. It's PE it's pop pelvic organ prolapse. Yes <laugh> I got you. Right. And so like, say that did happen. I know I've heard, I knew this doctor, she trained up in the Appalachia and she's like, they would put potatoes, put a potato up there to hold it up.
[24:02] You know, what's so funny in ancient Egypt, they used to use like rocks or pomegranates. And then Roman times they'd use rocks or potatoes, which I don't recommend any of those things. They do make medical devices called pessaries, which are usually made out of silicone. And they're coming all kinds of crazy shapes and sizes. Some like look like very small Frisbees all the way to, they look like donuts or cubes.
[24:48] Some people have heard about vaginal mesh and I see the 1-800-BAD-DRUG commercials. And I have to say vaginal mesh is not a hundred percent as bad as it was made out to be, but that's a whole nother topic. But when I first came out, I was doing surgery on everybody cuz that's what you were treating to do. And then one day I realized, wait a minute, why am I doing surgery? If it's not bothering the person or if it's not causing health conditions. And so you don't necessarily need to have surgery there's non-surgical options. Or if it's not causing recurrent urinary tract infections or it's not affecting your kidneys, it can actually just be followed and you can kind of leave it alone and manage it that way. But you do have to get it checked out to make sure it's not affecting your kidneys or your urinary tract.
[25:33] Yeah. So what is a treatment? So pessaries are one option. The mesh was big fiasco and our doctors even using mesh at this point, say there's somebody listening. Who's like knows that she's got stress, urine incontinence. She's got a cystic seal, right? The bladder's falling. Maybe she has a recusal and or an entere. So the backside's coming down too. What should she look for in trying to find someone to complete a surgical repair for her? What, what things are available?
[26:03] You know, there's are some regular gynecologists are very well trained in this, but I, of course I'm a little partial to Euro gynecologists or someone who's gone through female pelvic reconstructive training the problem with any of the surgeries. And this is something that as a profession we've learned over time is none of them are a hundred percent permanent. It's not like you get your appendix out and like you no longer have your appendix like the process that caused you to have that in the first PA place. And the fact that we know that some people are just genetically have weaker tissue, even when you put it back surgically, it can recur.
[26:50] So there are a number of surgeries. There's ones that go can go through the vagina and it's not like people always ask, well, why don't you just find the ligaments that are torn and just rehook up into those? Well, a lot of times those ligaments are so thin and non-existent, there's not anything really to rehook up into, but there are still vaginal procedures though. The vaginal mesh only refers to the mesh that's placed through the vagina and mesh has been used for surgery for hernia surgery since the eighties. So mesh is actually still used, but it's actually placed in through the abdomen and that's not considered vaginal mesh.
[27:41] And people always ask like, is a robot doing my surgery? And I'm like, no, no, no, it's the doctor's running the robot. The robot has the ability to do finer movements. So mm-hmm <affirmative> and then basically they're reconstructing and wrapping this material. And it's usually like a thin mesh around the vagina and kind of attaching it to the tailbone to reconstruct that, that ligament. And then I have to say over the years, I've gotten a lot of, uh, questions about mesh. Like some people picture it in their mind as being like a window screen. It's not that rough.
[28:29] When you were talking about like, why can't you just reattach the tendon? So I was thinking it's not like a cut shoelace. It's more like panty hose. That's been so stretched.
[28:39] Exactly. Exactly. Yeah. If you could like run in your that's a great I and where were you when I BA Brazilians of years ago? And I could have used that. Yeah. Like if you get a run in your, your stockings, you're not gonna sit there and try to try to sew it back up cuz you're just gonna make more runs and it's just gonna keep going. And there's really not much to pull together.
[29:00] And the mesh. Yeah. It's like TWI or it is like panty hose kind of like a really fine fishnet panty hose, but alright, so some great solutions there. Well tell them about what they're going. Who else is gonna be, uh, the happy vagina rally summit. I'm there? You talked about Susan. She's amazing. Any other people and we will have the link in the show notes and it airs on what days?
[29:28] June 9th through 12th.
[29:30] Ninth through 12. Yeah. So anything else you wanna share about what? Good goodness they will get there.
[29:35] Yeah. Even though we call it the happy vagina rally, it's not everything about vaginas is we're talking everything from perimenopause to menopause and vaginal health. So we're kind of covering it all. So we have Kevin Ellis, the bone coach talking about osteoporosis when, uh, which was actually interesting. When I interviewed with him on his podcast, we actually found studies that connected bone health with vaginal health, which I was fascinated by. I was like, what? We have people like Susan Bretton. We have we Jagger. Who's the, the erotic therapist. We have JJ Virgin talking about sugar and your diet. We have Deborah Atkinson talking about exercise and how, why we can't lose weight. As we get older. I have Dr. Aika Becca talking about hysterectomies and menopause. I have some your other urogynecologist talking about prolapse, talking about incontinence, different vulva dermatology, a vulva dermatologist on Dr. Lynette Maren.
[31:21] Vagina smoothies. There's a pelvic meditation. This was actually fun. I, I, I actually created this pelvic meditation. I started looking into things beyond traditional medicine and looking into some of these alternative therapies and sound therapy and certain wavelengths that are supposed to stimulate your pelvic chakra, which is opens up creativity. And we created a pelvic meditation at a certain frequency as with something called Bial beats where it's like slightly different tones in each ear and actually has a relaxing property to the brain, which was actually fascinating to look into and create. So we have a little bit of everything going on. It it's all gonna be a lot of fun.
[32:33] Can, and it's funny, you mention, it's funny, you mentioned the vagina spa because that's in the works. That's in the works.
[32:40] Ah <laugh>. Yeah. And you know, I was gonna ask you along those lines, I have to we'll end with this. So I go to this, don't tell anyone, but like one of my favorite places in Atlanta, when I go there is Jeju sauna. Do you know Jaju?
[32:56] So JJO is this, I don't know. It's like 20,000 square feet, Korean bathhouse up in Gwinnett county. Oh. And they have first off every kind of sauna you could wanna go to. Right? They've got the Jade sauna and this salt rock sauna and the gold sauna. And like all these saunas, they've got steam rooms, they've got the best foot reflexology I've ever had. Every time I go there, I get the foot reflexology. They have this Korean scrub where the women, you lay naked on this table. It's like this big room of all these, they look like surgical tables T VH, and they scrub you down. You're like totally naked. They have a towel over your head. If you didn't know what was happening, you'd think it was really weird. And they scrub down to your body with this scrub and it is, it is just, it's wonderful.
[34:08] You know, it's funny you bring that up cuz I know that was made super popular, especially with Gwyneth PTRO. I know she's been kind of touted as making that super trendy and there is a lot of belief that vaginal steaming can help with fertility or the biome or menopause. I think when you come, I I'm really into body mind spirit. So I think if you believe it's gonna help, it's going to help. And I think it's maybe very relaxing, but honestly it doesn't work anywhere close to what people think it believes does. They think they're gonna sit on this pot of herbs and that this steam is gonna go up in the vagina and clean it out. But Reno is gynecologists.
[35:05] So the steam is really not gonna get up there. Plus you have the lips of the VVA that are kind of protective and for most, and there's so much, I always say, vulvas are like snowflakes. There's not like there's not, they all they're all look different. But for the most part, the lips of the VVA are kind of keeping that area closed. So it would be really difficult for that team to get up in there and steam things out the way people are picturing it. But if you think it's relaxing to do so, I'm like, okay, you know, go ahead and do it though.
[36:05] Yeah. So if you've had one, check me out on Instagram or Betsy and let's hear your experience, I'd love to know I did it one time cuz I wanted to see and the herbs are great. You get to breathe them in. So I'm wondering if actually it has more respiratory benefit than anything else I else have
[36:26] I'm with you. Like the vaginas collapsed down. It's not a stove pipe <laugh> and so I don't really know how much benefit there is to it. But I do think that if you have a belief around it and it could be working at an energetic level on the energy body and on that SAC chakra, that is all about creativity. So I we'd love to hear your thoughts and opinions on that. So check out Betsy on her Instagram, what's your Instagram, Betsy
[36:52] At Dr. Dr. And then Betsy Greenleaf underscore you gotta put the underscore. This is my second account. I kind of okay. off the Instagram. Talk about not keeping my mouth shut. I off the Instagram. God's the first, the first account. So
[37:06] <laugh> yeah. Well, let's end with this other quote you had from Anne Rand, which I love it. The question isn't who's going to let me it's who is going to stop me? Well, Instagram may try, but the vagina lives on with the happy vagina rally. Thank you so much for joining me, Dr. Betsy Greenleaf, we will see you at the happy vagina rally.
[37:33] And thank you for joining us for another episode up the hormone prescription with Dr. Kirin. It's been my pleasure to have you here today. I want you to take in mind some of the things that we've shared. If you learned something that could benefit another woman, please do consider sharing it. And I want you to think about developing your voice and not being silent. What is it that you need to speak up about and be truthful about?
[38:00] Thank you so much for listening. I know that incredible vitality occurs for women over 40. When we learn to speak hormone and balance these vital regulators to create the health and the life that we deserve. If you're enjoying this podcast, I'd love it. If you give me a review and subscribe, it really does help this podcast out so much. You can visit the hormone prescription.com, where we have some free gifts for you, and you can sign up to have a hormone evaluation with me on the podcast to gain clarity into your personal situation until next time, remember, take small steps each day to balance your hormones and watch the wonderful changes in your health that begin to unfold for you.
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