Ep.184 Menopause, Microbiome & Libido: A Urogynecologist’s Guide to Midlife Intimacy

Episode Transcript
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Michele Folan (00:00):
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We're removing the taboo fromwhat really matters in midlife.
Let's be honest, we'll talkabout hot flashes, wrinkles, and
even our own supplement stackbefore we'll talk about what's

(01:44):
going on down there.
But pelvic health, pleasure,and intimacy, they matter a lot.
My guest today, Dr.
Betsy Greenleaf, is a totaltrailblazer, the first female
board-certified urogynecologistin the U.S., and she's here to
break the silence.
We're talking about thegut-brained sex connection, how

(02:05):
to revive your libido inmidlife, and what's really worth
putting in your cart from herpelvic floor store.
Get ready for a real talk aboutpleasure, function, and
everything your doctor shouldhave told you, but didn't.
So buckle up.
This conversation might makeyou blush, but it might also
change your life.
Dr.
Betsy Greenleaf, welcome toAsking for a Friend.

Betsy Greenleaf, DO, FACO (02:28):
Thank you so much, Michele.
And I love the name of yourpodcast.
It is so perfect.

Oh, thank you.
You know, I like to say I wasan original, but unfortunately
there are some other podcasts uhnamed Asking for a Friend, but
yeah.

Yours is the best, though.

I think so personally, but yeah, so thank
you for that.
You know, we have talked alittle bit about urogynecology
and pelvic floor health, but I'mexcited to get your
perspective.
You're an osteopath doctor, andI really think that you're
gonna bring a whole differentperspective to this topic.

(03:09):
You're the first female in theUS to become a board-certified
urogynecologist.
I'm really curious what drewyou to this specialty early in
your career.

Betsy Greenleaf, DO, FACOOG (03:21):
You know, it's kind of interesting
because I didn't really know iteven existed.
And there's only 1,500 eurogynecologists in the United
States.
And even then, when I told myfamily that I was gonna be, I
started obstetrics andgynecology and I kind of
discovered urogynecology like mysenior year of residency when I
should have been looking for ajob.
All of a sudden I'm like, waita minute, I like this thing.

(03:44):
And I told my family I wasdoing urogynecology.
At first, they're like, Eurogynecology?
Like, what is that?
Is that like fancy, fancygynecology?
It's like it's like European.
And I'm like, well, it doeshave to do with peeing.
So yes, kind of, but it's notlike European, it has to do with
urology, so the bladder healthand the pelvic health, along
with gynecology.
So it combined the two.

(04:05):
But I really found it superjust fascinating.
And I love just working withwomen and having that
relationship because I actuallystarted off in general surgery,
was my first, my first training.
And I I loved the surgery, butI didn't like the fact that you
didn't really connect with yourpatients.
So basically, you know, youwould take out an appendix and
then you'd never see them again.
And that was that.
So I like the fact that withgynecology, you could have that,

(04:28):
those long-standingrelationships with patients and
kind of really make a differencein people's lives.
And then urogynecology, evenmore so.
It was just, um, and plushonestly, obstetrics, even
though it's fun deliveringbabies, like I like sleeping at
night.
I don't do well on like lack ofsleep, and you can't really
control when babies are coming.
And I don't know if if you lookaround at people who are the um

(04:50):
the OB doctors around there,they usually look about 10 years
older than what they reallyare, and that's because of lack
of sleep.
Yeah, like lack of sleep reallycan aid you.
And I was like, yeah, no, I'mnot in for that one.

So yeah, you know, I shared with you that my
dad was a urologist and he had aton of friends that were
OB/GYNs.

unknown (05:12):
Yeah.

And those guys, I hate to say this, but many of
them had serious cardiovascularissues later in life.
And I have to think the stressfrom lack of sleep and just that
pressure of just their job ingeneral, um, that can't be easy

(05:33):
uh long term, right?

Speaker 1 (05:34):
Yeah.

And, you know, speaking of urogynecology, I'm
not sure women really knowexactly what you do.
Can you kind of explain howyour field differs from
traditional OBGYN and then maybepelvic floor physical therapy?

Yeah.
So we get a little bit morein-depth with some of the pelvic
conditions.
So we take every take care ofeverything from like the belly
button down and the thighs up.
So we're taking care ofbladder, urethra, the 2PP
through, the vagina, the rectum.
So, for the most part, mosturogynecologists are dealing
with incontinence.
So, like leaking when youcough, last sneeze, or like

(06:15):
you're having problems runningto get to the bathroom, or
recurrent urinary tractinfections, or the other issue
would be prolapse.
So, prolapse is kind of likewhere your bladder's fallen and
it can't get up.
Yeah.
And uh, yeah, that is it, thatis a thing.
So there's ligaments that'ssupposed to hold up everything
in your pelvic floor, but ourpelvic floor is just a big hole

(06:35):
open to gravity.
There's really just someligaments in there, maybe some
muscles, some skin, but there'sreally not much holding things
up.
So the weight of a childbirthor giving birth, or sometimes
just lifting heavy objects, orjust dealing with gravity over
the period of your lifetime canaffect those ligaments.
And now the bladder can lean onthe vagina and push the vagina

(06:58):
out.
The vagina can turn inside outlike a sock.
I know this is terrifying ifyou didn't know this this
existed, or the rectum can leanon the vagina and push it out.
So the prolapse is a type ofpelvic hernia where you get this
bulging of tissue out of thevagina.
Yeah.
And unfortunately, most womenlike will come in and they think
that they have a tumor becauseall of a sudden, like maybe
they're fine, and then one daythey look down and there's

(07:20):
something hanging out orbulging, you know, maybe they've
coughed or sneezed or liftedsomething heavy and that like
kind of did the final straw withthe ligaments.
And now if somethingsomething's bulging, it's
usually just like if you picturethe vagina literally like a
sock, and things are in thatsock is just starting to turn
inside out and starting to hangout.
So, yeah, unfortunately, that'suh and 50% of women will have a

(07:43):
prolapse at some point in theirlives.
So that's the scary statistic.

Oh dear God.
Yeah.
Do you also deal with likefecal incontinence too?

Would you Yeah, okay.
We do.
Okay.
Yeah, definitely.
So we you know urogynecology iskind of a misnomer, and they've
been like battling for yearswhat to call our specialty.
I think like the last thingthat they've settled on was
urogynecology and reconstructivepelvis, pelvic surgery.
Uh, and they they keep changingit every couple years, like

(08:16):
what our official titles are,and they can never they can
never settle on it, but it'sreally anything that's in that
pelvic area from the rectum tothe vagina to the bladder.
So okay.

And this isn't just from childbirth.
No.
Can you talk a little bit aboutwhat else would cause these
issues other than just planalgravity?

Yeah.
So unfortunately, anytimethere's pressure on the pelvis,
so like when we lift heavyobjects, they tell you to blow
out.
And the reason why you'reblowing out when you're lifting
something heavy is so you don'tget a hernia.
Like you may have seen like theOlympic, you know, power
lifters do that.
You know, they're liftingsomething heavy and they're
like, you know, they're blowingout because they're trying not
to give themselves a hernia.

(08:57):
Because when you hold in yourbreath and you're lifting or
straining, and that could evenbe for like bowel movements and
constipation, if you strain toohard, that's going to be too
much pressure on the pelvis, andthose ligaments can easily just
rip and tear.
Some people are geneticallymore predisposed to the to the
ripping and tearing of those,um, that tissue than others.
I've seen it happen withactually seen the youngest

(09:21):
person I've ever seen with aprolapse was 15, and she was a
gymnast.
And we think it was from herhard landings, like on the
floor, was really kind of doinga number on her, on her
ligaments and her structures.
But it's, you know, umexcessive coughing.
Sometimes we see it with peoplewith bronchitis or asthma,

(09:41):
vomiting can do it, liftingheavy objects can do it,
straining to have bowelmovements can do it.
So, I mean, some of thosethings you just can't avoid.
So I don't want everyone tolike worry every time they like
sneeze or like cough.
Right.

But yeah.
What about straining to pushurine out?
Would that cause it too?

And wouldn't necessarily cause
that.
But you know what?
That's one of my things that Inobody teaches you how to pee.
This is a really interestingthing.
I didn't know until I went intothis field that you're not
supposed to bear down to emptyyour bladder.
But how many of us are so busythat we're like, you know,
taking two minutes to go to thebathroom is like really
difficult to fit in your day.

(10:25):
So you're like run in there,you're bare down, you're
pushing, you're trying to getthe bladder empty so you can get
back to doing whatever you weredoing.
But the bladder is a giantmuscular bag and it is designed
when your brain triggers andsays, okay, time to pee.
It's designed to do the pushingand emptying.
So when you bear down, likeyou're having a bowel movement
and trying to like rush italong, what you end up doing is

(10:48):
the urine's gonna go where theleast amount of pressure is.
And you hope it's out of yourbody, could also go back up to
the kidneys.
So doing that, especially ifthere's any bacteria present in
the urine, there's a higher riskof getting kidney infections
when you urinate that way.
So take the time, take a deepbreath.
You know, you don't get a lotof time.

(11:09):
It's probably that, especiallyanybody who's a mother, you
know, probably, and even then wedon't get free time when we're
in the bathroom because you knowthe kids are always knocking on
the doors, but um, just takethe time, sit, relax, let the
bladder do its pushing.
And and uh that's the properway to pee.

You know, that now listen, at three in the
morning, yeah, and you just wantto get back in bed, that's when
I would probably be moreinclined to do that.
And why is it, and I'm this isTMI.

Speaker 1 (11:36):
Yeah.

Why is it harder for me to pee at night after
I've been asleep?

You know, it's uh so there's a lot,
some things that make it hardto pee.
It depends.
So one of the things, so thatthere's two things that happen,
happen have to happen whenyou're urinating.
One is the urethra, which thetube you pee through has to
relax, and then the bladder hasto push.
And sometimes those signalsbetween the two areas kind of
get a little wonky.

(12:00):
And so sometimes, likesometimes people complain,
especially like of shy bladder,like they know they have to go,
but it's just not happening.
It's usually because theurethra is staying tight and not
doing its relax.
So it's relaxing.
So sometimes it's just, youknow, maybe you're not awake
enough and things just haven'tsynced properly.
There are some tricks.
I mean, actually running watercan sometimes trigger your brain

(12:23):
to get the muscles in thepelvic floor to relax, to get
the urethra to relax and thingsto um come out.
Sometimes we actually tellpeople to take their hand and
tickle their back, like theirtailbone, because the sacrum is
where the nerves come out thatrun the pelvic floor.
And sometimes just doing thatwill distract the nerves enough
to kind of get things to relax.

(12:43):
Oh.
Yeah.
Okay.
There's also medications.
Like the worst time I seepeople having problems emptying
their bladder is during thespring when allergy season is
around, because thedecongestant, uh, all the
decongestant medications, all ofthem, well, as if it's a
decongestant, different thanantihistamine, but if it's a

(13:04):
decongestant, one of the sideeffects is it causes your
urethra to spasm and not relax.
So people tend to have moreproblems peeing during allergy
season because of that.

You know, that happened to me one time.
I was doing the scopolaminepatch for motion sickness.

Betsy Greenleaf, DO, FACOO (13:21):
Yes, that'll do it too.

And I could not pee.
It's like, yeah, my dad, my dadwas like, take that, take that
patch off.

Betsy Greenleaf, DO, FAC (13:28):
That's what's causing it.
So I'm like, Yeah, that onethat makes that makes the
bladder floppy, so the bladdercan't push the way it needs to.

Yeah.
Yeah.
And I didn't want to blow uplike my kidney all blow up
because I'm my bladder is full.
So, all right, we're gonna takea real quick break, and when we
come back, I want to talk aboutthis audience, which is really
50 plus women, and what you seemost commonly with them.
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All right, we are back.
Before we went on break, I toldyou I wanted to talk about this

(14:59):
audience.
So we're typically 50 pluswomen.
What do you see most commonwith this group and what is
still being brushed under therug?

Yeah, so it's a combination of two
things.
It's either complaining of lowlibido, but I think sometimes
even people are scared andnervous to talk to their doctors
about sex.
So that's definitely somethingthat needs to be opened up
about.
So that's one topic.
The other topic is recurrenturinary tract infections and
vaginal infections andpotentially like vaginal odor,

(15:31):
which is all the same, they allhave the same cause.
So which one do you want totackle first?

Um, let's let's tackle the recurrent infections
because I think that's one thatI really think gets swept under
the rug.
People don't realize thatthere's some connections there.

Yeah, so this gets so crazy.
So, really, we have to take astep back and look at the
microbiome.
So the microbiome is bacteriaand organisms that live in an
area of the body.
So the microbiome of our mouthis different than our gut, then
it's different than our vagina,than our skin.
So, what happens is when we'regoing through menopause, our
estrogen is lowering.

(16:11):
And prior to menopause, we havea lot of estrogen, the vaginal
tissue is growing like actively,you know, it's multiple levels
thick.
That tissue is nice and thickand moist and healthy.
And as it grows, the old cellsslough off, and the old cells
contain something calledglycogen, which is the food
source for lactobacillus, whichis the healthy bacteria that

(16:34):
lives in the vagina.
And why does it keep us healthyis when that bacteria is
present, it helps to keep thevagina very acidic.
Because the pH of a vagina isabout 3.5 to 4.5.
Like the pH of water, which isconsidered right in the middle,
is like seven.
So vaginal secretions are andthe vagina is very acidic, which

(16:54):
keeps us healthy because itkeeps away other bad bacteria,
it keeps away the yeast.
And so this is how thisbacteria kind of works in
conjunction with our bodies.
Now, what happens is as we'regoing through perimenopause,
menopause, and beyond, thatvaginal tissue starts to thin
out because we don't have thatestrogen anymore telling it to

(17:17):
actively grow.
So essentially, there's no foodsource for the lactobacillus,
and the lactobacillus starves todeath.
And now other bacteria from ourenvironment, from our gut, now
start inhabiting the vagina.
So some of those bacteria maycause odors.
So some people complain of achange in odor in menopause.

(17:37):
Some of them cause bacterialinfections or yeast infections,
which can be itching, burning,heavy discharge.
But the other thing is becausethe vagina is also so close to
the urethra, the TBP through, nomatter how well you clean, it's
very easy for this bacteria tokind of pass back and forth.
And so the vagina can be areservoir for the quote, bad

(18:00):
bacteria that is now gettinginto the bladder and causing
yeast infections or bladderinfections.
And so we're talking about howsome of this, these bacteria,
are kind of originating from thegut.
They're actually coming fromlike the rectum and then getting
to the vagina and thenpotentially getting into the
bladder.
Then we have to even kind oflook back at the gut because

(18:21):
what happens is let's say youget a urinary tract infection.
A lot of times the doctorthrows you on three to five days
of antibiotics, and now youfeel good for a little while,
and then all of a sudden itcomes back.
And then you go on antibioticsagain, and you're good for a
little while, and then it comesback.
When I start seeing thatpattern, what it's telling me is

(18:43):
unfortunately, when you'vetaken the antibiotics, I might
have cleared it, the infectionout of the bladder, but now
we've thrown off the bacteria inthe gut even more so.
And so now this becomes thisvicious cycle where, okay, it
clears up for a little while,but now you have more bad
bacteria in your gut and lessgood stuff because then we've
killed off a lot of the goodstuff, and now that's getting

(19:05):
into the vagina and then intothe bladder, and then it happens
over and over and over again.
I mean, it's unfortunatelysometimes we just need to use
the antibiotics, but if you findyourself in that cycle, we have
to also stop and be like, allright, what is going on with the
gut?
And let's see how we canrebuild and treat the gut with
that too.

So you do then do you recommend probiotics and
even prebiotic typeformulations?
Okay.

Yeah, definitely.
And I take it even furtherbecause I'm really into
integrative and functionalmedicine.
I like to actually do stooltesting on my patients and look
at the actual microbiome.
And you don't need to get thatfancy, like, I just like the
fancy tests.
But like when I'm looking atthose tests, I can see exactly
what's there, exactly what's notthere.
And then sometimes we have todo herbs to kind of chase away

(19:56):
the bad bacteria and then addprobiotics.
And fiber to stimulate like thegood bacteria to want to be
there.
And sometimes there's othersupplements, anything from
things like colostrom, which islike a it's a milk product, but
it can help heal the lining inthe gut, or there's also
something called glutamine thatcan heal the lining of the gut.

(20:18):
But honestly, a lot of peoplecan just do this with diet
because sometimes our guts getthrown off, our guts get thrown
off not just from antibiotics,but they can get thrown off from
stress and then any stressor,mental stress, physical stress,
but then they also can getthrown off from a bad diet.
So uh inflammatory foods likeprocessed foods and diets high

(20:39):
in sugar can throw off that gut,which can now affect not just
only your pelvic floor and yourbladder, but in fact, uh 90% of
your happy hormone, serotonin,is made in your gut, and 80% of
your immune system is made inyour gut.
So this is why also sometimeswe see problems with anxiety and

(21:01):
depression.
And then we also with theurinary tract infections, you
know, now we're getting, youknow, your immune system is low
because we just gave youantibiotics and killed off the
good stuff.
So it becomes this horrible,incredible vicious circle.
But really focusing on wholefoods is the key.
So I always tell my patientsyour food should come from four
categories, and it's not thatyou have to do all four, but it

(21:22):
should be in one of the four.
The four categories is that ityour food should have at one
point walked, swam, grew, orflew.
As long as it does that,because I said there's no
Twinkie trees, you know, there'sno like no, no twinky trees,
pasture-raised free-rangeDoritos, you know, like that
doesn't that doesn't happen.

(21:44):
But like, I mean, like 80% ofthe time, if you're eating
healthy, that's the way to go.
And yeah, 20% enjoy yourself.
But but the other thing is weevolved, we were probably
getting a lot more bacteria inour food sources, and because of
preservatives andrefrigeration, we don't get as
much bacteria in our food.
Not to get rid of preservativesand refrigeration, because our

(22:05):
food safety issues there, butyou know, we need to look at
getting more bacteria, and thatcomes in the form of either uh
fermented foods like kombucha,kimchi, sauerkrauts.
If you tolerate dairy, thenthat's uh yogurt or kefir.
There's so many fermented foodsout there now that you can

(22:25):
easily get in the supermarket.
Or if you don't tolerate any ofthem, getting um a very diverse
probiotic, meaning that youdon't want to pick up a
probiotic that just has one typeof bacteria in it.
The more types of bacteria thatit has in that probiotic, the
better, because bacterialdiversity in the gut makes you
healthier.
So you don't want to have justone type.

(22:45):
Um, and then the bacteria hasto live on fiber.
And so we get fiber througheither plant foods, so like
vegetables, fruits, grains, oryou add you add some fiber into
your diet.
Like I like um, like there's acouple ones, either it's called
Sun fiber or Benefiber.
And I have people just put itin their coffee because it's not

(23:08):
gritty and you don't even knowit's there.
And we all could use morefiber.
Absolutely.

And the whole reason I'm sitting here smiling,
I don't know if you notice, I'mlike smiling ear to ear.
Yeah.
Betsy, this is exactly what Itell my clients.
You've got to get fiber it like25 to 35 grams a day.
Yes.
And I'm able to do it many,many days without having to
supplement anything.
Um, I use garden of life that'slike a powder uh fiber.

(23:36):
I put I put like a half a scoopof that in my smoothies, and
I'm I'm typically almost at 35grams almost every day.
So I appreciate that.
You're just reinforcing what Ikeep, you know, harping on with
my clients.
But I also want to get back tothis probiotic thing because
this came up with my VIP clientsthe other day, and we we we
really dug into probiotics.

(23:58):
You said to get one with thathas multiple strains in there,
and I I I get that, but howmuch?
Because you've got the onebrand that's got a hundred
million, and then you've got theone billion.
Like, where's the sweet spotthere?

You know what?
That's the one thing that theyhaven't really figured out with
the research yet.
I unfortunately, I don't thinkwe're completely there yet.
I do say that people that aregetting the ones that have just
like the one billion colony,it's probably just a drop in the
bucket and not doing anythingbecause we have trillions of
bacteria in our gut.
So it is kind of hard to overdoit, though.

(24:33):
There are certain autoimmuneand immune deficiency um
conditions where you shouldn'tbe taking probiotics.
So make sure you talk with yourdoctors.
If I am really aggressivelytrying to rebuild someone's gut
or if they've been on heavy-dutyantibiotics, I might shoot for
100 to 250 billion colonies.

(24:54):
They're actually make aprescription one that's 900
billion colonies.
Oh, geez.
Very, very rarely use that one.
But for on a daily basis, Itend to shoot for ones between
20 to 50.
And then it's just been overyears of experience and just
going, all right, well, thatsounds good.
But I don't unfortunately havelike research articles that

(25:16):
support it because we're not, Idon't know why that they just
really haven't figured out likewhere is, you know, what should
we really be doing?
But that's been pretty muchwhere I usually keep it and to
have people do it.
And that's what I do myself.

So Okay.
All right.
That's that's great advice.
And hopefully some of myclients are listening and
they'll they'll hear that.

But I'll follow up with them
because we I I couldn't providethat information because well,
and the and you know, uh well,the gut microbiome has been
connected with so many things.
It's been connected withlongevity.
Um, but there's been a numberof studies that have shown, even
in men and women, that if yourgut microbiome is off, the body
perceives that as a stressor.

(25:55):
And anything that the bodyperceives as a stressor, it will
dampen digestion, it willdampen like anything having to
do re with reproduction.
So that would be sex drive, andit will dampen healing because
anything that's a stressor, allyour energy goes into cortisol
and making stress hormones.
So, you know, if you'rethinking about like a healthy

(26:16):
gut can help your sex drive,then like eat some more
fermented foods and some more ofthose probiotics.

So honey, I'll be right with you.
I gotta eat some sauerkraut.

I know, right?

Maybe not then, but but that was gonna be one of
my questions too, is you know,you do talk a lot about the
gut-brain sex connection.
Yeah.
So it really there is a directconnection then with our libido.

Yeah, and it's fine, and it's
interesting.
So not just with the gut andthe brain, it really just comes
down to stress because you wehave the two um nervous systems.
We have parasympathetic, whichis your relaxation state, that's
when you're digesting, that'swhen you're healing, that's when
reproduction happens.
And then you have your stressstate, which is your sympathetic
nervous system, and that's whenyou make cortisol.

(27:03):
And listen, being stressed isnot a bad thing.
It's just only supposed tohappen in short spurts.
So it keeps you alive.
Because when we were likewalking across a field and out
jumped a lion, that's not thetime to be like eating a
hamburger, having sex with yourhoney, you know, like there's
not to be time to be doing that.
It's time for all your blood togo into your muscles and all

(27:26):
your energy go into fightingthat lion or running away from
that lion.
And then once you get tosafety, then your body's
supposed to go back into that,like, ah, that calm where you
can heal and you know, havefertility and have a sex drive
and digest your food and getyour nutrients.
But the problem is nowadays ourstressors, our lions, are a lot

(27:49):
more.
So we're getting stuck in thosestress, that stress kind of
mode, and we're losing out onsex and healing and digestion
because of it.
So even when we look at thechemical pathways of how these
hormones are made, they do, theythey divert and they it goes
one way or the other.
So I always say sex and stresscan't coexist.
You got one or the other.

(28:10):
So Yeah.

Now I had a a guest on not too long ago.
She talked about oxytocin helpscurb your cortisol.
Yeah, yeah, it will.
And and that it after an orgasmthat it increases your the
oxytocin?
Oxytocin.
Jesus pee.
Yeah.
It increases your oxytocin fourto 500%.

(28:35):
So, you know, when you thinkabout intimacy, it's not just
about the sensuality and all ofthat.
It's it's actually good foryou.
Yeah.

And even so, like, not just from a
hormonal standpoint and evenbrain relaxation standpoint, but
it's also great for pelvichealth because it is actually
true that if you don't use it,you lose it.
So think about using your, youknow, parts, uh, men and women,
both sexes need to use it for itto continue to function.

(29:08):
So you, you know, it's, youknow, I know I'm not joking, but
joking, it is a touchy subject,but the idea of self-pleasure,
but whether you're with apartner or with yourself, like
stimulating the genitals isactually a form of pelvic
physical therapy.
Like doing that keeps the bloodflowing, keeps things healthy,

(29:31):
keeps it in working order.
I was just telling a storyabout a patient of mine who was
um an older woman who waswidowed and, you know, kind of
lost her sex drive and hadn'tused things in a very long time.
And then she met this young manand was ready to kind of get
back at things.
But because she waspostmenopausal and didn't do
anything for her vaginal healthto keep that tissue young, and

(29:53):
she hadn't been using it, itliterally, her vagina shrunk up
to the point where I couldbarely get a pinky inside of
her.
Oh no.
So it is that definitely if youdon't use it, you lose it.
It will, it will shrink.
So you want to keep using it.
And not that like once it getsto that point, not that we can't
reverse it.
It just takes, you know,anywhere from hormones or even
lasers and dilators, and and wecan get it back to working

(30:17):
order, or you know, or you findother places to express yourself
intimately.
Um, but there are there ishope.
There's things that can bedone.
But in the meantime, think ofit as your pelvic physical
therapy.
And there was a study that Isaw, um, even just with
self-pleasure, that there was a98% improvement in sleep, and it
didn't depend on whether thatperson had an orgasm or not.

(30:39):
So it was independent oforgasm.
And then there was like a 95%improvement in mood, and there
was like all these other likeimprovements in confidence, and
yeah.
So it is definitely definitelya form of physical therapy.
And like I said, you can do itwith or without a partner.

So yeah, but those are all really great
things.
I mean, it's like I want that,right?
Yeah.
So I want to talk a little bitabout vaginal estrogen and the
the proposal that maybe we'll beseeing the removal of the black
box warning here soon, which isway overdue.

(31:18):
My listeners have heard me sayit probably a hundred times.
I think everybody should be onvaginal estrogen, particularly
in this age group.
But what else besides vaginalestrogen and maybe even pelvic
floor exercises?
What are some other things thatwe can do to preserve our

(31:39):
vaginal and pelvic health?

Yeah.
Well, that first of all, we'llgo from with estrogen first
because there's a whole range ofoptions for treatment for
vaginal rejuvenation now.
So vaginal estrogen is onegreat thing.
It's usually available as uh aprescription.
And hopefully we'll start tosee more coverage with this with
insurances in the future,because that's been a problem.

(32:02):
There is a slight issue withsome of the vaginal estrogen
creams.
Some people find them veryirritating because not because
of estrogen, but they contain auh filler ingredient ingredient
called propylene glycol.
And unfortunately, some thatcan be a mucosal irritant.
So some people that canirritate the vagina.
So it if you get burning orirritation from that, like that

(32:24):
just means let's try to find adifferent form of hormones that
we can use on that area.
But um, they even make littleovules that can be placed and
rings that can be placed in thevagina.
There's also a prescription umDHEA suppository, and DHEA is a
precursor to estrogen andtestosterone.
And we also have testosteronereceptors in the vulva and

(32:46):
vagina.
So a lot of people like that.
Um, it goes by a brand namecalled Intrarosa, and that's
actually usually from acommercial you know, pharmacy.
You can get that as it'sprescribed.
And any of these things, youcan actually even have them
mixed up at compoundingpharmacies.
And sometimes when you look atyour insurance cost, sometimes,
depending on your insurance,it's not that much more to have

(33:08):
them compounded.
So you can have them madewithout those other ingredients
that could be irritating.

Oh, okay.

Or something we'll even use
testosterone cream, which is nota commercially available, but
you can have it compounded, andthat sometimes um that can also
help.
Um, there is a commerciallyavailable oral medicine that
directly affects the vagina.
I honestly haven't used it muchin my career.
I just really neverparticularly liked it.

(33:37):
But the and for no reason otherthan we just didn't use it that
much, but it is one that is nota hormone, but it tricks the
tissue in the vagina to thinkit's a hormone and can help um
regrow.
So that one's called um, wasgetting that one.
It's Asphina.
Asphina is that one.
But then beyond that, we have awhole range of regenerative

(33:58):
therapies, unfortunately notcovered by insurance, but a lot,
a lot of other options.
So in 2014, the first vaginallaser came to be used in the
United States.
And so lasers have been usedsince the 1980s for skin
rejuvenation.
And somebody had the brilliantidea.
Well, wait a minute, if we cando this to someone's face, why
can't we do it to their vagina?

(34:20):
And I wish I was the personthat came up with that.
But um, I was like, oh, that'sbrilliant.
So lasers just use light energyto make little channels in the
skin.
So it causes like a microscopicinjury to the tissue, and then
your body senses that and itfloods the area with growth
factors to get it to heal.
And when it does it, itbasically tricks the tissue into

(34:41):
regrowing, like it was, youknow, uh prior to menopause.
But it also depends how longyou've been in menopause, how
many treatments.
Most people usually usuallyhave to do with lasers, three
treatments faced about a monthapart.
And then you have to maintainit with a lasering once a year.
But sometimes you need more ifyou've been in uh menopause a
little bit longer, or if youhave conditions like in

(35:04):
sclerosis, which areinflammatory conditions of the
tissue, sometimes you need more.
But when the laser first cameon the market, that really
opened the floodgates becausethe aesthetic world went, wait a
minute, what other things thatwe do to people's faces that we
can we do down there?
And now there's so manydifferent products on the market
from uh radio frequency, whichis uh sound waves to create

(35:27):
heat, which stimulates collagen.
So that can rejuvenate thevagina.
Um, we use shock waves.
Um, shock waves are a littlebit different type of sound wave
that goes in, and what it doesis it stimulates the stem cells
in the tissue and the bloodvessels to grow new blood
vessels in that area to helpsupport the tissue.
Things like platelet-richplasma.

(35:48):
They basically draw your blood,they spin it, they pull out the
plasma, which has all thegrowth factors, and then they
apply it to the vagina and thevulva.
And so, um, and there's a lotof these things, those are all
things that have to be done by apractitioner.
So historically, what happenedwas the pandemic came along and
nobody was going out to gettheir vaginas lasered because

(36:10):
everybody was going to thedoctor's offices.
So then we saw really theemergence of a lot of home
therapies.
And so there's devices like theJoy Lux D fit device, which is
a red light wand.
And so we know that red lightat certain wavelengths has a
very anti-aging effect on thetissue.

(36:30):
It stimulates your mitochondriain your cells, which is your
anti-aging kind of powerhouse.
And so basically figured out ifyou put this red light in your
vagina, then you can like, youknow, have a younger Do they
work?
They do, they do.
And that's the only thing Iwill tell you that no matter all
whether you're using creams orlasers or red lights or

(36:52):
anything, unfortunately, nothingworks overnight.
You usually have to dosomething steadily for about
three months before you see adifference.
So I wish I could say, like,oh, the lasers were quicker than
the creams, but they all prettymuch work about the same amount
of time before you start seeinga difference.
And then there's there's likepeptides that people are, you

(37:12):
know, they're coming up withpeptide creams that people can
apply to their vagina.
Um, there's another companycalled CO2 Lift that makes a
carboxy therapy, which is acarbon dioxide gel.
And when you apply it, itattracts oxygen and that
stimulates the tissue to regrow.
So there is a giant range ofthings that can be done for your
vaginas to feel comfortableagain.

Wow.
I mean, I mean, I knew therewas a lot out there, but that
that was that's quite the list.
So the the message in all thisis that there's hope, right?
If you want to change your thestate of your vagina and having
comfortable intimacy, this isyou know, this is hope for you.

(37:56):
You know, but I often thinkthat maybe there's pelvic pain
or discomfort that feeds intothe I'm not in the mood cycle.
And maybe for those women thatare in long-term relationships,
maybe they want to reframe theirview of intimacy.

(38:17):
How do you coach patientsthrough that?

Yeah.
So, well, first of all, um, Ithink sometimes there's too much
attention put on the genitals.
And so I think that, you know,when it comes to intimacy, like
number one, our brain is ourlargest sex organ.
So really it comes down tostimulating the brain.

(38:41):
Because if you don't stimulatethe brain, nothing else actually
will work.
And then our well, so ouractually, our brain is our most
important sex organ, our skin isour largest sex organ.
And so it doesn't always haveto be genital focused.
Um, in fact, very interestingenough, they found they mapped
this out in the brain recently.
I saw the study, they did MRIstudies, they actually found

(39:05):
that in some people, noteverybody, some people in their
brains, the nipples are wiredvery close to the genital.
So there are people that canhave nipple orgasms just from
stimulation of the nipple.
So it's very interesting.
But the brain is also veryinteresting in that it's not, we
used to think it's set and thenthat's the way it's gonna be,

(39:28):
but now they found out throughneuroplasticity that you can
rewire the brain and basicallymake anything an erogenous zone.
Um, and we see this often withparaplegics because if they have
no feeling from like the waistdown, their sex life isn't over
because it hasn't affected theirtheir brain.
So um we they just have tolearn to rewire and associate

(39:52):
another body part with pleasure.
So, you know, people that arehaving like dryness and
discomfort because of Menopause,maybe receptive, you know, sex
is not going to be fun for them,especially if they don't want
to do anything to rejuvenate thevagina or they, you know, don't
have them the budget or worriedabout hormones, or um, but that

(40:14):
you can actually, you know, doother areas.
Plus, even something just assimple as cuddling and touching
can boost those happy hormones,that oxytocin and that that
bonding hormone.
So it doesn't always have to belike what we think of as the
sex.
The other thing I see in thisage group, and it's been really
fascinating, is there's I thinkbecause when we don't get the

(40:36):
sex education that we reallydeserve, you know, everyone's
like basically we get, you know,in school, it's like, here's
how not to get pregnant, andthen okay, go out and figure out
everything else on your own.
Exactly.
And so unfortunately, there'sthis belief, but women like in
women that we need to be in themood to have sex.
And so, and where that soundslike really weird at first is

(40:58):
because when we look at like theMasters and Johnson's who did
like the big sex research in the1960s, there they had a graph
of um sexuality that was verylinear.
And it was great for the time.
It basically was like you hadto have desire first, and desire
led to arousal, arousal led toa plateau, and hopefully there

(41:18):
was an orgasm, um, and thenthere was a resolution.
And it's very start to stop,like one direction.
Um, Rosemary Basson, and then Ithink it was in the 1990s,
reorganized female sexualityinto a different graph.
And I like to show my patientsthis graph because when you
understand it, you go, oh, okay,maybe I'll try that.

(41:39):
She had like it's all thesecrazy intersecting circles, but
not that spontaneous desirecan't still exist.
It can still exist.
Um, it tends to happen more sowhen we're younger and more so
when we're in new relationships,because we get these big
dopamine hits when we're in anew relationship because the
brain likes novelty.

(41:59):
But the longer you're in theyou are in a relationship, or
the older you get, or the morebusier or more stressed you get,
sometimes that spontaneousdesire is really difficult.
And so actually, in RosemaryBasson's model, she put
willingness as the first step.
So willingness to engage insome sort of sexual activity.
But I always tell my patientsthat willingness has to be

(42:22):
discussed with a partner, thatif it's not going anywhere, you
don't want to just, you know,muster through it because then
it's gonna create a negativeloop that you're not gonna want
to do it again.
So you got to be like, hey, youknow what, it's not working
tonight.
Let's try it another night.
It's not you, it's just, youknow, it's just not gonna happen
tonight.
Or even if with your, you're ifyou're doing something yourself
and it's not working, just giveyourself grace and be like,

(42:42):
yeah, you know what?
Today's not the day, tonight'snot the night, let's just do it
another time.
So having that willingnessfirst and just kind of going
through the motions, whateverthose motions look like for you,
can actually start stimulatingblood flow to the genitals,
which can start preparing thingsso that the physiologic arousal
starts to happen first, andthen all of a sudden you kick

(43:05):
into desire and go, you knowwhat?
I think I might want to dothis.
And then hopefully it's asatisfying sexual event that
then feeds back into the circleand goes, okay, wait, I want to
do this more.
Because a lot of times mypatients will come in and
they're like, I need hormonesbecause of my sex drive.
And I'll show them this, andI'm like, well, we're we'll work
to getting the hormones, butthe hormones are only a tool,

(43:27):
and they're not necessarilylike, they're not horny pills,
you know.
We don't have a horny pill, wedon't, it doesn't exist.
Even even Viagra is not, youknow, Viagra is just a blood
flow pill.
It does not to do anything inthe mood, it all does is help
with blood flow, whichinteresting enough can help
women too with blood flow downthere, but they never properly
marketed it for that reason.

(43:48):
So, and then everyone's becausethe brain is the more important
sex organ, everyone's brain isdifferent.
So it's hot, you gotta figureout what are the things that
turn your brain on, get you inthe mood, and then see if you
can kind of go through that.
And hopefully, you know, a lotof my patients after I show them
this model, they come back andthey're like, you know, I tried
that.
We set it, I you know, we set adate with my husband and we put

(44:10):
it on the calendar and we putall the other things aside and
we went through this and it wasgreat.
Then they were they come backand they go, Why don't we do
this more often?
I'm like, Yeah, that's usuallywhat people say once I've shown
them that graph.

And I think that's a great point, Betsy,
because if if you talk about it,you know, earlier in the day or
schedule it, or you know,there's that anticipation and
the buildup, which maybe that'sthat's kind of what we need.
I do, I gotta tell you thisfunny story though.
So I was in the pharmaceuticalindustry back when Viagra

(44:44):
launched.

Speaker 1 (44:45):
Yeah.

And it was driving every nurse crazy
because their phones wereblowing up.
You know, Mr.
Jones, Mr.
Smith, they all wanted to getthe Viagra.
These guys were 75 years old,probably hadn't had intimacy
with their wives.
They may have even beensleeping in separate bedrooms,

(45:08):
but I felt so badly for thesewives who all of a sudden are
being put in this position of,wait, what?
You want to do what?
No, I I go to lunch withfriends and I sleep in a
separate bedroom.
What are you talking about?
So anyway, I just yeah, I Iremember that.

Oh, I was seeing it from the other
side because I was taking careof the women who are fine, and
then all of a sudden they werelike, Oh my god, my husband's
not leaving me alone.
Like they're like, they'relike, I was fine before the
Viagra.
Uh-huh.
But I think this is where likecommunication is so important.
And I mean that's really thekey to relationships, is you

(45:47):
mean this is your partner.
You should be able to talk tothem about the most intimate
things, and sex should be aconversation that's like normal,
you know, and not have to guessand figure out, and you know,
so but I it's not that I thinkit it's still an uncomfortable
taboo topic.

And when you have mismatched desire, it's it can
be sticky to try to have somekind of a resolution of what
that means for yourrelationship.
And I've said this before, youknow, I I talk to women all the
time, whether they're friends orclients.
And I'm finding more and morethat that's not happening.

(46:30):
Like the intimacy in a lot ofmarriages really peters out.
And but it's not always thewoman, it's sometimes the male
partner that's kind of lost hisvavoom.

And they're the because the men,
unfortunately, are starting,their testosterone is starting
to decline around the age of 40.
And so that's what they'reseeing too.
So some of their drive is now,is now kind of, and I mean, they
also get the brain fog and themood swings and the body
composition changes and thedecreased sex drive.
So, yeah, so it's it's all kindof happening.

(47:09):
And so it's a trying to, Imean, like there's obviously
there's tools for everybody, andthere's, you know, and that's a
personal decision whether youwant to do hormone replacement
or not.
But it yeah, it is kind of allhappening at the same time.
And I I do hear that,especially when I get my pay my
female patients, that's why Istarted treating men too,
because I'd get my femalepatients on hormones, and then

(47:29):
they'd be like, Hey, can youtake care of my husband too?
Because like now, you know, thewomen were like, Okay, now we
have our sex drives back, andthe husbands don't.
Or like, what can you do forit?
Absolutely.

Yeah.
What about the O-Shot?
Can you explain what that is?

Yeah, so you know, I think, well,
here's the thing.
So because your brain is animportant sex organ, if you
think something is going towork, it's going to work.
So, okay, when it comes to theO-SHOT, what that is being
marketed as is basically they'retaking platelet-rich plasma.

(48:06):
So they usually draw out yourblood, take out those growth
factors.
Sometimes now they're usingexosomes, which are um also um
stimulate the cells toregenerate, but they don't have
to draw your blood.
And they're injecting it in acouple different places.
One of it is they're injectingit on the anterior wall of the
vagina, so the front wall of thevagina, right under the
urethra, the bladder, that'swhere the proposed G spot is

(48:29):
supposed to be.
So that's one area that they'regoing in and injecting and kind
of plumping up that area.
And the other thing is thatthey're injecting in and around
the clitoris.
So, yes, it's rejuvenating allthat tissue.
Does it necessarily have adirect correlation with
boosting, you know, sex lives?

(48:50):
Yes, and that if there'sdiscomfort that was coming from
dryness and um, you know, maybeshrinkage of that tissue, yes.
But I think a lot of it iscoming from the fact that people
believe like they're havingsomething done to them and
they're like, okay, this is nowgonna fix everything.
So I don't want to burst anypeople's bubble because now me

(49:10):
saying that is like, you know,like they say the placebo, but
this is this is like a no-cebo,it's a nocebo when you say
something's not gonna work, andnow I put that in your mind.
So just saying it's you know,anything you think is gonna work
is gonna work.
In fact, actually, going backto the Rosemary Basan model and
and um having willingness, it'sreally funny because there are

(49:30):
some products on the market.
There's one that's been on themarket forever.
It's called Zestra, and it'slike this botanicals that are
used.
Um, it's a botanical oil.
And if you read theinstructions for it, it says
you're supposed to take theseoils and rub them into your
clitoris for 10 minutes beforesexual activity.
And I'm like, Well, hello,there's probably nothing special

(49:53):
about those botanicals.
We just basically followed theRosemary Basan model, and that
we created a willingness to dosomething that was stimulating
and probably increase the bloodflow and then cause the desire.
Probably has nothing to do withwhatever's in that oils.
It's foreplay.
What the heck?
And I like it specifically, theingredient the instructions are

(50:16):
you have to rub it for 10minutes.
And I'm like, we shouldanywhere come up with a product
like does that?

All right, I have what I have another question
for you.
These keep popping in my headas we're talking, so we're I'm
totally off my list of questionshere.
The G spot.
Yes, let's talk about the Gspot.
How big is it?
Is it really a thing?
And do women all have thecapability of having that type

(50:45):
of an orgasm?

Um, sorry, this is a loaded
question.
There is a debate on whether itactually exists.
So scientifically, in theresearch, there's there's a big
debate and there's been noconsensus.
The thought is it's supposed tobe basically on the anterior
wall of the vagina, about threecentimeters from the opening of

(51:07):
the vagina, which happens toline up where the urethra and
the bladder meet.
So the thought is there aresome glands in that area that
may actually produce prostaticlike fluid, so prostate-like
fluid, like in a man, becauseour parts are we actually from
the way we developed as embryos,like our parts are very similar

(51:29):
to male parts.
So the clitoris is actually theanalogous or like the same as a
penis.
So we do have glands that canproduce fluid.
So the question of whether itexists or not is debatable.
Um, I think it's more of aperception of some people find
having that area stimulatedbeing very stimulating.

(51:52):
And so, yes, technically,women, any everybody and
everybody could potentially umhave that area stimulated and
cause an orgasm that might feeldifferent than other orgasms.
So, and then I guess that alsoI'm gonna bring up the idea of
there's also debatable is thatsome women they call like
squirt.

(52:12):
So there's some women withstimulation of that area.
There are some women when theyorgasm um will release a fluid.
And they've been trying, theyactually have done studies.
Usually these studies are donein like Denmark.
For whatever reason, theScandinavians Scandinavians are
really into sex research andthey like have labs where they

(52:35):
have people like masturbatingand they're like measuring
things and stuff.
They're there.
I I think in America we'remaybe a little bit too prudish
to be doing that kind ofresearch, but they've tried to
collect the fluid and figure outwhat exactly is in it.
And they have there's also allover the research, it's it's
different consensus.
You'll find some research thatsays it's a little bit of that
prostate-like fluid that'scoming from some of the glands

(52:57):
that are in that area.
To you have other studies thatsay like it contains urine.
So there's been no consensus ofwomen that are able to do that.
What um, you know, what is thatfluid made out of?
And either way, who reallycares if it feels good?

I just don't, right?
No, I just I have never askedthat question of a guest.
And I was like, oh, Betsy seemslike she knows.
No, you might as well.
I'm here.
I know.
She she she knows her stuffhere.
Yeah.
You know, one other one otherquick thing is and being a
health and wellness coach,working with women and working

(53:35):
on their body confidence.
I think that oftentimes is whatreally is holding women back in
the bedroom.
Yes.
And I'm sure you've you've hadthat talk with with with
patients before.
How do you kind of get theminto a better place when it
comes to their confidence in thebedroom?

Betsy Greenleaf, DO, FACOO (53:55):
Yes, you know, here's the thing.
I think a lot of times we getreally hard on ourselves about
like, oh, my body doesn't lookright, like I want the lights
off because I don't want to beseen and we're embarrassed about
like this or that.
When honestly, most of the timethe partners don't really care.
I mean, majority of the time,the partners really want to

(54:15):
either enjoy themselves and theywant you to enjoy yourself.
So, and and confidence ingeneral is so much more sexier
than having the perfect body.
Because I mean, you could havelike a perfect body and have no
personality, and that isdefinitely not sexy, or you
could have an imperfect body andlike have all this sassiness
and spunkiness and confidence,and that just comes off as

(54:39):
super, super sexy.
So I really think that youknow, there is no perfect body
anyway.
Everybody, you know, likeyou're attractive to somebody,
like you're you should likestart to learn how to be
grateful for yourself and beattractive to yourself because
listen, it's you know, life isshort, so might as well feel

(55:00):
sexy and be sexy and walk intothe room, walk into the room
like you're the sexiest personon the face of the earth.
Absolutely.
Because I mean, I even thinkback, and I was like a couple
years ago, I made the commentabout like, oh, my bikini days
are over, which they've beenlong, long over.
I probably haven't been in abikini since my 20s and I'm in
my mid-50s now.
And last summer I went and Ibought a bikini, uh thinking it

(55:24):
was gonna motivate me toexercise, but then one day I was
like, it didn't motivate me toexercise, but um, one day I just
put it on and I was like, I'mjust gonna wear it.
And the first time I wore it,it was in my pool in my
backyard, nobody was around.
But then I got the I I did getthe like I don't just say balls,
I'm just gonna say it, but ohwe can do it here.

(55:44):
I got the the, you know, towear it on a beach, and I was
terrified.
Like I remember walking out onthe beach going, oh my god, oh
my god, like thinking, like, arepeople gonna faint?
Are they gonna scream inhorror?
Like, what is gonna happen?
And I remember taking my coverup and like off and like nothing
happened.
No one fainted, no one screamedin horror, you know, children

(56:04):
didn't go running off the beachin terror, like nothing
happened.
And I was like, Oh, well, thatwasn't that bad.
And then I was like, you knowwhat?
You know, they say like if youthink it, it'll be.
So I was like, I'm just gonnathink that I'm the sexiest
person on the face of the earth,and then I'm just gonna put
those vibes and frequencies outthere, and we're just gonna see
what happens.
And so I wore my bikini.

(56:26):
I don't even think I've ever,even when I was like super
skinny as a 20-year-old, everwore a bikini on the beach that
confidently.
So I was like, Yeah, I'm thisis me.
And I mean, you've seen you'veseen the people on beaches that,
you know, they're they're youknow, not the typical what what
somebody might say is uh theideal body type, and they're
rocking that bikini, and you'rejust like, yeah, you know, I

(56:47):
look at those people now and I'mlike, good for you, yeah, good
for you, because you gotsomething that most of us else
don't have.
So I say just do it, just justdo it, wear the outfits, be
sexy, get the lingerie, get theyou know, just do it, just
surprise your partner for God'ssakes.

It could be like the the biggest treat of of the
year.

And it's so nice too to kind of see
women go through thattransition.
I think a lot of times it kindof happens when we're kind of in
midlife, where we kind of reacha time when we're just like, uh
I just don't have the energy tocare what other people think
about of me anymore.
And I was just recently at aconference, it was a medical
conference, and there's umthere's a couple that's there,

(57:31):
both doctors, and the wife hasalways been very kind of mousy
and quiet and very kind of likelibrarian in her outfits.
And I came to the conferencethis year, and she was like hair
done up, she was in this littleskimpy outfit, and I was like,
Whoa!

unknown (57:53):
What did you do?

And she's like, I just finally got
to a time in my life, she'slike, I don't give a crap
anymore.
And so she's like, This is thenew me.
You know, she had the attitudethat like I'm here, this is my
life, I'm sexy, and this is thisis how it's gonna be.
And I'm like, good for you.
I like the new you, this isamazing.

You gotta love midlife reinvention, it's the
best.
I know it's so awesome, it'sgreat.
All right, I what I want to getto the pelvic floor store.
You founded this.
Yes, I want to know whatinspired it.
And then, like, what are yourfavorite products?

Yeah, so um, what inspired it was I
used to recommend products to mypatients, and I most of them
were not sold on Amazon.
And honestly, I tell peoplenow, don't get your personal
products off of Amazon because alot of times you might be
getting counterfeits.
You don't always know whatyou're getting on there anyway.
But I would tell my patients,like, oh, go to this website and
buy this thing, go to thatwebsite and buy this thing.

(58:50):
And one day one of my patientssaid, Why can't there just be
one place that I go?
And I went, Oh, I don't know.
I had no clue how to make awebsite.
I honestly didn't even knowenough that you could hire
somebody for this.
So I started YouTubing how tomake a website.
Took me four months to buildthe website.
Now I know I probably couldhave hired somebody that it

(59:12):
would have done it in a day.
But I basically startedcurating all the products that I
was recommending.
So anything from like, let'ssay, D-mannose and cranberry,
that I like people to take, youknow, either after sex or take
daily if they're gettingrecurrent urinary tract
infections, because theD-mannose helps to bind the bad

(59:32):
bacteria in the bladder, and soit helps to flush it out, and
the cranberry makes it so thatthe bacteria doesn't like to
stick to the bladder wall.
There's a bunch of healthylubes on there because
unfortunately, some of thelubricants on the market are not
made for the vagina.
They're not pH balanced andthey purposely dry.
Like, I'm gonna throw it underthe bus.
KY jelly is probably the worstthing you can use because it can

(59:54):
throw off the pH and itpurposely dries the vaginal
tissue.
So you have to use more of it.
So great if you're A lubecompany because you're selling
more and more of it.
Bad if you're a vagina owner.
So um, so we have some healthylubes on there.
I've also recently partneredwith an intimate device company.
Um, I'm a spokesperson forthem, so I have a number of

(01:00:15):
their products on there.
So anything from dilators tokegel exercisers to um there's
no nice way to put it, butvibrators on there.
Because remember, it's yourpelvic health.
You want to keep thingsworking.

Michele Folan (01:00:27):
So um, and that's actually been a Yeah, but a
vibrator can actually help withstimulating that tissue, right?
So it's it's like, okay.

unknown (01:00:35):
Yeah.

And it's something you can don't have to
use alone.

Betsy Greenleaf, DO, FACOOG (01:00:38):
You can use alone or with a
partner.
You know, the brain legsnovelty.
So maybe pull that into things.
So that might create help tocreate some newness.
So, yeah, so we have a wholerange of things, and I'm
starting to start put someproducts for men on there too.
Um, anywhere from likeexercisers and things for them.
Um, so uh trying to find someof those products.

(01:00:59):
So there's a whole range.
I actually put a coupleproducts that I myself not
necessarily great, not thegreatest thing for for pelvic
health, and that uh I don't knowthat I can't get the
information from the companyabout pH balance, but um,
there's a couple products that Ifound that I personally have
tried that I like.
There are some um arousal oilsthat have CBD in them.

(01:01:19):
I like that.
There's a there's a C B D-basedlube that can help relax the
muscles.
There's also a company calledPure, which is PJ-U-R.
They make a really uhlong-lasting lube, but they have
this product that interestinglyenough, it can be a little
irritating to people, but it canbe very stimulating, but it's a

(01:01:39):
stimulating cream.
It contains extract from what'scalled the toothache plant.
So you would think that thetoothache plant is normally a
plant that is used to numb themouth, but for whatever reason,
they don't know why.
When you put it on down thereon a woman, it doesn't numb, it
creates this buzz, buzzysensation, like something's

(01:02:01):
moving.
Oh wow.
So it can add to stimulation.
So it's something I found, andI like and I tried it and I'm
kind of liked, and I was like,I'm gonna put that on the
website too.

Well, I've I figured you try some of this
stuff, so we would get somepersonal recommendations.
Yeah, yeah, that's that's sogreat.
I do have a personal questionfor you.
What is one of your personalself-care non-negotiables?

Betsy Greenleaf, DO, FACOOG (01:02:28):
You know what is now is getting
eight hours, uh, seven to eighthours of sleep.
Yeah.
I like listen, I love to be onmy computer and get one more
thing done on work, but I shutmy computer off at seven o'clock
at night because I know thatthe light from the computer will
stimulate you and keep youawake, and I know it affects my
sleep.
And then when I looked at someof the data on um on sleep, like

(01:02:52):
if you get less than six hoursof sleep at night, your risk of
obesity goes up 23%.
If you get five or less hoursof sleep, your risk of obesity
goes up like tremendously.
It's something like 75%.
Like it just skyrockets.
So I'm like, something's sosimple, and it's something we
often try to put off.

(01:03:12):
And I'm like, no, like now, I'mlike, I need to go to sleep.
Yeah.

You and so many of my guests in the health space
are all talking about theimportance of sleep.
And I don't, I think it'sundeniable.
Uh, the obesity thing is big,and then also dementia, just
your brain health.
There's there's so many thingsthat you know, yeah, we just we
need our sleep.

Speaker 1 (01:03:36):
Yeah.

Dr.
Betsy Greenleaf, this was somuch fun.
I am so glad we were able toget this together today.
Thank you for being a guest.
No problem.
I enjoyed it.
Thank you, Michele.
Thank you for listening.
Please rate and review thepodcast where you listen.
And if you'd like to join theAsking for a Friend community,

(01:03:58):
click on the link in the shownotes to sign up for my weekly
newsletter where I share midlifewellness and fitness tips,
insights, my favorite finds, andrecipes.

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