March 12, 2025 • 33 mins
Certified Nurse Practitioner Alix "Babs" Babuscak joins Host Dr. Holly Thacker on the Speaking of Women's Health Podcast to discuss vulvar care and vaginal health.
Nurse Babs shares indispensable tips on maintaining a healthy vulvar environment, from selecting the perfect cotton undergarments to practicing impeccable hygiene after your workouts.
Uncover the mysteries of common vaginal infections, such as yeast infections and bacterial vaginosis, and learn how lifestyle choices can make a difference.
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Episode Transcript
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Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode.
(00:27):
Joining me on this new Speakingof Women's Health podcast is
nurse practitioner Alex.
We call her Babs Babushak andshe joined our Center for
Specialized Women's Health andwe're so excited to have her
here for an interview on allthings that women need to know
about.
(00:48):
Let me tell you a little bitabout her.
She earned her Associate Artsand Associate of Nursing here in
the Northeast Ohio area fromLakeland Community College, and
then she then went on to get anundergraduate degree in nursing
from Ohio University, and shethen went on to get an
undergraduate degree in nursingfrom Ohio University and from
there she went to the Universityof Cincinnati where she got a
(01:09):
graduate degree for family nursepractitioner.
So she is a certified nursepractitioner in our OBGYN and
women's health department at theCleveland Clinic and she spends
the majority of her time in ourCenter for Specialized Women's
Health.
Welcome, babs, thank you, I'mexcited.
(01:30):
Well, we're so excited to haveyou as a guest and we're so
excited about you personally.
Just the other day we had ababy shower for you.
Do you want to tell us aboutyou expecting your first baby?
Speaker 2 (01:43):
Yeah, do you want to tell us about you expecting your
first baby?
Yeah, I'm expecting a baby girlon January 23rd, which here is
a very important day.
Speaker 1 (01:54):
And you have a name picked out for her.
Speaker 2 (01:56):
Yeah, we're going to call her Eloise L for short L.
Speaker 1 (02:00):
Oh, eloise, that is so beautiful.
I'm so excited for you and yourhusband.
Thank you, and for any of ourlisteners.
If you want to go on ourspeakingofwomenshealthcom site,
we posted those in and aroundThanksgiving of 2023.
But this podcast will podcastprobably after you have your
(02:23):
daughter in season three, and sowhat we're going to talk about
and it's been a popular topic onour speakingofwomenshealthcom
site one of the most searcheditems and hits is on vulvar care
what women need to know alsoabout cramping and spotting and
(02:43):
non-sexually transmitted vaginalconditions like yeast and
bacterial vaginosis.
Those are so common and soirritating and it's so nice to
be able to get in and get agreat exam and care from people
like you and like Dana Leslie,who we've also had on this
(03:04):
podcast and will probably haveagain on season three.
So why don't we just start withyou talking about what's proper
and appropriate care of thevulva?
Speaker 2 (03:17):
So top priority for care of our vulva is mainly to
keep it dry and to keep it freefrom irritants.
We suggest wearing looseclothing, avoiding the synthetic
fabrics, and tight clothinglike your yoga pants, your
spandex.
Long underwear Long underwearyes.
Thongs yep and thongs yep.
(03:39):
We recommend using cottonundergarments.
They allow for breathability.
Avoiding going to bed withoutunderwear is also recommended,
and we say this becauseunderwear can help protect the
sensitive genital area fromirritations or infections that
(04:00):
can be in the bedding,especially if we're hot sleepers
at night.
You know we can keep themoisture in, and that is true
for perimenopausal andmenopausal women as well.
We recommend getting some typeof physical exercise daily, so
cardio and strength, which is agreat exercise regimen for us
women, but we should shower soonafter.
(04:23):
We don't want you staying inthose moist clothings very long.
When showering, we suggest touse warm not hot, but warm water
to wash the exterior vulva, andwe like bar soaps, like Dove
and Ivory and Cetaphil.
Any unscented, sensitive soapwill do.
And we want you to keep awayfrom rags and sponges when
(04:45):
washing the vulva area.
Instead of you know we can useour hands and wash the vaginal
area.
So it just suds up our handsand lightly wash the outside of
the vulva, and that should bethe last thing you wash in the
shower before you step out.
Grab that clean towel and patdry and avoid the excessive
rubbing.
Speaker 1 (05:05):
That is so important and I hate to admit it, but I
was getting ready for my recentgynecologic exam with one of
your partners, Dana, and I justoverwashed myself so much I was
rushing and I'm trying to getready and be super clean and I
actually gave myself a bladderinfection and we will have a
(05:29):
podcast or maybe it's alreadyjust posted on urinary tract
infections, and so the urethrais so small and so close and
very delicate, and too much soapor too much trauma is not good.
And so we women certainly haveissues with the delicate vulva,
and you'll have fun changingyour daughter's diaper and
(05:52):
taking care of her littledelicate vulva.
I had boys, and so when mygranddaughter started to arrive
and I'm about ready to get mythird granddaughter it was just
shocking to have to change thedirty diaper because it's like,
oh my goodness, you have to takecare of the vulva and the
vagina and it was just a loteasier to clean little boys up
(06:14):
for diaper changes.
That's what I hear.
And then when I was giving mygranddaughters they like to take
baths in our little whirlpooland I put Epsom salts and my son
was like, well, you shouldn'tbe doing that, mother.
And I said I did it with youguys all the time.
I raised three boys and helooked at me.
He goes they're girls.
(06:35):
I'm like, what are you talkingabout?
But fragrances and bubble bathsand those kinds of things can
be very irritating.
And so Epsom salts is justmagnesium Sulfate is just a
natural salt.
But do you have any commentsabout women who like to take hot
baths or sit in hot tubs, orthey love the water?
Speaker 2 (06:54):
So the water is great , hot tubs are great.
I myself personally love a goodbubble bath to relax and unwind
, especially giving birth in twomonths.
I love my bubble baths but itjust it's very, you know,
depending on what we use and thefragrances.
I know we all love our bath andbody works and our smelly soaps
and everything, but we justwant to make sure that once
(07:15):
we're done, we're getting up anddoing like a thorough cleanse
with those appropriate, you know, the Dove, the Cetaphil, the
ivory soaps, the very mild ones.
Speaker 1 (07:26):
I always ask women what type of soap they use, and
when they say Irish spring orthese really harsh ones, that
might be fine for your husband,or maybe fine for your feet and
maybe even hands, but not thevulva or the nipples.
Um, so what are symptoms thatshould lead a woman, um, you
(07:50):
know uh, or a young female toseek um a gynecologic
examination with their woman'shealth nurse practitioner or
their uh physician?
Speaker 2 (07:58):
So symptoms such as like itching, which can be, you
know, the outside of the vulva,the um inside of the vagina,
irritation of the vulvar tissue,which can consist be, you know,
the outside of the vulva, theinside of the vagina, irritation
of the vulvar tissue, which canconsist of, you know, a burning
sensation or a pain fromexcessive scratching caused by
itching.
Other symptoms include odor,and the most I get from patients
(08:19):
when they explain an odor is afishy smell or something that's
tart, vinegary, and they get avaginal discharge, a white,
clumpy discharge.
I hear a lot.
Yellow, any, you know, green,red, anything in color can be a
sign of a vaginal infection.
White and clear vaginaldischarge is, for the most part,
(08:40):
considered normal.
The amount can vary it can be alittle, it can be a lot.
I try to tell patients, you know, to think of their.
You know, vulva area and vaginakind of like a self-cleansing
system.
If you clean it properly andyou let it do its job, it'll
keep your pH in check, either byraising or lowering it, and
(09:00):
that's sometimes why we get, youknow, more discharge than less
discharge some days.
Other symptoms, obviously youknow pain with urination, any
pain with sexual intercourse orany swollen vaginal tissues.
Speaker 1 (09:15):
Yeah, those are all things that should be dealt with
and I think that one of thethings I see a lot of women do
is they think they have toprotect their underwear from
normal vaginal discharge andthey get like addicted to liners
.
Yes, you need a liner if you'rebleeding or you know losing a
lot of urine and you need to getthat evaluated.
(09:37):
But to protect your underwear,no, just change your underwear.
Like it holds in so muchbacteria, just like wearing
something wet and soggy orsomething that's not breathable,
like really those breathablecotton crotch pants.
Underpants are very importantand, like you said, not sleeping
in underwear necessarily.
And just I tell women whenthey're around their house, like
(09:58):
just wear a skirt and don'teven wear underwear necessarily.
Speaker 2 (10:01):
Yeah.
Speaker 1 (10:01):
Yeah, so those little things.
So talk about the two mostcommon non-sexually transmitted
infections that women frequentlydeal with.
Speaker 2 (10:11):
Yeah, so our two most common.
Second most common is ourvaginal yeast infection mainly
affects women of thereproductive age.
It's an inflammatory infectionof the vagina caused by the
Canada pathogen.
Yeast can grow in all parts ofthe body, but there's certain
(10:32):
types that grow mainly into thevagina, which is what we call
our yeast infections.
Most common symptoms of theyeast infection includes itching
, irritation of the vulva aswell as around the opening of
the vagina.
It's that classic cottagecheese white thick discharge
with we're uncomfortable, we'reitchy.
(10:53):
It mainly occurs in women, likeI said, who are menstruating.
It's less common inpostmenopausal women who do not
take estrogen and aren't on somesort of a hormone replacement
therapy, or girls who have notyet started their menses.
There's a lot of risk factorsthat can lead to the development
of a yeast infection.
Commonly those would beantibiotics.
(11:14):
You know, when we have sinusinfections or strep throat or
any other vaginal infection, weget on antibiotics and that
seems to cause an upset andthat's mainly why I have people
who come see me with an itchingvaginal discharge.
They know as soon as they takean antibiotic they're going to
get a yeast infection.
Other risk factors, likecontraception devices, like IUDs
(11:37):
that are inserted into thecervix, weakened immune systems.
Pregnancy causes a littleuproar in yeast infections.
Someone who's diabetic, sosomeone whose sugars aren't well
controlled, or on certainmedications for diabetes, like I
see a lot of people on Jardians, which helps lower the sugars
in your body through urination,and I see them have a lot of
(11:59):
yeast infections as well.
Speaker 1 (12:01):
Because there's a lot more sugar just locally there
and people have bad diets.
We have so much on our websiteprior podcast on healthy eating
and how there's no essentialcarbohydrate and most Americans
get way too much sugar.
So whether you're diabetic ornot, I think it's good to get it
out of your diet.
I warn women that aremenopausal, that are just
(12:25):
starting on estrogen, that whenthey're very thin and atrophic
and then they make that tissuehealthy and pink and plump, that
it takes a while for thehealthy bacteria, the
lactobacillus, to lower the pHof the vagina.
But the vagina is healthier andthere's glycogen inside the
cells, so there's the naturalyeast that could be on the skin
is now getting a food source.
(12:46):
So sometimes people transientlyget worse in terms of yeast
infections or alterations oftheir microbiome or even bladder
infections, before the wholemicrobiome of the vagina and the
vulva right itself.
No-transcript.
(13:16):
Do you want to tell us aboutbacterial vaginosis, which is?
Speaker 2 (13:23):
not an infection, but it's a very irritating
condition.
Yeah, and that is probably oneof the most common vaginal
infections that I see, at leastin our practice and in our
office.
It's a vaginal infection that'scaused by either an increase or
decrease of the vaginal pH,caused by an overgrowth or an
imbalance of bacteria.
It can be associated withincreased risk of HIV and
(13:47):
sexually transmitted diseases,pelvic inflammatory disease,
even adverse birth outcomes.
A rise in bacterial vaginosiscan be associated with increased
, like you were just saying, thepad.
Use the tampon, use thedifferent soaps and cleansers.
We use the ones that arescented and those essential oils
.
We want to make sure we're notvaginally douching or using any
(14:11):
vinegar type baths.
I have a lot of people who comein and use apple cider vinegar
baths that they find on TikTokor they Google it and they can
see it.
And we want to stay away fromengaging the use of the
over-counter products such asSummer's Eve Honeypot Vagisil.
Although signs for bacterialvaginosis aren't as common as
(14:32):
those with yeast infections, youusually experience that fishy,
acidic, tart odor.
It's usually pretty indicativeof BV, although not always.
Bv can commonly cause, you know, the vaginal itching, the
irritation, the discharge, andthat's what we see sometimes
with our patients who come inwho have that cramping and
spotting.
They're not, you know,necessarily on their menses, but
(14:54):
they're getting this, you know,little spotting with this
vaginal irritation, and that'sjust one of the main tests we
run as soon as someone complainsof that.
That's a test we run to makesure they don't have an
infection.
Speaker 1 (15:08):
Yeah, and it's so important to get evaluated and
if there's any concern aboutsexually transmitted infection,
that can be evaluated as well.
I have found over the years thata lot of women with recurrent
bacterial vaginosis are low invitamin D, which affects the
immune system and I think it wasmy third podcast of season one
was low in vitamin D whichaffects the immune system, and I
think it was my third podcastof season one was all about
vitamin D, and since thatpodcast there's been even more
(15:31):
research about the benefits ofthis pro-sterile hormone.
So when I see women withrecurrent vaginitis, I'm
concerned about their vulvarcare, about their sugar levels,
about their vitamin D levels,their general health and what
other medications they're on.
Like you mentioned Jardiance,which excretes sugar in the
urine, so it can increase bothbladder infections as well, as
(15:53):
you know, vaginal yeastinfections, which are terribly
itchy and terribly uncomfortable.
One of the things I tell womenas a tip is to keep refreshed
vaginal gel, which you can getonline or at your local pharmacy
, because it's just pure lacticacid and it lowers the pH of the
vagina, which keeps it acidic,and that helps lower or maybe
(16:17):
even stop in its tracks reallyearly yeast or really early BV.
That might help prevent someonefrom having to come in and have
any takeoff from work or takeoff from taking off their kids,
taking care of their kids orgrandkids, and maybe it might
just nip it in the bud.
Can you talk about the hometest for yeast and BV, like the
(16:38):
pH test kits?
Speaker 2 (16:42):
So the test kits that you get can get at.
You know any CVS or Walgreensare great.
We do recommend they come andsee us for it.
Unlike you know you can'treally get a urine sample.
You need to do an actual swab.
There's no urine sample, like Isaid, no urine sample to
confirm STDs.
We in the clinic test for BVand two types of yeast.
(17:04):
That's what our swabs test forUm and we treat accordingly.
So if we come up with a yeastinfection, you know number one
we go to is the fluconazole,which is also known as diflucan.
If someone comes and you knowis has an infection of BV, you
know gold standards thatmetronidazole, also known as
(17:26):
flagyl um.
The only thing with themetronidazole for some people is
that it can be super harsh ontheir stomach.
They complain of a lot ofnausea and vomiting and we do
have a gel that they can useinstead but there could be
interactions with alcohol, evenalcohol mouthwash yeah, so I
usually recommend that flushingeffect?
Speaker 1 (17:47):
yeah, from from that and the two types of yeast you
want to talk about, the regularuh common, uh canada albicans
and then galabrata, and some ofthe different symptoms that make
might make you think of a moreresistant yeast yeah, so the
canada albicans.
Speaker 2 (18:04):
That's, like I said, our most common vaginal yeast
infection.
That's why I said we treat withdiflucan or the fluconazole.
You take one pill for threedays.
We usually give a backup pill.
Sometimes it takes a littlewhile to get rid of those pesky
yeast infections.
The candida glabrata is adifferent kind of yeast.
It is not going to reallyrespond to the diflucan.
(18:26):
When we have that, we usuallytell our patients to use boric
acid suppositories, which youcan buy over the counter.
Speaker 1 (18:33):
They can buy over the counter and we do have.
Bruxifem is the brand name ofibergia frump, which is very
good at actually killing yeast,but it's pretty expensive.
And we have a lot ofinformation on
speakingofwomenshealthcom aboutall different types of options
(18:54):
for treatment so that a woman,if she thinks she may have this,
can arm herself so she's readyto understand the different
treatments.
And you have been listening tothe Speaking of Women's Health
podcast and I am your host, theexecutive director of Speaking
of Women's Health, Dr HollyThacker, and I am talking to
nurse practitioner AlexBabushkak, who is in our Center
(19:15):
for Specialized Women's Health,and so we had talked about ways
to prevent infection withvaginal refresh.
Do we want to switch gears alittle bit and talk about other
conditions that can really causea lot of pain?
Can you tell us what lichensclerosis is and how you see it
(19:38):
and how you evaluate and treatit?
Speaker 2 (19:42):
Sure, lichen sclerosis is another one of
those vaginal infections.
Typically I don't really see alot of that at our practice.
I know we have a lot.
We have a wonderful vulvavaginal clinic at the Cleveland
Clinic that helps take care ofthat.
But they have this veryitch-scratch cycle.
They're super itchy, theyscratch at it, they have a
(20:06):
discoloration, usually of thevulvar area.
What I usually basically do issend them with a steroid cream,
something like clobetazole.
Speaker 1 (20:17):
Yes, it's an autoimmune condition and a lot
of times it's misdiagnosed, evenby experienced women's health
clinicians.
I've seen that at least in alot of post-menopausal women.
It certainly gets worse whenthey're low in estrogen, but
estrogen will not treat it.
One of the old fashionedtreatments, like what I started
to practice way back when, wastopical testosterone ointment,
(20:41):
and sometimes I'll still usethat off label, but in
randomized control trials reallya potent steroid like
clobetazole ointment.
I personally favor many timesprescribing ointments for the
vulva as opposed to creams,because there's some differences
and of course ourdermatologists are very expert
about lotions which are moredrying and then ointments which
(21:03):
are the most moisturizing.
But it's a chronic condition andit's not something that you
cure, you just control.
But some of the things that weworry about when someone has
lichen sclerosis could actuallybe vulvar cancer.
So if it doesn't get better,then I definitely recommend a
(21:24):
punch biopsy of the vulva, whichis, of course, very sensitive
skin to be biopsying around thelabia minora or the introitus,
the opening of the vagina, oranywhere near the clitoris,
which is very vascular.
So I think it's good to haveexperts to refer to people who
can look with a microscope.
People can look with amicroscope, but we don't want to
(21:51):
miss vulvar cancer, which isassociated with the human
papilloma virus, and that's oneof the things you test for when
you do pap smears.
Right, you test for HPV, hpvand I guess I can't make enough
of a plug to our listeners andto our clinicians to get those
pap smears.
I mean, some women can go asfar as five years, but
(22:12):
personally I just went in, I gotmy one at three years, because
I have seen women with cervicalcancer who had a normal pap and
a normal HPV and four and a halfyears later they have cervical
cancer and that is a terribledisease.
It can be very devastating andwhen you have to have surgery
and radiation and chemotherapyand some vaginal discharges can
(22:36):
be cancer, can be uterine cancer, can be fallopian tube cancers.
So most of the time peoplewho've had vaginitis like yeast
or BV, they know that.
Okay, I've been through thisrodeo again and some people will
self-treat.
And even though Diflucan is afavorite and I've, I've
certainly personally taken itit's very potent and goes
(22:58):
through the liver.
So for people on other livermedicines or for women on uh,
adiflabancerine, that's that's amedicine we prescribe a lot
because it treats low sex drivein women.
If they're going to take aDiflucan they have to, you know,
skip their Addi for a day ortwo so they don't increase their
levels.
Some women really like justtopical treatments, like you
(23:20):
said, because they get nauseatedor, you know, they want to be
able to not, you know, takeanything on their stomach.
But then other women seem verysensitive, like their microbiome
gets off kilter if they putsomething in the vagina.
So, which reminds me abouthaving you make some comments
about douching I just can'tstand it when I see these things
(23:41):
on the shelf, all thesedouching products and feminine
hygiene and, like you said, thevagina is self-cleansing.
Speaker 2 (23:48):
It is, and it's very sensitive.
So we start adding, you know,putting things that don't need
to be up there or part of it,and we, you know, that's how we
start with all these BV yeast,all of these different vaginal
infections.
Speaker 1 (24:04):
And one tip, and I don't know if you have any
techniques on how you talk topatients, because you don't want
to.
Um, obviously it's a verysensitive information to talk
about how people take care oftheir private parts, or, as my
granddaughter Artemis calls them, passports.
She was uh in in the airportwith my son Stetson, who's been
(24:25):
on our podcast, and they werecoming back from Europe.
They had been on three planesover 24 hours, tired, and she
starts whacking him near hisbeltline where he had their
passports and he said, hey,don't hit the passports.
He physically meant thepassports.
She thought he meant theprivate parts, so she calls them
(24:46):
the passports.
Speaker 2 (24:46):
That is too cute, it is so funny.
Speaker 1 (24:47):
You're going to have.
So she thought he meant theprivate parts, so she calls them
the passport.
It is so funny.
You're going to have so muchfun with your daughter and all
these cute little things and theperception that children have.
Oh, I can't wait.
Oh, it's going to be such a joyand eventually maybe she'll be
able to visit when she's a youngwoman and come to our center
for specialized women's health.
We're for specialized women'shealth.
(25:14):
But getting back to talking topeople about sensitive things, I
found with BV, certainly somepartners women that are with
some partners are more likely toget BV.
Just from the bacteria,normally on the male genitalias
or if they're using toys or ifthey're with a female partner
and that female partner has BV,it increases as well.
It's not sexually transmitted,but it is sexually related and I
(25:36):
think it's very important toremind women that they have to
remind their, their partner, towash the penis before sexual
activity because you know menmay go to the bathroom and touch
themselves to urinate.
Then they wash their hands, butthey might've touched dirty
money and, you know, equipmentand anything else and so there
can be a lot of bacteria on thepenis and I know with
(26:00):
uncircumcised males.
Sometimes there can be some,you know, increased yeast around
that foreskin.
So do you have any tips on howyou empower your women patients
to talk to their partners abouttheir genital hygiene?
Speaker 2 (26:18):
It's being open and honest.
I mean, if they're your partnerand you're, you know, sexually
involved and you know with eachother, it's just you know they
have to be informed.
Sometimes they don't know, theydon't know proper hygiene they
may.
I mean, I find a lot of youngmales don't really go see
physicians or their doctors andget their regular routine
checkups and so they can be anadvocate for them and let them
(26:41):
know.
I mean, I don't think anybodywants to be the cause or the
reason for any itchy, anydischarge, anything like that.
Vice versa, for anybody Right.
Speaker 1 (26:51):
And I try to preface it, it has nothing to do with
you know what kind of person youare, or cleanliness, it's just
kind of microbiology.
Yes, and it's just.
You don't want overly cleangenitals because you can
self-inoculate yourself withinfection.
Clean genitals because you canself-inoculate yourself from
infection.
And that's why, even though itseems like it's self-explanatory
(27:13):
, it really isn't, especiallywith the vulva, Just like with
hand washing.
You know, we teach the childrento sing happy birthday, you
know, so that they can washtheir hands long enough.
And hand washing is soimportant for us in the medical
field because it really islinked to infection and it's
very important, you know, towash your hands before and after
procedures.
(27:35):
So do you have any other tipsor advice to give our listeners?
Speaker 2 (27:43):
Yeah, I mean also things, just like you said, that
lactobacillus that you can.
There's vaginal probiotics thatare on the shelves that you can
buy that help neutralize the pHof the vagina and have those
probiotic effects.
Eating the yogurts that havethe good lactobacillus in it to
(28:04):
keep up with vaginal flora.
We mentioned the boric acidinserts that you can get over
the counter, which really help.
You know, rinsing our clothing,like sometimes, you know, our
undergarments.
You can get the self-reusablebags where you can all put it in
a bag so it's not touchingother clothing.
If it's delicates, you can putthem in there.
(28:24):
Doing a double rinse cycle.
Yeah, using gentle cleanserswhen we're washing our clothes
as well, and I've seen women doit.
You know, when we spray aperfume and we want to smell
good, you know keeping away fromspraying towards that vulva
region keeping it on the wrist,on the neck.
Speaker 1 (28:43):
Excellent, excellent.
Yeah, I actually tell a lot ofmy patients to do a delicate
load once a week of all theirbras and underwear without other
clothes and double rinse it anduse the kind of detergent that
you would use like on your babyclothes, all those cute baby
clothes that you got.
(29:03):
The other day oh those are sofun.
She'll grow out of them so fast, but enjoy every moment.
Speaker 2 (29:09):
I know, but of them so fast.
But enjoy every moment.
Speaker 1 (29:11):
It's going to be so fun and, oh babies, they smell
so good and so fresh.
They're so intoxicating, aren'tthey?
They are.
But the other tip really isjust to not douche and really,
the diet and the gut microbiome.
I think eating fermented foods,eating like drinking kefir
(29:32):
which is rich in lactobacillusnot all yogurts are equal for
how much bifidobacteria there iswhen you take antibiotics, you
really hurt your gut microbiomeIf you eat a lot of processed
foods and sugar.
it's terrible on your gut, whichalso affects the vulvar area,
(29:52):
and I think that increasinglywe're learning a lot more about
the gut microbiome and we dohave functional medicine
services and they do some stooltesting to check for what the
gut microbiome does.
Have you sent any women withrefractory vaginitis for any of
that to functional medicine, tochange their diet or check their
(30:14):
microbiome?
Speaker 2 (30:16):
Yeah, actually I've sent them over to functional
medicine or, you know, ifthey're having any refractory
symptoms I send them to, likeour GYN infectious disease If
we're getting recurrent, youknow BV yeast for over six
months to a year.
Speaker 1 (30:32):
Yeah, many times that is very um.
It has to be done so that womendon't suffer.
So tell us um for any of ourlisteners in the Northeast Ohio
area who might want to make anappointment with you or learn
more about your practice.
How can they reach you?
Speaker 2 (30:49):
Yeah, anyone can make an appointment with me at Main
Campus Cleveland Clinic.
They can call our, you know GYNscheduling number.
It all leads to the same place.
If they're already establishedwithin the Cleveland Clinic,
they can log on to their MyChartand make an appointment.
Any benign GYN care including,you know, annuals, scd and
(31:10):
non-SCI, like our vaginalinfections, any you know I do,
medication refills, hormonereplacement therapy, medication
refills, any birth controlcounseling and any vulvar
problem visits, they can comeand see me.
Speaker 1 (31:24):
That is excellent.
You have a great scope ofpractice.
We are so glad that you joinedour practice last year and we
look forward to having you backagain, and I just want to thank
our listeners and thank nursepractitioner Babs Alex Babushak
(31:44):
for joining us, and if you enjoythis podcast, please share it
with others and give us afive-star rating.
And if you don't alreadysubscribe to our podcast, hit
the follow or subscribe button.
It is free and that way, youwon't miss any of our great
(32:05):
information, because we want toempower you to be strong, be
healthy and be in charge, and wewill look forward to seeing you
next time in the SunflowerHouse.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode.
(00:27):
Joining me on this new Speakingof Women's Health podcast is
nurse practitioner Alex.
We call her Babs Babushak andshe joined our Center for
Specialized Women's Health andwe're so excited to have her
here for an interview on allthings that women need to know
about.
(00:48):
Let me tell you a little bitabout her.
She earned her Associate Artsand Associate of Nursing here in
the Northeast Ohio area fromLakeland Community College, and
then she then went on to get anundergraduate degree in nursing
from Ohio University, and shethen went on to get an
undergraduate degree in nursingfrom Ohio University and from
there she went to the Universityof Cincinnati where she got a
(01:09):
graduate degree for family nursepractitioner.
So she is a certified nursepractitioner in our OBGYN and
women's health department at theCleveland Clinic and she spends
the majority of her time in ourCenter for Specialized Women's
Health.
Welcome, babs, thank you, I'mexcited.
(01:30):
Well, we're so excited to haveyou as a guest and we're so
excited about you personally.
Just the other day we had ababy shower for you.
Do you want to tell us aboutyou expecting your first baby?
Speaker 2 (01:43):
Yeah, do you want to tell us about you expecting your
first baby?
Yeah, I'm expecting a baby girlon January 23rd, which here is
a very important day.
Speaker 1 (01:54):
And you have a name picked out for her.
Speaker 2 (01:56):
Yeah, we're going to call her Eloise L for short L.
Speaker 1 (02:00):
Oh, eloise, that is so beautiful.
I'm so excited for you and yourhusband.
Thank you, and for any of ourlisteners.
If you want to go on ourspeakingofwomenshealthcom site,
we posted those in and aroundThanksgiving of 2023.
But this podcast will podcastprobably after you have your
(02:23):
daughter in season three, and sowhat we're going to talk about
and it's been a popular topic onour speakingofwomenshealthcom
site one of the most searcheditems and hits is on vulvar care
what women need to know alsoabout cramping and spotting and
(02:43):
non-sexually transmitted vaginalconditions like yeast and
bacterial vaginosis.
Those are so common and soirritating and it's so nice to
be able to get in and get agreat exam and care from people
like you and like Dana Leslie,who we've also had on this
(03:04):
podcast and will probably haveagain on season three.
So why don't we just start withyou talking about what's proper
and appropriate care of thevulva?
Speaker 2 (03:17):
So top priority for care of our vulva is mainly to
keep it dry and to keep it freefrom irritants.
We suggest wearing looseclothing, avoiding the synthetic
fabrics, and tight clothinglike your yoga pants, your
spandex.
Long underwear Long underwearyes.
Thongs yep and thongs yep.
(03:39):
We recommend using cottonundergarments.
They allow for breathability.
Avoiding going to bed withoutunderwear is also recommended,
and we say this becauseunderwear can help protect the
sensitive genital area fromirritations or infections that
(04:00):
can be in the bedding,especially if we're hot sleepers
at night.
You know we can keep themoisture in, and that is true
for perimenopausal andmenopausal women as well.
We recommend getting some typeof physical exercise daily, so
cardio and strength, which is agreat exercise regimen for us
women, but we should shower soonafter.
(04:23):
We don't want you staying inthose moist clothings very long.
When showering, we suggest touse warm not hot, but warm water
to wash the exterior vulva, andwe like bar soaps, like Dove
and Ivory and Cetaphil.
Any unscented, sensitive soapwill do.
And we want you to keep awayfrom rags and sponges when
(04:45):
washing the vulva area.
Instead of you know we can useour hands and wash the vaginal
area.
So it just suds up our handsand lightly wash the outside of
the vulva, and that should bethe last thing you wash in the
shower before you step out.
Grab that clean towel and patdry and avoid the excessive
rubbing.
Speaker 1 (05:05):
That is so important and I hate to admit it, but I
was getting ready for my recentgynecologic exam with one of
your partners, Dana, and I justoverwashed myself so much I was
rushing and I'm trying to getready and be super clean and I
actually gave myself a bladderinfection and we will have a
(05:29):
podcast or maybe it's alreadyjust posted on urinary tract
infections, and so the urethrais so small and so close and
very delicate, and too much soapor too much trauma is not good.
And so we women certainly haveissues with the delicate vulva,
and you'll have fun changingyour daughter's diaper and
(05:52):
taking care of her littledelicate vulva.
I had boys, and so when mygranddaughter started to arrive
and I'm about ready to get mythird granddaughter it was just
shocking to have to change thedirty diaper because it's like,
oh my goodness, you have to takecare of the vulva and the
vagina and it was just a loteasier to clean little boys up
(06:14):
for diaper changes.
That's what I hear.
And then when I was giving mygranddaughters they like to take
baths in our little whirlpooland I put Epsom salts and my son
was like, well, you shouldn'tbe doing that, mother.
And I said I did it with youguys all the time.
I raised three boys and helooked at me.
He goes they're girls.
(06:35):
I'm like, what are you talkingabout?
But fragrances and bubble bathsand those kinds of things can
be very irritating.
And so Epsom salts is justmagnesium Sulfate is just a
natural salt.
But do you have any commentsabout women who like to take hot
baths or sit in hot tubs, orthey love the water?
Speaker 2 (06:54):
So the water is great , hot tubs are great.
I myself personally love a goodbubble bath to relax and unwind
, especially giving birth in twomonths.
I love my bubble baths but itjust it's very, you know,
depending on what we use and thefragrances.
I know we all love our bath andbody works and our smelly soaps
and everything, but we justwant to make sure that once
(07:15):
we're done, we're getting up anddoing like a thorough cleanse
with those appropriate, you know, the Dove, the Cetaphil, the
ivory soaps, the very mild ones.
Speaker 1 (07:26):
I always ask women what type of soap they use, and
when they say Irish spring orthese really harsh ones, that
might be fine for your husband,or maybe fine for your feet and
maybe even hands, but not thevulva or the nipples.
Um, so what are symptoms thatshould lead a woman, um, you
(07:50):
know uh, or a young female toseek um a gynecologic
examination with their woman'shealth nurse practitioner or
their uh physician?
Speaker 2 (07:58):
So symptoms such as like itching, which can be, you
know, the outside of the vulva,the um inside of the vagina,
irritation of the vulvar tissue,which can consist be, you know,
the outside of the vulva, theinside of the vagina, irritation
of the vulvar tissue, which canconsist of, you know, a burning
sensation or a pain fromexcessive scratching caused by
itching.
Other symptoms include odor,and the most I get from patients
(08:19):
when they explain an odor is afishy smell or something that's
tart, vinegary, and they get avaginal discharge, a white,
clumpy discharge.
I hear a lot.
Yellow, any, you know, green,red, anything in color can be a
sign of a vaginal infection.
White and clear vaginaldischarge is, for the most part,
(08:40):
considered normal.
The amount can vary it can be alittle, it can be a lot.
I try to tell patients, you know, to think of their.
You know, vulva area and vaginakind of like a self-cleansing
system.
If you clean it properly andyou let it do its job, it'll
keep your pH in check, either byraising or lowering it, and
(09:00):
that's sometimes why we get, youknow, more discharge than less
discharge some days.
Other symptoms, obviously youknow pain with urination, any
pain with sexual intercourse orany swollen vaginal tissues.
Speaker 1 (09:15):
Yeah, those are all things that should be dealt with
and I think that one of thethings I see a lot of women do
is they think they have toprotect their underwear from
normal vaginal discharge andthey get like addicted to liners
.
Yes, you need a liner if you'rebleeding or you know losing a
lot of urine and you need to getthat evaluated.
(09:37):
But to protect your underwear,no, just change your underwear.
Like it holds in so muchbacteria, just like wearing
something wet and soggy orsomething that's not breathable,
like really those breathablecotton crotch pants.
Underpants are very importantand, like you said, not sleeping
in underwear necessarily.
And just I tell women whenthey're around their house, like
(09:58):
just wear a skirt and don'teven wear underwear necessarily.
Speaker 2 (10:01):
Yeah.
Speaker 1 (10:01):
Yeah, so those little things.
So talk about the two mostcommon non-sexually transmitted
infections that women frequentlydeal with.
Speaker 2 (10:11):
Yeah, so our two most common.
Second most common is ourvaginal yeast infection mainly
affects women of thereproductive age.
It's an inflammatory infectionof the vagina caused by the
Canada pathogen.
Yeast can grow in all parts ofthe body, but there's certain
(10:32):
types that grow mainly into thevagina, which is what we call
our yeast infections.
Most common symptoms of theyeast infection includes itching
, irritation of the vulva aswell as around the opening of
the vagina.
It's that classic cottagecheese white thick discharge
with we're uncomfortable, we'reitchy.
(10:53):
It mainly occurs in women, likeI said, who are menstruating.
It's less common inpostmenopausal women who do not
take estrogen and aren't on somesort of a hormone replacement
therapy, or girls who have notyet started their menses.
There's a lot of risk factorsthat can lead to the development
of a yeast infection.
Commonly those would beantibiotics.
(11:14):
You know, when we have sinusinfections or strep throat or
any other vaginal infection, weget on antibiotics and that
seems to cause an upset andthat's mainly why I have people
who come see me with an itchingvaginal discharge.
They know as soon as they takean antibiotic they're going to
get a yeast infection.
Other risk factors, likecontraception devices, like IUDs
(11:37):
that are inserted into thecervix, weakened immune systems.
Pregnancy causes a littleuproar in yeast infections.
Someone who's diabetic, sosomeone whose sugars aren't well
controlled, or on certainmedications for diabetes, like I
see a lot of people on Jardians, which helps lower the sugars
in your body through urination,and I see them have a lot of
(11:59):
yeast infections as well.
Speaker 1 (12:01):
Because there's a lot more sugar just locally there
and people have bad diets.
We have so much on our websiteprior podcast on healthy eating
and how there's no essentialcarbohydrate and most Americans
get way too much sugar.
So whether you're diabetic ornot, I think it's good to get it
out of your diet.
I warn women that aremenopausal, that are just
(12:25):
starting on estrogen, that whenthey're very thin and atrophic
and then they make that tissuehealthy and pink and plump, that
it takes a while for thehealthy bacteria, the
lactobacillus, to lower the pHof the vagina.
But the vagina is healthier andthere's glycogen inside the
cells, so there's the naturalyeast that could be on the skin
is now getting a food source.
(12:46):
So sometimes people transientlyget worse in terms of yeast
infections or alterations oftheir microbiome or even bladder
infections, before the wholemicrobiome of the vagina and the
vulva right itself.
No-transcript.
(13:16):
Do you want to tell us aboutbacterial vaginosis, which is?
Speaker 2 (13:23):
not an infection, but it's a very irritating
condition.
Yeah, and that is probably oneof the most common vaginal
infections that I see, at leastin our practice and in our
office.
It's a vaginal infection that'scaused by either an increase or
decrease of the vaginal pH,caused by an overgrowth or an
imbalance of bacteria.
It can be associated withincreased risk of HIV and
(13:47):
sexually transmitted diseases,pelvic inflammatory disease,
even adverse birth outcomes.
A rise in bacterial vaginosiscan be associated with increased
, like you were just saying, thepad.
Use the tampon, use thedifferent soaps and cleansers.
We use the ones that arescented and those essential oils
.
We want to make sure we're notvaginally douching or using any
(14:11):
vinegar type baths.
I have a lot of people who comein and use apple cider vinegar
baths that they find on TikTokor they Google it and they can
see it.
And we want to stay away fromengaging the use of the
over-counter products such asSummer's Eve Honeypot Vagisil.
Although signs for bacterialvaginosis aren't as common as
(14:32):
those with yeast infections, youusually experience that fishy,
acidic, tart odor.
It's usually pretty indicativeof BV, although not always.
Bv can commonly cause, you know, the vaginal itching, the
irritation, the discharge, andthat's what we see sometimes
with our patients who come inwho have that cramping and
spotting.
They're not, you know,necessarily on their menses, but
(14:54):
they're getting this, you know,little spotting with this
vaginal irritation, and that'sjust one of the main tests we
run as soon as someone complainsof that.
That's a test we run to makesure they don't have an
infection.
Speaker 1 (15:08):
Yeah, and it's so important to get evaluated and
if there's any concern aboutsexually transmitted infection,
that can be evaluated as well.
I have found over the years thata lot of women with recurrent
bacterial vaginosis are low invitamin D, which affects the
immune system and I think it wasmy third podcast of season one
was low in vitamin D whichaffects the immune system, and I
think it was my third podcastof season one was all about
vitamin D, and since thatpodcast there's been even more
(15:31):
research about the benefits ofthis pro-sterile hormone.
So when I see women withrecurrent vaginitis, I'm
concerned about their vulvarcare, about their sugar levels,
about their vitamin D levels,their general health and what
other medications they're on.
Like you mentioned Jardiance,which excretes sugar in the
urine, so it can increase bothbladder infections as well, as
(15:53):
you know, vaginal yeastinfections, which are terribly
itchy and terribly uncomfortable.
One of the things I tell womenas a tip is to keep refreshed
vaginal gel, which you can getonline or at your local pharmacy
, because it's just pure lacticacid and it lowers the pH of the
vagina, which keeps it acidic,and that helps lower or maybe
(16:17):
even stop in its tracks reallyearly yeast or really early BV.
That might help prevent someonefrom having to come in and have
any takeoff from work or takeoff from taking off their kids,
taking care of their kids orgrandkids, and maybe it might
just nip it in the bud.
Can you talk about the hometest for yeast and BV, like the
(16:38):
pH test kits?
Speaker 2 (16:42):
So the test kits that you get can get at.
You know any CVS or Walgreensare great.
We do recommend they come andsee us for it.
Unlike you know you can'treally get a urine sample.
You need to do an actual swab.
There's no urine sample, like Isaid, no urine sample to
confirm STDs.
We in the clinic test for BVand two types of yeast.
(17:04):
That's what our swabs test forUm and we treat accordingly.
So if we come up with a yeastinfection, you know number one
we go to is the fluconazole,which is also known as diflucan.
If someone comes and you knowis has an infection of BV, you
know gold standards thatmetronidazole, also known as
(17:26):
flagyl um.
The only thing with themetronidazole for some people is
that it can be super harsh ontheir stomach.
They complain of a lot ofnausea and vomiting and we do
have a gel that they can useinstead but there could be
interactions with alcohol, evenalcohol mouthwash yeah, so I
usually recommend that flushingeffect?
Speaker 1 (17:47):
yeah, from from that and the two types of yeast you
want to talk about, the regularuh common, uh canada albicans
and then galabrata, and some ofthe different symptoms that make
might make you think of a moreresistant yeast yeah, so the
canada albicans.
Speaker 2 (18:04):
That's, like I said, our most common vaginal yeast
infection.
That's why I said we treat withdiflucan or the fluconazole.
You take one pill for threedays.
We usually give a backup pill.
Sometimes it takes a littlewhile to get rid of those pesky
yeast infections.
The candida glabrata is adifferent kind of yeast.
It is not going to reallyrespond to the diflucan.
(18:26):
When we have that, we usuallytell our patients to use boric
acid suppositories, which youcan buy over the counter.
Speaker 1 (18:33):
They can buy over the counter and we do have.
Bruxifem is the brand name ofibergia frump, which is very
good at actually killing yeast,but it's pretty expensive.
And we have a lot ofinformation on
speakingofwomenshealthcom aboutall different types of options
(18:54):
for treatment so that a woman,if she thinks she may have this,
can arm herself so she's readyto understand the different
treatments.
And you have been listening tothe Speaking of Women's Health
podcast and I am your host, theexecutive director of Speaking
of Women's Health, Dr HollyThacker, and I am talking to
nurse practitioner AlexBabushkak, who is in our Center
(19:15):
for Specialized Women's Health,and so we had talked about ways
to prevent infection withvaginal refresh.
Do we want to switch gears alittle bit and talk about other
conditions that can really causea lot of pain?
Can you tell us what lichensclerosis is and how you see it
(19:38):
and how you evaluate and treatit?
Speaker 2 (19:42):
Sure, lichen sclerosis is another one of
those vaginal infections.
Typically I don't really see alot of that at our practice.
I know we have a lot.
We have a wonderful vulvavaginal clinic at the Cleveland
Clinic that helps take care ofthat.
But they have this veryitch-scratch cycle.
They're super itchy, theyscratch at it, they have a
(20:06):
discoloration, usually of thevulvar area.
What I usually basically do issend them with a steroid cream,
something like clobetazole.
Speaker 1 (20:17):
Yes, it's an autoimmune condition and a lot
of times it's misdiagnosed, evenby experienced women's health
clinicians.
I've seen that at least in alot of post-menopausal women.
It certainly gets worse whenthey're low in estrogen, but
estrogen will not treat it.
One of the old fashionedtreatments, like what I started
to practice way back when, wastopical testosterone ointment,
(20:41):
and sometimes I'll still usethat off label, but in
randomized control trials reallya potent steroid like
clobetazole ointment.
I personally favor many timesprescribing ointments for the
vulva as opposed to creams,because there's some differences
and of course ourdermatologists are very expert
about lotions which are moredrying and then ointments which
(21:03):
are the most moisturizing.
But it's a chronic condition andit's not something that you
cure, you just control.
But some of the things that weworry about when someone has
lichen sclerosis could actuallybe vulvar cancer.
So if it doesn't get better,then I definitely recommend a
(21:24):
punch biopsy of the vulva, whichis, of course, very sensitive
skin to be biopsying around thelabia minora or the introitus,
the opening of the vagina, oranywhere near the clitoris,
which is very vascular.
So I think it's good to haveexperts to refer to people who
can look with a microscope.
People can look with amicroscope, but we don't want to
(21:51):
miss vulvar cancer, which isassociated with the human
papilloma virus, and that's oneof the things you test for when
you do pap smears.
Right, you test for HPV, hpvand I guess I can't make enough
of a plug to our listeners andto our clinicians to get those
pap smears.
I mean, some women can go asfar as five years, but
(22:12):
personally I just went in, I gotmy one at three years, because
I have seen women with cervicalcancer who had a normal pap and
a normal HPV and four and a halfyears later they have cervical
cancer and that is a terribledisease.
It can be very devastating andwhen you have to have surgery
and radiation and chemotherapyand some vaginal discharges can
(22:36):
be cancer, can be uterine cancer, can be fallopian tube cancers.
So most of the time peoplewho've had vaginitis like yeast
or BV, they know that.
Okay, I've been through thisrodeo again and some people will
self-treat.
And even though Diflucan is afavorite and I've, I've
certainly personally taken itit's very potent and goes
(22:58):
through the liver.
So for people on other livermedicines or for women on uh,
adiflabancerine, that's that's amedicine we prescribe a lot
because it treats low sex drivein women.
If they're going to take aDiflucan they have to, you know,
skip their Addi for a day ortwo so they don't increase their
levels.
Some women really like justtopical treatments, like you
(23:20):
said, because they get nauseatedor, you know, they want to be
able to not, you know, takeanything on their stomach.
But then other women seem verysensitive, like their microbiome
gets off kilter if they putsomething in the vagina.
So, which reminds me abouthaving you make some comments
about douching I just can'tstand it when I see these things
(23:41):
on the shelf, all thesedouching products and feminine
hygiene and, like you said, thevagina is self-cleansing.
Speaker 2 (23:48):
It is, and it's very sensitive.
So we start adding, you know,putting things that don't need
to be up there or part of it,and we, you know, that's how we
start with all these BV yeast,all of these different vaginal
infections.
Speaker 1 (24:04):
And one tip, and I don't know if you have any
techniques on how you talk topatients, because you don't want
to.
Um, obviously it's a verysensitive information to talk
about how people take care oftheir private parts, or, as my
granddaughter Artemis calls them, passports.
She was uh in in the airportwith my son Stetson, who's been
(24:25):
on our podcast, and they werecoming back from Europe.
They had been on three planesover 24 hours, tired, and she
starts whacking him near hisbeltline where he had their
passports and he said, hey,don't hit the passports.
He physically meant thepassports.
She thought he meant theprivate parts, so she calls them
(24:46):
the passports.
Speaker 2 (24:46):
That is too cute, it is so funny.
Speaker 1 (24:47):
You're going to have.
So she thought he meant theprivate parts, so she calls them
the passport.
It is so funny.
You're going to have so muchfun with your daughter and all
these cute little things and theperception that children have.
Oh, I can't wait.
Oh, it's going to be such a joyand eventually maybe she'll be
able to visit when she's a youngwoman and come to our center
for specialized women's health.
We're for specialized women'shealth.
(25:14):
But getting back to talking topeople about sensitive things, I
found with BV, certainly somepartners women that are with
some partners are more likely toget BV.
Just from the bacteria,normally on the male genitalias
or if they're using toys or ifthey're with a female partner
and that female partner has BV,it increases as well.
It's not sexually transmitted,but it is sexually related and I
(25:36):
think it's very important toremind women that they have to
remind their, their partner, towash the penis before sexual
activity because you know menmay go to the bathroom and touch
themselves to urinate.
Then they wash their hands, butthey might've touched dirty
money and, you know, equipmentand anything else and so there
can be a lot of bacteria on thepenis and I know with
(26:00):
uncircumcised males.
Sometimes there can be some,you know, increased yeast around
that foreskin.
So do you have any tips on howyou empower your women patients
to talk to their partners abouttheir genital hygiene?
Speaker 2 (26:18):
It's being open and honest.
I mean, if they're your partnerand you're, you know, sexually
involved and you know with eachother, it's just you know they
have to be informed.
Sometimes they don't know, theydon't know proper hygiene they
may.
I mean, I find a lot of youngmales don't really go see
physicians or their doctors andget their regular routine
checkups and so they can be anadvocate for them and let them
(26:41):
know.
I mean, I don't think anybodywants to be the cause or the
reason for any itchy, anydischarge, anything like that.
Vice versa, for anybody Right.
Speaker 1 (26:51):
And I try to preface it, it has nothing to do with
you know what kind of person youare, or cleanliness, it's just
kind of microbiology.
Yes, and it's just.
You don't want overly cleangenitals because you can
self-inoculate yourself withinfection.
Clean genitals because you canself-inoculate yourself from
infection.
And that's why, even though itseems like it's self-explanatory
(27:13):
, it really isn't, especiallywith the vulva, Just like with
hand washing.
You know, we teach the childrento sing happy birthday, you
know, so that they can washtheir hands long enough.
And hand washing is soimportant for us in the medical
field because it really islinked to infection and it's
very important, you know, towash your hands before and after
procedures.
(27:35):
So do you have any other tipsor advice to give our listeners?
Speaker 2 (27:43):
Yeah, I mean also things, just like you said, that
lactobacillus that you can.
There's vaginal probiotics thatare on the shelves that you can
buy that help neutralize the pHof the vagina and have those
probiotic effects.
Eating the yogurts that havethe good lactobacillus in it to
(28:04):
keep up with vaginal flora.
We mentioned the boric acidinserts that you can get over
the counter, which really help.
You know, rinsing our clothing,like sometimes, you know, our
undergarments.
You can get the self-reusablebags where you can all put it in
a bag so it's not touchingother clothing.
If it's delicates, you can putthem in there.
(28:24):
Doing a double rinse cycle.
Yeah, using gentle cleanserswhen we're washing our clothes
as well, and I've seen women doit.
You know, when we spray aperfume and we want to smell
good, you know keeping away fromspraying towards that vulva
region keeping it on the wrist,on the neck.
Speaker 1 (28:43):
Excellent, excellent.
Yeah, I actually tell a lot ofmy patients to do a delicate
load once a week of all theirbras and underwear without other
clothes and double rinse it anduse the kind of detergent that
you would use like on your babyclothes, all those cute baby
clothes that you got.
(29:03):
The other day oh those are sofun.
She'll grow out of them so fast, but enjoy every moment.
Speaker 2 (29:09):
I know, but of them so fast.
But enjoy every moment.
Speaker 1 (29:11):
It's going to be so fun and, oh babies, they smell
so good and so fresh.
They're so intoxicating, aren'tthey?
They are.
But the other tip really isjust to not douche and really,
the diet and the gut microbiome.
I think eating fermented foods,eating like drinking kefir
(29:32):
which is rich in lactobacillusnot all yogurts are equal for
how much bifidobacteria there iswhen you take antibiotics, you
really hurt your gut microbiomeIf you eat a lot of processed
foods and sugar.
it's terrible on your gut, whichalso affects the vulvar area,
(29:52):
and I think that increasinglywe're learning a lot more about
the gut microbiome and we dohave functional medicine
services and they do some stooltesting to check for what the
gut microbiome does.
Have you sent any women withrefractory vaginitis for any of
that to functional medicine, tochange their diet or check their
(30:14):
microbiome?
Speaker 2 (30:16):
Yeah, actually I've sent them over to functional
medicine or, you know, ifthey're having any refractory
symptoms I send them to, likeour GYN infectious disease If
we're getting recurrent, youknow BV yeast for over six
months to a year.
Speaker 1 (30:32):
Yeah, many times that is very um.
It has to be done so that womendon't suffer.
So tell us um for any of ourlisteners in the Northeast Ohio
area who might want to make anappointment with you or learn
more about your practice.
How can they reach you?
Speaker 2 (30:49):
Yeah, anyone can make an appointment with me at Main
Campus Cleveland Clinic.
They can call our, you know GYNscheduling number.
It all leads to the same place.
If they're already establishedwithin the Cleveland Clinic,
they can log on to their MyChartand make an appointment.
Any benign GYN care including,you know, annuals, scd and
(31:10):
non-SCI, like our vaginalinfections, any you know I do,
medication refills, hormonereplacement therapy, medication
refills, any birth controlcounseling and any vulvar
problem visits, they can comeand see me.
Speaker 1 (31:24):
That is excellent.
You have a great scope ofpractice.
We are so glad that you joinedour practice last year and we
look forward to having you backagain, and I just want to thank
our listeners and thank nursepractitioner Babs Alex Babushak
(31:44):
for joining us, and if you enjoythis podcast, please share it
with others and give us afive-star rating.
And if you don't alreadysubscribe to our podcast, hit
the follow or subscribe button.
It is free and that way, youwon't miss any of our great
(32:05):
information, because we want toempower you to be strong, be
healthy and be in charge, and wewill look forward to seeing you
next time in the SunflowerHouse.
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