The vaginas + vulvas episode

Show notes

Dr Sophie and Fiona discuss:

• The education gap with female genitalia • Porn and female body shame • Do vulvas / vaginas need washing? • Vaginal discharge • Thrush / candida • The vaginal microbiome • What vaginas are meant to smell like • Recurrent and painful UTIs / peri-meno • D-mannose • Pelvic floor / bladder weakness • Pelvic floor devices and trainers • Sophie’s views on vaginal weight lifting • Vaginal oestrogen and the role of HRT • Pelvic floor training devices • The Emsella Chair • Vaginal atrophy inc. severe pain • PRP for the vagina / the ‘O’ shot • Vaginal rejuvenation and labiaplasties • The language around vaginal procedures • Skincare considerations for the vulva and vagina • How the vulva ages – e.g. labia bigger / vaginas smaller • Vaginal laser devices • Vaginal radio frequency devices • Jade eggs in the vagina – yes or no?

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All the other links and notes are here:

Vaginas have their own pH which is somewhere between 3.8 and 4.5 - a healthy vaginal microbiome should be dominated by a good bacteria called lactobacilli, especially the species called lactobacillus crispatus. If you notice a foul-smelling odour, that could be a sign of an overgrowth of one of our vaginal bacteria called gardnerella.

Dr Sophie mentioned Dr. Amy Myers, a functional medicine doctor in the USA - plus Dr Jen Gunter and Dr Kelly Casperson (Dr Gunter says she uses a gentle Cerave cleanser as a vulval wash).

Find out more about The Eve Appeal’s Know Your Body education programme here https://eveappeal.org.uk/news-awareness/know-your-body-education-programme/

Dr Sophie mentioned caprylic acid (found in coconut oil) and a supplement called Candifense which contains enzymes that break down the parasitic and fungal cell walls.

Some people say that a yeast called saccharomyces boulardii really helps candida –a yeast that fights yeast — but while it’s helpful for some, others don’t tolerate it well.

Optibac do a specialist women’s probiotic with lactobacillus paracasei, Lactobacillus rhamnosus, and Lactobacillus reuteri - which are all good bacteria for the vagina.

Fi mentioned Symprove, the liquid supplement.

Dr Sophie mentioned Dr Rachel Rubin who’s a urologist in the US and is doing a lot of campaigning on women’s behalves – e.g. re-naming peri-menopausal UTIs as Genitourinary Syndrome of Menopause (GSM).

Vaginal oestrogen plumps the tissue back up, feeds the vaginal microbiome and according to one study, reduces UTIs by 50%. Read more here: https://www.contemporaryobgyn.net/view/vaginal-estrogen-effective-against-recurrent-utis

Dr Sophie mentioned Professor Chris Harding, a consultant urologist at Newcastle upon Tyne Hospitals NHS Foundation.

Dr Sophie mentioned an NHS-approved hormone based treatment called Prasterone which contains DHEA.

Dr Sophie mentioned an article by the novelist Nina Stibbe which is here https://www.theguardian.com/society/2023/nov/04/nina-stibbe-on-menopause-and-hrt-i-was-glad-to-note-that-my-friend-was-much-worse-than-me-weeing-herself-wise

Dr Sophie mentioned pelvic floor trainers – the Kegel8 is one of the best known.

Dr Sophie talked about the Elvie app and the NHS Squeezy app.

Dr Sophie talked about the Emsella Chair which she offers at her Kent clinic https://illuminateskinclinic.co.uk/condition/urinary-incontinence

Dr Sophie mentioned various women’s health physios including Clare Bourne, Maria Elliott, Kate Walsh, and Caitlin O’Malley.

Diastasis Recti is where the abdominal (tummy) muscles have separated.

The private vaginal atrophy support group is here https://www.facebook.com/groups/1505719029448248/?locale=en_GB

Dr Kelly Casperson has a great podcast on all things gynae.

Intrarosa contains three different types of hormones (inc. testosterone)

Dr Sophie mentioned the YES range of moisturisers – inc. the vaginal Ph gel which can be used internally with a lube applicator.

Dr Sophie mentioned Cheryl Iglesia, a professor of obstetrics, gynecology, and urology at Georgetown University School of Medicine - a leading researcher on energy-based devices.

She says that some preliminary small studies have found slight improvements in vaginal dryness and tightness 6 or 12 months after three treatments of laser or radio frequency. In one study she reviewed, it was found that erbium-YAG lasers may improve dryness slightly more than topical oestrogen – this is promising but she also said that women would need follow-ups over the course of many years to determine how effective and safe the treatments are, especially as women age. Some manufacturers are starting to conduct clinical trials and there have been a few promising, slightly larger placebo-controlled studies – one focused on investigating the link between a radio-frequency therapy called Viveve-1 and sexual satisfaction and found it might improve the collagen, fibroblasts, and connective tissue of the clitoris after menopause, which could lead to enhanced sensation and arousal.

This suggests lasers could be a better option for vaginal dryness while radio frequency might be better for urinary incontinence along with “sexual functioning” – so tightening of the vaginal muscles.

There’s also now Morpheus8 V – this is showing signs of helping with vaginal dryness, weak pelvic floor muscles, incontinence, vaginal wall laxity, recurrent vaginal infections such as candida - and something called lichen sclerosis which is a chronic, inflammatory skin condition more common in women who’ve been through menopause, but it can impact any gender or age. It’s been FDA cleared but at the moment we have no long term data.

Dr Sophie mentioned the Issviva Joylux at-home device – this uses light technology to rebuild collagen and elastin to rejuvenate the vaginal tissues.

The content in this podcast is for general information purposes only and is not meant to serve as medical advice or to replace or substitute advice given by, or consultation with, your doctor or any other healthcare professional. Please contact your healthcare provider if you have any questions or concerns about your health. Dr Sophie Shotter, her company and any employees or representatives are not liable for any claims arising out of or in connection with this podcast