Episode Transcript
Speaker 0
Today, we've got the incredible doctor Dolores Fernandez back on the podcast. And it's such a great conversation. Everyone is going to learn so much about their vulvas, their vaginas, and so many of the conditions that you might be experiencing, but your doctor just can't seem to diagnose.
Speaker 1
And, Michal, this is a very personal one for you if I'm not mistaken.
Speaker 0
It is because I went through something and it went on for far too long where I was waking up in the night with burning and itching down there that was brutal. I couldn't sleep. I couldn't think. I couldn't function.
Speaker 1
No. And and this went on for, like, a long time. Right?
Speaker 0
It well, let's just say that the the luckily, that phase went on well, it went on for too long, but I think it
Speaker 1
was a
Speaker 0
couple of weeks, which was, like, twenty years. Yeah. But I saw multiple people, and they kept saying, well, you don't have a yeast infection, and you don't have a UTI. And and I was like, oh What
Speaker 1
do you mean? Wait. Okay. But there it's something I wrong. Like, something is wrong. Wrong. Well and, my god. I can't I thankfully have never gone through that. I can't even imagine. But this is why these conversations are so important. And, like, how many women are walking around with itchy burning vulvas and vaginas, and they're going to the doctor, and they're just not getting the help. They're getting dismissed. They're not getting the help they deserve and that they desperately need.
Speaker 0
Well and maybe their doctors just don't know. No shade on doctors. Like,
Speaker 2
you know,
Speaker 0
how you're navigating all of this is is I'm not sure about either, from a from a medical, you know, professional perspective. Yeah.
Speaker 1
How do you know what they're talking about? I would say there's probably a lot
Speaker 0
of women who are going through this, and they're too ashamed to bring it up, so they haven't. And they're just dealing, and it's not something you should need to deal with ever.
Speaker 1
No. Well, doctor Dolores is definitely the right woman to have on task today. She kinda knows everything. She's been specializing in this for years.
Speaker 0
Yes. So she's a naturopathic doctor, a menopause certified, or a menopause society certified practitioner, excuse me, and is the founder of IRIS, which is clean, science backed, vulvar and vagina care. And she developed an interest in this because she kept seeing patients who had gone to a medical provider who were struggling, couldn't find answers. And so she decided to go down this rabbit hole and has become and has become an expert.
Speaker 1
Well, it's gonna be awesome. Everything's on the table in this conversation because this is perimenopause. And so let's get into it.
Speaker 2
Hi there. Volva speaking. We need to talk. For years now, you've been calling me the wrong name. I'm the vulva, not the vagina. I'm all the external bits you can see. My neighbor, the vagina, she's the internal tunnel connecting me to your uterus, you know, the baby highway. Different parts, different names. It's pretty hard to address dry, uncomfortable situations when you don't even know which one of us needs the attention. Now that we're properly introduced, can you please hook me up with some Iris? Their water based moisturizer and lube are exactly what I need. No irritating fragrances, just clean ingredients to keep me happy and well hydrated, not dry and disgruntled. Eternally grateful for the hydration and finally getting my name right. Signing off, x o x o, your vulva.
Speaker 1
And now that you've been properly introduced, do your girls a favor and use code t I p twenty for twenty percent off at love my iris dot com. That's t I p two zero at l o v e m y I r I s dot com.
Speaker 0
Hi. Thanks
Speaker 3
for having me here.
Speaker 0
We'll always have you here whenever you can sort of squeeze us into your crazy schedule. We're gonna talk today about something near and dear to our hearts here at This is Perimenopause, which is a vulvar and vaginal health because it is not properly understood. Most women don't know anything about that part of their body. And so many things can happen that, so many things can happen especially during perimenopause and and or any time of hormonal change. And some things are quite serious if they're not addressed. So we wanted to chat a little bit with you about your practice, why this is also an area an area of passion, if I may, for you. And then have you talk with us about some of the common things you see in your practice and what can be done about them and why it's important to do something about them.
Speaker 3
Love it. I think that it's been pretty well talked about that women's health is not heavily funded and studied, let alone vulvovaginal condition. Right? And Yep. It sucks because in a way, even being a practitioner, it's not always easy to come up with a treatment plan because we don't always have great evidence to follow. Mhmm. And as you're trying to be an evidence based practitioner, you have limitations because sometimes the studies are just not done. And so but you still need to help that person in front of you. Right? Yep. And so, my clinical focus or, like, subclinical focus really in Volvo vaginal conditions kind of came to me. I had a very menopause focused practice. Yeah. And I was so, intrigued by the, like, vulvar vulvovaginal piece to it because I grew up in a household, and I know that I'm super privileged to have this experience. But I grew up in a household where we talked about vaginas and vulvas. Like
Speaker 0
Amazing.
Speaker 3
Just like we did anything else. And so for me, I thought it was so interesting that, like, people were having such a hard time talking to me about this change that I thought was just, like, the same as saying, you know, my my elbow was hurting. Right? And so Right. I was fascinated, and I was trying to normalize these conversations. And as this was happening, I got more interested in the research, and people in my clinic started walking in with new conditions that I didn't really know too much about. And so it really just brought me into a rabbit hole of learning and really just to support my patients because that's the support they needed. And then, a lot of great doctors out there, but really didn't know what was going on. Mhmm. And if it wasn't an infection, it kind of was getting kinda put off as, like, it's in your head because I don't see anything. Swabs are coming back normal. And I believe my patients. And so I just wanted to learn more, and that's kind of brought in more people. And then, you know, that that kind of guides the courses I take for my own continuing education. And, so, yeah, that's that's kind of just how my clinical focus has evolved.
Speaker 0
Amazing. Amazing. So thank you for doing that because that's another, common thing with the experts we have on the podcast and that we work with in this space is them taking on a significant amount of education themselves to learn about what can happen in perimenopause. And their expertise really evolving and becoming what it is because of their clinical practice. Right? So what you said about women coming in, they've been told there's nothing wrong. But there's something wrong because they're uncomfortable and in pain and things just aren't right. And then you going down the rabbit hole to figure it out and then being able to apply that knowledge to other women as appropriate. So thank you because it's not, it's a lot of work. It's a lot of work.
Speaker 3
It isn't obviously super rewarding. Right?
Speaker 0
Well, obviously super rewarding. Right? I can't even imagine when you've helped someone. I mean, having experienced some episodes of burning vulva that like, I couldn't sleep. It was that atrocious. And when the relief finally came, I I words cannot describe.
Speaker 3
I believe it. It literally affects every part of your life. Like Yeah. Your ability to sleep, function, think, your relationship, everything.
Speaker 0
Yeah. Yeah. It's awful.
Speaker 3
It's awful.
Speaker 0
So Yeah. Should we get into, some of the common things you see in your practice, particularly for women who are in the perimenopausal stage and, you know, maybe not quite attuned to the fact that their hormones are going crazy and what that can and and what that can cause. And that it's not just hormones, obviously, but that certainly has a big, role in a lot of these things.
Speaker 3
Definitely. I would, so I would say that in in if we're talking specifically perimenopause, menopause, when I was learning about GSM, the genitourinary syndrome in menopause, I was taught that it typically happens later in the menopause transition
Speaker 0
Mhmm.
Speaker 3
And that it's something that, you know, might show up ten, fifteen years after that last period. Mhmm. And I would say that, like, that might be farthest from the truth because I see people before they've lost their last period definitely experience vaginal changes. And so I would say in, like, that realm, maybe maybe that's the most common I see is probably like that GSM piece, which is pretty well known and pretty well researched for treatments, treatment options for these patients.
Speaker 0
Yeah.
Speaker 3
But then there could be other things happening at the same time. There can be muscular pieces. There can be skin. And so, I I mean, I don't just see people in menopause anymore. I see for vulvar conditions or vulvovaginal conditions. I kinda see everybody because there really isn't too many people who, maybe even know all of the potential diagnosis that can Right. Come up.
Speaker 1
And the
Speaker 0
and the risk there, I would imagine, is that things get misdiagnosed.
Speaker 3
Yeah. Unfortunately, yes. And so, usually, when somebody comes in to see me, the way that the the the the visit is laid out, and I must say that I have the beautiful sorry. That's okay. I have the, beautiful privilege of time with my patients. Right? And I will never, like, it's the best piece of my job because this specific, focus would be really hard without that time. The first thing we do is, like, a super long history because most of the time, I'm not the first person they're seeing for this. It's just the way that health care is in Ontario, that's just not typically a natural patient. It's not the first person I go to. Right. And so that history will tell me so much because it'll tell me what they've done. It'll tell me what's worked, what's helped, what's made it worse. And sometimes that information actually helps guide me my investigation, figuring out what's going on.
Speaker 0
Right. When they How long how long is that appointment? Just out of curiosity.
Speaker 3
So if it's a vulva vaginal, I usually will block off about seventy five minutes. Wow. Oh, wow. Yeah. Yeah. Wow. Because, like, we are grabbing and, usually, I've also collected information from them before the appointment too. So I have them send in anything that's been done, and I've had a chance to, like, look over everything. This way, I'm coming in prepared too. Yeah. And, you know, when did it start? All all of the history, any family history, any medications you're on, all that. And then we will do a physical exam, and that tells me a lot too. But what I will add is that often on physical exam, everything looks normal. Right? And, that's because if usually it's a super obvious thing, somebody else has got it. Right. Yeah. Right. So I did some extra training in pelvic floor physiotherapy because in Ontario, naturopathic doctors are allowed to do, manual insertion. So I can do a a bit of an assessment with that too. If I wanna do any swabs, we can do swabs at that point. But usually, usually, it's more to, like, talk about where the pain is located. And so I I kind of based on talking to the person and oftentimes these patients come in so well informed. They have notes on everything they've been through and oftentimes they don't like, I can ask them a question and they know right away. And so
Speaker 0
to name all the parts of their vulva? Sorry to interrupt.
Speaker 3
Not great at that. And I'm
Speaker 0
just I'm curious how many patients actually are well versed. Probably not very many.
Speaker 3
Right? Not very many.
Speaker 0
And well And there's no shade on anyone. That's just that's part of our societal, you know, shaming of the vulva. Anyway, I start interrupt.
Speaker 3
Lucky that I can do that. Like, I take my time with the physical exam and say, like, I can point. But if you have five minutes and you can't be specific or where the pain is, it's really hard for the practitioner.
Speaker 0
Right? Yeah. Yeah. Yeah. So then
Speaker 3
I'm thinking about, like, location. Is it really deep, the pain, or is it kind of, like, right at the vestibule, like, right on insertion, let's say? Mhmm. And all these things are guiding me on what what I think is going on. And, I so I actually this this was not mine. I it was taught to me, and it was, like, one of the most useful things, but was putting these patients in one of four buckets. The first bucket being hormonal. So that's kind of like the hormones we talked about perimenopause postpartum. If it's because of a side effect of something hormonal like birth control or medications that are blocking estrogen. So that's my first bucket. Second bucket is muscular. So we're thinking of the pelvic floor. When the pelvic floor muscles are really tight, they can block, blood supply, which can cause a burning feeling, which might not feel like it's muscular, but it can.
Speaker 0
And
Speaker 3
that's usually where my, pelvic floor physios will come in. My third bucket is nerve related. So that can be if somebody's had a lot of chronic yeast infections, let's say, it can actually affect the sensitivity of the nerves, like, later. Even if you've cleared the infection, the nerve sensitivity, can be it's just very heightened, and then anything insertion will hurt.
Speaker 1
There's also forever or then they come and you have a solution
Speaker 3
for them? Can kind of do, like, nerve sensitivity training with some things, but Okay. Sometimes it it needs surgery. Oh, wow. Yeah. There's also a small group of people that are born with too many nerves inside of the vestibule. And Really? We would see real like, a lot of pain from infancy.
Speaker 0
Wow. The things we take for granted.
Speaker 3
Yeah. Right? So the solution for that one is surgery to actually remove some of those nerves. Wow. That that one is, like, nerve stuff is not as common. Sometimes we see nerve damage, people who have, like, been in accidents and hurt parts of their spine that might have, like, specifically hit the branch that goes to the vestibule, let's say. And then the fourth bucket is inflammatory. And inflammatory, we're thinking, like, inflammatory skin conditions, like, autoimmune skin conditions, like like in sclerosis, maybe psoriasis, ICV, vulvar, dermatitis, And then the second thing being infections. Those are the two inflammatory buckets. So as I'm talking to them, grabbing this history, doing the physical exam, learning about them, I'm starting to, like, place together which bucket I think they might be in.
Speaker 0
Right. Right. And it is wild to me. The the okay. Four buckets, fine. But what can be going on within those buckets? Wow.
Speaker 3
Yeah. Yeah. And so people will come to me, and on their intake form, they'll write vulvodynia. Painful vulva. And I'm just like, that literally tells me nothing. Yeah. When somebody comes in and is like, I'm a type two diabetic, we have a whole road map of, of, like, you're gonna do this first, then you're gonna do this. And if that doesn't work, we'll move to this. But with this, it's like, we really have treatment options, but you have to know where you fall in order to pick the right treatment. And so if we don't have the time to really, like, learn about the person and do the physical exams, then how can we figure out which treatment plan to give them?
Speaker 0
Mhmm. Well, like, how many women are wandering around with burning, painful, itching vaginas because they haven't had an opportunity to have a lengthy discussion with someone with the level of expertise that you have?
Speaker 3
Like In Ontario, I mean, I can only speak on my experience, but I have a very limited scope with what I can prescribe. So I might find I might be the first one to find the lichen sclerosis Mhmm. But I can't actually prescribe the treatment for it.
Speaker 0
So then what?
Speaker 1
And so yeah. So then what you
Speaker 3
And so that is but that's a challenge. I'm so like, I'm thankful that I've found practitioners now who I can work with, and refer my patients to specifically them so that I know that we kind of have a little bit more of a trained eye together. But sometimes, like, at the especially at the beginning, this was resulting in a lot of, my opinions, like, because yeah. And I'm asking somebody to do something with their license that I can't do that maybe they don't see.
Speaker 0
Right.
Speaker 3
Which was a challenge.
Speaker 0
Especially because my I know from my experience, with a vulvar condition, sometimes the treatments are, if you don't know about this condition and why the treatment is necessary, a well trained provider without that knowledge would say this is inappropriate.
Speaker 3
Exactly. Yeah. So when I would try to and and I would argue that a big piece of my job is helping to figure it out for sure, but also helping advocate for my patient to their practitioner, to give them the tools, to give them the words, to give them the knowledge so that they can show up to their appointment and advocate for themselves. But I'm also writing letters and, you know, trying to push for the right treatment too. And sometimes it's really challenging, and we get a lot of pushback. And other times, it's been great, and we have collaborative care. But But it's hard because, you know, people have come in and they've already tried a lot of things. They've they've feel, like, this is never gonna get better. And, I mean, that also contributes to the anxiety loop of all of this. Right? Of course. And then you have two of your practitioners who you value Trust. Saying completely
Speaker 0
opposite ends.
Speaker 1
Yeah. That's gotta be really challenging and very confusing. We're already confused and overwhelmed and don't understand a lot of this stuff. I could see that I would I would feel like, I don't know. Who do I trust?
Speaker 3
Totally. Totally. So I I well, I'll share a patient's story. I once had a patient who yeah. I might have been, like, the fifth practitioner she had seen. She had driven in drove from quite far for a physical exam. I did the physical exam, and I was pretty confident that it was like in sclerosis. Like, in sclerosis can be diagnosed clinically. Meaning, like, I can look at it, and it can you can give the diagnosis based on a physical exam. So I was pretty confident. I had seen enough of it, enough of, like, in to feel confident that that's what was going on. I wrote a letter to her doctor, and I I said, you know, I did the physical exam. I think this is what's going on. If you don't feel confident or comfortable with that, we can also do a skin biopsy. I talk to the patient about it. I like what that looks like just to confirm it. Maybe that would make the doctor feel better about writing the prescription. Anyways, with, like, a lot of back and forth phone calls, he finally agreed to do it. And, we were pumped. We're, like, really excited. Like, finally try something she hasn't tried. It looked like this was I was hoping this is not gonna work out. And then she got to the pharmacy, and the pharmacist wouldn't fill it and called the, called the family doctor and said, you know, these are ultra potent steroids. They definitely should be should not be used on sensitive tissue. And, then, understandably, the medical doctor because he kind of just didn't write
Speaker 1
it down. Yeah. Yeah.
Speaker 3
Yeah. He was like, yeah. Okay. Don't do that. And, anyways, all of this to say then the patient didn't get an opportunity to try our gold standard treatment for lichen sclerosis. And just an example of the barriers, sometimes barriers to finding the practitioner, but then also barriers to getting the treatment that that person you need.
Speaker 1
Well, sorry. I do wanna know dive down into what lichen sclerosis is, but how long was this process for this and what ended up happening for this patient?
Speaker 3
We ended up so she was, like, in the outskirts of the city, so I ended up getting her or asking her GP
Speaker 0
to
Speaker 3
get a referral to a Volvar clinic in the city who Okay. Yeah. So I was like, I think we're confident that this is like in sclerosis, and if I don't really wanna, like, jump around trying to get the prescription you need, so let's just get you in the right place. And, and she got it. Yeah. It was a long wait. The the wait times are are long to get in just because there's only so few people seeing, like, with the specialty and vulvar conditions. But we did she got in and she got her treatment, and it was like in sclerosis, and now she's doing great. And we do other things to support her or I do other things to support her with her diagnosis alongside her steroid treatment. And, yeah, and it all worked out. It just sucks because, you know, some people might give up there or some people not might not end up in my office with some
Speaker 0
Or how long did it take this patient of yours to get treatment for this? Yeah. It could be as pain
Speaker 1
as you get in years. Years.
Speaker 3
Yeah. Years.
Speaker 1
And is it painful? Like in gross sclerosis?
Speaker 3
It's quite uncomfortable and itchy, and the skin will tear really easily. So you get a lot of discomfort and burning. Sleep gets impacted because you're so itchy, and it happens to be more itchy at night. So maybe we talked we touched on GSM. Let's talk about
Speaker 0
lichen sclerosis and then maybe you can tell us about some of the other common things, that our peeps need to be looking out for and not putting up with.
Speaker 3
Yeah. So with GSM, that is I don't wanna say easy, but our treatment is pretty, like, straightforward now. The gold standard is, like, a vaginal local vaginal estrogen, and that comes in lots of different forms, whether it's gonna be a cream, a tablet, a a ring, lots of different options for treatment.
Speaker 1
Sorry. And quickly, GSM, what what are the symptoms if people don't know what that is?
Speaker 3
GSM is the genitourinary syndrome of menopause, and so it's the vulvovaginal and urinary symptoms or changes that happen because of the loss of estrogen. And that might look like dryness, itching, pain with sex, pain with urination, increased risk of UTIs. Then you might actually see physical changes. You might see some, like, hypopigmentation. You might see, some labial reabsorption or, like, the the, the smaller internal labia is kind of, like, getting smaller. And and some people don't like, not everybody comes in being like, I have vaginal dryness. They're just like, yeah. It's different. It's like Mhmm. People can't always pinpoint it. Not everybody is actually active, so not everybody's coming in saying painful sex. And so, but it is quite common. It's like eighty seven percent of postmenopausal people are going to experience it. I think a hundred percent at some point in time will experience it. That's my my personal clinical opinion. And but we have lots of treatment options.
Speaker 0
Mhmm. Including that's what's away on its own. So And
Speaker 3
it needs to be treated. Away on its own. Yes.
Speaker 0
It needs to be treated. Exactly. Yeah. And can get really bad as well.
Speaker 3
Like And will get worse over time if it's not treated. It's, I often tell people, like, you know, the hot flashes will eventually get better. Eventually, that might be ten, fifteen years, but it will eventually get better. The vaginal changes, vulva vaginal urinary changes will just progressively get worse if not treated. And so we have lots of treatment options. We have moisturizers. We have vaginal, hormones, whether that be estrogen. I would say most people probably start with estrogen, but we also now have approved DHEA that can be used, which the DHEA gets to turn into both estrogen and testosterone. Some people need more of the testosterone support in the area. There are both estrogen and testosterone receptors in the vagina, and so sometimes we gotta support both. And I would say most of the time, that gets rid of
Speaker 0
it. Yep.
Speaker 3
Whereas some of these vulvar skin conditions, like like in sclerosis, like in planus, I see a lot of vulvar psoriasis and a lot of vulvar, dermatitis, so, like, even eczema. And we don't treat it any different than if it was anywhere else on your body. We always say skin is skin. We just, people feel it's different because of what it is. But it doesn't really get treated differently, at least not from my perspective of when I treat this. I also see recurrent UTIs often, and a lot of times, those are fixed with estrogen. Sometimes we can do cranberry and supplements to support them in a preventative way, but a lot of times, it is those hormonal changes that will impact it because it's a that's why they actually changed the name of GSM. It used to be called vaginal atrophy, but that didn't and we did love that term, but also it didn't include the urinary changes that happen because of the loss of hormones. And so those are things I see. I see a lot of recurrent yeast infections, recurrent BV.
Speaker 1
Sorry. What's that? Bacterial bacteria? That's And what is that?
Speaker 3
Bacterial vaginosis is interesting because it's not actually a infectious bacteria. It's more of a dysbiosis or unbalancing of the, quote, unquote, good and bad bacteria. We want more of certain bacteria, and we want less of others. It's normal to have them all there, but then as soon as that balance kind of, like, tips to be more favorable with the quote, unquote bad guys because they're supposed to be there. They're just only supposed to be at a certain level. Soon as we see that tip, people will get symptoms. And so we might see gray or green discharge or smelly discharge, itching, and then even sometimes you'll see the actual vaginal tissue really inflamed and red.
Speaker 0
And what do you do for that?
Speaker 3
So usually, BV is a quick antibiotic. Like, an adrenaline will get rid of it. But I see those, but honestly, not that much because, again, those are
Speaker 1
obvious. Yeah. Something that your practitioner has seen and is comfortable with. Yeah. Right. And and is that like a topical antibiotic or an
Speaker 3
oral antibiotic? They will often do either an oral. Like, it's usually more often an oral for BB, and then a yeast infection is more an anti fungal, and those ones can be oral or a suppository.
Speaker 0
Mhmm. And
Speaker 3
then sometimes we get so then what can happen if the vaginal flora starts getting a little bit like, it stays tipped like that, we just see more infections. We might see more yeast. And that's why after somebody goes on, let's say, antibiotics for strep throat, unfortunately, we don't get to pick where that antibiotic kills things. It kills them where you're infected, but also maybe in the gut and maybe also in the vaginal canal. And then that might be the thing that tips it over, and you might get a yeast infection because of it. Yeast has the opportunity to overgrow. The hard part about treating vaginal infections is that a lot of that bacteria is supposed to be there. It just needs to stay in this beautiful, like, the ecosystem is made to thrive. And as soon as something throws it off, you can see infection, which is what happens in people who use products that are not considering that. Things that might throw off the pH or might feed some of that bacteria, then you might throw them off and then increase risk for infection. Right.
Speaker 0
Which is why you created virus products.
Speaker 3
Which is why we created them because I was looking at all this in my clinical practice with my patients, and I'm like, yeah. No. You can't use this lube because every time you use it, you get a yeast infection because it's the pH is too high or because of the glycerin in it. And I don't ever like to villainize any ingredients, but for some people who are more sensitive, those ingredients do make a difference. There's people who can use these things that have no issues for sure, but that's just not who is walking into my office.
Speaker 1
Yeah. Yeah. So for UTIs, recurring UTIs, vaginal estrogen is the gold standard. For someone who's getting recurring yeast infections, is there a gold standard
Speaker 3
that fits that? So no. Probably not. Okay. We have certain medications that are in the Azle group that we'll try, and there's the first one most people will try. And then if that doesn't work, there's other ones in that, grouping of medications. Sometimes it's more about actually repopulating that good bacteria too at the same time. We can't just kill the yeast. Sometimes we gotta support some of that good bacteria that is missing. Right?
Speaker 1
Is there, like, vaginal probiotics? Like, what do you do for that? Oh, no way. Really?
Speaker 3
Probiotics. There's oral probiotics. And you wouldn't believe how much, your diet plays a role in the bacteria that grows inside of you and even vaginally. I I was I remember being in school and learning that the microbes literally walk from your butt over because I was like, how do they get there?
Speaker 1
Oh, really?
Speaker 3
Yeah. Yeah. Or, you know, hygiene things. And so that's why the diet will also, influence the type of bacteria and the diversity in the bacteria, which diversity is the key here. Right? Yeah. If we have too much of something, you get symptoms. You have if you have too much good bacteria, you get you get symptoms. So it's just like this perfect balance. And so I'm trying to figure out based on history, based on exam, based on talking to you, where are you off? Have you used a lot of antibiotics in the past for your acne or for whatever? And, like, that kinda helps me decide, okay. You probably need probiotics, some, diet and fiber support, and that's how we make the plan. I would say when you have an active infection, whether it's a UTI or BV or a yeast infection, I am very much of the take your antibiotics during this acute active infection, and together, we will work on you not getting another one. But in this moment lifestyle Yeah.
Speaker 0
Considerations. But, like,
Speaker 3
what people will call, I have a UTI. I don't wanna go on antibiotics. Can I book an appointment? And it's like, no. If you have an active infection, please take the antibiotics. We'll do a probiotic with it. We'll do other things, and then we'll try to avoid another one. But we are like
Speaker 0
Yeah. We don't want nerve damage.
Speaker 1
Yeah. Yeah. Yeah.
Speaker 0
Or what I mean, that's a that's a severe case, but, like, yes.
Speaker 3
We don't want your UTI to travel to the kidneys and you end up septic. Gosh. Yeah. Yeah. So and so that's why my appointments and my patient, we are in it. I tell them that every single patient at the first appointment, I tell them we are in this together for the long run. There's not much that happens in one appointment. Like, there's lots that happens. But if we're looking for prevention, we're looking at the the hard things, the things you're doing every day to to make this work better long term.
Speaker 1
Makes sense. Okay.
Speaker 0
So I think we've covered, like that's a great overview of what can happen, to one's vulva. And I mean, presumably, a lot of this stuff impacts the vagina as well. But I think the vulva is kind of the it's been really ignored. But that's the epicenter of where most of these conditions really are problematic. Is that fair? Yeah. So what for people who can't access you or, you know, have been dealing with this ongoing whatever it is. I think we've made clear that they need to get it taken care of. How would you how would you advise them to go about being heard and taken seriously?
Speaker 3
I think that the most important thing is to write everything down. I know most people do, but I I can't tell you how helpful that is when somebody has come in and they know exactly where it hurts, exactly when it hurts, what has makes it worse, what makes it better, really just helps the practitioner. And there are people who will have a focus in it. You can I I'm pretty sure Ishwish, they do? They have a directory online that have people who are interested in in sexual health and things that are related. And even if the person is not necessarily the goal is not penetration, let's say, these people are just more well versed in vulvovaginal conditions. And so that might be a place to go
Speaker 0
To find a practitioner who has some skill.
Speaker 3
Right. Yeah. Right. Yeah. And there's practitioners, I think, all through North America on there.
Speaker 0
Okay. Amazing.
Speaker 3
The whole world. Yeah. And really, like, not giving up if you feel like you're not being heard because a lot of times people have come in and they were like, yeah. I know there's nothing there, but I feel something. And, it really gets pushed on it being in your head, and and patients come in feeling like like like like I'm not gonna believe them. It's almost like they really wanna have to justify and make sure, but I do believe them. And and there are people who believe you. And, the more they know, the more they can advocate for themselves, even understanding what some of these diagnoses are. We do have access right now in twenty twenty six to so much knowledge. And while you might not be able to diagnose yourself or run some of the tests on yourself, you can learn about these conditions.
Speaker 0
Amazing.
Speaker 3
Amazing. Thank you.
Speaker 0
Thank you. Always so great to chat with you. Thanks so much for listening to the show. If you like what you hear, please subscribe and write a review.
Speaker 1
So more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 0
This information is not intended as medical advice. The intent of this information is to provide the listener with knowledge to support more efficient and effective communication with their medical provider.
