Episode Transcript
[00:00:02] Welcome my outside the box thinkers to the Anti Aging Unraveled podcast where I am your host, Dr. Lori Gerber. In this podcast we will explore the fascinating world of personalized anti aging medicine that considers the whole person inside and out and how all systems are interconnected to each other. In today's world of modern medicine, we often find ourselves like just another number in a system that prioritizes quick fixes or over sustainable and more natural solutions.
[00:00:32] Well, let's get ready for a paradigm shift in health and beauty. We look far beyond treating symptoms and aim to get to the root cause of our health and cosmetic issues. This podcast is your go to source for all things natural, outside the box and innovative in integrative medicine and cosmetic dermatology. So sit back, relax and get ready to dive deep into the world of functional medicine and aesthetics with me, Dr. Lori Gerber.
[00:00:58] Let's take a trip down the real skin revolution pathway together.
[00:01:03] Hi everybody. It's been a while, so I'm happy to be back. This is the next episode of Anti Aging Unraveled and I apologize for making you all wait, but I think I'm back on a good trajectory to get these out to you regularly. And I'm really excited to bring you a title and a topic that is really hush hush and not talked about. And that topic is Vaginal Rejuvenation and we're talking about hormones, herbs and high tech healing. So we're going to talk about some different types of lasers, things like that. And for me this is really where we start to redefine regenerative wellness and really empowering you to age the way that you want to. Because really people aren't talking about vaginal pain, pain with intercourse, dryness and the discomforts that happen even before menopause, but a lot of the time with menopause as well. So I'm really happy to talk about this topic with you and really go through some of the most important protocols and things to think about with vaginal health and vaginal healing.
[00:02:01] So, you know, it's time to reclaim this topic and talk about this topic on our terms. And I'm shining the light upon this topic because it really is whispered about. You know, someone will come into my office and make sure the door is shut and just say, hey, can we talk about, you know, vaginal rejuvenation? And they'll, their voice will go down, their tone will go down, and like I said, it doesn't matter if it's postpartum or perimenopausal. We have Women that have other reasons to have labial issues or bacterial imbalances, immune imbalances, that really need the help in vaginal comfort. And these are things we should talk about openly and honestly. And vaginal dryness, loss of intimacy, specifically, especially younger age, is very, very detrimental to a relationship, but obviously an older age too. As we go through menopause, we want to make sure we protect that and, and try to keep that so it doesn't have to be hush hush, doesn't have to be quiet. And we're going to talk about this today. We're talking science, hormones, herbs, oxytocin, lasers, dhea, and how we can create what I like to call a life Jevity protocol with our Real3 method, which is really just focusing on bringing things into light that are regenerative and healing into our practice to help you feel connected, confident and strong.
[00:03:17] And this is successful aging, or aging the way you want in our book. So let's talk a little bit about what's happening down there. So estrogen is really important and, but it's a late decline.
[00:03:28] So what happens early on is we get some testosterone decline initially. And testosterone is a really important topic in women's vaginal health because it does improve some lubrication.
[00:03:39] So when we talk about loss of testosterone, it happens sometimes even in our early 30s and that loss, even late 20s, actually, I've seen it both. Or that someone just starts out low on the bell shaped curve, right? It's something that they're just not used to having a lot of. And when their numbers dip down, they lose that vaginal lubrication. And they also lose some sensitivity to orgasm. So we can work with things that will sensitize the clitoris, that will actually give back some vaginal moisture without necessarily starting hormonal therapies. And we're going to talk about that. But that's one of the first things that starts to affect women when they start going through hormone changes, PH changes as well, especially when women go on birth control.
[00:04:21] When women change their diet, suppose they were eating keto for a long time and then went off. Or maybe they actually were eating gluten or not eating gluten and then went off the wagon. We see a very big ph fluctuation with just dietary changes, or they started running and started new exercise routines. Those can all do it. And when that PH of the vaginal tissue changes, it actually starts to usually rise and then yeast can grow and other things can happen.
[00:04:49] So what I would tell you is that we really need to be conscious of things that can Vary our vaginal pH, which is extremely sensitive.
[00:04:57] All right, so let's add pelvic trauma to the list. You know, there's lots of reasons for pelvic trauma. It could be someone that actually has a lot of biking experience and does a lot of ironman training. But it could also be post birth or sexual changes after puberty or even after your age 40, when our, our whole uterus and the whole, the whole pelvic floor starts to change, or even a sexual assault can set all of this into motion. And then we really don't have vaginal comfort. So this is just the tip of the iceberg. The last thing that starts to happen is estrogen starts to change. And estrogen can change for a lot of reasons. It can change with weight loss, it can change with, with birth control. It can change with IUDs. Specifically hormonal IUDs. It can also change with menopause and peri. Perimenopause and perimenopause. So when we start to get that estrogen dip, or any kind of alteration in our estrogen that makes it go down, the vaginal mucosa suffers.
[00:05:58] Estrogen makes the lining of the uterus and the muco mucous membranes thicker. And when we lose that, it starts to get a little thinner, a little drier, and then the ph changes too. So you get irritation, you get some sandpaper like feeling. And maybe you get a different back bacteria or different bug, even different yeast. And we're going to talk about that. And then things start to fluctuate and shift.
[00:06:20] So when we talk about the perfect storm, it's usually cumulative. It's not one thing that creates vaginal issues. And even when we talk about something called lichen sclerosis, which is a scarring down of the vaginal tissue, that's an autoimmune tipping of the iceberg, if you will. And that autoimmune tip starts to make the mucous membranes very tough and scarred. And that can actually be helped by treating the vagina as well. Well, so this isn't vanity, guys. This is biology. It's what happens. And you know, you deserve more than a hug, kind of from your local OB GYN and a tube of lube. Right? You actually deserve real help. And that's usually what we get is, hey, a little tap on the shoulder, just do some lubrication, put a date in your phone for a reminder to have sex and deal with it. That's not the way this has to be. So let's talk about some things that we can do that are hormonal and and I'm going to then we're going to go backwards. So we're going to talk about topicals and oral. I'm going to start with topical estrogen. So there are lots of topical estrogen formulations that work and I will tell you that there is bioidentical, there's ones that are prescription, that are pharmacologic, made from your pharmaceutical companies and there's actually over the counter topical estradiol and estriol serums.
[00:07:40] There are three types of estrogen.
[00:07:42] Estradiol is our mid potency estrogen and it does improve hydration and thickness and helps with the comfort but and it has some systemic absorption but when it's topical it's not a lot. So it doesn't get a lot. There's not a lot that goes into your bloodstream. This can be taken as an oral loinger under your tongue as well. Especially for women that are actively in menopause that need help a little more systemically. We like to usually mix this with what we call estriol, which is a very weak estrogen but it's really good for the vaginal mucosa. So we tend to use this in serums that are actually over the counter. One of the ones that I like to use is by Quicksilver. It's our vaginal beauty serum and that has the estriol in it, which I really love and it has a little bit of estradiol in it. So it's going to give you some other stuff as well. But we'll talk about those. And it's a little low dose topical and then you can go up to the prescription topicals if you need to. And like I said, we can always do an oral version if we need to get a basically someone that's either postmenopausal or needs a little help in in that department and can't get good absorption for whatever reason.
[00:08:52] So that is really foundational for most women. It's really not contraindicated for most people. There's very few reasons to say you can't have topical estradiol or even topical estriol or a combination of both which we call BI EST for 99.9% of women. I even have my post breast cancer patients on some of this, especially if they're five years out. If they're not five years out, we talk about estriol and how weak it is and with very little systemic absorption. And that's a really Nice adjunct for them that is very safe and we check levels. Something else that's available both at the pharmacy and topically and as a liquid is dhea. DHEA is a beautiful option for those that maybe can't use estrogen, don't want to use estrogen, but it's a, what I call like a, a pro hormone or a precursor hormone. And DHA is an interesting molecule. The only downside to DHA is you can't pick what direction it goes. It can make any hormone.
[00:09:52] So we wanted to preferentially, in this case, make estrogen, which it doesn't always do. It can make testosterone and it's really hard to pick what direction it decides to go. But we do really like quicksilver makes actually a nice liquid under the tongue for hormone support, which does have a nice effect on some vaginal lubrication and mood. And also there's topical DHEA available as well that you can use intravaginally or commercially. They have an ovule that can be used of DHEA that you can place vaginally as well. So increased libido, increased tissue tone and lubrication. I mean, and someone that's on these two things or a combination of these two things with, with herbs and some of the other regimens, I mean, really are going to be super happy. They're going to find their sex life back is. Is probably the most enjoyable they've had in a really long time. A patient once told me that by day three, because this happens pretty quickly, guys, within about a week to 10 days, they cried because they had relief from their itching and irritation. They were actually able to have sexual intercourse, which they haven't been able to do without irritation afterwards.
[00:11:01] So this is what we mean at Dr. Lurie by wellness redefined. We're giving a new label to someone who wants to age successfully and age the way they want to, and not putting them into a box and just giving them lubrication. We're giving them real healing results.
[00:11:17] Now, these things you do need to kind of stay on. They don't need to be stayed on every day necessarily, but they should stay on them long enough enough times during the week to keep the results. So usually what I'll do is I'll have them do daily until they get results, and then they go to about three times a week to four times a week if they need daily because they're postmenopausal, which is possible, they might need daily. So, and as long as we're checking levels and we're Making sure blood counts look good, then I'm not concerned. And we do check level even on my topical prescription, estradiol or estriol patients, my topical over the counter ones, typically speaking, I'm not checking lab levels with them because there's so little systemic absorption that it's really not necessary. So. All right, let's talk about what else. What else is there that is not a hormone? You know, there's a lot, actually. There is. There are herbs and there are precursors to like, kind of like our fillers we're going to talk about. So if we're not ready for hormones or we want to layer extra support, which I do a lot, I tend to layer these. I'll go the lowest dose of hormones needed and I'll add in some of these other therapies, one of which is using a compound with hyaluronic acid, which is what's in our fillers. Right. It's actually what holds onto water. It's a lubricant. So I will use hyaluronic acid topicals vaginally that are one specifically for vaginal mucosa. Quicksilver's vaginal one does have hyaluronic acid in it.
[00:12:44] We'll use that with aloe and vitamin E restoration topicals. Works really nicely in combination therapy. I will drop links to this in the podcast links for you. I'll drop links in the chat for you in the description so that you guys can see these on the website as well. Well, okay. Pelvic floor therapy. I love pelvic floor therapy. It is not just for bladder leakage. I will tell you. A lot of women use it obviously for bladder leakage. But think strength, flow and intimacy. You will get such great core, or I would say subcore strength. Your uterus will actually lift up if it's done appropriately, and so will your bladder. And you'll get some strengthening that actually gives you some more room, if you will, in the vaginal canal and actually will help you a lot.
[00:13:31] So think about intimacy and pelvic floor therapy also for women that might have lichen sclerosis. I like pelvic floor therapy and using dilators to help to keep the vaginal opening or canal open. Because what's going to happen over time with dryness as well is that canal is going to get smaller and that's going to allow for micro tears and stretching, which we don't want.
[00:13:53] So combining dilators and pelvic floor therapy with some of these herbs and even the hormonals will do A great job layering into your plan is part of the way that we help you age your way. It's strategic and supportive and it's really empowering to have these tools to be able to bring to your vagina, for lack of a better way to describe it. So let's talk about some really fun things. There's some really cool lasers out there. They're all different names, so I don't know that I'm going to bore you with a ton of them, but I'm going to really talk about the technology behind them.
[00:14:24] There's one laser that we have at the office that I love. It's called the votiva. The votiva is radio frequency. So think about radio waves as a wave, as a squiggly line heating up the mucous membranes of the vagina.
[00:14:40] You heat up the external and you can heat up the internal canal. And by doing this, just like most other lasers that we use for tightening, we're building collagen by heating it up and improving blood flow. So you're getting improved blood flow, tissue and tissue tone. And by doing that again, what's going to happen, you're going to actually lift up the bladder, actually you're going to get some more mucous membranes in there, it's going to be more lubricated and you're going to have improved sensation and satisfaction. So it actually improves the orgasm and blood flow. So postpartum women especially often report improved sensation. When you start to stimulate that area, the clitoral area, and usually the external and right on the entrance of the internal canal with this votiva, it does not hurt. It gets mildly warm. We do them in about series of three to six sessions, about six to eight weeks apart.
[00:15:33] Collagen does take time to build up, so it does take a little while to see these results. But I will say the results are pretty impressive. They're even more impressive when it comes to doing these for women that have been abused, sexually abused, or with lichens sclerosis.
[00:15:50] So I say, you know, this is a really good adjunct to therapy, especially if someone doesn't want to do hormones or in addition to, so that they can keep their hormone levels really low. One of my favorite products, there's also some other lasers on the market. I'll drop that into the notes as well so that you guys can take a look at a link on Votiva. There's also CO2 lasers out there. And CO2 lasers are lasers that actually will slowly start to resurface the skin and while that sounds traumatic, right. It sounds like it could be damaging when you do that on a micro level, you'll actually get new collagen deposition. Your body will think it needs to come in and heal and repair and that's going to build collagen. But it's also going to help the PH of the skin and enhance the tone with which you're able to contract and the tone with which you're able to lift up the uterus.
[00:16:40] So and it does have pretty quick enhancements. It is uncomfortable. I will say CO2 laser, the Mona Lisa is one brand is slightly uncomfortable, but you do see nice results of collagen building. And I know lots of practices that do combo these two lasers together and they alternate them. Let's talk about kind of some more power packed herbs. And it's a peptide actually, or a prescription.
[00:17:06] And one of those is oxytocin. Oxytocin is really interesting and without going into a whole science lesson, it's basically regulating our pleasure center essentially. So it's really good for mood.
[00:17:19] So we use oxytocin a lot for mood in the peptide and regenerative world. We use it for libido as well because it helps to regenerate that epithelium of the lining of the vaginal canal and the external vagina reduces dryness as well as. So if we're not a hormone candidate, we don't want to use hormones. Oxytocin is really nice and you can use it as a vaginal gel. You can use it as a nasal spray too, especially for mood. I've seen it used that way as well. But it can be used vaginally as a nightly cream and the results take about a week, but sometimes longer. I would say up to two, two to four weeks on, on average. Let's talk about some other fun ones. So I love. There's a probiotic that we use called Vaginal Balance by Microbiome.
[00:18:04] Vaginal balance is wonderful. Anyone that's treating any kind of vaginal discomfort needs a vaginal probiotic. And the data is becoming more and more and more convincing on this. And actually if you want to really read the data, you can go to Microbiome's website. They have a really good site on, on the studies that were done with this vaginal balance. But it's anti yeast, it's vaginal ph regulating. It helps to actually even your skin tone out and metabolism. So actually finding that it helps with weight, which is really, really interesting. It's also mixed with cranberry and three different probiotic species.
[00:18:38] One is Sarcomyces crispitus, Sarcomaces rhamnosus and Sarcomaces gasseri and Gen sensi.
[00:18:47] So why are these important? Oh, sorry. And LA5. LA5 is an acidophilus species. These five have been really shown together to really synergistically help one, like I said, with that metabolism boost. But two, to really enhance the vaginal microbiome and replenish the pH back to normal acidic environment, which is really important. They do this with a cranberry powder mixed in, which also helps for UTIs and also it doesn't allow for bacteria sticking. It's great for mild to moderate dryness, especially early on if we're not ready for hormones or some of these other modalities. And I use it almost always in combination with, with my hormones.
[00:19:26] Other ones that are really gentle, they're plant like I would say they're estrogen, like as far as supplements go, fennel and licorice. And there's a Citrus orontium which is a really interesting one too. But those tend to be found in a lot of our over the counter topical preparations that promise to heal and help with dryness. They work. They're just think about them as molecules that look like estrogen. So they start to create like an estrogen like effect in the body. And which is good for hot flashes too, right? You've heard a lot of people say licorice for hot flashes, fennel, but it also helps with some of that vaginal wasting away. So let me talk to you really quickly about one of my favorite success stories. She was a 58 year old female who came to me with no other complaint but painful intercourse. And she went to her OB GYN and her OBGYN did the stereotypical. Here's some lube, start using lube. And it was so bad and so painful that she would actually start having some blood. She would have to start having some like spotting when she wiped and she was so uncomfortable she would make her husband stop having sex. So she had scarring on examination of really just her whole introitus, the whole entrance to her vaginal opening. And just FYI of note, had normal vaginal deliveries with her babies and had no problems with the vaginal delivery and no scarring.
[00:20:52] So intimacy was her biggest complaint. And you know, and obviously low libido. So she also had burning all the time during the day and would complain that it was like itchy and burning and like even when she would put on leggings like it felt like. Or even jeans, she felt like she couldn't wear them. And she was kind of diabolically. She really at first didn't want to start laser therapy and she really just wanted me to give her creams to make her better. And I did eventually convinced her to do votiva. So what we started her with was because she was so uncomfortable. We started her with a prescription oral because she was postmenopausal. We did a biased troche in 8020 of estriol and estradiol, really low dose. Then we also gave her some DHEA topically with a vaginal probiotic. All right. And the DHEA topically also had some green tea in it, which I don't think I talked about, but green tea is a really good add on as well with the DHEA to build up mucosa. So we gave her the vaginal probiotic. I actually did it as a suppository for the first week. And then after the first week, I had her take it orally. We soaked it in coconut oil until it got really soft and was almost like almost dissolving. And then she did it as a nightly suppository for the first week. I had her come back. Let's see, how many weeks is that? After about three weeks I had her come back because I convinced her to do the votiva. And we start with our sessions of votiva. But I want to tell you, after two weeks, she messaged me online and said, I cannot believe that no one helped me with this before because I have no burning or itching. When I put my pants on, I was able to have sex. It didn't hurt. It was a little slow going because obviously she's, she's getting a little closed up, but no pain and no tearing.
[00:22:45] So. And after we've done three, we've done actually three Votiva sessions and she signed up for another set of sessions. But her three Votiva sessions, she's like a completely different person. She's got, she's got lubrication, she's actually got adequate discharge, not inappropriate discharge. And she's a happy, happy person.
[00:23:05] So just to put it out there, I mean, it can come back pretty quickly within. And. Oh, sorry. We did do a little bit of testosterone after that to help her with her libido. And we actually did some topical, we call it a scream cream to enhance some of her sensitivity upon having sex for the first couple weeks. But the testosterone and the little bit of scream cream did the trick with her libido. And that was done. That was done after the first couple votivas because we wanted to see if the votiva would give her enough sensation back where she would feel like she could orgasm again.
[00:23:37] Whole new person.
[00:23:39] So just that's what it's meant to age her way. Like she aged the way she wanted to and we helped her get there.
[00:23:44] So safety and efficacy. I mean, these lasers are amazingly safe. Obviously you want someone doing it in the right hands, but really, especially with radio frequency, there's kind of no way other than under treating it. There's really no way to mess it up. And it's pretty impressive how quickly the results start to happen. Oxytocin, to me, is a safe and emerging and exciting treatment protocol. And especially for those PMDD women that also have vaginal issues or emotional pmdd, just with anxiety and depression around the time of their period, really, really great option. And also for obviously postpartum anxiety and mood swings, as well as vaginal mucosa. The herbs and botanical bioidenticals and botanicals, there's some great mixtures out there. You just have to know what ingredients are good and then honestly, what brand is actually giving you good quality ingredients. And that's actually where we come into play. I have all my patients check in with me. If they found something online that they want to try to use, send it to me. I'll look up the company, I'll see what ingredients are in it. I see if they do third party testing, make sure you're getting what you pay for and make sure that the PH of the product you're using is meant for the vagina. A lot of people tend to use face products down there and that's typically not a good idea because the ingredients, some of them have alcohol bases, some of them are too strong for down there and they'll absorb too strongly. So that's a really kind of a no, no. You want to make sure something's approved for the vaginal area or that you're instructed to do that. And then tracking your progress is really important. I think tracking progress and understanding on a scale of 1 to 10, 1 to 5, what's better, what's worse is the most important. I know my women that just choose to go to pelvic floor therapy. It takes a while. So we're constantly tracking their symptoms. You know, how many times do you have bladder leakage with your workouts? How many times did you have painful intercourse? Was it pleasurable? Any of those times? Did you not have any bleeding? Did you not have any cracking or irritation? Were you able to get your. How many of your pelvic floor exercise were you able to do that week? How many do you need to maintain the results? Because that's part of it. Once you build up that muscle and mucosa with any of these topicals or any of these muscle exercises, it needs to be maintained because your body naturally wants to lose it with age, whether it's muscle or mucous membranes. So how much do we need to do to actually maintain that? It might be three days a week, it might be every day. And that's really important to make sure, you know, and document for yourself. So there is no one size fits all with this, guys. But the whole point of this is to age successfully and age the way that you want to age and to talk about vaginal discomfort. My younger women, they think it's like so taboo to talk about vaginal discomfort.
[00:26:29] Older women, they're like, all right, I know I'm in menopause. It might come out more. I want to hear from those younger people that are getting recurrent yeast infections, that are getting recurrent BV or bacterial vaginosis, that have discharge intermittently and they can't get rid of it. This is a ph disorder, guys. This isn't, you know, this is an immune system issue. This is a ph problem, and this is a vaginal mucosa problem. So we need to fix that in order to get this to calm down. It's an underlying sign of something going on that's not normal. We don't want to let those bugs take over. We want to have a good, healthy microbiome down there. So it's really important to talk about it. Even just anatomy, someone loses weight, we have labia that are just not inflated anymore. Well, what happens when you basically have a moist, damp place? We get new bugs and new bacteria and a new ph down there. So we need to adjust for that. Maybe surgery, maybe it's not. Maybe it's me just getting you on some herbal topicals to help the ph and make sure it doesn't happen. There's also some oral herbals that you can take to reduce yeast content. One that I love is called Candocid Pro, and that is actually kind of an oregano based anti yeast product. I'll pop that into our notes as well. But it's a great product to reduce yeast in. Someone that has an overactive yeast problem or eating a ton of sugar and you know that they have a yeast problem.
[00:27:53] So I 100% recommend you talking about it, opening up about it, shooting us a message. You can shoot us an email or you can shoot us a message on our website mydoctorlori.com it is secure. It will come through as a HIPAA compliant only to our staff to direct to the right provider or associate to help you. So you don't have to worry about messaging in that regard. So I think the take home message with this is you're not broken, you don't just need lube, you don't need to just deal with it. These are all transition phases. Whether you're transitioning because you lost weight, whether you're in puberty for kids. I do treat children and the teen ages that have this stuff. They're transitioning with their hormones. Is it that you're an athlete and everything is changing with what you do on a daily basis or is it pregnancy or hormonal changes? We can do something for just about anybody and you can reclaim your intimacy and not have discomfort, live beautifully, vibrantly, powerfully and take basically your vaginal health into your own hands and not be blown off. So head to the show notes, like I said. I will pop them in for the Votiva, the Candesid Pro, for the Quicksilver products topically that you can use down there, the Microbiome Vaginal Probiotic. I will pop into the notes. I might be able to pop in one of our trackers that helps you to track your symptoms and maybe some of the the key points of this podcast that you can have it so you can look up some stuff. But I would highly encourage you. We do have a what's called our HOPS program. It's a short vaginal protocol program that it's almost like a bundle with a little self checker that helps you to figure out what products to buy as a bundle and then it rechecks you again in six weeks.
[00:29:42] It's a 12 week protocol and if it works, you obviously stay on it. If you need additional assistance and it's not working, it'll actually direct you to one of our providers. So that is on our website mydrlori.com as our hops program.
[00:29:56] There's our female hormone hops and there's our vaginal hops, vaginal health hops. So please, I encourage you to go look them up or you can just look in the notes, click on the products and we'll help you find the bundles. If you can't find the right bundle for you, feel free to just message us us. All right? Guys, I am so excited to bring this topic to light. We do have specials and bundles on the Votiva at our office and refresh in Newtown. Lauren, my PA will be happy to do those for you. She's the primary person.
[00:30:27] We call her the Vaginal Rejuvenation Queen, so she's been doing a ton of our regenerative lower half, if you will, patients.
[00:30:34] So join her in the Lifeevity Real 3 Revolution of Vaginal Health and I hope you join me for my next podcast and I thank you for listening. Until then, guys, talk to you soon.
