In this conversation, the speakers delve into the significance of the vaginal microbiome, particularly its impact on women's health and fertility. They discuss personal experiences, challenges in diagnosing infections, and the importance of understanding the microbiome's role in overall health. Various testing methods and treatment approaches are explored, emphasizing the need for individualized care. The conversation also touches on the influence of diet and lifestyle on vaginal health, as well as considerations for pregnancy and postpartum care.

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Takeaways

The vaginal microbiome plays a crucial role in women's health and fertility.

Personal experiences can drive specialization in niche areas of health.

Recurrent infections often have underlying causes that need to be addressed.

Testing methods for the vaginal microbiome are evolving and becoming more comprehensive.

Patterns in microbiome testing can reveal insights into broader health issues.

Treatment approaches must be tailored to the specific type of infection present.

Diet and lifestyle choices significantly impact vaginal health and microbiome balance.

Microplasma and ureaplasma infections are often overlooked but can affect fertility.

Pregnancy and postpartum periods require special attention to vaginal health.

Individualized care is essential for effective treatment and management of vaginal health issues.

Chatpers

00:00 Introduction to the Vaginal Microbiome

03:13 The Importance of the Vaginal Microbiome in Fertility

05:57 Personal Journey and Challenges in Understanding Vaginal Health

09:00 Diagnosing and Understanding Recurrent Infections

11:53 Testing Methods for Vaginal Microbiome

14:55 Patterns in Vaginal Microbiome Testing

17:45 Treatment Approaches for Vaginal Infections

20:48 The Role of Diet and Lifestyle in Vaginal Health

23:56 Understanding Microplasma and Ureaplasma Infections

26:51 Pregnancy and Postpartum Considerations for Vaginal Health

About my Guest

Greta is a clinical naturopath working in the area of sexual health and the vaginal microbiome. With a wealth of knowledge and expertise in the field of vaginal health, Greta has become a sought-after practitioner and educator on the topic of identifying and treating even the most complex vaginal health conditions.

Connect with Greta here:

Website: https://www.gretanaturopathy.com/

Instagram: https://www.instagram.com/greta.naturopathy/

Connect with Dr. Jane Levesque

Website - https://www.drjanelevesque.com/

Instagram - https://www.instagram.com/drjanelevesque/

Facebook - https://www.facebook.com/DrJaneLevesque/

Hi Greta, thank you for being here. Thank you. Yeah, we met our we have the same mentor, Dr. Leah Hetchman. And how long have you been following Dr. Leah?

Thank for having me.

Well, in Australia, she's kind of like the... in naturopathy. So our textbooks in our degree are written by Leia. So I'd say the last 10 years I've been following her.

Amazing. Yeah, I found her only a couple of years ago. And I mean, I took a course and then I was like, she talks about things differently. And I didn't realize she had courses. And then as soon as I found out, I'm literally in every single course enrolled, which is a little bit overwhelming, but I'm like, I just want to learn as much as I can. So I appreciate you being here. And I'm really glad that we met because you specialize in tell everybody what you do.

Yes, in the vaginal microbiome. I mostly work with women with...

Isn't it amazing? Just the vaginal microbiome. I think like, wow, we couldn't have done that 10 years ago, I don't think. Yeah.

And you think it's so niche and I didn't really want to pigeonhole myself and become the vagina girl, but I realized that's exactly what people needed. And I wish I'd had someone who was the vagina girl who I could have gone to years ago. So yeah, I kind of niched very specifically and I think it's really necessary.

I'm assuming there's probably a personal story and then with clients, but tell me why is vaginal microbiome important? And if you can like just general health, but then also in the context of fertility, because most of my followers, patients are either looking to conceive in the next year or one to three years or have already been struggling to conceive. Why even look at the vaginal microbiome?

Yeah, I mean, the crazy thing is that the vaginal microbiome wasn't really even studied until about 20 years ago. So we didn't really know what was going on in the vaginal microbiome. We thought it was sterile. So we didn't think it played a role in things like fertility. We didn't think it played a role in, you know, how susceptible you were to getting infections like BV and thrush. So the vaginal microbiome, just for those who aren't aware, it refers to all of the

microbes that live inside the vagina. So that could be bacteria, could be fungi, could be viruses. And they keep a very particular balance to maintain the pH in an environment where the beneficial flora, which is generally lactobacillus species, can thrive and keep things nice and balanced. So when we have imbalance in the vaginal microbiome, we have an immune response in the vaginal tissue and the vulval tissue.

which can also extend up to the endometrium as well and the uterus. And that causes long-term inflammation and histamine release and things like that, which are not going to be beneficial for things like implantation with fertility. So one of the main ways that it impacts fertility is when there's implantation failure or early pregnancy loss. It can impact both of those things.

by having long-term inflammatory.

And I would argue it's also impacting the quality of the egg. think it's like, is still fragmentation in terms of how the research is done, how the studies are done of like, oh, what's happening in the uterus isn't impacting the ovaries. But it's like, you when you're a holistic practitioner, you know, that's not true. And just because the studies haven't quite come out and said that yet, we see otherwise in practice. But implantation is probably the most easy one to understand for people.

Yeah, absolutely. And there's also a fair bit of research now on just the tissue damage that comes with long-term infections. So when the infection can, is, you know, able to go up into the uterus and then up the fallopian tubes, we can have congestion in the fallopian tubes, inflammation, and also tissue damage, which can be like scarring. Yep. And that can really impact fertility and, you know, our ability to get pregnant and the sperm.

Scarring.

Eva and everything, Emily.

Yeah, traveling up to there.

So yeah, how did you get into studying all of it?

So when I was studying naturopathy, kind of do, our naturopathy degree is quite broad and it covers lots and lots of different things. We actually don't really cover the vaginal microbiome or...

I don't remember it all, no, I don't remember covering it at all either.

Yeah, mine came from more of a personal story. So when I was maybe in my second or third year of studying naturopathy, I had recurrent thrush and BB. It got so bad that I actually went to the hospital a couple of times and I assumed it was thrush and BB, but it actually turned out to be a stealth STI called microplasma. And what that causes is pelvic inflammatory disease, which can also impact fertility as well. And what that...

really feels like is a lot of congestion, a lot of pelvic pain, a lot of bloating, but then these kind of secondary infections of thrush and baby, which is what I thought I was dealing with. So I presented to the, the emergency room a couple of times. I was told you have period pain. I was told, you just have, at one point they, they did a bit of a, examination of my body and they, pressed on a point in my back.

And I spazzed and they said, you've got shoulder pain. It's referring to your pelvis, which was not at all true. They never did any swabs on me at all. And then I only found out that I had this infection once my partner got symptoms, which is often the case with women. Their male partners will get symptoms and then finally they'll get some answers. And I just really felt so dismissed through that whole ordeal. I felt like I couldn't.

And I felt like no one understood how to treat me and how to diagnose properly. And I just didn't feel like it was good enough. I even went to naturopaths as well. And at the time, pretty much the only tool we had was put yogurt on a tampon and that will rebalance your vaginal microbiome. So I just, yeah, I kind of took it under my wing to do better and to be able to help people in the same or similar situations. I love it.

Len? Yeah.

Yeah, thank you for sharing that. mean, tell me how do you start to unravel because when I see a lot of and I'm thinking of a couple of patients right off the bat when they have recurrent BV, I now know that it's like, well, yes, we want to treat the discomfort, but I always I now know that there's so much more going on. So what is your approach to actually diagnosing seeing what's going on? We'll talk about treatment after but getting to that root cause of the issue and I'm glad you brought partner.

on board, because sometimes it's the partner that causes the issue that I find like the partner is fine and he's carrying this infection and he doesn't have as many symptoms, but the woman is more sensitive and more susceptible. And so every time they have intercourse, she's getting, you know, reinfected essentially. So yeah, I'd love to hear how you approach it. How do you get to the root cause, you know, all the testing and we can get into some details around testing as well, because there's a lot that's coming out and not all of them are great.

Yeah, absolutely. Yeah. And there's a lot to that with the partner as well. I don't always treat partners because it is, or always test partners, sorry, because it is more difficult. So obviously with the vaginal microbiome, we have sort of a direct passage into the vagina. So we can do swabs and you know, there's a lot of different testing now, which I'll go into, which we can get a really good idea of what's going on in the vagina microbiome. For the male partners.

we've got three different infection sites. So it could be on the skin, it could be in the urine, or it could be in the seminal microbiome, which is the most common. And if it's in the seminal microbiome, they're pretty unlikely to have symptoms because it's sort of just being stored away there, right? So we, and we don't have a direct passage. So it's quite hard to test the seminal microbiome. In Australia, we don't have any testing available to test the seminal microbiome in the urine.

Yeah, there's some more coming out. think Dr. Diaz is working on a couple with Neutropaths slash U.S. Biotech. So I'm very excited because it's like, I'd love to see it. There is more, there is some, but it's not as prevalent as the vaginal microbiome test now.

Exactly. Yeah. I sometimes use Screening, which is a UK based, and you might have some in the US as well. yeah. So I don't often kind of test the seminal microbiome, but we can see if there's a pattern of, know, are you getting your infections or your flares every time after you have sex? Is it because of the irritation of sex and we're kind of stirring up microbes that might be more around the cervix or is it that there's a jaculant?

in the vagina every time because if there is a jaculant then, and that is flaring things for you, is it maybe that there's microbes in the seminal microbiome that are impacting. So I kind of get very, very specific about what kind of sex they're having and what, you know, what kind of symptoms they're getting.

protective barriers too, because I know there's some condoms that can be quite irritating for women. And so it's not necessarily the seminal microbiome, but the latex or whatever else they're putting on the condom.

Yeah, or even just that the tissue is so irritated that it can't really handle that kind of friction as well. And I also think a lot about, you know, a really balanced vaginal microbiome should be able to handle being, you know, having, you know, a pH challenge or coming into contact with a new microbe. But if the woman's microbiome is already quite imbalanced or there's inflammation there, or there's not a lot of protective bacteria,

then we might be more susceptible to picking up everything that we come into contact with. And in terms of testing, there's a few different ways that we can test. One, guess step one would be the sort of GP swabs. And usually they use a combination of the culture-based testing and PCR testing. I think they're more kind of leaning towards PCR testing now, but depends where you are.

The issue with those tests is that they're looking for specific microbes. So it really depends what your doctor writes down. So if they write down, we're looking for Candida, so Thrush, or we're looking for BB, they might miss things that they're not actually looking for. The other thing is if they're using culture-based testing, taking a swab and then growing it in a petri dish and seeing what grows.

a lot of different microbes don't culture well. So you're going to miss things that way as well, if they're just not a very cultureable microbe. And then the other kind of testing we've got now, which is the most new technology is the NGS testing, which is next generation gene sequencing, which basically maps the entire microbiome. So it takes a sample from the vagina fluid and it

looks for every single gene that is there, so every gene of every microbe. So it's very, very sensitive and it doesn't miss anything as long as you've got that microbe in the sample.

Hmm. And do you have specific brands that you use that you trust?

Yeah, there's a few in the US there's a couple of different ones. There's JunoBio that I use, which uses next generation gene sequencing. There's also Evvy as well, which is pretty popular. They're probably the two that I use in.

The neutropath, do you use the neutropath vaginal microbiome panel?

Yeah, I do use it sometimes. Neutropath is PCR. So it's not, generated in gene sequencing, but, it's, it's fairly good if we need quick results. it is Australian. So we get a lot faster results with that one. And it tells me enough, but if I'm looking for things like, you know, infertility cases, or I feel like something's missing, then I'm always going for that more comprehensive JunoBio or EVI.

Got it. Yeah, I using a lot of EVI, but I just switched to Neutropath, which is US biotech. And some of the things that I noticed with EVI is that they're testing bugs that are not really studied in, like even the lactobacillus strains that they're looking for. It's like when we know those strains are not really in the vaginal microbiome, why are we quote unquote testing them? Do you have any insight there?

actually don't see a lot of Evi because we can't do Evi in Australia. So, one that am familiar with, it just tells you the ones it picks up. So, they're basically looking for hundreds of different microbes. sometimes those things that you think aren't going to show up in the vagina do. And that's when, you know, it could be a real smoking gun. So, I've had things that really only live in the gut or really only live in the oral microbiome or wherever.

And that wouldn't have been picked up on a more selective test like neutropath. So sometimes you really do want to get that nuance and, and make sure you're not missing anything.

Got it. Love it. Tell me besides the vaginal microbiome, are you testing anything else? Like, are you testing the gut microbiome? Are you testing nutrient levels, liver, right? To just, yes, we're assessing the vaginal microbiome, but then where's the infection maybe coming from or how is the body handling it?

Yeah, I can often tell when I think there's a bit more going on with the gut microbiome and that's when I am testing the gut and doing a bit more gut treatment. The red flags for me with the gut is I guess if they have any kind of gut symptoms or symptoms of inflammation in the gut. If they've got things like itchy anus, like does their vulva itching go all the way up to the anus?

Is there any like inflammation around the anus? Because that tells me that there might be translocation from the colon to the vaginal microbiome. I'm also very often testing for UTIs and the urinary microbiome, because I find they all kind of interact close to proxy. So yeah, I'm often looking for those.

The one that I usually, the type of microbes that I usually find that are both in the gut microbiome and the vagina is the aerobic microbes. So things like E. Fecalis, things like E. Coli, Strep, things like that. Often if I see that in the vaginal microbiome, I'm thinking, did it come from the gut?

Yeah, I love that. Tell me, what is the, like, is there a common thing that you find? Do you find that there's patterns in what you're seeing or is everybody just all over the place? Like everybody is just so different and that's why we test.

There's definitely patterns, there's patterns for certain things. And I think because I've seen hundreds of these tests, I can definitely pick up where, you know, I think all that tiny little thing there tells me that it might also be X, Y, Z. And I try not to zoom in and think like, oh, that microbes there, I'm going to treat it this way. I try to think a bit more big picture. And I do find that there are patterns with certain microbes where it might tell me there's something else going on or there's a different condition linked there.

So I see certain microbes when there are tissue disorders like lichen sclerosis or lichen plantis. So sometimes I can pick up, I think there's actually something else going on. Like maybe there is lichen there. And sometimes I can pick up sort of, you know, the vagina microbiome might not look too bad, but they've got a lot of urinary symptoms. So maybe the chamber of infection is actually in there, in the bladder, rather than in the vagina. Yeah.

So there's little things that make me look elsewhere.

Yeah, mean, infection is just even studying some of the stuff that Leah teaches us is like that's, it's hard to catch them.

Yeah. Yeah. And sometimes it looks like it's not there on, on your testing, but you just know that they're in pain and there's discomfort. And so, you know, that you don't have the whole picture if you just have results that come back with nothing, no smoking guns. So you always.

How do you approach that? Because I'm also curious for my own like, know, when I can't name the infection, it's so hard. I'm curious, how do you approach it when you know something is there? It's like, do you start treating something and then wait to see until the symptoms show up a little bit more to retest or just treat it based on intuition and just what you know, like past clinical experience.

Yeah. I mean, I guess when I get a test result back and someone has symptoms, there's never nothing. So it's never perfect. It's never a perfect microbiome. So it's usually, I'm working more on things like the pH will usually be a bit disrupted. So maybe it's a bit high and maybe the beneficial flora is low. And that will tell me that she's going to have some, you know, some opportunistic infection pop up.

So those things I just sort of work on. If nothing's coming up and there's no smoking gun, I would work on her immune response, the inflammation in the tissue and just making sure we've got a really healthy vulva tissue and vaginal tissue. And then working on things like pH balance and boosting up those beneficial lactobacillus species.

Yeah, love it. tell me, I mean, I'm a big proponent of individualized care, but I know everyone is dying to know what, know, recurrent BVs or recurrent yeast infections, what are some treatment approaches once you've done the testing and once you do, what are some general treatment approaches? And then if you have some specifics, just like nuggets of like, hey, when I see this, this is what I typically like, I know it's infection is not going to clear in six weeks or in two weeks or whatever. Cause that's, I have somebody in the

program right now. She's like, I did this candida cleanse for a month. And then ever since then, everything has been a mess. And I'm like, let's unpack that, you

Yeah. Yeah. It's so interesting. And everyone is very, very different. Yes. I had definitely have some go-tos with treatments, but that's why I definitely want to know exactly what microbes are there because a lot of the treatments that I use, they might flare particular microbes. So the, guess the kind of four things that I treat a lot would be bacterial vaginosis. So BV, BV.

characteristically has, you know, higher pH, lower beneficial flora, and then an increase in anaerobic bacteria, so microbes that don't do well in an oxygen-rich environment. And then the other one is aerobic vaginitis, which is the same as BV, but it has aerobic microbes, which do very well in oxygen-rich environments. So already you can see that those two things, if you do it...

treatment for BV you're probably going to spur on those aerobic microbes or a treatment for AV will spur on the BV microbes. So you need to be very very specific there. The other things that I often treat are thrush or chronic candida and then also plasma infection so microplasma and urea plasma. Have you seen a fair bit of those two in your practice? Yeah.

It's one of those, it's tricky when it shows up, like it never, because a lot of women are not coming to me with vaginal microbiome symptoms. Like some will have BV, but it's like, I used to get it. And then when I test, I'm like, you still have it. Like you just don't feel it. And then with ureoplasma, it's been a couple of times where we catch it, we see it. And it's like, the person doesn't even know, like she doesn't have any reproductive symptoms except fertility, those like infertility.

because of the ureoplasma and then like fatigue and inflammation and some neurological symptoms I see a lot as well, but not like discomfort with sex or discharge or, know, and sometimes I think the smell is hard to explain. Like women won't realize that they have smelly discharge or smelly menstrual cycle because they're just like, that's my norm. I've always had that. And then when we do clear things out, they're like,

My period doesn't smell at all. Like I don't have any smell and it's like, that's what it should be, you know?

Yeah, it's very hard to know what the normal is when your normal is all you know.

Especially if your doctor has just been telling you everything is normal and it's fine when you are bringing up issues. And I find that like that's like, that's what I try to break through a lot for that patients, but like future patients in my marketing where I'm like, literally everything your doctor told you is normal, isn't normal. Like it's this psychological belief that my body is broken. And so if you're a kid that's been on medication for all of your life and now you're 35 trying to get pregnant, it's like, you don't know what normal is because you've never

actually been heard or validated and said, that's interesting. Why do you have that symptom? Let's figure it out. And so I find a lot of it is breaking through those old beliefs that are essentially just keeping you unwell because you don't think you have to do anything.

Yeah, and always pushed down and suppressed.

Suppress lots of suppression. Yeah.

Yeah. So with the treatments for those, guess those different, I sort of put those into four different categories and some have mixed infections where we've got some aerobic microbes and some anaerobic and urea plasmus chucked in there and a bit of thrush. And that's quite tricky because we want to make sure that we're treating those things without flaring the other things. So some common things that I use with BV is I used a lot of.

rinses in internally and I would say don't kind of try this yourself. do sort of need to have these treatments, make sure that they're prescribed by someone who understands.

Yes, Greta is just so kind to share her knowledge. Please don't just take it and do it like... And I say this on my podcast, like we have a disclaimer before any of this plays. It's like, we are not your practitioners. Please find a practitioner. But why I think it's important to share is a lot of the times we will find a practitioner and we will trust them. And we trust them, but we're like, I don't know if this is it.

And then what ends up happening is you don't actually get better. And then you're like, I tried naturopathy and it didn't work. And I'm like, well, it's not that it didn't work. It's that, you you probably didn't find the right person to help you. And so I encourage you to continue to look for it. And so the more that, you know, when I interview a practitioner to work with me, my questions are very different than somebody who, you know, has never done naturopathic medicine, all that kind of stuff. So it's to elevate the population and then also elevate the standard of care in the naturopathy.

Yeah, a hundred percent. Yeah. And I think even amongst practitioners, the really specific vaginal microbiome prescribing is not well understood. We're getting there slowly, but it's not, it's not very well understood what the differences are. So I think a really big key is that, you know, difference between aerobic and anaerobic. So with BV, I use a lot of low dilution, hydrogen peroxide. So obviously.

putting oxygen into the vagina microbiome where anaerobic microbes are going to, it's toxic to them basically, so it's going to kill off those anaerobic

It would do the opposite for the other one because it would essentially feed it. Exactly. have to know what it is before we treat it, folks. This is good. This is so good.

I love it. Yeah. And my, my sort of typical treatment for BV would be that hydrogen peroxide with lactulose. And I also put a couple of herbs in there just to help with the biofilms. So those two things, lactulose and hydrogen peroxide are going to be completely contraindicated in aerobic vaginitis. So if we did that with AV, we're probably going to cause a lot of inflammation and really feed those aerobic microbes as well. So that's why, yeah, we need to be very, very careful.

Same with thrush, if we did hydrogen peroxide and lactulose, it's more that thrush comes with a lot of, know, histamine release and a lot of tissue damage and that kind of treatment in a liquid would be really painful for someone with thrush. So if you did that to someone with thrush, you'd be, you know, a lot of burning, a lot of stinging. So yeah, definitely needs to be based on your current vagina microbiome testing. And then with things like...

uh, thrush or candida, I am sort of treating, uh, very differently depending on the person. And it really depends on how long they've had it. it recurrent? Is it just systemic? Yeah. Um, if it's, know, just a very acute thrush infection because maybe they took anti, uh, antibiotics. Yeah. Um, then, you know, that might clear up with a little bit of boric acid, uh, or even just, you know, over the counter canister.

systemic?

don't know if that you call it that in the US. Yeah. if it is more sort of, you know, embedded into the vaginal tissue or if it's, you know, causing that real almost like virulent action now and, you know, long-term chronic inflammation in the vulva tissue, then we're going to need a lot of different treatments. Mostly my first goal with that is to stabilize histamine, stabilize the vulva and vaginal tissue.

and not just go straight in with antifungals or with really hardcore treatments because it's just going to flare things up more. So we really want to make sure that if there's discomfort there, if they're irritated, we're actually working on the tissue and getting that stable before we're going in with more hardcore treatments. things that-

Yeah, go ahead. I'll ask after in terms of how long it takes to clear an expectations, but I think you still have to go through one more.

Yeah, couple of, yeah, a of different treatments. with, with thrush, um, anti-fungals, uh, can be really useful. So things like, uh, if we're using herbs, garlic is, is great. Um, pomegranate is a really good one as well. Uh, there's a few others like, uh, do you use horopeto in your practice? There's a.

I haven't. Podarco, is that one?

Yeah, I don't actually use lot of Pildarko. I use a lot of Horapeto, which is a antifungal herb. think it might be a Chinese herb. So there's a few of the Chinese herbs which are actually very good with the vaginal microbiome. So a lot of different herbs that we didn't use at uni are now kind of my staples.

Amazing. love it. It's like I'm taking notes.

Yeah, yeah. So a few of the other ones I use are Hotunia, which is another Chinese herb. There's also Coptus, Ousnea, Burmarygold. I use a lot of calendula and green tea as well, kind of staples.

And is that the herbs that you have in the background that you're mixing?

Yeah, I lot of intra-vaginal creams using the herbs and sometimes pessaries if we need something that's a little bit more like an oil base, a pessary. I do a lot of intra-vaginal probiotics as well and we can get very specific with probiotics too. So I think it is important to really understand what strains you need in a vaginal probiotic based on the infection as well.

Yeah, I do think that there's a lot of like, it's crisp pastas, select basil, it's crisp pastas, that's what you need. So then everybody should just have that. And I think this is where, if you need it, it will work. But if you don't need it, it's essentially you're wasting money. Can it cause harm?

You can actually, yeah. So with different probiotics, chryspartis is the most likely, it is the most protective. We do love chryspartis, but it is the most likely to cause cytolytic vaginosis, which we haven't touched on yet, but cytolytic vaginosis or CV refers to when we have an overgrowth of the good stuff and there's too much of it. And then what happens is,

the crispartis produces too much lactic acid and hydrogen peroxide, which causes tissue damage and irritation. So kind of seems like almost thrush symptoms, but it's actually just an overgrowth of the crispartis. So if we're constantly putting crispartis intra-vaginally, and we've already dealt with all the overgrowths and we just keep doing those probiotics, we might actually push into that satelitic vaginosis.

And I've seen that happen a couple of times with people who have been on intra vaginal probiotics. They might've done a course with their naturopath a couple of years ago and just kept going. So they just kept doing it for two years. And that's when we get issues with, with chryspardus. I also find clinically that you don't need to put chryspardus into the vagina in order for it to grow there. So usually when we, when we're dealing with dysbiosis and there's, you know, too much.

opportunistic bacteria and not enough beneficial bacteria. Once we deal with that dysbiosis and we get rid of what we need to get rid of, and we're balancing the pH, that crispartis will naturally just come back. So it will usually just naturally shift back into a crispartis dominated environment. So it's not necessarily that we need to put that there. We need to

Yeah, you need to create the environment for it to grow.

Exactly. Yeah. So that's really the goal. The goal is to create the environment for the chryspartis to naturally grow because what happens when you stop putting chryspartis in there, it's, you know, if you don't have the right environment for it to grow, it's not going to stick.

What is an overgrowth? So like I'm thinking of an EVI test and the percentages. Do you have the percentages of like what's a healthy versus it's an overgrowth?

of the...

Lactobacillus in general or crispasters.

Usually, I mean, I don't have the exact percentages of what would be, what we would call an overgrowth, but usually what I'm seeing is it's generally like a hundred percent crispardous. So when I've seen CV, I've seen it as a hundred percent and there's nothing else there. We're generally aiming for above like 80, 85, even 90 % of lactobacillus species. That could be just crispardous. It could be just another type of lactobacillus and

Some are better than others. Or it could be a combination of a couple and maybe some very, very small amounts of opportunistic microbes. As long as we've got that real dominance of lactobacillus, then we are probably in good spot.

Yeah, I've heard Leah talk about like it's important to have at least two because if it's just solo, it doesn't have it like it needs a buddy. And the more you if it has that buddy, then it's just more resilient. So if you have any infection that's introduced or an imbalance of any kind, the body can handle it. And I think, yeah, I'm trying to remember the exact number. And I think it's also like seventy five minimum. But I think maybe over ninety five is when you're starting to think like, hmm, I don't know.

Over 95, I would question, yeah, are we looking at? Yeah. And you can kind of tell based on what else is there. So it might be like, it would usually be one type of lactobacillus that is overgrown to that 95%, not rather than two.

And sorry, what did you say the treatment for that is?

Usually what we're looking to do is increase the pH. it's almost like it feels sacrilege because it feels like the opposite of everything we're usually trying to do. So we're not trying to go in and kill the Lactobacillus species, or that's not my approach anyway. My approach is just to change the environment, shift it slightly just so that we don't have a huge overgrowth there. So with CB, usually we have quite a low, like too acidic the pH.

So what we can do is just increase the pH by using something as simple as like a bicarb bath or sits bath. that's usually what I'm doing. And then just stopping the intra-aginal probiotics and stopping the things that they're doing. Usually they're doing lots of things to increase. Yeah.

how simple it is just sits bath is basically a little tub. You're going to put some bicarbonate sodium bicarbonate in it, right? And then you're going to sit in it for 20, 30 minutes.

Yeah, 10, 20. Yeah, 10, 20 minutes.

love natural medicine.

Very simple. It's not a huge, you know, it's not like a huge protocol to deal with it. We just need to slightly shift the environment. And usually they're doing things that are, you know, they're really trying to support their vaginal microbiome. And so they're doing all the things. so maybe too much stop those things. Yep. And, do a couple of sit-baths. Usually that's all that we really need. Sometimes we might need a little bit more, but I don't tend to see it be one of those things where we need to go in with antimicrobials and kill things off.

For sure. Now, I don't think you talked about microplasma yet or urea plasma, have you? No, okay. Because that's a big one.

Yeah, no.

Yeah, something I see a lot as well. And I know we touched on urea plasma before that the interesting thing with urea plasma is that so many people carry it. So about 70 % of their sexually active population carries urea plasma. And it's not an issue for a lot of people, but in the research we see that it's, you know, really linked to infertility and the current guy.

complications during pregnancy and postpartum as well and complications for the baby.

Yep, yeah, so the current kind of guidelines is just only treat, I'm talking medical guidelines, only treat if they're trying to, if the couple is trying to get pregnant, which doesn't seem good enough for me. Yeah.

That's crazy. I'm like, why wouldn't you? If it's causing to me, I'm like, fertility is always a reflection of health. And I know that like there's, I always think of being able to, it comes from a place of abundance in the body. It should anyways. There's plenty of people that get pregnant, not feeling abundant, but it's just gonna be a much better pregnancy because of so many nutrients that it requires. And so if you have this infection, even if you're not trying to get pregnant, well, are you really, do you have the energy that you should?

What's your inflammation? What's your immune system? Is that predisposing you to other bugs? Like, yeah, it's so crazy to say, well, you have this infection, but because you're not trying to get pregnant, don't worry about it.

Yeah. And I do see so many issues for people as well. And just to give people a bit of a background, we're talking about micro plasma and urea plasma, are the clusters, molecules or molecules, however you want to say it, very, very tiny microbes with no cell wall. So they kind of clump together very well and they're very hard to get rid of. They're a bit harder to treat than your typical bacteria or fungal infections.

And they're actually parasites that can inhabit the genital tract. So yeah, it's very interesting if we think about it as parasites. And I don't think we kind of put that word to them enough, but they're just basically teeny tiny parasites that can cause a lot of inflammation and long-term sort of inflammatory immune response in the tissue. So that's going to have huge impacts on implantation, but also

even whilst pregnant as well, having that chronic, like almost viral immune response.

Yeah, it is difficult to treat. I don't know if you find that it's probably one of the trickier ones. So give us your golden nuggets.

Yeah, it is difficult to treat. And this is something where I'm always thinking about, do we need to treat, you know, with antibiotics for that person? What's the timeline like? It takes a while, it takes quite a while to clear it naturally.

That's a wild naturally, just so we have an idea.

at least 12 weeks of intra-vaginal herbs and then for the male partners it's a bit trickier so we need to do oral, you can do penis clusters and things like that as well.

Always learning something new.

It depends on, on how much is there as well. sometimes I'm thinking about the JunoBio test. Sometimes it'll be, you know, urea plasma at, you know, 0.5%. Sometimes it'll be 4%. Sometimes it'll be like 10%. So we really need to see how much space that is, that microbe is taking up. And is it, is it really the smoking gun for that person or is it an innocent bystander? And sometimes it is at such tiny, tiny levels that

It is probably an innocent bystander, but it's part of the bigger picture of dysbiosis at least. So it's probably something that needs to be moved on if that person has symptoms. The way that I'm treating usually is based on whether that person has like a timeline of trying to get pregnant, whether they are symptomatic or whether they're not.

I do have quite a specific treatment that I use for urea plasma and also micro plasma. And it uses some, some of those herbs I've talked about before. there's a few different, Chinese herbs. The protocol that I generally use is called the Bunna protocol, you might've heard of before. it's called, it's B-U-H-N-E-R the Bunna, urea plasma. Yeah. So that one is,

Yes, okay.

I find that really useful for treating, especially the vaginal microbiome, but you can use those same herbs orally for the men as well. The way that I do it is in a rinse, so in a liquid rinse with a syringe. And so it's a lot to do. It's a lot for the person to take on. And so I think about...

And if it's like three months too, you know what I mean?

Yeah, exactly. So the thing that I think about is, and I talked to each client about this, do you think that you can, you know, prepare this syringe not every day, but at least like four to five days a week? and you know, insert into the vagina for at least 12 weeks. Like, do you think that you can do that and keep up with that? And then there's other treatments that they're on at the same time as well. So it's very expensive. Like it can get quite expensive and is it worth it? Or do we go to antibiotics?

The medical treatment is usually, depending on the type, but usually they'll do like a triple therapy antibiotics, so three different types of antibiotics. For urea plasma, they might just do something like doxycycline, but it has to be a fairly long course as well, like that two week mark. So if they can't get rid it in two weeks with antibiotics, sometimes that is the preference.

Yeah, Dr. Lee is a Z through in doxy for seven to 10 days. So

Yeah. usually we would do, yeah, Doxy, Doxy and azithromycin, azithromycin at least five days and then Doxy at least 10.

Yep. Yeah. Do you bring the energetics into it at all? Do you spend any time?

Yeah, I'm not a very energetic practitioner. It's something that when we sort of were studying and some people got really into energetics, just, it never resonated with me. Sometimes I think about it, but it just doesn't, I don't really treat that way personally.

Yeah, I was just curious because I do this is something that I've been more of an aha moment with Leah. I've just like, and every energy has a bug. And so how is that bug expressing itself? How are people talking? And I remember one of my first like calls with her. She's like, you know how you can just look at someone and they have urea plasma. And I was like, no.

Please tell me more, you know, like, I guess that's 30 years of practice, you know, versus 10. You know, you just look at them and you can, I'm like, how? So it's always fascinating how these bugs show up and how they change our world, you know? And then when we get them out, how much lighter you feel, even if you don't feel anything, it's like you just feel better.

Yeah, that's so funny. It's so interesting. I don't think I, I put like the personality or the person to the bug. I certainly put the symptoms to the bug. Like I can tell when people say certain things, I'm like, you've got X, Y, Z and then wait for the results to come back. I'm like, yep.

It's so good. Yeah. Yeah. It's the game I play. like, I wonder if I guessed it right. And then with the test, what I'll say with my patients, I'm like, there's always something that I'm confirmed. And I was like, I know this is it. Let's see it. And I'm not surprised. And then there's stuff where I see on the test and I'm like, I would have never guessed that, you that's why you run testing.

Yeah, yeah. Yeah, that's why I like the, the NGS testing because things pop up where you're like, huh, and things that you've never seen before sometimes will pop up. and, things that aren't very well studied, whereas with some of the other tests where they're, you know, at the main microbes you're looking for, you're not necessarily surprised to see them.

Yep. Tell me length of treatment to expect is that usually, and before I go into that, are you also, assuming that doing like diet lifestyle, recommendation, digestion, you know, so like eating. I remember my first practitioner, like my first natural birth experience was like, you know, Candida, you should go on the Candida cleanse. And it was like the worst experience of my life because I just like, it was too much. And so I'm very cautious with how much and what I give people. But then there's also the reality of like,

If you eat a lot of sugar, you're feeding these bugs. Even if it's fruit sugar.

Yeah. Yeah, exactly. I'm not one to do like really hardcore dietary stuff unless I think it's absolutely necessary. Usually I am trying to give some dietary advice around like, you know, nurturing the environment and, you know, having enough prebiotics and having enough fiber and...

things like that. A lot of the time with the vaginal infections, I'm also really honing in on histamine. So if I am giving a diet that's a bit trickier, it's often to do with histamine and oxalates as well, which can really impact mostly the chronic UTI side of things, which I see a lot of as well. So definitely a lot of specific dietary advice, but it's not too, too hardcore most of the time with me.

Um, and then lifestyle advice would be things like, you know, what kind of underwear do you, do you wear swapping? Yeah, Always swapping over to bamboo if we can, at least 90 % organic bamboo. Um, it's just going to be so much more breathable, but also it's all about the cut too. So are you wearing G-strings every day or are you wearing briefs? Um, if you're wearing G-strings every day and it's, know, that little stringy G-string, you're sort of giving a ladder into the vaginal microbiome from.

Did you recommend?

When I heard that, I was like, I could never wear thongs again. Like I just, cannot do it. And I have this whole drawer of them and I haven't been able to get rid of them. And it's like every patient that I tell, the husbands are like, are they going to be able to go back to the other thing? It's like, get used to it.

and through breaks now, I think.

That's it. It's a special occasion, but I notice it now and I'm like, can't, just, feel it, it feels different. I can't tell you how I wasn't aware of it before, but yeah.

Yeah, it's yeah. And so a lot of that kind of advice and advice around sex as well and proper hygiene. Yeah, but mostly things.

Which is what? What is some proper hygiene around sex? Because I think this is something that is really important for us to have with patients. even something like, hey, how often do you wash your bed sheets? And how often do you wash your towels? Are you sharing a towel with your partner? Where sometimes it's like, if that's what your parents did and you're doing it, it's like, that makes sense why you're getting a vaginal infection every time you have sex or every two weeks.

Yeah. Yeah. So getting really specific around what sex looks like for those people as well, because it's very different. It's not, you know, especially these days, it's not just penis in vagina sex. So a lot of the time where, you know, there's sex toys involved, they might be in an open relationship, there might be multiple partners. There might be anal sex. And some people aren't really, still aren't aware of the impacts of going from, you know, anal sex into vaginal sex.

passing microbes back and forth. Things like, are you wearing condoms? Obviously, what kind of condoms are you wearing? Are you getting any irritation from that? And then how are you cleaning afterwards and beforehand? And how are you cleaning your sex toys as well? So a lot of people will almost never clean their sex toys. those things are, yeah, something we need to think about. Or are they cleaning with very, very harsh,

chemicals.

Yeah, yeah, I've had quite a few people who use alcohol swabs to clean their sex toys and that's...

Which makes sense, like alcohol is just, but like, ooh, when I think about putting alcohol up my vagina, I'm like, ooh, that doesn't feel right.

Yeah. Yeah. And, yeah, and that's going to cause a bit more irritation when you use those toys as well. and then all the different kinds of intimate washes that are out there. I, I do use intimate washes with clients, but I, I've really, I use, make sure that I've got, you know, the specific wash that they need and, based on what, kind of issues they're experiencing. And I do think it can be useful to use, you know, a really good, natural.

a pH balanced wash if you are prone to infections after sex, just to use it before and after sex. But things like, you know, I don't know the exact brands that you'd have over there, but you have FemFresh over there.

Maybe, I don't know. You can just say whatever brands you have and then people can look them up. Don't worry about it.

So that's it.

So FemFresh is like kind of the most abundantly available generic intimate wash here. You can buy it at the supermarket. It's full of chemicals. It's, you know, very, very harsh washing. So that is going to kind of just wipe out the vaginal microbiome. It also contains things like endocrine disrupting chemicals as well. So you want to be very mindful of what you're actually putting on that tissue because it is so

highly absorbable, absorbent. So anything that we put on topically, we're going to absorb. So we need to think about that as well. The brands that I use, there's a few different ones here, but there's one called Yes, which I think we both have access to. They do quite a great wash. Sometimes they use boric acid washes as well, which just helps to kind of rebalance the pH and break down some of the biofilms that might have formed.

What about menstrual cycle hygiene?

Yeah. So it depends on the person again, because some people will be very irritated to things like, you know, tampons or even pads. My preference would be organic cotton pads. I don't love tampons just because they sort of, you're sort of plugging the blood up there and stifling the flow. So we can really increase the pH of the vagina by, you know,

putting a cork in it.

a better term that that's it. Joe Rogan did like a whole bit on it. It was very funny. So I'm like, Yep, that's exactly what it is. Because men invented it.

Yeah, of course. Yeah, makes sense. And the blood has quite a high pH. So the issue is, you know, the pH of blood, menstrual blood is around 7.5 ish. And we want the vaginal microbiome to be around that 3.5 to 4.5. So it's quite a lot higher. So that alone can, you know, cause opportunistic infections to thrive. The other issue is that if we have microbes,

or infection more around the cervix or higher up in the vaginal canal, that blood is going to, you know, wash them through and, you know, bring them to the, through the vaginal canal. So if we've got tampons and we're kind of blocking it, it's actually kind of important for us to be able to have that flow and get things out and clean out. So yeah, my preference would be the organic cotton pads or reusable pads as long as you're really

with washing them and you've got the right washes for them. The period underwear can be good for some people, there's some issues around you know the kind of material they're made out of, they're not very breathable, they're actually made with a lot of chemicals as well so...

And it's hard to tell how much volume you've lost.

Very hard to tell what quality your period is as well. So yeah, always preference.

And what about cups? Do you feel like the cups have the same impact as the tampon in terms of plugging?

Yeah, it kind of depends on how good you are at cleaning it. So the issue with cups is that it's a great surface for biofilms to form and it's a kind of a great surface for infection to, you know, dock onto. So, and then we're also kind of squeezing the cup into the vaginal canal and opening it.

which can cause a bit of inflammation, especially if you've already got infections there and already have inflammation in the vaginal canal. It doesn't necessarily have that same plugging effect only because it's pulling in the cup. So the blood isn't sitting on the bobble tissue, but the issue is that it does stay in there for a long time. So usually with the cups, it will stay there for, you know, all day, 10 hours, 12 hours. So.

you are going to have a pH challenge with that as well. Yeah. So it's not my preference, but if people do want to use them, I'm always just kind of coaching around how to properly clean them and how to properly sterilize them.

Sure. Yeah. I know we're running out of time, but my last kind of, I answered this as short or as long as you'd like to, but do you notice a big change in pH with pregnancy and postpartum? And do you treat pregnancy infections and all of that? Cause I do find that this is a time that can be very risky and also obviously very important to address infections so they don't travel up to bub.

Absolutely. Yeah. I, it's, I'd say a huge part of my client pool is people who have, you know, who are pregnant and have just realized they, you know, have had their first kind of chronic thrush infections or, BB during pregnancy. And yeah, that, that is because we do have a big pH shift, during pregnancy. and then also postpartum as well.

I guess with pregnancy, it's more about the hormonal shifts and that impacting the vaginal microbiome. So usually without going too, too deep into it, but the raisin estrogen will contribute to creating an environment in the vaginal tissue that more supports that higher pH and also might feed bacteria as well. So

The higher our estrogen, the higher our glycogen secretion in the vagina. And then glycogen is going to hopefully feed our beneficial lactobacillus species. But if we don't have them there, it can also feed. Yeah, opportunistic microbes. it really depends on, know, if you have a very balanced vaginal microbiome going into pregnancy, you're a lot less likely to have that happen. But absolutely the hormonal shifts will impact that.

to feed the other ones, yeah.

I exaggerate the situation. I found I was like with my pregnancies and patients that I have taken through pregnancy, they're just so much more sensitive and they don't realize how sensitive they are. They're like, I just had a little piece of candy. Like it was just Easter and I had, and I had, I got an yeast infection almost immediately. And it was just like, yep, you don't have much room for the body's already inflamed. It's already vulnerable. There's already nutrient depletion just because of what it's doing. So anything can throw it off.

Yeah, yeah, we're sort of treading this really like delicate path during pregnancy. And the goal really is to stabilize the environment and reduce inflammation. If we do find that there's, you know, an overgrowth of something, I'm not going in with, you know, hardcore antimicrobials because then they're contraindicated in pregnancy. So it might be somewhere where sometimes it might be.

useful to have antibiotics or useful to have medical treatment depending on the microbes. But most of the time I'm just trying to keep things at a low level and supporting the growth of that beneficial flora, which we can do.

Yeah, I would crowd with the good bacteria and hope that the rest. That was so good. Thank you.

Yeah.

Thank you for having me. I love notes.

Yeah, it's I'm so glad you decided to become the vagina girl. I don't know if you want to be known as that but it's like that's so good. I love the niche, you know, it's and you're in the right space for it just because there's so much more coming out. So I've had so many women message me it's what do you do for chronic rash? What do you do for chronic thrush chronic BV? So I really appreciate all of your insights.

Yeah, thank you so much for having me.

Of course. Do you want to tell people where they can find you? Do you have a website? Do you have

Yeah, absolutely. So you can find me on my website, which is just gretanattropathy.com and then my Instagram is gretanattropathy. So much Gretta. No worries. Thank you.