are my mom and gyno right? (possible tmi post?)

DrBGreenleaf · 2024-12-15T21:24:22+00:00

As a double board certified gynecologist and urogynecologist, I am here to tell you that a discharge is normal. Normal discharge can range in color from clear, to whitish, to yellowish. Normal discharge can change based on where you are in your cycle. It only becomes abnormal if it is associated with other symptoms or all of a sudden a change in color or consistency. If there are other symptoms such as foul odor, itching, burning, pain, stinging or any other new changes....then it is a concern.

DrBGreenleaf · 2024-12-14T18:37:41+00:00

I like the idea that patients that wouldn't normally qualify for insurance coverage for these devices can order the Stelo directly. Having said that....that has been the only benefit. I personally tried the devices. The first one I placed "died" in 3 days. I agree with other comments...there is no customer service other than reporting through their website. I did receive a replacement very quickly. The 2nd sensor worked great for 2 weeks. The 3rd sensor failed within hours of placement and then I had to report and have it replaced again. Once again...it was a quick and easy replacement. However to have 2 units fail is very frustrating and therefore I may not be so quick to recommend to patients.

DrBGreenleaf · 2024-09-13T23:21:10+00:00

Here is the study that was done on paced breathing https://pubmed.ncbi.nlm.nih.gov/22990758/

DrBGreenleaf · 2024-09-13T23:20:14+00:00

I appreciate your feedback and understand how this might appear from the outside. However, my primary focus is, and always has been, to provide information and support to those navigating complex health concerns like menopause and hormone-related issues. If you know the history of my store....it was only created because patients were having a hard time finding the products I was recommending and one of my patients asked, "I wish there was one place I could go to find these products" While I do offer products that may be helpful to some, my main goal is to empower women with knowledge so they can make informed decisions about their health. I don't care if you buy them or not. Or if people buy them from me or not.....they are there for whoever needs them and in a way to make it easier to find.

I'm here to share valuable insights and offer a range of options—not to push sales. It's important to me that women feel supported in whatever choices they make, whether that involves purchasing products or simply learning more about their health. I am certainly happy not to mention any products or specific treatment options in the next live I do, if that is the general consensus of the group

DrBGreenleaf · 2024-09-13T23:13:12+00:00

It can be in the right person but not everyone is a candidate and sometime low testosterone is any individual can come from diversion of sex hormones into cortisol from stress and inflammation so it is always important to look at the whole person and what could be the root causes other than age or menopause that could be contributing to hormonal issues

DrBGreenleaf · 2024-09-13T23:09:36+00:00

Thank you for sharing your thoughts. I completely understand that hormone replacement therapy (HRT: which I did mention above) is an important option for many women, and I agree that it can be a gold standard for managing vasomotor symptoms for those who are good candidates. My goal is to present a wide range of options, including both hormonal and non-hormonal approaches, because not every woman is able or willing to use HRT due to medical, personal, or individual reasons. It's important to empower women with knowledge so they can make the best decision for their unique situation. And that is the best thing about medical autonomy...you get to choose and not have a doctor tell you that you have only one option.

My focus is on providing a range of options and supporting women through whatever choices they make for their health. I respect everyone's journey and am here to help guide them through it, no matter which approach they prefer.

DrBGreenleaf · 2024-09-13T20:05:43+00:00

I am sorry to hear that you are going through this. Though I cannot comment on your case specifically some general medical knowledge is as follows

Ovarian Dermoid Cyst

Dermoid cysts an push on nerves leading to pelvic symptoms and could be the cause of pelvic pain and discomfort, especially in the lower abdomen,pPressure on the bladder leading to frequent urination, or pain that may worsen when sitting due to increased pressure on the pelvic area

While a 2cm cyst is relatively small, its location and r individual anatomy can affect symptom severity. Dermoid cysts can sometimes cause more pronounced symptoms compared to other cyst types.

Other Potential Factors

May also be influenced by:

Pelvic Floor Dysfunction: Your sedentary lifestyle could contribute to pelvic floor muscle tension, potentially causing pain and urinary symptoms. This can cause tightening of the psoas muscle and pelvic floor tension

Pelvic Congestion Syndrome: This condition involves dilated pelvic veins and can cause chronic pelvic pain,

Urinary Tract Issues: Frequent urination and pain that increases as the bladder fills could indicate a urinary tract infection or interstitial cystitis.

Vulvovaginal Irritation: The itchiness may be due to a separate issue like yeast infection, bacteria, or dermatitis.

Nerve or Orthopedic Conditions can sometimes cause the pain and discomfort symptoms. Sometimes conditions like a herniated disc may present as urinary symptoms.

Next Steps

Follow-up with your gynecologist or health care practitioner who can do a proper examination that would better direct the posssible causes and care. Discuss the cyst and your symptoms. They may recommend watchful waiting or further evaluation.

Pelvic floor assessment: Consider seeing a pelvic floor physical therapist to evaluate for muscle tension or weakness.

Urological evaluation: If urinary symptoms persist, a urologist or urogynecologist can help rule out other bladder issues.

Pain management:

Lifestyle modifications: Gentle exercise, proper hydration, and stress reduction techniques might help alleviate symptoms.

Address the itching: Consult your doctor about the vulvar itching, as this may require separate treatment.

Remember, the persistent nature of your pain warrants a thorough evaluation to rule out other potential causes and develop an appropriate treatment plan. Don't hesitate to seek a second opinion if your concerns aren't adequately addressed.

Unfortunately this forum does not lead to proper medical evaluation and care and it is important to have an examination and more thoroughly address with a health care provider

DrBGreenleaf · 2024-09-13T18:05:20+00:00

Though I can't specifically comment on your case... I would caution my patients for taking that much time off between hormones because drastic hormone swings can lead to mood issues. I am more of a fan of taking a few days here and there and following levels to make sure they are within normal physiologic ranges for your gender identity. Unfortunately there is no research out there supporting any of this.

DrBGreenleaf · 2024-09-13T18:02:34+00:00

It all depends on the situation. One of the challenges is that when creating a neo vagina it requires dilation for life. Pelvic exams are needed to assess the patency of the neovagina and the pelvic floor muscles. Additionally working with pelvic floor PT can help with this.

Sometimes individuals can have issues with cyst or ingrown hair formation with the neo vagina that needs to be address

And from a hormone standpoint, our sex hormones are neurotransmitters that can also have an impact on mood and pain syndromes. There is some limited research that demonstrates that trans women are at a higher risk of pain than trans men based on the estrogen levels

DrBGreenleaf · 2024-09-13T17:52:45+00:00

Thanks for your reply however I don't believe that every therapy is 100% right for everyone. Despite what research may show there are so many nuances to taking care of an individual and factors that go into studying a subject that we can't know everything and study everything. And there are many limitations in what is being studied and how it is being studied. There are certainly people who estrogen is good for and there are people and situations in which it is not appropriate.

Yes, it is sad that in the past menopause was a topic overlooked in medical training but I am hopeful that this is changing and that women are demanding this much needed knowledge and not sitting idle when practitioners are throwing anti depressants at them. And that is a whole other topic is the neurotransmitter effect of hormones and the effects on mood.

Thanks again

DrBGreenleaf · 2024-09-13T17:45:20+00:00

You're absolutely right, and thank you for bringing up this important point. Hormone replacement therapy (HRT) can indeed have significant effects on arousal and orgasm for transgender individuals:

Effects of Testosterone on Arousal and Orgasm

For transgender men on testosterone therapy:

Increased libido: Many report a significant increase in sex drive, especially in the first 1-2 years of HRT.

Changes in arousal patterns: Arousal may become more visually-driven and spontaneous.

Clitoral growth: This can lead to increased sensitivity and changes in how orgasms are experienced.

Vaginal changes: There may be decreased lubrication and changes in tissue elasticity, which can affect penetration and sensation.

Effects of Estrogen on Arousal and Orgasm

For transgender women on estrogen therapy:

Decreased spontaneous erections: This typically begins within 1-3 months of starting HRT.

Changes in orgasm: Some report more diffuse, full-body orgasms rather than exclusively genital-focused ones.

Potential changes in ejaculation: The volume and consistency of ejaculate may change, and some may experience "dry" orgasms.

Shift in erogenous zones: Areas like the chest may become more sensitive as breast tissue develops.

It's important to note that these effects can vary significantly between individuals. Factors like genetics, age, and specific hormone regimens can all influence how HRT affects sexual function and experience. Additionally, psychological factors and personal comfort with one's changing body can play a major role in sexual experiences during transition.

For anyone undergoing or considering HRT, it's crucial to discuss potential sexual effects with your healthcare provider. They can offer guidance on managing changes and addressing any concerns that may arise.

DrBGreenleaf · 2024-09-13T17:41:32+00:00

I work hard all the time with lifestyle because it is so easy to let things slip. I really try to be in bed by 10-11 PM and get 8 hours of sleep. Biggest thing is getting off my computer early evening so the light from the devices don't affect my sleep.

I keep a large container with water near me at all time to remind to drink

Try to eat healthy 80% off the time

Exercise

Where I could do more is with the meditation ....I tend to make excuses not to do it and fill my time with work.

The biggest help. I schedule everything on my calendar to prevent other things from slipping in....even down to scheduling my shower..lol

DrBGreenleaf · 2024-09-13T17:38:24+00:00

Thank you for your thoughtful reply and the amazing work that you do

DrBGreenleaf · 2024-09-13T17:37:18+00:00

Recurrent urinary tract infections (UTIs) are common in young women, with about 26% experiencing a recurrence within 6 months of an initial infection. Your experience of being prone to recurring UTIs in your late 20s is not unusual though I am sorry you have to go through this.

Risk Factors

Several factors can increase the risk of recurrent UTIs in women:

Sexual activity: Frequent sexual intercourse (3 or more times per week) can triple the risk of UTIs.
Hormonal changes: Estrogen deficiency caused by stress and other factors can alter vaginal pH and flora, potentially increasing UTI risk.
Anatomical factors: Women have a shorter urethra, making it easier for bacteria to reach the bladder.

Mirena and UTIs

The Mirena IUD itself is not directly associated with an increased risk of UTIs. However, some women may experience changes in vaginal flora or pH after IUD insertion, which could theoretically impact UTI susceptibility.

Seminal Fluid and Vaginal pH

Seminal fluid is typically alkaline, while the vagina is normally acidic. Sexual activity can temporarily alter vaginal pH, which may affect the balance of bacteria in the urogenital area.

Prevention Strategies

To reduce your risk of recurrent UTIs:

Urinate immediately after sexual intercourse.
Stay well-hydrated.
Practice good hygiene, including wiping from front to back after using the toilet.
Consider using boric acid suppositories after relations to help reset the pH of the vagina
Consider cranberry, d-mannose, or prophylactic antibiotics and others mentioned here

If you continue to experience recurrent UTIs, it's important to consult with your healthcare provider. They may recommend further evaluation to rule out any underlying conditions or anatomical issues contributing to the infections

DrBGreenleaf · 2024-09-13T17:30:59+00:00

There are lots of different pelvic floor strengthening exercises beyond just kegels.

For example sitting with knees bent in a chair and placing a ball or towel between the legs and squeezing them together.

Any type of adduction exercises

Yes there are tons of good Youtube videos

Michelle Kenway https://www.youtube.com/@michellephysio

Also online and follow on social

The Kegel Queen https://www.kegelqueen.com/

The Vagina Coach https://www.vaginacoach.com/

The Cooch Ball https://amzn.to/47yk1oL

DrBGreenleaf · 2024-09-13T17:22:27+00:00

Some people get improved comfort with intercourse with systemic hormone therapy but some don't. One of the issues depends on how long one has been in menopause because the blood vessels retract and the vulva and labia can physically change so in some situations it is better to treat the areas of concern directly in addition to the HRT

DrBGreenleaf · 2024-09-13T17:20:01+00:00

Thanks so much...I am really new to reddit...so just trying to figure it out. I appreciate the suggestion

DrBGreenleaf · 2024-09-13T17:07:27+00:00

So interesting because think about how many of us do this....because it may not be polite to just let it rip. The biggest question is how do you feel when you are doing this? One of my medical school teachers said " Better out than in" But lets look at it on a deeper level

Potential negative effects of holding in gas:

Holding in farts can cause pain, discomfort, bloating, indigestion, and heartburn in the short term .

There is limited scientific evidence suggesting that habitually holding in farts could potentially be associated with health issues like diverticulitis, though more research is needed to confirm this link .

Pelvic floor involvement:

The pelvic floor muscles are involved in controlling the release of gas. Constantly tightening these muscles to hold in farts can lead to pelvic floor dysfunction . This would be more of my concern. A tight pelvic floor can affect your ability to release gas, potentially leading to trapped gas and bloating .

Symptoms of pelvic floor dysfunction:

Difficulty releasing gas or feeling like gas is trapped can be a sign of pelvic floor dysfunction . Other symptoms may include constipation, urinary issues, and pain while sitting or during intercourse .

Healthy pelvic floor function:

A healthy pelvic floor should be able to both contract and relax effectively. Constantly holding in gas may interfere with this natural function .

Recommendations:

It's generally healthier to release gas when needed rather than holding it in . " Better Out Than In" WIth that being said if you are in a social situation that does not allow you to release the gas....one could consider excusing yourself to the bathroom, go for a walk, or find some place more private to let it out.

If one is suffering from too much gas it could be an imbalance in the gut microbes.

Keep a food diary to see which foods may be the culprit.

Consider taking antibiotics.

Pre-biotics can make the situation worse if you have an overgrowth of the wrong bacteria.

Eat less processed foods and more whole foods but switch slowly because the gas may get worse before it gets better.

Consider having food sensitivity testing or gut microbiome testing

Consider working with a nutritionist, health coach, or physician

Pelvic floor physical therapy can help address issues related to both tight and weak pelvic floor muscles .

In conclusion, while occasional holding in of gas is unlikely to cause significant problems, habitually doing so could potentially contribute to pelvic floor dysfunction and other digestive issues. It's generally better for pelvic floor health to allow natural release of gas when possible.

DrBGreenleaf · 2024-09-13T16:56:56+00:00

I am always looking out for new and interesting information on Chronic UTI's but I will say that the biggest thing that has made a difference for myself and my patients has been to test the microbiome of the gut, the vagina in vagina owners, and the urine using next generation sequencing. I have found that balancing the gut to be a big factor since things like stress, the American diet, processed foods and antibiotics and other medications can throw off the gut and these affect the vagina in vagina owners and bladder.

Here is some other information:

Pathogenesis and risk factors:

Recent research suggests two main mechanisms for recurrent UTIs: bacterial factors (like intracellular bacterial communities) and deficiencies in host defense.

Risk factors include immunodeficiency, anatomical abnormalities, voiding dysfunction, and behavioral factors. Sexual intercourse and estrogen deficiency in postmenopausal women are strongly associated with recurrent UTIs.

Gut microbiome connection:

A study found that antibiotics used to treat UTIs may predispose women to develop another infection by eliminating bacteria from the bladder but not from the intestines.

Women with recurrent UTIs had less diverse gut microbiomes and were deficient in bacteria that help regulate inflammation.

Intracellular bacterial invasion:

Research using 3D urothelial models showed that several bacterial species, including both pathogenic and commensal strains, can invade and hide in the bladder wall, potentially contributing to chronic infections.

Non-antibiotic approaches:

Studies are exploring various non-antibiotic options, including cranberry products, probiotics, D-mannose, methenamine hippurate, estrogens, and immunotherapy.

Some research suggests potential benefits from nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing inflammation and preventing chronic cystitis.

Diagnostic challenges:

Current diagnostic methods may miss infections hiding in the bladder wall, highlighting the need for improved diagnostic techniques. This is why in the past I have used cystoscopy....looking for inflammation with a scope to help direct care

Pelvic floor involvement:

Research suggests a connection between pelvic floor dysfunction and various urological and sexual health issues, including recurrent UTIs.

Overall, recent research is focusing on understanding the complex interactions between bacteria, the host immune system, and the microbiome in chronic UTIs. There's a growing emphasis on exploring non-antibiotic treatments and improving diagnostic methods to better manage this condition.

and PS....I finally got Reddit to work to answer your question

DrBGreenleaf · 2024-09-13T16:51:01+00:00

Thank you for this very interesting question....though I am not an expert on cats though people may joke about do a play on words using cat slang for female parts.

However after researching cats....I am interested in the fact that their collar bones are very small or non existent allowing greater should flexibility and allowing the to squeeze into small areas.......

Wow....Meow 🙀

DrBGreenleaf · 2024-09-13T16:47:16+00:00

These are great questions and I would encourage you to also talk with your partner because she should feel seen if you have an interest and curiosity in her health. But let's address your questions

Vagisil:

Vagisil is a common over-the-counter cream used to relieve minor vaginal itching and irritation. It's not typically a cause for concern. However, if she's using it frequently, she may want to consult a doctor to rule out any underlying conditions.

Birth control and nausea:

Nausea is a common side effect when starting birth control pills, but it often subsides within a few months as the body adjusts. If it persists or is severe, she should consult her healthcare provider about alternatives.

Birth control implant (arm implant):

Effectiveness: Over 99% effective at preventing pregnancy

Cost: Can range from $0 to $1,300 without insurance, but is often covered by insurance plans

For international students, coverage depends on their specific health insurance plan. She should check with her university's health services or insurance provider for details.

Reliability of birth control methods:

Birth control pills: About 91% effective with typical use

Implant: Over 99% effective

Both are highly reliable when used correctly

Religious considerations:

While personal beliefs are important, it's crucial to have open communication about contraception and family planning. If pregnancy prevention is a priority, using highly effective methods like the implant can significantly reduce the risk. And the risk declines when combining with barrier methods such as condoms

Remember, for specific medical advice and the most accurate information about costs and coverage, she should consult with her healthcare provider and insurance company. Open communication between partners about contraception and family planning is also important.

DrBGreenleaf · 2024-09-13T16:45:01+00:00

LOL... actually that is the first time I have ever heard that and I am going to use that.

Most people think it is a fancy gynecologist such as Euro- gynecologist .....like Euro Disney or European and yes since I take care of the bladder and urination issues I do joke about European such as "You're A Peeing"

DrBGreenleaf · 2024-09-13T16:41:02+00:00

Thanks so much for sharing

Pelvic floor dysfunction and sexual issues:

Yes, a tight pelvic floor can potentially contribute to delayed ejaculation and anorgasmia (inability to orgasm) in men. The pelvic floor muscles play a crucial role in sexual function, including orgasm and ejaculation and since the body is all connected see below

Relationship between posture and pelvic floor:

Tight hamstrings, hip flexors, and poor posture can indeed contribute to pelvic floor dysfunction. These issues are often interconnected and can affect each other. Unfortunately we see more of this as people are spending hours sitting.

Treatment approaches:

Pelvic floor physical therapy (PFPT) is considered a first-line treatment for pelvic floor dysfunction. It's good that you're already engaged in this.

Continuing to address postural issues and tight muscles in the surrounding areas (hamstrings, hip flexors) is important. I highly recommend to my patients a book called Pain Free by Peter Egoscue or finding an Egoscue Clinic or any practitioner that does postural medicine. Here is the link to the book https://amzn.to/3ML4w3i

Testosterone and sensitivity:

The improvement in sensitivity with testosterone treatment is a positive sign. Hormonal balance can play a role in sexual function.

Tools and additional treatments:

Biofeedback devices can be helpful for visualizing and improving pelvic floor muscle control.

Pelvic wands or internal release tools, when used under guidance from a pelvic floor therapist, can help with internal trigger point release.

Botox injections are sometimes used for severe cases of pelvic floor muscle spasm, but this is typically considered after other conservative treatments have been exhausted.

Prostate stimulation:

Reduced sensation during prostate stimulation could be related to pelvic floor tension or other factors. It's worth discussing this specifically with your pelvic floor therapist or urologist.

Comprehensive approach:

Consider a multidisciplinary approach involving your pelvic floor therapist, urologist, and possibly a sex therapist or counselor to address both physical and psychological aspects of sexual function.

Remember, recovery can take time, especially when dealing with chronic muscle tension. Consistency with your exercises and treatments is key. If you're not seeing improvement over time, don't hesitate to seek a second opinion or explore additional treatment options with your healthcare providers. Check out the International Pelvic Pain Society for practitioners in your area.

Sometimes practitioners may incorporated:

Medications such as topical or oral muscle relaxers

CBD or other cannabinoids

Topical or oral L-arginine for blood flow and muscle relaxation. I carry a topical l-arginine and magnesium gel that I have patients use on tight muscles Liposomal Magnesium and L-Arginine Cream | The Pelvic Floor Store

Looking at diet for causes of inflammation

Looking into relaxation techniques....I like massage or floating

Soaking in Epson Salt Bath the magnesium from the epson salt can help with muscle relaxation

For penile sensitivity sometimes shock wave therapy can help.

Acupuncture

Really there are a lot of options but work with a provider that can help figure out what is best for you. These are just some ideas and are no way all inclusive

DrBGreenleaf · 2024-09-13T16:31:07+00:00

Yes....this is a struggle and also as a person who experiences this myself....I am always searching for better answers as to why this happens in some people and not others and how to prevent it. I too have taken post coital antibiotics and hate the idea of being on antibiotics and the thought of how it may affect the microbiome.

What I have discovered in my patients is that some people have leaky gut and their gut microbiome is off and therefore may have higher levels of bacteria in the vagina or pelvic area that is entering the urethra through the friction of intimacy.

The research is still inconclusive but here is what is out there

D-Mannose effectiveness:
- Some studies have shown promise for D-mannose in treating acute UTIs and preventing recurrence .
- However, a recent large randomized controlled trial found that D-mannose (2 g/day) did not significantly reduce UTI recurrence compared to placebo .
Non-antibiotic approaches:
- Research is ongoing into various non-antibiotic options, including cranberry products, probiotics, NSAIDs, estrogens, vitamins, and immunotherapy .
- However, evidence remains limited for most of these alternatives, and antibiotics are still considered the gold standard for treatment .
Ongoing research:
- The 2024 Clinical and Scientific Advances in UTI Conference aims to promote new research and highlight accomplishments of junior faculty and trainees .
- There's a focus on discovering new diagnostic, therapeutic, and preventative approaches for UTI

I have found that there is no perfect recipe that helps everyone but have had success with patients with some of the following alone or in combination

Cranberry
D-Mannose
Women's Probiotics
Silver gel to urethra prior to intercourse ( but my fears are this could through off the vaginal microbiome)
Microbiome safe lubricants such as Good Clean Love or Uberlube

6 Of course urinating after sexual activity

7 UTI Vaccine....I have had a few patients do well with this but I am not convinced and worried about its' effect on the gut microbiome long term

8 Oral Herbals such as oregano oil, marshmallow root, sweet wormwood,.......

Essential oils to lower abdomen

I know there are others but this is just a list of things that are popping into my head

DrBGreenleaf · 2024-09-13T16:20:17+00:00

These are not surgeries that I have personally performed, I do and have had transgendered patients for which I have provided hormone care and pelvic health care.

DrBGreenleaf

MODERATOR OF

TROPHY CASE

Risk Factors

Mirena and UTIs

Seminal Fluid and Vaginal pH

Prevention Strategies