Episode 35: What’s Up With My Yoni? How to Deal With Yeast, Bacterial Vaginosis and Vaginal Dryness

All about vaginal health! In this episode, Dr. Lisa and Dr. Toni give you a crash course on: your anatomy "down there"; ways to optimize your vaginal pH and microbiome; how hormonal changes contribute to urinary tract infections, vaginal dryness and atrophy; and what to do about yeast infections and bacterial vaginosis. Basic Genital Anatomy:  Your vulva is the outside of the genital tract, where your clothes touch your skin.  Your vagina is the inside of the genital tract and the transition zone from your vulva to your vagina is called the vestibule. As you get closer to the vagina, your skin has fewer layers and less keratin, along with no hair follicles. This makes the area more vulnerable to trauma and irritation. The mucosal skin of your vestibule and vagina have cells filled with storage sugar called glycogen. “There’s a lot of money in vaginal shame” Dr. Jen Gunter - Vagina Bible * Each woman’s vaginal smell is unique and based on your changing hormonal balance and microbiome, which can be impacted by your diet and use of antibiotics. * No douching (which is flushing the vagina with a medicated solution or even water) is needed. * Any washing of your vagina can damage the protective mucus and Lactobacilli beneficial bacteria there.* No vaginal cleansing products have been scientifically studied.* Research has shown that washing your vagina with soap can increase the risk of HIV transmission by almost 4 times, while washing your vagina with only water can more than double the risk of HIV transmission. Your Vaginal Microbiome: This is your symbiotic relationship between bacteria and yeast along your vaginal tract and on the skin of your vulva.  You may always have some yeast or unfavourable bacteria present, but as long as your beneficial bacteria outnumbers your unfavourable micro-organisms, then you don’t have any issues or symptoms. How Hormonal Changes Impact Vaginal Health: As estrogen decreases in perimenopause and menopause, you can have less blood flow to your vagina and vulva which can cause: * your vaginal and vulvar tissues to lose strength and elasticity, becoming more fragile and losing their ability to stretch* your vaginal and vulvar skin to become more thin and feel more dry* the amount of your vaginal and vulvar tissue to decrease, as your cells lose volume* your microbiome balance to change, as your cells have less glycogen to feed Lactobacilli beneficial bacteria Vaginal pH: * Lactobacillus bacteria produce lactic acid to keep our vaginas acidic with a pH between 3.8 and 4.5, while the pH of your vulvar skin is between 5.3 and 5.6* This acidic pH allows for favourable microbes to thrive and unfavourable ones to not become a problem* You can check your pH by parting your outer labia and applying pH paper with a narrow range as close as possible to inner vaginal wall, then hold a few seconds, compare colour to the key provided* If above 4.5, a bacterial imbalance like bacterial vaginosis is possible * Yeast or Candida doesn’t change your pH value Possible Vaginal Imbalances: Yeast infections:  An overgrowth of Candida albicans can irritate your vagina and your vulva resulting in symptoms like:  * thick, whitish or yellow discharge (but not always!) * redness, itching and swelling of vulva* pain after urination  What do you do if you think you have a yeast infection? First, rule out allergic reactions,