Kim Vopni (00:02.258)
Hi, Dr. Mora, thank you so much for joining me. I am so excited. It's been a while. We were just talking offline of us trying to connect with different time zones and busy schedules. And I'm so glad that we finally have an opportunity to speak. This is a topic that I personally want to know more about, but I know my audience is definitely interested in. And first, I'd like to start out. we're talking about the vaginal microbiome.
and that and all of what that encompasses. But before we dive into the particulars, I would love to know your story and what got you into the work of specializing in the vaginal microbiome.
Moira Bradfield Strydom (00:41.45)
Yeah, thanks for having me. And I sort of found myself in this area because I'd been a clinician for many years and I started to have a run of people that were having quite strange vaginal symptoms and I was using the toolbox that I had at that time, which wasn't great in hindsight, and finding that it wasn't working, that people were having symptoms, they were being told mixed things from other care providers.
And then the interventions we were putting in place weren't seeing a resolution. So I went back to the drawing board and decided that there must have been something that I wasn't considering. And when I discovered the vagina microbiome initially, I was like, wow, we haven't even covered this. You it was still relatively new. And then it really provided the answers that I was looking for. Well, then I could start making quite significant change. And in retrospect of seeing that and knowing that I also had the insight then in my own
Kim Vopni (01:26.012)
Okay.
Moira Bradfield Strydom (01:34.818)
personal health journey, which was one in my early 20s and 30s of quite a lot of urinary tract infections, of having an insight on what could have been going on there and why I had that recurrency issue and why thankfully I came out the other side of that, but not with the knowledge base that I have at the moment. You know, it was very much stumbling along and making things up as I went. And so it's an area that since I have jumped in and specialised in that niche, it's
Ever surprising, but also not that the amount of people that have quite significant recurrent issues of infection that aren't finding that they're getting the support that they need, who aren't finding the answers in the resolution, which I think the microbiome and understanding of the microbiome gives us quite specific insights. It's obviously one piece of the pie in a whole big meal, but it gives us very specific insights that we can modify and address that can help that person move towards a resolution.
Kim Vopni (02:05.499)
you
Okay, super interesting. And usually in everybody who I interview, there's always some little thread in there, sometimes a big thread of a personal journey as well and kind of our pain to purpose, right? okay, so big picture, many people have heard the term gut microbiome. We hear the term microbiome and we are now learning that there are microbiomes
Moira Bradfield Strydom (02:43.15)
Mm.
Kim Vopni (02:55.884)
in many parts of our body. So what is a microbiome? And then we'll move specific to what is the vaginal microbiome.
Moira Bradfield Strydom (03:01.942)
Yeah, so you're right, we have a lot of them, pretty much any orifice within our body and potentially even further in terms of things like blood and organs have microbiome and microbiome refers to a collection of microbial species, whether they are bacterial or fungal. And we also can include loosely in that definition viral components as well, which are not strict microbes as such, but they fall in that category.
And so it's a collection of those things that are housed in health and disease within that particular area in a human. So we're not to look at them as being separate to us. Essentially we are that and they are us and we work synergistically together to maintain health essentially. I like to view them as part of our regulation of health or our homeostasis for want of a better term. And so we have those in lots of different areas and
Kim Vopni (03:34.041)
.
Moira Bradfield Strydom (03:55.374)
you're right, the most well known is the gut microbiome and we have different understandings of the different microbiomes because they are quite different to each other in terms of their key characteristics and what microbes may exist in those spaces and what they do for us based on what the function of that area is as well. So if we think about the vaginal microbiome, it's quite different to their gut in a few key ways. One is that when we talk about gut health,
Often you hear people talking about diversity of microbes, having lots of different types of microbes and a good balance and a general understanding of what some of the larger groups of beneficial microbes might be within the gut and how that is maintained by diet and lifestyle and what we do with our health and that they work towards us regulating having a good digestive system, having good absorption of nutrients, maintaining the mucosal or the area and its immune system response.
Kim Vopni (04:32.952)
.
Moira Bradfield Strydom (04:54.434)
Whereas the vaginal microbiome is different in that diversity or lots of different bacteria primarily is not what we want to see in the vagina at all. In fact, in health for the majority of people, and there are exceptions to this, but for the majority of people in health, the microbiome is made up of quite, very few microbes and predominantly lactobacillus species and not even just having all the lactobacillus, some people just have one.
Kim Vopni (05:02.615)
.
Moira Bradfield Strydom (05:22.138)
and that can be completely normal. saw a number of microbiomes in the last few weeks on testing where they just had 100 % of one particular bacterial species. And so the Lactobacillus, I talked about a lot because they are quite amazing and they produce for us beneficial acids like lactic acid and they produce hydrogen peroxide and they produce a whole lot of very important byproducts or metabolites that regulate
Kim Vopni (05:32.214)
Okay.
Moira Bradfield Strydom (05:50.134)
and that area and that system from threats as they come in from the external world and also from internal factors as well. So it's a very important eco niche and very important obviously for people who are assigned female at birth because they have vaginas and in their lifespan may do a lot of different things from birthing to menstruation, from having intercourse.
and different hormonal fluctuations over a lifespan may also change and shape that microbiome. So while we think about food being really important for the gut microbiome, one of the primary important influences of the vagina microbiome is hormones across a lifespan and in particular, estrogen, in that if we have predictable...
Kim Vopni (06:24.325)
.
Kim Vopni (06:34.749)
.
Moira Bradfield Strydom (06:37.07)
in range good estrogen, theoretically then we have a good fuel source for these beneficial lactobacillus to grow and thrive in that space and then maintain and take out those really important factors in terms of health regulation for us.
Kim Vopni (06:52.59)
Got it. Okay. You mentioned one thing that I would like to know, Mara, that you said in testing, how do you test somebody's vaginal microbiome?
Moira Bradfield Strydom (07:02.142)
Yeah, there are lots of different ways. Some of them are still in the realms of more functional testing and obviously not mainstream for us. And when I work with somebody, all of the data is important. I want to see the results of swabs, culture and microscopy, which is generally what happens when you pop along to your doctor's office and there's a swab that's taken, you get an insight of what it looks like under a microscope and you get an insight of what will grow if they feed it the right thing. So that's sort of...
testing information is useful, particularly in very acute situations where you need information fast. And then there are a number of additional tests that are based on DNA based technologies. So we have PCR technology, is some of that is very mainstream in terms of identifying quite specific bacterial.
Kim Vopni (07:42.612)
you
Kim Vopni (07:49.535)
.
Moira Bradfield Strydom (07:52.334)
microbes and quite specific viral microbes for us. So that's something you can do very individualized specific testing, or you can look at slightly larger panels to capture some information. And then we move into the realms of testing that is more in alignment with where the predominance of our information comes from with research. And that is looking at next generation sequencing, so DNA based technologies that give us the all it tells.
us all of the bacterial species and all of the fungal species that are in that area. And then with some of that next generation sequencing, very specific forms called shotgun metagenomic, you can also understand viral components as well. And so when I'm working with people who are often accessing my clinic because they've done all the things and the things aren't working and there are, you know, recurrent symptoms or they're being told there's nothing wrong when that's
know, couldn't be further from the truth. We then typically go with that higher end next generation sequencing testing so we can see the snapshot of what's going on in the microbiome at the time when they have the symptoms which are the most worrying for them so we can understand what that influence is and using an overall again research based understanding of what constitutes health in this area we can look at overall trends in lactobacillus to potentially
BV associated bacterial, bacterial vaginosis associated bacteria or aerobic bacteria and we can look at fungal species and we can also understand very specific bacterial traits as well because sometimes things don't need to be there in a big percentage to be a problem in the background for an individual and that often is why they have very non-specific symptoms that aren't coming up on standard.
culture based testing is because it's about a shift in how the environment works or a true, the term is dysbiosis, know, an imbalance, but it's not necessarily a big acute infection as such. And so we see these recurrent things kicking along. And so that type of testing can give us quite specific insight into what may need to be supported and what might need to be targeted if we're looking at targeting with anti-microbials of any form.
Moira Bradfield Strydom (10:11.662)
And then you step out and use that information in concurrence with good case taking. know, what is this person's stage of life? Where is their hormone or status at? When are their symptoms appearing for them? Is that around a specific point in a menstrual cycle if they have one or after certain activities or when they've eaten certain foods or had a really stressful week? So that those are also then factors that in a holistic clinical setting.
are worth supporting and modifying as well, you know, so that you can modify certain sexual behaviors or put barrier methods in place and, you know, look at lifestyle factors and all of that as individual things, maybe not be enough to create that change. But when you bring it all together, you're supporting that particular area to be as stable as possible for as long as possible. So hopefully it gets its act back together and it can, you know, realign and come back on in terms of helping us.
Kim Vopni (11:08.142)
Yeah.
Moira Bradfield Strydom (11:09.518)
In general, yeah.
Kim Vopni (11:10.925)
What, before we go down the path, like you've just mentioned a bunch of lifestyle things, which can be beneficial and helpful, but before we go there, what are the, what would indicate, so there's testing, but what are some of the signs and symptoms that somebody may have come to you or have gone to their care provider about that could indicate dysbiosis as it pertains to the vaginal microbiome?
Moira Bradfield Strydom (11:35.464)
Yeah, which is a great question because as I mentioned most people have lactobacillus in health. There is a subgroup of people that don't and they have diverse vagina microbiomes and that's completely okay. So if you're only ever looking at testing you don't actually know what's going on at all and the signs and the symptoms are the reason why you would even seek that type of testing and so
A lot of the time it can be related to a change in discharge or discharge that's concerning. So the fluid that is coming out of the vagina from the cervical and vaginal walls essentially. And whether that's a change in terms of the amount of it, the consistency of it. Is it really gushy or really thick? Has it got a color to it? Has it got an odor to it in general? Those types of things are typically on people's radars as not being right, hey, something has changed. And then
In accompanying with that for some people, then see a lot of signs of inflammation. know, there is pain, there is burning, there is swelling or redness, or there might be tissue that, you know, tears easily or breaks easily with intercourse, or you might also see an increased tendency to urinary tract infections. So all of those things may indicate that there is a microbiome consideration and as
you know, from your work and also may indicate a whole lot of other things in terms of pain response and neurological pathways and things like that. But it is those types of things mainly what people are concerned about. And as I said, sometimes they're told nothing is wrong, but they're very adamant that that is not the discharge that they had previously and that the amounts of it are copious. And there are definitely parts of our life where we're going to have a transition and things will change and it's still normal.
Kim Vopni (12:58.72)
Yeah.
Moira Bradfield Strydom (13:25.496)
for us, but sometimes that is something that you can still modify depending on what's going on for an individual as well.
Kim Vopni (13:32.213)
Right. So what can be some of the reasons why we may get to having dysbiosis? And the more common questions I get, mean, you've highlighted estrogen, the hormonal piece. So obviously a low estrogen is that disrupts the lactobacillus and that is one contributing factor. The other questions are things like lubricants, moisturizers, ingredients in those products, tampons, menstrual cups, silicone.
what ingredients in things that we put in or on our vulvas and vaginas could potentially disrupt the microbiome.
Moira Bradfield Strydom (14:13.142)
Yeah, which is a great question because I think a lot of people will traverse through their life and not have an issue and then there's an event and they do and they're like, it used to use that all the time and now all of a sudden every time I use it there is a symptom occurring. we can look at those things so if we're looking at lubricants for example the current consensus is you want something that is pH correct so the vagina I did mention before is
by these lactobacillus and the acids they produce is very tightly regulated in an acidic range in health. So between about 3.6, 3.8 to 4.5 is the healthy range up to and including 4.5. When we see it move above that, it tells us that the bacterial environment is imbalanced. But at the same time, we can challenge the bacterial environment by introducing things that aren't acidic, that aren't pH correct as well. And so sometimes in lubricants,
if the lubricant isn't pH correct, or if it has ingredients like glycerin that can disturb the cells and create inflammation, or if it has an ingredient that is an antimicrobial ingredient like lehexadine, or in certain parts of the world, thankfully not Australia, some lubricants will have spermicides in them as well, which are quite damaging to some cells in the area and the overlinking environment, or fragrances and things like that. So a lot of unnecessary
ingredients that are by nature on a very delicate cell surface irritating and may change the environmental pH or may change how fluids move in and out of a cell and so create damage to the cell as well. So lubricants are quite a big issue if you're using them. It's also a issue if you're not using them and you need it. know so it's about finding that happy ground and finding a good quality lubricant. So there is that side.
But sometimes people experience disruption from medication use, know, classically antibiotics might disrupt the bacterial environment, which when the microbiome is robust, theoretically you should recover from that, you know, over time, but some people don't ever recover from it, you know, and they may take an antibiotics many times and this one time something changed.
Moira Bradfield Strydom (16:31.566)
So that's something to consider as well and other types of medication. There's lots of things that might be drying up secretions or change particular pathways in the body or change neurological pathways. So those sorts of things are also big and important in the broader context. And then if we're looking at personal hygiene products, know, anything again, if the microbiome is slightly challenged, they will find it more problematic, but things
like natural fibres are a great idea because they tend to wick moisture away and they don't create an overly moist or sweaty environment which particularly fungal species will find very you know in tune with their growth so looking at you know underwear is very important but again in isolation lots of people are like well it changed my underwear but it's still happening i'm like but yes it's better than not having changed your underwear we need to track along that then
may also, you know, typically not washing with really anything other than water unless it's a medicated prescribed wash is a good idea because again we might be disrupting the external microbiome primarily and you're not meant to be irrigating or douching the fluids internally which a lot of people get in the habit of if they already have symptoms particularly odour they're like oh I'm just gonna wash it away for the day but that becomes more disruptive.
and compounding in the long term in general. And so when we're thinking about, I guess, inserted things like the tampons, definitely there was, there are considerations and some people will find that potentially organic cotton tampons are better and certainly no fragrances or perfumes in that and changing them frequently enough as well because the longer you leave something in the more
opportunity for microbial growth. is. And when we've got the new fantastic, you know, obviously reusable menstrual management things like cups and discs and things like that, which can be great. But again, it's about frequency of changing them and appropriate sterilization of them because we don't necessarily have
Moira Bradfield Strydom (18:50.828)
the data at the moment to conclusively say, you can wear that for 14 hours, no problem. You know, that's problematic, obviously. So I tend to take the conservative approach of changing as frequently as you would with a tampon, which usually should be around four to six hours and sterilizing as frequently as possible as well. And at least daily for those types of things or having them on rotation in general. Yeah. So those sorts of lifestyle factors are important. And, you know,
Kim Vopni (19:14.135)
Yeah.
Moira Bradfield Strydom (19:19.202)
But there are obviously a lot of things associated with sex that we also need to consider and can be disruptive to this area when you are already predisposed to disruption in general.
Kim Vopni (19:31.35)
Yeah, the other device that would be inserted a lot in terms of my community is pessaries. And there are some that are inserted and removed daily, but they would be left in usually for the day. are others that can be left in certain types or brands can be left in upwards of three months and then taken out. And so I always am guiding people to make sure you have a well estrogenized vagina to help keep that in check.
Is there anything else that you would add on top of that for people who are using either over-the-counter pessaries or the medical-grade silicone pessaries that we would need to keep in mind?
Moira Bradfield Strydom (20:09.896)
Yeah, a few things. Potentially one is with those things that are designed to be kept in longer, as you would know, some people tolerate that very well and then others straight off the bat will have problems with it, you know. And so the people that are straight off the bat having problems with it, I agree, estrogenisation and then microbiome support initially. And that may be as simple as thinking about, you know,
diet and lifestyle and hydration, which are key things for this area to be very regulated, particularly quite specific nutrient factors. But there may be an opportunity to use a probiotic where we have, you know, as a sort of a safeguard in the background, it doesn't all if you take an oral probiotic, it all doesn't magically appear in your vagina. But it can be part of a modulation of overall immune health and lactobacillus support to have that in place. And then there are other
more specific ones around the world where you can insert those vaginally as well. And that might be an appropriate thing initially why that person's area is being supported with oestrogens, know, an MHT in whatever form, or they're working towards having that tolerance and rebuilding that area as well.
Kim Vopni (21:25.642)
So on the note of vaginal probiotics, you said there are some that could be taken orally, but as you say, how much of it actually will get to the tissues is going to be buffered by all of the other, all of the systems it's going through. Whereas a vaginal probiotic is kind of like where we look at systemic versus vaginal estrogen, where it's being inserted and designed to act more locally. Is that really, and is it?
Moira Bradfield Strydom (21:50.958)
Mm-hmm.
Kim Vopni (21:52.765)
would a probiotic for the vaginas still be in a capsule form or would it be in a delivery mode?
Moira Bradfield Strydom (21:59.874)
So they can still be in capsule form. Typically the vagina is pretty good at degrading standard gel capsule as long as it's not enteric-coated. And you're right, I mean the ones that we take orally, sometimes their impact on the vaginal microbiome is not even seeing the same strains show up. It's about modifying that person's host response or you as the host and how much resource your body has then to be able to support a microbiome site.
When we use something very locally and directly like an intra-vaginal probiotic, we're still not, we're not hoping that that microbe, all of a sudden we put it in there and it starts a whole new colony and off we go for the rest of our lives. The probiotics, for most probiotics, in most microbiome sites within the body, move through that site, modulate a response and support that site's own native bacteria to recover.
to a baseline that is set through a whole lot of different things in terms of our life stages and our birth cycle and things like that. So you put in a probiotic vaginally, you end up with a whole lot of lactobacillus typically in that area. The lactobacillus while they are in there are acting to produce the acids and the environmental control and a pseudo colony if you like that crowds out or decreases opportunistic or pathogens in general. And then if you have
your own lactobacillus species, even if they're very depressed, it can create an environment where they're more likely to thrive and survive because most of the lactobacillus with the exception of one don't really or aren't able to survive at high numbers when the pH moves above five ish. And the only one that's set up to do that is lactobacillus irons. And there's a lot of discussion around whether it's even.
that helpful all the time, like it's a placeholder lactobacillus and sometimes it behaves aberrantly a bit like a pathogen for some people when they've got a lot of it as well. So when we're putting in quite specific strains we're just regulating the environment for the time and then if we stopped using that probiotic theoretically the colonies that we put in there from the probiotic would disappear over a period of time, it's different for different formulations.
Moira Bradfield Strydom (24:20.438)
And then hopefully we've got some recovery because we've considered not just what's going on locally, we've thought about hormones and we've thought about the lifestyle impacts that could be challenging the environment. And we've thought about that person's nutrient status and hydration status and what they are doing with their vagina and modified those factors as well to give it the best opportunity.
Kim Vopni (24:43.567)
I want to ask about a few ingredients that I get asked about all the time. One being coconut oil. I hear it. I've heard and I've also done my research to look at the what what is the truth about it? Because I've heard the two camps of it's it's almost saying it's antimicrobial. You can use it as a some people call it a moisturizer. It's more like a lubricant like anti-friction. Another say that it is disruptive to the pH. So where
Where does coconut oil fit on the favorable versus non-favorable?
Moira Bradfield Strydom (25:16.394)
Yeah, I tend to clinically avoid it and there's a few reasons. When we think about pH, which is this measure of acidity and in science that's a measure of hydrogen ions in an aqueous or water-based solution. so theoretically, oils don't have a pH. So their ability to disturb an environment is based on other factors and the fact that they coat and adhere and obviously are oily in nature.
with coconut oil, which does have a very unique medium chain triglyceride or fatty structure associated with them that has quite well known antimicrobial and antifungal properties. There's almost like a division of people where some people have initiated and started coconut oil and it fixes everything. It fixes the irritation. It fixes their tendency to thrush. And then there's the other people who start it and it just creates more.
issues for them. know, it can for people that have a lot more bacterial imbalance. In my clinical experience, a lot of, well not a lot of, some of the oils can create an environment that then is harder for that microbiome to re-regulate itself because it's adherent and sticky and takes a long time to come out. So for those people, oils in general and coconut
as a lubricant or moisture are not always the best thing for the internal vaginal environment. Sometimes it's very different if we obviously look at the anatomically, there's the external environment of the vulva and the labia. And then there's this internal vaginal canal, which is where the microbiome we've been talking about sits. So if you are using coconut oil on the external to soothe tissues, there might be a little bit of transference into the vaginal canal, but it's very minimal for most people. And so that might be one way to use coconut oil.
in those scenarios, but it is a little bit of a very, well, it's very specific to the individual and potentially specific to what's going on for them with their microbiome as well. In terms of things like sex, for example, where people might be using it as a lubricant. I do think from personal experience and from talking to people that coconut oil has this tendency that with friction almost becomes a little bit sludgy or
Moira Bradfield Strydom (27:37.314)
you know, clusters a little bit and that's not great. You want a slippery lubricant that reduces friction and doesn't create its own, you know, problem as well. And if you're needing an oil-based lubricant, which is typically better if you're not relying on a barrier method and you potentially, a lot of people as they move into menopause and have a lot more atrophy, oils are better because they're longer lasting and tend to stay slippery for longer.
If you are needing an oil-based lubricant, then either having one that is specifically built for that or choosing a more compatible oil. mean, even olive oil is considered to be better for beneficial bacteria than coconut oil is in general.
Kim Vopni (28:18.615)
Yeah.
Yeah, so it's interesting what you're talking about the oils, because there's also a lot of, some people call them moisturizers, some people call them salves or bombs, which are more, I would say, vulva as opposed to vaginal, even though they may use the term vulva vaginal, that may contain things like shea butter or almond oil or beeswax that are, as you say, they kind of they adhere a little bit more. So if I understand those would
Moira Bradfield Strydom (28:47.79)
Okay.
Kim Vopni (28:49.984)
potentially be appropriate more for the external, excuse me, external, not so much for the internal, but if the little transfers, it's not the end of the world. Is that accurate?
Moira Bradfield Strydom (28:54.35)
you
Moira Bradfield Strydom (28:58.56)
Yeah, typically you want something that's, you know, either already liquid or melts very quickly and doesn't solidify, you know, mid act. I mean, therapeutically, I will deliver oil based ingredients if I'm using a therapeutic pessary. I will do that in an oil based pessary at times. And shea butter or cacao butter are really great delivery because they tend to be solid, more solid at room temperature than coconut oil will.
Kim Vopni (29:03.562)
Yeah. Yeah.
Moira Bradfield Strydom (29:26.168)
but it's still very much specific to the individual, whether that is tolerated and what that feels like. And we do know, particularly when estrogen is lower across a lifespan, that moisturising is fantastic. Then we've got these studies that tell us that the use of moisturisers can be equivocal to, for some people, as the impacts of estrogen, topical estrogen. So for people where they're not tolerating estrogen, finding a groove where they're using vaginal moisturisers and they're using topical estrogens.
is often the way of finding their way out of that inflammatory state as well.
Kim Vopni (30:00.638)
Yeah, yeah. I want to move into now, what are things, like we've talked a little bit about what could potentially be, well, some of what could be disruptive. So anything that I've missed on what could be disruptive to our microbiome, and then also now what can we do to, I'm going to assume one answer is going to be vaginal estrogen. So keeping the, helping keep the pH where we want it to be in the more acidic zone. What are other things we can do to support our vaginal microbiome?
Moira Bradfield Strydom (30:27.308)
Yeah, so I guess we'll start with the first question. And it's probably more just in addition to what we've been discussing around disruptors and that is the impact of sex. for us, sex is an interesting thing in that it involves other people and it involves potentially interacting with their microbiome sites. So there is microbial transference even if
that other person hasn't got an infection, you can pick up things. that's sometimes, I mean, obviously on an evolutionary level as humans, it's a very normal act for us to engage in. And so there is advantage to that as well to acquire new microbes and to strengthen the microbiome. It's not all fear based. So we have that side of things. And we also then have the exchange of body fluids in general, which are not.
pH regulated to the environment. it's one of those things when people, some people are adamant that there was a particular partner when things all spiraled out of control and it wasn't an STI acquisition, or that every time they have sex, there is a disruption and that initiates symptoms for them. And on that level, then we're thinking about estrogen and the tissue state and inflammation. We're thinking about what's happening at that disrupts the pH. Is there a lubricant involved if the partner is
Kim Vopni (31:35.541)
.
Moira Bradfield Strydom (31:48.992)
a male partner, is their ejaculate involved? What other fluids are involved that might be challenging that environment if it's already unstable? And in those scenarios, why we work with people typically barrier methods, be they condoms or vaginal dams are recommended so that you can create stability, minimise the input of that other person's microbial transference and get your microbiome back on track. And doing that
with sometimes with things like topical oestrogens and then for me as a clinician because my work is as a naturopath primarily and so in Australia we can't prescribe hormones but I have lots of fantastic co-referers that we work with but we can work with the overall person and as I mentioned before hydration and nutrient status and making sure tissue integrity is great and for a lot of people you know diet is such a huge thing in terms of not
Kim Vopni (32:28.689)
.
Moira Bradfield Strydom (32:46.496)
necessarily, you know, the sugar, which is very demonized, I think, or putting people on strict anti Candida diets, which are not necessarily the answer either, but it's about improving your overall quality and diversity of plant foods and things that are known to support the microbiome and making sure people's vitamin D is adequate and making sure that you've got enough zinc, you know, cruising around your body and that your protein intake is adequate, particularly in that perimenopause or to menopausal transition.
So those things are very core fundamental that if you don't think about and address no amount of probiotic is going to get you out of that. You you have to think about those things. So, and then we look at very, you know, prescribed interventions that might be like we use the local estrogens might be local, you know, herbal or medicated pessaries or creams or using insert probiotics or using
Kim Vopni (33:25.038)
Yes.
.
Moira Bradfield Strydom (33:45.61)
very low volume, medicated, what I call even irrigation, which is 10 mL of fluid that comes in and out and then you support the microbiome. Those are things you do under practitioner guidance. So those types of things can support that why we work on hormonal rhythms and, you know, essentially finding all the pieces in that person's puzzle that potentially could be impacting the ability of this microbiome to be its best version of itself in general.
Kim Vopni (33:57.614)
What about something like, there's two things I want to ask about that are, hear about talked more so in people who have maybe recurrent BV, bacterial vaginosis.
boric acid is one and silver and so there are silver you can ingest silver you can also put there sometimes they are in gels or creams so boric acid and silver where do those fall in terms of favorable versus not
Moira Bradfield Strydom (34:28.739)
Hmm?
Moira Bradfield Strydom (34:42.142)
They have potential roles for people that need immediate symptom relief, I guess. But both of them are somewhat indiscriminate and both of them are not curative in their own right, in my experience. So with silver, it's a very broad spectrum antimicrobial. Globally, it's a little bit dysregulated in allowable parts per million and concentration, which becomes a very interesting
scenario to think about. again, in terms of its direct action, topical would have a bigger action than if you were ingesting it. So it's not something that I would necessarily prescribe to anyone. But it's something that I've had people come to me like, when I had the height of this symptom, the only thing that gave me some relief for that night to sleep was I did I had a bath in silver.
So in that scenario, I guess that the action is that it's pulling down the microbes, but it's not replenishing anything. It's not dealing with the Y undercurrent. So maybe has a role. I would be mindful over what you are decreasing because I said it's indiscriminate in its reduction of microbes and that potentially we don't really have data on whether it will impact beneficial bacteria or not. Boric acid is a very interesting
Kim Vopni (35:51.02)
Yeah.
Moira Bradfield Strydom (36:05.516)
prescription because gosh, it can be amazing. You know, when somebody has really acute thrush symptoms, you can divert them very quickly or you can provide relief very quickly. And I'm on board with that. You know, I think that boric acid plays a role for my clients. We use it as a first aid remedy. You know, it's like have this in your cupboard. Things suddenly go wrong and you're on camping trip. That would be your first intervention, right? And
Kim Vopni (36:30.547)
Yeah.
Moira Bradfield Strydom (36:33.248)
The problem I see with it is that if that is the only way you are keeping symptoms at bay and you have to do it repetitively every month, then the bigger background is not fixed yet. And sometimes the bigger background takes a while to fix. I I often work with people and we're looking at six months or more to see shifts and more maintained changes in their presentation. But if boric acid is the only thing that you're using, then potentially that's
problematic and because boric acid has different safety considerations globally there are different safety things imposed on it as well. It's not compatible with pregnancy at this point in time so that it sort of becomes one of those things if that's how you're managing things and you're having to do it every month or every time you have symptoms you still need to do further work but if you found yourself in a situation where you couldn't use it anymore then you're back to SCOE 1 again.
Kim Vopni (37:28.281)
Yeah.
Moira Bradfield Strydom (37:29.314)
Sometimes boric acid is also interesting in that it gives us some perspective because in the literature we see a whole lot of information on boric acid in candida based infections, particularly atypical candida like glabrata and its role in that is very defined and lots of people will get quite good symptom resolution if they use their boric acid to treat their candida glabrata and in those scenarios those are the ones that often I will see people walk away from never needing it again.
But when we are using it again and again, then I'm like, well, what is the microbe that's underpinning this that's not being addressed? And sometimes we're looking at things like undiagnosed mycoplasma infections or urea plasma infections, which are controversial with the exception of mycoplasma genitalium, which is a defined STI, but they're controversial in that globally there's no consensus on whether they're capable of causing the symptoms that are attributed to them.
And that we have a spattering of studies that show them being associated with quite significant health outcomes. But they don't behave like that in everybody. So sometimes you identify them and they're just in the background and a little bit of a scapegoat. And so if you spend all your time and energy trying to eradicate it, sometimes you just disturb the microbiome further. But for people where it is a problem, sometimes when they use boric acid and then it gives them symptom relief, but they don't relapse.
It's an indicator that you know, to go looking for those things as well that potentially those types of microbes are there and they need to be considered in a bigger context if the symptom matches them as well. Yeah.
Kim Vopni (39:05.914)
Yeah. Yeah. I'm a big fan of red light therapy. I think it's about maybe 10 years. I don't remember exactly. I was a distributor, Canadian distributor for a product called the V Sculpt or the V-Fit by Joylux. And it's an insertable red light infrared heat.
And now there's several different red lights and there's also a new one that has also blue light. it's suggested that this is a way to help reduce infection and deal with potential challenges like overgrowth. So what are your thoughts on benefits versus not with red light therapy, but also these new ones that have the blue light in that as well?
Moira Bradfield Strydom (39:37.678)
you
Moira Bradfield Strydom (39:48.846)
Mm-hmm.
Moira Bradfield Strydom (39:57.526)
Okay, I don't know if I know much about blue light therapy. have some experience with red light therapy. Clinically, I run an online clinic now, but pre COVID, I was in a practice and I was using low level laser in my practice in various forms as an acupuncturist, I was using it in an acupuncture application. using laser acupuncture.
And then working within a clinic that dealt with a very specific niche, which is very different to what I do now. We were working with degenerative eye disease and we were using laser in that capacity as well. And I saw it do some quite astounding and amazing things. And likewise in the literature, we see it working in multiple ways, everything from oral infections to vaginal infections, to improving tissue healing, immune activation, wound healing.
Kim Vopni (40:27.186)
Okay.
Kim Vopni (40:37.541)
Okay.
Moira Bradfield Strydom (40:50.23)
that sort of thing. And so I certainly when people come to me and say, I mean, particularly with things like like, and sclerosis, for example, you know, I'm in a group and this is everyone's chatting about this. I would say give it a go, you know, like, because there's not any harm. I mean, the low level laser, the red light therapy is not heat inducing, it's, you know, wavelength itself, as long as you're, you know, being sensible with its application initially to understand what action it has and how your body responds to it.
Kim Vopni (41:02.612)
Yeah. Yeah.
Moira Bradfield Strydom (41:19.212)
I think it's a great addition to support tissue healing in those scenarios where something else is required to think about the immune picture in general. So I think that, you know, there's obviously a lot of laser now where we can see it, know, face masks and things like that. And it's quite confusing in terms of the quality of it. But I would suggest that, you know, as you were involved, that, you know, getting a reputable brand and one that is designed for that application would be a really important thing to be doing.
Kim Vopni (41:35.347)
Yeah.
Kim Vopni (41:48.993)
Yeah, yeah. Yeah, before we wrap up, what are some final tips, but maybe it's ingredients to avoid, maybe it's things to include or not include in your diet? Before I'll ask you the final question after that.
Moira Bradfield Strydom (42:02.848)
Okay, the biggest tip that I see people are pretty poor at is drinking water, myself included. Yeah, because when we think about it, if you want tissues that are plump and healthy and lubricated, primarily that's a hydration status. And so if you do that one thing, things will improve and lots of people with urinary symptoms are like, I don't want to increase that. But your body goes through a bit of an adjustment phase and then it tends to settle down.
Kim Vopni (42:09.057)
I see the same thing.
Moira Bradfield Strydom (42:32.694)
as well and you start to enjoy the water versus you know having to remember to do it. So that's a big tip. Likewise thinking about the quality of your diet with protein I mentioned you know making sure you're getting adequate protein but just really making sure that you're eating an abundant array of different you know whole foods and thinking about potentially you know fatty acids in the form of
Kim Vopni (42:52.887)
Mm
Moira Bradfield Strydom (42:57.994)
sure in where we might be finding that in good avocados and things like that in our diet and then making sure we have a really good array of coloured vegetables and fruits in our diet. It's pretty basic fundamental stuff but if you get those foundations right then the body has the resources to put its work in other places as well. So on a dietary level those things are really important. The other thing I would say is a lot of people
Kim Vopni (43:07.635)
Yeah. Yeah.
Kim Vopni (43:16.696)
Yeah.
Moira Bradfield Strydom (43:26.55)
will have symptoms and spend more time worrying about them than actually making actions to access care. And so that would be my tip as well. If you've got something that's on your mind that you think is different, take some steps. And I noted sometimes health practitioner interventions are not what you want them to be, but it's a starting spot, at least, know, in the realm of vaginal health advocate for a swab and a microscopy is a starting point or
Kim Vopni (43:32.885)
Yeah.
Kim Vopni (43:44.265)
.
Moira Bradfield Strydom (43:53.944)
go and access somebody that works in this area. There are a range of different types of practitioners globally from gynaecologists to vulva dermatologists to naturopaths to nutritionists to pelvic physios who are working in this area and see it all the time. So it becomes a specialised niche and they have the information at hand as well. So accessing that sexual health clinics are also fantastic as well.
Kim Vopni (44:17.011)
Yeah. Yeah.
Moira Bradfield Strydom (44:17.696)
as a first port of call. And so do that because I can guarantee you that what you're thinking in your head is probably a million times worse than actually what's going on. And that and having the patients as well when you are working, if you're thinking about microbiome restoration, that the fixes are not quick. Yes, you should be able to get some symptom relief, but the ongoing restoration of this space is multifaceted. And so you have to have that patience. It's not taken antibiotic and we're fixed. And in fact,
Kim Vopni (44:42.955)
Yeah.
Moira Bradfield Strydom (44:47.638)
if you need to take an antibiotic, is completely okay, the current missing step in that is that you're not restoring the microbiome afterwards. And so, you know, all the reason why you ended up with the infection in the first place. So those are sort of the biggest tips is sort of taking the actions, become self-educated around it. There's so much fantastic information out there, know, understanding your anatomy, understanding what's normal, what may not be normal, and also what can happen at stage of life. And I think that, you know,
Kim Vopni (44:55.601)
Yeah.
Kim Vopni (45:00.959)
Yeah. Yeah.
Moira Bradfield Strydom (45:17.878)
up until the last few years, something like menopause, for example, was a very coveted, talked about thing. And I'm the sort of person, I just want to know what all the potentials are, so that I'm aware that if I need to act, you know, I can act about it. And so I think that becoming educated in that and not, you know, buying into things like, your anatomy is going to change. Yes, my skin is sagging, things are going to change as I age, etc. But
what is then considered abnormal when should you be seeking support as well.
Kim Vopni (45:51.778)
Yeah, yeah. I just thought of one other thing before we ask where people can find you, but you had mentioned something about underwear and clothing. is it, you know, it's often
should be cotton is a recommendation. Is that true? And is it that is the forever chemicals that are in other types of clothing that is the problem? Or is it the fabric not being breathable? Like, what is it about underwear and clothing that we need to pay attention to?
Moira Bradfield Strydom (46:18.656)
Mm-hmm. I think that there's multiple aspects. One is primarily breathability. You know, the breathability or the ability to wick moisture away, not hold moisture, that not create a breeding ground for bacteria primarily. And so cotton is long regarded as being a great place and it still is. find for certain, I live in a very hot climate and so cotton in a tropical climate, which is where I live,
sometimes means that you sweat and then you stay moist. And so it's not, you know, it's like if you jump into the pool with a cotton t-shirt on, it takes ages to dry. And so I tend to then recommend bamboo as a better alternative. And granted there are various environmental concerns by people in bamboo production, but as a fabric, if you're looking at underwear that has 90 % or more of bamboo in its composition, it's a much more comfortable experience in terms of wearing underwear and reducing odour.
in the long run for you. So it's a good choice. And then we have to think about other things, practical things like where is the seam? know, is the gusset a natural fibre when the rest of the underwear isn't? What's the elastic like? Is that going to cut into you? Because when tissue is quite fragile or when there is a condition like a lichen sclerosis, these things have even bigger impact. know, a seam in the wrong place can open
a tissue or change the tissue and then start a flare and then off you go again. So those things to consider and know chemicals and dyes and all of those things are definitely on the radar for a lot of people. So if you're choosing natural fabrics if you can aim for more organic in that that's also a good idea and then considering how you wash things as well because sometimes the detergent is problematic in general. So and then and the outer clothing I mean
Kim Vopni (48:00.649)
Yeah. Yeah. Yeah. Yeah.
Moira Bradfield Strydom (48:11.648)
If you wear natural underwear, sometimes the outer clothing, it's completely okay if you have a little bit of a blend going on. But seam placement is interesting, particularly in atrophy type situations, jeans are really problematic for lots of people. Workout clothes can be problematic because they're often recycled plastics, which is great environmentally, but you're going to work out in a pair of...
Kim Vopni (48:14.552)
Right.
Moira Bradfield Strydom (48:37.486)
know, workout clothes that are made out of bottles, essentially, it's not great for the ability. So changing quickly out of those clothes or choosing things that are comfortable to sit in. And then in general, natural fabrics, I think there some interesting information this last year that came out around natural fabrics and electrical currents in humans as well. So it is quite nice to think about.
Kim Vopni (48:41.107)
Yeah.
Kim Vopni (48:53.104)
Yeah.
Moira Bradfield Strydom (48:59.842)
things like linen and cotton and bamboo as just everyday wear and what that brings in terms of your body's ability to thermo adjust, regulate temperature in general.
Kim Vopni (49:01.21)
Very cool, very cool. This has been so interesting and fascinating and I just, I love all that you do. Thank you so much for everything you do to support women and their volvos and vaginas. where can people find you to learn more? You have amazing online courses and a community on Facebook. Where can we find you?
Moira Bradfield Strydom (49:28.32)
Yeah, so social media, if you're on it, is a good place to start. So on Instagram and Facebook, you can find me and my clinic as Intimate Ecology. So you'll find me there. And the Instagram feed particularly has a lot more discussion around quite specific bacteria and conditions. I have on our website, which is www.intimateecology.com.au.
You can go on there and find out information about the clinic in general and the practitioners that work with me. So there's three of us on the Intermedicology team and there's also a link as well for people that are looking for practitioners that might be more local to them or able to work with them in different geography. There's a list of what I call the Guild practitioners which are practitioners that have completed quite advanced practitioner training with me around them, the vaginal microbiome and genitourinary health as well. So that is there.
And then we do run education. A lot of that is for practitioners. So if you're practitioner listening, you're welcome to check that out. But we are a couple of times a year, it's now our goal to be running direct to public education, which we have one coming up, as you know, which is on pH regulation, but they are available as well on replay through the online school, which you can access via the website. And they're very low cost webinars that just give you the basics so you can start thinking and accessing care appropriately.
Kim Vopni (50:27.812)
.
Kim Vopni (50:51.064)
Amazing. And I'll have all the links in the show notes. Thank you so much for your time, Dr. Moira. I've learned a lot and I really appreciate all your wisdom. Thank you.
Moira Bradfield Strydom (50:59.239)
Thanks for having me. It's been great.
