Kim (00:01.961)
Hello, Dr. Greenleaf. Thank you so much for joining me on today's episode. I'm looking forward to our chat. How are you?
Dr. Betsy Greenleaf (00:09.288)
I am so excited, Kim. I love talking to you, so this is just going to be so much fun.
Kim (00:13.457)
Well, the feeling's mutual, the feeling's mutual. Your energy and always your glasses. I always love your glasses. I covet the glasses that you wear. Yeah. Can we start out by having you kind of do a self intro with regards to what brought you into the field of pelvic health? So kind of your journey to become a physician, what led you to becoming the first board certified urogynecologist in the United States, which I think is really amazing. So tell us how you got there.
Dr. Betsy Greenleaf (00:18.958)
Thank you. Got a match. Ha ha.
Dr. Betsy Greenleaf (00:42.146)
Yeah, well, it's definitely not something as a little girl that I was like, I want to look at vaginas all day long and definitely not something I went to medical school for either because I was just in the boat of probably many listeners being like, why would you look at that all day long? But I was really interested in medicine and helping people. And so when I went off to medical school, I wasn't exactly sure what specialty I wanted to be in. And as we went through our different rotations, I found myself really drawn to.
Kim (00:48.62)
I say that too.
Dr. Betsy Greenleaf (01:12.034)
both urology, so dealing with the bladder and gynecology, and kind of couldn't decide between the two of them. So, and you become desensitized over time and then when it comes to like looking at things down below. In fact, I have a good friend who's a podiatrist and when we were residents, we were eating lunch one day and I looked at her and I was like, ew, how do you look at nasty feet all day long? And I think she almost choked on her sandwich because she looked up from her plate and she's like, are you serious? She's like, you know you're...
Kim (01:24.817)
Mm-hmm.
Dr. Betsy Greenleaf (01:41.022)
in gynecology and I'm like, oh yeah, I kind of forget what I'm looking at. So I actually didn't start off in gynecology. I actually started off in general surgery and because once again, I couldn't decide, I like general surgery, I liked obstetrics and gynecology, I like urology and then I was like, ah, I don't know where to go. So I started off in general surgery and got halfway through that training and realized that it just wasn't for me. Like I wanted more of a relationship with my patients.
And not that general surgeons are like, I don't want to say anything bad about general surgeons, but I found that they, the really good ones were like body mechanics, like get in, fix things, get out. And then they were done. Like they didn't, I was the one who on rotations were walking around going, so how do you feel now that your appendix is out? How do you feel now that you don't have a gallbladder? You know, that's really didn't. So, um, so I ended up switching into OBGYN and then even then I didn't know what urogynecology was, never heard of it.
I remember even when I told my mom I was going into it, she's like, what is that, like a fancy gynecology, like European gynecology, like Euro Disney? And I'm like, no, it's like urology and gynecology together. So I was really excited when I found that was actually a specialty because it put together everything that I liked. So yeah, and then that was history after that.
Kim (02:49.506)
Yeah.
Kim (03:03.005)
That's funny. That's funny. Euro. Yeah, Euro. I never even thought of it that way. Yeah. Yeah, yeah, yeah.
Dr. Betsy Greenleaf (03:06.882)
And then I even joke around about the European, you know, because like you are peeing.
Kim (03:13.881)
Oh my gosh, so many tangents we could go off on there. So with urology and urogynecology, I interviewed another doctor as well, and she was kind of talking about the difference. So urology is more focused on, as you say, kind of urinary, but it can be male and female. Urogynecology brings in the kind of reconstructive piece of not just urinary.
challenges but kind of the whole thing. Is that a fair way to describe it?
Dr. Betsy Greenleaf (03:44.854)
Yeah, you know, years ago, and this has been a battle for years, like, what do we call the specialty? So it started off as urogynecology, but then there was kind of a fight between the urologist and the gynecologist. And urogynecology, it's easier to say, but it doesn't exactly fit what we do. Then they renamed it female pelvic medicine and reconstructive surgery. And then that's a mouthful. So that, but that really kind of fits more of what we're doing. We're really dealing more with the whole pelvic.
Kim (04:09.01)
Yeah.
Dr. Betsy Greenleaf (04:14.062)
floor, pelvic organs, bladder, colon, rectum, vagina, vulva, nerves, muscles, everything in that area, and more from a female function standpoint. So it's hard to really come up with a really good word that just says that. So we still just go with urogynecology because it's a lot easier. But you know, where the confusion happens is...
Kim (04:26.087)
Right.
Dr. Betsy Greenleaf (04:42.65)
I worked in a urology office and I did their urogynecology for a while and if somebody had a kidney stone, that was not my specialty. If someone ended up having bladder cancer, not my specialty. But if you were leaking when you cough, laugh, sneeze or jumped up and down, I took care of that. If your vagina was falling out of your body, I took care of that. And then I, in particular, had a really big interest in pelvic pain.
and in recurrent urinary tract infections, recurrent vaginitis, and something called interstitial cystitis, which is now being called painful bladder syndrome. So I, and not all gynecologists do that. You're gonna have to find like ones that specialize even further in these other areas. Yeah, yeah. And there's only like 1500 gynecologists across the United States. So there's not that many of us. Yeah.
Kim (05:26.565)
Right, specialized within the specialty kind of thing. Actually, I'd like.
Kim (05:34.981)
Really? Wow. Oh, I didn't.
Dr. Betsy Greenleaf (05:38.102)
Yeah, I'm actually on the membership board for the American Urogynecology Society. And I was looking at the numbers, I was like, wow, there's really not a lot of us out there. But there's such a need because 50% of women will have a prolapse at some point in their life. So, you know, and forget about the numbers of people leaking and, you know, the pad industry is a multi-billion dollar industry for incontinence pads.
when there's things that we can do for this stuff. So there's definitely a need.
Kim (06:10.065)
Yeah. Interesting. So how would somebody go about finding, how do you know if you've got a really good urogynecologist?
Dr. Betsy Greenleaf (06:20.65)
Ooh, that's a good question. I guess the really good one is the case. You know what, I've seen things from behind the curtain and so I've worked with other urogynecologists and so my criteria of somebody who would be really good as a urogynecologist is the person who does not encourage surgery as the first therapy. Now, you gotta remember some of these people.
are in it because they're surgeons and they love surgery. So you come in and there's something going on and they wanna fix it and they wanna fix it with surgery. But I really, as my career went on, I started doing less and less surgery because I was like, well, if there's ways that we can do things naturally and help the body and avoid the risks of surgery. And this kind of came out of, I trained when vaginal mesh was really big.
And we were being told at that time, this is going to fix everything. And we were putting meshes in people left and right. And then they weren't holding up. And it wasn't fixing. And they weren't lasting. And people were getting, some people were getting other problems, like something called mesh erosion, where the mesh was kind of coming through the tissue, or it was rubbing on a nerve. And so I started going, wait a minute. Why would I do things that could potentially cause more harm? Let's start looking at the things we're taught.
in medical school and in residency are, let's look at diet, let's look at exercise, let's like all the conservative therapies. But I think one of the problems in especially insurance based medicine that we see nowadays is that doctors don't have the time to go and sit and talk through all the conservative therapies. They, and also at the same time you're going to a doctor because you want your problem fixed. But, you know, so they go, well, let me just jump to medicines.
and surgery, medicines and surgery. So I would really gear a good urogynecologist as somebody who doesn't just do surgery just because they can, but that really uses all their other tools and uses surgery as like the last, the last ditch effort. So and this is something I see all the time with patients is.
Kim (08:24.079)
Right.
Kim (08:32.57)
Yeah.
Dr. Betsy Greenleaf (08:36.858)
There not everybody but there are some people who believe like well if the doctor said it it's true and like I don't want to I don't want to go against them. I don't want to hurt their feelings You know what keep going to the doc you like if you leave a doctor like honestly, they're sorry There are they're not gonna really remember, you know, they see so many people so you really are gonna
Kim (08:41.832)
Mm-hmm.
Kim (08:54.345)
It's okay.
Kim (08:58.534)
Right.
Dr. Betsy Greenleaf (09:02.314)
You know go to the one that you feel comfortable with don't stick with somebody cuz you're afraid of insulting them or are going against what they have to say you gotta find the person that you match with mesh. I'm not really but i'm the person that you can interact with the best and you feel good because i'm today it's your body. You have to feel confident in what's being done to your body.
Kim (09:16.201)
No pun intended.
Kim (09:26.437)
Yeah, yeah, that's so important. It's so important to have a good relationship because it is, it's not, it's part, it's your body, but it's also a really intimate part of your body that is so central to so many things that you do. And a big thing that I promote is kind of, what's happening in the overall world right now is more people looking for this root cause medicine piece. And, you know, rather than just saying, here's a problem and here's the, here's the pill or here's the surgery.
Dr. Betsy Greenleaf (09:34.7)
Yes.
Dr. Betsy Greenleaf (09:48.08)
Yeah.
Kim (09:52.945)
Why is that happening? And there are things that we can change that would mitigate that. So I think that's kind of what you're promoting. Yeah, yeah, I love that. So you're doing less and less surgery. What percentage of your practice is surgery versus all of the other things that can be done?
Dr. Betsy Greenleaf (09:58.134)
Yeah, yeah, definitely.
Dr. Betsy Greenleaf (10:09.718)
Yeah, well, actually, I am retired from surgery, so I'm not doing any surgery anymore. And that's actually, unfortunately, due to a neck injury from a car accident. But even near the end of my surgical career, I was probably only doing maybe about 10% surgery, maybe, because there's so many more steps to before you get to the surgery. I mean, and I'm and that's.
Kim (10:12.806)
No, you are okay.
Kim (10:28.932)
Oh, wow.
Kim (10:35.153)
Yeah, yeah.
Dr. Betsy Greenleaf (10:38.75)
I guess I should clarify because in my mind, surgery is I'm cutting into somebody, I'm doing major dissection and there's like a six to 12 week recovery period. That's my, in my mind, that surgery, but we were doing procedures. Now see, that's, that's the different to the doctor. I'm like, okay, procedures, we're still doing tons of those, but in the mind of a, of a patient that can sometimes equate to a surgery.
Kim (11:02.473)
Still be surgery. Got it.
Dr. Betsy Greenleaf (11:04.406)
So when I'm thinking of some like a procedure, that might be something where they just come in the office and we're doing something and there's maybe like a two week recovery. So, or there's like a.
Kim (11:15.491)
What would examples be of procedures?
Dr. Betsy Greenleaf (11:17.954)
So procedures might be like a cystoscopy where we're looking in someone's bladder with a scope and we did tons of those because, especially if someone gets recurrent urinary tract infections, you gotta be like, all right, well what's going on in there? Is there something that's causing that? Are there stones? Are there growths? Is there something else going on? If people have blood in the urine, even microscopic blood, we have to go like, well, why is that happening? So taking like a small camera.
and looking into the bladder and make sure the lining of the bladder looks okay. I will tell you I've been on the, and I kind of make it sound like it's no big deal, but I've been on the receiving side of as a patient for many of the procedures that I've that I, you know, used to do. And I will tell you that sometimes the cystoscopy can be a little uncomfortable and a little bit of burning afterwards. So, you know, they still are procedures and they still have risks. But, um,
Kim (12:03.613)
Yeah.
Dr. Betsy Greenleaf (12:11.53)
We used to do your dynamic testing where we put like a little tube into the bladder that has pressure sensors on it and we fill people up drop by drop and we see how much they can hold and how much they can pee and it's kind of like an EKG of the bladder because we can't do it any other way other than putting these little sensors in there. So that and even like biopsies or sling surgeries are kind of fall into.
Kim (12:25.363)
Mm-hmm.
Dr. Betsy Greenleaf (12:40.682)
like this little kind of, they're definitely a surgery, but they're also kind of can be office-based procedures. Or even we use bulking agents where we put this thicker solution into the urethra that's kind of fatten it up to help with incontinence, help it stay closed. Or here we go, another, Botox in the bladder. That's always a fun one. So, you know, people are like, Botox, isn't that for wrinkles? But
Kim (12:42.845)
sort of procedure.
Dr. Betsy Greenleaf (13:07.606)
Botox relaxes muscles and then some people with overactive bladders, if you've gone through all the conservative things and the medications, the step that you can do before having, you can go as far as having a pacemaker implanted into your body that controls the bladder and gets it working properly, which they work wonderfully, but that's more of a, you know, that's more of a procedure slash surgery where in the office you can go in with a little scope and then.
Kim (13:33.69)
Mm-hmm.
Dr. Betsy Greenleaf (13:36.654)
inject some, place some Botox into the bladder and that lasts for about six months. So that's actually one that works really well for people.
Kim (13:45.947)
With the cystoscopy, is that something that you would use for patients with IC as well?
Dr. Betsy Greenleaf (13:51.55)
Yeah, yeah. So, you know, interstitial cystitis is, or IC for short, is also known as painful bladder syndrome. And this is one of these conditions it's been known about since the late 1800s. It was when it was discovered. But we're not any farther along with knowing what causes it or how to care for it. And interstitial cystitis is definitely one of those conditions where
You can't do cookbook therapies on patients. You can't be like, oh, you have IC. Well, you're going to do this, and this, and you're going to be better. That is one of those conditions where you definitely have to personalize it every step of the way, because I have a lot of my own theories on interstitial cystitis. But cystoscopy is one of those things where sometimes we can use it for diagnosis. There's actually really no great way to diagnose it. The diagnosis is that you have to have a painful bladder.
for six weeks or more that doesn't respond to antibiotics and doesn't fit the definition of a urinary tract infection. And that's interstitial cystitis. Sometimes when we look in, sometimes we'll actually see ulcers in the bladder. And if you do see an ulcer, you're like, okay, that is definitely interstitial cystitis, but majority of people don't get ulcers. There is like a down the road therapy, it's sometimes stretching the bladder when someone's sleeping.
by using just watered over filling the bladder that sometimes can disrupt. Yeah, it's called hydrodistention. It's a procedure that sometimes can help with the symptoms of IC because it disrupts the nerves in the bladder. So they don't get the pain. And that's one of those procedures where I never know how someone's gonna feel. Like I could look in someone's bladder and their bladder could look perfect. They have that procedure and they can go home and feel like crap afterwards.
Kim (15:20.003)
I've never heard of that.
Kim (15:35.078)
Yeah.
Dr. Betsy Greenleaf (15:41.498)
or they go in and their bladder looks terrible and you stretch it and they go home, they feel fine. You can't tell by the way it looks like how they're gonna feel afterwards. But I could talk to you about hours on interstitial cystitis, but my honest theory about interstitial cystitis is that the bladder is not the problem, that there's some other underlying inflammation that's going on in the body and the bladder is just where the symptoms are. And it's the bladder that's trying to scream for help.
I find the majority of patients that I've seen with interstitial cystitis, they have typically an underlying gut inflammation. So like a leaky gut, which can happen from poor diet, inflammatory foods, stress. But there's so many factors that go into interstitial cystitis. So it's a diet, it's a big, big mental, like body, mind, spirit connection with interstitial cystitis.
Kim (16:30.198)
Yeah
Kim (16:38.942)
Mm-hmm.
Dr. Betsy Greenleaf (16:39.382)
because patients that have it, you know, when you're in pain, you have more anxiety, the more anxiety you have, the more pain you have. So it's a vicious cycle of like trying to decrease the stress, decrease the cortisol that's being produced from the stress, getting the body to heal itself and working on, like really to get rid of interstitial cystitis, it has to be a full body mind spirit approach that you could be thrown all the medicines and
Kim (16:55.376)
now.
Dr. Betsy Greenleaf (17:07.75)
supplements and things in the procedures in the world but if you don't deal with the mind spirit aspect of it it's not we won't get better on its own.
Kim (17:15.725)
Yeah, yeah. It's amazing how when you bring up the gut, it's amazing, you know, gut health has been such a hot topic over, you know, been kind of trendy, so to speak, over say three ish last three or so years. And it's amazing. Every, every kind of person practitioner in any field, not necessarily just pelvic health, everybody's coming back to the gut being so important.
Dr. Betsy Greenleaf (17:25.454)
ass.
Kim (17:40.617)
for healing, for root cause, for all that kind of stuff. So have you ever heard of the medicine called low dose Naltrexone, which is used in a lot of autoimmune and used in a whole bunch of cases. But as you're talking about inflammation, that a big part of that medicine helps with reducing inflammation. Have you ever used it in your practice with a condition like this?
Dr. Betsy Greenleaf (17:42.218)
Yes.
Dr. Betsy Greenleaf (17:48.243)
Yes.
Dr. Betsy Greenleaf (18:01.318)
Yeah, I yeah, with interstitial sites and pelvic pain, chronic pain. Because when we talk about pelvic pain in the medical community, if you have pain between your belly button down and top of your thighs, every other specialty goes, that's not my problem. Go see a gynecologist, you know, but it's the same process and we have pain management doctors.
Kim (18:07.492)
Oh, interesting.
Dr. Betsy Greenleaf (18:26.934)
like handling pain of the limbs, and it's the same exact process that happens. So I started looking into what's called chronic regional pain syndrome, which is usually defined as these chronic pains that happen in like arms and legs and things, and started mapping my therapies for chronic pain around what they were giving for chronic regional pain. But what you call interstitial sinus or pelvic pain, everyone's like, no, that's not the same thing, but it's the exact same process. So with low delg-
Kim (18:48.379)
Mm.
Dr. Betsy Greenleaf (18:56.202)
dose naltrexone is really fascinating. That was developed in, well, naltrexone was developed in the 1980s and they were actually using low dose. So actually many people have heard of it as naltrexone. It's used in higher doses. It's used to reverse drug overdoses, but they found in very, very low doses, the research they were doing in the 80s, they were using it in HIV patients that were having chronic pain.
and they're found in very, very low doses. It actually stimulates your body's own production of endorphins. So you make your own pain medicine. So, and it kind of, it's been around since the eighties, but it kind of got forgotten about. And then it's become really big again because of the opioid epidemic. And, you know, opioids were never meant to be chronic medications. So how that ever happened, I'm not exactly sure, but.
Kim (19:45.682)
Right.
Dr. Betsy Greenleaf (19:50.074)
So people started looking, doctors started looking for alternatives. And so with low dose naltrexone, the idea is that medicine is only in your body for 15 minutes. So you have to take it at night because your body makes endorphins at night. So you take it before you go to sleep and it's only in your body for 15 minutes, but it triggers your body to make your own pain medicine. The frustrating thing when it comes to it for patients is they take it and they're like, oh, it didn't work. Well, it's not a quick fix. It's
you have to build up your own endorphins over a period of six months. So when I put patients on it, I would tell them, like, let's evaluate you in six months and like minimally be on a year and see if it's helping. And when things are that slow, some people times people are like, well, I don't think it's working. I don't think it's working. Like, OK, well, let's stop it. Well, then as soon as they stop it, they go, oh, wait, you know what? It was working. So and there's actually some really interesting anti-aging research on it, too. So like the guy who actually
Kim (20:38.945)
It was. Yeah, that's interesting.
Dr. Betsy Greenleaf (20:47.958)
like came up with those protocols for the low dose. Like he was on it his whole entire life as like an anti-aging therapy too, so.
Kim (20:56.025)
Yeah, it'll be the next in the biohacker world. It'll be the next. Well, I think it already is talked about in the biohacker space, but.
Dr. Betsy Greenleaf (21:00.266)
Yeah. And it's not commercially made. So you usually have to get it from a compounding pharmacy because the commercially made naltrexones are much, much higher doses. So like low dose naltrexone is maybe one to four milligrams tops. And most of what you can get through a pharmacy is like 32 milligrams and higher. So you usually have to deal with a physician that works with it or a healthcare practitioner that works with a compounding pharmacy to get that.
Kim (21:26.918)
Yeah, yeah.
Dr. Betsy Greenleaf (21:27.094)
But yeah, I've seen it, especially for pelvic pain, it has been really helpful. Like, and it's great while we're trying to figure out like what's the root cause of the pelvic pain. So.
Kim (21:31.418)
Interesting.
Kim (21:35.993)
Right, just something that can kind of come in and help dampen the symptoms. Interesting.
Dr. Betsy Greenleaf (21:39.05)
Yeah, yeah. Well, and then here's the other fascinating thing. What happens in the brains of people with chronic pain is that over time, you actually will develop more pain receptors. And they've actually done what are called functional MRIs of people that are in pain and people that are not in pain. And people that are in pain have physical changes in their brain. And so they actually become more sensitive to pain. So where people with out
Kim (22:02.633)
Wow.
Dr. Betsy Greenleaf (22:08.59)
chronic pain, their brains look completely different on under functional MRI. And it's interesting, they've done a number of studies where they put people through no medication at all, but just put them through like, meditation, yoga, acupuncture, cognitive behavioral therapy, where you picture your body without pain. And they've done this time and time again, and they've done studies of eight weeks.
where at the end of eight weeks, they re-MRI'd those people's brains and their brain started to look more like the people without pain. And at the same time, they were reporting less pain. So ultimately the body wants to heal. It's just, we gotta try to figure out how to get it to heal. And sometimes when you're in pain, you get into this cycle of focusing on the pain instead of you can create and rewire your brain to think it's healthy and heal yourself. So there are ways to do it.
Kim (22:50.738)
Yeah.
Dr. Betsy Greenleaf (23:03.902)
So, yeah.
Kim (23:04.229)
Interesting. When we're talking about pelvic pain, I know under that umbrella there are so many different, I guess you could say, variants of pelvic pain. So are there ones that you see that are more common and has that changed over the years?
Dr. Betsy Greenleaf (23:20.854)
You know, I will say when it comes to interstitial cystitis, and I don't just, I don't know if it's because people just happen to find me as being able to treat that, but I've seen interstitial cystitis go up a lot, especially I'm in New Jersey. So I don't know if it's a New Jersey problem, but I am shocked at the number of people that have the painful bladder syndromes. So that's been, that's been one that I've seen higher and higher. Now
some pedendal nerve injuries. So pedendal nerve is that's kind of a nerve that goes near your sit bones. I always see problems with that around January. And this is a funny, not funny, but it's kind of funny. Why January? It's because everybody's gotten their pelotons for the holidays. And now they've got their New Year's resolutions and now they're trying to exercise. And unfortunately, those stationary bikes
Kim (24:05.279)
Interesting.
Dr. Betsy Greenleaf (24:13.41)
you're sitting a lot of times and compressing that nerve. That's why cyclists have terrible problems with pedendal nerve injuries. So if you have a Peloton, either don't sit on it or a stationary bike, don't sit on it or get like, there's specialized seats that you can trade out that are much more supportive. So that's always an interesting thing because we see that cyclically. And then there's something called vulvodynia, which some patients
A lot of times when you have pelvic pain, sometimes you're seeing like five to 10 doctors before you get an answer. And when patients come in and you're like, oh, it's vulvodynia, they're like, thank God I have a diagnosis. Well, vulvodynia only means pain of the vulva. That's all it means. Still doesn't mean that we know what's causing it. And there can be anything from allergies to any products that you're using topically to nerve irritation in the back or higher up.
that are causing it. So unfortunately I don't want to not give people hope because they think like, oh I have a diagnosis that means if I have a diagnosis then you can fix it. Well no that unfortunately that's a diagnosis of just means pain in the vulva and now we got to go look into you know are is it infectious diseases maybe the microbiome of the vagina is off maybe you know when it comes to the pelvic pain I'm actually surprised at the number of conditions
Kim (25:26.511)
Right.
Dr. Betsy Greenleaf (25:40.118)
that cause pelvic pain where the root cause is not in the pelvis at all. So, and that's where it gets tough because I'm trying to bring in other specialties and I'm like, hey, I think they may have like herniated discs in the back, or I've had people have herniated discs in their neck and their neck is fine, but they feel the pain in their vagina. I've had women who've torn ligaments in their hips. They don't feel the pain in the hips, but it radiates the pain.
Kim (25:46.194)
Mm-hmm.
Kim (26:00.51)
Wow.
Dr. Betsy Greenleaf (26:08.85)
endings, the nerve endings in the vulva and vagina or where they're feeling it. So, you know, same thing we're talking about, like, definitely. You know, I love Hippocrates in 440 BC said, let food be thy medicine and medicine be thy food. And I think we're just coming back to that. And I can honestly say when we were talking earlier before about gut health is that 90% of all medical conditions are either caused or worsened by poor gut health.
Kim (26:15.145)
So interesting.
Dr. Betsy Greenleaf (26:38.55)
So I think that's why you're hearing everybody talk about this now because we're finally figuring out this connection. I get excited about the whole microbiome of the gut, which is microbiome is the microscopic organisms that live in an area. And so the microbiome of the gut is different than that of the vagina. But just looking at the gut by itself, a lot of the pain receptors and chemicals,
We make 90% of our happy hormone is made, 90 to 95% of our happy hormone is made in our gut. 80 to 85% of our immune system is made in our gut. A lot of the neurotransmitters that help with feeling good and not feeling pain are made in the gut. Lactobacillus acidophilus, which is a common bacteria that's found in the vagina and also in the gut, they found that when your levels of lactobacillus acidophilus are low,
you have more propensity to having pain because there's some interaction between that microbe and the nervous system that decreases the sensitivity and decreases pain. So that it's and you know and now I'm getting into like I've gone down some rabbit holes of the research and this connection between the gut and the vagina and the brain and it's been absolutely amazing that like if the microbiome of the vagina is off it can affect your sex drive.
Kim (27:49.53)
So interesting.
Dr. Betsy Greenleaf (28:06.782)
And you're like, wait a minute, how is your vagina coming all the way up to your brain and affecting your sex drive? But they're finding that they're through the vagus nerve, which is a big long nerve that runs through your body. There's a connection between most of our other areas of our body, like the gut and the vagina. And if that nerve senses that things are off, it's going to start realize it's going to sense that as a stressor. And you can't have sex drive and fertility and stress at the same time.
Kim (28:11.751)
Mm-hmm.
Dr. Betsy Greenleaf (28:34.578)
So if the gut microbiome is off, if the vagina is off, the body goes, okay, not an ideal time to be reproducing. So we're gonna shut down all the processes of having a libido or all the processes of fertility. And so it's really amazing the connection that they're finding between all these areas. So.
Kim (28:53.193)
Hmm. Okay, what with the, with the vaginal microbiome, there's some people will take vaginal probiotics either orally or inter vaginally. Is that something that you think again, I think it's more, it's not so much saying that, oh, we should all be taking a vaginal probiotic, but if we happen to be low in that specific lactobacillus, what was it? Lactobacillus. What did you call it? Acidophilus. Yeah. There's a lot. Yeah.
Dr. Betsy Greenleaf (29:16.642)
That one's acidophilus. There's a whole bunch of ones that are really good for, yeah. There's a, everyone's gonna be like, what? Spell that again, but I'm gonna go through them quickly. The ones that I really like that need to be in the vagina is lactobacillus is the main bacterias like species and then there's more underneath that. Lactobacillus keeps the body healthy because it lowers the pH of the vagina, but it lives in symbiosis with our vagina. So as long as our vaginal tissue is thick and healthy.
Kim (29:24.378)
Yes.
Dr. Betsy Greenleaf (29:45.994)
which is usually the way it is when we're younger and have our hormones. And so when we get to menopause or if we're on birth control or if we're pregnant or we're breastfeeding, that vaginal tissue thins out and we actually lose the food source for the lactobacillus. And so this is why in those populations, they have much higher risk of recurrent urinary tract infections, recurrent bladder infections. So amongst the lactobacillus, there's a bunch of other ones. There's acidophilus, there's gasseri.
chryspidus, rhamnosus, ruteri. So those are like the main ones that I, because they're finding out through some of the advanced laboratory testing that they're able to do now, that there's a lot more that's living in the vagina than we used to think. But those are the lactobacillus that we now are starting to see in some of those probiotics that are, because they're discovering them, they're like, hey, these are the ones that are keeping the vagina healthy.
Let's start putting these in probiotics or in vaginal suppositories. The only potential problem in a lot of people, once again, I've been in that boat too, like where I was like, all right, I want the quick fix. Like I'll just take some probiotics and everything will be good. But if the vaginal tissue is not healthy or if the pH of the vagina is off, that bacteria is not going to want to live there. So those, unfortunately,
When you're pregnant, there's not much you can do because there's not a lot of products that you're going to get approved to be using when you're pregnant because even if they don't affect your pregnancy, nobody wants to take that responsibility if something happens in a pregnancy even if it's completely unrelated. Same thing with breastfeeding, but women on birth control, that's going to suppress their normal production of estrogen, their tissue is going to start thinning out and perimenopausal and menopausal women, when they're without estrogen, which is one of our female hormones
does a lot of different things in the body. It helps our vaginal tissue be thick and grow and be healthy. And as those cells are growing and they get to the point where they are so thick, like they keep growing from the bottom up and then they slough off and die, those cells when they die contain glycogen which is the food source for the lactobacillus. So if we don't have nice thick healthy tissue, you could be putting all the probiotics in there or taking all the probiotics you want.
Dr. Betsy Greenleaf (32:09.77)
It's not going to work because there's nothing feeding the bacteria to make it want to stay there. So the bacteria is going to end up dying or leaving or then these other bacteria are going to kind of take over. And it's kind of like, you know, the bad neighbors moving in and now all of a sudden you got yeast and the bacteria that's causing BV, bacterial vaginosis, and everybody else is coming in to party. So, so it's a combination of we need to support.
Kim (32:14.585)
Right. So vaginal estrogen.
Dr. Betsy Greenleaf (32:36.194)
the microbiome, but we also have to support the tissue, whether that's through hormones or what's been great since 2014 in the United States, we have a lot of other regenerative therapies. So before 2014, it was like, all right, here's your hormone cream, here's your hormone tablet, here's your hormone ring that you put in your vagina and that's all you got. But now we have things like laser therapy and radio frequency therapy.
which uses sound waves to generate heat to regenerate the vagina. There's home version red light therapies that will regenerate the tissue of the vagina. So they're finding tons of other ways to regenerate that tissue without having to use hormones. But there's tons of hormonal options too. So there are so many more products that whole industry has pretty much exploded since 2014 which is nice.
Kim (33:34.949)
Yeah, I wanted to...
Dr. Betsy Greenleaf (33:36.006)
Not everybody knows about them and then some of you know, and a lot of the regenerative therapies are not covered by insurance that there does there's limitations with that.
Kim (33:42.093)
Yeah, yeah. Yeah, and it's I kind of want to cut you you're beautifully taking me through this full circle. But I kind of wanted to come back to at the beginning where you were talking about the bulking agents. And I, I feel like there's again, you and I will find the humor in these. But you know, when we think of lip filler that we're using on our faces and all that it's that's kind of what we're so you were talking about it with the urethra. And I is there a place where there could literally be
Dr. Betsy Greenleaf (33:53.388)
Oh yeah.
Dr. Betsy Greenleaf (33:59.703)
Yes.
Dr. Betsy Greenleaf (34:03.22)
Exactly.
Mm-hmm.
Kim (34:10.753)
lip filler. I've heard of labial fat grafting, which I think is kind of like lip filler, but it's using your own fat to kind of bulk up where we're starting to lose that mass and volume, which can some people don't like the look of, but maybe it doesn't feel the same. So could, like you mentioned, bulk emit is one. There's another one I forget the name of that's more calcium based. I think it is where can you, could you
Dr. Betsy Greenleaf (34:13.783)
Yeah.
Kim (34:36.453)
inject those other places. So that's one question. But then the other is then the other thing that's being used and, you know, especially in that biohacker space now that's emerging is PRP or PRF. So is that something that you that you use?
Dr. Betsy Greenleaf (34:46.082)
Hmm. Yes. Yeah. So yes to all those above. So, um, so one of the things, so traditionally urethral bulking, there have been different products have been on and off the market over the years. So the idea is that sometimes when people have stress incontinence and that's leaking of urine, when you cough, laugh, sneeze.
That's actually coming from a problem where the support ligaments under the urethra are weak. And so instead of when you cough and sneeze the pressure from your abdomen pushing and compressing your urethra, the tube you pee through, and compressing it against that ligament, it should close. Well, instead, because that ligament's been stretched or torn, that tube is now opening and now you leak. So very common, unfortunately, after having childbirth and in...
You don't even have to have a vaginal birth for them to have that problem. And then there's also women who've never had children who can have that issue too. Where bulking came into this is because they were looking for a less invasive way to fix the problem. So traditionally fixing those, you can't really fix the ligaments. It's really hard to fix the ligaments, but implanting a sling, which is usually made out of mesh,
The slings have been around since the late 1990s and even though they're made out of mesh they're still they've been researched so much they're considered safe but other companies came on the market like well let's try another way and so they go into the urethra and fatten up the walls. So now the tube stays closed and now you don't get those accidental leaks because the tube is staying always closed. My only potential problem with the bulking agents.
is I'm always thinking about, well, what was our bodies meant to do? And so if we're bulking up the urethra, now how do you pee? So, yeah. And so what ends up happening is you have to try to overcome that pressure of that bulking agent that's holding that tube closed. So now you have to usually bear down to urinate to empty the bladder, which now, yeah, so now you're going to like...
Kim (36:45.238)
I was just going to ask you that.
Kim (36:57.161)
pushing more. You have to keep your hair down. Yeah.
Dr. Betsy Greenleaf (37:05.026)
balance it out, like, all right, well, which is worse? Leaking or the risk that maybe now I'm emptying my bladder all the way and there could, not everybody, like some people do great with this, but maybe I'm not getting, maybe I'm not emptying all the way and maybe I'm getting recurrent urinary tract infections come out emptying all the way. And the worst case scenario would be if the urine isn't coming out of the body because you're burying down to urinate, it's gonna go where the least amount of pressure is and that's back to the kidneys. So,
That's one of the cautions with the bulking agents. There was one that used to be on the market, it was collagen-based. And you had to do an allergy test first, because it was from, it was based collagen from cows. So you had to make sure you didn't have a cow allergy. And what was nice about that one was it was reversible. It wore off over time. And so, but it came off the market because
It was interesting story the farmer who was applying all the collagen for this product decided to retire. So and then no one else picked up the business so and because it only lasted like a year patients were like you know companies were like why don't we want to find a more permanent solution so they made some of these longer acting bulking solutions. Even to the point where there was being silicone which we don't have that on the market anymore but it was like that they were they were injecting silicone into the urethra which was terrible but now.
Kim (38:13.008)
Interesting.
Dr. Betsy Greenleaf (38:33.278)
Some of the bulking agents are more like what we're seeing in lip fillers, where they can last a little bit longer. They're more like hyaluronic acid, which is more like the body. And they will wear off over time, but once they're in place, it takes a little while for them to wear off. But using PRP is a great option. So.
Dr. Betsy Greenleaf (38:58.842)
Sorry about that, I don't know why. So using PRP is a really great option because it's using Fleetlet Rich Plasma, which is your own body's product. And so...
Dr. Betsy Greenleaf (39:20.23)
Let's see, am I back? Not yet. So it's using your own body's product where they're taking your blood and they're processing it to where you can actually inject that into your body. That's going to wear off over time too, but it's your own body. So the PR.
Kim (39:21.469)
Yep, you're back.
Kim (39:42.181)
Yeah, yeah, I think there's, I'm looking and sort of following some pelvic health professionals who are working with regenerative medicine doctors, physicians, and using it in the pelvic health space for things, you know, some people are looking at levator, evulsions, and all sorts of things. So I think that there's a lot of potential there.
Dr. Betsy Greenleaf (40:06.774)
Yeah, so in the integrative world, there is so much that is going on. And I think that's one of the things that is great is that they're always coming up with new things. So...
Kim (40:20.645)
Yeah, there's also some innovation happening. Yeah, very, very cool. Okay, well, I guess I'll leave off. I know we're kind of running out of time. I could talk to you all day long, but.
Dr. Betsy Greenleaf (40:30.886)
I know, and I apologize, I don't know what happened to my video here, so...
Kim (40:35.405)
Oh, it's okay. It's okay. Where so first of all, where can people find you and then just if you can touch quickly on you've got another kind of aspect of your business, which is education and famversity and your happy vagina summit. So can you tell us a little bit about that and where people can learn more?
Dr. Betsy Greenleaf (40:47.437)
Yes.
Dr. Betsy Greenleaf (40:53.29)
Yeah and I'm so excited because Kim is part of this. So if you guys love listening to her, come listen to her at the Happy Vagina Rally and Kim has a link for that to help you guys sign up. We have 50 different sessions of talking about all things women's health. So it's not just vaginas. We do talk a lot about pelvic health and sexuality but we also have somebody talking about hair health and we have someone talking about...
Energy levels and hormones so we are we're talking about a whole bunch of things, which is really awesome so So that's gonna be live August 10th through the 13th of 2023 and Then the nice thing with that is you come watch it live, but the other option The other option is that you can buy it pretty cheaply
Kim (41:25.477)
Amazing.
Dr. Betsy Greenleaf (41:45.41)
to watch whenever you want to go back to it. So we got a couple options with that, but.
Kim (41:50.431)
Yeah, I always buy summits because I can't take out the time to listen to a whole thing. And I love to be able to, that was a really good one. I want to go back and listen over and over. So I always buy them because they are such a valuable resource. I love them.
Dr. Betsy Greenleaf (42:02.198)
You know, and that's the thing is that like my point is I want to educate people and normalize this conversation. So we made it pretty cheap so that, you know, like I think about if you had to pay 50 experts to get their opinion, how much and I think we're selling this thing for like $37. So yeah, and I find to like, I do the same thing with summits. There might be something that didn't apply to me when I watched it, but then I'm like,
Kim (42:13.402)
Oh, I know.
Kim (42:19.897)
Yeah, totally buy it, totally buy it.
Dr. Betsy Greenleaf (42:27.99)
like a year from now, I'm like, wait a minute, I remember there was a lecture about, and now I'm having that issue. And then, yeah, to go back and, and it does apply later on. So it's always great to add these things to your library. So yeah, between that and so, um, yeah, use Kim's link for that. And, um, also hack I'll get Kim is we'll get to a link for the pelvic floor store, which is my e-commerce store where. Started off where I was recommending patients. Um,
Kim (42:30.429)
Mm-hmm.
Kim (42:37.327)
Yep.
Yeah, yeah, totally.
Dr. Betsy Greenleaf (42:56.782)
products and they were having a hard time finding it because a lot of these companies don't sell on Amazon. And they were getting frustrated with me. I was like, okay, go to this site and buy this thing and go to that site and buy this thing. And one day one of my patients is like, well, can you just put it all in one place? I wish it was all in one place. And I was like, well, I've never started a website. Let me do that. So, I have the pelvic floor store and I'm always looking for products. So, if you guys have something that you're like, you know, that you love and I don't have it.
Contact us through the through the website because I'm always looking for new things to add on there And then social media. I'm all over social media though I wish I could say I had a consistent name But every once in a while Instagram likes to kick me off. So my name is changing all the time So if you just look up dr. Betsy Greenlee, if you'll find me in one form or another
Kim (43:31.781)
Yeah, yeah, that's so valuable.
Kim (43:42.413)
Oh, I know. We've all been there.
Kim (43:48.793)
Yeah, yeah. Amazing. You are doing such amazing work and I just appreciate your energy and your desires. You said like what would the body want to do and trying to find that root cause I think is just so refreshing to hear. So thank you for all you do. Thank you so much for your time today and I'm looking forward to the summit and hearing from others and also grateful to be a part of it.
Dr. Betsy Greenleaf (44:12.022)
goodness. Thank you so much, Kim.
