kim_vopni (00:02.702)
Hi, Dr. Babb, welcome to the show. I'm really excited to chat. I have a lot of questions and I think that this could be a bit of a doozy of an episode. So thank you for taking the time.
If you can start by introducing yourself. So I found you on Instagram and I have appreciated sort of the evolution that I've seen of, I remember at one point there was sort of pencil sketches of certain things and now there's a consistent theme of you kind of coming into the scene and talking about a specific topic. So if you can introduce yourself, who you are, what you do and how you got into Instagram.
corey_babb (00:25.64)
a right
kim_vopni (00:43.919)
Oh, did we lose you?
kim_vopni (00:53.006)
Are you there? Oh, okay, something froze. Okay, so let's start that again just in case. I think it probably got it, but okay, start that again. Hi, Dr. Bab, welcome. Thank you so much for taking the time to join me on the podcast today. I found you on Instagram, and it looks like you froze again.
corey_babb (00:53.96)
there i'm here now yes
yeah
corey_babb (01:00.5)
okay
corey_babb (01:14.92)
it froze again
corey_babb (01:20.26)
now you're back
kim_vopni (01:20.346)
There you go. Okay. What, okay, I feel I've closed all of the main tabs on mine. Do you have any, do you have a lot of tabs open up on your side?
corey_babb (01:30.44)
no not at all this is the only thing on mine so no i've got i don't have anything else going my internet is at
kim_vopni (01:33.37)
Hmm. Weird.
corey_babb (01:44.56)
trying to reset that there
corey_babb (01:50.84)
i'm secured here i'm connected so
kim_vopni (01:54.202)
That's so weird, I don't know why it's... Hang on a second, it says here, poor internet affecting the flow, let's see. Load data mode, turn off everybody's live video. High quality.
corey_babb (02:10.96)
i can wonder if i can turn a if i can turn off my actual camera i don't kno if that would help but i guess you said that gets recover or you recorded like that so
kim_vopni (02:23.978)
Well, I typically put in a video onto my YouTube channel as well, but are you gonna be using any props or anything? Okay, so then let's turn our video off, I guess. I like it for a conversation, but whatever. We'll turn it off and see if that helps. Let's just give it a try and see. If it's working, we'll carry on. If it's not making a difference, then we'll figure something else out. Okay.
corey_babb (02:27.26)
sure
no not at all
corey_babb (02:37.54)
yeah
corey_babb (02:44.62)
okay sounds good so my camera is off now so
kim_vopni (02:47.974)
Okay, load data mode for all. All right, let's see what happens.
corey_babb (02:53.34)
okay
kim_vopni (02:56.342)
Hi, Dr. Babb, welcome to the show. Thank you so much for taking the time. I would love to start with having you introduce yourself. I know I found you on Instagram and that's where I follow you, but I'd love for you to tell the audience who you are, where you practice, and what your areas of specialty are.
corey_babb (03:17.5)
okay well my name is cory bab i am a physician in tulsa oklahoma in the united states i am a ginicologist by training but then have done extra work and certificatian in the areas of sexual medicine vovovational disorders and mina pause management and hormone care so i am the owner and only physician at the haven center for sexual medicine and vobovational disorders which is my private practice in tulsa
kim_vopni (03:47.766)
Amazing. Well, the world of menopause is definitely exploding right now. And there are a lot of people looking for help and therapies, hormone therapy being one of them. And I was speaking to somebody else the other day saying that being a vagina coach talking about pelvic health, there's been an evolution and they're starting to be a little bit more freedom with regards to what we can say on social media and what we can put into ads. And I actually feel that
corey_babb (04:12.14)
right
kim_vopni (04:15.706)
The menopause movement has played a role in helping with that because of genitourinary syndrome of menopause. So there's vaginal health being talked about a lot in that community and I think that it has maybe played a role in helping open up the doors of conversation for other areas.
corey_babb (04:32.92)
oh no i i agree totally i mean and this is something that you know we kind of in the sexual medicine community struggle with all the time is kind of the censorship you sometimes get on social media you know when you're saying quote quote bad words you know so it's and it's ridiculous when you're just talking about anatomy or you know sexual you know intimacy or things along those lines so
kim_vopni (04:49.638)
Exactly.
kim_vopni (04:58.442)
Yeah, yeah, I have been shut down so many times because the word vagina is inappropriate. Yeah, so I would like to start with you mentioned vulva vaginal disorder. So maybe if you could start with what are the more common conditions that you treat and there's a couple that I want to ask a little bit more specifics about.
corey_babb (05:03.46)
that's right
corey_babb (05:09.08)
yes
corey_babb (05:16.94)
sure so probably the most common things we see in the realm of the vovalvvaginal disorders are either kind of chronic vaginal or vulvar infections and then also the skin conditions that affect mostly the vulva but can also affect the agin as well things like likensclorosis or like in simplex things along those lines
kim_vopni (05:39.394)
Yeah, so that was one that I wanted to dive into a little bit deeper was lichen sclerosis and the difference between the two that you just mentioned. So can you talk about what they are, what causes them, and then also what some of the treatment methods are?
corey_babb (05:48.22)
sure
corey_babb (05:56.3)
yeah so so there's three main like annoyed disorders of the vulva so there's like an simplex chronics which is basically the best way to kind of think of it is anximatype reaction to the vulvar tissue it causes significant itching and irritation but it does not have any type of concern about you know progressing to cancer or things along those lines you know and i mean this in the nicest way but it's
mostly more of an irritation to the patients as opposed to something to be concerned really about umlikensclorosis is a condition that that can affect pretty much anywhere on the body you know we see t on the vulva obviously in my realm but i've seen it on the breast on the arm and it's basically an auto immune condition so the body is immune system is attacking in this case the skin and basically what you see is an
bliteration of two of the main skin layers the dermis and the epidermis there's not as much differentiation between the two and so you kind of get this this area of thickening it can have kind of a glassy appearance sometimes and it often will cause the skin to become hypopigmented or turn white or pale in appearance now this one is typically presents with itching as well and this is itching that you know may wake you up in the middle of the night type
itching um and it can lead to kind of fissures or cracks in the skin and if it goes untreated it can cause significant alterations in the actual anatomic structure of of the vulva and can actually progress to a type of skin cancer the third one is like an planes and this can affect the vulva as well but it also affects the vagina it also affects the mouth as well so you're getting kind of more mucus membrane involvement and
it can cause extensive scaring similar you know type of kind of the skin reaction like i talked about with the lion sclerosis but in vaginal tissue you can actually make the vagina stenatic so that nothing can can go in there patients will sometimes especially if it's really not treated they'll be unable to insert even a q tip you know cotton swab into the vagina because the vagina has basically sealed shut due to the scar tissue and this one also has a malignant
corey_babb (08:26.04)
tential as well if it's untreated so so that's kind of the main differentiation between those three
kim_vopni (08:31.726)
So before we go into the treatment piece, just a couple of things that came up. I guess the thinking about the menopause community and vaginal atrophy, vaginal dryness, the changing of the pH as we move beyond menopause and further into our life, there are many people who potentially have lichen sclerosis but may not know it. It could potentially present similarly
corey_babb (08:42.1)
hm
kim_vopni (09:01.45)
in some capacities or even the like as like in plainness you mentioned it could contribute similarly to atrophy and dryness and irritation would you say that's accurate?
corey_babb (09:12.68)
yeah and that's actually you know it's a very common thing in our clinic we have patients that come in saying well i'm just having virginal dryness and there's some itching down there and then when we actually see them we say ha actually this looks like more one of these you know like annoyed drmatosis um you're definitely right and you know in terms of mina pause and actually also prior to puberty you see a larger percentage statistically of liken sclera
kim_vopni (09:30.383)
Mm-hmm.
corey_babb (09:42.5)
the same and like an plainness to a lesser extent but definitely like in sclerosis than you do in a reproductive age person with ovaries but it can all of these can affect people of any age and any gender you know as well so it's it's exclusive to that but the hormoneffect does play a role in it
kim_vopni (10:01.518)
So you can develop it at any point in your life? And is there typically, are there triggers that could, you mentioned autoimmunity with regards to like, and sclerosis, that's one piece. Are there other things that could potentially trigger it?
corey_babb (10:05.2)
correct
corey_babb (10:17.36)
i mean obviously the things that kind of go into the whole i think they all are now licensclerosis and likenplanis and if you view exema as an autumn type condition as well which you know i do so i mean that's going to be the big thing you know we see these conditions you know in families we see them in people that often have other autumn conditions as well so you know there's a genetic predisposition
kim_vopni (10:31.119)
Mm-hmm.
kim_vopni (10:38.351)
Mm.
corey_babb (10:47.28)
towards them and then like you said there's got a typically some event that triggers it and that's such a unique thing that you know i can't give you a definitive for that but we've seen it with illness we've seen it with hormonal contraceptive use i've seen it with you know patients get a really bad east infection and then it starts so there's a number of things but something that triggers that autoummuneresponse to really start that progressive destruction of that epidoe
mal andnddermal um kind of barrier there to cause the licentification
kim_vopni (11:21.999)
Right.
And what is it that can lead to skin cancer? What is it about those two types that can make it cancerous?
corey_babb (11:31.42)
yeah sure so so basically when you're having skin change and so let me back up it's actually probably this is a good time to really talk about you know what causes cancer in general um so cells have a life span and at the end of their life span they go through what's called a poptosis which is its program cell death and so this is going on continuously in our body you know cells are being born quote an quote there
kim_vopni (11:44.046)
Mm-hmm.
corey_babb (12:01.2)
dying and and as long as things do what here supposed to that you know goes in harmony now when you have cells that are rapidly like turning over you know the skin turns over very quickly just in general um you know but if you have something that is causing a metaplasia which is kind of a change in the cell type to where it may not it really shouldn't go that way you know
but it's not problematic by itself or a displeasure which is a change in the cell towards a more abnormal problematic or pathologic um kind of state the more you have those events the more likely those cells are to kind of ignore that program cell death and then becomcanceris in the case of the vulva especially with likansclerosis we do see a high correlation with
human papalomavirus are h p m causing those type of changes as well so in patients at have l s who also have h p v you know that's kind of may be a predisposing agent towards that development of the squemuscell carsonoma which is usually the type of cancer that we see
kim_vopni (13:21.814)
Interesting and just to go back to the apoptosis and another term that I have heard is zombie cells or senescent cells. So are those the ones that are ignoring the programmed cell death? Got it. Okay, so we don't want many zombies. Okay, so what do we do? Do these three have similar treatments or are they are they all completely different?
corey_babb (13:31.24)
yeah
corey_babb (13:34.9)
exactly yep
corey_babb (13:39.34)
exactly
corey_babb (13:51.02)
they have similar treatment in that the gold standard of treatment for all of them is some sort of sterroid cream typically our own ointment you know but some sort of topical steroid is the gold standard for them now the licensclerosis and the likenplainus we are often using ultra potent steroids for those the licensimplex you know you can get away with not as potent steroids with it
and it will be controlled so that's kind of the common thread throughout them now there are other things that you want to consider you know in postmenpausil patients especially if they're not on any type of hormone therapy adding you know vaginal estrogens and possibly even estrogentest ostroncombination to the vaginal and vulvar tissue can help the tissue respond better but that
itself is not a treatment alone for the condition m obviously if you can find things that are auto immune triggers and and you know what those are avoiding those can be really helpful as well but you know that's also kind of an individualized type thing but the gold standard is like i said steroids there are some kind of secondary therapies we can use especially if that if the steroids aren't working your patients aren't responding well to them but that's what we're always going to start off
kim_vopni (15:21.63)
Okay, and I'm not an expert in steroid creams, but one thing that sticks in my mind about steroids is that they can contribute to thinning of the skin, is that correct?
corey_babb (15:32.54)
right so and that's something that in this case i don't want to say it's a theoretical risk but if you are doing the steroid application properly that the risk for that should be amenable and when i say properly you know the amount we typically use an ointment for license chlorosis specifically because it is has a slower absorption time it's you can cover more space with a little like a smaller amount so you really only need somethin
you know actually smaller than a p size a p size would be the most amount of stheroid you would need and the goal with it you know is kind of starting off with daily application of the spheroid and then once you get controled in that you know you're not having symptoms the architecture is starting of the of the vulva starting to return to normal you can start backing off the amount of application that you the you know going from daily to every other day to you know
ouple of times a week you know once a week even in some patients who are really well controlled so you know i have i have yet to see skin thinning in a patient that is applying things properly now if they're slathering it in their multiple times a day and there's other than yeah you can you can definitely have that but if they're doing the way that you know we tell them to then that risk should be very minimal
kim_vopni (16:59.398)
Okay, and then as you mentioned, a question I did have which you already answered is, can they use local vaginal estrogen or hormone therapy? So they can and that could potentially help with some of the kind of offset, even if there was some risk, would that be accurate to say?
corey_babb (17:16.82)
yeah i mean that's a really good way to think about it you know one of the things we see since you brought up you know g s m or the general urnrycendrom of mina pause earlier ou know what we see in those low hormone states is the tissue starts to retract and withdraw and become thinner and more easy to disrupt with penetrative activity or you know any type of really activity that may cause friction and so adding that hormone therapy allows the tinted tissue to kind of for
kim_vopni (17:40.602)
Mm-hmm.
corey_babb (17:46.68)
better turn plump back up again um and makes it more resilient to that as well so you're exactly correct and then if you have a postman a puzzle patient you should be having them on you vaginal estrogen kind of regardless and there's a that's a whole topic in itself to talk about but um yes i would definitely recommend that
kim_vopni (18:05.622)
Right. Ha ha ha.
kim_vopni (18:10.774)
Yeah. And then I mean, I feel like we have loads of evidence for the use of local vaginal estrogen around the start of menopause for the rest of our lives for many patients. Now you talked about estrogen and testosterone together. And this was another question that I had with regards to testosterone specifically, because it is difficult, at least here in Canada, where I am, it's difficult to find
corey_babb (18:21.4)
yep yep
kim_vopni (18:37.158)
professional who will prescribe testosterone to women. There is no Health Canada approved testosterone, so it does need to be compounded. And I've heard various conflicting recommendations with regards to where to put your testosterone cream. Some say, absolutely put it on the vulva, and others say, absolutely do not put it on your vulva. So you're saying that we could potentially mix the two and put it there and it would be not a problem.
corey_babb (18:46.52)
hm
corey_babb (18:55.8)
sure
corey_babb (19:01.52)
right
corey_babb (19:05.5)
right so so remember from a from a anatomic standpoint to the vestibule which is you know the the external or basically the kind of reproductive track femal reproductive track is divided into three parts so you have the vagina which is the inside part the vestibule which is the area right at the very entrance to the vaginal canal you vestibule similar like you'd see in a hhurch or an you know a house or things in the vulva is the external genital so from an embryo logic standpoint the vest
bul is an anatomic homologue to the art of the prostatic our thrust so that tissue is the same whether you are an x x chromo zone or an x y chromo zone and what that means then is that the vestibule has a high number of andrigen receptor so like testostorone and so you know when you have patients that are hormonially deficient then especially if they have tenderness or irritation
that vestibule you can do a lot with estrogen don't get me wrong or estra dial specifically but you know adding that test of strone will actually be even more beneficial to helping that that tissue um you know systemic test of strone there's definitely you know pros and cons to that um and once again if you know there is a school of thought that ll if you're applying it virginally um you know you can have issues with literal enlargement or things along those lines
kim_vopni (20:10.575)
Mm-hmm.
kim_vopni (20:33.86)
Mm-hmm.
corey_babb (20:35.84)
um that tends to be very dose dependent and so you know if you're doing so and same here in the united states we don't have you know there's no kind of approved form of test aston for people who identify as women because are food and drug administration doesn't believe that that those people need test strone which is ludicrous because the overs produce four to ten times more test stone on daily basis than they do estrogens so but so you do you're right
kim_vopni (21:01.54)
Right.
corey_babb (21:05.24)
you do have to get it compounded or you can prescribe kind of a quote unquote mail test astro and then dose it for someone who has ovaries um but it's like i said the safety with test austin really is in the dose of it not even so much as where you're putting it per se so
kim_vopni (21:25.238)
And dosing is, you know, I hesitate to ask a little bit, but of course everybody's gonna say, well, what dose should I use? And obviously it's very personalized and this is not medical advice. Dr. Bab is not your doctor, but what would be the, what are the sort of standard ranges that may be appropriate for women and people who identify as female?
corey_babb (21:31.16)
correct
corey_babb (21:40.34)
right
corey_babb (21:51.52)
yeah so so basically you're going to be looking at roughly one tenth of a dose that you would give for for men or people who identify as men so if you have for instance we used to do test ostrom via injections and there is a medication called testostrincipi and it comes in a little vial and there is one mile leader in that vial of medicine and it's two hundred milligrams per that one mill leader so if you had a male patient
you would give him the one vial that injection that one m l if you were to have a female patient you would give them one tenth of that so point one m l so so that's kind of the general point you want to think of now in my practice we typically start patients at around a five mile gram per zero point five m l of transdermal testostrone and then we monitor test ostrom labs and we can
hytrate up as we need but that's about the smallest dose that i have seen that really can be effective in patients um and then like i said it can go up you know sometimes we have all the way up to giving a patient you know twenty milligrams on a rare instance but usually that five milligrams will will start to go into effect and they'll see a benefit from that
kim_vopni (22:53.167)
Mm-hmm.
kim_vopni (23:07.514)
Mm-hmm.
kim_vopni (23:14.094)
Okay, so I have other questions with regards to testosterone but I wanna stay on LS for a couple of more questions. Can things like hyaluronic acid be helpful? So that's, you know, a lot of people, especially as they're approaching and moving beyond menopause, find benefit in vaginal moisturizer containing hyaluronic acid. Is there any reason why somebody with LS could not use that or could it be beneficial?
corey_babb (23:19.28)
sure
corey_babb (23:33.18)
yep yep
corey_babb (23:38.26)
no i mean it can definitely be beneficial and i mean there's you know nothing wrong with using a vaginal moistureizer at all i mean it can definitely help with virginal dryness and with l s specifically we do recommend that you know if like you put let's say your steroid on in the morning then you also use some sort of emollient throughout the day as well to keep the tissue moisture eyes so if you have a typical hyloronic acid or you know we'll use sometimes coconut oil
kim_vopni (23:44.975)
Mm-hmm.
corey_babb (24:08.28)
vaseline or there's a thing here called a and d ointment i mean there's pretty much you know the world is your oyster there in what you want to use for that you know kind of mollie moysturizer type thing but yeah hiloranic acid s great
kim_vopni (24:23.222)
Okay and the other with the other one the other thing or treatment therapy that I have seen recently that is talking about benefits for lichen sclerosis in particular is the O-shot. Can you talk about what that is and have you seen that is effective?
corey_babb (24:36.2)
yeah
corey_babb (24:40.06)
so the shot is a trade mark for basically what's called pr p r platletrich plasma it was created by a doctor named charles runnels and he kind of has popularized it for sexual health so there's the shot and there's now the p shot for peron's disease for penuses and there's other things kind of with it but the thought is that m p r p or the playlet rich plasma basically the the
kim_vopni (24:46.159)
Mm-hmm.
corey_babb (25:09.48)
plasma that you would be injecting into the l s legions has lots of growth factors and what are called plura potential cells in it and those are cells that can basically change into whatever they want and so the theory is that that has you know will be helpful in reducing the cancer likelihood for l s and and healing the tissue and the original studies for this that were done by runnels and out at the center for vocal vat
al disorders in washington d c we're promising um there have been subsequent studies however that have shown that actually it was not effective in reducing the cancer risk so even if patients may have felt better you know the big thing with l s is is hey we don't want you to get involved our cancer and so you know that's why the steroids have have so far still been the gold standard of treatment for it so
kim_vopni (26:08.282)
So, Oshod was more thought of as the potential reduction and the risk of cancer not so much in the treatment of symptoms.
corey_babb (26:16.98)
they were used they were looking at both so they were looking yeah so they said hey is this going to make patients feel better and are we going to see the microscopic repair of the tissue that would decrease the chance of cancer and what they found is it while patients may feel better they did not see that tissue repair like they had hoped in the subsequent studies and so you still have that risk so it's one of those things that you know there's a lot of things that are out there
kim_vopni (26:19.04)
Okay.
kim_vopni (26:39.854)
Right, okay.
corey_babb (26:46.52)
may make patients feel better with it but you know the ultimate thing is hey are you going to have these long term issues so
kim_vopni (26:55.682)
And then last question with regards to this topic is vaginal DHEA. So you talked about the kind of the androgen receptors and the DHEA, as I understand it, helps with the conversion of estrogen and testosterone and can be beneficial where hormones may not be indicated or chosen. So can this population use vaginal DHEA like intra-Rosa as well?
corey_babb (26:59.32)
sure
corey_babb (27:03.7)
uh huh
corey_babb (27:17.9)
oh sure and you know since you mention i mean into rosa is probably you know this is my professional opinion like i see that the most benefit with that medication for g s m and you know just any type of hormonal thing and i use it off label for other things as well but like it so yes one hundred percent you can get that benefit because you're exactly correct you know d a is as a pro hormone so it will convert into strog
and andre gens um and so yes you can see that effect there too
kim_vopni (27:53.454)
Got it. Are you allowed to say what the off-label uses are?
corey_babb (27:57.1)
i mean this is my you know i am not a representative of farmacitical company for you know for thou um so i will use it actually a lot of so any type of hormonal vestibulitis whether that is in a patient who is on our contraceptive pills a patient that was who is nursing and is having painful sex you know pretty much any time i see hormonal vstibulitis i prescribe interosa or
get it compounded if the patients can't afford it because i think that that the benefit there is so huge and it doesn't have any systemic spread you know that we that we're aware of it all haven't seen any with patients with it and so like it's you know i just i've seen it work miracles so yeah
kim_vopni (28:47.362)
Right, okay. And just for listeners who don't know, vestibulitis is like inflammation essentially at the vestibule you were talking about earlier, correct? Yeah. Okay, so I wanna move into low sexual desire and this sort of transitions in some ways nicely. Painful sex or anything that can contribute to pain with or without insertion, with or without a partner.
corey_babb (28:57.88)
correct
kim_vopni (29:19.732)
is a big topic. I know that painful sex especially and sort of sex can be challenging for people with the liking conditions we just talked about. Who else could be experiencing painful sex? But then I also want to kind of go into the low sexual desire and sometimes painful sex can contribute but there's other reasons for low sexual desire.
corey_babb (29:21.18)
sure
corey_babb (29:28.54)
hm
corey_babb (29:43.4)
right so so to answer the first question i mean painful intercourse and whether that's you know you divided into kind of superficial you know pain whether you now with penetration or with even kind of exterior you know non penetrative sexual activity or you with deep penetration the amount of stuff that can cause it is staggering we really break that down into is it something related to an organic like me are meaning like
kim_vopni (30:00.818)
Mm-hmm.
corey_babb (30:13.38)
organ related issue so something like you know intersicialsys titus or you know irritable balsindrum die verticulos things like that indemetriosis is another condition that you know the text books always correlate with painful sex to things you know in the muscle so pelvic floor dis function the pelvic floor is spasmed that can be really painful or even if it's weakened that can be painful to m pedendal neuralgia so something nerve related and then you know
one of the conditions that we treat a lot of at my clinic is a condition called vagnismis which is basically an uncontrolled spasming of the muscles right at the entrance to the vagina which can make penetration you know almost impossible and that can be obviously if patients are trying to you know grit their teeth and you know bear through it or whatever can can cause you know all sorts of trauma to the tissue and also psychologic trauma too and then that leads into a whole nother set of of concern
so
kim_vopni (31:14.862)
And so the term dyspareunia is often applied to pain with sex where there is some sort of touch or something being inserted. And then as I understand it, vaginismus is almost the fear of that penetration because it potentially has been painful in the past or they anticipate it being painful. Is that accurate?
corey_babb (31:36.84)
yeah so dis prune is basically an umbrella term so you know it's going to say there's pain with some sort of know sexual penetration i honestly think we need to kind of revise it to even say external sexual contact you know but that technically at the moment falls into the realm more of vulvadinia which is another umbrella term but yeah yeah vaginismas is basically a you know pain with or with the anticipation of penetration
kim_vopni (31:49.338)
Mm-hmm.
corey_babb (32:07.38)
um and you're right a lot of times there's a panic response sits there and so the those muscles spasm as a protective mechanism you know if you come up some towards someone and you know in an aggressive stands and act like you're going to hit them instinctively our muscles tense up you know we get into kind of either a fight back type stance or or you know uh defensive posture and that's what's going on in those muscles it's it's anticipating for a number of reasons that this is going
kim_vopni (32:16.922)
Mm-hmm.
corey_babb (32:36.74)
be uncomfortable and so you know those muscles spasm so
kim_vopni (32:38.007)
Mm-hmm.
Mm-hmm. And what would your recommendations for therapy be for, you've mentioned a few, obviously there's gonna be different ones, but what are some of the main therapies that you would recommend?
corey_babb (32:51.08)
for painful intercourse in general so yeah so i think the biggest thing and what we try and do here at haven is really kind of get to the root cause of what's going on you know so if it is for instance pelvic floor issue you know if it's weak end to pelvic floor definitely pelvic floor physical therapy without a doubt if it's a hyper tonic pelvic floor so it's too spasm pelvic floor physical therapy and then we also will sometimes do was called kemodinnervation or basically using bow taks
kim_vopni (32:53.114)
Yes.
kim_vopni (33:10.307)
Mm-hmm.
kim_vopni (33:20.815)
Mm-hmm.
corey_babb (33:21.2)
um to basically paralyze those pelvic floor muscles if it's um you know a nerve issue then you want to try and treat the root of the nerve pain whether that's spinal or you know more kind of end nerve so and you know that goes into things like pelvic floor physical therapy once again or doing pedendal nerve blocks if it's hormonal treat the hormones so you know once you know what the cause is then treating the cause can often be you
kim_vopni (33:40.387)
Mm-hmm.
corey_babb (33:50.98)
therapeutic are completely therapeutic you know curative even for that pain but if it's there for a long time your brain creates these tracks in it due to this neuro science term called neuro plasticity and so it basically will always then once those tracks are there associate pain with sexual activity so even if you take away the painful stimulus then it's going to still
associate pain there so you also have to look at the psychologic aspect of this as well
kim_vopni (34:26.746)
Right so if somebody maybe had been dealing with some sort of pain had that treated they found the root cause that has gone away and they still experience they were wondering if that was contributing to their low sexual desire but that was addressed so now they still have low sexual desire how do you how do you go about addressing that and treating that?
corey_babb (34:41.859)
hm
corey_babb (34:47.28)
yeah so with pain i mean it's rather straight forward with it you know because obviously we don't want to do things as a species that that hurts usually you know so if you know if you have always associated sex with pain why would you want to engage in sex even if you take away the painful stimuli so that's where the you know i like to refer to counselors that use some of the trauma based there pies like e m d r which is
kim_vopni (35:15.727)
Mm-hmm.
corey_babb (35:17.12)
movement re processing and i movement desensitization and re processing basically a trauma therapy where you know you take that trauma and you process through it so it's no longer kind of hanging over everything if you will and so i think that can be really helpful then because not only have you addressed the physical cause of the discomfort but now you're also helping the brain to get back to where hey sex can be pleasurable you know or not pain
kim_vopni (35:23.15)
Mm-hmm.
kim_vopni (35:33.294)
Mm-hmm.
corey_babb (35:47.2)
at least
kim_vopni (35:48.066)
Right. And then in true low sexual desire, there's two I've seen you talk about and have heard, there's two medications called one's called Addie and the other is Veilisi. When did those come into play? When would those be indicated? Is it a last resort, first resort? How do you address that?
corey_babb (35:53.12)
hm
corey_babb (36:01.74)
correct
corey_babb (36:10.44)
yeah so those came in to they were released on the market here in the u s m and kind of the mid teens you know two thousand teen so i think addie was two thousand i think i want to say seventeen may have been earlier than that and then vilis was around two thousand nineteen m but don't quote me on that's it's around that time they obviously were in development a lot sooner than that they are both approved
kim_vopni (36:21.081)
Mm-hmm.
corey_babb (36:40.4)
are indicated from the you know food and drug administration here in the u s for the treatment of hypo active sexual desire disorder or h s d d in pre menopasil patients now they can be used for post menopasle patients or you now even in people who identify as men as well and they're still really effective is just that the u s f d a is kind of it has a really odd way of doing drugs for women and then
have to specify is this a drug for prementapos women or postmen poste and if you want to get both you have to submit a whole nother application for the other one which is filly you know but so that so they work on nor on the neurochemical side uf low sex drive and with hypo active sexual desire to order specifically basically there's an h and incorrect interplay
kim_vopni (37:19.662)
Wow. Yeah.
corey_babb (37:40.94)
between ceratonn and dopamine which are the two main nero transmitters involved with sex drive um so the brain is the most important organ for sexual desire and dope amine is a sexually excidatory hormone and sratonan is sexually inhibitory hormone and in a person who does not have problems with sexual desire there's a normal there's a proper interplay
between the two you know when you are in a situation where you may want to engage in in sexual activity that you know dopemein goes up and then when you're in a place that you don't really want to do that you know then that's you getting more kind of seratenurgic effects there well in s d d basically the ceratonanis always high it's kind of like driving with a parking break on um you know so you it takes a lot to get going but once you get there you know you can drive with it
and you you know but so it's kind of you got to find a way to take the parking break off and that's where those medications come into play
kim_vopni (38:45.904)
Mm-hmm.
Testosterone is also indicated for low sex drive. Would you start with that or would you start with these first or potentially even both?
corey_babb (38:51.3)
hm
corey_babb (38:57.48)
yeah so so the nice thing about all of these is that they do play well together um testostran obviously you know from a hormonal standpoint you do get a rise and testosteron around ovulation and that's an evolutionary thing you know obviously you want to have sex and reproduce when you're fertile but from a narrow chemical standpoint it's a dopamine analogue so that's kind of how it works to increase sexual desire so it's going to increase that at dopamen as well
um you know with testostron i think the thing you do have to be careful about is because you know you want to make sure that the cause is secondary to low testosterone and right now you know at least here in the u s if you look at the m i guess it's actually going to be in all north america the north american menopause society so you know names their guide line for the treatment of low sex drive and postmen pause women is to start with testostrone because if they're not on
kim_vopni (39:38.533)
Right.
kim_vopni (39:48.154)
Mm-hmm.
corey_babb (39:57.26)
hormontherapy you know we're going to see that ovarian um you know decrease in production of sex hormones in general including testostrone so by supplementing it you can increase that sexual desire and premenaposil patients you know you definitely would want to check test ostrom to see if that is a cause and if it is okay great you can use that but more often than not that's not really the whole thing so i you know if you're going to use it the other thing after
member is you have to monitor it and some patients don't want to monitor it and some patients don't care but i typically personally start with addie and valise because they play really nicely together and they're used in different ways um and then if i'm still not getting success and i have a patient with you know low test ostrom then i will add that so
kim_vopni (40:50.986)
Okay, so when you say play together, meaning you would put somebody on both medications or you would try one and Excuse me, see how it works and then potentially try the other one
corey_babb (41:00.02)
no so usually i'll start him on both actually so so yeah so addie is taken every night irrespective of sexual activity and it is basically um inhibiting the kind of sexually inhibitory ceratonan cells in your brain and it's kind of exciting or what's called agonizing the more dopamine related ceratonan cells in your brain so it's a carat
kim_vopni (41:02.755)
Oh wow, okay.
corey_babb (41:29.8)
an agonist antagonist is its actual classification and so what it does is it makes you more receptive to sexual activity it's not going to make you go out and say hey let's let's get it on it's going o make you basically say hey that sounds like that's fun let's do that whereas before you may have said no i'm not interested at all so and it takes a little bit to kick in you know most patients will see will start to notice changes in about a month after taking it
kim_vopni (41:42.203)
Mm-hmm.
kim_vopni (41:50.692)
Right.
corey_babb (42:00.46)
um and so like you know it takes a little while to work um the vilis on the other hand is an on demand medication so you're going to use it when you want to engage in sexual activity or you anticipate wanting to and it's basically just a pure shot of dopamine um and so it's a little injector kind of like an epi pin you know for people that have an act reactions to whatever and it lasts you know
kim_vopni (42:26.158)
Mm-hmm.
corey_babb (42:30.84)
it first came out they said it was twenty or twelve hours now they're saying more than you know likely twenty four or more i have in full disclosure tried both of them and the the vilis it definitely works mean but the main side effect that you know kind of about thirty to forty percent of patients who are on it will get as headache and nausea so you want to and it goes away but yeah so
kim_vopni (42:45.776)
Mm-hmm.
kim_vopni (42:56.41)
So you want to get it on, but then you feel sick. Yeah.
corey_babb (42:59.84)
so i tell my patients hey if you're planning to go out in the evening take it like in the morning or you know give yourself enough time for it to get that side effect of because it kicks in in about thirty to forty minutes um i took it right before i went to bed and i mean it was pretty you know i was like man i do feel kind of nausea to hear i went to sleep i woke up the next morning and i was you know i had no side effects at all and i you know like i said without trying to be crass i was like what
kim_vopni (43:13.124)
Oh, wow.
corey_babb (43:29.72)
touching my genitals and it was my pants you know so it was like hyper sensitivity s like this is this is crazy like a wind blew and i got in erection type you know things so and it was you know it definitely works so that the addie um its main side effect is it makes you sleepy so you take it right before you go to bed and the first night i took it i slept better than i have in you know a long time so i've been on it for a little bit more than a month and i
kim_vopni (43:37.326)
Ha ha
corey_babb (43:59.9)
for me and about seventy percent of people are responders to it and i am one of the respondors as well so i'm like you know hey this is definitely kind of increasing my my level of desire and like i said the sleepiness you know i usually get between six and seven hours of sleep and i which i know i need to get more but it doesn't make i don't feel groggy when i wake up in the morning with it so they were both yeah a success for me so obviously that's just so but
kim_vopni (44:20.134)
Mm-hmm, mm-hmm. Yeah, that's interesting.
kim_vopni (44:25.386)
Yep. Yeah, but the sleep part is interesting too, because in especially in the postmenopausal population, well even in perimenopause, sleep is often a huge challenge. So, um, uh, industry. Okay, so I'm not going to get a chance to get to everything, but I did want to come back to one more question, um, about testosterone. And I think we'll have to have you back on here for a part two to get all the other questions that I had for you. But, um, with regards to testosterone, uh, coming
corey_babb (44:33.92)
oh yeah totally
corey_babb (44:49.82)
got you okay
kim_vopni (44:55.242)
you know, we had talked about that a little bit earlier. The part I wanna ask is pellets. So I've seen lots of controversy as well on pellets. Some people say they're life-changing and it's the best you put it in and you don't need to think about it and other people say it's dangerous because too high of a dose and it's slow release. So interested on your thoughts on hormone pellets specific to testosterone.
corey_babb (45:00.6)
go
corey_babb (45:04.08)
yes
corey_babb (45:19.3)
so no specialty society that really deals with you know women's health or hormonal health recommends the use of pellets for women are people who identify as women um and like you said you hit the nail on the head there the issue is you end up with these super therapeutic levels of testostrone um and that can definitely cause problems some of which can be reversible when you come off if it but others can be actual
kim_vopni (45:33.562)
Mm-hmm.
corey_babb (45:49.16)
permanent um you know i've seen patients who come in and you know there they and don't get me wrong patients typically feel wonderful on the test on the pellets especially you know while usually about the first month that they have them and then they start to kind of notice the fall in testosrund then they start to get really irritable and achy and angry and they don't feel good until it's time for here's another pilot um and the biggest
kim_vopni (45:50.118)
Mm-hmm.
kim_vopni (46:00.858)
Mm-hmm.
kim_vopni (46:12.417)
Mm.
corey_babb (46:19.08)
you though like i said i've seen patients whose test of throne is higher than mine on with the pellets and those patients you know those say why is my hair falling out why am i getting acne why is my clitoris enlarging or have one patients that has voice deepening permanently from it when those viralization things start to happen they're often not reversible um and so that is why i i do not recommend them you know with the daily transdermal test off
drone we can get you to a steady state to where you're getting the same amount every day and that test austrian level is really not budging much um and so that's why i prefer that and that's the recommendation from both the north american minispause society the indocran society and then also the international society for the study of women's sexual health that's kind of the preferred method
kim_vopni (47:11.742)
Right, yeah, okay. And last question I'll ask for today anyway, would be can testosterone, if somebody, if it was indicated, do we test their levels are low, they have some other symptoms potentially, could increasing testosterone levels systemically or maybe even locally, could that, meaning local application versus systemic application, could that influence the...
strength, endurance, resilience, reaction time of the pelvic floor muscles. So people who have incontinence and that kind of thing.
corey_babb (47:44.98)
yeah yeah that's a that's a great question so so the short answer is yes um you definitely see and that's one of the things you know we see with patients especially men apostle patients who go on systemic test astro you know they say you know i feel stronger if i have more muscle endurance if i am exercising i can go longer without feeling tired i'm not fatigued in general i have more mental acuity so no one hundred percent it can be very beneficial
kim_vopni (48:09.85)
Mm-hmm.
corey_babb (48:15.0)
for you know even just like said for a local application you'll still see some muscular improvement with it you know but usually if you're doing those patients or if you're seeing those you'll probably put them on a systemic form of it you know so
kim_vopni (48:28.258)
Right, right. And I can attest, so I use systemic testosterone and I can definitely attest to the more energy, more endurance, I don't get so fatigued. It made a really big difference for my sort of capacity throughout the day, if you will. So yeah, I'm a user and a believer. Yeah, but.
corey_babb (48:31.88)
hm
corey_babb (48:50.6)
yeah exactly
kim_vopni (48:53.978)
I have a whole list of other questions. I really would love to have you back for a part two, if you are open to that. I've loved this conversation. I love your approach to it and I'm really grateful for you sharing your time with us today. So thank you so much.
corey_babb (48:59.18)
of course
corey_babb (49:07.26)
no it's my pleasure thank you for having me all right thanks by
kim_vopni (49:09.782)
All right, see you again.
