134. Stop Gaslighting My Vagina

On social media A woman asked – my vagina is so dry that sex is painful, how can I fix this? Wikipedia: Gaslighting is a colloquialism, loosely defined as making someone question their own reality. The answer provided on social media to this question: - Regular sexual activity, self stimulation and pelvic floor exercise can help keep your vagina health. - IS THIS ACTUALLY TRUE? - This doctor said “I tell women to avoid sugar and use probiotics to make sure their entire ecosystem is “humming along” – NO evidence that oral probiotics affect vaginal microbiome – then she plugs her diet and her probiotic products - She then goes on to say – two additional ways to counteract vaginal dryness is to strengthen the pelvic floor by doing kegel exdrcises and using a “holistic formulation” that helps maintain optimal levels of natural moisture, and “supports a healthy vulva and vagina”. – this is her product – which states it “prevents leaks” and costs 70 dollars. Also claims to “reignight desire” – WTF I searched in J sex med - does intercourse delay or treat vaginal atrophy? – can’t find a damn thing I found on an internet site - “Regular sexual activity, with or without a partner, can help maintain healthy vaginal tissues through increased blood flow and avoid or lessen the effects of vaginal atrophy.” - No citations, so again I went to J Sex med – can’t find a thing On menopause.org - Regular vaginal sexual activity is important for vaginal health after menopause because it stimulates blood flow, helps keep your vaginal muscles toned, and maintains your vagina’s length and stretchiness. - No citations, and furthermore, the vaginal muscles are smooth muscles controlled by the autonomic nervous system – you can’t tone them with sexual activity - I will buy that stretching the vagina frequently probably allows it to be stretched frequently without pain – but is there evidence and why sex, why not just dilation? Current treatment options for postmenopausal vaginal atrophy Iuliia Naumova1 and Camil Castelo-Branco2 Int J Womens Health. 2018; 10: 387–395. It is important not to forget about the positive effect of sexual intercourse on the improvement of vaginal health – no citations (JAMA 1983;249:2195-2198) Vaginal Atrophy in the Postmenopausal WomanThe Importance of Sexual Activity and Hormones - But this study was not randomized – perhaps the less atrophy allowed the women to be sexually active and not vice versa? How do we know the sexual activity caused less atrophy? We don’t have any studies. Another paper on vaginal atrophy gave this recommendation - Regular sexual activity should be encouraged to maintain vaginal health. (II-2B) - Usefulness/efficacy is less well established by evidence/opinion Why is level 2-2B evidence cited as scientific fact? Pro-tip – Billionaire Marc Cuban just started an online pharmacy for low cost generic drugs https://costplusdrugs.com/ - vaginal estrogen tabs for < 10 bucks, cream for 54 dollars. What other myths do you want me to bust? Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/C7gjrk --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message

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