Pussy Talk - Everything you need to know about Bacterial Vaginosis from a Vaginal Microbiome Expert, Greta Durston

[MUSIC] Hello everyone and in today's episode we're joined by our vagina microbiome specializing naturopathic credit dustin. We're going to be talking about all things bacterial vaginosis. But before we get into the topic today we can go through a few life updates which first you're now credit dustin. How does it feel? Name change? It's official with the government now. Yeah it feels good. I'm still getting used to writing GD instead of GH. I love to flow a bit. I think it actually sounds really good. I like it too. Yeah, I feel like the credit dustin. Yeah absolutely. I actually love going through all the admin stuff changing. Yeah, really? Yeah, really? It's a different destiny. Yeah. There's been about 20 different things I have to change my name with as well. It makes you realize how often you use your name in so many different things. Like all the debit cards, the credit cards and the Medicare cards, like all that kind of stuff you'd be going to have to change. Yeah, and every membership you have. What an expensive process. Yeah, such a process. Yeah. Any other life updates and clinic updates since we spoke last in our last episode where you joined us with Paige. We were talking about relationship with food and encouragement from Paige. One of the life updates. Yeah, I guess professionally a life update is that I'm adding another day with a render. So. I think that's pretty close. Re clinic days to four clinic days which is exciting. That's probably my only professional update. I guess you spent most of the summertime just traveling around. Yeah. Yeah, I've been awesome. I've been a little bit weak. Yeah. I'm in relax mode. I'm trying to get back into it. Yeah, oh my god. It's been a few weeks, hasn't it? Yeah, definitely. But let's get into the topic for today which is bacterial vaginosis. So can you actually break down what bacterial vaginosis is? Yeah, absolutely. So when we're talking about bacterial vaginosis, we're talking about simple anaerobic bacterial vaginosis. I just want to make that distinction because there are quite a few different microbes at different classes of microbes that can cause bacterial infections. So when we're talking about bacterial vaginosis, we're talking about anaerobic microbes. So the way that we kind of categorize BV or diagnosed BV is three different criteria. One being that the pH in the vagina is increased. So above 4.6, actually that alone is already diagnostic of bacterial vaginosis. And then we've also got low levels of beneficial bacteria and an overgrowth of one or more anaerobic bacteria. So anaerobic bacteria are things like gardenerella, atopobium, megasphere and crevatellar. They're probably the most common causes of BV. You can kind of think of BV as like a dysbiosis of the vagina. So like we have gut dysbiosis, it's like an imbalance in the beneficial and more pathogenic bacteria in the vagina. So I guess it's probably a little bit different to thrush than where thrush is kind of mostly looking for the presence of candida, whereas with bacterial vaginosis, it's almost like a little checklist of multiple different signs or symptoms that you could see that then kind of fit you into the diagnosis of BV. Yeah, absolutely. It's not like a simple infection of one thing. It's more like a categorizing all of those different criteria, basically, to hit those criteria. So then what are the stats then around how many people infected? Because I feel like that would be so easy. Like the amount of things that can then impact your pH, the amount of things that can cause a decrease of beneficial bacteria, ankles and overgrowth of the pathogenic bacteria. I almost feel like every woman at some stage would have probably experienced BV. Yeah, absolutely. I don't think I know anyone who's never had BV. In terms of statistics, it's really tricky because they're all over the place. So they kind of go anywhere from like 20% of the population of the female population has had BV up to 80%. So that's a very big. Yeah. Yeah. So I'm not really trusting those statistics. The one I do trust is that it is the most common vaginal bacterial infection is BV. And I guess that variants in the percentages potentially also just because of who's kind of collecting the data, what kind of reporting that they're basing that off in terms of like diagnostic criteria as well, where one might say 20% 20% of the population will have an overgrowth of primatella or whatever it is. But then another kind of reporting system might be just basing it off pH imbalances, where that's like 80% of the population is it? Yeah. 100% and even for diagnostic purposes, some of the labs that we use won't diagnose BV if the pH isn't above 4.6. So it might be at 4.5 and you've got overgrowth of gardenerella and atopobium and you've got no beneficial species, but they still won't diagnose it because of that pH isn't above 4.6. Yeah. Well, I think it's even just good to bring it to the attention for everyone listening as well, like how common it then is because I know that when it comes to anything related to the journal, how there's so much shame. And I also know with some of like my friends and family that have had BV is like this instance like shame or like feeling of, oh, I'm disgusting because I've had or I have this and it's like actually it's very easy just like it's very easy to get gut dysbiosis because of the food you eat and the environment will be very easy to have the same thing happen to the journal of our drive as well. Yeah, I think that's a really good point as well. And I guess especially in terms of BV because you do get, you know, the discharge becomes quite smelly and you feel kind of unclean. So there's that kind of shame around you might be smelled or you might feel like you're unclean. So then what are the main symptoms of someone gets if they've got BV? So BV is usually a smelly discharge. Usually people will get like a fishy odor or like a rotten odor really pungent. So it's quite a distinct smell. It can even be more like a chemical smell. It's had a lot of people say it smells like a peroxide smell like a really like chemically smell. The other one is like painful sex irritation down there. So you could have itching. You could have heat redness things like that and then that tissue degradation. So you get like burning pain as well if you've got tissue degradation. And would you say BV is almost like a scale whereby like your symptoms can present different person to person based of the level of damage that has been done or the imbalances that's there. Yeah, definitely. So I guess if the more kind of acute infection like if you're getting BV you know an acute infection that doesn't last too long probably won't colonize the vagina quite as much and you probably won't have as high levels as you could have in a more chronic case. And you don't have that severe drop in beneficial bacteria. So you might only get some symptoms where it's if you've had BV for like two or three years or ongoing you're going to have much more tissue degradation and you're going to have really, really high levels of those microbes as well. So you'll get a lot more severe infection. Okay, now I know for some people that are listening as probably also the first time that they've ever heard that the vagina has its own microbiome. Yeah, as they do that as they're talking about it, they probably like watch like beneficial bacteria is of the gyna, like what's this supposed to do. So maybe before we get into it a little bit further can you give us just like a general overview of like what the vagina microbiome is and like why it's important? Absolutely. So similar to the gut microbiome, the vaginal microbiome is all of the bacteria, fungi, viruses, all of the microbes that inhabit the vagina. So it's basically the ecosystem of the vagina. So it could be even things that feed the good bacteria. So it includes all of those glycogen and things like that that feed the bacteria. The whole ecosystem. And what do we need the vaginal microbiome for? What's its actual function? So I guess the main function is protection, right? So beneficial bacteria are going to protect against those more harmful bacteria by producing things like lactic acid and hydrogen peroxide to keep things the pH nice and low. So we really need it for that protection so that when we have sex or when we go in the pool or you know have that connection to other things in the environment that we have that protection there that can keep out more pathogenic bacteria. So if we would relate that to every other system in the body, we would say for example the skin is our organ that also you know it blocks things from the internal and the external environment. We've got our skin barrier that helps us to protect us. Our stomach has our stomach acid so nothing bad gets into our digestive tract to try to you know invade our microbiome of the intestine to make us sick. And the vagina microbiome then has these good beneficial bacteria that have these particular secretions like the hydrogen peroxide to kill the bad things that can enter our body. Yeah, that does a more. Yeah, yeah, 100%. I always like to explain it to my clients in a bit of an analogy of like a police force. So the beneficial bacteria which are generally the lactobacillus species, they're like your police force. And so if you've got a really big police force then you can keep out the baddies. But if you don't have much of a police force, the baddies are more likely to come in and invade. And then they can wipe out the police. Yeah, they're little pence and to make a nice home for themselves and then they've probably taken over that territory. That makes perfect sense. So then with the symptoms of BV, how would you say that they differ to someone that has the rush? Because I know they're probably, they would you say the two most common things you're seeing clinic or BV? First common. Yeah, definitely the most common. I guess the discharge which I don't think I've talked about before is very different. So with rush you get usually quite a thick discharge that's more of like a cottage cheese consistency. Or you might even get little like flecks of what looks like yeast coming out in the discharge. With BV, it's more of like a watery discharge usually. So it might be like a gushy watery discharge either with a gray tinge, a green tinge, a yellow tinge or it could actually just be Clio Cloudy. And can the body recover from BV on its own? I could do it a little bit. and do nothing at all would have fixed itself. - It kind of depends on the infection and how much supportive stuff you have as well. So if you've got a good lactobacillus count and there was like a reason that you currently have baby like you've had sex with someone and now you've got this new bacteria that's been introduced, there is a chance that your body can then push out that bacteria on its own, but a lot of the time just kind of depends how long that's been going on for, but a lot of the time it does need some intervention. - Yeah, yeah. And I guess this is where it's important to actually have an understanding of what you're treating in the vagina microbiome than rather than just trying to take a stab at it, your stomach and throw a random treatment at it. - Yeah, it's so important to know, even with BV, even if we know it's BV, it's important to know what the actual microbes are that you're treating. - So then in terms of the partner, so you mentioned that just briefly there. So you said, if they've got a partner and they've been introduced to new bacteria, that can kind of disrupt things. - So can we go through like the influence of what the partner's role is in it or not in it? - It depends if we're talking about female and female sex or if we're talking about male and female sex. It is a little bit different. So obviously if you're having two vaginas, you'll get their microbes and they're probably more similar to your own microbes, or they might have BV and then pass that exact BV to you. Whereas with a male partner, they've got the P-Nile or the Seminole microbiome. So it depends if they are actually ejaculating inside the woman. If they're not, then they've just got the skin microbiome, which has very different microbes to the the journal microbiome. It's just, yeah, it kind of depends about the partner as well and what kind of microbes they've got. But if they've got something that they're passing to you and you're gonna continue to have sex with that person, you are gonna pass it back and forth. - Okay, so does that mean that they need to be treated to? - Yeah, it's what it depends. So with men, let's just say female and male sex, with men, if they've got something like a rush on their penis or any kind of symptoms, then they probably do need treatment as well and maybe the same level of treatment as the woman. If they've got no symptoms whatsoever, they might just be a carrier of that microbe, and it's probably not causing them any harm. So it sort of depends whether you actually want to eradicate that from that person as well, or if they just want to wear a condom. Yeah, it depends on person person. So basically like for the male, as I for example, male, female, dynamic, the male is carrying a particular type of bacteria and for them that could be fine. It could be almost like a mental happy to live there, doesn't disrupt anything. But once that enters the female's environment because they've got the other factors like maybe just regulated pH of the vagina microbe, and they have low beneficial bacteria. That bacteria that's now then invading their space, is causing havoc because of the system that they have. Exactly, exactly. So if you think about that, those like modifiable things is that she has already a high pH and already not enough police force. So if we work on her police force and her pH, you can probably handle that. Yes. It's more about her environment than like that she's given that to her. Okay, I think that's just important to, yeah, to clarify because I think the main thing as well is like a lot of males, they probably also don't feel or see a lot of the symptoms if they do have a specific type of microbe, that's growing and they may not get the discharge, like we get discharged and we get changes like we're able to see. Or like painful periods that might become about because there's been a new infection or anything like that. So they may not be understanding. So I think that's just important to clarify because I know also when speaking to other friends or family members that have had BV before, it's instantly like off this dirty guy gave me BV. And it's like actually let's probably not blame the guy. It's like it's not blaming anyone. It's just like a microbe that's been passed on for them, it didn't cause an issue. They didn't even probably know that that was there. Yeah, yeah. And so think about it as like it's probably not an infection for him. No, exactly. Like an infection for you because of all of these other drivers, but it's not infection for him. If he has no symptoms, he might have tiny levels at this and his penis is a skin microbiome. It's not a penile microbiome. It's the, you know, his semen has a microbiome, but the actual penis is skin. It's a very different tissue than vaginal tissue. Okay. And then even in saying that the ejaculation itself and like semen itself can change the pH or the vagina microbiome too. That's probably the biggest thing. Yeah. So it's quite a high pH semen. And it contains a lot of like simple carbohydrates, which are going to feed things mostly like Candida, so more relative to thrush. But yeah, it does contain a really high pH, which changes the pH in the vagina. And especially if you're constantly having unprotected sex where there's ejaculation involved, that's going to change the vaginal microbiome a lot. Okay. So then how does someone actually know if they have BVB base of testing? So there's a couple of different ways that you can test. You can go to your GP or even a sexual health clinic as well. And they'll do a simple vaginal swab. Usually you can even self administer it. So it's just one of those long swabs that goes up to the vaginal canal. He's in there for 10 seconds, comes out. They send that to a lab and they test for basically classes of bacteria and yeast as well. So your actual result will come back pretty simple. So it'll say sometimes they'll test the pH a lot of the time they don't. But usually it will say like medium growth of beneficial bacteria, high growth of anaerobic bacteria, high growth of yeast. Like it'll just be like that simple. So if you don't know the species, we don't know what's causing it. And also if you get a mixed infection like that with the anaerobic bacteria and the yeast, the doctor then has to decide what they're going to treat. Are they going to treat the yeast or are they going to treat the bacteria? And a lot of the time the yeast will cause more symptoms. So they'll treat the yeast. So they'll treat the yeast with something like flukonazole, like an antifungal medication, which then is going to disrupt the vaginal microbiome more giving rise to more of that anaerobic bacteria. - Okay. And is that where you then see like a vicious cycle of people then getting more symptoms and being like, oh, the Candida's come back. Let's take another round of flukonazole without testing. And then they end up with this perfect picture where they've got low beneficial bacteria of the vaginal microbiome. And then that's allowing the baby to be more of an issue. - Yes, yeah, absolutely. So you get that cycle. And sometimes they will give you both antibiotics alongside the antifungals. - Uh-huh. - So they'll do either a antibiotic gel or a tubular alongside antifungals. If you think about that as a treatment, that's just knocking out everything. So like antibacterial gel is going to knock out all the bacteria in the vagina. And then also the antifungal, all the fungal infection as well, which means you're then left with like a clear forest. Like down all the trees, you've pulled out all the weeds. You've taken everything away and now you have nothing there. So something can easily come in and colonize that space now. So you might have no symptoms for a short period, but you'll probably get a lot of symptoms if you don't also do the, like bring up the beneficial bacteria after that. - So then how does this do for the type of testing that you're currently doing in clinic? - Yeah, so it's quite similarly in the way that it's administered. So I do functional testing for the vaginal microbiome. So it's basically like a whole microbiome. There's a couple of different ones I use. So one is more of like a PCR and culture, where it's the same kind of thing as swab of the vagina, goes back to the lab. They culture the sample. So they see what bacteria grows on it and what fungal infections grow on that swab. And then they also do PCR analysis as well. So they pick up different STIs with that and other bacteria as well. - And are there other markers that you see in that functional result that help them guide your treatment? - Yep, so they also test for the pH every single time and they test for the beneficial bacteria. So you'll get ratings of like how high every species of beneficial bacteria is as well as the particular type of fungal infection and the different bacteria. So some of the tests just will basically screen for like 20 different types of bacteria. So they're looking for that specific bacteria, which means there is a margin for error 'cause they might not pick up something they're not looking for. Whereas other ones will test for like the entire microbiome and report on every single species there. And I'd like both of them to be honest. I find when we have really a lot of vaginal symptoms and we know that their infection there, I think those more PCR based tests are still really useful. - Yeah, and I think the more information you have the better so then you can actually make the treatment plan so tailored to them that they can kind of break this vicious cycle of needing to take antibiotics to come as well. - Yep. - And breathe into that cycle so they're then not getting the long-term change because they're not focusing on the growth of the beneficial bacteria. - Yeah. - And the police force and the pH are like a little analogy. - Yeah, they've been good. - And then what about the long-term side effects? So if someone has had baby for a while, they're leaving it untreated. Maybe they're just kind of like this regarding it was like, oh yeah, like it's just this normal vagina smell. What are the long-term side effects? - Yeah, so it'll impact the vaginal microbiome more the longer it goes on. - So the longer you have baby, the more tissue degradation you're gonna get, the higher the pH will get generally. And then the more tissue degradation you have, the higher it spreads as well. So is it gonna go all the way up the vaginal canal? Is it gonna affect the cervix? Is it gonna go into end of uterus? So down the track it can also affect fertility as well. If you think about that tissue degradation and having that bacterial biofilm along all of that surface area, when we then want an answer. embryo to implant in that uterus, we might encounter some issues. Is this where we also then consider this kind of pathology in the conditions of like adenomyosis and endometriosis when we're talking about the genomic abound, then I guess impacting the endometrial microbiome? Yeah, they usually is some interplay with dysbiosis, gut dysbiosis actually, and to general dysbiosis. In endometriosis it is a bit more complex than that and it probably didn't start from baby, but we do often see beaving other vaginal infections in endometriosis and adenomyosis as well. And I guess especially because it's both of those conditions are driven by immune system dysregulation, which was certain extent, and then you've got literally an infection right in that area. Exactly. That can then be exacerbating. So not the cause, but an exacerbation potentially. Yeah, an exacerbation and you just usually see them both coinciding together. So so far we've got BB that's caused by pH dysregulation, low beneficial bacteria, potential overgrowth of bad bugs. So if we were then to think about like the lifestyle factors that can exacerbate that kind of environment and create that environment, what are you generally seeing? Anywhere where there's a lot of heat and not a lot of breathability, so I know we talk a lot about different kinds of underwear. So if we've got synthetic underwear like spanned decks and even cotton as well, because it is so sprayed, there are a lot of chemicals in cotton unless it's organic cotton, and it's not quite as breathable as we all think it is as well. So bamboo is like the number one for underwear. So if we can swap all of our underwear to bamboo, that's a massive, massive step in the right direction. Other things, you know, hygiene, so not washing for long periods of time, say you've been at the beach and then you stay in that underwear all day, whatever microbes have made their way in can then kind of proliferate in that time. Diet can also play a role as well. So we want to be eating a lot of different fruits and veggies that are going to support our immune system and multi-microbium health as well. And then things like sex as well. So a lot, things to do with sex. So, you know, cleaning of your sex toys, cleaning of your vagina or your vulva after sex, so getting on the toilet, doing away, going in the shower, washing your vulva, things like that could just really help to prevent those microbes from entering. And how about things like tampons, pasts, looops? 100%. So I guess in the tampon realm, one of the things I see the most contributing to BB is using period cups and period underwear. And not at all saying that I don't love these things, because I do, but you need to look after them really well. So things like the period cups, if you're not sterilizing them properly. And I mean like on the stove in hot water, even with buy carbs, something that's going to really scrub them, you need to be doing that at least twice every time you're using it. So before you're inserting it for that period and after you've taken it out, along with washes throughout that cycle as well, because the bacteria can really form around the period cup. It can form its biofilms and create colonies on the period cup as well. Okay. Wow. I could imagine like so many people that would probably just feel like, well, I'll just quickly rinse it underneath the tap that we find or like check some, you know, check some soap on there. That's probably full of things that are breaking down the material or not beneficial for the vagina microbiome. Yeah. Exactly. Oh, I remember using like, and I do love period cups, but I remember when I was like early 20s and I had started using period cups, and I would wash it in the shower. And I wouldn't, I think I'd boil it before my period. And that was in and I was constantly getting either threshold BV after using the period cups. Now I really understand why, but at the time, I was like, well, but I'm washing it. Yeah. Yeah. Yeah. It's like a third or enough. And then even in terms of loops, like that's where we kind of think about things like glycerin, don't we? Yeah. That's in some of the documents. A lot before. Yeah. No lubricants. Like, you know, we're talking about more kind of conventional lubricants here, where they're possibly flavoured or heating or ice or something like that. They'll often have glycerin in them, which can be a really good source of food for certain microbes. So making sure that your lubricant is a really nice, natural and organic lubricant might actually just be the only thing you need as well. So in terms of the naturopathic treatment options that are then available for you to use in terms of your little toolkit, where you often go to when you can see that someone has long-term recurrent BB. So with recurring BB, I would say that the number one thing that I would do is to make sure that we're building up their tissue integrity. So if they do have that long-term tissue degradation, things are really sore, burning. We don't really want to go straight in with intrapagyinal preparations, because that's hidden really burned. So we need to make sure that we're actually preparing the tissue for the treatment. So the first thing I would do is introduce something like a sea buckthorn oil or mineral oil. Those two oils have been shown to build up that tissue integrity. And then we would use something like a lactolose and hydrogen peroxide combination, if it's relevant. Those two things together, they're actually produced by the lactobacillus species. So we're kind of just giving you a bit more of what you don't currently have in order to change the pH and also break down the biofilms of that more pathogenic bacteria. I will say though with this that it's really important about the ratio of those two things. And I would say if you are going to do that kind of treatment to make sure that you're working with a practitioner who knows how to administer that kind of treatment, because it can be a little bit dangerous. -No, like do I have DIY? -Yes, please don't, I guess it's not. -Yeah. And then the other things we have in our toolbox are vaginal probiotics. So specific probiotics usually again, that lactobacillus, these things, like specific antimicrobial herbs that will go in and target certain bacteria. And then another one that's quite simple is green tea as well. So green tea has been shown to increase lactobacillus species in the vagina. And this can be used internally or topically. So you can use green tea like in a spray bottle on the vulva, can be really soothing and also help that lactobacillus species. -Uh-huh. -Okay. So there's quite a few things and it's usually the your treatment is then dependent, either on like what stage of the BV, you're seeing it up plus the level of tissue damage that you're seeing and the types of microbes present. -Yes, all of those things and just their particular presentation as well and what symptoms they have. -Okay, because you can cause a lot of habit in the vagina regimen. -Yeah, you can grow more damage. -So then for people that have reoccurring BV, that are listening, what would your three tips be for them? -Number one if it is recurrent BV would be to test the whole microbiome and really like invest in one of those functional tests that you can get done with one of our naturopaths or most naturopaths will do these kinds of tests for you. It's just a really good idea to get an idea of what your whole microbiome is doing. -Uh-huh. -And then my second one would be to really look at your triggers. So I use someone who gets BV after sex. I use someone who gets BV after you've been sweating, back riding, at the gym, whatever it might be. I use someone who gets BV after your period because you use a period cup and just modifying those triggers. So you might be taking away the period cup for a period of time or increasing your hygiene. It might swap over your underwear to bamboo and you know modify the things that you use in sex like the lubricants and condoms. And then my other tip would be and something safe that you can do at home get a really good vaginal probiotic. So the two kind of most studied vaginal probiotics are lactobacillus remnosis. Now it's called GR1. We're going to put this in the show notes. You don't need to. -Yes. -Yes. -And lactobacillus, Ruteria or Ruteria RC14, those to a really, really specific against pathogenic bacteria in the vagina. -Okay. Excellent. And that's important to know also that not all capsules are essentially designed to be inserted intrapidronally as well. So it also depends on making sure that the capsule can be broken down by the acidity, by the vagina microbiome. -Yeah. -Yeah. Definitely. And also just to note that those two you can take orally, there are these on it being taken orally and you do get that translocation to the vagina with those two species. You don't with all of them but with those two, they do have pretty good translocation. So you can take them orally as well. -Great tip. So if I would summarize a few things that you kind of said today and jump in if you think that there's anything that I'm kind of missing. One is that a lot of people that probably have BVD, they might be mistaken as just reoccurrent thrush and they're constantly taking treatments to correct a thrush when really there's other treatments they need to be doing to building and supporting the health of the vagina microbiome and tissue and address the specific microbiome that's impacting the BVD. The other would be is that it can be a combination of different types of criteria to meet to say that you have BVD. It's not just the presence of one particular pathogen that you've caught from someone. It's because of these other factors like pH imbalance, low beneficial bacteria, which can often be due to things like antibiotic use because they've been sick. That's impacting the vagina microbiome or the types of body washes and mental cuts and lobes and sex toys that aren't washed and all those kind of things that can impact all of that. So it's never just this one person that infected us and ruined our vagina microbiome. -It was an STI. -Yes. -The head okay. You can point the fingers. But other than that. -That they are long-term treatments that you can do to be able to get on top of this and you don't need to constantly be using topical antibiotic gels or internal antibiotics. There are ways that you can be able to manage this long-term and that you shouldn't try to just throw anything at it because you've got to assess where you're sitting on that scale. -100%. Yeah. -Okay. -Someone that I've been really couldn't say it was my bad. -Oh. - Amazing, I learned things, this is great. So thank you so much for coming on to the show today. For those that are listening, if you do feel like you need some further support in this kind of area, Greta does take consults nearly four times a week now. - What is a week now? - Yeah, so we're gonna either head to the link in our show and it's in booking through Discovery Call, or if you know that you wanna work with Greta, then just jump in and book in a consult with her so you can jump in and do an initial consultation where she can filter through which type of testing might be best appropriate for you. And then take your treatment from there. - I think thank you. - Well, thank you so much. And if anyone has any questions, please feel free to always send us a message on Instagram or either Greta's Instagram. And we can always record multiple podcasts to answer your questions. - Yes, and we will. - Yes. - Thank you so much. - Thank you, thanks for having me. - Thanks for the show.