Ep. 203: Vaginal Health 101 with Dr. Sarah Pederson

Outside of a yeast infection, do you know how to gauge the health of your primary sexual organ? If not, you're not alone. Most ladies know very little (if anything) about vaginal health, and Dr. Sarah Pederson wants to help change that. In today's episode, she addresses the most common mistakes made in caring for yourself "down there" and provides tips for topics like lubricants, discharges, and more.

NOTE: This episode may not be appropriate for all audiences; it does include frequent use of anatomical terms.

GUEST BIO: Sarah Pederson, MD, is a board-certified OB/GYN and CEO of Vera Health and Fertility, where she leads with a personalized, holistic approach to women’s health. She is passionate about making holistic care the standard in medicine, empowering women to balance their hormones, feel their best, and create the families they desire as naturally as possible.

HELPFUL RESOURCES:

Ep. 119: Fertility Tests that shouldn't be skipped! with Dr. Sarah Pederson, OBGYN

Vera Health and Fertility, Denver

Transcript

Caitlin Estes (00:24)
Welcome back to the Woven Well podcast. Today we're talking about a pretty interesting topic that I'm gonna guess you know very little about. ⁓ I know very little about it. I think most women know very little about it, even though that is going to be shocking because we're gonna talk about vaginal health. We talk about hormones, periods, fertility, but we skip over this important area of female anatomy and health.

So we're gonna talk with Dr. Sarah Pederson from Vera Fertility to give us the information that I think we need to know. She is a board certified OB-GYN who specializes in fertility, holistic medicine and surgery. She's originally from Phoenix, Arizona. She studied biomedical engineering and went to medical school at USC in Los Angeles. She completed her OB-GYN residency at the University of Alabama at Birmingham.

And then she moved to Denver where she's been practicing ever since. So she'd been on our show before talking about specialty fertility tests that often get overlooked. So we'll make sure to link that in the show notes because you're going to want to listen to that. But we're thrilled to have her back again. Dr. Pederson, welcome to the show.

Sarah Pederson (01:33)
Thank you, Caitlin.

Caitlin Estes (01:35)
I'm going to jump right in and say that I think that the only thing that women know of as related to this is to be cautious of a yeast infection or maybe not to sit around in a wet swimsuit. You know what I mean? Like just these little things that we've heard over the year, but we don't really have a comprehensive understanding of what, you know, vaginal health really is. So could we start there? Like what's healthy? What's not?

Sarah Pederson (01:50)
Love that. The first thing I would say is you never want to think about your vagina. You always want it to feel excellent. So the four warning signs are pain, discharge, odor, and dryness. As far as pain, you never want your vaginal walls to hurt. You never want the outside, which we call the mons, or the labia to hurt. You want to be able to walk around, sit, stand, never have any pain, pressure vaginally.

And then as far as discharge, what we think of as normal discharge is sometimes as your vaginal walls are shedding cells, there'll be some yellowness. So sometimes we'll see this yellowness in our underwear or around the time of ovulation, you'll see a clear gloppiness. I would say any discharges outside of that could potentially be a red flag. For example, if you have brown spotting, if it's a color, if it's just pure white, if it itches, if it's green, those can be warning signs. I would also say that odor can be a warning sign. Most of us know our bodies pretty darn well. If you feel or smell a smell and it's just not a normal smell to you, that's a big red flag. And then the last thing is you always want your vagina to feel lubricated. Not necessarily that you always are having so much lubrication that it's coming out as a discharge. But for example, during intercourse, during your regular life, you never want to feel that the walls are rubbing together. You always want to feel like it's moist.

Caitlin Estes (03:32)
Those are really good clarifications because obviously we talk a lot about cervical mucus and we talk about maybe not on the podcast but when I work with couples and clients, excuse me, we'll also talk about arousal fluid and things like that, what's normal and what's not. So it's really good to clarify the difference between cervical mucus and vaginal discharge and what's healthy and what's not. And certainly if they're working with a fertility care practitioner, we can talk even more detail about those kinds of things. But especially the smell, I really appreciate the fact that you said if it's, if it's something smells different to you. Because if you look online, they give all these examples of what the smell could be, but you know your own body smell. So if something smells off or different than that could be enough to go ahead and start looking into, which I think is important.

Sarah Pederson (04:29)
Yeah, and also change over time is a big deal. If this is how you've always smelled ever since you were a teenager, or it doesn't bring any red flags in your brain, then it's okay. But if there's a big change over time that's notable, then it's definitely something that it might be worth getting looked into.

Caitlin Estes (04:47)
Yeah, especially with the comfort level too. So you use the word lubrication and I know a lot of the clients use the Creighton model system or ladies that I work with think about lubrication is that really extreme sensation as you wipe. But I think what you're talking about is that comfort level. Like you don't feel really dry, uncomfortable, which could lead to itching or pain or those other things. Is that always related to estrogen or could that be related to other things?

Sarah Pederson (05:04)
Right. The big things that I see are hormones is a big one and the other thing is a disruption in your vaginal microbiome. And oftentimes they're actually related because one can lead to the other.

Caitlin Estes (05:23)

Okay, would you talk to us a little bit about that? Like explain what is the vaginal microbiome for us?

Sarah Pederson (05:34)
Oftentimes we know what a gut microbiome is, or we're kind of familiar with that, right? There's some good bacteria and you're bad bacteria and you can have SIBO or a small intestinal bacterial overgrowth that gives you gut symptoms. The vagina is similar. We have a whole bunch of bacteria that are good and bacteria that are bad. And so when we think about our vaginal microbiome, there's a number of healthy bacteria, which are usually called lactobacillus, and then there are a number of unhealthy bacteria. And so that balance in the ratios of those two are really important. So lots of things can throw that off. For example, if we're stressed, if we're not sleeping well, if our hormones are off, we, the things that we traditionally think of, right, left a tampon in too long or we're in a wet swimsuit that can slowly over time really start to throw off our vaginal microbe and cause a lot of those symptoms that we talked about.

Caitlin Estes (06:23)
That's so interesting, isn't it? Like how our everyday lives can affect even that? We don't think about it. Like how could sleep make a difference or how could... but it does. It does make a difference. ⁓ Now I know that probiotic is not the answer. It's a lot bigger than that, but I'm curious. Do you have a probiotic that you recommend for the vaginal microbiome?

Sarah Pederson (06:52)
One thing that's important is that there's not great penetration from oral probiotics to the vagina. So the one that I usually start with is called femtophilus. However, sometimes depending on the state of your vaginal microbiome, it might not be enough to cut it if that makes sense. So then you want to use a vaginal probiotic. My favorite is called Seed. There's a company called Seed that makes the whole protocol called VS1. And they're capsules that you put in your vagina that really help reconstitute your vaginal microbiome.

Caitlin Estes (07:24)
Okay, that is so good to know. And is that the kind of thing that you would say wouldn't hurt for anyone to do or only if they have symptoms, you know, that there could be something off with the vaginal microbiome, would you recommend like talking with their doctor and starting a probiotic?

Sarah Pederson (07:40)
I definitely wouldn't just do it to do it. If you're feeling symptom free, I say that the vagina is a self-cleaning oven. Like a healthy vagina should clean itself. You never want to put anything in your vagina except really specific types of lube, tampons, intercourse. Other than that, you really don't want to put a lot in your vagina because what we run into a lot is your vagina has a very, very specific pH. So the different bacteria, as they actually release certain acids and fluids and substances that set the pH of your vagina. If you throw that pH off, that's when the bad bacteria grow. So when we put things in our vaginas that don't have the same pH as our vagina, that can actually bring a huge notice of infection. So for example, you really don't want to be using coconut oil or sometimes you'll hear like yogurt or in all kinds of different essential oils. You have to make sure whatever you're using is the same pH match to your vagina. 

So that's one thing is that be really careful what you put in your vagina. Don't treat something that you don't need to prophylactically fix your vaginal health. You wanna fix your underlying health and that should naturally help your vaginal health. But if you are having those symptoms, like you're having an abnormal discharge, you feel like your odor is off, yes, it absolutely makes sense to do a vaginal probiotic because sometimes that can avoid you from ever having to take antibiotics, which would be great.

Caitlin Estes (09:03)
Absolutely, and I'm gonna go back to something that you said very briefly because I know already people are gonna ask me questions about it. You said skip the coconut oil and this is a common topic.

ladies using coconut oil and like, it's so healthy. It's so natural. But you're not the first person that I've heard say that there are some some definite downsides to using coconut oil. So maybe talk with us for just a second about that and maybe even what you recommend instead.

Sarah Pederson (09:37)
I think one thing is that, number one, you always want to know your body. So if you say, you know, Sarah, I've been using coconut oil for years. I've never had any problems. It keeps me lubricated. Okay, that's okay. However, coconut oil is not designed to have the exact same pH as our vaginas. Usually our vaginas are actually a little bit more acidic than coconut oil is and slowly over time that can cause other, you know, that growth, that really important growth that we talk about of like those bad bacteria slowly overgrowing the good bacteria is because coconut oil is a little bit more basic than our normal vagina. And so there are certain bacteria that grow in that environment. The thing that I recommend is I tend to of course use fertility lubricants.

So you wanna make sure, and ⁓ of course I'm kind of anal about what I recommend and all that, as far as you want it to be fertility friendly and you want it to be paraben free. And then you want it to have the same pH ⁓ as your normal vaginal microbiome. So those are the things that I really encourage people to look for when they're looking for a lubrication.

Caitlin Estes (10:50)
Yes, and I think a lot of times I will recommend lubricants that are fertility friendly and they're like, but we're not trying to conceive. I'm like, I know, but it's, it's about your overall health. Like those fertility friendly lubricants are designed to be the most natural, so to speak, replacement. Um, and so

It's still gonna be better for you than getting something that is not thinking about fertility at all when they decide what ingredients to put into it. So Yeah, I'm glad to hear that. I know people are gonna be interested in that. So just had to go ahead and follow up on that

Sarah Pederson (11:26)
Yeah. And I think one thing about lubrication to your point is that the goal of some lubrications is not always to make your vaginal microbiome okay. Sometimes it's just to feel better or to support other things. But even, totally agree, if you're not trying to get pregnant, you still want to use fertility-friendly lubricant because your vagina is connected to your cervix, connected to your uterus. So whether you want to be pregnant or not, you really, really want to keep your vagina healthy because it's connected to your whole--It's also connected to your bladder, your kidneys, it's connected to your whole urogenital system. So putting something healthy and safe in there is really important for the health of many of your other organs.

Caitlin Estes (12:07)
Yes. Now you mentioned the possibility of being able to prevent the need for antibiotics. And just so often, if we have any sort of vaginal symptom, we go to the doctor and we get put on antibiotics. could you walk us through like, what are the situations where maybe you've caught it really early? Or like, what are the ways or situations that we could potentially prevent antibiotics or not actually even need the antibiotics?

Sarah Pederson (12:38)
I love that question. One thing that I think is important is to test your vaginal microbiome and see where you are. Because another huge thing that I see a lot is silent bacterial vaginosis, urea plasma, mycoplasma, Prevotella, bacterias that we've harbored in our vaginas for sometimes many, many years. And we don't really know because they don't cause so many symptoms that it gives us a huge red flag. So it does start just to have a sense of what your vaginal microbiome

So I recommend doing an advanced vaginal microbiome test. The company I use that for people who aren't in our clinic is called EVVY.

Caitlin Estes (13:17)
great. So that would be a place that you start and then if it comes back and you know don't have any symptoms but you could go ahead and treat some of those things maybe it would prevent down the line issues. Is it that once you already have those symptoms it's probably too far like you probably do need antibiotics at that point if you already have symptoms? Okay.

Sarah Pederson (13:40)
Not necessarily. If they're mild, vaginal probiotics can be wonderful because even if you have an overgrowth in bad bacteria, if you support your natural microbiome, they'll naturally kill off the bad bacteria. But there are some cases where you have so much bacterial overgrowth or you have your real plasma or you have specific types of bacteria that are really bad for your microbiome that antibiotics will help you.

Of course, I tend to be a really low antibiotic person. Like have a holistic clinic. But as with all things, there is a time where medicine really plays a role. Because you take your antibiotics. And the great thing about vaginal health is that we can do vaginal antibiotics. So they don't even have to be oral and systemic. You take your antibiotics. You reconstitute your healthy microbiome. Maybe that's followed by a vaginal probiotic. And then you fix a lot of issues and stay on top of them.

Caitlin Estes (14:05)
I'm going to guess that very few ladies listening to this have ever heard of vaginal antibiotics. not that they're not out there, but you just think about, if I have to take an antibiotic, it's going to be, oral. It's going to affect my whole body. It's going to affect my gut health and gut microbiome. And I'm with you. I am not against antibiotics when you need them, but I certainly don't think that we should be taking them. Just why not? Let's try it. You know, let's actually try something else first. So I'm with you on that.

Sarah Pederson (14:59)
Right, for sure. And it is perfectly reasonable to start with probiotics, see if it makes a difference, and then if you have to use antibiotics, use them later.

Caitlin Estes (15:11)
Yeah, yeah, that's a really good point. ⁓ So we've talked a little bit about lubricants and coconut oil, that sort of thing. You mentioned tampon use earlier. I always tell my ladies, make sure that you're changing it in less than six hours. Don't sleep in it. Don't wear one that's a higher absorbency than what you would actually need during that time. I also encourage ladies to use organic tampons. I mean, if it's going to be sitting inside your body soaking for hours, maybe make it organic. Do you have any other recommendations or suggestions for tampon use or does that pretty much cover it?

Sarah Pederson (15:48)
I, of course, it's very personalized. I think, yeah, we tend to, especially in our clinic, we tend to have very organic products. However, if you've been using something and it works for your body and it feels great in your vagina, you put it in, it doesn't hurt you, you take it out, it's easy to use, you feel comfortable with, it's perfectly fine. Because I think one thing about organic tampons is that they tend to be very cotton ball-esque. And so they shed a little bit easier than other type of tampons. So if that's that feeling, it doesn't, isn't comfortable for your body, I would just say, really, really listen to your body. Like just because something is organic, it doesn't mean that it feels good for you or it's good for you. So whatever feels the best is the best thing for your body.

Caitlin Estes (16:30)
That's a good point because even in the organic tampon world, there is just such a variety of types and experiences with them. ⁓ so you always have to kind of look around to find the one that suits you best. And then there's the whole world of menstrual cup. You know, we've got a lot of ladies using menstrual cups now. Period underwear is getting bigger and bigger. As far as vaginal health, do you see either one of those causing any problems or concerns?

Sarah Pederson (17:12)
I think you just have to be careful that you're not introducing anything that doesn't have the same pH as your vagina. So if it requires a lot of work, you feel like you have to put your fingers up there a lot, that can throw off your vaginal microbiome. So I don't necessarily, if you want to use a Diva Cup, lovely. If you want to use pads, if you want to use tampons, if you want to use period underwear.

All of us have lighter, heavier periods, different needs for different things, but just make sure it's something that you're comfortable with and be aware of your anatomy. Be aware of what's normal, what's not normal, what feels good. When you wear a tampon, when you wear a menstrual cup, it should feel perfect. It should never hurt your vaginal walls. It should never cause you any pelvic pain. It should never make your vagina feel more stressed or under pressure.

Caitlin Estes (17:57)
That's a really good reminder. ⁓ Listeners, if you've learned even one new thing so far in this episode, I hope that you'll leave a review so that others can find it as well. You know, we try to keep our content free and without commercials to make it available to as many women as possible, so feel free to leave a review and so it can make an even bigger impact. ⁓ Dr. Pederson, thank you so much. Is there anything else you'd like to share with our listeners about vaginal health before we close out?

Sarah Pederson (18:25)
I think one thing that is important to know is maybe we're sort of raised or we don't want to talk about our vaginas or it's kind of a taboo topic. But I really encourage you to number one, just know your anatomy, right? Like know the shape of your vagina, know the inside, know the outside so that you can find those red flags easier. And it's better to get checked out than to wait. Because like I said, all your organs are connected. If you if there's something in the back of your mind that's saying, I don't know if my vagina is healthy or not, you know your body better than anybody else and if you get a test and a swab that comes back normal and your doctor says it's normal but you don't feel normal, don't let anybody tell you that you're normal and everything's fine if you know in your heart that it's not fine and you're not feeling normal so if you have to get a couple second opinions please please please do not give up on your health and your vaginal health because it's so important to advocate for that.

Caitlin Estes (19:20)
Absolutely, totally agree with you. Well, thank you so much for being on the show and sharing with us.

Sarah Pederson (19:26)
Thank you so much for having me. I could talk about vaginas all day.

Caitlin Estes (19:31)
Listeners, if you'd like to get connected with Dr. Pederson or her team, we'll make sure to have them linked in the show notes, As always, thanks for listening as we continue to explore together what it means to be woven well.