Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Vulvar Care: Expert Tips To Prevent Infections
Certified Nurse Practitioner Alix "Babs" Babuscak joins Host Dr. Holly Thacker on the Speaking of Women's Health Podcast to discuss vulvar care and vaginal health.
Nurse Babs shares indispensable tips on maintaining a healthy vulvar environment, from selecting the perfect cotton undergarments to practicing impeccable hygiene after your workouts.
Uncover the mysteries of common vaginal infections, such as yeast infections and bacterial vaginosis, and learn how lifestyle choices can make a difference.
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I am glad to be back in the Sunflower House for a new episode. For a new episode. Joining me on this new Speaking of Women's Health podcast is nurse practitioner Alex. We call her Babs Babushak and she joined our Center for Specialized Women's Health and we're so excited to have her here for an interview on all things that women need to know about.
Speaker 1:Let me tell you a little bit about her. She earned her Associate Arts and Associate of Nursing here in the Northeast Ohio area from Lakeland Community College, and then she then went on to get an undergraduate degree in nursing from Ohio University, and she then went on to get an undergraduate degree in nursing from Ohio University and from there she went to the University of Cincinnati where she got a graduate degree for family nurse practitioner. So she is a certified nurse practitioner in our OBGYN and women's health department at the Cleveland Clinic and she spends the majority of her time in our Center for Specialized Women's Health. Welcome, babs, thank you, I'm excited. Well, we're so excited to have you as a guest and we're so excited about you personally. Just the other day we had a baby shower for you. Do you want to tell us about you expecting your first baby?
Speaker 2:Yeah, do you want to tell us about you expecting your first baby? Yeah, I'm expecting a baby girl on January 23rd, which here is a very important day.
Speaker 1:And you have a name picked out for her.
Speaker 2:Yeah, we're going to call her Eloise L for short L.
Speaker 1:Oh, eloise, that is so beautiful. I'm so excited for you and your husband. Thank you, and for any of our listeners. If you want to go on our speakingofwomenshealthcom site, we posted those in and around Thanksgiving of 2023. But this podcast will podcast probably after you have your daughter in season three, and so what we're going to talk about and it's been a popular topic on our speakingofwomenshealthcom site one of the most searched items and hits is on vulvar care what women need to know also about cramping and spotting and non-sexually transmitted vaginal conditions like yeast and bacterial vaginosis. Those are so common and so irritating and it's so nice to be able to get in and get a great exam and care from people like you and like Dana Leslie, who we've also had on this podcast and will probably have again on season three. So why don't we just start with you talking about what's proper and appropriate care of the vulva?
Speaker 2:So top priority for care of our vulva is mainly to keep it dry and to keep it free from irritants. We suggest wearing loose clothing, avoiding the synthetic fabrics, and tight clothing like your yoga pants, your spandex.
Speaker 2:Long underwear Long underwear yes. Thongs yep and thongs yep. We recommend using cotton undergarments. They allow for breathability. Avoiding going to bed without underwear is also recommended, and we say this because underwear can help protect the sensitive genital area from irritations or infections that can be in the bedding, especially if we're hot sleepers at night. You know we can keep the moisture in, and that is true for perimenopausal and menopausal women as well. We recommend getting some type of physical exercise daily, so cardio and strength, which is a great exercise regimen for us women, but we should shower soon after.
Speaker 2:We don't want you staying in those moist clothings very long. When showering, we suggest to use warm not hot, but warm water to wash the exterior vulva, and we like bar soaps, like Dove and Ivory and Cetaphil. Any unscented, sensitive soap will do. And we want you to keep away from rags and sponges when washing the vulva area. Instead of you know we can use our hands and wash the vaginal area. So it just suds up our hands and lightly wash the outside of the vulva, and that should be the last thing you wash in the shower before you step out. Grab that clean towel and pat dry and avoid the excessive rubbing.
Speaker 1:That is so important and I hate to admit it, but I was getting ready for my recent gynecologic exam with one of your partners, Dana, and I just overwashed myself so much I was rushing and I'm trying to get ready and be super clean and I actually gave myself a bladder infection and we will have a podcast or maybe it's already just posted on urinary tract infections, and so the urethra is so small and so close and very delicate, and too much soap or too much trauma is not good. And so we women certainly have issues with the delicate vulva, and you'll have fun changing your daughter's diaper and taking care of her little delicate vulva. I had boys, and so when my granddaughter started to arrive and I'm about ready to get my third granddaughter it was just shocking to have to change the dirty diaper because it's like, oh my goodness, you have to take care of the vulva and the vagina and it was just a lot easier to clean little boys up for diaper changes. That's what I hear. And then when I was giving my granddaughters they like to take baths in our little whirlpool and I put Epsom salts and my son was like, well, you shouldn't be doing that, mother. And I said I did it with you guys all the time.
Speaker 1:I raised three boys and he looked at me. He goes they're girls. I'm like, what are you talking about? But fragrances and bubble baths and those kinds of things can be very irritating. And so Epsom salts is just magnesium Sulfate is just a natural salt. But do you have any comments about women who like to take hot baths or sit in hot tubs, or they love the water?
Speaker 2:So the water is great, hot tubs are great. I myself personally love a good bubble bath to relax and unwind, especially giving birth in two months. I love my bubble baths but it just it's very, you know, depending on what we use and the fragrances. I know we all love our bath and body works and our smelly soaps and everything, but we just want to make sure that once we're done, we're getting up and doing like a thorough cleanse with those appropriate, you know, the Dove, the Cetaphil, the ivory soaps, the very mild ones.
Speaker 1:I always ask women what type of soap they use, and when they say Irish spring or these really harsh ones, that might be fine for your husband, or maybe fine for your feet and maybe even hands, but not the vulva or the nipples. Um, so what are symptoms that should lead a woman, um, you know uh, or a young female to seek um a gynecologic examination with their woman's health nurse practitioner or their uh physician?
Speaker 2:So symptoms such as like itching, which can be, you know, the outside of the vulva, the um inside of the vagina, irritation of the vulvar tissue, which can consist be, you know, the outside of the vulva, the inside of the vagina, irritation of the vulvar tissue, which can consist of, you know, a burning sensation or a pain from excessive scratching caused by itching. Other symptoms include odor, and the most I get from patients when they explain an odor is a fishy smell or something that's tart, vinegary, and they get a vaginal discharge, a white, clumpy discharge. I hear a lot. Yellow, any, you know, green, red, anything in color can be a sign of a vaginal infection. White and clear vaginal discharge is, for the most part, considered normal. The amount can vary it can be a little, it can be a lot.
Speaker 2:I try to tell patients, you know, to think of their. You know, vulva area and vagina kind of like a self-cleansing system. If you clean it properly and you let it do its job, it'll keep your pH in check, either by raising or lowering it, and that's sometimes why we get, you know, more discharge than less discharge some days. Other symptoms, obviously you know pain with urination, any pain with sexual intercourse or any swollen vaginal tissues.
Speaker 1:Yeah, those are all things that should be dealt with and I think that one of the things I see a lot of women do is they think they have to protect their underwear from normal vaginal discharge and they get like addicted to liners. Yes, you need a liner if you're bleeding or you know losing a lot of urine and you need to get that evaluated. But to protect your underwear, no, just change your underwear. Like it holds in so much bacteria, just like wearing something wet and soggy or something that's not breathable, like really those breathable cotton crotch pants. Underpants are very important and, like you said, not sleeping in underwear necessarily. And just I tell women when they're around their house, like just wear a skirt and don't even wear underwear necessarily.
Speaker 2:Yeah.
Speaker 1:Yeah, so those little things. So talk about the two most common non-sexually transmitted infections that women frequently deal with.
Speaker 2:Yeah, so our two most common. Second most common is our vaginal yeast infection mainly affects women of the reproductive age. It's an inflammatory infection of the vagina caused by the Canada pathogen. Yeast can grow in all parts of the body, but there's certain types that grow mainly into the vagina, which is what we call our yeast infections. Most common symptoms of the yeast infection includes itching, irritation of the vulva as well as around the opening of the vagina. It's that classic cottage cheese white thick discharge with we're uncomfortable, we're itchy. It mainly occurs in women, like I said, who are menstruating. It's less common in postmenopausal women who do not take estrogen and aren't on some sort of a hormone replacement therapy, or girls who have not yet started their menses.
Speaker 2:There's a lot of risk factors that can lead to the development of a yeast infection. Commonly those would be antibiotics. You know, when we have sinus infections or strep throat or any other vaginal infection, we get on antibiotics and that seems to cause an upset and that's mainly why I have people who come see me with an itching vaginal discharge. They know as soon as they take an antibiotic they're going to get a yeast infection. Other risk factors, like contraception devices, like IUDs that are inserted into the cervix, weakened immune systems. Pregnancy causes a little uproar in yeast infections. Someone who's diabetic, so someone whose sugars aren't well controlled, or on certain medications for diabetes, like I see a lot of people on Jardians, which helps lower the sugars in your body through urination, and I see them have a lot of yeast infections as well.
Speaker 1:Because there's a lot more sugar just locally there and people have bad diets. We have so much on our website prior podcast on healthy eating and how there's no essential carbohydrate and most Americans get way too much sugar. So whether you're diabetic or not, I think it's good to get it out of your diet. I warn women that are menopausal, that are just starting on estrogen, that when they're very thin and atrophic and then they make that tissue healthy and pink and plump, that it takes a while for the healthy bacteria, the lactobacillus, to lower the pH of the vagina. But the vagina is healthier and there's glycogen inside the cells, so there's the natural yeast that could be on the skin is now getting a food source. So sometimes people transiently get worse in terms of yeast infections or alterations of their microbiome or even bladder infections, before the whole microbiome of the vagina and the vulva right itself. No-transcript. Do you want to tell us about bacterial vaginosis, which is?
Speaker 2:not an infection, but it's a very irritating condition. Yeah, and that is probably one of the most common vaginal infections that I see, at least in our practice and in our office. It's a vaginal infection that's caused by either an increase or decrease of the vaginal pH, caused by an overgrowth or an imbalance of bacteria. It can be associated with increased risk of HIV and sexually transmitted diseases, pelvic inflammatory disease, even adverse birth outcomes. A rise in bacterial vaginosis can be associated with increased, like you were just saying, the pad. Use the tampon, use the different soaps and cleansers. We use the ones that are scented and those essential oils. We want to make sure we're not vaginally douching or using any vinegar type baths. I have a lot of people who come in and use apple cider vinegar baths that they find on TikTok or they Google it and they can see it. And we want to stay away from engaging the use of the over-counter products such as Summer's Eve Honeypot Vagisil.
Speaker 2:Although signs for bacterial vaginosis aren't as common as those with yeast infections, you usually experience that fishy, acidic, tart odor. It's usually pretty indicative of BV, although not always. Bv can commonly cause, you know, the vaginal itching, the irritation, the discharge, and that's what we see sometimes with our patients who come in who have that cramping and spotting. They're not, you know, necessarily on their menses, but they're getting this, you know, little spotting with this vaginal irritation, and that's just one of the main tests we run as soon as someone complains of that. That's a test we run to make sure they don't have an infection.
Speaker 1:Yeah, and it's so important to get evaluated and if there's any concern about sexually transmitted infection, that can be evaluated as well.
Speaker 1:I have found over the years that a lot of women with recurrent bacterial vaginosis are low in vitamin D, which affects the immune system and I think it was my third podcast of season one was low in vitamin D which affects the immune system, and I think it was my third podcast of season one was all about vitamin D, and since that podcast there's been even more research about the benefits of this pro-sterile hormone. So when I see women with recurrent vaginitis, I'm concerned about their vulvar care, about their sugar levels, about their vitamin D levels, their general health and what other medications they're on. Like you mentioned Jardiance, which excretes sugar in the urine, so it can increase both bladder infections as well, as you know, vaginal yeast infections, which are terribly itchy and terribly uncomfortable. One of the things I tell women as a tip is to keep refreshed vaginal gel, which you can get online or at your local pharmacy, because it's just pure lactic acid and it lowers the pH of the vagina, which keeps it acidic, and that helps lower or maybe even stop in its tracks really early yeast or really early BV. That might help prevent someone from having to come in and have any takeoff from work or take off from taking off their kids, taking care of their kids or grandkids, and maybe it might just nip it in the bud. Can you talk about the home test for yeast and BV, like the pH test kits?
Speaker 2:So the test kits that you get can get at. You know any CVS or Walgreens are great. We do recommend they come and see us for it. Unlike you know you can't really get a urine sample. You need to do an actual swab. There's no urine sample, like I said, no urine sample to confirm STDs. We in the clinic test for BV and two types of yeast. That's what our swabs test for Um and we treat accordingly. So if we come up with a yeast infection, you know number one we go to is the fluconazole, which is also known as diflucan. If someone comes and you know is has an infection of BV, you know gold standards that metronidazole, also known as flagyl um. The only thing with the metronidazole for some people is that it can be super harsh on their stomach. They complain of a lot of nausea and vomiting and we do have a gel that they can use instead but there could be interactions with alcohol, even alcohol mouthwash yeah, so I usually recommend that flushing effect?
Speaker 1:yeah, from from that and the two types of yeast you want to talk about, the regular uh common, uh canada albicans and then galabrata, and some of the different symptoms that make might make you think of a more resistant yeast yeah, so the canada albicans.
Speaker 2:That's, like I said, our most common vaginal yeast infection. That's why I said we treat with diflucan or the fluconazole. You take one pill for three days. We usually give a backup pill. Sometimes it takes a little while to get rid of those pesky yeast infections. The candida glabrata is a different kind of yeast. It is not going to really respond to the diflucan. When we have that, we usually tell our patients to use boric acid suppositories, which you can buy over the counter.
Speaker 1:They can buy over the counter and we do have. Bruxifem is the brand name of ibergia frump, which is very good at actually killing yeast, but it's pretty expensive. And we have a lot of information on speakingofwomenshealthcom about all different types of options for treatment so that a woman, if she thinks she may have this, can arm herself so she's ready to understand the different treatments. And you have been listening to the Speaking of Women's Health podcast and I am your host, the executive director of Speaking of Women's Health, Dr Holly Thacker, and I am talking to nurse practitioner Alex Babushkak, who is in our Center for Specialized Women's Health, and so we had talked about ways to prevent infection with vaginal refresh. Do we want to switch gears a little bit and talk about other conditions that can really cause a lot of pain? Can you tell us what lichen sclerosis is and how you see it and how you evaluate and treat it?
Speaker 2:Sure, lichen sclerosis is another one of those vaginal infections. Typically I don't really see a lot of that at our practice. I know we have a lot. We have a wonderful vulva vaginal clinic at the Cleveland Clinic that helps take care of that. But they have this very itch-scratch cycle. They're super itchy, they scratch at it, they have a discoloration, usually of the vulvar area. What I usually basically do is send them with a steroid cream, something like clobetazole.
Speaker 1:Yes, it's an autoimmune condition and a lot of times it's misdiagnosed, even by experienced women's health clinicians. I've seen that at least in a lot of post-menopausal women. It certainly gets worse when they're low in estrogen, but estrogen will not treat it. One of the old fashioned treatments, like what I started to practice way back when, was topical testosterone ointment, and sometimes I'll still use that off label, but in randomized control trials really a potent steroid like clobetazole ointment.
Speaker 1:I personally favor many times prescribing ointments for the vulva as opposed to creams, because there's some differences and of course our dermatologists are very expert about lotions which are more drying and then ointments which are the most moisturizing.
Speaker 1:But it's a chronic condition and it's not something that you cure, you just control.
Speaker 1:But some of the things that we worry about when someone has lichen sclerosis could actually be vulvar cancer.
Speaker 1:So if it doesn't get better, then I definitely recommend a punch biopsy of the vulva, which is, of course, very sensitive skin to be biopsying around the labia minora or the introitus, the opening of the vagina, or anywhere near the clitoris, which is very vascular. So I think it's good to have experts to refer to people who can look with a microscope. People can look with a microscope, but we don't want to miss vulvar cancer, which is associated with the human papilloma virus, and that's one of the things you test for when you do pap smears. Right, you test for HPV, hpv and I guess I can't make enough of a plug to our listeners and to our clinicians to get those pap smears. I mean, some women can go as far as five years, but personally I just went in, I got my one at three years, because I have seen women with cervical cancer who had a normal pap and a normal HPV and four and a half years later they have cervical cancer and that is a terrible disease.
Speaker 1:It can be very devastating and when you have to have surgery and radiation and chemotherapy and some vaginal discharges can be cancer, can be uterine cancer, can be fallopian tube cancers. So most of the time people who've had vaginitis like yeast or BV, they know that. Okay, I've been through this rodeo again and some people will self-treat. And even though Diflucan is a favorite and I've, I've certainly personally taken it it's very potent and goes through the liver. So for people on other liver medicines or for women on uh, adiflabancerine, that's that's a medicine we prescribe a lot because it treats low sex drive in women.
Speaker 1:If they're going to take a Diflucan they have to, you know, skip their Addi for a day or two so they don't increase their levels. Some women really like just topical treatments, like you said, because they get nauseated or, you know, they want to be able to not, you know, take anything on their stomach. But then other women seem very sensitive, like their microbiome gets off kilter if they put something in the vagina. So, which reminds me about having you make some comments about douching I just can't stand it when I see these things on the shelf, all these douching products and feminine hygiene and, like you said, the vagina is self-cleansing.
Speaker 2:It is, and it's very sensitive. So we start adding, you know, putting things that don't need to be up there or part of it, and we, you know, that's how we start with all these BV yeast, all of these different vaginal infections.
Speaker 1:And one tip, and I don't know if you have any techniques on how you talk to patients, because you don't want to. Um, obviously it's a very sensitive information to talk about how people take care of their private parts, or, as my granddaughter Artemis calls them, passports. She was uh in in the airport with my son Stetson, who's been on our podcast, and they were coming back from Europe. They had been on three planes over 24 hours, tired, and she starts whacking him near his beltline where he had their passports and he said, hey, don't hit the passports. He physically meant the passports. She thought he meant the private parts, so she calls them the passports.
Speaker 2:That is too cute, it is so funny.
Speaker 1:You're going to have. So she thought he meant the private parts, so she calls them the passport. It is so funny. You're going to have so much fun with your daughter and all these cute little things and the perception that children have. Oh, I can't wait. Oh, it's going to be such a joy and eventually maybe she'll be able to visit when she's a young woman and come to our center for specialized women's health. We're for specialized women's health.
Speaker 1:But getting back to talking to people about sensitive things, I found with BV, certainly some partners women that are with some partners are more likely to get BV. Just from the bacteria, normally on the male genitalias or if they're using toys or if they're with a female partner and that female partner has BV, it increases as well. It's not sexually transmitted, but it is sexually related and I think it's very important to remind women that they have to remind their, their partner, to wash the penis before sexual activity because you know men may go to the bathroom and touch themselves to urinate. Then they wash their hands, but they might've touched dirty money and, you know, equipment and anything else and so there can be a lot of bacteria on the penis and I know with uncircumcised males. Sometimes there can be some, you know, increased yeast around that foreskin. So do you have any tips on how you empower your women patients to talk to their partners about their genital hygiene?
Speaker 2:It's being open and honest. I mean, if they're your partner and you're, you know, sexually involved and you know with each other, it's just you know they have to be informed. Sometimes they don't know, they don't know proper hygiene they may. I mean, I find a lot of young males don't really go see physicians or their doctors and get their regular routine checkups and so they can be an advocate for them and let them know. I mean, I don't think anybody wants to be the cause or the reason for any itchy, any discharge, anything like that. Vice versa, for anybody Right.
Speaker 1:And I try to preface it, it has nothing to do with you know what kind of person you are, or cleanliness, it's just kind of microbiology. Yes, and it's just. You don't want overly clean genitals because you can self-inoculate yourself with infection. Clean genitals because you can self-inoculate yourself from infection. And that's why, even though it seems like it's self-explanatory, it really isn't, especially with the vulva, Just like with hand washing. You know, we teach the children to sing happy birthday, you know, so that they can wash their hands long enough. And hand washing is so important for us in the medical field because it really is linked to infection and it's very important, you know, to wash your hands before and after procedures. So do you have any other tips or advice to give our listeners?
Speaker 2:Yeah, I mean also things, just like you said, that lactobacillus that you can. There's vaginal probiotics that are on the shelves that you can buy that help neutralize the pH of the vagina and have those probiotic effects. Eating the yogurts that have the good lactobacillus in it to keep up with vaginal flora. We mentioned the boric acid inserts that you can get over the counter, which really help. You know, rinsing our clothing, like sometimes, you know, our undergarments. You can get the self-reusable bags where you can all put it in a bag so it's not touching other clothing. If it's delicates, you can put them in there. Doing a double rinse cycle. Yeah, using gentle cleansers when we're washing our clothes as well, and I've seen women do it. You know, when we spray a perfume and we want to smell good, you know keeping away from spraying towards that vulva region keeping it on the wrist, on the neck.
Speaker 1:Excellent, excellent. Yeah, I actually tell a lot of my patients to do a delicate load once a week of all their bras and underwear without other clothes and double rinse it and use the kind of detergent that you would use like on your baby clothes, all those cute baby clothes that you got. The other day oh those are so fun. She'll grow out of them so fast, but enjoy every moment.
Speaker 2:I know, but of them so fast. But enjoy every moment.
Speaker 1:It's going to be so fun and, oh babies, they smell so good and so fresh. They're so intoxicating, aren't they? They are. But the other tip really is just to not douche and really, the diet and the gut microbiome. I think eating fermented foods, eating like drinking kefir which is rich in lactobacillus not all yogurts are equal for how much bifidobacteria there is when you take antibiotics, you really hurt your gut microbiome If you eat a lot of processed foods and sugar.
Speaker 1:it's terrible on your gut, which also affects the vulvar area, and I think that increasingly we're learning a lot more about the gut microbiome and we do have functional medicine services and they do some stool testing to check for what the gut microbiome does. Have you sent any women with refractory vaginitis for any of that to functional medicine, to change their diet or check their microbiome?
Speaker 2:Yeah, actually I've sent them over to functional medicine or, you know, if they're having any refractory symptoms I send them to, like our GYN infectious disease If we're getting recurrent, you know BV yeast for over six months to a year.
Speaker 1:Yeah, many times that is very um. It has to be done so that women don't suffer. So tell us um for any of our listeners in the Northeast Ohio area who might want to make an appointment with you or learn more about your practice. How can they reach you?
Speaker 2:Yeah, anyone can make an appointment with me at Main Campus Cleveland Clinic. They can call our, you know GYN scheduling number. It all leads to the same place. If they're already established within the Cleveland Clinic, they can log on to their MyChart and make an appointment. Any benign GYN care including, you know, annuals, scd and non-SCI, like our vaginal infections, any you know I do, medication refills, hormone replacement therapy, medication refills, any birth control counseling and any vulvar problem visits, they can come and see me.
Speaker 1:That is excellent. You have a great scope of practice.
Speaker 1:We are so glad that you joined our practice last year and we look forward to having you back again, and I just want to thank our listeners and thank nurse practitioner Babs Alex Babushak for joining us, and if you enjoy this podcast, please share it with others and give us a five-star rating. And if you don't already subscribe to our podcast, hit the follow or subscribe button. It is free and that way, you won't miss any of our great information, because we want to empower you to be strong, be healthy and be in charge, and we will look forward to seeing you next time in the Sunflower House.
