Health, Fitness & Personal Growth Tips for Women in Midlife: Asking for a Friend

Ep.184 Menopause, Microbiome & Libido: A Urogynecologist’s Guide to Midlife Intimacy

• Michele Henning Folan • Episode 184

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If you can talk about hot flashes and wrinkles but freeze up when the conversation turns to sex, this episode is for you.

This week I’m joined by Dr. Betsy Greenleaf, the first female board-certified urogynecologist in the U.S., to talk about everything we don’t discuss enough in midlife: pelvic floor health, recurrent UTIs, vaginal dryness, low libido, pain with sex, and what’s really going on with your microbiome and your mojo.

We dig into the gut–brain–sex connection and how stress, antibiotics, diet, and hormone shifts in menopause all collide to affect your pelvic health, your confidence, and your desire. Dr. Betsy breaks down why so many women over 50 struggle with recurrent urinary tract infections, vaginal odor, and irritation—and why the answer isn’t just another round of antibiotics.

We also get real about:

  • Recurrent UTIs & vaginal infections in midlife and how the vaginal and gut microbiome are connected
  • Why vaginal estrogen is such a game-changer (and what to do if you can’t tolerate certain forms)
  • Pelvic organ prolapse, incontinence & fecal incontinence—what’s actually happening and when to seek help
  • How probiotics, fiber, and fermented foods support pelvic health and sex drive
  • The truth about low libido in midlife, stress, and why “sex and stress can’t coexist”
  • What we know (and don’t) about the G-spot, squirting, and the O-Shot
  • Why self-pleasure counts as pelvic physical therapy and how “use it or lose it” is very real
  • Reframing intimacy when you’re dealing with pelvic pain, dryness, or body confidence issues
  • Dr. Betsy’s Pelvic Floor Store and what’s actually worth putting in your cart (lubricants, devices, and more)

This conversation might make you blush, but it might also change how you think about your body, your pleasure, and what’s possible for you in midlife and beyond.

🎧 Listen in if you’re a 50+ woman who’s tired of suffering in silence and ready to feel comfortable, confident, and connected again—down there and everywhere.

You can find Dr. Betsy Greenleaf at https://www.instagram.com/drbetsygreenleaf/

Her Pelvic Floor Store https://pelvicfloorstore.com/

_________________________________________
1:1 health and nutrition coaching or Faster Way - Reach me anytime at mailto:mfolanfasterway@gmail.com

If you’re doing “all the right things” and still feel stuck, it may be time to look deeper. I’ve partnered with EllieMD, a trusted telehealth platform offering modern solutions for women in midlife—including micro-dosed GLP-1 peptide therapy—to support metabolic health and longevity.

https://elliemd.com/michelefolan - Create a free account to view all products.

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🎤 In addition to coaching, I speak to women’s groups, moderate health panel discussions, and bring experts together for real, evidence-based conversations about midlife health.

Transcripts are created with AI and may not be perfectly accurate.

Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions regarding a medical condition.

Michele Folan:

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Betsy Greenleaf, DO, FACOOG:

Thank you so much, Michele. And I love the name of your podcast. It is so perfect.

Michele Folan:

Oh, thank you. You know, I like to say I was an original, but unfortunately there are some other podcasts uh named Asking for a Friend, but yeah.

Betsy Greenleaf, DO, FACOOG:

Yours is the best, though.

Michele Folan:

I think so personally, but yeah, so thank you for that. You know, we have talked a little bit about urogynecology and pelvic floor health, but I'm excited to get your perspective. You're an osteopath doctor, and I really think that you're gonna bring a whole different perspective to this topic. You're the first female in the US to become a board-certified urogynecologist. I'm really curious what drew you to this specialty early in your career.

Betsy Greenleaf, DO, FACOOG:

You know, it's kind of interesting because I didn't really know it even existed. And there's only 1,500 euro gynecologists in the United States. And even then, when I told my family that I was gonna be, I started obstetrics and gynecology and I kind of discovered urogynecology like my senior year of residency when I should have been looking for a job. All of a sudden I'm like, wait a minute, I like this thing. And I told my family I was doing urogynecology. At first, they're like, Euro gynecology? Like, what is that? Is that like fancy, fancy gynecology? It's like it's like European. And I'm like, well, it does have to do with peeing. So yes, kind of, but it's not like European, it has to do with urology, so the bladder health and the pelvic health, along with gynecology. So it combined the two. But I really found it super just fascinating. And I love just working with women and having that relationship because I actually started off in general surgery, was my first, my first training. And I I loved the surgery, but I didn't like the fact that you didn't really connect with your patients. So basically, you know, you would take out an appendix and then you'd never see them again. And that was that. So I like the fact that with gynecology, you could have that, those long-standing relationships with patients and kind of really make a difference in people's lives. And then urogynecology, even more so. It was just, um, and plus honestly, obstetrics, even though it's fun delivering babies, like I like sleeping at night. I don't do well on like lack of sleep, and you can't really control when babies are coming. And I don't know if if you look around at people who are the um the OB doctors around there, they usually look about 10 years older than what they really are, and that's because of lack of sleep. Yeah, like lack of sleep really can aid you. And I was like, yeah, no, I'm not in for that one.

Michele Folan:

So yeah, you know, I shared with you that my dad was a urologist and he had a ton of friends that were OB/GYNs.

unknown:

Yeah.

Michele Folan:

And those guys, I hate to say this, but many of them had serious cardiovascular issues later in life. And I have to think the stress from lack of sleep and just that pressure of just their job in general, um, that can't be easy uh long term, right?

Speaker 1:

Yeah.

Michele Folan:

And, you know, speaking of urogynecology, I'm not sure women really know exactly what you do. Can you kind of explain how your field differs from traditional OBGYN and then maybe pelvic floor physical therapy?

Betsy Greenleaf, DO, FACOOG:

Yeah. So we get a little bit more in-depth with some of the pelvic conditions. So we take every take care of everything from like the belly button down and the thighs up. So we're taking care of bladder, urethra, the 2PP through, the vagina, the rectum. So, for the most part, most urogynecologists are dealing with incontinence. So, like leaking when you cough, last sneeze, or like you're having problems running to get to the bathroom, or recurrent urinary tract infections, or the other issue would be prolapse. So, prolapse is kind of like where your bladder's fallen and it can't get up. Yeah. And uh, yeah, that is it, that is a thing. So there's ligaments that's supposed to hold up everything in your pelvic floor, but our pelvic floor is just a big hole open to gravity. There's really just some ligaments in there, maybe some muscles, some skin, but there's really not much holding things up. So the weight of a childbirth or giving birth, or sometimes just lifting heavy objects, or just dealing with gravity over the period of your lifetime can affect those ligaments. And now the bladder can lean on the vagina and push the vagina out. The vagina can turn inside out like a sock. I know this is terrifying if you didn't know this this existed, or the rectum can lean on the vagina and push it out. So the prolapse is a type of pelvic hernia where you get this bulging of tissue out of the vagina. Yeah. And unfortunately, most women like will come in and they think that they have a tumor because all of a sudden, like maybe they're fine, and then one day they look down and there's something hanging out or bulging, you know, maybe they've coughed or sneezed or lifted something heavy and that like kind of did the final straw with the ligaments. And now if something something's bulging, it's usually just like if you picture the vagina literally like a sock, and things are in that sock is just starting to turn inside out and starting to hang out. So, yeah, unfortunately, that's uh and 50% of women will have a prolapse at some point in their lives. So that's the scary statistic.

Michele Folan:

Oh dear God. Yeah. Do you also deal with like fecal incontinence too?

Betsy Greenleaf, DO, FACOOG:

Would you Yeah, okay. We do. Okay. Yeah, definitely. So we you know urogynecology is kind of a misnomer, and they've been like battling for years what to call our specialty. I think like the last thing that they've settled on was urogynecology and reconstructive pelvis, pelvic surgery. Uh, and they they keep changing it every couple years, like what our official titles are, and they can never they can never settle on it, but it's really anything that's in that pelvic area from the rectum to the vagina to the bladder. So okay.

Michele Folan:

And this isn't just from childbirth. No. Can you talk a little bit about what else would cause these issues other than just planal gravity?

Betsy Greenleaf, DO, FACOOG:

Yeah. So unfortunately, anytime there's pressure on the pelvis, so like when we lift heavy objects, they tell you to blow out. And the reason why you're blowing out when you're lifting something heavy is so you don't get a hernia. Like you may have seen like the Olympic, you know, power lifters do that. You know, they're lifting something heavy and they're like, you know, they're blowing out because they're trying not to give themselves a hernia. Because when you hold in your breath and you're lifting or straining, and that could even be for like bowel movements and constipation, if you strain too hard, that's going to be too much pressure on the pelvis, and those ligaments can easily just rip and tear. Some people are genetically more predisposed to the to the ripping and tearing of those, um, that tissue than others. I've seen it happen with actually seen the youngest person I've ever seen with a prolapse was 15, and she was a gymnast. And we think it was from her hard landings, like on the floor, was really kind of doing a number on her, on her ligaments and her structures. But it's, you know, um excessive coughing. Sometimes we see it with people with bronchitis or asthma, vomiting can do it, lifting heavy objects can do it, straining to have bowel movements can do it. So, I mean, some of those things you just can't avoid. So I don't want everyone to like worry every time they like sneeze or like cough. Right.

Michele Folan:

But yeah. What about straining to push urine out? Would that cause it too?

Betsy Greenleaf, DO, FACOOG:

And wouldn't necessarily cause that. But you know what? That's one of my things that I nobody teaches you how to pee. This is a really interesting thing. I didn't know until I went into this field that you're not supposed to bear down to empty your bladder. But how many of us are so busy that we're like, you know, taking two minutes to go to the bathroom is like really difficult to fit in your day. So you're like run in there, you're bare down, you're pushing, you're trying to get the bladder empty so you can get back to doing whatever you were doing. But the bladder is a giant muscular bag and it is designed when your brain triggers and says, okay, time to pee. It's designed to do the pushing and emptying. So when you bear down, like you're having a bowel movement and trying to like rush it along, what you end up doing is the urine's gonna go where the least amount of pressure is. And you hope it's out of your body, could also go back up to the kidneys. So doing that, especially if there's any bacteria present in the urine, there's a higher risk of getting kidney infections when you urinate that way. So take the time, take a deep breath. You know, you don't get a lot of time. It's probably that, especially anybody who's a mother, you know, probably, and even then we don't get free time when we're in the bathroom because you know the kids are always knocking on the doors, but um, just take the time, sit, relax, let the bladder do its pushing. And and uh that's the proper way to pee.

Michele Folan:

You know, that now listen, at three in the morning, yeah, and you just want to get back in bed, that's when I would probably be more inclined to do that. And why is it, and I'm this is TMI.

Speaker 1:

Yeah.

Michele Folan:

Why is it harder for me to pee at night after I've been asleep?

Betsy Greenleaf, DO, FACOOG:

You know, it's uh so there's a lot, some things that make it hard to pee. It depends. So one of the things, so that there's two things that happen, happen have to happen when you're urinating. One is the urethra, which the tube you pee through has to relax, and then the bladder has to push. And sometimes those signals between the two areas kind of get a little wonky. And so sometimes, like sometimes people complain, especially like of shy bladder, like they know they have to go, but it's just not happening. It's usually because the urethra is staying tight and not doing its relax. So it's relaxing. So sometimes it's just, you know, maybe you're not awake enough and things just haven't synced properly. There are some tricks. I mean, actually running water can sometimes trigger your brain to get the muscles in the pelvic floor to relax, to get the urethra to relax and things to um come out. Sometimes we actually tell people to take their hand and tickle their back, like their tailbone, because the sacrum is where the nerves come out that run the pelvic floor. And sometimes just doing that will distract the nerves enough to kind of get things to relax. Oh. Yeah. Okay. There's also medications. Like the worst time I see people having problems emptying their bladder is during the spring when allergy season is around, because the decongestant, uh, all the decongestant medications, all of them, well, as if it's a decongestant, different than antihistamine, but if it's a decongestant, one of the side effects is it causes your urethra to spasm and not relax. So people tend to have more problems peeing during allergy season because of that.

Michele Folan:

You know, that happened to me one time. I was doing the scopolamine patch for motion sickness.

Betsy Greenleaf, DO, FACOOG:

Yes, that'll do it too.

Michele Folan:

And I could not pee. It's like, yeah, my dad, my dad was like, take that, take that patch off.

Betsy Greenleaf, DO, FACOOG:

That's what's causing it. So I'm like, Yeah, that one that makes that makes the bladder floppy, so the bladder can't push the way it needs to.

Michele Folan:

Yeah. Yeah. And I didn't want to blow up like my kidney all blow up because I'm my bladder is full. So, all right, we're gonna take a real quick break, and when we come back, I want to talk about this audience, which is really 50 plus women, and what you see most commonly with them. Peptides aren't voodoo, they're real science. They're short chains of amino acids your body already makes, just not as efficiently as you age. And it's not just GLP1. There are peptides for longevity, anti-aging, skin, lean muscle, sleep, and recovery. But here's the key: peptides don't replace a healthy lifestyle. You still need protein, whole foods, strength training, good sleep, and stress management. Peptides simply enhance the results of the work you're already doing. That's why I partnered with a peptide resource, a trusted medical team using evidence-based protocols and high-quality formulations. If you're doing all the things right and still feel stuck, peptides might be the supportive tool you've been missing. Check out the link in the show notes, create an account so that you can see all the peptides available. All right, we are back. Before we went on break, I told you I wanted to talk about this audience. So we're typically 50 plus women. What do you see most common with this group and what is still being brushed under the rug?

Betsy Greenleaf, DO, FACOOG:

Yeah, so it's a combination of two things. It's either complaining of low libido, but I think sometimes even people are scared and nervous to talk to their doctors about sex. So that's definitely something that needs to be opened up about. So that's one topic. The other topic is recurrent urinary tract infections and vaginal infections and potentially like vaginal odor, which is all the same, they all have the same cause. So which one do you want to tackle first?

Michele Folan:

Um, let's let's tackle the recurrent infections because I think that's one that I really think gets swept under the rug. People don't realize that there's some connections there.

Betsy Greenleaf, DO, FACOOG:

Yeah, so this gets so crazy. So, really, we have to take a step back and look at the microbiome. So the microbiome is bacteria and organisms that live in an area of the body. So the microbiome of our mouth is different than our gut, then it's different than our vagina, than our skin. So, what happens is when we're going through menopause, our estrogen is lowering. And prior to menopause, we have a lot of estrogen, the vaginal tissue is growing like actively, you know, it's multiple levels thick. That tissue is nice and thick and moist and healthy. And as it grows, the old cells slough off, and the old cells contain something called glycogen, which is the food source for lactobacillus, which is the healthy bacteria that lives in the vagina. And why does it keep us healthy is when that bacteria is present, it helps to keep the vagina very acidic. Because the pH of a vagina is about 3.5 to 4.5. Like the pH of water, which is considered right in the middle, is like seven. So vaginal secretions are and the vagina is very acidic, which keeps us healthy because it keeps away other bad bacteria, it keeps away the yeast. And so this is how this bacteria kind of works in conjunction with our bodies. Now, what happens is as we're going through perimenopause, menopause, and beyond, that vaginal tissue starts to thin out because we don't have that estrogen anymore telling it to actively grow. So essentially, there's no food source for the lactobacillus, and the lactobacillus starves to death. And now other bacteria from our environment, from our gut, now start inhabiting the vagina. So some of those bacteria may cause odors. So some people complain of a change in odor in menopause. Some of them cause bacterial infections or yeast infections, which can be itching, burning, heavy discharge. But the other thing is because the vagina is also so close to the urethra, the TBP through, no matter how well you clean, it's very easy for this bacteria to kind of pass back and forth. And so the vagina can be a reservoir for the quote, bad bacteria that is now getting into the bladder and causing yeast infections or bladder infections. And so we're talking about how some of this, these bacteria, are kind of originating from the gut. They're actually coming from like the rectum and then getting to the vagina and then potentially getting into the bladder. Then we have to even kind of look back at the gut because what happens is let's say you get a urinary tract infection. A lot of times the doctor throws you on three to five days of antibiotics, and now you feel good for a little while, and then all of a sudden it comes back. And then you go on antibiotics again, and you're good for a little while, and then it comes back. When I start seeing that pattern, what it's telling me is unfortunately, when you've taken the antibiotics, I might have cleared it, the infection out of the bladder, but now we've thrown off the bacteria in the gut even more so. And so now this becomes this vicious cycle where, okay, it clears up for a little while, but now you have more bad bacteria in your gut and less good stuff because then we've killed off a lot of the good stuff, and now that's getting into the vagina and then into the bladder, and then it happens over and over and over again. I mean, it's unfortunately sometimes we just need to use the antibiotics, but if you find yourself in that cycle, we have to also stop and be like, all right, what is going on with the gut? And let's see how we can rebuild and treat the gut with that too.

Michele Folan:

So you do then do you recommend probiotics and even prebiotic type formulations? Okay.

Betsy Greenleaf, DO, FACOOG:

Yeah, definitely. And I take it even further because I'm really into integrative and functional medicine. I like to actually do stool testing on my patients and look at the actual microbiome. And you don't need to get that fancy, like, I just like the fancy tests. But like when I'm looking at those tests, I can see exactly what's there, exactly what's not there. And then sometimes we have to do herbs to kind of chase away the bad bacteria and then add probiotics. And fiber to stimulate like the good bacteria to want to be there. And sometimes there's other supplements, anything from things like colostrom, which is like a it's a milk product, but it can help heal the lining in the gut, or there's also something called glutamine that can heal the lining of the gut. But honestly, a lot of people can just do this with diet because sometimes our guts get thrown off, our guts get thrown off not just from antibiotics, but they can get thrown off from stress and then any stressor, mental stress, physical stress, but then they also can get thrown off from a bad diet. So uh inflammatory foods like processed foods and diets high in sugar can throw off that gut, which can now affect not just only your pelvic floor and your bladder, but in fact, uh 90% of your happy hormone, serotonin, is made in your gut, and 80% of your immune system is made in your gut. So this is why also sometimes we see problems with anxiety and depression. And then we also with the urinary tract infections, you know, now we're getting, you know, your immune system is low because we just gave you antibiotics and killed off the good stuff. So it becomes this horrible, incredible vicious circle. But really focusing on whole foods is the key. So I always tell my patients your food should come from four categories, and it's not that you have to do all four, but it should be in one of the four. The four categories is that it your food should have at one point walked, swam, grew, or flew. As long as it does that, because I said there's no Twinkie trees, you know, there's no like no, no twinky trees, pasture-raised free-range Doritos, you know, like that doesn't that doesn't happen. But like, I mean, like 80% of the time, if you're eating healthy, that's the way to go. And yeah, 20% enjoy yourself. But but the other thing is we evolved, we were probably getting a lot more bacteria in our food sources, and because of preservatives and refrigeration, we don't get as much bacteria in our food. Not to get rid of preservatives and refrigeration, because our food safety issues there, but you know, we need to look at getting more bacteria, and that comes in the form of either uh fermented foods like kombucha, kimchi, sauerkrauts. If you tolerate dairy, then that's uh yogurt or kefir. There's so many fermented foods out there now that you can easily get in the supermarket. Or if you don't tolerate any of them, getting um a very diverse probiotic, meaning that you don't want to pick up a probiotic that just has one type of bacteria in it. The more types of bacteria that it has in that probiotic, the better, because bacterial diversity in the gut makes you healthier. So you don't want to have just one type. Um, and then the bacteria has to live on fiber. And so we get fiber through either plant foods, so like vegetables, fruits, grains, or you add you add some fiber into your diet. Like I like um, like there's a couple ones, either it's called Sun fiber or Benefiber. And I have people just put it in their coffee because it's not gritty and you don't even know it's there. And we all could use more fiber. Absolutely.

Michele Folan:

And the whole reason I'm sitting here smiling, I don't know if you notice, I'm like smiling ear to ear. Yeah. Betsy, this is exactly what I tell my clients. You've got to get fiber it like 25 to 35 grams a day. Yes. And I'm able to do it many, many days without having to supplement anything. Um, I use garden of life that's like a powder uh fiber. I put I put like a half a scoop of that in my smoothies, and I'm I'm typically almost at 35 grams almost every day. So I appreciate that. You're just reinforcing what I keep, you know, harping on with my clients. But I also want to get back to this probiotic thing because this came up with my VIP clients the other day, and we we we really dug into probiotics. You said to get one with that has multiple strains in there, and I I I get that, but how much? Because you've got the one brand that's got a hundred million, and then you've got the one billion. Like, where's the sweet spot there?

Betsy Greenleaf, DO, FACOOG:

You know what? That's the one thing that they haven't really figured out with the research yet. I unfortunately, I don't think we're completely there yet. I do say that people that are getting the ones that have just like the one billion colony, it's probably just a drop in the bucket and not doing anything because we have trillions of bacteria in our gut. So it is kind of hard to overdo it, though. There are certain autoimmune and immune deficiency um conditions where you shouldn't be taking probiotics. So make sure you talk with your doctors. If I am really aggressively trying to rebuild someone's gut or if they've been on heavy-duty antibiotics, I might shoot for 100 to 250 billion colonies. They're actually make a prescription one that's 900 billion colonies. Oh, geez. Very, very rarely use that one. But for on a daily basis, I tend to shoot for ones between 20 to 50. And then it's just been over years of experience and just going, all right, well, that sounds good. But I don't unfortunately have like research articles that support it because we're not, I don't know why that they just really haven't figured out like where is, you know, what should we really be doing? But that's been pretty much where I usually keep it and to have people do it. And that's what I do myself.

Michele Folan:

So Okay. All right. That's that's great advice. And hopefully some of my clients are listening and they'll they'll hear that.

Betsy Greenleaf, DO, FACOOG:

But I'll follow up with them because we I I couldn't provide that information because well, and the and you know, uh well, the gut microbiome has been connected with so many things. It's been connected with longevity. Um, but there's been a number of studies that have shown, even in men and women, that if your gut microbiome is off, the body perceives that as a stressor. And anything that the body perceives as a stressor, it will dampen digestion, it will dampen like anything having to do re with reproduction. So that would be sex drive, and it will dampen healing because anything that's a stressor, all your energy goes into cortisol and making stress hormones. So, you know, if you're thinking about like a healthy gut can help your sex drive, then like eat some more fermented foods and some more of those probiotics.

Michele Folan:

So honey, I'll be right with you. I gotta eat some sauerkraut.

Betsy Greenleaf, DO, FACOOG:

I know, right?

Michele Folan:

Maybe not then, but but that was gonna be one of my questions too, is you know, you do talk a lot about the gut-brain sex connection. Yeah. So it really there is a direct connection then with our libido.

Betsy Greenleaf, DO, FACOOG:

Yeah, and it's fine, and it's interesting. So not just with the gut and the brain, it really just comes down to stress because you we have the two um nervous systems. We have parasympathetic, which is your relaxation state, that's when you're digesting, that's when you're healing, that's when reproduction happens. And then you have your stress state, which is your sympathetic nervous system, and that's when you make cortisol. And listen, being stressed is not a bad thing. It's just only supposed to happen in short spurts. So it keeps you alive. Because when we were like walking across a field and out jumped a lion, that's not the time to be like eating a hamburger, having sex with your honey, you know, like there's not to be time to be doing that. It's time for all your blood to go into your muscles and all your energy go into fighting that lion or running away from that lion. And then once you get to safety, then your body's supposed to go back into that, like, ah, that calm where you can heal and you know, have fertility and have a sex drive and digest your food and get your nutrients. But the problem is nowadays our stressors, our lions, are a lot more. So we're getting stuck in those stress, that stress kind of mode, and we're losing out on sex and healing and digestion because of it. So even when we look at the chemical pathways of how these hormones are made, they do, they they divert and they it goes one way or the other. So I always say sex and stress can't coexist. You got one or the other. So Yeah.

Michele Folan:

Now I had a a guest on not too long ago. She talked about oxytocin helps curb your cortisol. Yeah, yeah, it will. And and that it after an orgasm that it increases your the oxytocin? Oxytocin. Jesus pee. Yeah. It increases your oxytocin four to 500%. So, you know, when you think about intimacy, it's not just about the sensuality and all of that. It's it's actually good for you. Yeah.

Betsy Greenleaf, DO, FACOOG:

And even so, like, not just from a hormonal standpoint and even brain relaxation standpoint, but it's also great for pelvic health because it is actually true that if you don't use it, you lose it. So think about using your, you know, parts, uh, men and women, both sexes need to use it for it to continue to function. So you, you know, it's, you know, I know I'm not joking, but joking, it is a touchy subject, but the idea of self-pleasure, but whether you're with a partner or with yourself, like stimulating the genitals is actually a form of pelvic physical therapy. Like doing that keeps the blood flowing, keeps things healthy, keeps it in working order. I was just telling a story about a patient of mine who was um an older woman who was widowed and, you know, kind of lost her sex drive and hadn't used things in a very long time. And then she met this young man and was ready to kind of get back at things. But because she was postmenopausal and didn't do anything for her vaginal health to keep that tissue young, and she hadn't been using it, it literally, her vagina shrunk up to the point where I could barely get a pinky inside of her. Oh no. So it is that definitely if you don't use it, you lose it. It will, it will shrink. So you want to keep using it. And not that like once it gets to that point, not that we can't reverse it. It just takes, you know, anywhere from hormones or even lasers and dilators, and and we can get it back to working order, or you know, or you find other places to express yourself intimately. Um, but there are there is hope. There's things that can be done. But in the meantime, think of it as your pelvic physical therapy. And there was a study that I saw, um, even just with self-pleasure, that there was a 98% improvement in sleep, and it didn't depend on whether that person had an orgasm or not. So it was independent of orgasm. And then there was like a 95% improvement in mood, and there was like all these other like improvements in confidence, and yeah. So it is definitely definitely a form of physical therapy. And like I said, you can do it with or without a partner.

Michele Folan:

So yeah, but those are all really great things. I mean, it's like I want that, right? Yeah. So I want to talk a little bit about vaginal estrogen and the the proposal that maybe we'll be seeing the removal of the black box warning here soon, which is way overdue. My listeners have heard me say it probably a hundred times. I think everybody should be on vaginal estrogen, particularly in this age group. But what else besides vaginal estrogen and maybe even pelvic floor exercises? What are some other things that we can do to preserve our vaginal and pelvic health?

Betsy Greenleaf, DO, FACOOG:

Yeah. Well, that first of all, we'll go from with estrogen first because there's a whole range of options for treatment for vaginal rejuvenation now. So vaginal estrogen is one great thing. It's usually available as uh a prescription. And hopefully we'll start to see more coverage with this with insurances in the future, because that's been a problem. There is a slight issue with some of the vaginal estrogen creams. Some people find them very irritating because not because of estrogen, but they contain a uh filler ingredient ingredient called propylene glycol. And unfortunately, some that can be a mucosal irritant. So some people that can irritate the vagina. So it if you get burning or irritation from that, like that just means let's try to find a different form of hormones that we can use on that area. But um, they even make little ovules that can be placed and rings that can be placed in the vagina. There's also a prescription um DHEA suppository, and DHEA is a precursor to estrogen and testosterone. And we also have testosterone receptors in the vulva and vagina. So a lot of people like that. Um, it goes by a brand name called Intrarosa, and that's actually usually from a commercial you know, pharmacy. You can get that as it's prescribed. And any of these things, you can actually even have them mixed up at compounding pharmacies. And sometimes when you look at your insurance cost, sometimes, depending on your insurance, it's not that much more to have them compounded. So you can have them made without those other ingredients that could be irritating.

Michele Folan:

Oh, okay.

Betsy Greenleaf, DO, FACOOG:

Or something we'll even use testosterone cream, which is not a commercially available, but you can have it compounded, and that sometimes um that can also help. Um, there is a commercially available oral medicine that directly affects the vagina. I honestly haven't used it much in my career. I just really never particularly liked it. But the and for no reason other than we just didn't use it that much, but it is one that is not a hormone, but it tricks the tissue in the vagina to think it's a hormone and can help um regrow. So that one's called um, was getting that one. It's Asphina. Asphina is that one. But then beyond that, we have a whole range of regenerative therapies, unfortunately not covered by insurance, but a lot, a lot of other options. So in 2014, the first vaginal laser came to be used in the United States. And so lasers have been used since the 1980s for skin rejuvenation. And somebody had the brilliant idea. Well, wait a minute, if we can do this to someone's face, why can't we do it to their vagina? And I wish I was the person that came up with that. But um, I was like, oh, that's brilliant. So lasers just use light energy to make little channels in the skin. So it causes like a microscopic injury to the tissue, and then your body senses that and it floods the area with growth factors to get it to heal. And when it does it, it basically tricks the tissue into regrowing, like it was, you know, uh prior to menopause. But it also depends how long you've been in menopause, how many treatments. Most people usually usually have to do with lasers, three treatments faced about a month apart. And then you have to maintain it with a lasering once a year. But sometimes you need more if you've been in uh menopause a little bit longer, or if you have conditions like in sclerosis, which are inflammatory conditions of the tissue, sometimes you need more. But when the laser first came on the market, that really opened the floodgates because the aesthetic world went, wait a minute, what other things that we do to people's faces that we can we do down there? And now there's so many different products on the market from uh radio frequency, which is uh sound waves to create heat, which stimulates collagen. So that can rejuvenate the vagina. Um, we use shock waves. Um, shock waves are a little bit different type of sound wave that goes in, and what it does is it stimulates the stem cells in the tissue and the blood vessels to grow new blood vessels in that area to help support the tissue. Things like platelet-rich plasma. They basically draw your blood, they spin it, they pull out the plasma, which has all the growth factors, and then they apply it to the vagina and the vulva. And so, um, and there's a lot of these things, those are all things that have to be done by a practitioner. So historically, what happened was the pandemic came along and nobody was going out to get their vaginas lasered because everybody was going to the doctor's offices. So then we saw really the emergence of a lot of home therapies. And so there's devices like the Joy Lux D fit device, which is a red light wand. And so we know that red light at certain wavelengths has a very anti-aging effect on the tissue. It stimulates your mitochondria in your cells, which is your anti-aging kind of powerhouse. And so basically figured out if you put this red light in your vagina, then you can like, you know, have a younger Do they work? They do, they do. And that's the only thing I will tell you that no matter all whether you're using creams or lasers or red lights or anything, unfortunately, nothing works overnight. You usually have to do something steadily for about three months before you see a difference. So I wish I could say, like, oh, the lasers were quicker than the creams, but they all pretty much work about the same amount of time before you start seeing a difference. And then there's there's like peptides that people are, you know, they're coming up with peptide creams that people can apply to their vagina. Um, there's another company called CO2 Lift that makes a carboxy therapy, which is a carbon dioxide gel. And when you apply it, it attracts oxygen and that stimulates the tissue to regrow. So there is a giant range of things that can be done for your vaginas to feel comfortable again.

Michele Folan:

Wow. I mean, I mean, I knew there was a lot out there, but that that was that's quite the list. So the the message in all this is that there's hope, right? If you want to change your the state of your vagina and having comfortable intimacy, this is you know, this is hope for you. You know, but I often think that maybe there's pelvic pain or discomfort that feeds into the I'm not in the mood cycle. And maybe for those women that are in long-term relationships, maybe they want to reframe their view of intimacy. How do you coach patients through that?

Betsy Greenleaf, DO, FACOOG:

Yeah. So, well, first of all, um, I think sometimes there's too much attention put on the genitals. And so I think that, you know, when it comes to intimacy, like number one, our brain is our largest sex organ. So really it comes down to stimulating the brain. Because if you don't stimulate the brain, nothing else actually will work. And then our well, so our actually, our brain is our most important sex organ, our skin is our largest sex organ. And so it doesn't always have to be genital focused. Um, in fact, very interesting enough, they found they mapped this out in the brain recently. I saw the study, they did MRI studies, they actually found that in some people, not everybody, some people in their brains, the nipples are wired very close to the genital. So there are people that can have nipple orgasms just from stimulation of the nipple. So it's very interesting. But the brain is also very interesting in that it's not, we used to think it's set and then that's the way it's gonna be, but now they found out through neuroplasticity that you can rewire the brain and basically make anything an erogenous zone. Um, and we see this often with paraplegics because if they have no feeling from like the waist down, their sex life isn't over because it hasn't affected their their brain. So um we they just have to learn to rewire and associate another body part with pleasure. So, you know, people that are having like dryness and discomfort because of Menopause, maybe receptive, you know, sex is not going to be fun for them, especially if they don't want to do anything to rejuvenate the vagina or they, you know, don't have them the budget or worried about hormones, or um, but that you can actually, you know, do other areas. Plus, even something just as simple as cuddling and touching can boost those happy hormones, that oxytocin and that that bonding hormone. So it doesn't always have to be like what we think of as the sex. The other thing I see in this age group, and it's been really fascinating, is there's I think because when we don't get the sex education that we really deserve, you know, everyone's like basically we get, you know, in school, it's like, here's how not to get pregnant, and then okay, go out and figure out everything else on your own. Exactly. And so unfortunately, there's this belief, but women like in women that we need to be in the mood to have sex. And so, and where that sounds like really weird at first is because when we look at like the Masters and Johnson's who did like the big sex research in the 1960s, there they had a graph of um sexuality that was very linear. And it was great for the time. It basically was like you had to have desire first, and desire led to arousal, arousal led to a plateau, and hopefully there was an orgasm, um, and then there was a resolution. And it's very start to stop, like one direction. Um, Rosemary Basson, and then I think it was in the 1990s, reorganized female sexuality into a different graph. And I like to show my patients this graph because when you understand it, you go, oh, okay, maybe I'll try that. She had like it's all these crazy intersecting circles, but not that spontaneous desire can't still exist. It can still exist. Um, it tends to happen more so when we're younger and more so when we're in new relationships, because we get these big dopamine hits when we're in a new relationship because the brain likes novelty. But the longer you're in the you are in a relationship, or the older you get, or the more busier or more stressed you get, sometimes that spontaneous desire is really difficult. And so actually, in Rosemary Basson's model, she put willingness as the first step. So willingness to engage in some sort of sexual activity. But I always tell my patients that willingness has to be discussed with a partner, that if it's not going anywhere, you don't want to just, you know, muster through it because then it's gonna create a negative loop that you're not gonna want to do it again. So you got to be like, hey, you know what, it's not working tonight. Let's try it another night. It's not you, it's just, you know, it's just not gonna happen tonight. Or even if with your, you're if you're doing something yourself and it's not working, just give yourself grace and be like, yeah, you know what? Today's not the day, tonight's not the night, let's just do it another time. So having that willingness first and just kind of going through the motions, whatever those motions look like for you, can actually start stimulating blood flow to the genitals, which can start preparing things so that the physiologic arousal starts to happen first, and then all of a sudden you kick into desire and go, you know what? I think I might want to do this. And then hopefully it's a satisfying sexual event that then feeds back into the circle and goes, okay, wait, I want to do this more. Because a lot of times my patients will come in and they're like, I need hormones because of my sex drive. And I'll show them this, and I'm like, well, we're we'll work to getting the hormones, but the hormones are only a tool, and they're not necessarily like, they're not horny pills, you know. We don't have a horny pill, we don't, it doesn't exist. Even even Viagra is not, you know, Viagra is just a blood flow pill. It does not to do anything in the mood, it all does is help with blood flow, which interesting enough can help women too with blood flow down there, but they never properly marketed it for that reason. So, and then everyone's because the brain is the more important sex organ, everyone's brain is different. So it's hot, you gotta figure out what are the things that turn your brain on, get you in the mood, and then see if you can kind of go through that. And hopefully, you know, a lot of my patients after I show them this model, they come back and they're like, you know, I tried that. We set it, I you know, we set a date with my husband and we put it on the calendar and we put all the other things aside and we went through this and it was great. Then they were they come back and they go, Why don't we do this more often? I'm like, Yeah, that's usually what people say once I've shown them that graph.

Michele Folan:

And I think that's a great point, Betsy, because if if you talk about it, you know, earlier in the day or schedule it, or you know, there's that anticipation and the buildup, which maybe that's that's kind of what we need. I do, I gotta tell you this funny story though. So I was in the pharmaceutical industry back when Viagra launched.

Speaker 1:

Yeah.

Michele Folan:

And it was driving every nurse crazy because their phones were blowing up. You know, Mr. Jones, Mr. Smith, they all wanted to get the Viagra. These guys were 75 years old, probably hadn't had intimacy with their wives. They may have even been sleeping in separate bedrooms, but I felt so badly for these wives who all of a sudden are being put in this position of, wait, what? You want to do what? No, I I go to lunch with friends and I sleep in a separate bedroom. What are you talking about? So anyway, I just yeah, I I remember that.

Betsy Greenleaf, DO, FACOOG:

Oh, I was seeing it from the other side because I was taking care of the women who are fine, and then all of a sudden they were like, Oh my god, my husband's not leaving me alone. Like they're like, they're like, I was fine before the Viagra. Uh-huh. But I think this is where like communication is so important. And I mean that's really the key to relationships, is you mean this is your partner. You should be able to talk to them about the most intimate things, and sex should be a conversation that's like normal, you know, and not have to guess and figure out, and you know, so but I it's not that I think it it's still an uncomfortable taboo topic.

Michele Folan:

And when you have mismatched desire, it's it can be sticky to try to have some kind of a resolution of what that means for your relationship. And I've said this before, you know, I I talk to women all the time, whether they're friends or clients. And I'm finding more and more that that's not happening. Like the intimacy in a lot of marriages really peters out. And but it's not always the woman, it's sometimes the male partner that's kind of lost his vavoom.

Betsy Greenleaf, DO, FACOOG:

And they're the because the men, unfortunately, are starting, their testosterone is starting to decline around the age of 40. And so that's what they're seeing too. So some of their drive is now, is now kind of, and I mean, they also get the brain fog and the mood swings and the body composition changes and the decreased sex drive. So, yeah, so it's it's all kind of happening. And so it's a trying to, I mean, like there's obviously there's tools for everybody, and there's, you know, and that's a personal decision whether you want to do hormone replacement or not. But it yeah, it is kind of all happening at the same time. And I I do hear that, especially when I get my pay my female patients, that's why I started treating men too, because I'd get my female patients on hormones, and then they'd be like, Hey, can you take care of my husband too? Because like now, you know, the women were like, Okay, now we have our sex drives back, and the husbands don't. Or like, what can you do for it? Absolutely.

Michele Folan:

Yeah. What about the O-Shot? Can you explain what that is?

Betsy Greenleaf, DO, FACOOG:

Yeah, so you know, I think, well, here's the thing. So because your brain is an important sex organ, if you think something is going to work, it's going to work. So, okay, when it comes to the O-SHOT, what that is being marketed as is basically they're taking platelet-rich plasma. So they usually draw out your blood, take out those growth factors. Sometimes now they're using exosomes, which are um also um stimulate the cells to regenerate, but they don't have to draw your blood. And they're injecting it in a couple different places. One of it is they're injecting it on the anterior wall of the vagina, so the front wall of the vagina, right under the urethra, the bladder, that's where the proposed G spot is supposed to be. So that's one area that they're going in and injecting and kind of plumping up that area. And the other thing is that they're injecting in and around the clitoris. So, yes, it's rejuvenating all that tissue. Does it necessarily have a direct correlation with boosting, you know, sex lives? Yes, and that if there's discomfort that was coming from dryness and um, you know, maybe shrinkage of that tissue, yes. But I think a lot of it is coming from the fact that people believe like they're having something done to them and they're like, okay, this is now gonna fix everything. So I don't want to burst any people's bubble because now me saying that is like, you know, like they say the placebo, but this is this is like a no-cebo, it's a nocebo when you say something's not gonna work, and now I put that in your mind. So just saying it's you know, anything you think is gonna work is gonna work. In fact, actually, going back to the Rosemary Basan model and and um having willingness, it's really funny because there are some products on the market. There's one that's been on the market forever. It's called Zestra, and it's like this botanicals that are used. Um, it's a botanical oil. And if you read the instructions for it, it says you're supposed to take these oils and rub them into your clitoris for 10 minutes before sexual activity. And I'm like, Well, hello, there's probably nothing special about those botanicals. We just basically followed the Rosemary Basan model, and that we created a willingness to do something that was stimulating and probably increase the blood flow and then cause the desire. Probably has nothing to do with whatever's in that oils. It's foreplay. What the heck? And I like it specifically, the ingredient the instructions are you have to rub it for 10 minutes. And I'm like, we should anywhere come up with a product like does that?

Michele Folan:

All right, I have what I have another question for you. These keep popping in my head as we're talking, so we're I'm totally off my list of questions here. The G spot. Yes, let's talk about the G spot. How big is it? Is it really a thing? And do women all have the capability of having that type of an orgasm?

Betsy Greenleaf, DO, FACOOG:

Um, sorry, this is a loaded question. There is a debate on whether it actually exists. So scientifically, in the research, there's there's a big debate and there's been no consensus. The thought is it's supposed to be basically on the anterior wall of the vagina, about three centimeters from the opening of the vagina, which happens to line up where the urethra and the bladder meet. So the thought is there are some glands in that area that may actually produce prostatic like fluid, so prostate-like fluid, like in a man, because our parts are we actually from the way we developed as embryos, like our parts are very similar to male parts. So the clitoris is actually the analogous or like the same as a penis. So we do have glands that can produce fluid. So the question of whether it exists or not is debatable. Um, I think it's more of a perception of some people find having that area stimulated being very stimulating. And so, yes, technically, women, any everybody and everybody could potentially um have that area stimulated and cause an orgasm that might feel different than other orgasms. So, and then I guess that also I'm gonna bring up the idea of there's also debatable is that some women they call like squirt. So there's some women with stimulation of that area. There are some women when they orgasm um will release a fluid. And they've been trying, they actually have done studies. Usually these studies are done in like Denmark. For whatever reason, the Scandinavians Scandinavians are really into sex research and they like have labs where they have people like masturbating and they're like measuring things and stuff. They're there. I I think in America we're maybe a little bit too prudish to be doing that kind of research, but they've tried to collect the fluid and figure out what exactly is in it. And they have there's also all over the research, it's it's different consensus. You'll find some research that says it's a little bit of that prostate-like fluid that's coming from some of the glands that are in that area. To you have other studies that say like it contains urine. So there's been no consensus of women that are able to do that. What um, you know, what is that fluid made out of? And either way, who really cares if it feels good?

Michele Folan:

I just don't, right? No, I just I have never asked that question of a guest. And I was like, oh, Betsy seems like she knows. No, you might as well. I'm here. I know. She she she knows her stuff here. Yeah. You know, one other one other quick thing is and being a health and wellness coach, working with women and working on their body confidence. I think that oftentimes is what really is holding women back in the bedroom. Yes. And I'm sure you've you've had that talk with with with patients before. How do you kind of get them into a better place when it comes to their confidence in the bedroom?

Betsy Greenleaf, DO, FACOOG:

Yes, you know, here's the thing. I think a lot of times we get really hard on ourselves about like, oh, my body doesn't look right, like I want the lights off because I don't want to be seen and we're embarrassed about like this or that. When honestly, most of the time the partners don't really care. I mean, majority of the time, the partners really want to either enjoy themselves and they want you to enjoy yourself. So, and and confidence in general is so much more sexier than having the perfect body. Because I mean, you could have like a perfect body and have no personality, and that is definitely not sexy, or you could have an imperfect body and like have all this sassiness and spunkiness and confidence, and that just comes off as super, super sexy. So I really think that you know, there is no perfect body anyway. Everybody, you know, like you're attractive to somebody, like you're you should like start to learn how to be grateful for yourself and be attractive to yourself because listen, it's you know, life is short, so might as well feel sexy and be sexy and walk into the room, walk into the room like you're the sexiest person on the face of the earth. Absolutely. Because I mean, I even think back, and I was like a couple years ago, I made the comment about like, oh, my bikini days are over, which they've been long, long over. I probably haven't been in a bikini since my 20s and I'm in my mid-50s now. And last summer I went and I bought a bikini, uh thinking it was gonna motivate me to exercise, but then one day I was like, it didn't motivate me to exercise, but um, one day I just put it on and I was like, I'm just gonna wear it. And the first time I wore it, it was in my pool in my backyard, nobody was around. But then I got the I I did get the like I don't just say balls, I'm just gonna say it, but oh we can do it here. I got the the, you know, to wear it on a beach, and I was terrified. Like I remember walking out on the beach going, oh my god, oh my god, like thinking, like, are people gonna faint? Are they gonna scream in horror? Like, what is gonna happen? And I remember taking my cover up and like off and like nothing happened. No one fainted, no one screamed in horror, you know, children didn't go running off the beach in terror, like nothing happened. And I was like, Oh, well, that wasn't that bad. And then I was like, you know what? You know, they say like if you think it, it'll be. So I was like, I'm just gonna think that I'm the sexiest person on the face of the earth, and then I'm just gonna put those vibes and frequencies out there, and we're just gonna see what happens. And so I wore my bikini. I don't even think I've ever, even when I was like super skinny as a 20-year-old, ever wore a bikini on the beach that confidently. So I was like, Yeah, I'm this is me. And I mean, you've seen you've seen the people on beaches that, you know, they're they're you know, not the typical what what somebody might say is uh the ideal body type, and they're rocking that bikini, and you're just like, yeah, you know, I look at those people now and I'm like, good for you, yeah, good for you, because you got something that most of us else don't have. So I say just do it, just just do it, wear the outfits, be sexy, get the lingerie, get the you know, just do it, just surprise your partner for God's sakes.

Michele Folan:

It could be like the the biggest treat of of the year.

Betsy Greenleaf, DO, FACOOG:

And it's so nice too to kind of see women go through that transition. I think a lot of times it kind of happens when we're kind of in midlife, where we kind of reach a time when we're just like, uh I just don't have the energy to care what other people think about of me anymore. And I was just recently at a conference, it was a medical conference, and there's um there's a couple that's there, both doctors, and the wife has always been very kind of mousy and quiet and very kind of like librarian in her outfits. And I came to the conference this year, and she was like hair done up, she was in this little skimpy outfit, and I was like, Whoa!

unknown:

What did you do?

Betsy Greenleaf, DO, FACOOG:

And she's like, I just finally got to a time in my life, she's like, I don't give a crap anymore. And so she's like, This is the new me. You know, she had the attitude that like I'm here, this is my life, I'm sexy, and this is this is how it's gonna be. And I'm like, good for you. I like the new you, this is amazing.

Michele Folan:

You gotta love midlife reinvention, it's the best. I know it's so awesome, it's great. All right, I what I want to get to the pelvic floor store. You founded this. Yes, I want to know what inspired it. And then, like, what are your favorite products?

Betsy Greenleaf, DO, FACOOG:

Yeah, so um, what inspired it was I used to recommend products to my patients, and I most of them were not sold on Amazon. And honestly, I tell people now, don't get your personal products off of Amazon because a lot of times you might be getting counterfeits. You don't always know what you're getting on there anyway. But I would tell my patients, like, oh, go to this website and buy this thing, go to that website and buy this thing. And one day one of my patients said, Why can't there just be one place that I go? And I went, Oh, I don't know. I had no clue how to make a website. I honestly didn't even know enough that you could hire somebody for this. So I started YouTubing how to make a website. Took me four months to build the website. Now I know I probably could have hired somebody that it would have done it in a day. But I basically started curating all the products that I was recommending. So anything from like, let's say, D-mannose and cranberry, that I like people to take, you know, either after sex or take daily if they're getting recurrent urinary tract infections, because the D-mannose helps to bind the bad bacteria in the bladder, and so it helps to flush it out, and the cranberry makes it so that the bacteria doesn't like to stick to the bladder wall. There's a bunch of healthy lubes on there because unfortunately, some of the lubricants on the market are not made for the vagina. They're not pH balanced and they purposely dry. Like, I'm gonna throw it under the bus. KY jelly is probably the worst thing you can use because it can throw off the pH and it purposely dries the vaginal tissue. So you have to use more of it. So great if you're A lube company because you're selling more and more of it. Bad if you're a vagina owner. So um, so we have some healthy lubes on there. I've also recently partnered with an intimate device company. Um, I'm a spokesperson for them, so I have a number of their products on there. So anything from dilators to kegel exercisers to um there's no nice way to put it, but vibrators on there. Because remember, it's your pelvic health. You want to keep things working.

Michele Folan:

So um, and that's actually been a Yeah, but a vibrator can actually help with stimulating that tissue, right? So it's it's like, okay.

unknown:

Yeah.

Michele Folan:

And it's something you can don't have to use alone.

Betsy Greenleaf, DO, FACOOG:

You can use alone or with a partner. You know, the brain legs novelty. So maybe pull that into things. So that might create help to create some newness. So, yeah, so we have a whole range of things, and I'm starting to start put some products for men on there too. Um, anywhere from like exercisers and things for them. Um, so uh trying to find some of those products. So there's a whole range. I actually put a couple products that I myself not necessarily great, not the greatest thing for for pelvic health, and that uh I don't know that I can't get the information from the company about pH balance, but um, there's a couple products that I found that I personally have tried that I like. There are some um arousal oils that have CBD in them. I like that. There's a there's a C B D-based lube that can help relax the muscles. There's also a company called Pure, which is PJ-U-R. They make a really uh long-lasting lube, but they have this product that interestingly enough, it can be a little irritating to people, but it can be very stimulating, but it's a stimulating cream. It contains extract from what's called the toothache plant. So you would think that the toothache plant is normally a plant that is used to numb the mouth, but for whatever reason, they don't know why. When you put it on down there on a woman, it doesn't numb, it creates this buzz, buzzy sensation, like something's moving. Oh wow. So it can add to stimulation. So it's something I found, and I like and I tried it and I'm kind of liked, and I was like, I'm gonna put that on the website too.

Michele Folan:

Well, I've I figured you try some of this stuff, so we would get some personal recommendations. Yeah, yeah, that's that's so great. I do have a personal question for you. What is one of your personal self-care non-negotiables?

Betsy Greenleaf, DO, FACOOG:

You know what is now is getting eight hours, uh, seven to eight hours of sleep. Yeah. I like listen, I love to be on my computer and get one more thing done on work, but I shut my computer off at seven o'clock at night because I know that the light from the computer will stimulate you and keep you awake, and I know it affects my sleep. And then when I looked at some of the data on um on sleep, like if you get less than six hours of sleep at night, your risk of obesity goes up 23%. If you get five or less hours of sleep, your risk of obesity goes up like tremendously. It's something like 75%. Like it just skyrockets. So I'm like, something's so simple, and it's something we often try to put off. And I'm like, no, like now, I'm like, I need to go to sleep. Yeah.

Michele Folan:

You and so many of my guests in the health space are all talking about the importance of sleep. And I don't, I think it's undeniable. Uh, the obesity thing is big, and then also dementia, just your brain health. There's there's so many things that you know, yeah, we just we need our sleep.

Speaker 1:

Yeah.

Michele Folan:

Dr. Betsy Greenleaf, this was so much fun. I am so glad we were able to get this together today. Thank you for being a guest. No problem. I enjoyed it. Thank you, Michele. Thank you for listening. Please rate and review the podcast where you listen. And if you'd like to join the Asking for a Friend community, click on the link in the show notes to sign up for my weekly newsletter where I share midlife wellness and fitness tips, insights, my favorite finds, and recipes.