The Most Common Vaginal Infections and Conditions with

DR. REBECCA LEVY-GANTT

0:05:55 - Danielle Bezalel

Hello mom, what's up? 

0:05:55 - Dr. Rebecca Levy-Gantt

Oh, as you know, lots up, lots of things are up, lots of things are up. 

0:05:59 - Danielle Bezalel

Today is a really, really important day for you. Do you want to talk about what today is for you? 

0:06:04 - Dr. Rebecca Levy-Gantt

It's a lot of things, I think. 

I'm not sure if this is the biggest thing because, of course, this is also the day that my first child was born, so I'll have to give that some credit. 

So it's your brother's birthday, hi, Jake, he's 33. 

Yep, and today is the day that I made a huge change in my practice pattern, and I can give you kind of the short story on the details is that for the last 30 years I've been practicing OBGYN as a full scope physician, and about a year ago and I think we did talk about it on the show my plan was I'm getting older and you know, delivering babies, while I love it, is extremely hard on the body and on the sleep pattern and on the family time and all that. So about a year ago I decided there would be an endpoint to when I would stop, where I would stop delivering babies, and that was to be August 1st of this year, which meant everyone that was currently pregnant had to deliver by August 1st. So I thought my last person would deliver pretty close to that date, maybe the week before or so, but it just so happens my last pregnant person delivered today. Today we caught you on the day, you caught me about six hours after it happened and on a completely no sleep night. 

0:07:36 - Danielle Bezalel

Oh, are you super exhausted? I bet. 

0:07:38 - Dr. Rebecca Levy-Gantt

Well, the thing was she called me about one in the morning. She delivered around I don't know 6 : 30 this morning and of course, once the call comes in, it's just my nature to go there. I don't always stay the whole night in the hospital if I'm not sure that someone's been delivered right away. But I had a feeling she would and I just stayed there and delivered her and then never really got to sleep. So it kind of embodies everything good and bad about why I wanted to deliver and why it's time that I stopped delivering, which is I love the energy, I love the rush, I love taking care of people, I love delivering babies, I love presenting people with a baby and they're all so happy. I love when it goes great, which is kind of like a unicorn right now because a lot of deliveries don't go so great anymore, with a lot of high risk things happening at complications. 

But this one was really good because it's so nice and everybody was very happy and I just had a weird happy, sad feeling along with it. So happy to do it, so happy I'm done. And it's weird because it's like anybody who goes through a major life transition, like you go from one job to another or you retire. There's that little voice in the back of your head that says are you sure? That says who are you Without it If you don't do that? Yeah? 

0:09:15 - Danielle Bezalel

Is that something that's? 

0:09:16 - Dr. Rebecca Levy-Gantt

present for you. Yeah, I mean I know I have plenty of other things. I'm not retiring. I'm certainly going to be doing gynecology. I love that. I run my own practice, everything's great. But I don't remember a time of me really being an adult and not delivering babies and not staying up all night and not feeling tired and sad that I might miss a family function and planning around my delivery calendar, which that's all just a necessity. It was all just part of the job. But that's going to be such a major change now that it's only today, right. So I don't know how I'm going to feel about that. 

0:09:56 - Danielle Bezalel

Yeah, it is such a part of your identity and it doesn't mean that that part goes away. I mean, that was such a large chapter of your career and you had so many dreams of doing that for such a long time and I imagine it feels like a very strange feeling to feel like okay, well, I don't have another patient that I'm going to be delivering again. 

0:10:19 - Dr. Rebecca Levy-Gantt

Yeah, and it really struck me kind of yesterday when I was like what kind of travel plans might I like to make in the new year? And that's never been a question that I could answer without saying wait, let me look at every month of the year and see who's going to deliver when and how can I work around that? It's almost feeling like my life has really not been my own, and I'm sure you and your two brothers have this identity of me always going out in the middle of the night and someone else taking care of you and me coming home either really happy and satisfied or really upset and taking it to heart when there were complications or something happened that was not expected, and it's just a huge part of me. 

0:11:09 - Danielle Bezalel

Yeah, I'm even getting emotional, just thinking about that, because obviously it's your life and you're like this independent person who this impacts the most, but as your kid, I think there is a big transition process for me too, as someone who's always known like, oh well, you can't do that because you have a patient or you can't be too far from home, and that has been. I've always been so proud of you and so inspired by how seriously you take your career and how much you love it and how passionate you are about it. But I also am very excited to get that part of you back a little bit or it's never been there actually, so it's going to be a completely new experience and, yeah, I feel really excited about that new phase for you and for all of us. 

0:11:57 - Dr. Rebecca Levy-Gantt

Yeah, and it doesn't at all take away from all the people I've delivered and the people that I still will take care of but not deliver. 

I'm not saying any of that is something that I hated or didn't want to do or you know, not at all. 

But in this business there's no way to do it. A little bit Like I can't just say I'll just deliver people who are already part of my practice and that will be maybe a few people a year. Because when you really think of it that way, I have to be insured and the malpractice situation is such that either you do it or you don't do it. And if you're going to do it you have to be fully insured for the liability that brings your way. And so it wouldn't make sense in a lot of ways to say I'm going to pay for all this malpractice insurance and I'll deliver to people a year, because then actually I'd be paying to deliver them and honestly, if I were independently wealthy and I would volunteer and maybe go and do some deliveries or something like that, but to do it as your own entity in your own practice, it doesn't make as much sense. Yeah, it's regulated by more than just what I would like to do. 

0:13:12 - Danielle Bezalel

Yeah, I'm sure the fact that you have your blog and your two books and you are really good about documenting your stories and experiences. I'm sure that you're going to go back to those in the next couple of years, just because, even though you're I don't know, it's always going to be a part of you and it's such an important piece of why you became a doctor and why you were excited about becoming a doctor. 

0:13:38 - Dr. Rebecca Levy-Gantt

Yeah, it's so true. And when I look into the books that I've written about mostly things that have happened in the delivery room or in the hospital, I go right back there like it was yesterday, knowing that those experiences are just so imprinted in my brain that I really just remember. Yeah, and they're happy memories, as much as they mostly happen in the middle of the night or as much as they are fraught with worry when something happens unexpectedly. It's still the memories, the general memories are really happy, really happy. 

0:14:16 - Danielle Bezalel

Yeah, and your patients are just so lucky that they got to know you and you're just so attentive and so caring, so kind. People are just going to remember the best experiences from having you as their doctor. Yeah. 

0:14:30 - Dr. Rebecca Levy-Gantt

It's nice. That's a very, very nice feeling. I mean I've had some wonderful comments from patients. Somebody said to me last week so can I be grandfathered in? I have three kids, I wanted to have another one, but I think I would make my decision on whether or not you're going to deliver and I was like, please, don't make a decision based on me. She's like, can you just slip me in? That's funny, I mean, and it's so, and I get that. They really want that experience with me and, yes, a lot of it could be me, but a lot of it is really about me being the person that they know through their whole pregnancy and am going to be there to deliver them. 

0:15:12 - Danielle Bezalel

And that's. 

0:15:12 - Dr. Rebecca Levy-Gantt

You know it's a valuable thing, and many people have come back to me and said now I get it, now I see how valuable that was and you know I've enjoyed that too. Those relationships are just amazing. That you know, knowing so many people, that I know their whole family. They send me Christmas cards with all the babies I deliver. You know it's great, it's intimate. 

0:15:32 - Danielle Bezalel

It's a really intimate experience. Well, I'm really, really proud of you. I'm excited to see how those feelings progress and change over the next couple of months and years. And you know, as you said, you'll still be doing the gynecology part of your career for another couple of years, and so I'm really excited today we're having you on specifically to talk about a really sexy topic, which is vaginal infections and conditions. I want to know you know I came to you a couple of weeks ago. We were like on our vacation, on our family vacation, and I was like, okay. You were like okay, what do you want me to talk about? And I was like, okay, tell me what. Like what are people coming to you? What are patients saying to you? And this was a topic that you feel really, really passionate about for many reasons, which I'll let you say in a second. But why don't you tell me? Why did you want to talk about this? Like, give us some context with how often this comes up in your practice, with patients coming to you with these questions. 

0:16:30 - Dr. Rebecca Levy-Gantt

Well, it's very funny because you mentioned it to me again, like you said when we were on vacation a couple of weeks ago, and I said you know what it seems like I see a lot of people with these complaints. You know vaginal symptoms and problems, but from the moment we got back from that vacation I decided to count. 

0:16:48 - Danielle Bezalel

You just kept it tally. 

0:16:49 - Dr. Rebecca Levy-Gantt

Yeah, because I, you know, I work in an office where I'm the only practitioner in the office right now and I feel like this is like a pervasive problem, like it feels like maybe 40 or 50% of my patients are having vaginitis problems or infectious type problems. So I decided to count one: how many patients do I see in a day or then tally at the end of the week for these complaints or problems, and how many people call not really wanting to be seen, but call and go? I have these complaints. I have a lot of complaints about the condition. Exactly so I counted and now I see in the office I'm on a busy day, I see about 24 people a day in the office and on a slow day maybe somewhere between 16 and 18, I literally counted and every single day there were at least three appointments for something vaginitis related or something that you would put in that category and two to three calls a day, wow, just in the past couple of weeks. 

Yes, and this runs the spectrum, because I take care of girls, women, teenagers, older ladies, the whole spectrum. I looked at who was the youngest person who called, and she was 14, and who was the oldest person who called, and she was 87. Oh, okay, so, and I can tell you right now they're obviously not looking at the same problems, right, but the complaints are very similar. And if you ask me why I think this is a topic that needs to be talked about, it's mostly because there are so many different things that it could be. And if there's really, I guess this should be my conclusion. But if there's one thing I really want to drive home, it's really hard to know what you're dealing with without somebody who knows, at least the first time taking a look. Because I exactly had this situation this week where somebody called and said you know, I'm having a yeast infection. I feel like it's yeast, it's itchy, I have some discharge. Can you just send a DiFlucan, you know, a FluConazole, which is the oral medication for yeast which many people take? 

0:18:59 - Danielle Bezalel

I'm guilty of doing that. By the way, I also do that. 

0:19:04 - Dr. Rebecca Levy-Gantt

It's in a different situation, though, because if you, let's say, are somebody who kind of has a bunch of yeast infections that have been already diagnosed, and then you go to the gym and you're sweating and you know that the moisture might be a reason that yeast might grow, and then you get the exact same symptoms, symptoms that have been discussed with a practitioner, have already been treated in the recent past. Yes, you may be somebody. I might be able to do that over the phone, or, if you're my daughter, I might be able to treat you without examining you, but this person that called saying this is yeast, let me just have a DiFlucan or something I said. No, you know, I always look back in the chart and say when was the last time I saw her, what was I treating her for? The last time I saw her, what is it likely to be based on her history? And then, nine times out of 10, I go. No, I'm not going to call something in for you. You really do need to come in, and in this practice, I make that time for them. I don't say you need to be seen and then go. You can't be seen for three weeks, because that doesn't make any sense. We do have emergency spots for seeing people. So that's what she wants and I said, just come in for a quick visit. I even came in early in the day to see her, like before we started, so I could just look and do a quick culture and I said it might be yeast, but it really doesn't look like that to me. Let me send the culture off and we could use something temporary, not an antibiotic or anything but something to soothe your discomfort. There are things that you could use, externally, like protectants or some creams or something that don't necessarily treat it but kind of temporize you until you know what it is you're treating. 

Well, ps, three days later the cultures came back with trichomoniasis, and trichomoniasis, it is considered a sexually transmitted infection. It is something that, like both partners, should be treated for. It's certainly not cured by an anti-flu can. So I would have really been doing her a disservice by just calling something in because, one, it delays you from getting the right diagnosis and, two, you're treating something that's not really even there. So why have somebody taken either an antibiotic or an antifungal or something like that when they don't even have that infection? 

So if I have to drive some final plea to people. One, please get somebody to take a look so that they can either culture or tell you what they think is going on. And two, 爾о sharply subject to this current野國流行eboy almost everybody self-treats. You know, by the time I see somebody I would say they have at least spoken to their friends or gone to the store and got something over the counter. That may or may not make things worse and it makes it harder to diagnose when I see them. And they also don't even sometimes tell me what they did. And I'm not gonna fault somebody for wanting to be more comfortable, obviously if it's Saturday and my place is closed and whatever. But I just feel like that whole idea of not seeing it and just treating it or self-treating it with. I had this old tube of something that I had an infection last year, so, or I had the best one. The other day I used a tube of my mother's cream. You know, like how do you know? I mean I wouldn't even touch someone else's cream. 

0:22:11 - Danielle Bezalel

Where'd she get it from? 

0:22:13 - Dr. Rebecca Levy-Gantt

I didn't think you caught it from your mother. Right, right, but anyway it's just the thing of not treating things, that you don't know what you're treating. 

0:22:22 - Danielle Bezalel

But the way that you're saying this. I didn't really make this connection before, but it kind of makes sense in this economy that we're living in, where we're so used to getting everything quickly right, Like fast food, amazon, and next day delivery. We're really used to quick meals, like heating up a frozen thing from Trader Joe's. We, as an American society, have become very impatient about healing and I think even when we get a cold right, like I know for myself, you and I both had a cold in the past week. Every day I was taking zinc, I was taking an emergency. I was like when can I end this right? 

Like, we have very little patients, and I'm definitely one of these people for these kinds of things. So I wonder if it's a thing where it's like oh, I have a yeast infection. I know what this is for sure, I'm just gonna go solve the problem. But, like we were talking about on vacation when we were talking about this, this can cause resistance to antibiotics and to other kinds of things that you may need to take in the future, where your body isn't really well equipped as well as it was before to handle that medication. 

0:23:26 - Dr. Rebecca Levy-Gantt

Right, and that can definitely be a timing issue. There aren't a lot of clinics that you can just walk into, maybe Planned Parenthood and some other places but it's hard to get the right diagnosis right away, and there's plenty of people online who say use my test kit or buy this from my website. I mean, this will fix your vagina, and I can tell you that I see a lot of people buy a lot of things and come back worse than they were before because they don't know what's in them. Yeah, we're gonna talk about that. We're gonna talk about that. 

0:23:58 - Danielle Bezalel

Okay, so let's get down with the deets on exactly what kinds of vaginal infections we're talking about. I'd love for you to talk through maybe three most common vaginal infections and conditions, as well as their symptoms, and before you do that, I found a recent-ish stat from the CDC that bacterial vaginosis is the most common cause of vaginal symptoms among women. It's not clear what role sexual activity plays in the development of BV. The prevalence in the US is estimated to be over 21 million among women ages 14 to 49. And that's almost 30% of women in that age group. So that's a lot. That's a huge number of people who are struggling with BV or who have had BV. 

0:24:44 - Dr. Rebecca Levy-Gantt

Right. The last statistic I read was actually 35% of people with vaginas at some point will have a BV infection. Okay, so just any age, basically. So let's talk first like terminology. So there's a lot of words going around like is it a vaginosis, is it vaginitis, is it inflammation? So just the term vaginitis, vaginitis itself, is anything with an itis is an inflammation. It could be an inflammation because of an infection, and BV or bacterial vaginosis is one of those infections that could give you vaginitis. But vaginitis is kind of the umbrella term and vaginitis is anything that causes you to have symptoms, anything that causes inflammation, anything that causes discharge, which is kind of the big umbrella term, and then figuring out what, among all the different things that it could be, is the job of the clinician and then to treat it properly. There also are a lot of, let's say, inflammatory conditions which don't have to do with infection at all, and that's an incredibly common thing, especially in the older population. 

I'll talk about just menopausal women for a minute. Many peri and postmenopausal women come in and they do have this copious it almost looks yellowish, green kind of discharge and they are 100% convinced that this is some horrible infection, and many of them are not sexually active and have not been sexually active in a very long time and when I was at the beginning of my training. Sometimes I would put a small speculum in there to take a look in the vagina and I would see this like copious, like lots of yellowish kind of discharge and I would think, wow, that is some bad infection and nine times out of 10, nothing grows out of it. But the culture swabs that I use not only checks for many different kinds of infections, it also checks to see if you've got the normal vaginal flora that is supposed to be in the vagina, and that's a large group of bacteria that are normal inhabitants of the vagina, which are lactobacillus species, and there are several different types of lactobacillus. If you don't have those in your vagina then you can't fight off infections, and not only can you have discharge just because you don't have the right lactobacillus and the vaginal tissue gets very dry and that dryness causes its own discharge. So not everything that looks like an infection is an infection, and I would say maybe about 40% of the time that somebody really thinks they had an infection and I culture and no infection comes out, but the culture that says whether or not they have the right lactobacillus says you're lacking all of them. 

I have to kind of flip the narrative instead of like, here's something to take for your infection, here's how you make your vaginal environment more healthy, bring back the lactobacillus for the long term and keep it that way so that you don't keep getting these discharge and episodes of discomfort back. So there's kind of the non-infectious things and the infectious things. So we're gonna talk mostly about what I see as a younger population and up to the age of perimenopause. Definitely those are infections, and the most common infections that we see are BV, which is bacterial vaginosis. There are many different species that are involved in that. I'm not gonna go into all the different names of them, but basically it's a group of bacteria that make BV Yeast infection, so candida, and there are also different types of Candida. 

I've been lucky enough through the years going through all the different tests that I have tried with different labs. I really have focused now on this one set of tests from this one lab that I use, where I can do any test that I want. As well as look at the presence or absence of these lactobacilli, we do look at the different types of species of yeast, because if someone comes up with a Candida infection or a yeast infection, that's not the typical yeast, which is usually something called Candida albicans. That's the most common, that's probably 90 percent of yeast infections. But there are other yeasts that can be inhabiting the vagina and will cause just as bad itching, discharge, all the symptoms and worse, because they're much rarer yeast species and are not treated by the typical yeast medications. If somebody just says I think I have a yeast infection, you've given the typical yeast medication, you may be treating a species of yeast that they don't even have. 

0:29:34 - Danielle Bezalel

You can only know what species with a swab. 

0:29:38 - Dr. Rebecca Levy-Gantt

Exactly. It's considered a nucleic acid test, where you're actually testing the genetics of the species so that you can identify it. I mean, there are a lot of other ways to test. When I was in training, we had a microscope in the office and you could actually take a swab, put it on a slide and with different kinds of reagents you can tell whether something looked more like BV or more like yeast. Not only don't I have a microscope I don't have the time to do that, even though it's a pretty good test but these nucleic acid tests are really the standard of care right now, where you actually check to see that the genetics, dna or the RNA of what you're looking for is actually there. 

0:30:18 - Danielle Bezalel

Okay, so essentially wait, did you name the third? 

0:30:22 - Dr. Rebecca Levy-Gantt

No, the third is a group that's just in the group of STI, so sexually transmitted infection. So I personally in my office don't see a lot of gonorrhea, but there is a lot of gonorrhea out there right now and especially resistant forms of gonorrhea in other clinics in other populations. But I do see chlamydia and I do see trichomonas. So that would be the group. 

0:30:51 - Danielle Bezalel

Isn't Trichomoniasis a parasitic STI? It's like an amoeba. 

0:34:13 - Dr. Rebecca Levy-Gantt

That is something really interesting to look at under the microscope, because you actually see it too. Moving little guys. 

0:34:21 - Danielle Bezalel

When I teach about STIs to middle schoolers, we go over that there's bacterial, viral and parasitic, and crabs isn't as talked about, but Trichomoniasis falls under the parasitic. It removes that. What are the differences between infections and conditions? What are some of the perpetual or chronic conditions that you see? 

0:34:53 - Dr. Rebecca Levy-Gantt

If you're looking at the infections, obviously most of them cause symptoms. I don't usually do a culture on somebody who's completely asymptomatic, unless somebody comes in and says I had a new partner or I had unprotected sex or I want to know that I'm negative for all of these sexually transmitted infections. If somebody's completely asymptomatic I wouldn't run tests like yeast and BV and all these other things, because the reason to run them is because they're symptomatic and you want to identify what is causing their symptoms so you can treat them. So if people come in symptomatic, the most common symptoms that I see are what makes people call us or say I really need to get in today or soon so that I can feel more comfortable. Pain, burning, discharge, odor, sometimes lesions, and usually that would be some kind of viral lesions, other things like painful intercourse, sometimes bleeding. That shouldn't be happening. So all of those things it's kind of the detective job to one. 

Take a really good history. When did it start? What are your symptoms? How long have they been going on? What do you feel? What do you see? Does it burn when you urinate? All those things. Then it's important to do a really good exam. Examine the skin. You look at the outer area, where the labia are, where the hairline is, then look at the skin of the inner labia, look around the opening to the vagina and then look inside the vagina, look at the cervix. Certain infections will make the cervix very red and what we call friable. I mean, does the person have an IUD? This is a big kind of controversy. When I trained the big answer, there was one answer to the question: do IUDs make people get more infections or are they more prone? And our answer was always no, has nothing to do with it. I'm not so sure now. 

0:36:52 - Danielle Bezalel

Oh interesting, Is there new science? 

0:36:54 - Dr. Rebecca Levy-Gantt

There's some literature that says maybe we can't find that that's the cause of it, but it's a string, you know, there's something called a biofilm which there can be like a film, that kind of forms on the string which attracts bacteria and then it protects that bacteria from being eradicated with whatever you want to try to use to get rid of it. So, and anecdotally, I never really tell somebody that, oh, if you have chronic bacterial dagenitis and you have an IUD, let's pull the IUD out and see if you're any better. But anecdotally, if people don't want the IUD in anymore or it was time to come out anyway, I have seen some people not all, but some people say, hey, now I don't have those infections anymore. So who knows, you know it could factor in. You know people who are having these chronic irritations or infections. 

0:37:47 - Danielle Bezalel

So, Interesting. Let's talk about drugstore shelves, because you kind of referenced this before and I think eventually today we're going to talk about what people can do to prevent recurring infections and what people can do to avoid them. But I think, before we get there, it's really important to both of us to expose really BS kinds of products on drugstore shelves that we shouldn't really be. You know that we should be talking about what people should know about. 

0:38:18 - Dr. Rebecca Levy-Gantt

As far as what people should buy or use. As far as products are concerned, I'm going to reference an article that came out in September of 2022 by one of my favorite GYN authors, Dr Jen Gunter. So she is practicing. 

0:38:37 - Danielle Bezalel

She, by the way, might be coming on my podcast at some point. Wow, yeah, yeah, that would be lovely. 

0:38:41 - Dr. Rebecca Levy-Gantt

Yeah, okay, keep going. So she's lovely. I mean, I read all of her stuff. I really like her and I believe, the same way that she does, like we, should be very adamant about people who are trying to sell us shit, you know, and tell us that you know your genital area is not fresh or smells bad and therefore you need these products to make it feel better. So you wrote an article that's called All So-Called Feminine Washes Are Trash. So, and that's a pretty large, you know, variety of things. But I really agree with her that a lot of things on the shelves that have perfume, that have dyes, that have things on the labels that say intimate freshness, smell like a spring shower. You know it all. You don't need to smell like anything that comes out of a box. 

The vagina, if it's healthy, is a self-cleaning oven and if you have the right lactobacillus, you should not have an odor. You should not have itchiness and burning. Many people want to use something to keep that area clean. Of course, the best thing is really just plain water. You know, while you're in the shower you can just rinse off in that area, pat dry, and that should be enough. If people want to use something, I feel like they should stay away from all the things that are hard selling, talking to you about how they will make you smell and feel better and you must use it ongoing to keep everything fresh. But people can use very gentle cleansers on the outside. You really should never stick anything inside the vagina that's designed to make it more clean, because it won't do that and will likely disrupt the pH or disrupt the natural environment of the vagina. 

So, you know, gentle cleansers dove like a gentle soap. It could be in a bar or in a liquid that you can use a little bit of and use it on the outside area and it has no perfume, no dye in it. That's fine. There are a couple of other things that she also mentions in her article that I also recommend to my patients something called sero-V. Those products are very gentle. You can get a gel that foams. You can get, you know, a liquid or a bar soap and also something called Eucerin. They make products that have like gentle cleansing or, you know, gentle ingredients in them that are not harmful, that will not destroy the skin surface and allow things to. You know, I see so many people that either shave or have, you know, hair issues where they'll get a folliculitis problem From like an ingrown hair. 

Yep, and a lot of it is because either vigorously cleaning or using product down there that doesn't belong and it gets into the hair follicles and then, you know, just like getting a pimple, it walls itself off, it becomes painful and you know they end up in my office needing to have some procedure done, or me telling them just, you know, warm, soak it. And then sometimes it becomes a bigger issue, like an infection. 

0:41:41 - Danielle Bezalel

So yeah, so, so, basically anything, be wary of anything that says like smell better, feel better, you need to wash your vagina because you don't. And I would love to transition to people who experience recurrent infections. Like, I think it's more common that and we didn't really talk about UTIs, but like UTIs are super common and can be really painful for people. You mentioned yeast infections and other infections you talked about, but how, like why do people get these recurring infections? What are, like, some of the most common reasons they get them? And is there anything that folks can be doing independently on their own that isn't necessarily like hey, prescribe me this medication, but more so like any lifestyle things or things that they should be doing in order to try to prevent this from recurring? 

0:42:33 - Dr. Rebecca Levy-Gantt

If they're currently symptomatic, like with any of these symptoms that we described, itching, burning, discharge, odor, anything like that is very important to get diagnosed and treated first. If I see people that you know it's a one time thing, they really haven't had this recurring, and we just treat them, then I don't tell them you need to be on some kind of lifetime correction for your vagina. But often, as you're describing, I'll see somebody and either cyclically, like every time they get their period, they end up having the same symptoms and thinking, oh, I have a recurrent yeast infection every month which it probably is not or they, every time they have sexual activity again they have the same issues with discharge burning, and you know a lot of people will come in and go. It's just not worth it for me to have sex anymore because every time I do I end up with an infection. Well, the answer is not giving up the sex, especially for me. I'm a kind of ecologist. I want people to have sex, have more sex, yeah, but you have to correct the environment of the vagina. So, of course, first treat any infection that's there and then, if they want to be on some kind of a plan that will help them to not get these recurrent infections again. I mean, I'm very evidence based so I can't really say take a probiotic, because there's not a lot of good evidence, there's no studies with double blind, random studies that say any particular probiotic is any better than another one with large populations of women. But we do know that the vaginal pH is supposed to be pretty low and that is kept low and healthy by these lactic acid acidophilus bacteria, these lactobacillus that produce the acid that keeps the vaginal pH low. If you have the lactobacilli and your pH stays low, that's a good way to fight chronic infections. But there's a lot of things at work to destroy that pH. Because what's the pH of blood? It's high. What's the pH of semen? It's high. So no wonder after a period or after sex people feel like they're getting these chronic infections back. 

So there certainly are products that and most of them are made with something called hyaluronic acid, which is the same product that older people like me use on our wrinkles. And what does it do? It brings more moisture, it plumps it up, it treats skin or the vagina. That's where it's dry or the pH is too high and it brings it back down. So there are several different products that don't have perfume in them and don't, you know, make you smell like a flower, but they're just hyaluronic acid products. And, if your listeners are interested, there are a few that I use in my office because I do have samples of them and I give them to patients to see if this would be something that they would like to use, because it comes in gel, it comes in a suppository, it comes in a cream, but the basic ingredient is still hyaluronic acid. Some people feel like they want it with a little kind of oily base, or some people say the cream is too messy or something like that. So I recommend trying some different products that all have this hyaluronic acid as its base and see what works best for you. 

And I'm not saying people should put that in every day, but I have kind of two ways that I advise people to use that kind of a product, which is if you're somebody who's had chronic infections I've treated you now three times for something that's shown up on my cultures and we've treated it. 

As soon as the treatment is over, then go to using one of these products like twice a week or three times a week at bedtime, so that it gets the vaginal pH back to where it needs to be, or sometimes whatever the inciting thing is, that will make the pH go higher and make them symptomatic right after your period finishes. 

Use one suppository right then so it kind of combats what's causing the pH to rise and brings it back down. I have some people that keep them on their bedside night table right after sex. You know, I mean, you know how some people say you gotta get up and pee right after sex or you have to go wash right after sex. You don't have to wash. Sex does not inherently make you unclean or something. But if you find that for you personally, right after sex or, of course, unprotected sex, where there's actually semen in the area that will change the pH I have so many women who now, right after sex, just insert a suppository that has hyaluronic acid in it and they're done. And this is their plan and it's never my plan to say you must come back every month so I can cure your chronic infections. I don't want that. I want them to be able to do something on their own. I see the cat behind you with ears picking up. 

0:47:30 - Danielle Bezalel

Don't worry, she's just doing her thing. 

0:47:33 - Dr. Rebecca Levy-Gantt

So anyway, speaking of cats, anyway it's nice. But that's the kind of thing where you know where I love kind of having a relationship with the patient, where she can write me a message through my patient portal or she can call me and say I'm using this not really working for me, what else can I do? But the general idea is to get your lactobacillus back in there. And for some people we've tried all the products, we try so many different things and they keep coming back with this problem and with no lactobacillus. In extreme situations I will have a compounding pharmacy, make up some special suppositories and it's usually some older women who are, like, also lacking in estrogen, because estrogen also helps you bring back the lactobacillus. So if it seems like just an atrophy issue or a dryness issue, using estrogen will help bring those lactobacillus back. But if that's not even working, there's a product that it can use that has estrogen along with lactobacilli like actual acidophilus, which allows the normal flora to regrow and it recognizes and repopulates and they feel better. 

0:48:46 - Danielle Bezalel

Do you feel like people, like women, have always had these issues, like for centuries? Or are the things that were consuming and like our bodies, like more prone to these kinds of infections? What do you think about it? Like, has that always been happening and just women have just been like suffering through these things, or what is it? 

0:49:10 - Dr. Rebecca Levy-Gantt

I think what you said about people wanting to have a solution and an answer, like right away. There's no shortage of people out there online on the shelves, you know, saying do you feel like this? That's not right, do this, use this, wipe it with this, put this in there, and because those are snakes, oil what gets the loudest. 

Yeah, it gets the loudest volume. It gets loudest in your face, in your ears. You know people listen to that and go hey, you know I do have like a little bit of white discharge, should I not? Do I need to eradicate that with something? I mean, the best person to ask whether your discharge is something that looks normal is your doctor. 

Go let someone examine you because I would say in a percentage of people they're complaining. I'm looking and going. I see a normal cervix. I see normal looking ovulatory discharge. You know there's some discharge that goes along with just normal ovulation and sometimes just the reassurance is good. But if someone's uncomfortable there are things that you can help them do to get more comfortable. But I'm certainly not going to be treating things that don't exist Right. 

0:50:12 - Danielle Bezalel

It's tricky. I feel like I've been there, where I've been, like oh, I have these symptoms and like nothing I'm doing is working, and that can be really challenging for people, especially for chronic conditions or things that keep repeating. I know for some people who have a lot of sex, like them having recurring yeast infections, like you said, people coming in and being like it's almost not worth it, like the amount of pain and annoyance that I get afterwards feels so frustrating. 

So if you're listening and that's you, be a little patient, like know that you're not alone. A lot of people suffer from this and it's way more common than we think and maybe chat with your healthcare professional about, like you know, the list of options that you can try and what you know and your plan to try to figure out how you can combat it. 

0:51:02 - Dr. Rebecca Levy-Gantt

Yeah, and the website that people should look to for the right information. I love the CDC website. They do have good information on many different infections BV, yeast infections, STIs. One little plug I'm going to give that I didn't mention is that there is another bacteria that could live in the vagina in small amounts, something called mycoplasma or ureaplasma. These are other things that we don't go hunting for. 

I don't swab people for these unusual things and say, ah, you have this, we must treat you. But if somebody comes in and they're having discharge that looks unusual, not normal looking discharge, the pH is too high and I swab. I may swab from some atypical bacteria sometimes and I can't say that I have all the studies to say that this particular bacteria, like ureaplasma, is the cause of all your symptoms. But if you see somebody and they have this kind of discharge and you get this atypical bacteria on your culture and you treat them for it and actually something like mycoplasma and ureaplasma, we do recommend even the treating the partner because, even though it's not an STI, because the difference between an STI and all these other things are things that you pick up on an STI screen, are things that should never naturally be. There's no natural gonorrhea that grows in your vagina, so, but there are things that can be passed back and forth between people, but they're also natural inhabitants of the vagina in small amounts. So we do recommend sometimes treating a partner with something like that, but not like yeast. 

A lot of people come in and go, did I? Am I getting this yeast for my partner? And I'm like, well, does he have a huge jock itch that he's scratching all the time and then touching your skin with his skin and, yes, it's into skin contact. But are you getting yeast because he's giving you yeast somehow? No, and I do want to also put a plug in for if you are having chronic things that look like yeast, always, always other workups there are to be done, like people should be checked for diabetes, People should be checked to see if they have autoimmune conditions. 

You know these are down the road, but they are things that you have to think about. Somebody can't come in 10 times and be treated for yeast 10 times and nobody said what's your blood sugar doing, you know. So that is another benefit of having some kind of relationship with a doctor or, you know, nurse practitioner or somebody that can look over time at your history and see what's most likely to be happening. If I see a menopausal woman come in and their complaint is something vaginal if they're not using any estrogen or hormone replacement or anything vaginal it's almost always vaginal dryness first that's causing the pain and the discomfort and you know the symptoms that they're having. So you go there. It's an infection all the time. 

0:53:48 - Danielle Bezalel

Yeah, and yeah, like things can shift and change as you get older and your body reacts differently to different things and different partners. Like you said, different semen. You know if you're having sex with one person and their semen is a different pH and affects your vagina differently, you know you're someone who may want to consider like, instead of letting the semen go inside of you, like using a condom or whatever is like helpful for you at that time, because you shouldn't be in pain and you shouldn't be frustrated with how you're feeling and it should feel good generally and also, I do find a lot that sometimes women are not really aware of the architecture down there, like I definitely have had people come in and go oh, that mole, it's been there forever. 

0:54:36 - Dr. Rebecca Levy-Gantt

You know, and I know we're not really talking about skin conditions here, but this is the benefit of having somebody look, because at least three times in the past year that I can think of, somebody kind of just told me something was there, or I noted it on an exam, did a biopsy of it and it turned out to be something that really would have been bad had we just left it alone. You know, like pre-cancers, I had one person with a cancer that didn't look like cancer to me, it looked like a birthmark, but I said you know, that's kind of new, it looks like that off. So you know, it is just like it's good to have a dermatology exam where they do a skin check, because there's areas that you don't see. For most people, the vulva is not a sun-exposed area, you know. So for things to be there that don't belong there, or that crop up that are new or growing, always a good thing for somebody to take a look at, other than your partner, who probably doesn't know. 

0:55:29 - Danielle Bezalel

Their doctor. Well, this has been really really insightful and really fantastic. It's always great to have you on the podcast, mom, why don't you tell everyone what's next for you? Where can people find you and where can they buy your two really great books? 

0:55:48 - Dr. Rebecca Levy-Gantt

Okay, I did want to, if it's okay with you, mentioned some of the products, the hyaluronic Sure products. I'm not endorsing any one particular, but these are ones that have the base of hyaluronic acid in them and one's a gel, one's a cream and one is a suppository. So there is something called hyaluronic, so that's H-Y-A-L-O G-Y-N and the website for that is that name calm, and that's a gel of hyaluronic acid. There is something called via, which is the IA, that's a cream, and the website for that is something called soul wellness, soul wellness, calm. And then there is a suppository called reverie, and that comes from Company called bona fide, and the website is hello, bona fide, calm. So those are just three choices. 

And then what's next for me? Well, now that I won't be really delivering any babies anymore, my office practice will go on. It will be Just a gynecology practice, which I'm doing a lot anyway. So I will be seeing lots of menopausal women, perimenopausal women and younger women for birth control. I put in a lot of IUDs, we do a lot of next plan on, so I will be very busy in that part of the practice. I also will still see people who are trying to get pregnant and I can help them with some kind of Evaluation or fertility management up to a certain point. I'm not a fertility expert but also, you know, contraception and STI testing and anything that women and girls need through the spectrum. It's been a really interesting year because I do have a nurse practitioner you know my lovely nurse practitioner, lily, who works with me, and she has been out because she had some surgery for a couple of months now and she has a kind of a large following of young ladies that she sees, so teenagers and young 20 year olds, and I mostly was seeing the pregnant people, but also the older population, and now that she's been out I've been seeing everybody so I get to see the widest spectrum of Gynecology care that could possibly be. Like I said, the youngest, 14 or so. I just had a patient who I take care of, who said I need to bring my daughter to you. She is 15 and I think she's about to have sex and I'm like I'm all for it. You know we talk about consent, we talk about, you know, contraception, everything. So I love all of that. So I'll be continuing to do all of that. I Don't think I'll be waking up at night anymore because I don't think that I don't think those constitute emergencies, so that will be really good. 

I have written two books. One is called womb with a view and it's actually selling pretty well on Amazon so you could get it there. And the other one is called motherhood medicine and me and that is a collection of stories not only from the trenches of OB care and gynecology care, but that also has the stories of my own deliveries and my own obstetrical care and Of course, one of them is you. I Remember David Lee, yeah, and the other really big thing that I'm doing now which I'm actually focusing major parts of my attention and time on, is I am writing a Book that's going to be out in probably November or December and it is called Perry menopause for dummies and that is from a collection of the dummies books, those yellow books that everybody probably knows, or major has one on their shelf and that company approached me To write that book for them and I am in the latter half of that process and it's very exciting, very Pressuring and I'm great, though I love to write, so that's that's pretty much what I've been doing. 

0:59:44 - Danielle Bezalel

Can't wait to continue to Support you and can't wait till your dummies book comes out. I will Read it cover to cover pretty quickly and then tell everyone I know about it. 

0:59:56 - Dr. Rebecca Levy-Gantt

And the one most important thing that I'm gonna be doing over the course of the next year, I hope, is helping you plan your wedding. Yes, you are. 

1:00:06 - Danielle Bezalel

Yep, my partner and I, my fiance and I, are getting married In a year, almost so we're yeah, I'm really really excited about that. Still got to buy my dress, still got to do a lot of good things and, yeah, definitely need your help with that. 

1:00:22 - Dr. Rebecca Levy-Gantt

So very excited that you wanted and I happen to have more free time now. Yes, you do. 

1:00:28 - Danielle Bezalel

Well, I'm again, mom, really proud of you. What a special day that we got to interview you on, at the end of part of your career journey and continuing on a whole new chapter. Thank you for being on. I love you so much. I love you too, and I'm very proud of you as well. Thanks, mom. 

1:00:48 - Dr. Rebecca Levy-Gantt

Okay, love you, bye.