Understanding Vaginal Health: ,Interview with Beth DuPriest PhD

After having several chats, and getting several emails via peter@healthypostnatalbody.com asking about vaginal health this month I wanted to bring you this interview I did with Beth DuPriest PhD

Vaginal health expert Dr. Beth DuPriest, is the Chief Science Officer at Vaginal Biome Science

Dr. DuPriest is a former Professor of Biology and Division Dean and has been involved in research related to developmental origins of health and disease for over twenty years. 

Her PhD in Integrated Biomedical Sciences through the Dept. of Physiology & Pharmacology and post doctoral work through the Dept. of Pathology were completed at Oregon Health & Science University (OHSU). Her work has been focused on both women’s and maternal health.

She has taught courses in microbiology, eukaryotic cell biology, genetics, biochemistry and pathophysiology among many others. She brings a broad background in women’s health and biological science and strong leadership and collaborative skills to advancing the work and discovery of vaginal microbiome science. 

Beth has spent over a decade researching and teaching about women’s vaginal and maternal health, now running clinical studies to test how improving the vaginal microbiome can improve a wide variety of vulvovaginal conditions 

We are talking everything to do with vaginal health.

Why vaginal health matters much more than people think it does.
Whether you should use special soap or not
How taking care of your vaginal area improves your overall health, and the possible consequences of not taking care of it.
The vaginal biome.
UTI infections and how the vaginal biome ties in with this.
How much of a shame it is that women's health is soo ridiculously underfunded and the massive impact that has on women's health overall.

And much, MUCH, more

This is one of the most enjoyable, and informative, chats I've had in a long time and it'd be a shame to miss it!

You can find some products that Dr DuPriest recommends here

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Email peter@healthypostnatalbody.com if you have any questions, comments or want to suggest a guest/topic    

Transcript

Peter: 0:00

Hey, welcome to the L Postnatal Body Podcast with your postnatal expert, peter Lap. That, as always, would be me. This is a podcast for the 9th of June 2024. And this week I had some conversations with people and had some emails over the last few weeks talking about vaginal health and you know that is something I am not an expert in, but I know the person who is. I did an interview with Dr Beth DuPriest last year, very, very early last year. She's a chief science officer at Vaginal Biome Science, former professor of biology and division dean, all that sort of stuff. She has a PhD in integrated biomedical sciences and basically you're not going to find someone who's more qualified to talk about vaginal health than, uh, than dr DuPriest priest. Um, We're we're talking why vaginal health matters, whether you should need to use special soap, the vaginal biome, u uh, urinary tract infections, how to take care of your vaginal area, how, how it, how it improves your overall health and the possible consequences of not doing it and all that. You're gonna love this episode. It is mind blowing how good dr de priest really is. So, without further ado, here we go. The most basic of questions why does vaginal health matter?

Dr DuPriest: 1:44

Yeah, vaginal health matters for a couple different reasons. The way I think about it, there are two broad categories here and the first is just for a woman's health and the second is for maternal health. So for a woman's health, the reason vaginal health matters is because, number one, when you have vaginal infections it is just super, really uncomfortable. You know the quality of life when you have vaginal infections. It is just super, really uncomfortable. You know just the quality of life suffers if you have discharge and odor and itching and burning and all of those kinds of things that women deal with.

Peter: 2:14

that, quite frankly, men don't you know, in a lot of ways.

Dr DuPriest: 2:18

So, just from the amount of suffering that women have to deal with, vaginal health is really important. Um, also in that category. Um, the healthier your vaginal tissues are, the less susceptible to infection you are, and so that that relates to sexually transmitted infections, but it also then translates to maternal health, where, um, you're less likely to have maternal infections, the baby's less likely to have infections, uh, and the healthier the vagina, the healthier the pregnancy and the baby.

Peter: 2:48

Because that's an interesting part, because that kind of takes me to one of the first things one of my listeners mentioned. When I said that I'd be having a child, she said does it really matter? Is the difference between having a C-section and having a vaginal birth really as big as people say it is? Now, with regards to the health of the baby, yeah, that is just a big undetermined question.

Dr DuPriest: 3:13

So clearly there are some differences that happen. The colonization of the baby that happens during a vaginal birth just doesn't happen during a C-section. Colonization of the baby that happens during a vaginal birth just doesn't happen during a c-section and there are studies that show that that changes the baby's immune system early on in life. Um, the research I did before is in the area called developmental origins of health and disease, and so that talks about how critical, critical windows of development can set you up permanently for health or disease later, later online. And so there's this theory and it's, you know, it's a great well-supported theory that the way your immune system develops during that first 30 days after birth because of this, this vaginal inoculation, that that can actually set a baby's immune system up for the rest of their life. But right now that's a theoretical concern and we just don't have the data because we just haven't known about this long enough to do those really long term studies.

Peter: 4:09

Yeah, and it takes. It takes a fair while, and we know that with most studies to do with women's health and I'm sure we'll catch on this, get onto this a little bit there they're not, as they don't tend to be, as well funded, right, let's say. I mean, I would throw the opposite of female studies, for some reason studies into feminine health and female health. Is it not catchy enough to get the funding? Is that what it is?

Dr DuPriest: 4:40

Well, you know, it depends on who you ask what the reasons are. Is it not catchy enough? You know some people will say that it's misogyny and that's probably part of it, but I think the other piece of it is a lot of our health care dollars are focused on morbidity. So what kills people? And we're not as interested in quality of life, we're not interested in suffering. As long as you live, live it doesn't matter for suffering like have all the utis, have all the bv.

Dr DuPriest: 5:08

You know that's fine as long as you're alive, and that's you know people might argue with that, but you know we want to live well, we don't just want to live a long time, right, so, and so I think that's a piece, because a lot of these infections are not necessarily deadly, except in certain circumstances, and so they get ignored.

Peter: 5:29

Yeah, that makes complete sense and that is something that I know drives me nuts and drives most healthcare professionals absolutely up the wall. I did an interview a while ago with someone I can't remember Jade and Tim, I think their name were doctors. There were doctors in America and they explained how the funding system worked within the insurance company that they used to work for. With regards to how you make money and there is no money in illness prevention, there isn't as much money. It saves a ton of money down the road.

Dr DuPriest: 5:59

Exactly, but you can't quantify it. You can't count how many diseases didn't happen because something happened, right? So if you can't quantify it, you can't count how many diseases didn't happen because something happened right?

Peter: 6:06

No, so if you can't, quantify it.

Dr DuPriest: 6:08

They don't pay for it.

Peter: 6:09

No, exactly, and that's the tricky bit. So because one of the questions that I was asked, because you hear a lot about the microbiome at the moment I did an interview with Dr Jürgen Weimarma for those who have been listening for a while, I think it was a 60, 70 episodes ago um, who has a phd in skin biome and all that sort of interesting stuff, um, but he didn't. He immediately said but I'm not that familiar with the vaginal microbiome right, he just went.

Peter: 6:44

that is not my area of expertise, and that's why I love people with PhDs, because they just go no, that's not my, that's not my drawer, Whereas everybody who doesn't know anything just goes. I'm an expert in everything, Right. So but what? Because what one of the questions asked was so if you're having this, do you so? If you're having a C-section, and apparently they're now selling these treatments and I'm not sure how legit they are that you can have a C-section but find a way, through pill form or smears or whatever it is, to give your biomeome, your vaginal biome, to the baby and to see if that works. And should people be paying for that? Because everything in america.

Dr DuPriest: 7:32

Everything you need to pay for everything well, right, yeah, um, should people be paying for that? You know, I I don't know. My understanding is that the fda is cautioning people against doing that because the data just aren't there yet. And you know, I think it's a valid question when you consider that, at any given point in time, 29% of women in the US have bacterial vaginosis, about 30% have an intermediate which is not a super healthy vaginal biome, and only about a third have super healthy vaginal biome and only about a third have a healthy vaginal biome. If you don't know if you have a healthy vaginal biome or not, do you really want to be inoculating your baby with what might not be a healthy biome?

Dr DuPriest: 8:13

Right and so that's, I think, what you need to consider, like, if you know you have a healthy biome, maybe it's okay, but if you have an unhealthy biome, do you really want to have that be your first exposure to your baby? So, and you know, obviously it happens with vaginal births all the time, but at least you know that's a known thing where this is totally experimental. So you know, I, I kind of are on the side of caution no cool.

Peter: 8:36

I mean that's and I'm just like I said before, I'm just asking the questions, right and that makes sense to me. So what is bacterial vaginosis really? Uh, because I'm like, like you said, a lot of women have it, but they don't necessarily know that they have it. They don't. It doesn't go diagnosed all that often, or exactly it gets undiagnosed. So I'm thinking most women just don't know what it is exactly.

Dr DuPriest: 9:01

Well, there's partly where women don't know what it is, but it's also that very often it's asymptomatic.

Dr DuPriest: 9:08

So what BV is is what we call it as scientists it's a polymicrobial condition meaning that there are lots and lots of different species of bacteria present in the vagina that just shouldn't be there. So in a healthy vagina you have pretty much one species that will dominate, and it's usually a species of Lactobacillus. So it might be Lactobacillus crispatus or it might be Lactobacillus gasseri or Lactobacillus jensenii. Those are the most common healthy species and you generally have like 90 plus percent of one of those would be a healthy vaginal microbiome. In bv. Those are at very low levels, um, and then you have high levels of lots of other anaerobic pathogens like gardenerilla vaginalis, atopopium vaginae, prevotella bivia all sorts of different species. But you have lots and lots and lots of different species. So that's why we say it's polymicrobial.

Dr DuPriest: 10:03

And so in a woman who has symptoms, the symptoms of bb can include a discharge. It has an odor that people describe as fishy, based on amines or aminos that are present, and you end up having lots of. If a doctor does a vaginal smear, takes, takes some vaginal fluid and puts on a microscope slide and looks at it, you can see the vaginal cells that are just coated with bacteria, with the wrong bacteria, and then. So those are some signs. Oh, and then the vaginal pH becomes elevated in BV also, so it gets up above 4.5, whereas a healthy pH is 3.5 to 4.5 or so. So those are kind of the clinical signs and symptoms of BV, but not every woman has all of them. Some women have BV without having any symptoms. So we really haven't even figured out as a scientific community why some women have symptoms and others don't.

Peter: 11:00

Okay, so should women get tested for this, and especially people listening to this who are prenatal or thinking about having kids and they're just having that whole C-section vaginal birthing that we were talking about?

Dr DuPriest: 11:15

So for women who are planning pregnancy, I would say absolutely, get tested if you're having symptoms especially. But even if you're not having symptoms, a good obstetrician should be testing, I think. And that is because BV is associated with almost every kind of adverse pregnancy outcome you can think of. It's associated with infertility, it's associated with miscarriage, it's associated with chorioamnionitis, you know, maternal infections, endometritis, so all of these things, the risk of those is elevated when you have BV, whether it's symptomatic or not.

Dr DuPriest: 11:57

And so the current standard of care in the US, what the CDC recommends is that pregnant women with BV should be treated with antibiotics whether or not they have symptoms. Now, for women who are not considering getting pregnant, that's a different question. If a woman is symptomatic, sure go get treated. If you're not symptomatic I don't know that we currently have I don't think there's any benefit to screening at a doctor's office just to if. If you're curious, because the only tools currently available to treat bb are antibiotics and the risk benefit or the benefit risk ratio is just really off to give someone who has no symptoms antibiotics, right it just um.

Peter: 12:37

You're not going to give a woman who has no symptoms antibiotics because it's too risky oh yeah, absolutely, and especially with the whole um the problem of of antibiotic resistance and all that sort of stuff you don't want to throw antibiotics at anything.

Dr DuPriest: 12:52

So, you know, as new tools come available on the market that are not antibiotic based, at that point then it makes a lot of sense to start doing more screening and start asking the question can we help women who are asymptomatic with bb get a healthier vaginal microbiome? And so those are some of the studies that we're we're working on now is to try to figure out if we can improve women's microbiomes yeah.

Peter: 13:15

So because again, for uh, bacterial vaginosis there is no, there's no long-term cure. As kitty snores in the background, by the way, for all the everybody listening, I'll tell her, I'll turn her off. It's not me, it's not me, it's not beth, it's not myself, it's just dinky snoring because she's fat um.

Dr DuPriest: 13:35

So because there is no cure for bv, is there for um well, antibiotics should be a cure, um, but it fails so much of the time, so right. So if a woman takes metronidazole or clindamycin, 70% of the time she's not going to reach a clinical cure. But even if she does, for 70% of women within a year they'll have another episode of BV, and it's 43% within three months we'll have a recurrence. So there are women who are just constantly, constantly on cycles of antibiotics after antibiotics, after antibiotics and it's not every woman with BV who does that, but there are a lot of women who are just kind of constantly cycling through antibiotics to try to get rid of BV.

Peter: 14:17

Yeah, so what? Because this is an interesting image. I mean, there's many interesting things. So first of all, you mentioned vaginal pH, and that kind of takes me to the next question that I always wondered about, and I asked Dr Varma about this and he said he doesn't know. Should women be using different soap for their private parts than they use for their arms and their face?

Dr DuPriest: 14:47

Yeah, that's a great question and I think you'll get several different answers depending on who you ask. My opinion on this is that the soap you use in the genital area should be matched in terms of pH. It should be very, very gentle and not drying, and it should be safe for the lactobacilli, which are the healthy vaginal species. So there are some products out there on the market that match those characteristics. But you know, bar soap is not a good thing to be using. It's really harsh, it's drying, it disrupts the intercellular connections between cells and so it's really not good for very delicate tissue.

Dr DuPriest: 15:37

Now, the reason I say it depends on who you ask is there are a lot of women's health experts out there who will say that women shouldn't use any cleansing at all.

Dr DuPriest: 15:49

And I don't go that far personally, because when you consider all the different substances that the vulva is exposed to it's menstrual blood, it's semen, it's urine and feces and sweat and it's not just like the regular sweat on your forearms, it's the same kind of sweat you have in your armpits and it's this oily sweat. Water doesn't cut it. So I think you know, if you're a healthcare practitioner telling women only use water, they're just going to ignore you and go use bar soap. So I'd rather you give them an option that's you know the right pH, safe for lactobacilli and gentle, and have them use that product, than tell them that water is going to do a good job. And in fact in America ACOG says only use water. But there are other colleges of obstetrics and gynecology in other parts of the world that say using water alone is drying to the skin because of the osmotic properties. And so you know there's disagreement even among experts in different different countries. So I'm a proponent of using a gentle, intimate wash all right, cool.

Peter: 16:55

so that is the answer we're obviously going to go with, because you know much more about this stuff. And also, I think it's interesting when you mention um baycock and all those organizations and the same in the uk with regards to the National Health Service and all that sort of stuff. These organizations tend not to be, as, let's say, at the forefront of cutting edge science, as some other people might be. As in science takes time, it does. It takes a long time, like you said. With regards to the studies into C-sections versus vaginal birth, yeah, you're looking at 16, 20 years. You're looking at loads of. You need a decent amount of numbers and all that sort of stuff, and even then, results with regards to big organizations take a while to filter through. So we know, for instance, that in the UK the NHS is like 20 years behind the times on many things, as most doctors and scientists will tell you, and that's because it's an institution that every process has to be changed and it has to be run.

Dr DuPriest: 18:01

Documented Exactly.

Peter: 18:03

And there are just rules and procedures. There's nothing wrong with doing it that way In fact, it's probably the only way to do it if you run a big organization, right? But it does mean that people like yourself, who are more at the forefront of actually performing these things, tend to have slightly different opinions than, say, the, the organizational body exactly, exactly right.

Dr DuPriest: 18:31

So so those of us who are actually doing the research, um tend to hear things sooner than the rest of the public. So, uh, you know, we go to conferences, we talk to other professionals, we hear what they're working on, um, so our, our opinions might, might be a little ahead of schedule.

Peter: 18:47

I think that's a much better and much more succinct way of putting what I just spent five minutes trying to get out of my mouth.

Peter: 18:54

Yeah, it's all good I'm just because I always like to like to point that out to to people listening to the podcast. That is why, when I speak to experts in the field, and this is why I filter out a tremendous amount of people that I just have like books to sell that don't make any sense or products to sell that don't really stack up. But that's why I was, because they inevitably get emails in from people saying, ah, but the NHS says, or this organization says, I'm just going to, yeah, but that is because these things take a bit of time to filter through. That doesn't mean you should believe every quack out there that says, right, because that is probably something you come across a lot as well. Sure, but when you really know what you're talking about and this is kind of what you do for a living how many books do you get sent? Or questions that you get sent but people that say, oh, this is one, the product is out there now and this is what we should be buying, and all that sort of stuff.

Dr DuPriest: 19:57

You know. So I'm actually fairly new to the vaginal microbiome space, and so I I'm, I'm learning myself.

Dr DuPriest: 20:04

I came through the developmental origins um background so I've been in vaginal biome for about a year and a half, so I'm I'm just learning myself what all is out there. But you know, I last week I was looking at a bunch of different vulvar products and, oh my gosh, kind of the insane things are out there, like people putting herbs and flowers and like you don't need all that stuff, like, um, so vaginal care is actually really simple. It's really simple like there's. There's not really any magic to it. You want the right ph, you want to make sure that the whatever products you're using are not hyper osmolar, so they're not going to dry out the vaginal tissue.

Dr DuPriest: 20:45

Uh, lactic acid is a good ingredient to to get the acidity that you want. Uh, and that's, that's kind of those are the magical keys. And they're not really, they're not a secret. They're out there everywhere. Um, and so people who are trying to do all of these fancy fancy things with herbs and flowers and like it's just not necessary, it's really not necessary. So, um, so yeah, but the other thing, I I don't want to let this go too too far.

Dr DuPriest: 21:14

You know we're talking about like expert expert opinion and I just want to make sure that I point out that not every expert opinion means it's right. We're really well informed, but the space that scientists work in is in the testing, a hypothesis space, and so we can have this great idea, but once you do the test it turns out it's wrong. So I have a mentor, the chair of my dissertation committee, and he's a world-renowned scientist and he told me once that he's only right 50 of the time on his hypotheses. You know. So, like if, if, that's if, that's the bar. Like you, you definitely have to be careful listening to scientific opinion.

Peter: 21:53

Um, and this is why you know the national health society or the fda or the cdc here in the us, like they are behind, because they're making sure that when they put out a recommendation, that they know that it is solid, that there is evidence for it, right, so yeah, I did an interview and this for people listening to this the one I did which came out on the 1st of January I'm recording this a bit ahead of time With Anthony Lowe, who is like one of the biggest deals in Australia with regards to diastasis, recti and all that sort of stuff. Like he said, appealing to authority in itself is an issue, right, Just because someone has a PhD doesn't necessarily mean that what they're saying is right, even if their motives are completely uh exactly and sound because exactly.

Dr DuPriest: 22:50

I mean, and you know we've seen this, not to get too far off topic, but the the public has had, you know, a front row seat to seeing how science is done with the whole covid epidemic, and they've seen how chaotic it is when government tries to make policy when the science isn't settled yet, right, and that is the reason for the back and forth on masks and vaccines and this and that, and the public is left being really confused, rightly so, because the science just isn't settled yet, you know, and science takes a long time to really figure out what the real answer is. And science takes a long time to really figure out what the real answer is. So I just put that out there just because, number one, to help people understand COVID and science and why it's been so chaotic. But secondly, because that is the scientific process. It is back and forth and it is experts disagreeing with each other for valid reasons, right, until, over years, data comes in.

Peter: 23:41

Yeah, exactly, and that is what I always. The thing I think is nice when talking to scientists is, like you said, they disagree for valid reasons. They're not just point scoring, they're just going with the. Are you sure this is right? Because when I looked at it it was something else, and then oh, well, damn, turns out that was wrong and that is completely different from, let's say, the way other people debate things. Sure, sure.

Dr DuPriest: 24:09

That's a diplomatic way to say it. Yeah, exactly.

Peter: 24:12

It's a nicer way to put it, but you know, in the meantime, it still makes sense to listen to the experts over people who have no idea what they're talking about. Yes, people who have no idea what they're talking about. Yes, so when you said earlier on, you said that a healthy vagina biome is made up of 90% of the same lactobacilli, right, and you mentioned three or four different kinds. People know which kind they're because I know I'm going to get that question.

Dr DuPriest: 24:49

It doesn't matter which one you have. At this point in time we don't even know enough about how Lactobacillus crispatus is different from Lactobacillus gasseri or Ginsenii to know what functional differences they have differences they have or if some people do better with one and other people do better with another. We just know that a lot of women have crispotis and some women have gassery and some women have ginseni, but they all are healthy if they have those as their dominant species. So I don't think at this point is particularly useful for anyone to know which one they have.

Dr DuPriest: 25:20

It's more useful to know if you have bv or not um yeah, um, and but you know there are these direct-to-consumer at-home kits that that you can get if you're curious about what your vaginal microbiome is, and you know so, if. If you're. You know, some of us just like data and we just like knowing about our bodies and we, you know, we might want to do that. But but the thing, if anyone is interested in that, what's important to understand is that the vaginal microbiome changes so quickly from day to day, depending on what you're exposed to.

Dr DuPriest: 25:53

If you go through your period, it's going to change for a few days and usually goes back, but it doesn't always. Or if you have sex it's going to change. Or if you go swimming it might change, you know. And so anytime you do one of those measurements, it is a snapshot on that specific moment. That that's what your results looked like, but if you did the swab the next day, they could look very different. So so you just have to kind of understand that it's not a permanent state. It changes all the time cool.

Peter: 26:22

So that then answers my next question, because what most people, uh, will obviously do is, when they figure out, say what's their main. Um, I like to say is the first thing people tend to do these days is think oh, that means I need to buy different stuff because we have too much money in the West and therefore we immediately go onto Amazon. What?

Peter: 26:45

can I burn my money on yes, exactly how can I spend this and I'm sure and I haven't looked this up, but I'll finish it If I go onto Amazon, I can find some sort of probiotic specific for whatever lactobacilli you happen to. Should people be buying probiotics at all? I mean, I'm a big fan of kefir and all that sort of stuff for the gut biome and it makes me feel nice, but does it help for?

Dr DuPriest: 27:15

your vaginal microbiome, so that is a question that is not yet settled by science. There are quite a few studies out there that are small studies, not particularly robust, that do show a benefit of using vaginal probiotics, but there are also studies that show no benefit. I'm not aware of any studies that have shown any harm, though, and so for me, if you I my perspective is if you do a vaginal biome test and, um, you're not having any symptoms and you're not planning pregnancy or anything like that, I don't think it's worth using a suppository to try to fix whatever imaginary problem you have. If you're having symptoms and you can't get relief, or you've tried multiple rounds of antibiotics and you're still having recurrences, those are the women I think're going to benefit the most from trying a probiotic or a vaginal care system or something like that yeah, because that is um, because that tends to be the first and I'm very much.

Peter: 28:14

It's the same with regards to the, the gut biome and probiotics. I always tell people listen, the, the science is, it's iffy at best, but it makes me feel. So I take kefir and I don't tell you what to buy. I'm just saying this is what I take, whether you have kombucha or kefir or kimchi or whatever.

Dr DuPriest: 28:31

Yeah, I would say for vaginal probiotics, depositories or oral capsules. Most of the products that are out there right now are strains that really were developed for the gut microbiome. Yeah, so you'll see lactobacillus acidophilus or rhamnosus or salivarius. If you're into the gut microbiome, you might recognize some of those, but most of them don't have crispotis, ginseng and gasseri. So if you can find a product that has that has those three, you know, I think that's good. I also am a fan of combinations because, as I said earlier, like some women have a lot of crispata, but other women are dominated by gassery or ginseng, and we don't know yet why some women have this one versus that one, know yet why some women have this one versus that one, and so I think it. You know, if you're going to use a suppository, using one that has a blend makes the most sense, because you just don't know if your body's going to match up with one or the other better at this point, without any data, that's the way I'm guessing.

Peter: 29:36

Yeah, and then, especially when you're talking about how it changes quickly and and all that stuff, you just throw everything at the problem see what sticks, so to speak. Yeah, and especially with regards to because this was something Dr Weimer said at the time he said, and for him, a lot of the probiotics don't make sense with regards to skincare because it's basically made up of dead stuff. He said they're not live cultures you're working with. So he said what are you working with? You're basically putting dead yogurt on your face. Okay, with regards to your skincare on the face, he said it just doesn't make sense to okay to to do that. Um, so his point was I think, basically the whole probiotic scene is a bit of a minefield with regards to what, what you should buy, which is why he tends not to recommend stuff other than just saying that if it makes you feel better, genuinely, even if it's just an act of spending 50 bucks, the placebo effect is real, it really is.

Dr DuPriest: 30:42

So whatever makes you feel better and relieves your symptoms, but while doing no harm. Right, and that's the.

Peter: 30:47

Thing.

Dr DuPriest: 30:48

There are products out there on the market that definitely will do harm. You know, hyperosmotic lubricants is like the textbook example of vaginal products that do harm um. You know, hyperosmotic lubricants is like the, the textbook example of vaginal products that do harm um so what is that just?

Dr DuPriest: 31:02

so. So classically, the way lubricants were formulated is with lots of glycols in them, lots of glycerin in them. That give them a really high concentration of stuff, and what that does is it dehydrates the cells of the vagina to the point where they shrivel, they die, they slough off and so it thins your tissues and actually makes you susceptible to infection. So hyperosmotic lubricants all of the classic leading brands that you can think of are hyperosmotic. Now they've all come out with natural, less um, less damaging lines since then, but the original classic formulas are still hyperosmotic and so those definitely do damage um.

Peter: 31:47

So you know, if you're looking to to use something in the vagina, you definitely want to make sure that you're not going to be harming your vagina while you're doing it Absolutely, and I always have to look at the vaginal biome science website, which is your website, which I will obviously link to for everybody listening to this, and that's osmolality that you're talking about, isn't it?

Dr DuPriest: 32:08

Yes, osmolality, right. So the interesting thing about vaginal osmolality number one osmolality is one of those things that is so fundamental to human health. It's water balance, right. So we have known for hundreds of years maybe not hundreds for decades and decades about what osmolality should be for your blood, or what it should be for inside your cells, or what it should be in all these different body compartments, but nobody measured vaginal fluid until 2018. Oh, wow. Or what it should be for inside?

Peter: 32:40

your cells, or what it should be in all these different body compartments, but nobody measured vaginal fluid until 2018. Oh wow, that's even later than even I thought, right.

Dr DuPriest: 32:45

And still there's only one paper that has measured it. And so, and interestingly, the World Health Organization actually came out with guidance on lubricants for vaginal health before that right, suggesting that osmolality should be what they thought would match vaginal fluid. But in fact, vaginal fluid osmolality is higher than most other compartments in the body, so it's higher than plasma, higher than intracellular fluid, um. So so you know, the osmolality of a vaginal product really should be around 400. If 350 to 400 is like the narrow range, a wider range would be like 200 to 500, that would be kind of a safe, healthy range, um. But you get higher than 500 and then you start drying out your tissues and that's not great.

Peter: 33:38

Do products list that? Because, to be honest, I mean, I had a look on your website and then I had to Google what osmolality actually was.

Dr DuPriest: 33:47

Because when you're saying how we knew this with regards to blood style and we knew this with regards to other stuff, I'm like I never even heard of the word well, right, right, but a medical professional will know what you mean if you talk about osmolality. So at least if they, if they graduated from the doctor is on the board. Yes, yeah, um. So so that the question is like how do you find that information? Number one um, brands that produce lubricants or vaginal moisturizers that know about this will promote it because it's that important, and so if they're not promoting it on their website, it's probably not healthy yeah right.

Dr DuPriest: 34:26

So so if you're looking for products and they give you the range and it's anywhere around this 250 to 4 to 250 to 250 to 500, that that's fine and it'll be on the website, so yeah that's just something to look for, but the more natural brands tend to be paying attention to it.

Peter: 34:48

Sorry, yeah, so so the information is definitely out there when you start looking for it?

Dr DuPriest: 34:54

Yeah, absolutely.

Peter: 34:56

Yeah, cool, no, that makes sense. Okay, and that is. I mean, we're. We're now like 30 odd minutes in and we've only actually discussed the microbiome.

Peter: 35:05

Yeah, and, and and this is the thing that always fascinates me with regards to vaginal health and and a bit opaque about who I'm talking about here, because, let's say, someone I know is, let's say, a specialist in the field of vaginal health at one of the big hospitals. He's a gynecologistologist, a gynecological surgeon, and he's at the top of his game. I think a lot of this stuff isn't even that, and I already said he, so we know it's a bloke, right, and, of course, by the time you're at the top of your game, when you're a gynecological surgeon, you know he's going to be middle aged at least he's, at least my age, because you know otherwise, middle aged white guy. That's pretty much ballpark what we're talking about and therefore ignorant in the ways of the vagina. Okay, a lot of this stuff is not actually out there as much as you would think it is with regards to. I mean, sure, women don't know about it, but guys are completely oblivious about this sort of stuff.

Dr DuPriest: 36:23

Sure, sure, absolutely. You know I told you before we started recording I used to be a biology professor. I can talk forever, but you know I would teach anatomy and physiology to non-science majors. And the misinformation just about basic anatomy. And even you know I help with customer questions sometimes, and you know women can't differentiate between the vulva and the vagina. You know, like women can't Right Because society doesn't, and so there's so much information or disinformation out there.

Dr DuPriest: 36:58

It's not really surprising that women and men don't really understand. What gets me, though, is that gynecologists are not better trained, so I've been getting to know people in two different societies, issvd and ISWISH, here in the US. Well, I think they're both international, so that's why they start with I. Issvd is International Society for the Study of Vulvovaginal Diseases, and then ISWISH is, let's see, the International Society for the Study of Women's Sexual Health, and practitioners in these societies get it. They know about the microbiome, they know how to do wet mount microscopy, to look in office to see what vaginal health actually looks like, but practitioners who are not involved in those societies generally they don't even know about vaginal pH being an easy in-office test to help differentiate what kind of vaginitis a woman might have. Um, they're not doing these really simple things, they don't they? A lot of gynecologists don't even have a microscope in their office to be able to look at vaginal fluid.

Dr DuPriest: 38:04

Yeah, and that's just. It's so easy and so basic and gives you so much information, um and so for you know, when gynecologists aren't even regularly doing the basic, simple things, you know clearly they're not going to understand the molecular biology you know and take the time to really get that. But again, you know, we were talking earlier. You know they don't get reimbursed for checking pH and they don't get reimbursed for making a microscope slide, and so they tend not to do it. And the other thing is, practitioners want easy yes or no Does this woman have BV or does she not? And they want a molecular test that will say, yes, they have it or no, they don't. And the fact is, with BV, that it's too complicated to give a yes or no. It just is not, it's not that kind of condition. So so it would be better for gynecologists to actually know about BV and about the nature of BV and be able to diagnose it without relying on a molecular test.

Peter: 39:03

But it's a state of affairs, but yeah, that's kind of. We are what we are. Yes, exactly, it's like you said earlier on. We're not really sure what it is. I found it interesting that apparently the vast majority of gynecologists in the UK are men, at least at the top level. Not saying in medical school, not saying it's starting out. I'm not saying women aren't catching up, but you know, if the people at the top of the tree tend to be the opposite sex to the people with the problem, then there might be a disconnect somewhere. Yeah, yeah.

Dr DuPriest: 39:43

Yeah, it's hard to understand. If you've never had the symptom, you know.

Dr DuPriest: 39:50

If you've never dealt with that kind of infection. It can be hard with that kind of infection. It's really it can be hard. I mean, I've heard lots of doctors, after their own illnesses, say every doctor should be a patient at some point to know what it's really like. You know, and it's just. It's impossible for a male doctor to really understand women's health. You know, they can understand it pretty well, but can't really get it. No, but this is what I always say with regards to postnatal health.

Peter: 40:14

I always say, okay, I am genuinely incredible at helping women heal from diastasis recti and all that sort of stuff. I am myself on the back a little bit and spraying a little bit. I am shit hot at it. What I do not understand is living with diastasis recti. Exactly, I am basically house. Do you remember Drew Laurie's house?

Dr DuPriest: 40:38

Yes, yes, I do, I have the knowledge.

Peter: 40:41

I can empathize because I'm not a jackass and I'm not a sociopath.

Dr DuPriest: 40:44

So when you tell me something hurts, I can go.

Peter: 40:46

oh, that must really suck for you, but fundamentally, I do not have your lived experience as I believe the popular phrase is. Right, have your lived experience as I believe the popular phrases? Um, right, but that's okay because, fundamentally, I am just there to fix a problem and at least I understand what the actual problem is, and I am not the one deciding on funding for research, right? In fact, I'm the one screaming there needs to be a hell of a lot more research Into this stuff.

Peter: 41:14

But, not by me, and it is. Yeah, you would think it would filter through more and maybe that is happening. I don't know. You'd hope, you'd hope at some stage. It simply has to change. Now I also noticed on your. Like I said, we've only just touched on the buy-on stuff.

Dr DuPriest: 41:38

Yeah.

Peter: 41:40

Pelvic floor disorders and all this other stuff I'd just briefly like to get, because I have you in here and I need to because I have a lot of people.

Peter: 41:48

I get a lot of emails from companies selling me stuff. Okay, you're usually saying, if you list our thinking, can you read an ad out on the website on the podcast? The answer is usually no. By the way, I've never done any ads on the podcast. I'm not going to start now. Can, because according to your website, you know a lot, of, a lot of US women are have some sort of pelvic floor disorder right, especially, especially older it it.

Peter: 42:28

it increases with age, right we know that for a fact because, as it it happens, with all the all the aging muscle, wastage and right, should people be just doing kegels? You know it's, it's the kegel answer in the way that we are told it is so.

Dr DuPriest: 42:54

So the first thing I'll say is that I am not an expert in pelvic floor disorders. I am helping coordinate some clinical studies involving pelvic physical therapy for pelvic floor disorders. But, having talked to some experts who are doctors of physical therapy about this very question, uh, uh, kegels are appropriate sometimes and they are totally inappropriate other times. So, and the only way to know is to go talk to a qualified pelvic physical therapist. So so you, you really, um, yeah, kegels can be helpful in the right circumstances, but they can also um if, um, if.

Dr DuPriest: 43:36

I guess my understanding is that if you have um, uh, high, a hypertonic kind of situation, kegels can actually be detrimental and so or at least not helpful, but, but I think detrimental is what I understand. So I mean, if you have a woman who's considering doing kegels because she's read something on the Internet, I think she should be consulting with an expert who can tell her what her pelvic floor is actually like, right, and the only way to know that is to really get in there and test it. So an expert has to do that.

Peter: 44:09

Yeah, this is what I was, because I get all the people, because I've got my little PT business on the side as well, and I get a lot of emails from people saying, okay, can you do X, y, z, and also, I also need some sort of mummy MOT. They call it in the UK. Basically, you give birth and then you pay the physical therapist to check you out. Yeah, that bit I don't do. First of all, it has to be an invasive exam and I'm not ending up on that register. Do you know what I mean? Yes, and, and it's, it's. It has to be done, I think, by someone who is remarkably experienced in, yeah, in that field, that really knows what, what they're looking at and and all that sort of stuff.

Peter: 44:53

Um, because there are a lot of products out there now that help women with their pelvic floor issues and we're talking like I did an interview with someone a while ago who had an interesting thing which was like an electric sort of impulse thing. You insert that and it kind of does it for you, because Kegels are not everyone knows how to do Kegels. I know this is not like you said, this is not your ballpark, yeah, but it's. I just wondered whether you'd heard anything.

Dr DuPriest: 45:35

So here's my basic, fundamental concept about health care.

Peter: 45:41

Yeah.

Dr DuPriest: 45:41

All the treatment in the world doesn't matter if you don't have the right diagnosis. True. So Kegels are going to be the right treatment for some things, but if you're treating the wrong condition, you're never going to get better, and so you really have to get diagnosed well. And so if your pelvic floor disorders are causing you problems in life, if you're having incontinence, if you're having prolapse, if you're you know, if you're having those kinds of things, go get assessed and get get a treatment plan, and kegels might be part of it. But have have an expert tell you. So that that's my, that's my two cents.

Peter: 46:16

That makes that makes a lot more sense than just randomly doing whatever dr google right, right.

Dr DuPriest: 46:24

Well, dr google is a lot cheaper and faster to find information, but but you know knowledge you don't know what you're looking at that, that's right. So knowledge is different than wisdom, right? Yes, so there's plenty of knowledge on the internet.

Peter: 46:38

Very true, and that is always what I say with regards to the. Get yourself a sense of people just listening to the podcast. It matters that you know where you're starting from. If you set your stop now to go to New York, it really matters whether you're leaving from Chicago or from San Francisco. Yes, because your route is different.

Peter: 47:00

Yes, you want to end up at the goal, but how you get there really matters. I'm sure you can go to Google and just go. I need to get to enter, I need to get to New York, and you might well stumble upon the right directions, but chances are you won't Right.

Dr DuPriest: 47:15

That is just my Right, and I mean if you're driving. I mean if you have 50 miles to go, you're going to drive. If you've got 3,000 miles to go, you're going to take a plane. Right, and so there might be different approaches to getting from point A to point B depending on where you're starting to. So, yeah, proper assessment is foundational.

Peter: 47:36

Yeah, and that comes down to always work with somebody that knows what they're talking about. So the interesting thing again, I look at your website and I wrote this bit down because you have, obviously you have a lot of some clinical trials and I'm not sure how far along into these things you are, but one obviously stuck out to me preconception vaginal care. Yeah, that was this and it was obviously. You know. It would be a disgrace for me not to ask yeah, so this study is one of my favorites in concept.

Dr DuPriest: 48:20

I really, really, because of my, my background in developmental origins I'm all about, you know, pregnancy and fetal development and all that kind of stuff but we have had the hardest time enrolling in this study. Um, we're not, and I think I think the thing is that we're working with a fertility clinic to do this study and by the time women get to a fertility clinic they don't want to take three months to wait and try this clinical study. They want to go right to assisted reproductive technologies, and so I think that's why we've had difficulty enrolling. I still want to get the answer to this and I want it.

Dr DuPriest: 48:56

So this is supposed to be um, if we improve the vaginal microbiome, do we improve the odds of conception? I mean, it's a very simple question basically, um, and there are lots of data out there about intrauterine insemination, um or in vitro fertilization, but there are no studies about couples who are trying to conceive at home. It's a difficult kind of study to do, it's difficult to enroll, as we were finding right. So I think we need to work with a more general obstetrics clinic, or, you know, obgyn, where they're working with couples who are earlier in their fertility journey. So I think once we, you know, at this point we're focusing more on DV and recurrent UTI, but I think at some point, when we're ready to come around again, we'll we'll look at working with, like I mentioned, an OBGYN as opposed to a reproductive endocrinologist on it. But but, and that said, you, you know, the partners we're working with are great people. It's just, I think, the wrong crowd.

Peter: 49:57

So yeah, it's. It's always difficult to. Indeed, once people start seeing doctors, they're not necessarily uh or or sort of clinics. I I've trained a lot of and I've worked with a lot of women who are, um uh, struggling to conceive and and all that sort of stuff and that is really suited yeah.

Dr DuPriest: 50:23

And if you're someone who has struggled with infertility to the point where you're at a reproductive endocrinologist office, very often you're feeling like the biological clock is ticking and three months feels like forever to you, yeah, so so I I have a lot of empathy and I totally understand where people are coming from, and so that that's that's why I think we need to catch people who are earlier on.

Peter: 50:44

But yeah, like I did an interview a while ago uh, I would say a while ago, I mean over a year ago with gabriella rosa, who's uh, that's a fertility clinic in australia, so who's killing it there um, who had some very interesting ideas on on exactly what you're talking about. So so pretty hardcore, right. Um. So she's like listen, if, if, if you want to get pregnant, you have to pretend like you're already pregnant. Now that's kind of approach as in alcohol. Not a good idea. The husband is as responsible for you becoming pregnant as the women is, which is I know a lot of people listening to this.

Peter: 51:24

That's a shocker the problem might not be the lady. That's right that's right. Technically this is possible, boys and girls that's right, but but but she was really big on that, as in you have to have that sort of, so it'd be interesting to see whether, indeed, the vaginal biome because she's she's a big believer of that might well be a thing. But of course, like you said, the the study wasn't done yet.

Dr DuPriest: 51:54

Right, right. And so, like I said, based on the in vitro fertilization studies, there's lots of evidence that the vaginal, cervical and endometrial microbiomes definitely play a role in fertility. The question is if you change the biome, does that improve fertility? That question hasn't really been addressed yet.

Peter: 52:19

So well, if you ever get the answer to that one, definitely yeah oh, I'll be shouting it from the rooftops if I do believe me, because that's a facet, because that's you know, it's I.

Peter: 52:29

I spoke a while ago about the the difficulty with regards to a lot of health related studies. A lot of health related research it's not the human body is so remarkably complex that it's really difficult to get good answers from from a study. And even when you're looking at things like back pain studies and all, and just lower, but just just just standard lbp, lower lower back and lumbar back, it is remarkably difficult to get a really, really sound study. Anything above level four is almost impossible to get because there are that many factors in, in, in what, what could affect it. You can't control everything and all that sort of stuff. But this sounds like one of those dots. It'd be a game changer if you find, if you find out.

Dr DuPriest: 53:22

Yeah, yeah, what the answer is, and at least you can test this yeah, exactly, and, and what's required is a tool to be able to adjust the vaginal microbiome Right, and that's that's what is not really the vaginal microbiome right, and that's that's what is not really. Um, it's hard to come by, right, we have antibiotics and steroids and we have estrogen creams and we have things like that, but, uh, probiotics are the tool that's available that hasn't really been thoroughly tested, and so that's, you know what we'd like to look at, but oh, that'll be fascinating.

Peter: 53:55

That'll be really, really interesting.

Dr DuPriest: 53:57

We've covered a tremendous amount of ground.

Peter: 53:59

Yeah, and did you have anything else that you were like? Oh, Pete actually really wants to mention this.

Dr DuPriest: 54:07

No, you know, the thing that I the things that I wanted to mention, I have mentioned.

Dr DuPriest: 54:15

And so you know, I think I guess what we haven't talked about is UTIs, and UTIs are not directly related to the vaginal microbiome, but they're connected. They're like physically connected, and so what happens in the vaginal microbiome affects what happens in the urinary tract microbiome, and there's still and one of the reasons I want to put this out there is that there's still most healthcare practitioners believe that the bladder is sterile and that is not the case. So the right.

Peter: 54:44

Yeah, it's mind blowing.

Dr DuPriest: 54:47

It's mind blowing, but the reality is. The reason that BV research is so far behind, and the reason people still believe that the bladder is sterile, is that there are all these bacteria that just won't grow in culture and so you can't study them in the lab using old fashioned techniques. So it's only been the last 20 years that we've been able to detect the presence of these microbes using these fancy sequencing based approaches, and now we know about all these different bacteria that contribute to BV, and we know that the bladder is not sterile. Right, and so we're. We're still just at the very beginning of learning how the vaginal microbiome affects UTIs, but UTIs are 25 percent of all infections in the US.

Peter: 55:27

Yeah, they're huge, you know right.

Dr DuPriest: 55:31

And people my age I'm a middle aged woman and people my age they're a nuisance. You might miss work, right, you might miss some pay.

Dr DuPriest: 55:38

You got to take time to go into the office blah blah blah, cranberry juice supplements, whatever, right, it's annoying and it's it's, it's uncomfortable, but but we all have this perspective of UTIs as like they're just a nuisance. But if you look in the postmenopausal crowd, especially the very elderly, utis are a cause of morbidity, they kill people and we haven't really figured out how to address UTIs and how to prevent UTIs. And I think that the more we understand about the vaginal microbiome and the urinary tract microbiome, all of this is going to kind of help improve UTIs. The urinary tract microbiome, all of this is going to kind of help improve utis, both in younger people and in in the elderly too. So that that's the other thing that you know. I'm not an expert on the urinary tract microbiome by any stretch of imagination, but it's, it's the other frontier that's out there, that you know.

Peter: 56:29

Again, 25 of all infections and, like, every woman gets a uti at some point in her life, almost life, and this is the insane thing because maybe, maybe, this is a generational thing, right, but I I remember when I had a proper job a long, long time ago, like 20 odd years ago, I had a real job and I sat in an office and I did what everybody's supposed to do. I was and one of the reason I mentioned cranberry juice one of my staff walked in with cranberry juice A big jug A big thing of cranberry juice, Big jug.

Peter: 57:00

She'd run out to the shop or one of her colleagues had run out to the shop and bought her a whole thing of cranberry juice, and everybody except let me rephrase that every woman knew what that was for Knew what it was for yeah, and I was there, and I was I don't know 24, 25 years old. I had no idea.

Dr DuPriest: 57:16

Right, she really likes cranberry juice. That's weird, she likes cranberry juice.

Peter: 57:20

Oh, that's quite a lot of cranberry juice to drink, right? So I asked and they said, no, I have cystitis, and you know okay. Next question what is cystitis? What causes it? Apparently, you, and this is the genuine answer. You get it if you wear a short skirt and it's really cold in. Scotland. Yeah, I'm fairly sure it's horseshit and they were taking a piss, but that was genuinely the answer. I'm not 100% sure that that is what they.

Dr DuPriest: 57:50

I think if that were true in Scotland, of all places where men wear kilts, more men would get them.

Peter: 57:58

Men can't get you in get urinary tract infections. That's just science, right.

Dr DuPriest: 58:02

That's right.

Peter: 58:03

That's right.

Dr DuPriest: 58:08

But again it's one of those things where the burden of disease falls much more heavily on women than on kids. So even though men can get UTIs, and especially as they get elderly and they need to be catheterized or something, you know, that's a whole thing, but again it's one of those women's problems because that is indeed genuinely what it is.

Peter: 58:25

That's exactly what my point was. It was a woman's problem that can be fixed by drinking cranberry juice and it can't. I mean, it's one of those things, but the perception was that it's one of those things, but the perception was that it's a bonus problem that can be fixed by crime victims. Therefore, it's not really an issue Right, and the feeling is just that you find that absolutely everywhere when it comes to women's health.

Dr DuPriest: 58:53

It's true, and it's so insidious that that, even as you say that it doesn't hit me the way it should like, like I'm a woman like it should hit me really hard, but like it's so true that women's, women's problems are disregarded and they're downplayed and they're like and you just deal with it.

Dr DuPriest: 59:13

It's like, well, you know, you get menstrual cramps, everybody gets cramps, you just deal with it, it's okay that you're in, you know, curled up in the fetal position, in the corner of the, you know, wherever you are in some public space. That's just just cramps, it's normal, you just deal with it.

Peter: 59:28

No, no, that's not normal you know, women are just expected to buck up and deal and the insane thing is there isn't a guy out there listening to this, and there are some men listening to this. There isn't a guy out there listening to this who has never had cramp in her calf or in their foot Right, and that hurts like a bugger.

Dr DuPriest: 59:49

I mean, I can't walk.

Peter: 59:51

That's super painful because you can't walk. You wake up in the middle of the night and your calf seizes up. That's super painful because you can't walk. You wake up in the middle of the night and your cat seizes up, and that is the most after being kicked in the nannies or maybe potentially giving childbirth.

Peter: 1:00:02

it's the most painful feeling in the world. We all accept that that really hurts, yeah, whereas period cancer, that can't possibly be serious, yeah. So it's really odd that we accept that man problems and I'm not talking man flu, I'm talking problems. I'm talking things that happen to men that can be a real problem. We all empathize and we all, whereas women problems just tend to be a little bit. You get them every month yeah and then you struck up the shoulder rather than going.

Dr DuPriest: 1:00:37

Jesus, you get this every month right like why don't we do something to fix it?

Peter: 1:00:42

right, it can be sorted, and that's exactly where I was with with postnatal health, and anthony was uh as well, and and and and you clearly are in that. It is insane when there's 50 of the population that has a problem. There's a market. There has to be.

Dr DuPriest: 1:00:59

I mean you don't need to look at it as a market.

Peter: 1:01:02

But to get stuff done sometimes you have to look at things as a market right, and it is insane that there is a 50 percent group of population, population group out there that we just go yeah yeah, yeah, if only they've had the ding-a-ling, they'd be fine exactly, exactly.

Dr DuPriest: 1:01:26

You know, 29% of women have bv. Uh utis are 25% of all infections and most of those are for women, but they don't matter. You know, I mean the billions of dollars, if nothing else, the billions of dollars that can be saved in healthcare costs, the billions of dollars that women have to forego in pay or that they have to shell out for doctors opposite. Like the billions of dollars to get people's attention. Right, but I guess it's better that they're spending the billions of dollars, right?

Peter: 1:01:53

So I don't know. It keeps the economy going, it keeps the industry going, right Anyway but yeah, women, women's health really needs to be taken more seriously.

Dr DuPriest: 1:02:03

Only 4% of all medical research funds go to women's health, and when you consider ETIs are 25% of all infections, you'd think maybe more than 4%. It's insane.

Peter: 1:02:16

I think you might have caught this depending on, I know, john Oliver. Last week tonight with John Oliver he did a whole thing about medical bias. A couple of years ago it was on YouTube in the UK for everybody listening but they removed it because Comedy Central no longer has the rights or some shit like that. But it's basically he just he did a whole 25-minute thing on medical bias and showing that most medication out there, even those for problems with women's uterus, those medications were tested on men, because you know we don't test things on ladies because they're complicated no-transcript.

Dr DuPriest: 1:03:29

Like well, maybe exclude women who are trying to get pregnant or maybe require, you know, like women were actively excluded from research because we it might harm a potential baby that she might not even be planning on having, right, so you know, and finally they realize that that's not, that's not great. And only recently have they realized, like with the covid, pregnant women don't get tested for anything and therefore pregnant women don't have any options. You know what painkillers can they use, what vaccines can they get? We don't have any data telling us what's safe in pregnant women because we're so afraid to do research when there are ways to minimize risk and maximize benefit that really need to be taken more seriously.

Peter: 1:04:04

Um, so that that with all women pregnant women, you know everybody has options for health care yeah, and that is exactly like you mentioned covet earlier as well, the whole covet the, the development science thing, and I did a lot on covet and pregnancy early on because it was changing so much. Okay, I happen to have a PhD in something completely non-health related, but it means I know how to read the study and stuff just came out constantly and at the same time. At the start of the pandemic and I'm talking April May, so a couple of months after the start and then the vaccine started rolling out very, very quickly Most pregnant women were like, oh no, this is going to kill my baby or make it autistic or God knows what.

Dr DuPriest: 1:04:54

Right, that's what the Internet told us.

Peter: 1:04:56

And Facebook is a scary place is a scary place and it took a while. The science was already kind of there saying listen, this is going to be all right, but it takes a while to filter through and because you're working with a group of people, when they're pregnant, that are rightfully so and understandably so, very, very careful with what they do and what they want to do and all that sort of stuff, it took a long time. I still think in the UK, pregnant women or women who are considering becoming pregnant are still one of the least vaccinated groups in the UK and that is ahead of people with cultural problems with vaccinations, people with religious beliefs and all that. They're still much lower on the group. Even though the science is kind of established now, as in, listen, you're going to be all right, it's actually a really good idea to get vaccinated because you don't want to catch this thing when you're pregnant.

Dr DuPriest: 1:06:04

Right, yeah, it's, and I totally understand not wanting to do something that might hurt the baby. I completely understand that. But, like I said, there are ways to do research that minimizes risk. You know you start with very small studies and if you know, if you see, if you see anything that that starts to pop up.

Dr DuPriest: 1:06:24

You stop right, um. But but at this point in time, here we are like years down the road in the pandemic. If we had started those studies years ago, we'd have viable options for women now, and we don't. We don't for pregnant women, yeah right. So so at this point pregnant women are still, you know, relying on.

Dr DuPriest: 1:06:47

I mean, I remember early in the pandemic I'd heard Francis Collins, who was the director of the NIH at the time, saying that the data that they had at the time was that there were millions of people getting vaccinated, that there were millions of people getting vaccinated and of those, many women didn't know they were pregnant when they got the vaccine, or they were very early on, or something like that, and they had seen no adverse effects on pregnancy across, you know, the groups at that point in time. So that's a pretty weak piece of evidence, but that's a piece of evidence to start building on right. And the thing is that I only heard that because I was in an interview that he was doing. I didn't see that anywhere in the media, nowhere. Um.

Dr DuPriest: 1:07:31

What I heard mostly was about an untested hypothesis about how the covid vaccine or the virus might um attack the placenta. Like it was a hypothesis. It's worth testing. You look at it, but it's not something to base all your decision-making on, versus this clinical data that we have over here that shows it's probably safe. So you know, like you said, social media is a scary place.

Peter: 1:07:55

And also, yeah, and we have to understand a lot of science, and this is the problem it's not sexy.

Dr DuPriest: 1:08:02

No, it's not, it's messy.

Peter: 1:08:04

Yeah, and it doesn't make nice headlines, and vaccine attacking placenta is a lot more Hollywood than hey you're probably all right.

Dr DuPriest: 1:08:13

That's right, exactly, exactly, it's not much of a headline to go.

Peter: 1:08:17

Yeah, you're probably sound yeah Right, yeah.

Dr DuPriest: 1:08:21

So pregnant women don't want probably.

Peter: 1:08:23

They want certainty yeah, well, this is something and this is one of my favorite david bowie quotes ever uh, from one of his worst albums ever is. I don't want answers, I want certainty and you know, that is I mean. Obviously he meant it in an ironic way the song is is called. I'm Afraid of Americans, by the way, and it is about that.

Dr DuPriest: 1:08:48

I don't know the song. It is like I'm afraid of.

Peter: 1:08:50

Americans, I'm afraid of the world, I'm afraid I can't help it. He said I don't want answers, I want certainty. And he clearly meant, dude, you can't have both, you can get answers but with more answers come more questions. Yeah.

Dr DuPriest: 1:09:06

And, like you were saying earlier, it seems like the more people know, the less certain they are right, yeah, and the less they're willing to go out on a limb and say, yes, I know about that thing. And so the people with the loudest voices often have the least actual knowledge about things.

Peter: 1:09:21

That is very much where I am on. This is why I always put caveats in everything I say. When I get a listener email, everything's caveated. Yes, I don't know. I know some stuff. There's a lot of stuff I don't know, and even then, and then you'll.

Peter: 1:09:39

You'll have this, no doubt as well. You'll know there are people in the world that know more than you do, right, that are just like these. Guys and girls are just next level out there, and it's insane the wealth of knowledge they have, and hopefully we too one day will get there. But you know, in the meantime we're doing the best we can, at least I know I don't know everything that's right.

Peter: 1:10:06

And that is kind of on a rather depressing note for everybody listening to this. I will press stop record here, if that's all right, and press stop record is exactly what I did. Thanks very much to Dr DePriest or Beth for coming on. I had a phenomenal. I had great fun. I had a lot more fun than I thought I was going to have talking about vaginal, talking about vaginal health, and I'm guessing you had more fun listening to it than you thought you were going to as well. You can find. I will link, obviously I will link to Vaginal Biome Science website and all that. There's some tremendous resources, free resources. On that website as well. There's a ton of information. I'll also link to the Sexual Health and Wellness Institute, shwiorg, where there's some stuff on Biomatch and Women's Health Blog and all that sort of stuff, a bit about truth in advertising and all that sort of stuff. Basically, their website is well worth checking out if you're looking for information. Again, thanks very much to Dr DePriest for coming on. I love talking to experts. I love talking to people that really know what they're talking about.

Peter: 1:11:31

I was going to do an Indy News this week but you know we're already at an hour and 15 minutes with the new bit of music coming in. So I'm not going to. We're going to go back to that next week. I know I've only done one or two this month, but you know, sometimes I record these things in advance. There is no news and the podcast already runs over an hour and I know that a lot of you guys stop listening. So what's the point to add a useless bit of in the news? So here's a new bit of music. Have a tremendous week, peter at HealthyPosnatnatalbodycom. If you have any questions or comments, would like to be a guest or whatever, just get in touch. We'll be here for, obviously, three months, free access to the healthy postnatalbodycom program, just by signing up right. Um, you take care of yourself. Have a great, great week. New bit of music.

Dr DuPriest: 1:12:23

Bye, now I don't know why you're doing this to me. I left you alone and now you're out of the game. No, I don't know why you're doing this to me. There's nobody worth it. I just want you to see there's always gonna be possibilities, possibilities. I won't take a sip of my own medicine, cause I don't care. We could be out there. Baby out there. I don't know why you're doing this to me. I left you alone and now you're out of the game. I don't know why you're doing this to me. There's nobody worth it. I just want you to see there's always gonna be possibilities. I'm lying down so I can be out there. Out there. I won't take a sip of my own medicine, Cause I don't care if I could be out there. Baby out there. Thank you.