In Your Pants with Dr. Susie G - Vuh-jahy-nuh talk with Mama Doctor Jones

Episode Date: March 22, 2018

Hey ladies (and gents), I've got a great In Your Pants episode for you today. It's all about the vah-jay-jay. Yay! I chat it up with, the spunky and fun, Dr. Danielle Jones, MD otherwise known as "Mama Doctor Jones" Dr. Jones is an Obstetrician/Gynecologist and an advocate for female super women trying to merge medicine and all things that come along with being a woman.  She's a wife, mom to twins + 1 and a Texan who loves Chicago Cubs baseball. Woohoo, Go Cubbies! I ask Dr. Jones about benefits and risk of contraceptive therapy everything from birth control pills to the good ol' fashioned pull out method. She recommends checking out a cool educational website for all things birth control bedsider.org. Dr. Jones answers my curiosities about having a retroverted uterus and how it's totally common and nothing to freak out about. We even talk about why vaginas should be left alone. So, no, don't go sticking a cucumber up there ladies. I don't care what GOOP tells you. This episode is one not to be missed, so what are you waiting for?! Listen here.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey friends, it's Dr. Susie G here bringing you another delicious In Your Pants episode where we de-stigmatize social stigmas and cultural taboos. So I hope you're ready because we're getting in the know down below for the ladies. Joining us on the show today is Dr. Danielle Jones, aka Mama Dr. Jones. Dr. Jones is an obstetrician and gynecologist and an advocate for female superwomen trying to merge medicine and all things that come along with being a woman.

She's a wife, a mom to twins, plus one, and a Texan who loves Chicago Cubs baseball. Woo-hoo! Go Cubbies to all the Chicago fans out there. Dr. Jones, I'm so excited to have you on the show today. I'm a huge fan of your Instagram page and blog. You're as real as it gets, girl. You're funny, you're spunky, full of life, and your passion for what you do truly resonates with everything you share.

You do you, and you do it very well. So thank you again for being on the show. I know how busy life can be, juggling so many different things, and you're a superwoman yourself. I hope you know that. I really appreciate that. Sometimes it doesn't feel like that, but thank you. The vote of confidence is always well-received.

Absolutely, absolutely. Sisterhood, right? Absolutely. Great. So let's just start off by asking, you know, what inspired you to be an OBGYN? Oh, man, that is a question that probably would take over a lifetime of watching what I've done to answer. But I guess the short of it is I went to college and didn't have a clue what I wanted to do

with my life and ended up majoring in psychology, but deciding I didn't really think that was the direction I wanted to go. So went to med school and kind of started med school and said, you know, I'm going to have an open mind. I will go through my rotations and I'll be anything I find interesting or fun, except I don't really think gynecology is my jam because that's weird. And I did my rotation and I fell in love with taking care of women throughout their lifetime, being able to develop continuity and still do surgery. And just really, there was no field that let me do all of those great things. And it was amazing. And I just fell in love with it. That's awesome. So at first you were totally shying away from being a gynecologist and then you had a rotation and

it totally changed your world. Absolutely. So what's the best part of being an OBGYN? The patients for sure. I, you know, we have this incredible privilege to take care of people in some of the best and worst moments of their life. And I talk about it a little bit on Instagram and on the blog, but we're just kind of given this hall pass into sacred moments and conversations that people have. And it just feels like an amazing opportunity to connect with people and the patients are wonderful. That's amazing. So now I know I didn't give you this as a preliminary question. It just came to mind, but what would be the hardest thing about being an OBGYN? OBGYN? Um, you know, I think nothing feels, I wouldn't call anything hard. You know, it's,

it kind of, you develop a, over the time that you do your medical training, you develop kind of a process to get through hard things, but it's definitely a challenge to take care of people when bad things happen. But again, that also feels like such a unique opportunity and an ability to develop relationships with patients makes it better. And I don't know, I have a love-hate relationship with that because I feel like if you can go through those tough things and make it even just a little bit better by taking excellent care of people that you've made a difference. Yeah. And at the end of the day, you're truly helping and changing these people's lives on a daily basis, on a moment to moment basis. And there's not a lot we can control in

terms of the external environment to an extent. So yeah, we're doing the best we can. That's awesome. So I get a lot of questions as a pelvic health therapist from a lot of followers about pelvic health and gynecological health, urology and so forth and so on. So some of these questions that I'll be asking you next are actually from them. And I've kind of tweaked them to ask you from my own personal knowledge as well. So killing two birds with one stone, essentially. So my first question is, you know, I see a handful of young women with fertility difficulties. What can a couple do to optimize their conception? And I say couple because it really does take two to make a baby. So I love your thoughts about fertility and conception. And I know you have

three of your own, so I'm dying to hear what you think. So I will preface this by saying, I, I take care of a lot of women who have fertility issues, but I am by no means a fertility expert. And so I think the first thing is finding a good OB-GYN that you trust, who can kind of talk to you when you start to go down that journey of trying to get pregnant. Um, and you can do that by making an appointment for preconceptual counseling, um, just to talk about optimizing your diet, losing or gaining weight, just being at a, at a healthy BMI. Um, and then I think it's so important for women and their partners to understand the fertility window because I see women all the time who are putting a lot of data into apps, but not really understanding

when or why the app tells you that you're fertile on certain days. And that's something that we can help with too. So just coming in and chatting with your OBGYN about when your fertile window is and why is really helpful. Obviously being on a prenatal vitamin a couple of months before you really want to conceive. It's super important. And then it would amaze you how many times I see people who just really aren't having that much sex and you can't make a baby without it unless you're seeing a doctor to help with that. So if you're trying to make a baby at home, that's the key. Right. You have to put the bun in the oven, right? That's exactly right. So, so what in, in your experience, what are some reasons for why people are not having sex?

Oh, it's so, so multifaceted. You know, some people, I see a lot of people who their jobs are really challenging. So women whose significant other travels a lot and is out of town, we live near several military bases. And so we see people whose husbands are deployed or the wife is deployed. A lot of mental things go into that. So there's all kinds of histories that preclude women or men from being able to enjoy sex. And some of that can get in the way when you're trying to make a baby. And then sometimes people have kind of a block when it feels like a chore instead of a treat when you're trying to achieve a goal instead of enjoying the journey to get there. Right. Right. And I see that a lot. It's, it's a chore. Like you said, it's, you know, we have to

do this. We have to make sure we do it at the right time. And there's so much stress that these couples put on themselves to conceive that it really does take away the, the fun and the pleasure of, you know, conceiving and being in love and being compassionate with one another, regardless of the outcome, right? And that being said though, I think having with the twins gone through some difficulty conceiving and also using Instagram and Twitter to follow along on some journeys through infertility that people so openly share there, I also want to throw in that it's probably one of the most frustrating things when people see their physician and they say oh just relax and you'll conceive you know because it's it's really not that easy and so I would urge anyone

who's listening who is stressing about conceiving and frustrated with people saying things like just relax to get an appointment with your OB and talk to them about various things that they can do that are actually taking steps in the right direction rather than listening to their friends and family tell them that you just need to relax more. Right. Have some wine, go on vacation, right? Although effective occasionally, not an overall solution. Right. Right. Exactly. Right. Well, what, what, what works one for something for someone doesn't work necessarily for another. Totally. Totally. So what would you advise if like, you know, a woman or a couple have a gynecologist who's, you know, telling them pretty much this,

that, you know, you just have to relax, stop thinking so much about it when all the tests are coming out negative and they still can't conceive. What would you recommend that they, that they consider doing or if anything at that point? Yeah, it really depends a lot on kind of the person and people involved because there's different times and timeframes that are normal. So most people will conceive within six months, but up to a year of attempting conception is a normal timeframe in the OBGYN world. But there's some variations on that. So people who are over 35 or who have had fertility issues in the past. And then I also encourage people who have been trying to get pregnant for a while, but are not having regular cycles to go ahead and come

a little bit earlier because if you're not ovulating you're not going to get pregnant and if you're not having cycles you may not be ovulating regularly and so I think it's a person by person couple by couple evaluation but if you don't feel like you're getting support from the person you're seeing or if you feel like you are not understanding what they're telling you then you know the the physician patient relationship is so important and you both have to trust each other. And it's okay if that relationship that you find first, isn't the one that works for you. And it's okay to switch to somebody new, just like we don't always marry the first person that we date. It's okay. If you need to find someone who connects with you on a different level.

And I love that. That's a great analogy. We don't always marry the first person that we meet. And so sometimes we have to kiss a few frogs before we find our Prince. That's great. Now I know some of my ladies that I see, and even some family members who have been on birth control, I, myself included for many, many, many, many years. And my next question is about birth control. Um, in fact, actually, and it's been quite controversial in the pelvic floor world anyway, in terms of us therapists, like for example, changes to vulvar tissue, um, future infertility issues that we just kind of talked about, cardiovascular risks and nutrient malabsorption. Again, not to put you on the spot, Doc, but I'm curious to hear what your thoughts

about birth control are and what should women be aware of, you know, like the risks versus the benefits. And lastly, what advice would you give to a woman who doesn't know which options of contraception are best for her? That's a great question. And it's a question with a huge subset set of answers. The short of it is find a good family practice or OB-GYN and schedule a counseling only appointment where you can go in and just go over all of your concerns. Because sometimes we try to hammer into a 15-minute visit, an annual exam, and a contraception discussion, and it's impossible. And so you can call almost any office and say, I want to come in for a counseling only appointment for contraception and we can see you and just talk the whole time instead of doing

exams and paths and all of that at the same time. And that's a really good way to get your information. Bedsider.org, I've made no secret that I'm a total fanboy of this website. It is the epitome of integrating the way that current generations are consuming information into excellent evidence-based information on sex and birth control and all kinds of things. So that's a great place to find information. As far as risks of birth control go, so birth control carries, you know, and I guess it's also important that we designate what we're talking about. So there's a whole bunch of forms of contraception. And most of the time when we talk about risks, people are asking about risks of hormonal combined oral birth control or various

delivery methods of hormonal combined contraception. And that means estrogen and progesterone containing. So I'm not aware of evidence-based articles on vulvar tissue health, but I also am not opposed to learning more about that. I just haven't come across anything like that in the past. I know estrogen is a hormone that we consider to be a positive effect on the vulvar tissue. But if you have any good studies on that, I'd love to read them because I don't know as much about it. But as far as future infertility goes, there is this longstanding kind of old wives tale that future infertility can be caused by being on contraception. And I firmly believe that that is not the case. And the literature would support that.

And then last night, actually, when I was going through some of these questions, I thought, man, maybe I've missed something. I'm going to ask one of my friends who's a reproductive of endocrinologist and infertility specialist if there's an association that I've missed or something. And she said, no, absolutely not. Everything you learned is still the current most up-to-date thinking. And so, we don't believe that hormonal contraception decreases future fertility. Now, that being said, there's various delivery methods of hormonal contraception and some of them do occasionally take a little bit longer to return to normal ovulation. And so if you're on a certain one of those, then just go in and talk to your OB-GYN about what the average time to normal ovulation is after stopping them and use that to guide when you go off your birth control.

And what kind of contraceptive options do that? Is it like the pill form or the IUDs? So the birth control pills, generally you have rebound to ovulation really quickly. I see women not infrequently who go off their pill and come in pregnant before they've even had a cycle. And so that's generally thought to be the quickest rebound back. One of them that can take a little bit longer is Depo-Provera shot. And the reason is because the delivery method as an injection means that depending on your body makeup and various things about you as a unique person, that hormone, the progesterone in that medication, leaves your body at different rates than it might someone else. And so it's a little harder to predict when you will start ovulating again after taking a Depo shot. But IUDs are usually you go back pretty quickly to ovulation, but some people do take a little

bit longer. I would say that's kind of in the middle with Depo being a little kind of being on the far end of the spectrum and birth control pills being on the shorter end. And actually, when I was talking to Dr. Crawford, my friend who's an REI doctor, she's on Instagram to Natalie Crawford, MD, but she had told me she would usually prefer if we would tell patients to take their Mirena, which is a progesterone IUD, out about three months before they really desire pregnancy. So, I trust her opinion on all things fertility. So, the second question would be, what are some of the risks and benefits associated with some of these various contraceptive methods?

Sure. So I always, again, I'm going to just put a plug in for the bedsider.org site. It is so amazing. And they have a wonderful chart of birth control options and risks that I use in my day-to-day clinic counseling on a, like literally on a daily basis. But when we think about contraception, there's, I guess, three different levels. There's things like condoms and natural family planning, and those things don't require prescriptions or hormones. And then there are what we call long-acting reversible contraception and that would be things like the IUD and an explenon implant that goes in the arm. And those are progesterone-only options.

Progesterone-only options tend to have less of the traditional risks that people worry about with birth control, such as risks of blood clots, et cetera. And the long-acting reversible contraceptions are very beneficial because they are as effective as tubal ligation without the permanence of that procedure. As far as combined hormonal contraception, I think we always need to have a risk discussion that includes the risk of not being on contraception, which is pregnancy. And pregnancy brings about the same hormones that birth control does, but in much, much higher doses. And so every risk to contraception that we discuss is exacerbated times about 10 in

pregnancy. And so birth control, if you are not desiring pregnancy, is far safer than unintended pregnancy, which carries all, essentially all of the same risks. Some of those risks that people worry about or ask me about a lot are things like cancers. The most recent evidence on oral contraceptions and their association with various cancers would make us believe that there's a decrease in the incidence of colorectal cancer, endometrial cancer, ovarian cancer, and various lymphatic cancers that persists over a lifetime for women who have been on oral combined contraceptive pills at some point in their past. There have been a couple of studies recently which showed a slight and temporary increase

in the incidence of breast and cervical cancer in women who are on combined contraception for a period of time. It's important to note two things with that. One is that that risk is gone in five years after stopping the birth control. And the second is to look at the big picture in that the overall decrease in cancer risks far outweighs that slight and temporary increase, which is extremely rare. And then also to discuss a super important aspect of that, which is the cervical cancer aspect, because the most common, almost every type of cervical cancer is associated with HPV, which is a sexually transmitted virus. And so one of the things that we need to do a better job of doing is counseling women who are starting on birth

control that, of course, this does not protect against STDs, and you need to be protecting yourself against sexually transmitted infections, even if you're already using some kind of contraception to prevent unwanted pregnancy. And so another way to do that, everybody should have the HPV or Gardasil vaccine and get their pap smears when they're indicated. Yeah. I understand that completely. Just because you're on birth control, it's not the green light not to have unprotected sex. Absolutely. And if we're talking about infertility associations, infections like gonorrhea and chlamydia are unrevocably associated with tubal infertility.

Right. And going back to your question on the vulvar tissue health, I was at the international pelvic pain society conference two years ago in chicago and there are various doctors speakers and a lot of that information came from from them actually it's how it's almost like a reversal of the tissue itself because it's stopping the natural production of hormones and so and from my own clinical experience those that have been on prolonged birth control i mean I'm talking really long years. Um, their tissue is just more, uh, it's more dehydrated, a little more leathery, um, and sometimes associated with pain, almost like in a, in a menopausal state. But again, this is, this is my clinical experience. And then, um, I can actually look up some of those

studies and send them to you too, in terms of their presentations that they were kind of talking about in the, in the lectures. But yeah, I, um, I'm not that sort of versed on it, but just from my clinical experience too so that's why I brought that one sure yeah I would I would absolutely be interested in in reading that um because that's not something that I'm familiar with and I'm always looking for ways to kind of expand my evidence-based file cabinet yeah and that's what I love about you Dr. Jones like you're just an open book and so very real and can have a normal conversation and, um, without, you know, saying, Oh, right. Some people get very defensive. Absolutely. Yeah. And I, that, so someone the other day had asked me, you know, sometimes I do

live videos on my Instagram when I'm on call and someone had asked, how do you deal with patients who are non-compliant? And, you know, I thought, Oh gosh, how am I going to answer this? You know, I have patients who watch this. And then I started thinking, you know, what do you actually do. And we have to come up with what is the reason that someone is sitting in our office concerned about something and what is their goal? And everybody wants to take care of themselves. And if they're not doing that, there's some barrier to that that needs to be identified. And we have to do our best to work through that. And I don't think you can do that without being able to have candid conversations with people.

Right, right. Absolutely. You're again, treating the human, the human being in front of you and not just the diagnosis or the symptoms. Which is something I love so much about this field. It lets us do that all the time. Yay, that's great. Superwoman, superwoman. I don't know about that, but thank you. You're welcome.

I'm making you blush, it's okay. My other question is, so this question stemmed from actually a case scenario that I had. I had a woman who, she was an avid runner, very healthy, lived on a farm, had organic foods. I mean, she was pretty healthy. She suddenly started to have SI joint pain and that's pain in the pelvis and in the low back. And she went to see a gynecologist and the gynecologist did a scan and said, well, you have a retro

uterus and if it's causing you so much pain, we might have to remove your uterus. But before she did that, she sent her to me and we worked on pelvic floor releases, um, visceral mobilization, so forth and so on. And she was pain-free. So my question is, you know, women get, you know, they're told often that they have a retroverted uterus. And from my understanding, in most cases, it's, it's nothing to really worry about that. It's almost common and a common issue. And should, so should women really be worrying about this um this issue about having a retroverted uterus yeah so first off i want to say i so appreciate the pelvic floor physical therapist that we work with and i love what you're doing with this podcast because i sometimes will want to refer

someone to pelvic floor physical therapy and they won't have any idea what it is and will be very kind of apprehensive about seeing someone, um, who specializes in that. And I find it to be so incredibly helpful to women with chronic pain issues, with painful intercourse problems. And so I, I love that you're getting this field out there and telling people about it. Um, from a retro, you're very welcome. I'm, I'm serious. They are, it's such a skilled field and I very much appreciate the work. So retroverted uterus. So I get this question a lot clinically. So I love that you brought it up. It is extremely common. And basically, when we say retroverted uterus, what we mean is that in most people, the uterus tilts kind of

forward towards the bladder. And when it's, quote, retroverted, that just means it tilts backwards towards the rectum. This is like one in three to one in five women have that orientation of their uterus. And it's a variant of normal. So most people are right-handed, but some people are left-handed. And we used to force left-handed people to write with their right hand. And we used to think that retroverted uteruses caused major problems. That's not the case, and they're usually a genetic variation of normal that don't cause problems. Now, I do have to add in there, though, that there are occasional exceptions to that, and that would be women who have that orientation of their uterus secondary to some kind of adhesions that have formed from

the posterior aspect of the uterus down into the pelvis or women who have severe endometriosis which has caused the uterus to to tilt a different way women who have fibroids etc those things could potentially be problematic or painful but as an incidental finding that has been that way their whole life most of the time this is genetic and only just like being left-handed um super super rarely this can cause a pregnancy complication called incarcerated uterus but that is so rare that most people do not see it even over the course of their entire practice as an obstetrician wow well i'm glad that you put all of our minds at ease now so ladies it's just like having a left hand retroverted uterus is just a tilted uterus and nothing to freak out about because

you know they get scared when they see scans i think people in general and they see something come up on a scan right like low back pain for us physios you know bulging discs so forth and so on i mean you can scan everyone's back and they'll have some abnormality but not everyone is symptomatic and so um it's not usually a direct cause relationship to the symptoms that they might be happening either. So absolutely. That's a great analogy. And it's, it's super important for women to know that and important to us as physicians, remember that we need to really go over people's imaging reports with them and let them know what each piece means, because I'm a strong believer that this is your health information and you should have access to it.

people should have access to the labs that we draw and to the imaging that we do and all of that, but it needs to come with some explanation of what it means in English terms instead of medical terms. Right. Absolutely. Knowledge is power and you, you decrease so much stress that they have in terms of their health by just reassuring them that everything is okay. And they don't, and oftentimes it's not really talked about, you know, you'll get, you either get a no, no call is a good call, right? If you get your lab test done, like if nobody's calling you with any information, it's always good news, right?

And then it just completely goes over our heads, but understanding why you're doing what you're doing and ordering and what does it mean? And what are some variations? I mean, I think that's huge. That's, that's really great. And I'm so happy that, that you're a practitioner that prides herself in doing that. We certainly need more doctors like you. So thank you so much.

Thank you. On to more of a, maybe a little bit more of a less serious topic to more of a fun topic about what women are sticking up their vaginas. So I'm sure, I don't know if you're familiar with her at all, but Dr. Jen Gunter, are you familiar with her? I am very, very, very familiar with her. Um, actually I have followed Dr. Gunter on social media since I became a Twitter person when Twitter first became a thing.

And she was, she's also a twin mom. And so I felt a special connection to her when I found out I was pregnant in medical school with my twins. And so, yes, I am familiar with her and I, I know exactly where this conversation will go. exactly so for listeners that don't know who Dr. Jen Gunter is she is an OBGYN as well and she's an avid advocate for just really digging through the research and pretty much putting it into hearsay knowledge and crap on the internet that goes out pretty much and she

does it in a way that she does not censor she does not censor and she gives out really good information in my, in my opinion, you know, she'll really refute some of these crazy things about what to stick up your vagina and so forth and so on. Exactly. So my take on that is I will always side with Dr. Gunter a hundred percent of the time, no matter what she says. And if anybody ever tells me that she's wrong, then they're, they don't get to say anything else about it. Right. Exactly. I know. And she's recently, she's recently got this beef with, with the magazine, the Gwyneth Paltrow's magazine. And, you know, and it can, when it comes to ladies parts and what goes up there and you know, what I want to know what your take is on all this,

you know, there's so many vagina fans out there like jade eggs and herbal infusions, um, and even cucumbers. Yes. Cucumbers. So I I'm just, you know, why should women not be so obsessed with cleaning their vaginas and what should, or shouldn't they be putting up their vaginas. Well, I, you know, I think Dr. Gunter's stance on this is you shouldn't be putting anything up there that costs you a ton of money and could potentially, um, not come out easily. Uh, and that's probably a good rule of thumb that expensive things shouldn't go in there and things that could get stuck, shouldn't go in there. Um, I feel like she's talked so much about it that we should just direct people to her blog. Um, but the, the cleaning thing is

something that comes up clinically all the time. And I usually try to tell people, you know, the vagina is a self-cleaning oven. You do not need to be putting potions inside of it to try to fix anything if something is going on that you feel like needs to be fixed then you need to come in and see your gynecologist so that they can see if it's actually something that is concerning or something that's normal and just stick with with water and unscented soap nothing frilly no crazy douches you you know just let it be right how it's supposed to be exactly and i and it's really, it's such priceless, uh, logical knowledge that most people, you know, just overlook. It's just really what? And I think a lot of that comes down to, you know, sex cells and, you know, we

have to smell great as women and no hair and, you know, shaving and Landy strips and all so forth and so on. So, and that's exactly right. And that's kind of what Dr. Gunter tries to touch on too is, you know, who you listen to should be the person who is not profiting off of what they're telling you. And as a gynecologist, I am familiar with the physiology of the body and the vagina is an area that keeps itself the way it needs to be. And, you know, it's, it shouldn't be something that's requiring constant attention, but these people who are selling these products to you make profit off of telling you that something you've got going on is not normal and it probably is normal and if it's not then your physician should be the one who is helping to fix that

right right exactly and yeah it's distorting reality and and normalcy really um especially at such a young age so i'm so that's huge i i actually see people a lot who have this idea that something going on either their vaginal discharge or the way their labia is shaped or you know this or that thing is abnormal because the internet and the porn industry has told people that they have to look a certain way and I spend a lot of time trying to talk women through this process of you look just like you're supposed to look and there's nothing that needs to be done about it and if you if you want to shave then shave if you want to just let it be let it be you know there's no right or wrong way for your vulva to look you just you know well I guess

there's a few wrong ways and if something like that's going on then you need to let me know but otherwise just just be you and we need to live in a more body positive world and I have two girls and I want them to grow up feeling confident in who they are and and not feeling like they need to conform to some photoshopped picture on the internet right right yeah photoshopping reality and so what that's a great message and those girls are very lucky to have you as their mentor and their guide and all of us actually too so thank you have you seen the labia project website oh no i haven't what is this website so it is a body positive website that um i i don't know if my dad will listen to this but i hope that if he does he doesn't go googling it

because he might be just horrified that i'm talking about it in a public space but so the labia project is a body positive website that people who have some body image issues regarding the size or shape of their labia um can get on there and see real life pictures of real life women that are submitted by the women themselves. And it's a place where I'll direct women to go if they are trying to consider some kind of vulvar plastic surgery just for cosmetic reasons. Wow. I'm on it right now. Actually, this is great. What a wonderful website. Thank you for sharing. And I'll have this in the podcast show notes for all of our listeners to kind of take a gander. this is wonderful beautiful thank you you're welcome so speaking of vulvas vulva and surgery

and tissue and vaginas a lot my last question is about a recent vaginal laser technique i don't know if you've heard of the mona lisa touch and i'm sure there's others out there as well for vaginal rejuvenation um it from my knowledge there's not a lot of research on this so i'm curious what your thoughts are and if you've ever read anything about it and is this really good for someone who might be experiencing painful intercourse or in fact help restore their tissues um for example like in menopause yeah so i am i hesitate to say i'm familiar with the vaginal lasers like mona lisa um which is a brand of a co2 laser that uses kind of fractional co2 to what they count as rejuvenate vaginal tissues. I wouldn't say I'm familiar with it because

I've never used one or been in an office that has one. And that's certainly not something that we learned about in residency. But there is, from my understanding, some emerging evidence that this could be a beneficial thing to improve vaginal epithelium and improve vaginitis. But that currently it is not FDA approved and is kind of a experimental, potentially profitable procedure that you should kind of take with a grain of salt. ACOG, which is American College of Ob-Gyn, has said to their providers for their physicians to understand that it's not currently evidence-based and approach it with caution, but has not really put out anything, to my knowledge, that's negative about it.

So I think we are slowly gathering more evidence about the benefits and risks of fractional CO2 laser for vaginal health. Um, but it's important to note too, that we've been historically slow and coming up with things which improve women's health and sex life. Um, and so it's something that I think there's maybe some potential in, and I hope to see more research about. Great. And that's a wonderful answer. Again, you're giving a very non-biased, not really sure what it does. It's super expensive from my understanding as you said very profitable right exactly so always always take expensive things like that with a grain of salt but part of the expense is likely also that because it's not fda approved there's no insurance coverage of it so if we can get more evidence behind it

and in the future maybe an fda approval if it is worth it again i don't know enough about it to say either way, then that might help with costs decreasing for patient access. Right, right. Great. Well, those are all the questions I had. And honestly, I had such a great time having you on the show and chatting to you about some of these myths and misconceptions and reality distortions and what not to put up your vagina and just let it be. Absolutely. I am so excited that you invited me to chat with you and it's been it's been really fun yeah and you guys all you listeners out there um gals and and guys honestly check out her instagram page she's got a wonderful page that you can follow her she also has a great

blog um could you share a little bit about how our listeners can reach you and connect with you and other social media handles sure so my instagram is mama dr jones and i kind of use it as just a glimpse into the life of a mom and OB-GYN. And it's, you know, my goal there is to inspire people to have better work-life balance, whether you're a physician or med student or, you know, just a parent. Otherwise there's so much to be said for self-care and improving your work-life balance. And then my blog is mindonmed.com and it has been my kind of sounding board and creative outlet since my first year of medical school. And it definitely was more significantly updated when I was a med student and had a bunch of free time. But I'm hoping now that I'm out in

practice, I can kind of get back to that because I have a passion for kind of telling people our journey and hopefully inspiring women to live their best life and take care of themselves. That's a beautiful message. If anyone wanted to become your patient, is there a way to connect with you? Yeah. So I'm currently practicing in College Station, Texas, and I am working out of a hospital there. So if you have interest in that, If you'll just send me an email or a message. So daniellejonesmd at gmail.com is my email, or you can send me a message on Instagram and I can get you the information to get ahold of our practice.

Great. That's awesome. Well, if I was in Texas, I would be there. Thank you so much. Texas is a big place though. Everything is big in Texas, I hear. That's right. Well, thank you again, Dr. Jones.

You've been a blast. I am so grateful and so thankful for you to be on the show with us today and share your message. You're such an inspiration to us all. And I hope to one day give you a big, giant hug. So thank you so much again. And I'll see you later. Thank you so much, Susie. Thanks for listening to today's episode.

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