Ologies with Alie Ward - Gynecology (NETHER HEALTH) with Philippa Ribbink

Episode Date: April 3, 2018

Let's get intimate with the mechanics of nether parts via a frank chat with the calmest, coolest gyno in Portland, Dr. Philippa Ribbink. She visited Alie's weird hotel to chat about vaginas (vs. vulvas), self-care, mental health, imposter syndrome, trans care, childbirth, body image, the accuracy of assault statistics, grooming, hygiene and more. NO QUESTION WAS TOO DELICATE, FOLKS.Language alert: In considering the inclusion of trans women, I opted for the use of the term "women's health" and "women" -- as gynecology is currently (yet antiquatedly) defined. In so doing, I fucked up and overlooked and excluded non-binary and trans men friends in that language and I'm so so so sorry. Some amazing Ologites alerted me to this and I just want to say I'm so so sorry that the language I used (women/lady) made anyone feel unseen. So please know that trans inclusion was on my mind, but I'm super embarrassed to have missed the mark and overlooked the non-binary community and trans men community. I see you, I love you, and I care a bunch, and I will strive to do better when it comes to inclusionary language. Curiosity and compassion are so key to social health, and as you know I'm all about asking smart people dumb questions. So thank you for patience as we all learn new things and evolve into an even more inclusive, better-linguistically-equipped society. Please continue being patient and kind to each other and as always, keep your mind open to learning new things, whether it's about snake butts or bee dancing or the origins of the Universe or another person's perspective. Learning shit is cool.More episode sources & linksSupport Ologies on Patreon for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisMusic by Nick Thorburn

Hey, hello oligites. So I put this in the show description, but I'm also adding it up top just in case you're driving a car or You're working a forklift or you're feeding your chickens or I don't know if you listen on a high wire You should not reading text. This is just a pre-roll Linguistics alert so in this episode we talk about transgender healthcare and we touch on the history of the trans community in the US and when I recorded This episode in considering the inclusion of trans women I opted for use of the term women's health and women as

gynecology is currently technically but antiquatedly defined so I thought okay, I'm making sure to include everyone who identifies as a woman. We are golden great No in so doing I fucked up and I overlooked and excluded non-binary and trans men friends in that language And I'm super super super sorry. I'm so sorry Some really amazing and compassionate oligites alerted me to this and I just want to say I'm so so sorry that the language I used like women lady lady machine made anyone feel unseen Please know that trans inclusion was totally on my mind But I'm just super embarrassed to have missed the mark and overlooked the non-binary community and trans men community

Who also rely on gynecology for vital health care? I thought I had my bases covered and I did it. I'm an idiot. So my oligites each and every one of you I see you. I love you I care about you a bunch and I will strive to do better when it comes to inclusionary language as you know I'm all about asking smart people dumb questions and even when I think okay. I got this I'll do my best to just double-check triple check. So thank you for tipping me off to that That I could have been more in the loop about gender versus jennies and for your patience with me and with each other Just as we all learn new things and we evolve into an even more inclusive and better

Linguistically equipped society now if you don't encounter it often it may seem like what's a big deal? But I think these are some new and really exciting steps toward breaking down a lot of gender roles that hold all kinds of people back from cis to trans to non-binary like wearing pants was Illegal for half the population until that was challenged and reframed So if you're stoked that you don't have to drag a bustle on subway or fit a petticoat Into your Nissan Sentra then we have some brave folks who said this sucks and it's impractical to think so likewise with gender and labels and the trans and non-binary community for undoing some super stark

Gender expectations and roles that don't really fit anyone Completely so thank you. I see you Let's all be super kind and compassionate to each other and keep our minds open to learning new things Whether it's about snake butts or be dancing or the origins of the universe or another person's perspective So learning shit is cool. I stand by that. Okay, Gino. Here we go. Oh, hi. It's your guidance counselor Ellie Ward It's me First things first. I think I have my contacts in the wrong eyes, but I'm just gonna go for this. I'm gonna change them later Let's blaze through OBG. Why not? Let's get into it vaginas. Let's talk about them

Maybe you have one. Maybe you want one. Maybe you love them. Maybe you came straight out of one They're everywhere They're all around you and they're pretty handy in terms of shooting out humans to continue the survival of our species But how well do you know vaginas? How will do you really know them? It's kind of like when you've met someone a bunch of times at parties and you're like, oh my god I love her, but you don't want to admit that like you've never had a real one-on-one and Like you don't even text each other You've just hung out like a few times when people are drunk

So consider this episode it's just a deep-ass dive into the world of vaginas birth women's health mental health self-care hygiene all things that are happening in Parts of your body that you only care about when they're causing you either great pleasure or great pain So let's talk about gynecology First off before we celebrate crotch doctors. Let's celebrate you this engine of oligies runs totally on listener support It's a hundred percent indie so your patreon pledges did keep it running for month to month Thank you so so much for doing it patrons also get in return to ask the oligist questions And they get to walk around knowing that they're helping cocktail parties everywhere be way less vapid

So thanks to everyone who buys shirts and dad hats and pins and totes at oligiesmerch.com You're totally helping too But money's tight I get that you can also support so much by just subscribing and reviewing on iTunes Which is free it takes two seconds and I'm a creep and I read every review and this week's Warmed my heart so much it confused my soul a little bit TBH Moni walk says just listen to the podcast on ick theology and I realized that Ali sounds very similar to Ellen DeGeneres What could be better than listening to Dory tell you about fish? Do I sound like Ellen DeGeneres? Yes, I am. That's me. Okay

Back to gynecology now before we dive into where babies come from Let's look at the birth of the word. So gynecology. It means a science that deals with the health and diseases of women It comes from a Greek word Jaina Which comes from Gwen which has the same root. You ready for this as Queen Gwen Queen Jain boom So just think yes, Her Majesty the Rife Jai So let's bow to your Queens with a discussion with a gynecologist Now I had gone to Portland to record a few episodes beer bees and now this interview with a medical doctor Who grew up in the Philippines, South Africa? She grew up in Argentina the Netherlands all over

She's now based in Portland. She's been an OBGYN since 1997 and she's worked several medical missions in Ethiopia. She's a total badass She spent an hour on a Saturday morning getting peppered with questions for me now. She arrived in my hotel lobby I think a bit confused. I'm gonna be honest I think she was like, what am I getting myself into and I have a dear high school friend Hi, Paul and he had put us in touch and I think she's like who is this red-headed chick in a three-star Portland hotel? And why am I talking to her on a Saturday morning and side note? I had booked it on a hot wire where they tell you like it's probably a Sheridan

Like a Marriott and you're like, okay, and then after you pay for it They're like psych we gave you a creepy place that someone would stay if they're going through a divorce on a budget So this amazingly brilliant doctor shows up and on the way to my room She offers that the place has a bit of a motel six vibe and I was gently mortified. I was like hmm girl You are not wrong. Please forgive me. I have been foolishly catfished by how are Anyway, we got to my room and she has the calmest bedside voice of anyone I have ever met I imagine honed from literal decades coaching live human births like If a screaming rotisserie chicken made out of my own blood were to work its way out of an orifice

I would want someone with her calm intelligent disposition calling the fucking shots here Likewise, like if I found a rash somewhere delicate or needed my holes probed by imaging equipment her voice her coolness our goals So she pulled up a chair and we chatted about what your gynecologist thinks of your bikini wax unusual birthing strategies self-care and even like warning some super sobering statistics about Assaults how you can help victims how to wash yourself how to touch yourself all kinds of great stuff

So feel free to recommend this episode to anyone who's a woman or whose life has been affected by a woman Which is like all of us So please scooch just a little further down the table. It's a little more. Okay. That's too much. Okay for a gynecologist Dr. Philippa ribbing So here's your microphone, that's yours and we just talk into it dr. Ribbing dr. Ribbing Was there a particular day where they're like we can you can call yourself a doctor now After you graduate from medical school the day you graduate you can call yourself doctor. Did you? No, no did it take a minute to like

Get settle in to your identity Yeah, it took a while took a while I mean I did in residency I think from day one, so that was a month after I graduated So wasn't didn't take that long. Mm-hmm. But yeah It felt like I was acting in the beginning really I didn't I didn't feel like a real doctor for quite a while It actually took quite probably several years before I stopped feeling like I was acting that's really common though and in Doctors especially doctors with with a lot of empathy is that feeling of imposter syndrome?

It's very common. Yeah, it's very common. I'm not quite sure why but I Did a lot of acting in college So it kind of like I was okay with it But I felt like I was acting quick aside on imposter syndrome because I feel like so many smart capable people have it including so many Allegists that I mean first it's not a syndrome or a disease at all It's just an experience identified by two psychologists dr. Pauline Clance and dr. Suzanne Ims now They observe that many intelligent high achieving people especially women and people in ethnic minorities Tend to think that they are not intelligent. It's common across so many fields people like Maya Angelo and Cheryl Sandberg

And even Tom Hanks being like me a man. I do not belong here. I suck So a lot of people with imposter syndrome don't know that other people worry that they don't belong in the high ranks that they've achieved But admitting and talking about it tends to really help if not solve the problem So by the way, the the opposite of this is called the Dunning-Kruger effect when people of low ability Think that they are the best which can also happen in a lot of fields Such as for example politics as for imposter syndrome No matter if you're a doctor or a dancer you may have felt like do you do I belong here? At what point did you? Kind of decide to nurture the medical side of your

talents if you are if you're also doing arts and acting like was there a moment where you're like, I gotta choose I Always wanted to be a doctor when I was a little kid. I had I had I had a heart Apparition when I was a little kid and after that I always I kind of felt like well I have to do this when I grow up and my grandfather who I was very close to was also doctors So I kind of wanted to be like him Mm-hmm And I always thought I was gonna be a doctor and then I went to college and I discovered acting and I loved acting and then I thought well, maybe I'll be an actress in New York City, and then I was waiting tables in New York City and

kind of thinking well, I don't really want to do this and I Was very good at science. So I didn't in my last year in college. I was like I Need to rethink this. I need to do what I'm good at and applied to medical school and I got in and I Ever since that I've I'm I love medicine. It's just it's it's it's The only job I can imagine doing it's the only I Don't think there's a lot of jobs Except for maybe what you do where you can really you can hear stories people's stories

You can listen you can you can get really intimate details about people's lives and a Friend of mine said, you know, I don't lead read literature because I listen to patients all day long and you can't make up this stuff You can't make up this stuff the the degree of Kind of the the views in people's lives you get as a physician Maybe not all physicians. Maybe not if you're a radiologist or pathologist, but as an OBGYN or a family practitioner Or an internist. It's it's amazing. I mean, it's an incredible privilege. You get to like Listen to people's intimate details and then you get to give them advice and it's it's you get to change people's lives and There's very few jobs where you get to do that

Do you think that there's something about psychology and stories that drew you to women's health in particular? Probably I mean, I said I've always think I've always found there's also just something about women's health That's just it's so varied what what I do as an OBGYN is so varied. I'm a general OBGYN So I get to deliver babies. I get to take people the OR I get to do C-sections. I get to do I get to know people for 20 years and That's not, you know, surgeons get to meet someone one day and take out a gallbladder and then never see them again And I get to see people whose kids I've delivered and then maybe I've taken that they were very insist or I've You know, and I take care of their kids. I you know

I saw yesterday I saw a patient who's a who was a Katrina Refugee who had nothing when she came here now our kids gonna go to college. I mean, it's like I get to see these stories And I don't I don't you know, who gets to have that kind of inside view You know, even as a journalist you're like, you know, you get to hear a story and then you're in another town Yeah So you don't get that you don't get to know people on that level Did you find that when you were first starting out was that kind of intimacy was that easy for you? Or did that did that become more easy more natural as you gain experience?

Yeah, I mean, I think it takes time to be comfortable with people telling you things that may be somewhat embarrassing and somewhat You know Little too much information or a little bit like oh my god, I work with you and you do that. That's interesting Um, but I think that you know, it takes a while to ask the right questions as well It takes a while to ask questions About people's sex lives It takes a while to ask and to learn how to do it without judgment and where people are actually comfortable And they're gonna tell you details that are important for you to know

If you don't ask the question, you're not gonna get the answer. You're not gonna look for the The you're not gonna be able to make the diagnosis, you know I there's there's People make silly choices sometimes when it comes to sex and you don't you don't find out that They've made those silly choices until you've actually asked the really specific question Or they make silly choices when it comes to drugs or other things and again, you know Unless you're very specific and you learn how to ask questions very specifically without Without judgment and that takes quite a while

I think that in the beginning I wasn't that good at that Do you have to do a lot of guesswork with women's health? Are there any cases that you feel like really confused both you and the patient? I feel like as a as a person with a vagina and as someone who has friends with them there's a lot of times women's health can Absolutely confuse us and say why does this hurt? Why is this happening? And Do you find that that it's that sometimes diagnoses are difficult to make? Yeah, I mean probably pelvic pain is one of the hardest subjects for us all because people come in with complaints of pain And there's so many different things that can cause pain in the pelvis because all these you know

There's so many different organs in the pelvis and all the nerves travel together So you can have you know, you could you could have a hairline fracture in the tip of your You know in the tip of your femur in that in your femoral head and that could hurt It could make you hurt kind of in the midline as if you've got you know, something wrong with your ovary and so the pain All these pain fibers travel together I've had people with ectopic pregnancies on the left side and come in with intense pain on the right side side note ectopic means out of place literally and it refers to an egg Instead of implanting in the uterus

Deciding to just like attach to your fallopian tubes or elsewhere. So this is like moving into new house But setting up your bedroom in the driveway. It's like is here. Is here good? No No, it's not that's not good And sadly a top ectopic pregnancies usually do not have a good outcome and they can be super dangerous for both the fetus and The mom and they hurt a lot sometimes in the wrong spot. It's hard to locate pain just by Where people point or people say it hurts on this side and And I've you know, I remember Taking a patient to the or because she had intense pain on the left side and she had a cyst on the left side

and she was postmenopausal and she shouldn't have a cyst on the left ovary and We took out her ovary and she still had this pain on the left side And then I kind of scratch my head and didn't know what to do with her and send her to a friend of mine Who's a fantastic physical therapist who's also a really fantastic diagnostician and he would just kind of Figured out that she had started playing the flute and was holding her body really funny What Emma's just contracting her left side of her body and that's why she had this intense pain on the left side So there's all this this, you know people People hold their you know, hold tension in their Ilias oas muscles, huh?

They'll hold tension in their levidaeana muscles. So I've come again Okay, those are both part of your pelvic floor, which is kind of like a trampoline of Muscles holding your bowel and bladder and uterus in the right spots So this basin of muscles make sure your guts and gonads are well supported. Some of us Don't even realize we've strained them. Don't even know we have them We've never even thanked them once if you're feeling bad about it Just do like a little kegel squeeze right now like a high five like boop They'll hold tension in some of their muscles and it will be and it will feel like pain from their ovaries

We'll feel like pain from their uterus and it's and it's really referred pain. Wow. I didn't even know that could happen I can't imagine you're like I played the flute. Let's get this over yet here Who would have that's that's not something you're going to find in a medical textbook like no It's just kind of you know I Mean sometimes you can get it out through the history you you know you for finding out what kind of work people do whether they stand a lot and Sometimes people have a lot of women have had a history of sexual abuse and a lot of times when you've been

raped or you've been hurt you'll hold you know, you know, your body remembers the pain and It manifests itself later on in life. So in various different ways, so Having practiced now over 20 years. Have you seen any attitudes toward? women's health or being their own advocates for their health or their attitudes toward their own sexual relationships change at all over the last couple decades, unfortunately, I think women are still So What mystified by their body more so than they need to be I think there's a lot of information out there on the internet

That's very helpful, but I don't know how many people are actually accessing it There's there's an amazing website called oh my god. Yes about that basically talks about female sexuality Yes, I went to oh my god. Yes comm. Okay, so this is a site that raises money for women's sexuality research By providing in exchange Informative beautifully shot Instructional videos behind a paywall. I was like, do I pay? $39 in the name of science to see what this is all about and hell. Yeah, I used my business card and I did it So, let me just say whoa, dude. Whoa. Whoa. Okay. It's this gorgeously shot

Catacomb of videos you can go down about orgasmic tactics such as edging layering Signaling Orbiting and it's just right up in there. You see it all honestly the most striking thing was like Whoa, I have never seen it's like someone that you'd work in an office with talking or doing sexual things on camera like this There's like no performative moaning. There's no painful looking high heels or weird coy eye contact with the camera It's just women teaching women how to use their anatomy for pleasure Men might be thinking like you need a video for that We don't need videos for that because our bodies are human factories with a lot of real complicated parts

Most of sex ed that women get focuses on like mechanics like periods pads tampons Obulation how to make sure a dude does not put a baby in us when we don't want one etc. etc As we learned about in the sexology episode most women don't come through just vaginal Stimulation and no one really talks to us about that because for a quarter of our fertile lives We are busy hemorrhaging from our crotch and that just got dropped from the pamphlets. They give out in middle school They're like, oh, yeah, I guess you could come so I guess if you figured out I think it's kind of change I mean, I think the last year is very interesting to me because I think there's all these different You know, maybe because of the me too movement, maybe because of reaction to the election or there's

There are many more TV shows that talk about female sexuality that vary openly So I think I kind of feel things are changing now, but I don't you know, I don't know. I mean, there's still I See a lot of women with pain with sex There's a lot of great information out there about that Women have come in very very mystified about it and I really not they don't Know how to access the information on the internet and how to find How to find the right sources they come

And they come in with a lot of shame and a lot of shame Or they hear things like oh just continue to have sex because it will get better and They come in by the time they come and see me They've got they've had pain for so long that their muscles are completely tense and it will take ages for us to kind of reverse What's happened? I think the things may be changing now, but I in the 20 years. I've been here. I haven't necessarily seen You know, there are people that know how to access information and will From either books or from the internet and know how to take what's You know, they know how to separate the bullshit from the from the true information and there's also people that just

Get mired in the details and then really come in with some really kooky concepts Do you find that people sometimes over Google before an appointment and then like I think I figured this out and you're like, well Yeah, people do and and again sometimes people come in and they've Google things and they've really Fine they've found some stuff that I've never heard of and they've really and they educate me There's also people that come in and they've just really gone down a rabbit hole and they just are That hasn't helped them so again, I mean, I I don't know what makes people good at finding information and what makes people bad at it You know

Is that is there any book you think that every woman should read About her own health like is this in our bodies ourselves kind of a thing is that say Like is there a should there be a text book? There should be and I think our bodies ourselves is kind of outdated I know joy of sex is a kind of outdated. I mean, I think there's I Yeah, I think there should be something that's that's um I The thing about female sexuality is that there's so you know, it's finally being studied It's finally being studied in a more kind of scientific way

I remember a textbook when I was in residency that talked about it was a surgery textbook and talked about treatment for vulvar cancer and some vulvar cancers that are invasive That are spread the treatment is removing the entire vulva including the clitoris Let's take a few quick sex for a quick rundown of the key players in a gynecologist's Eyeline now when you say vagina such as in my vagina wants to text him But my heart knows better or I'm sorry. I stole your brownie. Please do not kick me in the vagina friend What we're probably referring to you

You're ready for this is a vulva Which is such a moist sounding word But I am a grown-ass woman and I just learned one minute ago that the vagina is just the muscular Canal, that's your baby shoot the vulva is everything else external including the pubic mound The labia majora, that's your burger bun the labia minora. There's your lettuce the clitoris Your pee hole your vag opening. That's all your vulva You've been calling it by its sister's name vagina all this time, but it's like whatever I'm used to it So as she was saying in some cancers if they spread they remove all or part of the vulva

This surgery textbook said that after that someone will still achieve orgasm And I read that and I tried to find the reference for this And I could not there wasn't a reference for it. It was just a statement in the textbook, but it wasn't referenced So I kind of thought where on earth did I get this information? And I kind of know where this information comes from because I've worked with those doctors and they you know The patient comes in says is everything still fine with your husband and patient says yes, it is and Hence the conclusion that women can still achieve orgasm. Oh my god bullshit. Yeah, I mean there's no I never found a reference for that statement If things are fine for your husband, they must be fine for you

So I think that you know finally There's people that are actually doing scientific research on Female sexual pleasure on females bodies, and I think that's really important I think that's Astounding that it hasn't been that it's such an afterthought. I mean To to women's health in general, I mean, I feel like the focus is is tends to be more on Reproductive I feel like we prioritize making more babies rather than having more orgasms probably. Yeah

I mean, I think it's all like, you know, who who's telling the story, you know, I mean, it's it's just like I Think for ages men have been telling the story I think finally women are telling the story women directors are directing movies and telling stories There's TV shows that are you know written by woman directed by woman and it's finally Women are telling the stories. So I think we'll get more You know science kind of Being spent on issues that are important for women. I think we need more women telling stories

We need more women in science. We need more women asking questions Do you did you gravitate toward gynecology? Because of your own interests in it necessarily were you were you kind of mystified by things and you thought this If I'm mystified and I like and I like science, maybe other people are or did you like the idea of delivering babies? What was it? I was a rape victim actor. I could in college So I think that kind of made me interested in women's health and them just in medical school. I mean I There were there were two fields. I loved so a psychiatry, but that happened to be because I did medical school in New York City and the Psychiatric hospital was Payne Whitney at Cornell and it was just such a fantastic psychiatric hospital and the

Psychiatrists were the smartest doctors I met And it was just fascinating and then the second field. I really loved was OB it just OBGYN I just absolutely fell in love with it. I really had no experience with delivering babies before I started Medical school. I just like I just fell in love with the field I'm so sorry that happened to you by the way. That's I wasn't a rape victim. Oh, right victim advocate Okay, so this is super embarrassing, but when she said rape victim advocate, I missed the advocate part of that sentence so that was the most Embarrassing and delicate conversational hiccup of my life. So thank you for witnessing it

I had never heard of a rape victim advocate, but Dr. Rubinke explained I went to the ER to like be with rape victims So they had a program that we they when you could be trained you could train to become a rape victim Advocate and you were on call and if some if a rape victim went to the ER You would go with them and sit with them basically during the interview. How did you get involved with that? I don't know. We'd someone there was a flyer up in my college. I went to a woman's college. I don't know Yeah, it was cool. It was cool. It was good a good thing to do in an ideal world perpetrators of these violent crimes wouldn't do this and

We all know society has a long way to go in addressing our culture of violence and Unfortunately, I hear these stories from people. I know a lot Every woman seems to have had a sexual experience that should not have happened to her or a near brush with one And those stories are so common They're incredibly common. I mean, it's just it's astonishing how many women have been Sexious salted or raped. It just is astonishing and underreported as well. I'm the reporter I mean we used to say one and four I think That's probably more one and two

God that's I Think I'm hoping I'm hoping that women will start this will start some kind of tide of Speaking up. I feel like this even the last couple months. It's been the first time that you really hear people Speaking out about it because the repercussions are so so much There's so much sharper for women than they should be ever Yeah, and they should be for any other victim of anything else So for more information on programs to help support victims one resource is rain.org are a Inn.org

So check that out. So alright in college. She spent some time being on call for volunteer work. What about now when it comes to being? You know be are you it is your life always? Are you always on call? No, we I'm in a group I could never always be on call that I I mean I don't I know that Obesities used to do that and I think they had wives that would like take care of their Personal needs and we're somehow able to do it I would never be able to pull that up now I work in a with a lovely group of

Physicians and we cover each other and our group was actually The founders of my group really felt that in order for us to be good physicians. We had to take care of ourselves We couldn't take care of other people if we didn't take care of ourselves So we from the very beginning that they the group we never took call for ourselves 24-7 We always covered each other so that if You had a dinner date you could go to your dinner date You didn't have to cancel your dinner date just because someone was in labor and Patients you know our B patients hear that from them, you know the first the day they come in the door

You know I work in a group. We want we take we cover each other for call Whoever's on call is going to do your delivery. Maybe me. It might make me one of my wonderful partners and You know if you if that's not okay with you then you need to find a different physician And when when you say taking care of yourself is of course that makes you a better doctor I think that's so interesting especially when it comes to women's house We don't take care of ourselves What are the basic tenets of like making sure that you're not ragged and it's not affecting your body? I'm asking this for selfish reasons because I'm always ragged get enough sleep when you can

Don't drink too much alcohol Have friends do things with your friends have family do things with your family go on vacation You know Do things that have nothing to do with medicine go to the movies read a book learn a new language do other things And exercise we all like every one of my group has an exercise routine and we stick with it religiously It's so important and eat healthy. I mean those are kind of I mean their basic things that everyone should do Don't eat junk food What's your exercise routine? I?

Got a yoga twice a week, and then I do this bizarre exercise called Gerotonics, and I take a private lesson with this Russian ballerina who tortures me Says I'm Russian. I had to do this when I was a kid, and you have to do this What is it? Does it involve a gyroscope? No, it's this it's kind of like Pilates, but it's More three-dimensional than Pilates. It's an amazing core muscle exercise routine a lot of what I do is bending over and Holding my body in funny positions when I'm waiting for someone to deliver or okay. I looked this up, and it's not Gyro tonics, it's technically Gyro tonic followed by an R in a circle like a registered trademark Gwyneth Madonna

They're both into it and videos I watched feature these super ripped swan lake types stretching cables around with such Elegance they look like alive Puppets doing this slow Sweeping modern dance performance. It's also expensive, but there are group ons if you're thirsty for abs You're a gyro gyno. I'm a gyro gyno. I'm not like there's actually three gyro gyno's in my group We actually thought about having a group retreat and doing a gyro tonics class you guys make t-shirts man And I run and I walk So so make sure to get some get some exercise

Yeah, I think we need a like a women's health Bible and that should be chapter one and then The rest of things like what the hell's a cervix? Yeah, okay, so cervix means neck and it's the lower part of the uterus that serves as an opening To your vagina now. I try to find a fun fact about a cervix that you would like And it might be uncomfortable So I'm just gonna sing it fast in case it's uncomfy so you can just tune out the words and grip the music if you need to Okay, so your cervix has glands that make mucus and you can monitor it to figure out how fertile you are And it's thicker and acidic when you're less likely to get knocked up

But it's stretchy and clear like an egg white when you have more estrogen and might be Obulating in that aspect of being stretchy like for instance in mucus has a name and the internet says it's pronounced like this Spin bar key-eyed. I'm sorry. I did that to you and also there's nothing less sexy than a robot describing your cervical mucus Okay, let's change the subject. This is a dumb question But when people are going to the gynecologist and they're like, oh my god, do I need to get a bikini wax? Does any of that really matter because I feel like there's so many women I talk to who are like, oh man, I'm going I'm rocking this bush. Oh, that's embarrassing. Does the gynecologist ever really care? Actually, I I actually tell everyone don't shave. Oh, okay, cuz hair is there for a reason

So where I mean if you talk to all the vulva specialists in the country, everyone's like don't shave Really? Yeah, it's so cool that out there right now. There are Vulvar Specialists like real ones and not dudes on spring break wearing shirts proclaiming that they're vulvar specialists They're not I mean, I see people come in with like nasty folliculitis because they've shaved or they've waxed or whatever and I'm always like, you know, I also think the shaving has kind of made people so much more aware with what their vulva looks like in their labia and Like there's like

So many people that think their labia are too long and they need they need to be reduced or cut off and and I think part of that's because everyone's shaving and so you can see them more and There are so many different normal shapes of vulvas and the range is amazing and I think people have this like idea of what that needs to look like. That's really artificial So there's all the plastic surgery that people are doing on their on their vulva I think part of it is the result of I'm part of the result part of it is the result of internet porn part of it is the result of everyone shaving and Thinking that this is kind of what it needs to look like and there really isn't a specific way that it needs to look like

I was that was one of my questions is I was gonna ask if you've seen in your practice like with labiaplasty has become more and more popular as we have more access to to images that maybe are It it has I mean, it's it's there's my practice is a we're it was started by two hippies So it's we've got a little more hippie-dippie practice Although the two hippies have since moved on and I do not like the Grateful Dead, so It's actually one of my interview questions That's so specific

I Grew up with the sex Perhaps as a future gynecologist she was influenced by the sex pistols seminal album never mind the Bullocks Bullocks mean testicles in British slang back to trimming your labia So not so much in my practice. I haven't you know I occasionally have done labiaplasty's especially in cases where like one labia is way longer than the other Or when they're so long that they're really rubbing and it's really uncomfortable Or when they're athletes and they just is a problem. So I've done labiaplasty's in those cases. I don't get that many

Requests for just purely cosmetic labiaplasty's but I know Physicians that are practicing elsewhere that are you know, that's a big bulk of their practice and they're you know, I know There's a in New York There's a specialist in maternal fetal medicine high-risk obstetrics that left his specialty and all he does is labiaplasty's And he advertises on the internet the before and after picture and has all these stories from women that felt Always felt horrible and felt that they were ugly and now they feel so much better and I you know, I to me It's just like there is no normal, you know, what let's let's talk about what's normal Let's talk about the range of of what the vulva needs to look like and let's and I think

What what the only thing that makes me really hopeful is that we're starting to see More women's bodies that are slightly different in advertising. We're starting to see Women's bodies on TV that are not the perfect Model that whoever decided was the perfect model. I'm hopeful that We're finally gonna have some more Except that woman are finally gonna learn how to accept her body the way it is, right? Because I think that's them that that's what it's about I guess and being an advocate for your own health is accepting accepting your body as

Fine as it is. I think women have such a women do tend to have a bit of an antagonistic relationship with her body because it's because of Perfection standards. I mean, I know I feel like every woman I know has something that they're no one likes their own boobs Yeah, it's like really it seems like very few people really Find that their breasts are they're either too big. They're too small. There's no Better lesson you could learn your dog taught you teach your daughter and then love your body the way it is. It's a lot cheaper Okay, let's pivot to have some IUD chat intrauterine devices IUDs They can last three to six years and be super effective in preventing pregnancy

So they interfere with sperm motility the booby trap your cervical mucus to make fertilization harder And in some cases they poke your uterus to make you think you're already pregnant so that an egg won't implant So that's very lay women's terms. They also can deliver hormones They can help with heavy periods like the marina IUD, you know, some people don't tolerate the marina IUD I was gonna ask about about IUDs How much more common they're becoming and if they're pretty painful if someone's considering one It depends on where you are, I mean on the coasts, I think they're a lot more painful right before the election

I think I was putting in two IUDs a day People are afraid they're gonna use contraceptive benefits and they you know an IUD last five years Or ten years depending on what kind of IUD you have we've always put in a whole We've always put in a lot of IUDs. I once did a review for a legal case from somewhere in the Midwest and They You know the patient was never offered an IUD and she presented with heavy bleeding One of the first things we would do in someone who presented with heavy bleeding would be to offer them a marina IUD because it reduces menstrual blood loss and it's so effective that my

You know, I worry about my resonance getting enough experience doing hysterectomies because we don't do that many hysterectomies anymore We use we use the IUD when it comes to Ovarian reserve and and eggs I feel like I know a lot of people who are waiting a little bit longer to have children Maybe they're in their mid 30s late 30s before they're considering starting a family This is a maybe maybe this is a stupid question Maybe it's not if you've been on birth control preventing ovulation for a number of years Does that mean that you have more eggs or not?

No, okay I mean, it's good to be on the birth control pill for many years because it decreases the chance of you developing endometriosis So it suppresses endometriosis. So it preserves fertility in that way It doesn't preserve fertility in terms of ovarian reserve. It's not that you don't have eggs It's just that your ovaries become more unresponsive So it doesn't it's not just the number of eggs you have left It's more just the responsiveness of your ovary Do you recommend?

Women who are waiting to have a family is there a time when you're like get these puppies on ice You know, that's a good question. I mean The our college the American College of overdoings just send out a hole I think it was last year that they send out a questionnaire where they asked all of us Up to what extent we offer our women our patients that are in their early 30s Up to what extent we talk about a fertility preservation with these patients and It's interesting because I think that what came out is that most of us if we had a patient who presented with cancer and was going to get whole radiation that was potentially going to destroy their ovaries we would

talk to them about preserving their eggs and We don't necessarily do that in our patients that are 32 that are getting their second PhD and Waiting to have kids because of that reason and and We should I I mean I ever since that they that study I have been asking people What are your plans in terms of kids? Is this something you want something you don't want? I'm not You know Occasionally I've talked to people about preserving their eggs the tricky thing in Oregon is that it's not it doesn't it's not covered under insurance

So it's pricey. Yeah, you know cost a fair amount of money and You know people that are students don't necessarily have an extra ten to twenty thousand dollars laying around to do that Yeah, no, so that's that's the problem. I don't think people are quite aware of how quickly How much age how much infertility is caused by age so 20 or so years ago The American Fertility Society wanted to launch an ad very well-meaning on buses that said hey ladies Start your families before you turn into a wizened crone Paraphrasing, you know, they showed the ads to groups of women and everyone just was completely offended, right?

You know, there's it's it's hard to how do you? Tell women, you know, your clock is ticking without telling women go make a baby. Exactly, you know, it's it's hard Yeah, and the ovarian, you know, the the oocyte freezing has You know, we used to we used to not be that good at freezing just unfertilized oocyte So now we've become much much better at it. So it's an option. It's a viable option now for those that can afford it But early 30s is a time to think about it. Maybe yeah, okay. Yeah I remember 20s early 30s. I remember someone mentioning it to me when I was 34 And I was like, how dare you and I was like, oh, yeah, okay. I see what you're talking about

No, I mean, it's just fertility starts plummeting in our late 30s and Different, you know, we're we're all a different curve some woman you know, I've had a patient that conceived with IVF with her own eggs at 45 and But that's the exception to the rule, right? There's always someone that's like, I don't know my cousin found out John accident was pregnant for 48 And so anything's possible and you're like, okay, whatever. Yeah, good to know. Okay. I'm have some rapid-fire questions Okay from listeners, but before we take questions from you our beloved listeners We're gonna take a quick break for sponsors of the show sponsors. Why sponsors?

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Okay, your questions Carrie steward wants to know what are OBGYNs doing to reduce the maternal mortality rate in the US and during a woman's pregnancy How do obese balance the mom's health with the baby self? well in California they they took Kind of control of the issue and they started investigating every maternal death and they came up with some really great Algorithms and kind of protocols and approaches and on how to address postpartum hemorrhage on how to recognize People at women at risk for preeclabtic seizures, California maternal mortality rates have gone down ever since they started these Investigating maternal deaths, Texas maternal mortality rates are have gone up

So I think it's a state-by-state response It has to do with access to care Texas maternal mortality rates are five times that of California. They're ten times that of some other developed nations So access to good medical care as prevention holds true on a global scale as well Staggeringly 99% of global maternal mortality happens in developing countries for me as a non-mom I had kind of taken for granted the danger of childbirth I mean it's such a natural process and on top of that We have phones that can scan our faces now and talking robots and soap and missions to Mars

I had thought like oh, we've totally kicked childbirth risk I had no idea that the statistics were still going up in some parts of the country, you know in obstetrics Most things go fine most of the time and occasionally things don't go fine and when they don't go fine They go south real quickly and it takes a certain volume to recognize. Oh, things are going south There's also, you know a whole kind of change in culture and for instance in our hospital the the way We've empowered our nurses to speak up so that if there's one person in the room That's not comfortable with what with what's happening. We have certain words on how to say stop

I need I think we need to change this tactic I'm uncomfortable with what's happening here and this is what I what I want to see happen And everyone in the room has a right to speak up and by empowering our nurses. We've also changed things We're moving away from this model that the physician knows everything and is the captain of the ship We're moving more to a team approach to medicine and it's a much better approach It's a much safer approach similar natural to squat and have a baby than it is to lie down and have a baby It is it but you know most of us don't have enough core muscle strength to actually do that I mean, I've only had a couple of patients in my career that could actually hold hold their body up in a squat and

Push out a baby We need a gyro one was exactly one was this like iron iron She was like competed in the Ironman and she was completely Like super woman she was able to she's just trail running Squats squat Push this baby out squatting most of us just don't have enough core muscle Strength, I mean, it's it's different. We sit in chairs. We sit at desks and and I Done some work in Ethiopia and Ethiopia woman can actually

Squat and push a baby out because they don't sit on chairs. They sit on the floor They they work in the field all day long. They have good core muscle strength We just don't have enough good core muscle strength to do that most of us Good to know I won't be squatting one out anytime soon, but I Should work on that work on my core Sidebar I started looking up chairs that are like really fancy balancing ones and some were like $700 which seems like a really gross way to mimic just not having a chair So then I found an article that said one thing you can do is just sit on the floor more

It's free and it has health benefits like improved posture It strengthens your core and according to this article It also keeps you humble and it's like dude. It's Saturday night. I'm googling Why am I a slob with atrophied abs? That I got that last one covered Rebecca Hall wants to know when you say you've seen everything before Do you actually mean that or are you just saying that to make us feel better when you're like? Oh, man I've seen everything don't worry about it Or do you just say that I?

Don't think I've said I've ever say I've seen everything before I've seen a lot But I don't I don't think I'll ever have seen everything. I I never cease to be amazed with what I see Um, no, I mean I life is messy life is just messy. We're all messy. We all are like Make silly mistakes. I don't know. I really don't have a lot of judgment when it comes to people's behavior I I don't I mean initially I think I was practicing non-judgment, but Eventually I just like it's like, you know, there's so many different ways of Living and there's so many different ways of being I don't I don't Yeah

Which is funny that leads to the follow-up question Katie Grant wants to know what's the most unexpected thing you have ever retrieved from a vagina And I don't know if you can answer that Senate car keys a muffin They got cross And residency I hope it was ironic. No Ouch Yeah, that is not ergonomic at all. Yeah

Collette Ayers wants to know why am I so irregular despite having every single form of test all coming out normal Including the one with the long stick covered in a giant condom. I think she's talking about a transvaginal ultrasound Are there negative effects on the body when periods are not regular? Or are there certain chemicals your body produces during menstruation that if you're a regular your body misses out on She asks is contraption a good way to regulate your period. I believe she means contraception and that was probably autocorrect But contraption maybe there's a contraption Uterine cage. Yeah, what are you irregular periods? What's happening here? It is normal for the period to vary from anywhere from, you know, every 24 days to every 36 days. That's normal

That's still considered regular. Okay. So I you know, some women consider that irregular, you know And some women are blessed with having a period every 28 days Even when they're not in the birth control pill, most women have slightly irregular periods quick knowledge drop about your Your red devil your crimson tide your leak week, etc So mensis comes from the latin word for moon because duh both are 28 days So of course the moon is a hollow orb that houses a period gremlin who controls us naturally But fact check this several scientific studies have shown there's no correlation between moon phases and mensis It's a dang mystery and to repeat the doc

Most women have slightly irregular periods anyway So the moon is not a conspirator in your ruined beach plans Skipping periods old together probably means she's not ovulating on a regular basis and Sometimes that's because you have polycystic ovarian syndrome and sometimes it's just you have oligoan ovulation You're just not ovulating on a regular basis and you just skip a period once in a while Um, if you have really long Intervals between periods and you don't you know, you menstruate once every six months or so the risk of that is that You're still making estrogen the estrogen is stimulating the lining of the uterus

You're not breaking down that lining of the uterus and so you can get an overgrowth of the lining of the uterus or you can get Uh Worse a cancer of the lining of the uterus if you don't If you're still making estrogen and you don't have progesterone to kind of break down that lining Once in a while We usually say you should have at least four periods a year So if you're not having four periods a year you should You should take progesterone to make yourself have a period four times a year

Um, it's a little bit of an arbitrary number. I don't think any of us have ever studied that that's The right number right number and that's what's going to protect the lining of the uterus Think if your periods are really really heavy Are you having a lot of bleeding in between your periods? um You need to get the lining of your uterus evaluated and even if you've done it two years ago you may need to do it again because it I've I've had patients develop endometrial cancer that I've

Biopsied every two years and every time that biop that lining was negative negative and lo and behold now it's positive They've got an endometrial cancer. So If you continue to have what's what we would call unopposed estrogen So estrogen to the lining of the uterus and not No progesterone to kind of break down that lining of the uterus Then you need to have the lining of your uterus evaluated If on the other hand you're having irregular periods because you're going into premature ovarian failure And you don't have a lot of it estrogen around

that's and you just once in a while still kick out and You know recruit and A follicle and ovulate Then it's not Then that's not as concerning. So irregular periods could be nothing Or it could be a sign that your lading machine is about to retire from the game early

Even when you thought you had a few innings left to play Also buckle up for a fun fact about how low fsh or follicle stimulating hormone Can be an indicator of good ovarian health and some tmi about all wards gonads I feel very vulnerable right now. It depends on You know, are you are you still making estrogen or estrogen levels normal as your fsh normal? Which is your follicular stimulating hormone, which is the hormone your brain makes to tell your ovaries make estrogen And as long as your follicular stimulating hormone is less than 10 You're still

making estrogen But you've got to get that checked on a certain day too, right? No, yes and no, but you think you know it it If it's less than 10 on a random day, you're in good shape. Bye Mine was 135 last it was checked But I you have premature failure. Sure do But I didn't that happened started happening to me in my mid 30s and I just was like, oh, I travel a lot I I just it's a regular and then um

They didn't figure it out until it was but when it came back They were like, there's a chart and you're off of it. I was like, oh good But yeah, I hadn't I didn't even think that that was a thing I think we kind of also do get fed like as a career woman like don't let anyone tell you that you're Losing fertility, you know what I mean? It's almost like a badge. It's fine. It's fine. I'm it's fine Like I'm an aunt. I'll get a dog probably babies seem like a lot of work. Anyway, it's fine. I am fine See Mads wants to know how scary are pap tests and OBGYN appointments, etc. She's like, I'm a young adult Um

With a for guba. I think she needs a vagina. I mean, I think that's adorable So many different words for I know She's terrified of getting her bits checked out. So how scary are they she wants to know Well, first of all, we don't do pap centers until people are 21. So, um If she's been sexually active, it's I mean, it depends a little bit on whether you've been sexually active before if she's never been sexually active She doesn't actually need a pap smear Um

If she's been sexually active if she's used tampons before It really shouldn't be It shouldn't be uncomfortable and how scary it is depends a little bit on how comfortable she is with the physician If she's uncomfortable, the physician don't have them do a pap smear And nowadays they always have a nurse in the room as well, right? That's fairly new. Um Um There's there. Yeah, there should be someone else in the room. Yeah, whether it's a nurse or a medical assistant or a squab. Yeah um

It's always just a matter of you just gotta keep scooching You think you're scooched to the edge of the table and then they're like, can you scooch more and you're like, really? And you scooch and they're like just a little more and you're like damn I gotta hang my butt off this thing for real. That's true. Yeah, that's true. Keep scooching. Um Lily Moss has a good question. Is there an equivalent of a gyno for trans woman? Um Is it same doctors for cis women or is that a fairly new job thing that specializes in trans women's health? Um There you know, there's

I see some trans women but not that many I actually see more trans men than I see trans women interestingly enough um There are um You know most trans women in terms of We'll have their vagina built by someone who specializes in Surgery uh, that's a very specific surgery tends to be people that are plastic surgeons. Sometimes it's urologists There's different groups In the country that are known

for their surgery some of our trans Woman patients will go to Thailand because the surgery is a lot more affordable there. Oh, wow Marcy Bowers is a um herself a trans woman she used to be an objuan. She specializes in

Uh, gender reassignment surgery and she's located in the bay area She used to be in a little town in colorado So the town of trinidad colorado became known as a hub for gender reassignment surgery when this local surgeon Dr. Stanley biber had come back from being a medic in the korean war and he was asked by a patient about The possibility for this procedure and he was kind of stumped. He was like, I don't know how to do that So he wrote to some colleagues at john hopkins in sanford. They sent some plans like some sketches Yeah, that's how we did it a couple times this way And so in the late 1960s, he got really good at it

So this doctor in colorado started practicing gender reassignment surgeries and trans folks started moving to trinidad colorado Because his medical care was the best So this doc kind of passed the torch to dr. Marcy Bowers But when she left for san francisco trinidad colorado became Kind of a bit of a ghost town the mayor himself called it an abyss of nothingness But recently they turned an abandoned Pepsi plant into a pot dispensary and business in trinidad is on The rise so for several decades trinidad colorado served as this kind of beautiful rare Gem in the middle of the wild west

But care for trans patients is now becoming a little more widespread So there's a couple of there's centers San francisco has a center for excellence in trans gender health OHSU has a center for excellence in trans gender health and these Centers kind of specialize in gender reassignment surgery and those tend to be the places where people go Christa trexler wants to know how many babies have you delivered and what's the longest you've ever seen a woman Be in labor for I don't actually I didn't keep Track of how many babies I've delivered. I probably delivered over 3000 babies. Oh my god. I I don't I didn't actually count them all

That's so many babies Just just based on how many years I've been in practice. What's the biggest one? My sister had a 10 and a half pound baby um It's like a turkey I Helped I kind of was supervising a midwife who delivered a 13 pound baby Oh, what that's like two babies

and I the biggest one I've delivered I think was was also close to 13 pounds, but that was a c-section Oh, we knew that baby is going to be big. So we We just felt like it wasn't going to be safe. Yeah. Yeah, let's let's Get out the uh, sunroof there. Yeah. Oh you may quick question. Why are some babies giant? So doctors don't call them giant babies, but rather lga, which stands for large for gestational age Any baby over eight pounds 13 ounces is diagnosed with fetal macrosomia, which literally means baby big body

And genetics can play a part totally as can things like maternal diabetes, which kind of messes with your insulin levels But sometimes you just don't know and my niece is now a lanky 12 year old She's almost taller than me, but she will always be our beloved lga fetal macrosomic giant turkey baby What's the longest you've ever seen someone in labor for? Oh, it can be we it can be days like real active hard labor probably two to three days Oh How what's the percentage of people they'd get epidurals because I would be like anesthesize me from the neck down Wake me up when this thing's over. It's about 70 to 80 percent. Yeah

Is there any risk to them if you get an epidural very early in labor before you're an active labor it may slow down your labor because It's when you first get into active labor It's probably a good idea to walk around because kids have big heads compared to our Pelvis and in order for the head to kind of fit down the pelvis it needs to kind of rotate to find a way to uh pass through the pelvis humans when they evolved from being a four-legged Mammal to becoming bipedal change the structure of their pelvis and so their pelvis got a little smaller In the meantime heads got bigger Listen to episode two on primatology if you want more details on our shitty head to pelvis situation

and so hence when the baby actually descends and Leaves the body it actually goes through these rotations to Make its way through the pelvis and those rotations Work way better if you're actually walking. Oh, so that if you can walk for a part of active labor your Kid's more likely to descend and your labor is going to be a little bit faster. Okay

Good get on that treadmill Oh do some breathing exercises Yikes, I mean I've had people that wanted all natural deliveries and labored for 24 hours and we're absolutely exhausted and their muscles are tense and They're just not going anywhere in a hurry and the epidural just allows all their muscles to relax and the baby descends and boom They can deliver their baby and they're dying and Emanuel We get a lot of transfers from home deliveries and about Half of those women still deliver eventually and these are women that the midwife has brought in that they thought could not deliver

Eventually and all they need it was some pain control and a little bit of sleep and They still have a vaginal delivery Get that puppy out of there. Do you have anything about your job that you hate that just sucks or that is difficult You know, occasionally the sleep deprivation gets to me. Yeah, it's tough. It's sometimes really tough to I mean typically if it's a delivery I can I can rally if it's a Kind of a silly phone call

yeah or sometimes it's stuff like you know some hospital wants to transfer a patient and That kind of stuff irritates me And it's like you guys can take care of this. Why are you calling me at two in the morning about this? Or an ER one of my patients has gotten an ER somewhere in the ER physician wants to just let me know that they've Seen the patient and I'm like so happy you're calling me at three to let me know that you've seen the patient and taken care of this patient

And you've just woken me up So happy about this Can you get back to sleep easily or no if I get irritated? No, it's hard to get back to sleep If it's a silly thing then I get irritated and then it's hard to get back to sleep, but I know what's your favorite thing about what you do I think it's still delivering babies. It's just such a beautiful thing I I mean, I didn't I never thought I would like that. This would be the thing I I always thought it eventually I'd stop doing OB and I just do gyn and have an easier life

But it's just such a beautiful thing I mean, it's just so amazing That we make these little human beings and they come out. I mean, it's just It's pretty cool. I imagine the patient's vibe also is Pretty great. Yeah, it's great. I mean, it's especially great if it's someone that I've you know, if I delivered their other kids and it's just that's It's kind of cool Do people give you a lot of cookies and Baked goods. Thank you. Yeah, lots of different things. I actually have gotten them like

One of my most beautiful bouquet of flowers was from a patient who I Who just was complaining that her she just her discharge just didn't smell Right and it'd been going on for a really long time and I told her to stop using soap and um or to stop using the antibacterial soap she was using And the smell went away And she like gave me this so many beautiful bouquet of flowers It's like Oh

It's funny a discharge based gratitude exactly. She's like you changed my life Exactly and my fluids So no antibacterial soap Don't use any antibacterial soap and don't use detergent soap in your body and use very little soap in your body Really soap is really not that especially for your vulva Don't use if you can avoid using soap you're better off. What about vaginal steaming and douches? Don't do right

Don't don't don't One of the vaginal specialists at Kaiser in uh in the bay area Did a kind of had Patients kind of come up with slogans for her vaginal health clinic And one of the patients came up with a clinic with a with a slogan the vagina is a self-cleaning oven And it's so true. It's like the vagina will keep its own balance if you don't mess with it If you upset the balance the anaerobic bacteria, which creates smell are going to overgrow so the less

And the the problem with soap is that a lot of soap has detergent quality So it's going to take away the oils and the oils are one of the things that protect the skin So if you take away oils from the skin, you're going to have more overgrowth of kind of bad bacteria as well so the thing with with the vagina is that Or with the vulva is that a lot of over the counter products are irritating to the vulva Like this product vagicill that people use for irritation has actually really irritated to the vagina most Vaginal specialists will say vagicill makes you ill brb. I'm going to go drop a single called vagicill makes you ill

and one of the you know Vaseline Is probably very safe coconut oil is very safe those oils are safe But creams and lotions tend to not be safe They tend to dry out the vagina and the vulva a lot of over the counter products have something called propylene glycol in it, which Five to ten percent of people get irritated from it's drying KY jelly tends to dry people out

So most of us recommend against KY You know either if you're using condoms oils will dissolve the condoms So you don't want to use an oil or a greasy substance when you're using condoms But as an alternative you can use some of the silicone based Lubricants, but you don't want to get rid of the oils in the skin of the vulva and the vagina because it They're really there to protect you So stay hairy stay oily Exactly stay greasy and stay

Where's to live by From the gyro gyno for the gyro gyno exactly This is good advice Thank you so and bidets are a great thing. Oh, but days are a great thing Bidets are great things. We should all have Japanese toilets. Shouldn't we exactly? Why don't we have them? I know we should they're a great thing Do you think the kind that are like aftermarket Like putting a spoiler on your toilet, but they're a bidet like the kind that just hook in they actually work fine

Okay, yeah, you have bidets. I don't get a bidet treat yourself. I know I should I have a separate shower head Treat yourself. I tried I tried it's I have an old house. It's a it's a long story. I know I I just don't understand why We have so much technology in our cars, but our toilets are just water holes. I know I agree I agree and all these and stay away from wipes too. That's my one other piece of advice A lot of those wipes are drying too and they also Make fatbergs in the sewers. Have you heard of that this? Yeah, I saw that picture in the london sewer Oh, you'll never see it. There's a picture of it. These people working on this huge like

Blob that's like obstructing the london sewer. It's like as big as an elephant. Oh, it's the grossest thing It's such an amazing picture. Okay, google fatberg and send me the invoice for the psychotherapy. It's worth it I will tell you that in one photo A london sewer worker is holding up this greasy chunk that's about the size of a small marlin where he a fisherman I was horrified. I was Traumatized to notice he was not wearing gloves. He was just raw dog in this fatberg my mind Raced and raced. I was like, why does he hate himself? How is his brain not capable of feeling fear? What is happening? Why why why and I zoomed in on the picture and I was very relieved to see

That his rubber gloves were just the same ruddy peach color as his skin But that was a rough rough 30 seconds from a psyche It's just like the only thing that could make Like I can't I'm like I just keep thinking of like sisyphus having to push like a fatberg up a hill It's just the grossest thing. Is that the term for a fatberg? It's a fatberg Because it's yeah, I don't know because it's grease and wipes Just clogging it up the grossest. It's so gross. This is all really good information Thank you so much for doing this

Yeah, yeah, you're good So don't flush those wipes even the flushable ones folks When in doubt put it in the bin as they say also go easy on the detergent Don't get a brazilian wax for your next pap your gino's like no No, what no To find out what episodes are coming up next You can become a patron for as little as a buck a month y'all 25 cents an episode And then you can submit your questions to the oligists and I say your name and ask your question

If you want to wear an oligy shirt or pin or tote or baby onesie. I don't know how old you are Head over to oligiesmerch.com. Take a look around To follow on social media. I'm ali ward with one l or at oligies on both instagram and twitter Also, if you like this podcast if it's improved your life at all Pella friend or a stranger or leave a review on itunes spread the word Also double check and make sure you're subscribed. So, you know the minute the next episode is out I noticed that sometimes my apple podcast will just unsubscribe me for my favorite things and i'm like what? Huh, even oligies. I was like you unsubscribe me from my own podcast apple itunes. What?

How dare you so double check Episodes coming up involve x-rays signs of hair Diabetes Darwinism so good stuff coming down the podcast vagina for you Meanwhile ask smart people dumb questions because that's how they got smart in the first place They love it. I want to say a quick. Thank you to Shannon Feltas and Bonnie dutch for running oligiesmerch.com You guys are amazing and to erin talbert and new boston resident. How's boston treating you hannah? Good oligites in boston. Say hi to hannah lipo online. She's amazing be her friend Show her your dogs and also to steven ray morris

My amazing editor for this. I could not put these out every week without you So thank you the theme song was written by nick Thorburn of the band islands. He's amazing Now if you stick around through the credits, you know that I tell you a secret Each time there's a thank you for sticking it out to the very end and Number one. I still haven't unpacked that duffel bag. I'm looking at it right now Should I unpack it while we're on I'm gonna unpack it while you guys are on mic. Okay, let's see Oh my god, why am I doing this this way? Okay All right

Here's the duffel bag that's in my closet. I'm gonna list out what I have green cardigan There's a tote bag in here. Why? a wool sweater pajama bottoms dirty sock that has a shark on it jorts t-shirt bikini

And a couple of washcloths because sometimes when I go on vacation, especially if I'm sharing like an airbnb with friends I bring a couple washcloths to wash my face so that I don't have to use dirty hand towels on my face pro tip um, okay guys I unpacked the duffel bag No, I just have to throw these things on the laundry. Um Thank you for being with me through that another secret. I'm gonna tell you really quick is another life hack sometimes if you see a group on

And you didn't get the deal in time or whatever you can call the place me like Hey, I was just about to buy a group on and they're like don't buy the group on just come in We'll give you that deal because group on takes a cut anyway So sometimes the places like salons or gyms prefer you just pay them the group on rate But don't do it through group on so Okay, this was this this is a weird secret patch. Thank you for making it through this thorny secret patch With me. Okay. Bye. Bye Oh

There you go boom. Oh boy. Oh boy. That's like two babies