Episode Transcript
[00:00:00] Speaker A: Foreign.
[00:00:04] Speaker B: Welcome to 3564, a podcast for middle agers. This episode, oh my gosh, is so good. Listen until the very end. Each minute, Dr. Betsy is going to drop interesting things that you want to know.
But let me back up here. Have you ever wondered about UTIs or should I be wearing thong underwear? How do I do a Kegel, right? Why is my sexual satisfaction decreasing as I age?
How many times should I be peeing? How should I wipe? I mean, seriously, we go through dozens of practical questions about all things pelvic health and everything a woman might want to know when she's over 35.
Okay, so I'm going to go through Dr. Betsy Greenleaf's credentials.
Honestly, it could be a novel here, so I'm just hitting some of the highlights, but Dr. Betsy is a pioneering leader, the first female in the US to achieve board certification in urogynecology.
She's a triple board certified physician specializing in obstetrics and gynecology, female pelvic medicine and reconstructive surgery, as well as procedural medicine and esthetics.
She has decades of experience.
She is an educator and an entrepreneur. She owns the Pelvic Floor store. She is the CEO of Pelvic Floor Store.
And she is also a best selling author, an award winning speaker. I am so, so thrilled she is here to answer all these questions about women's health. It is such a privilege. Welcome to the show, Dr. Betsy. It is so good to have you here today, Karen.
[00:02:12] Speaker A: Thank you so much for having me. I'm so excited to be talking with you. We're going to have some fun.
[00:02:16] Speaker B: We are. I have so, so many questions all about women's health, pelvic floor health. You are an expert in this area.
Your credentials are up and down, side to side. In fact, when I saw that you were the first women Eurogynecologist, is. Am I saying that correctly?
[00:02:38] Speaker A: Yeah. Yeah. Yes.
[00:02:40] Speaker B: Wow. I mean, leading the way in women's healthcare.
Hats off to you. We need more women, more research, and more answers for all of the things that women are facing today that we just don't have solutions for.
So thank you for what you do. And I have a gazillion questions, so I'm just going to dive in. I want to hear everything that you have to say about some of these things. My first question for you is what is pelvic health?
[00:03:11] Speaker A: Yeah. So pelvic health has to do with the area of the body, like below the belly button and above the thighs. So anything that falls into that area of the body is your pelvic health. So a lot of times when we're talking about it, we're talking about bladder health, vaginal health, reproductive organ health, even rectal, anal health. And so like, vulva, vagina, everything kind of in between. But even, like, the muscles, the ligaments, the nerves, anything that falls in that area would be considered. Considered the pelvis.
[00:03:43] Speaker B: Okay. I always think of the classic pelvic exam, you know, and. But I didn't know that it actually was included a couple of more pieces of the anatomy. I did not know that There are so many different parts of pelvic health that we could dive into. There's a couple of things that I know people in this age group, middle age, specifically, have interest in.
And so first question for you is, around bladder health, incontinence, what is normal? Can you just tell me what middle ages are facing as they age and what is normal in that area and what isn't?
[00:04:24] Speaker A: Yeah. So unfortunately, around that middle age area, perimenopause, menopause, we're getting a lot of shifts in our hormones, and they take a drastic effect on our pelvic health.
Because one of the things that's happening is when we're younger, our vaginal tissue is very thick, and I'm actually gonna get into urinary tract infections, and then I'll go into, like, the incontinence. Cause I'm like. Let me start with this one first. So our vaginal tissue is nice and thick when we're in our reproductive age group, and it's actively growing. And so when it's actively growing, it will make multiple cells, and then those cells will kind of slough off and die. And they contain a chemical called glycogen, which is actually the food source for lactobacillus, which is the healthy bacteria in the vagina.
So when we're in our reproductive age, everything's kind of working really well. Usually there's a lot. There's a lot more comfort in that area when it comes to intimacy. We don't. You can still get urinary tract infections and vaginal infections, but not as much as when we flip into the middle age. Because what's happening around that time is that lactobacillus, when we're in the reproductive age, it actually helps to keep the vagina very acidic. And so when it does that, it kind of chases away all the bad guys and yeast and bacterial vaginosis and kind of keeps things at bay. But what happens is, as our estrogen starts to decline, we actually don't start growing that tissue as fast as we used to, and essentially the food source for the Lactobacillus goes away, and our healthy bacteria kind of dies off.
And so now what ends up happening is other bacteria from our environment, most commonly from the anus and the rectum area, start to make its way over into the vagina. And now we get all these imbalances. We get shifts in the pH, the acid level in the vagina. And now we're more prone to having more issues with odor, more issues with itching and burning and discharge and what we term recurrent vaginitis. The vagina also acts as a reservoir for this bacteria. That now is one step closer to the urethra, the tube you pee through, and the bladder. And so now we're at much higher risk of urinary tract infections.
So that's one thing that we're starting to see in menopause. And that unfortunately kind of carries all the way through post menopause the rest of our life, those issues, unless we do something to deal with that thinning tissue.
The other thing is because of that thinning tissue and this, quote, bad bacteria that's coming in that area, it kind of sets up this inflammatory reaction that we might not always notice. We might not notice it as a burning, but our bladder may notice it. And so now we start getting things like irritated bladder. Symptoms like this may be where some urinary incontinence, whether it's like what's called urge incontinence, where you have to, like, one minute you're fine, next minute you're, like, running to the bathroom, that might show up, and then also because that tissue's a little bit thinner now, may unmask more of a stress incontinence. And stress incontinence is when you leak. When you leak, when you cough, laugh, sneeze. That typically is coming from a damage to the ligament that holds up the tube that we pee, the urethra.
But when our tissue is thicker, when we're younger, sometimes it kind of masks it and kind of.
We don't really know that there's been a rip or tear in that tissue. And then all of a sudden, as that tissue thins out, now it's starting to show up more.
So a lot of the times those. Those issues have started with childbirth or pregnancy. But not everybody has to have a child to have these issues. Unfortunately, lifting heavy objects, bearing down with, like, severe constipation, heavy coughing, heavy sneezing, heavy vomiting, anything that will put A lot of pressure on the pelvis can damage the ligaments and kind of make things weak. So then, so now we start to see a lot more issues with incontinence. And so even though it's incredibly common, it doesn't mean you have to live with it. I mean, the diaper, unfortunately the adult diaper industry is a very, very large industry because people just think that, okay, this is what it's like to get older. And they just accept it when there are tons of different therapies and treatments. And just because it's common doesn't mean that it's normal and doesn't mean you have to live with it. You know, at the same time, if it doesn't bother you, you know, that's the thing. Because there's so many things anywhere from depending on the type of incontinence, anywhere from doing Kegel exercises to medications, all the way up to surgeries because there's such a broad range of treatments. It doesn't mean just because you have those symptoms that you have to like go and get surgery, because that's some sometimes the problem. And having been a urogynecologist that did surgery in the past, I was like kind of like the anti surgery surgeon. Because basically if it bothers you enough that it affects your health or affects your mental health, like, it just bugs you to know about it, that's when it's time to think about surgery. But if it's something that you're like, yeah, you know, this isn't really affecting me and like, I can live with it and you know, not causing me any problems, then, you know, don't put yourself through surgery. That has its own set of risks because unfortunately none of the surgeries are perfect. There's always risks with those. And sometimes the surgeries don't even last. We don't have any like, perfect. It's not like when we do like appendix surgery and you take out someone's appendix, they don't. It's very, very rare for it to grow back. You know, it's usually it's out and it's done. But like with incontinence surgery or even more so, prolapse surgery. So prolapse is where the ligaments holding up the vagina or the bladder or the uterus or the rectum and get damaged. And now things start to droop and drop. And sometimes women will actually even see like a bulging coming out of their vagina. Often the first, their first thought is, oh my God, do I have a tumor? Because, you know, One minute you're fine, next, you know, there's something might be hanging out or bulging. And most people, like, panic and think it's a tumor when usually it's just the ligaments aren't doing the job, its job. And the vagina actually is almost like a sock and it starts to turn inside out. And so usually what you're seeing is like a bulging of the walls of the vagina. So sometimes people will hear the term like their bladder dropped. The bladder's not actually hanging out. The bladder's just leaning on the vagina and pushing the vagina out. But even then with those surgeries, unfortunately, they're not like we. We would love if we did surgery on that and if somebody lasted, it lasted their, you know, their whole life. But in reality, it's very difficult to do these surgeries because there's not a lot to attach things too, and you're battling gravity. And so there is unfortunately, a risk of recurrence, of it happening again. So we're happy if people get five years out of their surgery. And for some reason, I don't know why a lot of surgeons don't tell their patients this.
So, like, we're happy if we get five years. If it lasts you a lifetime, great. But even better. But there are people who will. It'll just happen again and again because you have already shown that your tissue has a tendency to rip and tear easily. And. And it's a type of hernia. And some people are just more prone to hernias than others.
So.
[00:11:40] Speaker B: So I have so many questions for you about all of this, but you mentioned something that I hadn't heard much. Most of us have heard. Oh, my friend had a large baby, and so she's struggling with her pelvic health. But some of the things you mentioned around coughing a lot, and I think you mentioned maybe some weight loss or weight gain, and then even. This is a question for you runners and people who are bouncing around a lot, like horseback riders, is this an issue that they might face as well?
[00:12:13] Speaker A: It could be, because anything. Basically our pelvic floor, which is the opening to, like, the bottom of our bodies, is just basically open to gravity. And there's not much holding it in other than some skin, some ligaments, you know, some fascia, and that's. And that's it. So unfortunately, anything that increases the pressure on the pelvic floor could potentially damage the ligaments. In fact, the youngest person I've ever seen to have a prolapse was. She was 15 and she was A gymnast, and we think it was from, like, her hard landings. So, yeah, unfortunately, now I don't want to. Don't give up your running. I mean, there's good things, but, like, maybe, like, run on softer surfaces, not on the road if you can't, if you. If you have a choice.
But, you know, just because you're running on a hard road doesn't mean that you're going to get a prolapse. But could it contribute to it? Yeah, certainly. And then this is why, like, when we see, like, the Olympic, like, power lifters, you see them, like, blowing out as they're lifting. They're like, you know, blowing out is because if. When you hold your breath, when you lift something heavy, you sometimes can actually put that pressure on your pelvis and risk, you know, causing a hernia or a prolapse.
So the big thing is, if you're lifting something heavy, blow out as you're lifting, or if you can avoid lifting heavy things. And that's probably the better thing to do.
[00:13:33] Speaker B: But, yeah, okay, that's. That's so interesting. And so back to the. The two issues here. The incontinence and then the two causes. One of them being, like, urge incontinence.
[00:13:47] Speaker A: Where you have to, like, run to get to the bathroom, and then stress incontinence, where you're like, leak when you cough, laugh, sneeze.
[00:13:53] Speaker B: Yeah. Okay, so what? Someone was on the podcast, a viral comedian duo, and they have something they called freeze, snee, freeze and sneeze. So it was there a whole bit that they do that is very, very funny that everyone can relate to in the 40 plus range. But what are some ways that people who aren't struggling yet with this or are sitting, seeing beginning signs of this, how can they protect themselves and even recover their health in that area? Are there simple things that we can do, you know, before it gets bad?
[00:14:29] Speaker A: Well, for the stress incontinence, because that one's usually from a stretch or a tear in the ligament. There's not much you can do to fix the ligament, but you can strengthen your pelvic floor muscles. So what people don't realize is that after the age of 30, we start losing 8% of our muscle for every decade that we live.
And so we're often thinking about exercising our arms and our legs and other parts of our body, but people don't really think about exercising their pelvic floor until all of a sudden there's a problem.
So doing your Kegel exercise is going to be really important, not only for Pelvic health with the bladder, but it's also going to help you holding, gas, and bowel movements, and it can help with sexual function.
So I do find that most women, when I would examine them, and I'd be like, okay, tighten up your muscles, and I want to see if you're doing it right. A lot of women don't understand where those muscles are. They, like, bear down, like they're having a bowel movement. And so. Or I get stories where people are like, oh, I do it every time I pee. And I'm like, wait, no. When you do it, when you're peeing, it's only so you can figure out what muscles to use. You're not supposed to be doing that all the time. You're not supposed to be stopping the urine flow, like, when you're peeing, because the bladder is a giant muscular bag that's pushing the urine out. And if you're trying to stop the flow, the urine's gonna go where the least amount of pressure is, and that could be back up to the kidneys if you're stopping it from coming out. So that's only to figure out where the muscles are. The other way to think about it is. And I can't take credit for this. And one of my colleagues explained this to me, that this is how he tells his patients. And I'm like, oh, that's really good. I'm gonna steal that. He's like, think of, like, a giant straw coming out of your vagina into a really thick milkshake. And if you had to, like, suck that milk milkshake, really kind of tough through a straw, you know, it's the more of, like, a lifting and sucking kind of sensation. So you want to think when you're tightening up your pelvic floor muscles, it's more of, like, a lifting and tightening. The other thing is, if you think about the muscles that you're using when you're trying to hold in passing gas, like, you know, let's say you're on stage or you're giving a presentation at work, and all of a sudden you got gas. You don't want to be farting in front of the whole, you know, boardroom. The muscles that you would be using to hold in that gas would be the same muscles as your Kegel exercises.
So that's. And then even then, sometimes people need a little extra help. And there's pelvic physical therapists, like, and everybody should see a pelvic physical therapist at some point in their lives. It's just really good to make sure that your pelvic health is doing well and that your muscles are strong.
And then fun fact enough was on my pelvic floor store, we carry a bunch of different Kegel exercisers. So they make little devices where you can put a little device in the vagina. One has, like, little lights on it that light up when you're doing it. Right. Some of them work with apps. Some of them have apps that you. They gamified it so you're like. Every time you tighten up, like, there's something like jumps. So they've created a bunch of different things. Another thing when it comes to Kegels that I tell people to do is if you go to a gym and the machines that have you pull your legs together, that will usually help the pelvic floor. Or if you don't have a gym, just sitting in a chair, rolling up a towel, putting a pillow or getting a ball and putting it between your knees and squeezing your knees together. If you squeeze and hold it, that will also trigger the pelvic floor muscles.
So that's gonna be help strengthen. So that's for, you know, that's pretty much for all pelvic health that also make it. When you do have urge. If someone has urge incontinence, where they're having a hard time holding it in, they gotta run to get to the bathroom.
It'll make that a little bit easier. The other thing is one of the things people tend to do that is counterproductive when they have an overactive bladder. They do two things. They tend not to drink any water or any fluids because they figure, like, all right, well, if I don't drink, then I won't have to pee.
But what ends up happening is that really concentrates the urine, and when the urine is more concentrated, it's more irritating to the bladder, and so it can actually worsen some of those symptoms. So actually, there is a balance between drinking enough fluid until your urine is clear, and so it's not as irritating to the bladder. And so that's one thing to do. The other thing is when we give into the bladder, when every time, like, you get the urge and you, like, run, or you're just, like, preemptively trying to empty the bladder because you're trying to keep the bladder volumes low.
Over time, you'll shrink the size of the bladder so it'll be able to hold less and less.
So you know it. Sometimes at first, it's called bladder retraining. Sometimes at first, it can be Difficult. So I tell people to practice when you're at home so that if you do have an accident, you can easily change.
But if you actually, when you get that sudden urge to go to the bathroom, if you can force yourself to hold it in, kind of take some deep breaths, let that urge subside, and then go, all right, do I really still have to go to the bathroom or was it just my bladder spasming? Because that's a lot of times what's happening is the bladder is doing a little spasm and then you go, all right, well, I didn't really have to go then you can keep waiting.
If you go, you know what, maybe I do have to go then, then you can go. But you, you calmly go so that you're telling the bladder when you want to go versus it telling you.
And like, for example, like, average bladder holds about 500 cc, which is equivalent to like, if you think about a 2 liter bottle of soda, it's about a quarter of that.
A quarter of a 2 liter bottle of soda is about, is about 500 cc. That's average bladder capacity. Now I have seen teachers and nurses because they can't get out of their classrooms or they can't get away from their patients over time. They have held it in for so long. I've had, I've seen bladders of teachers and nurses where they can hold a liter or 2 liters fluid. Like over time they've stretched their bladders out so it can be stretched.
[00:20:29] Speaker B: So wow, that's amazing. One of the things that a friend just told me that I thought was interesting was she was saying she's having a harder time emptying and that is taking longer. I thought that was interesting. I had not heard that before.
[00:20:45] Speaker A: And that can happen. There's a number of things that can happen. Prolapses can hap. Make that happen. So if the bladder is starting to droop, what ends up happening is it kind of leans on the vagina and it kind of falls below the level of the urethra, which is the tube you peed through. So normally it would have been like a dress direct shot out, but now that tube is getting kinked a little bit. And so if someone has a prolapse and they're finding difficulty emptying their bladder, some of the tricks are like leaning forward. So sometimes just moving on the toilet and moving in different directions can kind of rearrange where the bladder is sitting or actually using your hands to push on the lower abdomen instead of bearing down. And sometimes if you find it's happening too much. That might be time to get checked to make sure you don't have a prolapse and then see what other treatments that are available to help with that.
Another thing that can happen is if the tube you peed through is spasms. So. So it, like, shuts and kind of gets, like, tighter. And there's tons of different causes of that. The most common is allergy medicines.
Because when someone takes a decongestant, and not just allergy medicine, it's the allergy medicines with the decongestants in it. The decongestant is the problem. So every allergy season, I always see people coming in with problems. Cause it can't empty. It's cause one of the side effects of the decongestant is it causes the urethra to spasm. And so they may have a hard time getting it to. Getting it to relax. So that can be it. And then there's. There can be some nerve issues that can cause it. Sometimes some tricks that we can tell people to do is just going. When you go in the bathroom, kind of just sit. You don't want to bear down and push to have to urinate, because once again, the urine could go back up to the kidneys. You want to try to relax and almost do a reverse Kegels, like, try to relax those muscles.
Sometimes just running the water in the bathroom will trigger your brain to be like, okay, I can pee. Or another trick is we'll have people actually take their hands and kind of tickle their. Their tailbone, so their lower back. Because sometimes that can just distract the nerves. The nerves that take care of the bladder and the pelvic floor come out of the spinal cord out of the low back into the sacrum. And sometimes just like, tickling that area can kind of distract those nerves and get things to relax.
Wow. Those are simple things. And then there's. Then there's a whole bunch of other treatments if those things don't work.
Yeah.
[00:23:04] Speaker B: Yeah. Well, those are really practical to at least start with.
If one of those could relieve even half of the symptoms that someone is facing, that's a huge win.
[00:23:14] Speaker A: Oh, sure.
[00:23:15] Speaker B: Huge. Huge. Back to the Kegels. How do you know you're doing it right?
[00:23:20] Speaker A: Yeah. So, I mean, the biggest thing is you don't always know.
So, you know, that's why working with a pelvic physical therapist or even your doctor who's like, oh, yeah, yeah, you're doing it right. But it should be like a tightening and lifting and not a bearing Down. So often we'll say to people, try it when you're urinating, just to figure out where those muscles are. So, like, if you're urinating and you do it, then it should stop the flow of the urine. But it's not something you want to do it consistently like that. You just want to be like, okay, we. Are those the right muscles? Like, am I using it? Or, like I said, just, you know, investing in one of these devices to test to make sure that you're doing it right. You're like, okay, I am. And, well, I'll just, you know, keep doing those exercises. So. Yeah. Yeah.
[00:24:09] Speaker B: I once heard if you do five Kegels at every stoplight or red light, that you'll be golden. And I thought, hey, that might be, like, easy for someone to do a couple times a day just as that you're sitting there and there's nothing else going on. How many Kegels do you do a day?
[00:24:27] Speaker A: You know what? It's funny because I don't know if I actually keep track, but I will, like, all of a sudden be like, oh, wait, have I done them? And, like, I should, you know, I should be doing them. And. And I just. When I remember. But I'll tell people, even when they start, like, it's just like any, like, workout. You don't want to go, like, do ten bazillion of them right away because you can fatigue the muscles.
So you start off, like, you know, maybe just doing a set of 10, and if you can't get through 10, that's fine. And the idea is there's a couple ways you can do it. You can, like, hold it and then hold it to a count of 10, or as long as you can hold it and then relax and then do that a couple more times.
You can also do something called quick flicks. It's where you really tighten them because it uses different muscle fibers. When you do quick flicks, it's like when you tighten and relax, tighten and relax, tighten, relax. And you do it very quickly. And so I tell people, like, start off with five, ten of them, and then if you can do that, then graduate to, like, a set of 10, and then maybe, like, you know, like, well, repetitions, like, do 10 repetitions and then do two to three sets, meaning, like, you rest in between.
So. And maybe not even every day. Like, start off, like, two, three times a week and then kind of build yourself up.
[00:25:40] Speaker B: Yeah, it is. You have an arm day, a leg day, and a Kegel day.
[00:25:44] Speaker A: I don't know.
Exactly.
[00:25:46] Speaker B: It's such an easy thing to do. You don't need equipment, you don't need to be anywhere specific and. And it seems we could be doing.
[00:25:54] Speaker A: It right now and you don't know.
[00:25:55] Speaker B: I know I didn't tell you, but should men do these and do they have the same system as far as that, you know, ligament and all of those things?
Yeah.
[00:26:06] Speaker A: So they have the same muscles. There's just their muscles go around a little bit differently. Cause they don't have a vagina that they go around. So. But they have. Cause those muscles will sling past the urethra, the vagina and the rectum. Cause they're big U shaped muscle. So. And men have them too. And so not only for men does it help with holding in gas and bowel movements, but it also can help with erectile function in that it also can help with basically with sexual function and being able to hold onto, well for men and women, being able to hold onto an orgasm because really a lot of times with orgasm you're just getting spasming, like rhythmic spasming of the pelvic floor muscles in addition to other organs. But so if those muscles are stronger then the better the orgasms.
[00:26:49] Speaker B: I see, I see. Well, one of the things that I wanted to ask you about, I saw something on the pelvic floor store that you're the CEO of as well. I saw something emu oil.
What is that?
[00:27:04] Speaker A: Oh, I love emu oil.
So you know, unfortunately, I'm sorry if you're vegan, because it's not vegan. It does come from the bird, the emu. But the emu is their fat tissue is very, very rich in antioxidants and so it's been used for centuries for health purposes.
It's anti inflammatory and it absorbs deep into the tissue.
So I started using it for my patients years and years ago who had different skin conditions like psoriasis or things like something called lichen sclerosis, which can affect skin everywhere. So that can not just affect the skin on their arms and their legs, but can affect the skin in the vulvar area.
So because the, the oil is super anti inflammatory, it tends to work better than steroids and so and I like it better than steroids because steroids will tend to thin out the tissue. So yeah, you're helping with inflammation, but then you're thinning the tissue and then you have another set of problems.
So I've been using emu oil for the patients for years. But as in fact, actually I did start working On a book about it that I haven't published, I should just finish it and publish it on emu oil. But basically it can be used. Well, first of all, it also is super moisturizing to the tissue and it's a good carrier oil so that it helps pull things into, into your tissue. So when I found research on it, they found that, say, let's say people who do hormone replacement, if you put the emu oil on first and then you put your hormone on top of it, it will better absorb through your. Into your tissue. I also like then because of that, I kind of looked into the cosmetic aspect of it and it can be found in a lot of different cosmetics. And then also if you use it almost like as a beauty serum and put it on first and then put your other, your other products on, on top of it, it helps pull it better into the area.
And there are star. I don't have the products yet. I'm looking into it. There are some not as much research supporting it. And I think one of the reasons I haven't gotten there yet is it's not a hundred percent approved by the FDA yet. But there is some studies on taking it orally.
And so just like people take fish oil orally, but one of the risks of fish oil is there's so much mercury in our fish supply. So emu oil would be another alternative.
And, and I know like for, and I know for the people who are probably annoyed with me now that I said it's the animal, like, yes, unfortunately they do have to, you know, the animal sacrifices itself for us for this. But when it comes to farming of the emu, they use every, every, every single part of the bird. So nothing is ever wasted on emus. So the feathers are used, they're using bones for, for making collagen. So like every part of the bird, they use the skin for leather. So you know, from like, like a environmentally sound farming practice, every part of the emu is, is actually used. So.
[00:30:11] Speaker B: Wow. Well, speaking of other things that I saw that were interesting, I saw a lot of different lubrications. And can you just tell me, how does the, how does somebody choose the right lube? How important is it? I know a lot of women who are in perimenopause and menopause rely on lubricant for a good sexual experience.
Can you give us some advice on lubes? I've never asked a doctor this, but I'd love to hear what you have to say.
[00:30:43] Speaker A: Yeah. And you know what, first of all, there's a big misconception, and I don't know where this comes from, but there's a misconception amongst both men and women that the wetness of a woman is equal to the level of arousal. And in fact, that doesn't necessarily correlate every time because there's so many things that go into the amount of natural lubrication that's being produced. Because if you're too stressed or you're dehydrated or certain medications will affect how lubricated you are. And in fact, actually, how often you're engaging in sexual activity can also affect that. Because here's an interesting natural lubrication.
People often think it's like a mucus type of product, when in fact, it's actually a blood product.
So when we become sexually excited, our genitals are flooded with blood, just like men. But in men, they get erections.
We get this blood pressure that, like, increases on our walls. We get swelling of the clitoris, swelling of the vulva, swelling of the vagina. But then we also get. And I haven't come up with a great term, but it's almost like condensation.
So it's more like that the fluid is kind of coming through, and it's plasma that the lubricant is made out of. There is some mucus, but it's mostly this blood product, almost like plasma, that's coming through.
So, number one, give yourself grace. And that the reason, like, lubricants are on the market is because not everybody's gonna, you know, make enough lube their own. Or depending on how long you're engaging in sexual activity, it might not last that long. So you just need a little bit extra kind of slip and slide so that you don't get irritated.
The history is, unfortunately, lubricants in the past are not vaginally healthy.
And I am going to throw KY Jelly under the bus. I think they're trying to change things, but KY Jelly is probably one of the worst things you can use in the vagina. Most people think of that because it's been around for so long, because it wasn't. It wasn't PH balanced. So it wasn't balanced for the acidity of the vagina, and it wasn't osmolarity balanced. And you're like, what the hell is that word? So osmolarity has to do with the salt content of a solution.
And so it's actually too much of a salt content in their solution. So it's kind of like if you're A garden, if a gardener, if you're a gardener, you'll get this analogy. Like gardeners, when they have slugs in their garden, they sometimes will pour salt on them, unfortunately kill the slugs and basically the slugs just kind of shrivel up and die. Well, that's what's happening to your vagina when you're using like a not healthy vaginal lubricant is that you're actually drying out your vagina, which is great if you're a company that's trying to sell this product because then people have to use more and more of your product. But it's terrible if you're a vagina owner. So that's where.
And this is where like the, the website originally started because I was recommending products to my patients and they'd have to go to this website or that website to buy it. And one day one of my patients said, why can't there just be one place that we get all this stuff? And I went, huh, that's a great idea. I guess I'm going to try to figure out how to build a website. And so I took me forever, but I, you know, I built it. So I have a couple of them that are specifically peach balanced and osmolari balanced for the vagina. And those would be, the brands would be Good Clean Love, Uber Lube and yes. So those ones are specific. I do have some other ones that aren't necessarily PH balance, but it's one of those things if you don't have problems and if you're not getting recurrent urinary tract infections or vaginal infections, then feel free to use and try the other ones. But if you start to get issues then it could be that it's throwing off the balance in the vagina. But the couple of the other ones that I like that are on the website are one called pur.
That company makes one a little bit more expensive than the other ones. But it, it lasts a long, long time and they've been in that company has been around for a while. There's a couple ones that we have that actually have CBD in it which are great for women that have where their muscles in their vagina are too tight and have a, have problems to relax. So the CBD can actually get things to relax.
So and then sometimes like I'm always trying new things that if I find one that I like, then I'll just throw it up on the website.
[00:35:09] Speaker B: Great, great. Well, these are the kind of questions that I don't think people are Comfortable asking. And I'm just asking because I think. I hope it helps a lot of women. I have even a more unusual question for you. Are flavored loops?
[00:35:24] Speaker A: You know, it's one of those things, too. Just with lubes in general. I tell them, if you're not getting issues with odor, itching, burning, discharge, recurrent infections, or recurrent, like, vaginal infection or bladder infections, if it's working for you, it's not.
Like, go ahead, like. But if you're getting those problems, then I would take a look at the lube and switch to something a little healthier. The problem is with some of the flavored ones or scented ones is that some of those flavorings and scented incense can actually be an irritant to the mucosa.
And so if I had to officially say, like, are they healthy? Probably not, but I don't want to. If you're using it and you're like, well, I've never had a problem, then I would say, keep using it. Like, I get that question a lot of times about coconut oil, because the problem with coconut oil is it's antibacterial and so it can kill off the good bacteria in the vagina. But I have ladies that have been using coconut oil their whole lives and are happy with it.
And I'm like, as long as you're not using a condom with it. Because, like, oils will eat through a condom. So, like, if you're using condoms and you need to have something that's condom safe, but. But if it's not bothering you, then you know, why. Why fix it? And that actually kind of goes the same thing with. With soaps. Cause I've done a couple things on social media. People laugh There. There is a video of me. You can find it more readily on TikTok. It's on Instagram, but it's probably buried in all the. More of the things. But I'm in a giant vulva costume and I'm in the shower talking about how to properly wash. And really all you need is water to wash the vulva, because water is a universal solvent. It will dissolve, you know, dirt and grime. And you don't really need, like, these fancy body washes with all the scents and colors in it. That can be really irritating.
But apparently that struck a big chord with people. And, like, people were in the comments, they were either, like, loving that I said that, or they were hating it. And they're like, ew, why would I not use soap? And I'm like.
[00:37:34] Speaker B: And then.
[00:37:34] Speaker A: Or they'd be Like, I've used so for years and never had a problem. I'm like, well, if you've not had a problem, then you don't need to fix it. But if you're getting issues with odor and you're getting issues with irritation or infections, then that's saying that those soaps and things are throwing things off.
So. And the nice thing is there are companies now that are making ones that are more like, vaginal friendly. I just say, you know, when you're looking at the ingredients, you know, you want to go things with, you know, look at ingredients that you can understand.
Things you want to avoid in your products is propylene glycol. Propylene glycol, unfortunately, is a found in a lot of personal care products. It can be a mucosal irritant, so it can irritate it once again. If it doesn't, then fine. But some of the fragrances and the colorings and everything else, because, you know, like, there was a company that unfortunately was marketing to teenage girls, and luckily, I think there was so much social pushback on it, they were selling, like, vaginal, like, washes that were creamsicle scented. And we were like, you know what? It's hard enough to be a teenager to, like, you know, give them a complex about their odor, you know, and that's the other thing. If you have an odor, specifically two odors you want to look out for.
If it smells fishy, that's usually because of bacteria.
If it smells more bready, that can be because of yeast.
[00:39:02] Speaker B: So, okay, tell me about how the underwear you are wearing can contribute to these things. Because I have, like, a lot of combo with my friends about this and just the material of our underwear. And so I want to dive into that. Does my underwear cause problems? Can it?
[00:39:22] Speaker A: Yes, it can. Well, first of all, if it's not a natural material like cotton or bamboo, and like, listen, I know they have some of the really pretty satiny stuff, but it doesn't breathe. And so specifically, yeasts likes to grow in a dark, warm environment.
So like a dark, warm, wet environment.
So when you're, like, in your, like, even if you're in your, like, Lululemons for too long, you know, or a bathing suit, or if you're in these underwear that doesn't breathe, could you be setting up an environment where this, you know, where yeast can take over?
So, yeah, so that's one of the problems, making sure that you're getting underwear that breathes. But listen, I know sometimes, you know, you're wearing things, and you don't want your, like, you know, your panty lines to show through. And we got some of these other things that don't breathe as well. Like, the next best thing is to just get out of that underwear as soon as you can. I mean, I know I was recently speaking and I had a. I had Spanx. I'm sorry, I'm going to. I mean, I look good in the Spanx, but for your vaginal health, they're probably like a yeast infection waiting to happen. And I remember just being up on stage and these things and just felt like I was sweating my butt off. And I'm going, oh, God. Oh, God, I can't wait to get out of these things. Like, please don't let me get a yeast infection, because I, you know, wore these. But I looked really good. I was so nice and smooth and my stomach was flat. But just get out of those things as soon as possible. And ideally, I tell people, don't try not to wear underwear when you sleep. So, like, either is good. That is. Yeah. Either, like, wear something really loose. Like, if you want to wear sweatpants without underwear or shorts without underwear, or just not wear anything at all, that's the better way to go. At least, like, overnight. Let things kind of breathe. The other problem is thongs, unfortunately. And listen, I get it. Like, I know I don't want the panty lines. And, you know, I do own a fair number of thongs, though I probably am not wearing as many as when I did in my, like, 20s and 30s. But the problem with the thongs is it kind of acts like floss. You know, every time you walk, it's going, like.
It's going, like, back and forth. So it can potentially spread bacteria from your anus to your vagina to your urethra. And it just. Every time you're walking, it's, like, spreading bacteria.
[00:41:42] Speaker B: I just want to get, like, real about this. Is this bacteria coming from wiping poorly or clothes? Like, what is that coming from?
[00:41:51] Speaker A: Either way. Either way. And some of it is. Just. Some of it actually is from bad diet. Some of it's coming from stress. Some of it's coming from being on antibiotics. It's just. Some of it's on our skin, but a lot of it's coming from our gut. And so if our gut healthy. If our gut is not healthy, we have a bigger tendency to get vaginal infections and urinary tract infections. But, yeah, this is why they always say, like, wipe front to back.
But even though you can be the cleanest person and do all the right things and still have these problems. So, you know, sometimes women have a lot of shame around this and they're like, you know, I've had one patient, she was showering multiple times a day and was still getting urinary tract infections. And so some of it is not totally a cleanliness issue, but I know the whole wiping front to back can sometimes be difficult for people. Some people didn't. Never learned it that way. Some people. What is that what some people don't have?
[00:42:45] Speaker B: How should people do this? Like they should? Yeah, I want to actually make sure that people. I. I remember training my daughter on this front to back. And that is a real thing. That's a real thing.
[00:42:55] Speaker A: Yeah. Yeah, it is. And so I tell people, if you can't do the front to back for whatever reason, you don't want to do back to front, meaning you don't want to be wiping from your anus towards your vagina and your urethra because the anus is going to be the most, quote, dirty out of all the places. Meaning, I hate the word dirty. That seems like just such a judgment call. It has the most bacteria. And so you're potentially wiping those bacteria closer to the vagina, closer to the urethra. So the bladder and the vulva doesn't tend to have as much bacteria. So that's why when we're wiping it from front to back, we're kind of taking it from like the cleanest area to the dirtiest areas. We're spreading it that way. But here's the other thing. If you can't do the whole wiping, you're like, I don't know, when you pee, just dab. You can also just dab. You know, because I have a lot of people who are like, like, you know, if they have arthritis or they're a little bit larger and they can't figure out the dexterity on the whole front to back thing. Some people will do it with their arm in the front pushing back. Some people will reach from behind and do the front to back thing. I just say you're better off when you pee. Just taking some toilet paper and just dabbing in place this way, like you're not spreading anything anywhere. So that's the other option. Yeah.
[00:44:08] Speaker B: Is. What about all these feminine wipes and even like booty wipes? Are that's. Is that just a waste of money?
[00:44:15] Speaker A: Yeah. You know what? I have some mixed emotions about some of those. Some of them can be really drying to the tissue.
And so some people can get really irritated. You know, some of them also contain the fragrances and these extra chemicals that you don't need.
I tend to have people stick with the ones that they're not flushable. Water wipes. And. Which is exactly what they say. They. They have water. All they have is water in them. But even if you have skin conditions, even the water can be just like how getting things wet down there can be a problem.
It's also same thing. If it doesn't bother you, like, fine, don't change things up. I mean, I have to say, I personally use them, but, you know, I do have to watch because sometimes and I just get the flushable. Even though we don't flush them, But I get the flushable ones from the supermarket. But, you know, I have always. I'm always looking at those ingredients, and I'm like, they do kind of have some things that can dry the skin out. So I try not to use them as much.
Interesting enough in, like, in Europe with bidets, you know, they have less risk. They have less numbers of bladder infections in Europe than we do here in the United States. And I believe it has to do. It has to do with the bidets.
And so I think, you know, people are doing that more here in the United States, and they're getting the ones that attach to their. Their toilet seats. I think that that's a really great option.
[00:45:40] Speaker B: That's cool. That is cool.
[00:45:42] Speaker A: But then, you know, I also, I always like to think about, how did we evolve, you know, as humans? And you go, we didn't evolve with bidets or wipes. So, like, how is it really supposed to work? So. Yeah, yeah.
[00:45:53] Speaker B: Well, those had a huge resurgence during COVID when there was a toilet paper shortage. And so, hey, you know, that's a.
[00:46:01] Speaker A: Good solution company called Tushy during that time. And she did really, really well. And I was like, yeah, I think of that. Yeah. Yeah.
[00:46:09] Speaker B: Well, speaking of chemistry and bacteria, I've heard you speak about. Is it boric acid?
[00:46:16] Speaker A: Yes. Oh, my God, I love.
[00:46:17] Speaker B: What is that? And in, like, what. How can women use that for their pelvic health?
[00:46:22] Speaker A: So, you know, the history of boric acid is it's been used for many different things from health purposes all the way up to. As a, like, insecticide. So some people will be like, ew, why would I put cockroach killer in my vagina? Well, boric acid is actually derived from seawater, so. And it's made with. With boron, so. And it's also used for cleaning. But just get the the one that's specifically made for the vagina. The reason why boric acid is so good for pelvic health is it's used to kind of reboot things. So, like, you know when your computer is acting up and you're like, I don't know what's going on, I'm just gonna restart this thing. Well, same idea for your vagina. Like, majority of itching, burning, discharge. A lot of women will think it's yeast and they go out to the store and they'll buy yeast medicine. Only about 12% of the time is it yeast. The other percentage is usually bacterial. So the nice thing with boric acid is you don't have to think about it because they usually come in little capsules. Sometimes they sell them as suppositories. You put them in the vagina and it rebalances the ph.
Now, I will warn you, it's not the most comfortable thing because your body will respond to having something in there as a foreign object. You will get a heavier discharge when you use these products because the body is trying to flush things out. Kind of like if you've ever gotten, like sand or an eyelash in your eye and your eye waters, your eye is doing it to flush things out. So the reason why we get vaginal discharge is because the body's trying to flush out whatever's there.
So the boric acid, like, you don't really have to think about it. You're like, is this yeast? Is this bacteria? I don't know. Things aren't quite right down there.
And I tell people, like, easily just. I mean, it's sold over the counter so many different places. Usually the first one that came commercially on the market was a company called Ph.D. feminine Health.
So that's usually the one that I go for because they've just been around longer. But even in the medical industry, we've been using boric acid for vaginal health for years and years and years. It just used to have to have them made up by a pharmacy, a compounding pharmacy. Now you can just get it over the counter. But the key is usually using it, you know, anywhere from like three to seven days nightly. And then if you're still not feeling better or if you're getting worse, then you need to go seek medical attention.
So the good thing is it could be something. You know, it could be something. A lot of times, you know, these things pop up on, like, Friday night at like 6 o' clock at night when the doctor's office is closed.
And, you know, like, you're not going to get, you know, urgent care is closed. So it's something you could always try to kind of get you through until you can get medical attention. But if you definitely, if you tried it for a week and nothing is getting better, you really definitely need to see a doctor. But I'll have people, I have people use it for prevention too. Like sometimes, like if you're prone to infections and you want to go hang out at the beach, like maybe popping in a, you know, a boric acid suppository while you're in your bathing suit. Or some women are more prone to getting vaginal infections or bladder infections after having sexual relationships with a man. Because I haven't figured out an explanation for this. But the vagina is very acidic. Semen is very basic. So the ph of vagina is 3.5 to 4.5. The pH of semen is 7 to 8.
So if you're with a man and ejaculates in the vagina, that could throw off the ph of the vagina. And in some women, it makes them more prone to having issues.
Quick way to try to fix that is after sexual relationship, try using boric acid.
[00:50:09] Speaker B: Interesting. That is so unique.
So one of the things that I talk about with all of my girlfriends, and it is just on the repeat, is sexual satisfaction as someone ages. What are the, the top pieces of advice you would give women who are not experiencing satisfaction in their intimate life?
[00:50:32] Speaker A: Yeah, so, you know, a lot of the complaints I get are all around desire, too, that sometimes the desire is kind of dipping. So there's a couple things with that. So I'm going to go desire first and then we're going to go to something else. So unfortunately, the understanding of desire is still antiquated. People still believe in the linear graph of Masters and Johnson's that came out in the 50s and 60s where there was this belief that you had to have desire first, and that led to arousal. And then if you're lucky, you had an orgasm. And then that led to resolution. And that's a very start to stop kind of process.
Rosemary Besson, in the 1990s, she was a sex researcher. She remapped the female sexual response.
And so she said spontaneous desire can still exist. It's not that it doesn't exist, but it gets a little bit harder the older we get and the longer we're in a relationship. Because the longer you're in a relationship, when you're first in a relationship, you know, you kind of get those butterflies and the fireworks. A Lot of that is coming from dopamine. And you get these, like, dopamine hits in your brain. You get all excited about that person. But the longer you're with somebody and this happens, the body is so many different processes. The longer something is at steady state, the body kind of starts to tune it out.
So it's a process called habituation that. Not that you can't still get turned on by your partner, but it's not going to be like when it was new, because the brain likes novelty and it gets more excited with new things.
So we just have to kind of overcome that habituation process where the body's kind of gotten used to things.
So in Rosemary Besson's model, she said, okay, we admit spontaneous desire can still exist, but let's deal with the other things. The other thing is, instead of waiting to be in the mood. Cause that's what a lot of people will do. They're like, I'm never in the mood.
And like, they're waiting to be in the mood to have sex, but then they're never in the mood because you're probably stressed.
Because stress and sex can't coexist. And stress comes in so many different forms, like financial stress, work stress, emotional stress, relationship stress, physical stress from not getting enough sleep, not drinking enough water, eating inflammatory foods. Like, all those things can affect the sex drive.
So in Rosemary Besson's model, she says, well, instead of looking at desire as the first step, let's look at willingness.
Are you willing to engage in some sort of sexual activity? And that can be with a partner or that could be with yourself, but basically setting aside the time and go, okay, let's put it on the calendar. It's going to be date night. But the key about that is you don't want to go through something that you're just not feeling just because it's on the calendar. Because then it feels like a chore, and then it makes it. There's a negative loop. And then you just are not going to want to do anything. But if things are right and you've had a conversation with your partner, like, okay, let's try this. If it goes nowhere, then we have to agree to communicate and stop and like, and just admit, like, hey, it's not going to work tonight, like, or today, let's just try it another time. Like, no judgments, because you don't want to push through it, because that'll be the worst thing to do. So they. She found in her graph that if there was a willingness to start, then Just kind of going through the steps that there were physiologic changes that now started to increase the blood flow to the pelvis. And no physiologic arousal was happening before the actual desire.
And then the desire was coming next. And then you get into the mood all of a sudden, and then you're like, oh, wait, you know what? Yes, I want to do this. And then hopefully you do things. And then hopefully it's satisfying. And then that reinforces that loop to be like, oh, you know what? Why don't we do this more often?
And so a lot of times I'll show my patients that graft and they go home and when they try it, they say, gosh, that was great. Why don't I do that more often?
Because life, life gets lifey and you got to set aside time and make that a priority. And sex is the worst thing to multitask because, you know, women are really good at multitasking, but sex is not a multitasking event because you can't be thinking about other things when you're trying to get in the mood. It just distracts from the whole sexual health process.
So that's, that's basically the biggest thing. Then we have the problem just of menopause, and with that tissue getting thin, we start losing. We start losing the elasticity of that tissue. We lose collagen. So sometimes you can get dryness, sometimes it gets more uncomfortable, sometimes it can feel like cut glass.
And then there's a number of things that can be done for vaginal rejuvenation, but then we also start to lose the blood.
Our blood vessels that come into that tissue actually start to retract.
So this is something where it's true that if you don't use it, you lose it. Because sexual activity, whether it's self pleasure or with a partner, is actually a form of pelvic physical therapy. Because the more you use it, the healthier things will be and the better it will work.
So because once the blood flow starts, those blood vessels start to retract. You can get it back, but it makes it harder. Sensation tends to be a little bit not as good and the tissue doesn't plump up as much. And so you can, you can potentially start losing issues with sensation and enjoyment. So actually setting aside time to actually look at pleasure as being a form of pelvic physical therapy, so things are still kept in working order.
And this is, it's funny, I'm actually a spokesperson for a sex toy company, which we don't call them sex toys anymore. They're called intimate devices.
And so they've done a lot of research and they found that even just using these devices and they don't have to end an orgasm, but just using the devices, that there was a 98% improvement in sleep, there was something like 95% improvement in mood, like 93% like improvement in confidence. So there's all these mood and health benefits of. And it doesn't have to necessarily be with, you know, with a vibrator, but you know, with self, with some sort of self pleasure or with partnered pleasure. But that's, you know, talking about the, the devices.
Sometimes when we post things online about it, I'll get in the comments people saying things like I don't need one of these, I have a man.
And that's the point is that to look at them as toys like even though we're not calling them toys, but because it should be fun. And they're not necessarily things that you need to use by yourself though you could, they could be things you could incorporate with your partner. And that can be something that would bring novelty into the relationship. Because that's the thing. The longer in your relationship, the way you kind of keep things going is you finding new things to do.
And unfortunately this is why I joke that there's never going to be a horny pill. Cuz Viagra is not even a horny pill. It's a blood flow pill. That's all that that Viagra does is it increases blood flow for men to the penis. And actually for women it actually increases blood flow. They just never studied it for the right thing. But women can actually take Viagra too. It'll increase sensation and lubrication. But the. Where was I going with that? Oh, so the point is, is that your brain is your most important sex organ. And so they can't create a pill that's going to stimulate everybody's brain because everybody has different things that turn them on.
So it's basically having a serious conversation with yourself and having a conversation with your partner or partners or whatever the situation.
So that you do say like, hey, this is something I want to try, this is something new. A lot of times people realize when it comes to novelty when they have vacation sex, a lot of people will report that vacation sex is so much better because a lot of times, because you're in a new place, it's a new place, it's a different situation.
So it's just trying to keep things like new and exciting.
[00:58:30] Speaker B: So okay, those are all such good tips. I, I feel so, so lucky to know you. I, I, you have answers to so many questions that feel almost impossible to trust somebody on. And, and it's just such a privilege to ask you all these things and to be able to share it with all of these middle agers who have the same questions and don't have access to someone like you or just doesn't feel comfortable speaking with their doctor about it. So.
[00:59:00] Speaker A: Oh, yeah, thank you. Thank you.
[00:59:02] Speaker B: I, I could do this for hours because it's, it's of high interest.
Yeah. So, Dr. Betsy, what is the best way for our listeners to engage with you? There are so many resources you have out there. I'd love for you to tell everyone about them.
[00:59:20] Speaker A: Yeah. So the best way is follow me on any social media that you're on.
So I am Dr. Betsy Greenleaf. B E T S Y and then green leaf.
I, you can find me in any.
I unfortunately did not keep my name the same on all the platforms. So if you just look up Dr. Betsy Greenleaf, I'm sure you're going to find one of my, one of my profiles and I think on Instagram and even TikTok, I have more than one.
So follow me there, let me know that you heard me here.
The other thing is the pelvic floor store.com I will have a code for 10% off for the listeners and the code will be 3564. And you can come check out all the products or if you have a product that you're looking for or interested in, we don't carry it, let me know because I'm always looking to put new things on the store. So.
And then finally my medical practice is Pause Institute P A U S E. Like menopause without the meno, because I take care of both men and women. So it's the Paws Institute.com and if you go there, you can actually find. There's a free hormone quiz which kind of gives you, it takes like two seconds to do and it gives you kind of an overview what might be going on with your hormones. So you kind of get an understanding what something that might be happening.
[01:00:36] Speaker B: Great.
[01:00:36] Speaker A: Oh, and I always forget the last one. If you're on Apple, Spotify, Pandora, anywhere you can find Menopause Memo. It's my menopause rock album.
[01:00:47] Speaker B: Oh, that's awesome. That I. We're going to link all this in the show notes, but I'm checking that out. That's so interesting.
Are you actually taking patients right now?
[01:00:57] Speaker A: Yeah, yeah. Well, you are right now. I'm able to see people, specifically New York, New Jersey, Pennsylvania, Delaware. But we will be expanding the whole, the plans are to slowly expand and be able to hit every state. So. But right now those are the ones we're doing.
But there's always options. Like I said, if, even if you're right and be like hey, I'm not in one of those states, like let me know where you are. So this way I know which state to work on the licensing next.
[01:01:27] Speaker B: Yeah, well, California. I would like to be your first patient here please. Yeah, that would be awesome. Awesome. Well, thank you. Thank you. This kind of stuff changes lives. It really sincerely does. I know just bladder issues have affected so many of my friends lives. You know, sexual health ut I mean you name it, this is life changing information and I'm glad we can see spread that. So thank you for sharing with our audience. They're going to love all this.
[01:01:57] Speaker A: Thank you so much Karen. And I know it's really big shoes to fill and God bless her soul, Dr. Ruth Westheimer. But I, I aspire to be like the next Dr. Ruth. So hopefully you guys will be hearing and seeing a lot more of Dr. Betsy.
[01:02:11] Speaker B: I'm sure we will. I'm sure we will.
All right, thanks Dr. Betsy.
[01:02:16] Speaker A: Thank you.
[01:02:18] Speaker B: And that brings us to the end of another episode.
I hope you enjoyed the content and I'd love it if you would share this with a friend or family that you think would enjoy it. This is such a great time, middle age and I want to spread that message. The best way to do that is to share it and if you haven't already followed us or subscribed, subscribe. Make sure to do that so you don't miss any of our new content.
I'm going to leave you like I do every episode.
Remember, it's never too late, you're not too old and you're definitely not dead.
