Recurrent UTIs and The Secret to Kicking Them in The Butt - with Joanna Macmeikan

Speaker A [00:00:00]:

This program is brought to you by Pussy Magnets.

Speaker B [00:00:10]:

Welcome. Welcome, my lovely lumps, or should I say lovely labs? I'm so thrilled to have you here in the Labia Lounge. We're gonna yarn about all things sexuality, womanhood, relationships, intimacy, holistic health, and everything in between. Your legs. Oh. Can't help myself. Anyway, we're gonna have Vagelords of real chats with real people about real shit. So buckle up, you're about to receive the sex ed that you never had and have a bloody good laugh while you're at it.

Speaker B [00:00:39]:

Before we dive in, I'd like to respectfully acknowledge the traditional custodians of the land on which I'm recording this, the Wurundjeri people of the Kulin nation. It's an absolute privilege to be living and creating dope podcast content in Naam and I pay respect to their elders past, present, and emerging. Now, if you're all ready, let's flap and do this. Oh, my god. Is there such thing as too many vagina jokes in the 1 intro? Whatever. It's my podcast. I'm leaving it in. Access my new mini course for free before I start charging for it in future.

Speaker B [00:01:32]:

It's for people with vulvas and it's quick to complete. It's all about demystifying the female body and pleasure anatomy and getting some basic fundamentals to understand your body better. It's called Pussy Pleasure Secrets, Your Roadmap to Bedroom Bliss. You can grab it on the freebies page of my website or in the show notes. It's a great little free resource to kind of dip your toe in or act as a bit of a taster for my work. So if you've ever been curious about this sort of thing and you just don't know where to start or you want a really quick, easy, accessible, non threatening way to get the ball rolling and start working on this stuff, this is a great place to start.

Speaker C [00:02:12]:

Hey, labial lovers. Welcome back to the lounge. Today, I have probably a guest who's been on the most out of anyone, maybe even Hannah. I don't know. What do you reckon? Is this our 4th episode?

Speaker A [00:02:25]:

I think we might be up to number 4 now.

Speaker C [00:02:27]:

Yep. Yeah. Okay. Not playing favorites here, but, yeah, Joanna has just got so much expensive knowledge and there's generally things that we're nerding out on and we're like, hey, should we just do a podcast about it? So today, we're gonna be talking about UTIs. And in case you haven't listened to any of our previous episodes, Joanna's been on before talking about thrush, UTIs, and bacterial vaginosis, like, 2 over 2 years ago. And then we did an amazing episode about the pill, and another 1 about menopause. So feel free to check those out with Joanna McMeekin. Wait.

Speaker C [00:03:03]:

Am I saying that right? I should know. Yeah.

Speaker A [00:03:04]:

You are. Actually, well done. Most people will struggle.

Speaker C [00:03:08]:

Alright. Cool. That would've been embarrassing. And Joanna is a Chinese a traditional Chinese medicine practitioner, women's health and hormone specialist, all around fucking nerd, and I love it. So welcome back, Joanna. Yeah.

Speaker A [00:03:27]:

I think big nerd should be on my bio somewhere. Thanks for having me back. This is a topic that's really close to my heart because this is actually what kind of sent me, through personal experience down the rabbit hole of the vaginal microbiome, and then that directed me into the work I do now with menopause and perimenopause because but, yeah, because of my own my own journey with a recurrent UTI.

Speaker C [00:03:53]:

Yeah. Not much fun. Hey. So I'm, yeah, stoked to be talking to you, now that because I think that when we first chatted, maybe you hadn't had all of this, personal experience with the recurrent new chairs. That's kind of been happening more in recent No.

Speaker A [00:04:09]:

I had had it. So I so I suppose that's a good place to start is I'll just give a little bit of a we need to you know, in Scooby Doo where they go, like, woo, woo, woo, and they give you the backstory? I reckon it's, like, 7 years ago now that I've always had UCI's on and off during my life. Like, even when I was a little girl, I remember my mom would give me Citruvastatin or UroL, so, and I didn't know at the time why I was having it, but I must have said to her, like, it hurts when I pee or something. So I definitely had a history of these urinary symptoms. And then when I became I can't remember if my first 1 with antibiotics, I'm most likely it would have been after I became sexually active, and the pattern I would get is I would get 1 and then it would hang around for a while, and I'd need multiple rounds of antibiotics. It would be tough to get rid of, and then it would go away, and it would go away for years. And then it would come back, and I would have I'd be in this recurrent, state again. And it was often when I when I travelled, I did notice certain patterns, so scented toilet paper seemed to set me off, or at least I thought it did.

Speaker A [00:05:20]:

Now 7 years down the track, my case was, like, a multi layered onion situation, and I think there are a lot of people who are in a similar situation. It's not the way I experienced this journey. It's not the way everyone experiences it. Recurrent UTIs can be quite complex and quite broad as to what's driving it. But, yeah, there were these triggers that I would notice, and, you know, if I'd had, like, a sexy weekend where I got it on multiple times in a row, then that was, like, sure fire gonna gonna be a problem. And but it wasn't until 7 years ago, and I was, like, married by then, that I went out for my birthday, and we went to a Japanese restaurant. And, you know, I had a nice meal. I drank some sake.

Speaker A [00:06:01]:

Alcohol used to be a trigger as well, and I had lots of birthday cake, so sugar as well. And I got 1, and I was like, oh, man. I haven't had 1 for years. And that was, to date, the most persistent 1 that I had. And it was I would get rid of it for 2 weeks, and then it would come back. I'd try and treat it naturally because, of course, I knew more about, holistic health. My history of UTIs was before I went back study in, in health sciences. And at first, I did naturopathy, and then I transferred over to Chinese medicine.

Speaker A [00:06:34]:

So I was trying to treat it naturally and holistically, and it wasn't working. So then I go and get antibiotics, and I'd be like, right. Antibiotics. Clears it up, and then I would do the, you know, the mop up afterwards, but it wasn't working. And and if I just had a coffee, if I had a glass of wine, if I had sex, just bam. I was right back there, and it was becoming, yeah, it was becoming really, a bit of a head fuck, you know, because I thought none of the stuff that I'm doing is working, and I started to doubt my skills as a practitioner. I started to doubt Chinese medicine, you know, and I thought, what's going on? And so that I I was feeling kinda helpless for a while, and then I remembered that I don't do helpless. I I have finances.

Speaker A [00:07:15]:

That's my that's my schtick. And so I went and I did some studies, in the area. I went online and researched a lot, and I uncovered that there was most likely a microbiome issue driving this recurrent UTI, and that it wasn't a case of, you know, peeing after sex and wiping front to back, which is basically the only advice you'll get from a doctor. Drink water, pee after sex, wipe front to back. And I was like, you know, I'm not 3. Right? Like, I know I know how to use the bathroom by now. And so I I think it was a Harvard medical study that I read talking about the role of gardenorella, which is a vaginal microbe in recurrent UTI. And I was like, right.

Speaker A [00:07:57]:

Someone has to know about this, and then I found a mentor who teaches specifically about urogenital issues and the and the the microbiome's involvement. And so I did her studies. I actually got her as a practitioner, and I got on top of it. And I thought, right, it must been a microbiome issue and it was fine for a few years, and then when we moved to Mexico I got 1 when we got here I got really bad food poisoning, and I couldn't eat or drink for, like, a day or 2, and then I got a UTI, and I was like, oh man, I haven't had 1 of those for years, and then it started to come back. It was becoming recurrent. I was like, what the hell? I'm doing all the stuff that I know to do now that worked last time. Why isn't it working? And that's when I was, like, gosh. Back to the drawing board.

Speaker A [00:08:42]:

So I was back researching and looking at, the literature, and I discovered the role of oxalates and oxalate crystals forming in the body, and we'll undoubtedly talk about this, during this episode. But yeah. So then I realized, okay. I have a problem with oxalate crystals, and to me, that seems to have been, like, the final piece of the puzzle because I have been UTI free since. And that first time that I was, like, right. This I got the symptoms. I was, like, right, this is not a UTI. This is my body dealing with probably, like, bladder stones, you know, kidney stones.

Speaker A [00:09:16]:

You've heard of those? Yes. So I think I I've had bladder stones. So I was like, I can't take antibiotics. I just have to ride this out. And if I can ride it out, then I will know that I'm not dealing with a microbial issue. And so it was really scary because in the past, I had been really sick when I tried to let a UTI, you know, tried to treat it naturally, but I was treating it in a different way. This time, I treated it as though it was bladder stones and oxalate crystals, and, yeah, I wound up actually past a stone, and that confirmed what I had been suspicious about. And so, yeah, then now I'm off down this whole new path of oxalates and dietary things that are good for me in my diet and healing my gut, and that's that's a topic for another another day.

Speaker A [00:10:00]:

But, yes, that's synopsis.

Speaker C [00:10:03]:

Yeah. Wow. It's so frustrating how with these things, it's often like some serious, serious detective work and peeling back layers and unraveling things and following little rabbit holes and something working for a while, but then not like, it's just I I definitely have, like, fallen into the the sort of hopelessness hole with things like this. Luckily, I haven't had too much, too much trouble with UTIs. But definitely back in the day with the thrush and the BB, it was just I was just, like, ready to give up by the end. I've tried so many different things, and it's just so myth mythic, I suppose. You know, it's very confusing, sometimes, and it's hard to actually find solid support from practitioners that, you know, that do give you a little bit more in-depth advice than just drink water and, you know, have some cranberry juice and wipe from the back. You know? So, yeah, that was why I was keen to get you on because I know that we're gonna talk about it in a lot more depth than most people realize there even is to this subject.

Speaker C [00:11:06]:

You know? So many people just go, alright. Yep. Just take antibiotics. And, that's kinda the only you know, it's the main treatment path that we are offered for this. And that holds its own drawbacks because, obviously, if we're constantly taking antibiotics, we're just wrecking our gut microbiome and potentially creating, you know, antibiotic resistant bacteria and things like that. So I've always been very, reluctant to take antibiotics unless I absolutely fucking have to. So I'm super pumped to talk to you about different ways that we can approach this and things that we can focus on rather than just that usual sort of, pathway of, like, go to the doctor, get the antibiotics, rinse and repeat, because it's just not always a very sustainable way to deal with this. And, you know, recurrent UTIs can be a whole other kettle of fish than, like, a stand alone UTI episode that kind of, you know, is like a 1 event rather than this fucking, basically, a lifestyle that you have to get used to when you've got the constant recurrent UTI, going

Speaker A [00:12:14]:

on. So Yeah. Probably clarifying the difference between the 2 is important, that we that a lot of people will get a UTI and it will be this sort of snapshot incident where it will have been 1 of the traditional triggers, too much sex, maybe not peeing after sex, maybe being out and being kind of sweaty, and there's bacterial issues and, bam, we suddenly have e coli causing a problem in the bladder. That's sort of how we've traditionally understood it. It's usually down to e coli as the bacteria. I think the stats, I'm kind of guessing here, but I believe it's around 90% of UTIs are caused by don't quote me on that. Everybody, feel free to go and check it, but it's a high proportion of cases that are actually caused by e coli. And in those cases, you can go, you can do, oh, see, I've done the thing where I've started saying something and now 5 other thoughts have come into my head.

Speaker A [00:13:05]:

This is what happens when you have it. You're a spicy brain. I was gonna say you get a 7 day course of antibiotics, but then I'm like, well, you might or you might not because, 1 of the he's actually on the medical side. He's passed away now. He didn't see any value in holistic approaches. He's 100% medical doctor guy, and he believed he worked on Harley Street, the infamous Harley Street in, or famous Harley Street in the UK, I can't remember his name, but Malonely professor Malonely. And his work is really, fabulous, but it's very, very medicalized. But he believes that the issue with a lot of UTIs is that we get 1 instance, and then it should be treated with 14 days of antibiotics.

Speaker A [00:13:50]:

But for some reason, we've started I think it's because we're concerned about antibiotic resistance and the the impact of antibiotics on the gut microbiome, but nowadays, a standard course is 3 days of trimethoprim, and 3 days is not really very much. So he felt that what was happening was that 3 days is enough to calm the symptoms down, but it's not enough to eradicate the bacteria that are causing the problem. And so they kind of hang out and wait for an opportunity. Then they take another opportunity, and out they come, and you go back, and you get 3 days of trimethoprene. Or maybe they give you 5 days this time, And then you do 5 days, and then it goes away for a month. And then they've just been hanging around, they're waiting for the next opportunity, and out they come again. And because we don't see a family doctor often as well, people are just going to different doctors and so then another doctor might be like, alright, 3 days we try methoprim again. Again.

Speaker A [00:14:39]:

So, but in an acute UTI, you will go to the doctor, you will receive anywhere between 3 7 days of an antibiotic, and it could be Trimethopim or, Augmentin or some people are given Keflex, which does work, but I'm not I don't love Keflex because I don't think it's targeted enough. They'll usually send the urine away for culture to see if it's resistant to the type of antibiotic that's been prescribed. If it is, then they'll come in with a different antibiotic, and usually it's a 7 day course, the infection's dealt with, and then you move on with your life. And many women will have maybe 1 or 2, like, their whole life, and you can treat it with antibiotics like that and it's a successful way of doing it, and that's the end of it for them. But for a percentage of people, I was 1, you just start going down this really slippery slope. So today, I think we're gonna be talking about more about recurrent UTIs.

Speaker C [00:15:32]:

And Yeah. Yeah. Because those those are the really sucky ones. Like, I've I've had maybe 2 UTIs in my whole life, and and that's it, luckily. But I do know when I was going through that whole sort of thrush baby cycle and god knows whatever other dysbiosis was was actually causing the symptoms over, like, several years that I was kinda battling in this vicious cycle. It was just demoralizing and so disheartening. And you feel so hopeless, and you feel so pitted against your body and frustrated, and it's horrible. It really lowers your quality of life.

Speaker C [00:16:10]:

And I can imagine it's really similar with recurrent UTIs, potentially even more horrific because there's a lot more pain involved and potential for doing, you know, like kidney and bladder damage if it kind of yeah. Anyway, so let's maybe, like, get back to basics and just lay the foundation here because, as usual, we're getting ahead of ourselves. What actually happens in the body to create a UTI? Like like, give people a bit of a rundown because that might help, when we're going into more detail later.

Speaker A [00:16:41]:

So a standard, simple, uncomplicated UTI is where we get bacteria in the bladder that either shouldn't be there or is normally allowed to be there, but in quite low numbers, and it the bacteria will proliferate, will grow its numbers, and then there's too many of them in there, and it causes symptoms. And so that's basically a very cagey answer because you were like, let's have a basic answer, and I'm like, oh, but there's other things I could talk about. But that's, the traditional understanding is that particularly in a woman because the anus is so close to the urethra that you get translocation of bacteria from the anus, so gut bacteria, that makes its way into the urinary tract and ascends into the or either causes issues within the urethra or ascends into the bladder, and it's colonized by bacteria that shouldn't be there or that should be there in low numbers and that causes symptoms. And then can, as you mentioned, if not treated, progress up the urinary system and into the kidneys, and that can be a potentially life threatening situation. What we're now finding, and this kind of plays into recurrent UTIs, is that in between the anus and the urethra, you have the vagina, which is this incredible well, it shouldn't be that diverse. It's an incredible space which should have a fairly low diversity of microbes. And if the microbes in the vagina go out, then you can get translation from the vagina to the urinary system, and that can be what's driving it. So it's actually got nothing to do with the gut or or hygiene, you know, wiping front to back.

Speaker A [00:18:21]:

It's this relationship between the vaginal and urinary microbiomes, and we're learning about that all the time. We used to think that the bladder was kind of a sterile environment. Now we understand that we have a bladder microbiome and a vaginal microbiome, and those 2 will cross talk and will cross pollinate, and so that's another mechanism of having an ATI

Speaker C [00:18:42]:

microbiome nowadays. Right? Like,

Speaker A [00:18:44]:

the macromic microbiome, the brain

Speaker C [00:18:45]:

supposedly got 1 they've just discovered.

Speaker A [00:18:48]:

Yeah. And the brain and the gut talk, you know, so there's, like, that crosstalk. And you do have quorum it's something called quorum sensing, so, microbes can cross talk. They can talk to different microbial colonies and different parts of the body. So we we are on the tip of the iceberg about what we understand in terms of our microbiome. And I think I mentioned this in 1 of the old episodes that to me, it's just this beautiful, beautiful, representation of how we live in a universe, and we are this teeny weeny little itty bitty drop of speck of dust in this vast universe. And we ourselves are a universe because we form the universe for all of our microbes. Most of your DNA is microbial DNA.

Speaker A [00:19:31]:

They used to say that your microbes outnumbered the body cells 10 to 1. I don't I think that's been revised down. It's not quite 10 to 1, but there are more microbes than there are you in you.

Speaker C [00:19:45]:

Yeah. God. It's cool, but it's also like, jeez, couldn't it just be a little bit more simple? Because when shit starts to go wrong, it is really hard to rein it back in and figure out what's going on.

Speaker A [00:19:56]:

Well, it is and it isn't because I think at the end of the day, we do go back to basics regardless. Like, we don't necessarily have to understand all of the complexities of the microbiome if we understand how to bring the system into balance. And it's usually the same I always say the boring stuff, but it's the simple stuff, which is diet, stress management, lifestyle, exercise, medications, you know, these sorts of things. So it you can get super duper duper complicated, and you can genome sequence, and you can, you know, do PCR tests and all of that, or you can just be like, right. How how do I how do I set my system up? Because your system always wants to return to balance. But, of course, it can definitely be helpful knowing what's gone out, and that's why there are certain tests you can run. Like, I don't I don't tend to start with a microbiome mapping, a vaginal microbiome map, but in certain cases, it is we're, like, right. I wanna see what kind of microbes we're dealing with because the symptoms, I'll initially do a symptom, a case study sorry, a case and take down all the symptoms and then formulate a picture and say, right.

Speaker A [00:21:05]:

This is the direction I think we should go. But if that doesn't work, then we might do a microbiome panel because there's something in there that I'm potentially missing. So it can be simple, and it can be complicated. You're right.

Speaker C [00:21:17]:

Yeah. Something I really like simple little tips that I remember learning, which I'm not fully sure if if this is totally legit, but maybe you'll have some thoughts on this. And I guess it's probably more to tackle the 1 off UTIs. But, I remember learning that if you are making sure you get fully aroused before you have penetrative sex and your, erectile tissue, including your g spot, aka the urethral sponge, is all puffed up with blood, then it actually squishes the urethra shut and thereby prevents bacteria from the sex from, like, traveling up the urethral because of that, like, cushioning and that sort of, you know, sealing shot of the urethral with the g spot slash urethral sponge tissue. Is that, like, plausible to you?

Speaker A [00:22:08]:

100%. That makes perfect sense. And because if you because my understanding is that, the part of the reason that closes off, it's the same in a man's penis. Right? Because we have all that the same, anatomy base, is that it's so that he can ejaculate without urine mixing with the ejaculate. Correct? It, like, closes off the the valves. And so, yes, it would make sense that because women can ejaculate, and it would close off the urethral pathways that you don't pee during ejaculation and also would have the opposite effect of bacteria not being able to necessarily be pushed into that area. And I think this is an interesting 1 to an interesting point for us to be able to make, which is pee after sex is what you're always told to avoid UTIs. However, you need to give yourself a minute because, it's difficult to pee after sex for exactly the anatomical reason that you are saying.

Speaker A [00:23:02]:

You need to give yourself a minute, take some deep breaths, don't force that pee because that's going to be doing a number on your pelvic floor. But, yes, if you find it difficult to pee immediately after sex, it's because you're trying to do it too soon. And you might have some tips on how to relax and get that area sort of back to back to

Speaker C [00:23:21]:

Well, I mean, my jam is usually trying to get the erectile tissue engorged in the 1st place, not trying to get rid of it. It's kinda it's hilarious because it's that classic thing of, like, guys trying to pee with a boner. Yes.

Speaker A [00:23:33]:

Exactly. Exactly it.

Speaker C [00:23:36]:

So I guess, like, just think unsexy thoughts. Yeah. Okay. Cool. So I guess, like, yeah, I don't wanna get all too bogged down in like the I was gonna kinda ask, like, what are some of the other, like, risks or dangers of, like, having recurrent UTIs? Like, is that kinda constantly keeping your body in a state of, like, inflammation or irritation or whatever whatever? So feel free to touch on that if there's some relevant stuff. But, I do wanna make sure we have time to talk about, the, I guess, treatment pathways and, yeah, things that are, I guess, a little bit more geared towards giving people some hope and some some action steps

Speaker A [00:24:23]:

forward. Yeah. The the action items as opposed to the nerdy stuff. So yes. All of I

Speaker C [00:24:29]:

still love the nerdy stuff.

Speaker A [00:24:32]:

Everything you just said is so stress, inflammation, these can all be drivers. Immune status can be drivers. So if you're constantly run down, your immune system is not gonna be able to keep on top of infections where it normally would.

Speaker B [00:24:46]:

Hey, baby babes. Sorry to interrupt. I just had to pop my head into the lounge here and mention another virtual lounge that I'd love you to get around. It's the Labia Lounge Facebook group that I've created for listeners of the potty to mingle in. There, you'll find extra bits and bobs like freebies, behind the scenes, or discounts for offerings from guests who have been interviewed on the podcast. They'll also be, hopefully, inspiring, thought provoking conversations, and support from a community of labial legends like yourself. My vision for this is that it becomes a really supportive, educational, and hilarious resource for you to have more access to me and a safe space to ask questions you can't ask anywhere else. So head over to links in the show notes or look up the Labia Lounge group in Facebook, and I'll see you in there.

Speaker B [00:25:32]:

And now back to the episode.

Speaker A [00:25:34]:

Being diabetic can increase your risk and stage of life with women as well. So, you can be more prone to them when you're very little and when you're past menopause because the vaginal microbiome profile of a prepubescent girl is very, very similar to that of a postmenopausal woman because of the role of estrogen on the vaginal microbiome. So, yeah. So diet plays a role, of course, because if you want to maintain a healthy gut because you get that translocation happening, from the the different areas, so from anus to urethra. So diet plays a role as does sugar for so sugar feeds into diet, but sugar feeds bacteria and not the helpful ones. So making sure that your diet is dialled in, and stress also seems to play a role because a lot of people will find they get flares during stress, and stress drives inflammation, as we know. So, yeah, there's different there are different things that can happen. And once you get inflammation, you can be kind of on this, like, hamster wheel.

Speaker A [00:26:39]:

So yeah. Depending on what's driving it, will, it will that will dictate the other things that they're gonna exacerbate the problem.

Speaker C [00:26:51]:

Mhmm. Yeah. Yeah. And I heard that, like, if you are on that sort of hamster wheel of chronic recurrent UTIs, there can be things that go along with that. And I don't know. It's a bit of a chicken or an egg thing. I didn't look too deeply into it because I was like, I'm just gonna ask Johanna. But, you know, you can also get things like insomnia, chronic fatigue, anxiety, depression.

Speaker C [00:27:13]:

If you have been getting recurrent UTIs for a long period of time, some of those things can also start to affect you as a result. Is that correct? Or are they also all kinda like just interwoven and it's hard to tell

Speaker A [00:27:25]:

which concept? Yeah. You actually make a good point that are people who are more prone to anxiety likely to develop anxiety if they get chronic UTIs? I would say yes, but it it is very anxiety provoking. And it's, like you said, it's a real downer because you start to fear things I mean, for me, it was like coffee, wine, and sex, My 3 great loves. And all of those things filled me with dread for for quite a while. And you start it starts to it can have an impact on your relationship because most of us have wonderfully loving and kind partners who don't wanna pressure us into sex because they know it's a trigger point. And so they might not initiate and then or they might initiate, and you've knocked them back 3 times already because you were feeling a bit blattery. And then so you're like, oh, I better do it. And then you get an infection, and then that can build resentment.

Speaker A [00:28:19]:

And I you know, it can just be it can just be complicated. And equally, you can feel incredible guilt, like, because you're not able to be as available to your partner as you might want. And if you do make yourself available sexually to your partner, then you could be in for a world of hurt. So it's a no win situation, and it can be, yeah, it can be really, really stressful and anxiety provoking. And the other thing is you can stuff like going on holiday. You know, I've had a UTI. I was talking to a young client the other day who I have she's a UTI client, and she's off on a a trip, AAA 6 week trip. And we're putting together a little plan of action, a little UCI prevention kit sort of situation.

Speaker A [00:29:01]:

And I said to her, Look. If the worst case scenario happens, you'll find people to help. I've had UTIs in. I started to list off all the countries that I've wound up in the emergency room with UTIs. Japan, twice. Italy. Where else? Mexico. Where else? There was 1 there was 1 other place.

Speaker A [00:29:20]:

Like, I think there's I've I've had UTIs all over the world, and people have always helped me, you know, when I needed it. I had friends of mine when I was in Japan that was that got really bad. I actually had full on cystitis. I was peeing blood. My friends carried me to the emergency room, and a girlfriend who spoke better Japanese than I did did the cold consult with me because I just was in too much pain and didn't actually have the language skills. And so, yeah, it's, I've gone off on a massive tangent there. But it's it's really stressful because you start to you don't wanna go on holidays because you think, what if I get an ATI in Greece? You know? It can affect work. If you're at a workplace and you're constantly up and down to the bathroom, where you have to take a lot of time off because it's debilitating.

Speaker A [00:30:04]:

It's not,

Speaker C [00:30:06]:

yeah,

Speaker A [00:30:06]:

if you're happy to pay every hour, you can't work like that. So it definitely can feed into anxiety, depression, and and it can affect other systems as well. You can, as you were saying, go to the kidney and yeah. Yeah. Multifaceted.

Speaker C [00:30:23]:

Yeah. Such a bummer. I remember just being, like, terrified to even go camping, let alone go overseas. And I'd always have a thrush tablet, you know, tucked away in my first aid kit just in case I got caught out because I did get caught out in places where I couldn't access a pharmacy. And it was just like, oh my god.

Speaker A [00:30:39]:

And it always strikes at, like, midnight on a Sunday or a Saturday or a Sunday. You know? It's never 4 o'clock in the afternoon on a Tuesday. It's always the worst possible time. So yeah. So you're absolutely right.

Speaker C [00:30:52]:

So I didn't realize there were UTI vaccines, but in my little cursory Internet check before I jumped on this call, I was like, oh, there's like a bunch of these UTI vaccines. I have no I mean, I'm, like, just naturally quite suspicious. But what are your thoughts on UTI

Speaker A [00:31:11]:

vaccines? So I mean, I'm open to everything because it is a really complicated, issue, and there are again, we've we've had a beautiful meandering conversation, so I will just pull us back to what can you do about a UTI? So there is antibiotics that you can use. There are long term antibiotics that you can use. So if you've gone and had 3, 4, 5, 6, a year's worth of antibiotics and nothing's happening, what they will then put you on is a long term course or a prophylact or antibiotics is a prophylactic. So some women, every time they have sex, because that's their main trigger, they they will take an antibiotic afterwards in order to prevent a UTI, and they will do that for the rest of their life. It's usually a bactrim. I know. And for me, I am open to anything that helps the individual because, as we were just talking about, it's a living hell. So I'm not gonna rule anything out for someone, but if someone came to me and said, oh, yes.

Speaker C [00:32:07]:

A living hell because it would wreck their gut, like, wouldn't that just create other problems?

Speaker A [00:32:11]:

So it depends on the antibiotic. Yes is the short answer to that question. But, actually, some of the antibiotics that we use for UTIs don't actually impact the colonic bacteria that much because they concentrate in the bladder. That's why they're specific for UTIs because they concentrate in the bladder. That's where they have their main mechanism of action. So macrodantin's a common 1. It doesn't really have a detrimental impact on the colonic bacteria. But do you wanna be taking antibiotics every time you have sex? Probably not.

Speaker A [00:32:37]:

Like, no 1 wants to be on a long term medication. So those people for whom sex is their primary trigger and they're taking antibiotics after sex, I would say I think we need to be educating, primary care practitioners a little more about the role of the microbiome. I think it's starting, but because I believe that a significant proportion of those people, those women, are going to be better off if they have a look at the microbiome and the role that it's playing. So, many of them probably could wean off that antibiotic or maybe don't have to take it every single time if they had some other interventions. So you can then you can have long term antibiotics, but some people will take a low lower dose. I think it starts at a normal dose, and then they titrate down, over time, and you can do that for I think it's a year is the a year is the, current time frame, and that has certainly worked for a lot of women as well because they're actually eradicating that bacteria. Because what happens is every time you take antibiotics, this is how antibiotic resistance works, is the bacteria are not these dumb things that just float around by themselves. And, again, we talked about this in that episode that's couple years old, but it's still a cracker, so go back and listen to it.

Speaker A [00:33:57]:

But they actually they actually hang out in colonies in groups, and they're aware when they're under attack. And they will I used this example in the last podcast, like, in Vikings, when they go, shield, woah, and they all cluster together and put their shields up, and the arrow bounced off them. That's what microbes do. They get together in a group and they secrete a biofilm, which is kinda like sludgy material that protects them from antibiotic attack. And then they can just hang out there for the whole 10 days of your course of antibiotics, and then you go off antibiotics. And then they sense that the threat has gone, and they will start to mobilize maybe because, there's trauma to the area or, you know, your immune system is run down, as we were talking before. And so they will mobilize back out into circulation, bringing with them their symptoms, and then you hit them with antibiotics again, and they are already a little bit resistant to that antibiotic because they saw it last time. And over over time, they become less and less resistant to it.

Speaker A [00:34:57]:

They just hang out, and that's you know, we have these biofilms that form in the bladder, in the vagina, And breaking down that biofilm actually forms a part of treatment. So antibiotics, that's basically short term, prophylactically or long term antibiotics. What was the question again?

Speaker C [00:35:17]:

What are some other treatment treatment plans, I suppose? And, yeah, I'd love to know how the breakdown biofilms because those counts are the worst. Like, that was I did a lot of research into that when I was trying to kick the thrush stuff, and I was like, oh my god. Yeah.

Speaker A [00:35:30]:

N acetylcysteine is my favorite biofilm buster, but there are other ones. But NAC, the supplement, is very good at breaking down biofilms. So, so, yes, so then we need to figure out if if antibiotics hasn't

Speaker C [00:35:38]:

worked or someone doesn't want to be on long term or

Speaker A [00:35:45]:

prophylactic antibiotics or they would like to be able to stop antibiotics at some point in the future, we need to then look at the person and say, okay. What is why are you dealing with these recurrent UTIs? What is driving it for you? Maybe we look at figuring out, if there's any dysbiosis in the vaginal microbiome, and that will be pretty evident because they might have had an STD in the past or they sorry, it's an STI now, isn't it? They might have an STI in the past. They may have had recurrent UTIs, sorry, recurrent thrush or bacterial vaginosis that suggests that there's already some dysbiosis in the vaginal environment. So then you can work on stabilizing that environment, and that's done again through stress management, diet, herbs, and probiotics play a really important role, there as well. So in the vagina, there's sort of 4 or 5 main microbes that you want and then lower levels of lots of other ones. So you want to make sure that you're supporting the the 4 I think it's 4 or 5. The 4 or 5 main ones, they're there. They kinda, like, act like crowd control.

Speaker A [00:36:49]:

They're the bouncers. They make sure that not not too many rowdy people come in. Like, no 1 with singlets and flip flops are allowed in. And so you want to support the growth of those guys and make the environment inhospitable to the gatecrasher types that are coming in and causing problems. And you do that by adjusting the pH of the vagina. The vagina is meant to be quite acidic. So if you've got an alkaline shift in the vagina, then you can address that. You can correct that, and that can help stabilize that environment.

Speaker A [00:37:23]:

So looking at the role of the vaginal microbiome. And then just general health, sleep, stress management, exercise, Gut health. Those ones. Yep. They're the main ones.

Speaker C [00:37:36]:

So what the times that I did get the last time I had a UTI, I think it was, yeah, only the second 1 I've ever had. I really didn't wanna take antibiotics because I'd had so many gut issues, and I'd spent years trying to get my microbiome right. And I was like, oh my god. I'm not just gonna wipe out all my good work, you know, because of this UTI. There's gotta be a way that I can head it off before it really takes root. Little did I know, and it already obviously taken root, and that's when I started experiencing symptoms. And I was really shocked by the speed with which it just got really out of control. And I remember, being like, no.

Speaker C [00:38:20]:

No. I don't wanna I'm just gonna, like, take, you know, like I

Speaker A [00:38:24]:

don't know. I think

Speaker C [00:38:25]:

my housemate at the time had some urinal or some, I don't know, cranberry powder or but I was sort of just, like, trying to do all these natural things, and it moved to my kidney. I just got woken up at, like, 3 AM, like, the second day that I had symptoms. And I was getting these stabbing pains in my kidney. And I was like, oh my god. Because people had said, oh, you gotta look out because once it gets there, it's gonna really create a lot of damage, and it's really bad and you have to go to hospital. And so I, yeah, like, immediately went to the doctor and took the antibiotics. Is there something, you know, is there something we can do that isn't antibiotics, when we start noticing symptoms, or is it more like a preventative thing when it comes to the natural pathways?

Speaker A [00:39:10]:

Yes and no is the answer to that question. So, yes, theoretically, there is. If it's being driven I think you were gonna talk about d Mannose, so now's a good time. If it's being driven by e coli, then d Mannose is a supplement. It's a sugar, and it has the ability to bind, to the mann receptor on the e coli bacteria. So receptors are like little locks that keys go into to, you know, communicate with the cell, and d Mannose can lock onto that mann receptor and bind up the e coli. And then it concentrates in the bladder, and you pee it out. So the d Mannose runs around, basically gives big, big, big hugs to the e coli, and then pulls it out of the body via the bladder.

Speaker A [00:39:55]:

So theoretically, if you take d Mannose in high enough doses early enough in the, half of the infection, you can actually treat a UTI with d Mannose. So I think it's far better as a preventative, of course, because an ounce of prevention is worth a pound of cure, as they say. There are some herbs, like uva earthy is a common 1. We have some Chinese medicine herbal formulas that that we use, and I've used 1 of those successfully with my daughter. She she had 1 was after I had all the dramas with 1, and she got 1. And I remember it's quite funny when you are a practitioner and you have a child, you always panic. You're like, I I know what I'm supposed to do, but it's my child and blah. I just took her straight to the doctor, and, of course, they gave her an antibiotic.

Speaker A [00:40:46]:

And she did a week's worth of antibiotics, and then it came back. And it was in the middle of lockdown during Melbourne, And by that time, I was like, get a grip of yourself, Joanna. You know how to you know what you you know how to deal with this. So I put her on d Mannos and a herbal formula, the China made uroclia blend, and I put her on that for 10 days and she was fine. She's never had a problem since. So, yes, it's possible. However, massive caveat, as you know, very quickly can ascend to the kidneys. So, you don't want to muck around.

Speaker A [00:41:17]:

And I often say to people, go to the doctor, do a dipstick test, although we're sort of starting to see that maybe they're not as accurate as they could be. They're quite often contaminant. Like, maybe 50% of the time, they're inaccurate, but it's, you know, it's it's another tool that we use within the toolkit. But go to the doctor that will probably give you a script for antibiotics, and then you at least have that script, and you can go to a 24 hour chemist at any point, and fill that script. So but as you know, it it can it can turn pretty quickly, and it can be serious. So it's always best to involve a doctor as well as a holistic practitioner as well. And I would say in acute situations, I still support going to the doctor and at least having the option of antibiotics on hand.

Speaker C [00:42:02]:

Yep. Yeah. Yeah. Yeah. Nice to have in case of emergencies. So with the d Manus, I I kind of, saw a such a randomized clinical trial recently that, found that it didn't have any kind of positive correlate. Like, it didn't actually help. And they were like, oh, what the hell? Because so many women do report it being really helpful for them.

Speaker C [00:42:28]:

Is that because it depends what the cause of their particular recurrent UTIs are. Like, maybe in the trial, there was, like, you know, some that was due to e coli and some that was due to other things. And so there wasn't any kind of significant, you know, improvement with the d Mannos in that trial. But then in, like, real life, some people will have a lot of success with it and some people won't because of the cause of their specific, UTI. Would that be fair?

Speaker A [00:42:59]:

Yeah. I think we have to I I think we have to stop putting double blind, placebo controlled, randomized trials on a fucking pedestal. You know? Like, they we have to listen to people's lived experience. That I'm always going to listen to the person in front of me. I don't care what science says. I I think it's important to know the science. I don't think we should discredit the fact that trials are important. Testing is important, particularly for drugs and stuff.

Speaker A [00:43:22]:

But at the end of the day, we have to listen to the person in front of us. And so it could be a number of things that went wrong with that trial. Definitely, if the UTI was being driven by anything other than e coli, it wouldn't have been successful. Maybe they weren't using it in quantities that are large enough. So if they're only taking, like, 500 milligrams a day, for example, it might not have been enough. And I as I said before, I think it's better as a prevention, and nothing works in isolation, really. You know? You need to change other things. So a lot of the time when someone starts taking d Mannos, they might also throw in a probiotic because they read that probiotics are good, and maybe they cut sugar out of their diet as well.

Speaker A [00:44:01]:

And so it's the it's that cumulative impact of making several positive changes as well as that has the effect. Whereas in a clinical trial, you are removing those variables. You don't want anything that's confounding the results. So, I think is tool that forms part of a management strategy, but a 100% it is very effective when used for e coli driven issues in conjunction with other interventions Cool. In my clinical experience.

Speaker C [00:44:34]:

Yeah. Love it. Love it. Yeah. I really like what you said about, yeah, not pedestalizing those sorts of trials over the lived human experience and that anecdotal you know, it's so infuriating how dismissive, you know, Western medicine and so many people are around anecdotal evidence that's kinda like straight from the horse's mouth. You know? So, yeah, I like that you mentioned that. Speaking of studies, 1 just popped into my head I saw around, wiping direction, which I thought was a really funny thing that they've, like, studied. And, you know, it's just the 1 study, so you can never really take it as gospel.

Speaker C [00:45:13]:

But they, yeah, they found that the front to back versus back to front didn't have any significant impact on lifetime UTI events, but the age bracket 40 to 59, there was. There was the wiping front to back did significantly, sorry, wiping back to front significantly increased UTI. So I was like, oh, that's weird. Like, I wonder why that age bracket is it because they're more susceptible or the UTIs they're getting are more due to the the transfer of bacteria, yeah, from the anus to the vagina and then up into the yeah. I don't know. Do you have any thoughts on that?

Speaker A [00:45:53]:

I would say just, you know, theorizing that, yeah, it's because you get a change to the vaginal microbiome at that stage of life, and you also get a change to the gut microbiome. So a lot of perimenopausal women, suffer gut issues once they get into their forties. Suddenly, they're tolerant to foods that they've been eating their entire life. And I was actually was actually really reading a very funny thread today on in 1 of the perimenopause support groups that I'm a member of, on Facebook because I cruise around and answer questions. And, and 1 of them was like, why am I farting so much? What is it, the farting? All these women are like, oh my god. My husband thinks it's hilarious. I'm so embarrassed, but I just fart all the time. And it's because you get a change to the gut microbiome as well.

Speaker A [00:46:40]:

Food intolerances, more likely because at that stage of life, your immune system is going through a restructure. You're it's a it's second puberty, and go back and listen to that episode that we did if you haven't. So you can get functional dyspepsia, which is basically just any time you eat. You get full. You get a bit kinda nauseous, bloated, gassy. You only eat a small amount, and suddenly you feel really distended. So it would make sense that the changing microbial landscapes within both the gut and vaginal microbiomes in that age group would lead to an increase in urinary symptoms with back to front wiping.

Speaker C [00:47:20]:

Nice. Nice. Makes so much sense. Cool. So let's talk about differential diagnosis, and the importance of this because we've sort of touched on, like, hey. There's a it's not as simple, you know, as 1 might think. There's actually multiple different types of, well, different causes that might be driving, you know, each individual's UTI experience. Let's chat about, like, what differential diagnosis looks like and why that is so important and how you might be able to go about finding a practitioner who will do a good job of that.

Speaker B [00:47:54]:

Excuse this quick interruption. I'm shamelessly seeking reviews and 5 star ratings for the potty because as I'm sure you've noticed by now, it's pretty fab, and the more people who get to hear it, the more people I can help with it. Reviews and ratings actually do make a big difference to this little independent podcaster, and it's really easy to just quickly show your support by taking that simple act of either leaving 5 stars for the show on Spotify or even better, writing a written review and leaving 5 stars over on Apple Podcasts.

Speaker C [00:48:29]:

Or if

Speaker B [00:48:29]:

you're a real overachiever, you can do them both. That would be mad. If you're writing a review though, just be sure to use g rated words because despite the fact that this is a podcast about sexuality, words like sex can be censored and your review won't make it through the gates. Lame. Anyway, I would Yeah

Speaker A [00:48:58]:

Yeah. So I'll say 1 more thing about drivers of UTIs that I that's just popped into my head, which is sometimes we need to treat the partner as well because the penis has its own microbiome. And what you can actually find is that there's an incompatibility between what usually happens is you meet someone, you start having, a sexual relationship with them, if it's, you know, long term and unprotected sex over time, then those 2 microbial environments, the penile environment and vaginal environment, will homogenize. So they'll get used to each other. You'll share microbes, and you start you fall into bouts with each other. But sometimes that doesn't happen. And so it may be that the microbiomes don't quite mesh, or it may be that the penile microbiome is harboring a microbe that is disrupting the vaginal microbiome, and we need to treat that specific microbe for that individual. And sometimes it can also be something in the semen.

Speaker A [00:49:52]:

There can be a bacterial, because this that we have a seminal microbiome. So so you're talking about microbiome palooza. So that's the that's another thing that can potentially be driving it. And then in terms of just death, is it actually a recurrent UTI is a really good question. Or what maybe it was a recurrent UTI, but now you're getting urinary symptoms that are not a full blown in state of UTI, active UTI. And that's anything from interstitial cystitis, which is kind of, I'm being a bit harsh, but it's sort of what they diagnose people with when they don't have an actual diagnosis. It's an umbrella term for a collection of symptoms. I'm not saying it doesn't exist, but it's not it's not really a 1 thing.

Speaker A [00:50:38]:

It basically means that this person suffers irritation. Yeah. So it could be interstitial cystitis, and that could be driven from tissue inflammation. It could be driven from, you know, oxalate crystals causing inflammation. It could be a nerve condition. So the nerves of the bladder are not communicating properly with the brain and you're constantly feeling irritated and like you need to pee. So we need to dig into whenever anyone says they have interstitial cystitis, I like to dig into why that might be for that individual. There's the oxalate issue, which was my personal case, where I was eating a lot of foods that are actually healthy, but they contain a large quantity of something called oxalic acid, and oxalic acid binds to, calcium in the body and causes a crystalline structure that, under a microscope, looks like shards of crushed fiberglass.

Speaker A [00:51:35]:

So if you are not we can't metabolize these. We don't break them down. We just excrete them. We do have there is Oxalobacter, which is a microbe in the gut, which I think can work on breaking them down a little bit, but mainly, it's an excretion pathway. And if you're not excreting them well because, genetically, you're not good at it or if, like me, you were just overeating healthy food, things like spinach, peanut butter, almonds, black beans, sweet potato, white potato. These are all pretty common foods that we consider to be pretty healthy. Figs, I lived in when I had that that the 7 year commencement of the UCIs. There was a fig tree in my backyard in the house that I was living in, and I used to stuff myself with figs because I love them.

Speaker A [00:52:23]:

But they're incredibly high oxalate. So I would, yeah, like, overconsuming all of these foods, and we don't eat seasonally, really, anymore. So spinach, you can usually only get for a couple of months a year. And then you would have winter where you didn't have access to these kind of high oxalate greens, and your body has chance to detox them. But now you go to the supermarket, spinach is there 12 months of the year. And because people oh, spinach is healthy. You've got people I mean, it happened to Thor. What's his name? The hot Aussie guy.

Speaker A [00:52:56]:

Hemsworth. Chris Hemsworth? Chris Hemsworth. Yeah. He got a kidney stone because he was having smoothies in the morning, and he was putting, like, 5 handfuls of spinach with almond milk because almonds is that is healthy, you know, and peanut butter. And and so he wound up actually in hospital with a kidney stone.

Speaker C [00:53:12]:

So it

Speaker A [00:53:13]:

you can have too much of a good thing. And so if you have a problem with oxalate crystals, they can lodge in the bladder, and they can cause irritation and issues at constant, you know, feeling like you've got fiberglass in your bladder lining. But they also could create a structure that e coli bacteria hang out in. So they create, like, a reservoir for e coli. Yeah. And so, exactly, so that's why you can be having this constant low level irritation, and you think, oh gosh. If I go to UTI, you go to do a dipstick, you give a urine sample, and there is high concentration of e coli because the e coli has been making a home in the reservoir of oxalate crystals in the bladder. And so if oxalates are playing a role, then you just remove them from the diet, but you have to do it slowly.

Speaker A [00:54:04]:

I Even though even though I knew through my research that you have to step down slowly. Because what happens is the body starts stashing it in the tissues. It knows it's a toxin. It knows it's not good, so it just shoves it anywhere it can. And when your blood level of oxalate drops to a certain point, the body goes, oh, thank god I can get rid of all this shit that I've been stashing, and it dumps it out into the bloodstream. You can actually die if you have yeah. A 100%. Yeah.

Speaker A [00:54:38]:

It's it's great. Toxic Superfoods is the book to read by Sally k Norton if anybody's interested in this topic or sees themselves kind of in the picture. And so you have to calculate how much oxalate you are consuming, and then you have to titrate down. And I didn't wanna do the math because it's not like math. So I just kind of ballparked what I what I must have been eating, and I was like, oh, just cut out all this, but I'll keep in dark chocolate. That's another 1. Tea, English breakfast tea, really high oxalate. So, like, I'll just keep in tea and chocolate, but I obviously was eating more oxalate than I realized, and it started to come out through my skin.

Speaker A [00:55:18]:

And I got what looks to be a breakout initially, and that's the picture that's on Instagram. I thought I'd broken out in hives, but, it got so bad, I had to use, like, cortisone cream on my face. It was because the crystals forcing their way out of my face. Yeah. It was, yeah, it was full on. It was intense. So oxalates can be another driver. And then and then

Speaker C [00:55:42]:

that detox process take? Like, you you're at the other side, obviously, now. I'm about a

Speaker A [00:55:48]:

year on from it now, and This would depend on the person and how much they do. Yeah. There so there's a trying low oxalates, TL0, is a support group on Facebook, and I became a member of that group, when I sort of thought this was an issue for me. And there are some people who've been detoxing from Oxlots for 10 years, and they're still getting flares. And yeah.

Speaker C [00:56:14]:

So some people must be more sensitive to them. Right? Because I don't know. I feel like I've, like, IIA fair bit of stuff, and I've never had an issue with this. So is it just is it something everyone needs to be really careful of, or it's gonna affect some people more than others?

Speaker A [00:56:29]:

This is such a great question. I'd love to come back for a 5th time and talk about and talk about how to choose the right diet. You know? Because there's so much so much stuff online. And without going off down the rabbit hole because I am conscious of time on this slide, I promised myself I'd try and stay focused. When I discovered I couldn't eat and it's it comes from oxalate crystals are in oh, sorry. Oxalic acid is in plant food. It's not in meat and animal products. So when I found out that I couldn't eat these plant products anymore, I was like, well, I'm gonna give carnivore a go because look at all these carnival people.

Speaker A [00:57:01]:

They're all ripped. They've got great skin, you know, and and and I believe that the argument is there when you look into the literature that it's a species appropriate diet for us. So I did it for a year, and it has not agreed with me. And there'll be people who'd be like, oh, you haven't done it properly. You meant to test your ketones or whatever, but I just think we cannot be dogmatic about diet. Just because you have a problem with something doesn't mean someone else will have a problem with it. Just because something helped you doesn't mean it will help another person. So absolutely.

Speaker A [00:57:28]:

I think we should all know what oxalates are. I think we should all know what foods they are in, and I think we should all be a little just careful moderate in how we consume those foods. The easiest way, because it's in plant foods, is eat seasonally. I think if we were all eating what was available seasonally, we wouldn't have the issues. But you are a 100% right that some people are more sensitive to them. I have a couple of people in clinic who I was working with who are hardcore vegans for, like, 10 years, so they have super high levels of oxalate in the body just because of the types of food that they were eating. But if you've been an omnivore your whole life, then it's likely that you have consumed less of them. So, yeah, it's a little bit very

Speaker C [00:58:09]:

And the only times I got UTIs the 122 times I got UTIs were when I was a vegan. So, you know, just to know what the

Speaker A [00:58:18]:

anecdotal evidence is. That's really super interesting. And so maybe you did have some level of I mean, I'm just totally

Speaker C [00:58:24]:

apprehensive, but you might have

Speaker A [00:58:25]:

a little reservoir in the bladder, and that was causing a little bit of irritation. And then but if it went away with antibiotics, and that's the thing. Like, I believe it was probably was it when you had the vaginal dysbiosis stuff going on?

Speaker C [00:58:40]:

Probably. Yeah.

Speaker A [00:58:41]:

Yeah. So it's probably more likely linked to that because if the antibiotics did work, then, yeah, it was probably more of a mark. But who knows? It's com it

Speaker C [00:58:50]:

that's what

Speaker A [00:58:50]:

I'm saying. It's a complicated area. And that's why if someone has been helped by a year of antibiotics, then I just say, ring that bell. More power to you. You know, we have to be open to what works because depending on the microbe that's causing it, the individual, if it's microbially driven, you're gonna have varying levels of success with natural interventions. Antibiotics may be the best course of action for that individual. But working up an appropriate diagnosis, I think that's key. And so just to kinda close out what we were talking about in terms of differential diagnosis, endometriosis, can actually have right before the period, you can get a flare of bladder symptoms, particularly if you've got what they call bladder endos and the bladder's involved with the lesions.

Speaker A [00:59:31]:

That can be a tricky 1 because the only way you can diagnose endos on is on laparoscopic surgery. You have to go in and look. There is currently no test for endometriosis. I think they're working on a salivary test, and that will be revolution if they can because the current time frame to diagnosis for endo is between 7 to 10 years, I think. And a lot of people kinda trash talk doctors around that, and they're like, this is not good enough. You know, we need better outcomes for women, and we 100% do. I agree with that. But, and any doctor that says, you know, if a woman comes in with painful periods and painful sex that says, just have a glass of wine and lighten up, and do you have any problems in your relationship, I mean, that's that's unacceptable.

Speaker A [01:00:13]:

Right? But but if you suspect endometriosis, the only way to confirm that diagnosis is the laparoscopic surgery. And then you need to make sure that you get a surgeon that knows what they're doing because endolegions can look different. You can have flat white lesions. You can have quite red angry looking lesions. They do present differently. So you need an advanced trained surgeon who knows what they're looking for because it can be subtle.

Speaker C [01:00:37]:

Yeah. Yeah. Okay. Amazing. So are there any other kind of, different causes for UTIs that the differential diagnosis would be looking to try to discover?

Speaker A [01:00:50]:

I think they were the main ones I just went through, wasn't it? So I said oxalates, endo what was the other 1? Because you've asked me directly, and I blanked out.

Speaker C [01:01:03]:

Well, that's kind of

Speaker A [01:01:04]:

no. Interstitial cystitis. Yeah. I think they're the main ones. There may be some that I've missed because my brain's getting weary now after an hour of talking, but the I guess the major takeaway is that it is it actually a UCI? Yeah. Okay.

Speaker C [01:01:23]:

And so how would you suggest getting that diagnosis, like, when a lot of maybe doctors aren't super across this, like, going to someone like you or more more specialist vibes?

Speaker A [01:01:38]:

Yeah. I definitely think that it's necessary to find someone who specializes in this area. And now that may be a gynecologist who specializes in the area. Even so, they may if it's being driven by a microbe like, BV, gardenrella, for example, they will prescribe metronidazole, which is an antibiotic, and then that's what they what they failed to do, and I believe that we covered this in that UT vaginal microbiome episode. But what they failed to do post antibiotic treatment is rebuild the environment. So it's like if you have people robbing a bank, bank robbers, and they've got hostages inside the bank, there are different ways that you can deal with that situation. You can send in a SWAT team and a hostage negotiator. You can try and negotiate with the with the bank robbers.

Speaker A [01:02:30]:

You can try and get hostages. Okay. Give us the children and the women. Get them out for you. There's ways that you can diffuse that situation delicately. Or you could drop a bomb on the bank. Right? Solves the problems. No more bank robbers.

Speaker A [01:02:42]:

But you've annihilated the bank, and you've killed all the bystanders. That is what happens when you use antibiotics. You bomb the bank, And then you just kind of hope that it rebuilds itself in a balanced and healthful state. And we don't really have any reason to believe that it's going to magically do that because it was it was disordered when we started. So what we need to do after using antibiotics is then go on a restoration protocol and say, okay. How do we encourage this environment that we just wiped out because we had to get rid of some bad guys? How do we rebuild this this neighborhood and encourage the right kind of, people that we wanna come and live in at microbes, that we wanna come and live in at. We want good neighbors. And in the gut, you know, you want diversity.

Speaker A [01:03:27]:

You want, like, we need, like, a Jewish family, and we need, you know, like, the Asian family to come and have the takeaway shop. You want lots of multiculturalism, lots of diversity in the gut. In the vagina, it's a little bit more closed community. It's a little bit of a we,

Speaker C [01:03:41]:

what are they gated? Community.

Speaker A [01:03:43]:

Gated community. Yeah. It's a little bit more of a gated community. It's a fraction of me into here in in Mexico, because you need a lower level of diversity in that vaginal micro microbiome. But you need to help it restructure in a helpful way, and that's the missing link. So if they even if you do go to a gynaecologist or someone that is very medically driven, ask them if they can help you with a restoration protocol. And that should involve some form of probiotic, prebiotic therapy, and some strategies and tactics for lifestyle modification while that environment is rebuilding. So, for example, we don't wanna be having unprotected sex because semen is incredibly alkaline, and we want the environment of the vagina to be acidic while it's rebuilding.

Speaker A [01:04:28]:

So you might need to use condoms for a while. The oral microbiome can be quite challenging to the vaginal microbiome. So maybe abstaining from oral sex while it's rebuilding. So, yeah, there are it is a niche area, and there are people from all different kind of backgrounds, nutritionists, dietitians, you know, naturopathy and Chinese medicine. So they they're sort of the areas that you might wanna look in if you're looking for someone to help you out.

Speaker C [01:04:53]:

Beautiful. Yeah. And those are really practical tips, I think, as well around, like, you know, the the probiotics and the the lifestyle factors, the dietary factors. You know, not getting giz inside you, being a little bit more sparing with the oral. Because, like, when I it wasn't with UTIs, but when I was struggling with the thrush and the vaginal dysbiosis, definitely receiving oral or having sex with, you know, unprotected sex or sex with a new person, like, just a different person's bacteria, it always used to send me off the deep end. So I just had to get really become a very good gatekeeper for my. And just be super careful about what was what was coming into contact with it because it was just literally so the balance was so delicate and so easily tipped off balance. So, yeah, that's

Speaker A [01:05:47]:

How long did it take you to stabilize? I know everybody's different, but I'm just really curious about how long it took you to

Speaker C [01:05:54]:

well, it's I can't even really remember now, and it's tricky to know when, like, the sort of healing properly started because there would be periods of time where I thought I was on top of it for a while and then it would kinda come back. But, I was sort of really intensively working on it for at least 2 or 3 years.

Speaker A [01:06:14]:

Yeah. You know,

Speaker C [01:06:15]:

with all different gut protocols and cut out sugar and fruit and alcohol and mushrooms and all the things for, like, a year. And I was on super super restrictive diets at different points and going to natural parts and nutritionists and doing all the things. And it's funny because nothing really ever seemed to help. And then just when I stopped being a vegan and I stopped basically being orthorexic because I've become obsessed with health and biohacking and trying to do all the right things, and now everything was bad for me. When I just go I was like, fuck it. None of this is making me healthier. I'm feeling sicker and sicker. Everything started to just kinda balance out again.

Speaker C [01:06:51]:

And I don't know if it was, you know, it could have been the vegan thing. It could have been the stress. It could have just been, you know, my relationship with food becoming so, tenuous because of worrying about gut health and stuff. But, yeah, when I sort of stopped caring and I was like, fuck it. Whatever. Also, you know, I was, I think definitely being impacted by toxic mold. So when I moved house and then, you know, started detoxing that so there was so many things, and I still couldn't tell you which ones were the most kind of crucial to my healing because I was doing a lot all at once and making a lot of changes. So, yeah, I'm not really sure what was responsible for

Speaker A [01:07:33]:

the I think you're also an onion. We have a couple of onions together because it would have been multilayered and, you know, molds definitely is a massive immune system trigger. And I'm gonna go on record here and say that I I don't think most people do well on a vegan diet long term. I really don't. I think that it can be done, but the majority of people do better with animal products in their diet. So it might have had something to do with that, but it definitely sounds like it was probably probably a multilayered thing.

Speaker C [01:08:05]:

Yeah. Yeah. Totally.

Speaker A [01:08:06]:

But I guess the option of that like, the take the key takeaway of that is healing takes time. And so if, anyone listening to this is dealing with, any kind of chronic or long term condition, understands that it can and will get better. People have healed from similar things and the same thing that you're going through, but you may need to be patient.

Speaker C [01:08:27]:

And, you know, a kind of little bit more of a woo woo side note, I was, you know, trying to do the whole open relationship poly thing throughout that period of time, and I was sleeping with multiple different people over periods of time. So when I stopped doing that and then ended up in a long term relationship, that's that also kind of coincided with me not having the recurrent thrush issues as well. So I think, you know, on an energetic and spiritual and emotional level, that lifestyle was I was really struggling with that. And then also just the sheer amount of new and different bacteria I was letting into my vagina, you know, would've would've been throwing me off. So Yeah. Probably

Speaker A [01:09:06]:

not the faint of heart. Yeah.

Speaker C [01:09:08]:

Oh, totally. Totally. Yeah. And, I mean, having a ho phase is fun, but I don't think it's great for the old vagina. That's for sure.

Speaker A [01:09:16]:

No. I would have to agree with that. And I'm very libertarian. Like, I believe live and live live. Let people do what makes them happy as long as they're not hurting or harming another individual. But I would definitely say that I think, physiologically, we are more designed to be monogamous than polyamorous. But I think too, something you said, which is how I'll close out my portion of today is I don't know if people know the story of Buddha. Like, he was a prince and he lived in all of this opulent, luxurious life, and he wasn't happy or satisfied.

Speaker A [01:09:47]:

So he left the palace and went searching for enlightenment, and he decided that he'd been, you know, living a far too opulent lifestyle and that the answer must lie in poverty and simplicity. And so he starved himself down until he was emaciated, and he wore rags. And then he decided, shit. This isn't any better. And so he sat under the tree, and had his moment of enlightenment because he realized that it's the middle path. The middle way is the way to enlightenment. And if you put yin and yang as well, Chinese medicine, it's never about being super duper yang or super duper yin. It's about the balance and interplay between those 2 opposing forces.

Speaker A [01:10:27]:

And generally speaking for health anywhere in life, you know, and I'm prone to it too because I'm a big nerd, and so I get excited about concepts, like going carnival, for example. And it it just reminds me nicely, this discussion, that the middle path for every in your thought, in your speech, in the way you show up in the world, in your actions, everything, that we need to strike for that balance between between these streams.

Speaker C [01:10:53]:

Yep. Word. Totally agree with that. Do you have a TMI story you wanna leave us on that? We're not gonna even gonna bother doing get pregnant and die. We've done so many episodes together now. But do

Speaker B [01:11:04]:

you have a fresh TMI?

Speaker A [01:11:05]:

TMI, but we love it. Check TMI, but we love it. What? I forgot about your special, TMI.

Speaker C [01:11:15]:

I totally forgot about them as well.

Speaker A [01:11:17]:

Oh, man. Now I feel bad because, actually, nothing is jumping out. Although, I I suppose I can share 1 that would be relevant to, listeners, which is about just about I had because this carnivore diet has, like, thrown off my hormones. My hormones are whack at the moment, And I've had some anovulatory cycles, which I haven't had for many, many, many years now, which is basically if you don't ovulate during the month, your lighting just continues to build until such time as your body's like, well, might as well get rid of it. And then you'll get, air quotes, your period, but it's not your period. You only get a period if you have ovulated. That kind of blade is what they call an anovulatory anovulatory blade and anovulatory cycle. And it's generally a lot heavier than an ovulatory cycle because progesterone, which you only get if you ovulate, helps to lighten the period.

Speaker A [01:12:18]:

It stops that it opposes estrogen, and estrogen builds the lining. So if you have no progesterone, estrogen's just there happily making uterine lining. And so for, like, for the first time since I was a teenager, I bled through period products at the freaking supermarket, and I said to I was with my husband, and I was like, we have to go. And I was like, I've just bled through a turban. And I had to do, like, that little wobbly shuffle thing.

Speaker C [01:12:47]:

Yeah. Oh my god.

Speaker A [01:12:49]:

Yeah. So, fortunately, we only live 5 minutes away from the shops, and so now I'm tracking my cycle. And if I haven't ovulated, yeah, I when I get my period, I make sure that I double double protect on the way out of the house. Tampon and pad, I'm acting acting like a 15 year old. I remember me totally.

Speaker C [01:13:09]:

Oh my god bless. Yeah. I remember those days. Yeah. My period was so heavy when I was a teenager compared to now. Is that because when we first start, getting a bleed, often they are anovulatory cycles when we're first, you know, kissing at

Speaker A [01:13:26]:

me and but also, yeah, body's learning the steps of a dance. So if you think about when you're learning people who play musical instruments, you know, when you're learning something, it's kinda clunky at first. It doesn't flow smoothly. You need to your body needs a moment to figure out what it's doing. It's a complicated cascade of hormonal production that involves multiple systems in the body, you know, the brain, the gonads, thyroid, all these different things are involved. And so it's, yeah, it's learning learning the steps of a dance. And that's similarly why perimenopause, suddenly things go wacky, because the body's learning a new dance, a new way of being. And so it is the second puberty.

Speaker A [01:14:01]:

You get all very similar symptoms to the ones that you might have experienced in puberty. And, again, you know, just because everybody's different. Some people have an easy puberty, but a shitty perimenopause and vice versa, so there's different flavors of it. But, yes, a lot of the time with young girls, it's just the body figuring out which quantities of hormone to produce at which time.

Speaker C [01:14:19]:

Yeah. Gotcha.

Speaker B [01:14:21]:

Hey, Megan. If you'd like to support the potty and you've already given it 5 stars on whatever platform you're listening on, I wanna mention that you can buy some really dope merch from the website and get yourself a labia lounge tote, tea, togs. Yep. You heard that right. I even have labia lounge bathers or a cute fanny pack if that would blow your hair back. So, if fashion isn't your passion though, you can donate to my buy me a coffee donation page, which is actually called buy me a soy chai latte because I'll be the first to admit, I'm a bit of a Melbourne cafe tosser like that. And yes, that is my coffee order. You can do a 1 soft donation or an ongoing membership and sponsor me for as little as 3 fat ones a month.

Speaker B [01:15:06]:

And I also offer 1 on 1 coaching coaching and online courses that'll help you level up your sex life and relationship with yourself and others in a really big way. So every bit helps cause it ain't cheap to put out a sweet podcast, into the world every week out of my own pocket. So I will be undyingly grateful if you support me and my biz financially in any of these ways. And if you like, I'll even give you a mental BJ with my mind from the lounge itself. Saucy. And, I'll pop the links in the show notes. Thank you. Later.

Speaker C [01:15:39]:

Amazing. Alright, my love. Well, thank you so much for your time. I reckon we've done a pretty good job of, yeah, wrapping up the UTI topic for today. Is there anything else you feel like we haven't mentioned that's important to slip in before we close out the episode? No.

Speaker A [01:15:55]:

I tried to be cognizant of not repeating myself a lot in terms of the content that we had in that that old episode. So if anyone is more curious about a deep dive deep dive into the vagina microbiome, does that sound wrong?

Speaker C [01:16:10]:

That's a

Speaker A [01:16:12]:

visual vivid image, isn't it? If you would like to take a deep dive into the vaginal microbiome, then go back and check out that episode because we did cover stuff a lot more detail. But, yeah, I think no. I think I've I think we've done alright. Look at that. An hour and 10 minutes. I'm stopping talking now.

Speaker C [01:16:30]:

Alright. Amazing. Thanks, Joanna.

Speaker A [01:16:33]:

Bye bye.

Speaker B [01:16:35]:

And that's it, darling hearts. Thanks for stopping by the labia lounge. Your bum groove in the couch will be right where you left it, just waiting for you to sink back in for some more double l action next time. If you'd be a dear and subscribe, share this episode or leave a review on iTunes, then you can pat yourself on the snatch because that's a downright act of sex positive feminist activism. And you'd be supporting my vision to educate, empower, demystify and destigmatize with this here podcast. I'm also always open to feedback, topic ideas that you'd love to hear covered, questions or guest suggestions. So feel free to get in touch via my website or over on Insta. You can also send me and TMI stories to be shared anonymously on the pod.

Speaker B [01:17:20]:

My handle is freyagraf_thelabialounge. If my account hasn't been deleted for being too sex positive, which, you know, is always a possibility with censorship, But just in case the chronic censorship finally does obliterate my social channels, I'd highly recommend going and joining my mailing list and snagging yourself some fun freebies for the trouble at www.freyagraf.com/freebies. Anyway, later labial legends. See you next

Speaker A [01:17:52]:

time.