madman
Super Moderator
In this video, Dr. Rachel Rubin, a board-certified urologist, and sexual medicine specialist discusses the following:
● When it comes to various types of tissue in the body, the lining of the bladder is endoderm, the lining of the vagina is mesoderm, and the lining of the uterus is endometrium.
● The trigonitis is the bottom quadrant of the bladder where urine flows into and out of. It is this lower area that can become inflamed or develop lesions known as cystitis cystica. UTI is just one cause of this and a lot of uncertainty still surrounds inflammation in this area.
● It’s not understood if bacteria originate in the urine, the lining of the bladder wall, or somewhere else in the vaginal microbiome.
● When we are born, there are no hormones present. During puberty, when hormones arrive the vagina acidifies, enabling it to fight infection. From this point, a baseline of hormones is required for vaginal health. If this decreases, such as in menopause, the tissue becomes thin and vulnerable.
● The reason that hormones, particularly vaginal estrogen, are important for bladder health and reducing UTIs is that it enables the vagina to remain acidic, staving off bad bacteria and promoting good.
● While vaginal hormones are not a treatment for UTI, they are a preventative measure. All females, except those with active breast cancer on an aromatase inhibitor, should be using vaginal hormones.
● Though vaginal estrogen products frequently come with caution labels, Dr. Rubin insists that these warnings are inaccurately attributed and the products are completely safe. She believes the guidelines need to be changed.
● There is a suspected relationship between progesterone and/or testosterone and bladder health but more research is required.
● Though it may sound excessive, Dr. Rubin recommends preventative vaginal estrogen for anyone over 45 years old. There are different modes of delivery: Creams—check that you’re using the correct amount as this is often applied incorrectly—tablets and rings. Vaginal estrogen can prevent UTIs, painful sex, and muted orgasms, not to mention the extreme pain that some experience due to vaginal dryness. DHEA may also help.
● Initial side effects may include thrush or breast tenderness and it may take up to two months before patients see benefits. If the side effects don’t pass by then it may be advisable to add an androgen or work with a pelvic floor physiotherapist.
● In terms of estrogen levels in the blood, it is measured in picograms per milliliter. Normal levels are 50-150, in pregnancy, they are about 3000. In males, it’s around 25. Menopausal people would be zero.
● Vaginal estrogen does not impact the estrogen levels in someone with endometriosis.
● When it comes to choosing from the many hormonal preventative measures available, it’s important to do so in consultation with a medical provider who will draw from and share the latest research in order for you to make an informed decision.
