Latest / Pretty In Pink Again / Episode 31: The Down There Truth: Pelvic Floor Health—What’s Normal and What’s Not with Dr. Erica Lambert ( Part 2)

Transcript

Episode 31: The Down There Truth: Pelvic Floor Health—What’s Normal and What’s Not with Dr. Erica Lambert ( Part 2) · Pretty In Pink Again

• 0:00
  I'm Christina and I'm t and this is the Pretty and Pink again podcast where motherhood meets rediscovery.
• 0:17
  Hello, we're back.
• 0:19
  Hi again.
• 0:19
  Hi.
• 0:20
  We are back.
• 0:21
  Thank you for having me back.
• 0:22
  Of course.
• 0:23
  We have a lot more to unpack here.
• 0:25
  I know we couldn't even scratch the surface.
• 0:28
  So for all of our listeners who haven't listened last week, who are just tuning in this week, we got to share our listeners a little bit about you and how we met, how we were friends, and we talked a lot about hormone replacement therapy.
• 0:39
  And the misconceptions associated with that.
• 0:42
  This week we're gonna get into the nitty gritty of pelvic floor health sexual health.
• 0:47
  Intimacy.
• 0:48
  Yeah.
• 0:49
  All the things.
• 0:50
  Yeah, all the things down there.
• 0:51
  That's what we were calling that episode.
• 0:54
  We were calling it the down there truth.
• 0:56
  Good times.
• 0:57
  So I could start by saying, by trade I'm a urologist.
• 1:01
  As a urologist and treating female patients over the years, we deal a lot with for more young people.
• 1:08
  A lot of urinary incontinence from childbirth.
• 1:11
  As we age, we treat a lot of like recurrent urinary tract infections, urgency, frequency, which is how I really got into pelvic floor health.
• 1:23
  And which is how we became patient doctor relationship.
• 1:27
  Exactly right.
• 1:28
  I have a lot of people coming to me looking for, how do I stop the incontinence?
• 1:34
  A lot of, the younger people, probably more for your audience right after childbirth is the coughing, sneezing.
• 1:42
  I just started exercising again, so excited.
• 1:45
  But I go to the gym and I pee in my pants, like, how do I stop that?
• 1:49
  And what's the cause of that?
• 1:51
  How do you stop that?
• 1:53
  Let's hear it all.
• 1:54
  Let's go back.
• 1:54
  'cause I feel like pelvic floor, again, it's a very buzzy term.
• 1:58
  I think even with the rise of some of these exercise programs, I feel like Pilates is having a big moment.
• 2:04
  Yoga, they talk a lot about pelvic floor in those exercises, and so you always hear that as you're doing those workouts prior to kids, but what is your pelvic floor and what does that mean when it's not functioning properly?
• 2:18
  So the way I like to explain the pelvic floor is almost like your muscles of your pelvic floor.
• 2:24
  It's like a hammock.
• 2:25
  Okay, so prior to childbirth and life, but mostly childbirth, your bladder and your uterus sit on top of the hammock.
• 2:36
  As the babies go through the vaginal canal, it destroys those muscles.
• 2:43
  So it's like anything, if you notice, not so much with your pelvic floor, but as the babies grow in your belly, if you've ever heard of the term like diastasis or recti, because the babies have pushed so much against these muscles.
• 2:58
  At during childbirth, that hammock that is up like this, goes like this, okay?
• 3:05
  So because of that, the urethra, which is where you pee from that becomes weaker and starts to become mobile.
• 3:14
  So then when you have pressure on that hammock, it's just easier to let out urine.
• 3:21
  So this gets worse not only with vaginal deliveries, but just the carrying of the baby can upset the pelvic floor?
• 3:28
  Or is it really just the vaginal delivery that really upsets it?
• 3:32
  It's mostly the vaginal delivery.
• 3:34
  Okay.
• 3:34
  That's the biggest trauma to the pelvic floor.
• 3:36
  But even women that.
• 3:38
  Have not had vaginal delivery.
• 3:40
  Some women will say to me, I've never had a vaginal delivery.
• 3:44
  Why is my pelvic floor weak?
• 3:46
  I think that's why with Pilates and yoga, why that's so important is that core strength.
• 3:52
  So core strength isn't just your abdominal muscles, but it's also your pelvic floor muscles.
• 3:58
  So I have a question.
• 3:59
  I'm a Pilates girl.
• 4:00
  I've heard all about the pelvic floor.
• 4:02
  I definitely had a strong pelvic floor.
• 4:06
  I've had two babies.
• 4:07
  My first was a C-section and my second was a vba.
• 4:10
  I'm one of those people that didn't notice any sort of pelvic floor issues with my first delivery.
• 4:17
  And all of my pelvic floor issues have come afterwards.
• 4:21
  Honestly, something that I like I hate, it's something that I don't think I was prepared for, especially, you're not alone.
• 4:29
  Yeah.
• 4:29
  I'm sure.
• 4:30
  And that's why we thought that this was such an important topic.
• 4:32
  Mm-hmm.
• 4:33
  And it's, again, another one of those taboo topics that you might not wanna talk about.
• 4:37
  I openly talk about it with my friends.
• 4:39
  It's just something that I can't stand, it's just a complication after childbirth that I have personally dealt with the second time around, and I did Pilates in between and had an extremely strong pelvic floor between my births and I don't know I really just felt like there was severe damage done to it the second time around.
• 4:59
  So are you wondering if Pilates can help with your pelvic Yeah, or are there exercises Yeah, that can help.
• 5:05
  When is it an exercise like Pilates that can help?
• 5:08
  When is it physical therapy?
• 5:10
  When is it surgical intervention?
• 5:14
  When is it some of these modalities that you have?
• 5:16
  Like when can all these different things come into play?
• 5:19
  I think that's an important question and a lot of it is subjective, how much bother that you have.
• 5:26
  But I would say that when you're talking about Pilates and yoga and the pelvic floor, it's more of a core strength.
• 5:34
  So every time you work on your core, they tell you always to strengthen like the lower abdomen.
• 5:41
  That all helps to contract the pelvic floor as well.
• 5:45
  You can do specific exercises targeting the pelvic floor in Pilates and in yoga.
• 5:52
  But what we're really discussing when we talk about pelvic floor is kegel exercises.
• 5:58
  That's what you'll hear from your obs or other doctors that you need to do Kegel exercises.
• 6:04
  The way I explain Kegels, which I think is I think easier to understand'cause people say, oh, just squeeze your pelvic floor and you'll be great.
• 6:13
  And everyone's like, well what is the pelvic floor?
• 6:15
  What am I trying to do?
• 6:17
  So if you think about it, if you were in the bathroom and someone barged in on you and you were peeing you right away tense up all of those muscles down in the pelvic floor to stop yourself from urinating.
• 6:29
  That is your pelvic floor.
• 6:31
  It's not in the tush.
• 6:32
  Some people will squeeze their tush.
• 6:35
  Those aren't the'cause.
• 6:36
  That's a whole separate.
• 6:39
  And a separate issue that you could also have problems with, but we'll focus on the urinary system, but it's not so much the back.
• 6:47
  A lot of people will clench their butt muscles, but it's not that it's those front muscles and the vaginal muscles.
• 6:54
  So that's what I tell people.
• 6:55
  I think it's an easy way of understanding it.
• 6:58
  If you wanna practice doing them, you could do them.
• 7:02
  If you're urinating and you wanna stop yourself from urinating, just if you're in the bathroom just to figure out what those muscles are, those are those muscles to stop yourself from urinating the other things that you can do.
• 7:16
  How many times a day in a week would you suggest doing this?
• 7:20
  And for how long?
• 7:23
  So I recommend doing them three times a day as sessions, and then 10 times an hour, so three times a day.
• 7:32
  Wow.
• 7:33
  If that makes sense.
• 7:33
  That's so a lot.
• 7:34
  That's a lot.
• 7:35
  So that's a lot.
• 7:36
  Yeah.
• 7:37
  Yeah.
• 7:37
  I think if you really want to strengthen your pelvic floor and have an impact on the incontinence, I think you're gonna have to really do the exercises a lot.
• 7:48
  Does everyone do that?
• 7:49
  No, and that's probably why it doesn't hurt.
• 7:52
  But like I'll say, I'll be grocery shopping and while I'm standing in line, I'll remember to do my cables.
• 7:58
  You just squeeze a couple times.
• 8:00
  Wow.
• 8:00
  That kind of answers my question because I've done, when I was in between my pregnancies, I was maybe going to Pilates once or twice a week before kids.
• 8:08
  I was going a lot more, but that kind of answers my question.
• 8:12
  So I probably thought I had a very strong pelvic floor, but I clearly did not.
• 8:17
  So I guess that, that's interesting that you're saying it really does require a lot more thought and it's not something that you can just do a sporadic Pilates here and there.
• 8:26
  It's something that you need to actively engage multiple times a day, every single day.
• 8:33
  I think if you're having issues, you know you're having issues if you're real.
• 8:35
  Okay.
• 8:37
  Probably after your c-section, I know after my C-sections, that's something I don't have, I don't leak when I cough or sneeze unless I'm very full like we always are.
• 8:46
  But but really, I don't have any of those problems because I didn't have, vaginal birth.
• 8:53
  But I bet you are having those issues now just because, especially you're pretty close to when you had the baby.
• 8:59
  They just they destroy the pelvic floor.
• 9:01
  I always make jokes with women when they come to see me in the office.
• 9:05
  And they're complaining of stress incontinence.
• 9:07
  I'm like, how many babies do you have?
• 9:09
  Three.
• 9:09
  Wow.
• 9:09
  You can thank them.
• 9:12
  You can thank, wow.
• 9:12
  The precious jewel gave this to you and Yeah.
• 9:14
  Here we can do about that.
• 9:16
  All right.
• 9:16
  I have another question.
• 9:18
  You have a patient that says to you, Dr.
• 9:19
  Lambert, I've been doing my Kegel religiously.
• 9:22
  I'm still, when I do a jumping jack, it's a puddle.
• 9:25
  What would be right?
• 9:26
  Step two then, for that patient?
• 9:28
  What is the what is a nonsurgical option before you would then go to surgery?
• 9:34
  So the first thing we usually do just I'll say in the insurance world, is we'll start with pelvic floor physical therapy.
• 9:43
  The nice thing about the pelvic floor physical therapist is they'll really teach you how to do the pelvic floor exercises.
• 9:49
  They have different stimulation techniques and where you can really target the pelvic floor.
• 9:56
  So that is very helpful.
• 9:58
  It's usually paid for by insurance, so a lot of people like that option.
• 10:02
  When I went to see you, our first line of defense was physical therapy and I had a great experience with the pelvic floor physical therapist.
• 10:11
  And it was interesting'cause when I went, I was like, what do you mean when you think of physical therapy, you think of like back rehabilitation or knee rehabilitation.
• 10:19
  You don't necessarily think of this internal pelvic floor rehabilitation that they were offering.
• 10:25
  And she had all these different toys.
• 10:28
  They looked like sex toys that she was using to help my pelvic floor.
• 10:32
  I'm like, what is this all about?
• 10:34
  I am I gonna subscribe to this?
• 10:36
  And it did help tremendously.
• 10:38
  But the thing that I think really sealed the deal was that in combination with this other modality that Erica offered, which I'll have you speak to.
• 10:47
  Yeah.
• 10:48
  Okay.
• 10:48
  So I'll have you speak to those two things.
• 10:50
  So I'll say this at the pelvic floor physical therapist, what I think you were talking about Christina, was they have vaginal weights that you can actually get them on Amazon or anything.
• 11:00
  And basically they, the round goes inside the vagina and then you try to keep it in Yes.
• 11:06
  And hold it in.
• 11:08
  Yes.
• 11:08
  So that's, that's one of the things that they do.
• 11:11
  They also do stimulation depending on what you're going to the pelvic floor or physical therapist for, but they can also do a lot with painful intercourse and things like that.
• 11:22
  'cause they could do, sometimes you have pelvic floor tightness that can be an issue too, and have different different variations of pain or incontinence or.
• 11:32
  All different things just from that.
• 11:34
  So they'll do a lot of internal work and pressure points and things like that.
• 11:38
  So definitely public floor, physical therapy is not just for stress incontinence, but can really help with a lot of different issues, birth trauma, any type of sexual trauma, really anything.
• 11:50
  So I think they're very helpful.
• 11:52
  I've also gone to see them, I think they're wonderful.
• 11:55
  So big plug for pelvic floor physical therapists.
• 11:58
  A lot of the urologists, probably OBGYNs, have them on, our work speed dial just because they are so helpful.
• 12:05
  One of the things that I thought was in interesting idea modality was something called the Celi chair.
• 12:12
  I offer it now.
• 12:14
  I live in New Jersey, so I have a lot of people doing the cel and what the Celi chair is, it's a chair you sit on that has ultrasonic waves and it's like a stimulation of your public floor.
• 12:25
  So it's almost like doing 11,000 Kegel exercises at one time.
• 12:30
  They're 28 minute sessions and it's six sessions.
• 12:34
  And what I think this has been really helpful for our patients with mild issues.
• 12:39
  So these aren't patients that are having seven pads a day.
• 12:44
  These are patients with mild incontinence that it's bothersome.
• 12:47
  It's probably not so bad that they need surgery, but it's annoying.
• 12:52
  They don't like it.
• 12:53
  They can only wear black pants to the gym because, otherwise they'll leak and they don't like it.
• 12:59
  So it's also been nice for that transition.
• 13:02
  So women that are looking to have more babies instead of going through surgery, that, if you were gonna have another baby, it would ruin the surgery.
• 13:11
  You can do the cell machine and it gets you through the next childbirth.
• 13:16
  So those are the indications.
• 13:18
  I have older women who just have mild incontinence who they just don't wanna go through under anesthesia or through surgical procedures.
• 13:28
  The next modality, up the chain would be something that I have done a lot with is something called bulk ofid or bulking agents, which basically it's a surgical procedure, so you do go under anesthesia, but with the light anesthesia, a colonoscopy, something like that, where we we put in a a gel material that bulks up the urethra and it stops leaking.
• 13:54
  I have done this with older women, younger women, and people will say it's life changing so that you can do for more of your severe.
• 14:03
  Incontinence on postmenopausal peri or postmenopausal women?
• 14:08
  I would say the gold standard in stress urinary incontinence would be a sling.
• 14:13
  I'm sure you've heard it's basically a small piece of mesh that goes under the urethra and just is more stable.
• 14:23
  For me personally, I don't do this for post-menopausal women just because I think you need good vaginal tissue to put the sling in just so you don't get some of the complications, like erosion and pain with the just any, issues with really erosion or misplacement, things like that.
• 14:41
  But but that really helps also, women that have gone through sling again, life changing.
• 14:47
  So if you have a sling done when you're pre-menopausal is, and then how, what is the lifeline of that sling procedure?
• 14:55
  Does it last you till you're post-menopausal or then what sort of would happen then?
• 14:59
  Probably forever.
• 14:59
  Forever.
• 15:00
  It should last forever.
• 15:01
  Oh, wow.
• 15:02
  Yeah, because basically has scarred in there to keep your urethra stable.
• 15:09
  So then, even with pressure.
• 15:12
  You don't leak now, sometimes I would say with the bulking agents, sometimes you can, you'll need it again.
• 15:19
  But the nice thing about the bulking agents or bulk it or there used to be something called co-op type, but we've moved away from that.
• 15:26
  What's nice about it's, you can do it multiple times and it's much less invasive than a sling.
• 15:32
  So a lot of people have liked that, even for the younger women who are like, I don't want, I don't want any mesh, or I don't want anything in there.
• 15:41
  And, I think it's great.
• 15:42
  I definitely do way more bulking agents than I do slings anymore.
• 15:47
  Okay.
• 15:47
  Just because it, so a lot of different options.
• 15:49
  Yeah.
• 15:49
  And I wanna know from t because you did go through a couple of these options.
• 15:54
  You said you started with pelvic floor.
• 15:55
  Mm-hmm.
• 15:56
  You moved to the chair.
• 15:57
  What is your results?
• 15:58
  Yeah, so I didn't have a lot of the pig my pants situation.
• 16:03
  So I had three vaginal deliveries just for our listeners.
• 16:07
  One when I was 26, 1 when I was 28.
• 16:10
  And then I had the twins when I was 32.
• 16:12
  And after I had the twins, I couldn't push pee out.
• 16:18
  So whatever muscle was affected during that.
• 16:21
  It wasn't so much that I had like dripping when I was like doing a jumping jack.
• 16:25
  I like couldn't push the pee out.
• 16:28
  So I always felt like I had to go to the bathroom or I was having urinary tract infection.
• 16:33
  So is that the same Erica, is that the same sort of muscle as just the opposite?
• 16:38
  Yeah, it's the same.
• 16:40
  It's just retraining your pelvic floor to urinate naturally.
• 16:44
  Okay.
• 16:45
  I think that, as with a lot of women's health, we really underestimate the childbirth and what that does to our body, not just our pelvic floor, but really everything.
• 16:54
  I think it's just retraining your pelvic floor to work again some people have a high tone pelvic floor that has similar issues that Christina was talking about because you're almost too tight in there.
• 17:08
  I was like, too tense.
• 17:09
  You were too tense.
• 17:10
  So she had given me oral medication first that I guess like relaxes that relaxed it for more or less.
• 17:17
  It's yeah.
• 17:18
  And then she'd given me and that was okay, but that wasn't like a long term.
• 17:23
  You don't take those medicines long term.
• 17:24
  And then from there we did the physical therapy and I was like, so tense.
• 17:29
  And that kind of helped, loosen things up again.
• 17:32
  And then after that we did the ELA and that sort of sealed the deal.
• 17:36
  Oh.
• 17:36
  So it's hard to say if one helped more than the other, but the ela, like those Kegels and like just retraining that pelvic floor.
• 17:45
  It changed my life.
• 17:46
  I was in her office all the time oh my god, Erica, I have a urinary tract infection.
• 17:50
  I always have to go to the bathroom.
• 17:51
  I was like, bloated because I was like, everything was like inflamed and tight and it was uncomfortable and it was like also, like intercourse was painful.
• 18:00
  Like nothing felt good down there.
• 18:02
  And I, and also I had babies at home.
• 18:05
  I think the girls were like a year old, it's not like that was on the top of my priority list anyway, and what you were saying about, a different mechanism.
• 18:14
  I think what also happens with the chair is that you're really increasing the blood flow to the pelvic floor.
• 18:21
  A lot of people that are on the chair will tell me they have better orgasms just because, just more blood flow to the clitoris and just to the vaginal wall.
• 18:29
  I just think it helps in a lot of different ways and which is why I'll have, a lot of times I'll have people sit on it just to take a feel of what it is before they invest in it.
• 18:40
  My insurance didn't cover the sela.
• 18:43
  But I know that was a couple years ago and maybe now with insurance companies, they're always running behind.
• 18:47
  If there's like more indication, sometimes insurance companies have to catch up to that.
• 18:52
  Is this something that's covered by insurance?
• 18:55
  It is not covered by insurance, although it does have a CPT code.
• 19:00
  So I think in the future, it hopefully will.
• 19:04
  I know I have a patient right now who has tricare, which is the military insurance.
• 19:10
  And they actually recognize it.
• 19:13
  So we're trying to, I'm trying to work with the patient and do write a letter to the insurance company and try to get it approved, but right now it's not approved.
• 19:22
  But there is a lot of data on the Amela machine and I think for the right indication, it really works well.
• 19:29
  It would be so much better if it did get covered.
• 19:33
  But that is a problem with healthcare is that there are certain things that aren't covered.
• 19:38
  When we were talking last week about testosterone for women, that's not covered.
• 19:43
  People have to pay out of pocket.
• 19:44
  A lot of aesthetics is not covered.
• 19:46
  I guess a lot of things are medical need is the real issue and if you can prove medical need then sometimes you's just so funny, like what women live with.
• 19:57
  And if you go to a workout class and it's jumping jacks time and you look around the room, nine out of 10 women are crossing their legs Yeah.
• 20:04
  Before they do the jumping jacks.
• 20:05
  Yeah.
• 20:05
  And I'm thinking myself.
• 20:07
  You just listed four ways that you can fix it, and two of them are nonsurgical and the two that are surgical, one is like a twilight, so it doesn't seem like it's super, super invasive for such a big quality of life.
• 20:20
  Yeah.
• 20:20
  It's a quality of life issue.
• 20:22
  And that's, that it's sad.
• 20:24
  It really is sad.
• 20:25
  And like you said at the beginning of this, there's just not a lot of support around after childbirth.
• 20:32
  And a lot of these issues aren't topics that are discussed even by your doctor.
• 20:37
  We always talk about when you show up to the six week appointment after childbirth, and a lot of the times that's the last you hear of it until you go to your annual.
• 20:47
  And it's just, it's pathetic, honestly.
• 20:50
  It's a pathetic, it's really sad.
• 20:52
  And also what is also interesting about sort of insurance and, the expense of pads, right?
• 21:00
  So if insurance doesn't cover certain treatments.
• 21:04
  They also don't cover pads and incontinence, underwear and adult diapers or however you wanna say it.
• 21:11
  And it is so expensive.
• 21:14
  And it's really important for women to start talking about this and like you guys are doing, just opening up this conversation so that you feel comfortable sharing these issues with your doctor.
• 21:28
  And then, even if it's your primary care doctor, and then they're like, oh yeah, I can send you to see a urologist or a urogynecologist and maybe they can help you.
• 21:37
  Maybe, there's something we can do.
• 21:39
  But I do think it's sharing issues that are going on with you.
• 21:43
  A lot of times we will, as women, we suffer in silence.
• 21:46
  And I don't think we should be.
• 21:48
  I think that's why, what we talked about last week about hormone replacement.
• 21:53
  That's why, women weren't taking hormones because they wouldn't, they didn't have a voice to be able to go into what was causing them problems and how they were feeling.
• 22:05
  And is this normal, and, I talk to everybody about it because, I do think it's important and, especially with hormones.
• 22:14
  I know we're talking more about the pelvic floor, but with hormones, like people think they're going crazy and they're like, what is wrong with me?
• 22:20
  Am I going crazy?
• 22:21
  Is this normal?
• 22:22
  Can this be helped?
• 22:23
  I really think it's opening that discussion and feeling comfortable.
• 22:26
  I think that it really helps remove all of the shame that's associated with issues.
• 22:32
  Like we're talking about just women issues in general.
• 22:35
  And so I think trying to remove that shame and making the conversations more accessible and open to talking will hopefully encourage women to go seek help if they need it.
• 22:45
  And also, I'm happy on this platform.
• 22:48
  We've been able to help guide women where to go to seek help.
• 22:51
  Because what I'm finding in women's health is sometimes it's like you get passed on.
• 22:56
  You know what, the buck stops here.
• 22:58
  You go to your primary care doctor, they push you to the ob, GYN.
• 23:01
  Not very many women have urologists Right.
• 23:05
  On call.
• 23:06
  And when you don't, even as a female, you don't even think of urology.
• 23:09
  I always think of urology with men as a male.
• 23:11
  Yeah.
• 23:11
  As a male thing, for sure.
• 23:12
  And said a big percentage of your practice was men.
• 23:17
  You saw very few females, especially like mm-hmm.
• 23:19
  our age.
• 23:20
  So it's good to know that if you're having these symptoms, this is how you find a special specialist and this is how you have a treatment in place.
• 23:28
  Yeah.
• 23:28
  The importance of knowing who to ask and what to do, because to everyone's point, which we've been talking about, these issues can end up.
• 23:37
  Affecting your relationships, your intimacy, your day-to-day confidence as a woman.
• 23:42
  And it's important to get them addressed.
• 23:45
  Absolutely.
• 23:45
  And there's a whole, it's not new anymore, but the urogynecologist, so these are GYN trained who then focus in, in terms of some urologic issues.
• 23:58
  So they do deal with some incontinence.
• 24:01
  So even if you go the GYN route, a lot of times they'll know the urogynecologist around who do a lot of pelvic floor.
• 24:08
  And we work with the Urogynecologist a lot.
• 24:11
  There, there are definitely more people than there used to be who are out there, who are looking to help you.
• 24:18
  Can you share how these are considered, I guess maybe they're considered aesthetic offerings at uplift, like how they tie into overall women's wellness and why they're not just cosmetic.
• 24:31
  So I think that, with the CE chair, a lot of different med spas will now have'em, wellness centers have them, and they're really not targeted to urologists.
• 24:44
  I don't know why.
• 24:45
  I have some theories just because, we do have other modalities to do more definitive therapy.
• 24:53
  In, in some other things that we do, like probably, if you've ever been on my website for uplift, I also do vaginal rejuvenation.
• 25:03
  Now what does that mean, that is a, basically a vaginal laser.
• 25:07
  There's all different companies that have it, the Mona Lisa, the FemiLift, and the Diva, just all different companies.
• 25:14
  And basically what you're doing is you are similar to, everything we're talking about, we're basically rejuvenating the vaginal wall.
• 25:24
  So I don't know if some of your listeners has have ever done laser treatments to their face.
• 25:29
  And what you notice is like a couple days after, you're really red and what you're doing is you're doing these like micro punctures into the face to rebuild that collagen.
• 25:40
  So this is very similar to what we're doing with the vaginal laser rebuilding the vaginal wall.
• 25:45
  So these lasers, they actually help with stress incontinence.
• 25:51
  A lot of people will use them for stress incontinence.
• 25:53
  But they also use them for vaginal atrophy or dryness in the vagina.
• 25:57
  So it can help with painful intercourse.
• 26:00
  And again, when you ask about are these aesthetic they shouldn't be, you would think that they should get covered because, there's been so many studies on the vaginal lasers, there's no CPT codes for them.
• 26:13
  And they're not.
• 26:16
  Technically covered, but you would wanna go to a gynecologist, urologist, someone that really knows what they're doing, just because you wanna make sure you're getting it for the right indication and the preparation before these vaginal rejuvenation or the vaginal lasers is done.
• 26:32
  I've had a lot of women, like I've had two very recently who have had the FemiLift procedure because, one was a breast cancer survivor and one was ovarian cancer and they just did not wanna use vaginal estrogen.
• 26:46
  And and this really helped them, it's, look, it's not gonna be like you were when you were 30, but it can really help if you are on any type of treatment for breast cancer or for some reason, whatever your medical history is, you don't wanna use vaginal estrogen or the vaginal estrogen isn't holding you.
• 27:05
  Like you still have dryness or it's still painful.
• 27:09
  These are different options that we have for, vaginal health.
• 27:14
  It's interesting because the reason for the dryness is the loss of estrogen, and you would think because of that would be a medical reason to have this procedure done.
• 27:25
  Yeah.
• 27:26
  So yes, it all makes sense to us.
• 27:29
  It does, it makes sense to all the women.
• 27:31
  And that's exactly, I think to our point, I think a lot of these things get misconstrued as maybe in the male world as aesthetic, as cosmetic.
• 27:41
  And they're not.
• 27:42
  Again, another thing that's pathetic, I just keep using that word and also these procedures even fall under Erica's aesthetic practice.
• 27:50
  Aesthetic practice.
• 27:50
  Of her medical practice.
• 27:52
  So that alone just goes to show you that she had to put it somewhere.
• 27:55
  It's so misunderstood.
• 27:57
  That's where I think that, that's just what I'm getting from this conversation.
• 28:00
  When I started uplift, this is why these are procedures.
• 28:05
  They're not covered by insurance.
• 28:06
  So a lot of times when you go to a doctor's office, you just assume you're gonna go there.
• 28:11
  There's gonna be things, everything's gonna be covered under insurance.
• 28:16
  And then when you go to a med spa and you're going for Botox or fillers, you just assume it's not covered.
• 28:21
  So where does this stuff, why are these actual medical procedures, right?
• 28:26
  So they do help medically, they help prevention less money through the healthcare system, but yet they're not covered.
• 28:33
  So that's what kind of brought me into the aesthetic world that I never.
• 28:39
  Thought that I would be, it would be something, part of my, armar of Right.
• 28:45
  Things to offer, yeah.
• 28:47
  But but it has been very yeah.
• 28:49
  Worthwhile to patients and patients have been treated well.
• 28:52
  Yeah.
• 28:53
  Switching gears a little, I'm gonna Yeah.
• 28:56
  Channel my inner Nick Bon tempo.
• 28:58
  So let's talk sex.
• 29:01
  Sex is great.
• 29:02
  Let's talk sex.
• 29:03
  Oh, sex is great.
• 29:04
  Okay.
• 29:04
  You must be taking testosterone because that is not the answer that most of my friends are giving me.
• 29:10
  Usually it's whoa, tonight's the night.
• 29:12
  Is feelings from sex may not be perfect.
• 29:16
  Yeah, we can, I talk about sex basically all day.
• 29:19
  I think one of the first things to really go as women start the decline of hormones and just life, right?
• 29:28
  You have babies at home, you have work, you have, grocery shopping, laundry you have a million steps.
• 29:36
  It's last.
• 29:36
  So women have it's last on the list.
• 29:37
  It's last on the, it is dead last on the list.
• 29:39
  And in addition to that, it's not something that's talked about.
• 29:44
  I don't think anybody wants to hear about married people having sex.
• 29:47
  And I certainly wasn't raised in a home where we would.
• 29:50
  Talk about sex.
• 29:51
  It was something that was never spoken about.
• 29:53
  So you're raised never talking about sex, and then you put it last on the list.
• 29:57
  And then it goes back to the shame.
• 29:59
  Shame.
• 29:59
  It goes back to the shame, to shame.
• 30:01
  And then you get to a certain age and it, you don't wanna have it.
• 30:04
  And you're wondering why.
• 30:05
  And you have a husband who is in heat constantly, yeah.
• 30:09
  I would always make jokes.
• 30:10
  It's you're laying in bed and I'll like hunch over and pretend, I'm sleeping when I'm like scrolling on my phone, right?
• 30:18
  Because I'm like, ah, don't touch me.
• 30:19
  It's almost like becomes a visceral reaction, which it never did that before.
• 30:23
  Why does it do that now?
• 30:25
  Why now?
• 30:26
  Why now?
• 30:26
  So I think if this is hormonal, as we age, our hormones start dropping.
• 30:32
  So I think testosterone is the most important hormone for libido.
• 30:38
  It's probably also the hardest to fix your libido, just because there's so many things that go into it, relationship issues and everything else.
• 30:47
  But definitely if you have very low testosterone, that's not gonna make things any better.
• 30:54
  So a lot of times, even people in perimenopause that are getting regular periods, not having hot flashes, where they'll just come to see me for low libido and I'll check their testosterone and they have no testosterone.
• 31:07
  Very low testosterone.
• 31:09
  And so I'll give them that testosterone back and it really changes their intimate relationship.
• 31:15
  And it's really important to connect with your partner on some level.
• 31:20
  And I always make jokes like, if, my husband and I didn't go away for that, two weeks of the year, like we'd be divorced because there'd be no connection.
• 31:30
  But how do you get that more on a regular basis, right?
• 31:33
  And when you realize, oh I used to like doing this.
• 31:37
  So I think what happens as we age, and I think this is an important part, is your vagina.
• 31:44
  So as the vagina gets dry and it starts to hurt, having intercourse, right?
• 31:52
  So I think, we all, the first thing we think of is KY jelly, right?
• 31:57
  So now we start needing lube, but it's a weird thing.
• 32:00
  I never needed lube before.
• 32:01
  Why do I need lube to have, start having sex?
• 32:04
  Like why does, why isn't my body naturally doing this?
• 32:07
  So it could be corn hormonal.
• 32:09
  Just to let you know, a lot of people on the birth control pill, they have a lot of vaginal dryness.
• 32:14
  So other medic, it's always a side effect.
• 32:17
  They always say other medications, antidepressants, anti-anxiety, medications, that's always a side effect of that.
• 32:23
  And all of that can cause vaginal dryness.
• 32:25
  So if you've ever had sex with vaginal dryness, then it hurts.
• 32:29
  It almost is like your body protecting, that's the way I think of it.
• 32:33
  It's like your mucosa is fragile and it's like anything that hurts.
• 32:39
  It's like your feelings get hurt.
• 32:40
  You start protecting yourself, it's the same thing with your vagina.
• 32:43
  So when it starts to hurt, you start not wanting to do it and then all of a sudden it's months that go by, right?
• 32:50
  Or like just to make a joke or you've given a lot of blow jobs and now all of a sudden you have T NJ and you're like, it's never gonna happen.
• 32:56
  It's never gonna work.
• 32:57
  Oh my god.
• 32:58
  Maybe do, why?
• 32:59
  Maybe that's why my vagina was so tense.
• 33:02
  Because it was like, you already have four kids, you need to tense up and not have another kid.
• 33:06
  Your body's we're all set your body set.
• 33:07
  We're good here.
• 33:08
  We're good to go.
• 33:08
  Shop is closed, we're closed.
• 33:10
  Peace out close for business time.
• 33:13
  It's time to be done.
• 33:14
  The first thing that I do for like female sexual dysfunction or painful intercourse is I'll check hormones, I'll do vaginal exams.
• 33:23
  Again, the pelvic floor therapists are really important.
• 33:26
  They do a lot of pressure points.
• 33:27
  A lot of people with any type of trauma.
• 33:29
  I always say childbirth is vaginal trauma for sure.
• 33:32
  But any type of sexual trauma even like little kids that have had any urinary issues when they're babies, a lot of them have weird pelvic floor issues from being catheterized or things like that.
• 33:44
  So people have all different reasons.
• 33:46
  It's not just menopause or your hormones dropping that you would have any type of vaginal trauma.
• 33:52
  So things to treat that obviously, like you heard, my mantra last week is vaginal estrogen.
• 33:59
  I think it's really important.
• 34:01
  I.
• 34:02
  Use a compounding pharmacy where I compound a ton of different things for patients that have a lot of pain with insertion of, either sex, toys, penis, whatever you're inserting, if that initial, that is your vulva and you can have some different vaginal creams to just concentrate on the vulva.
• 34:24
  You can have suppositories you can put hyaluronic acid is really great.
• 34:29
  I have a cream that uses CBD oil for the vaginal wall.
• 34:33
  I've used lidocaine, gabapentin, I do all sorts of things to see what works for certain women, what doesn't work.
• 34:43
  And then you can go into some of the vaginal lasers.
• 34:46
  But but yeah, I have special lubricants that I like.
• 34:50
  I'll tell women to use coconut oil, uber, lube, silicone based or water based.
• 34:56
  And all of this you can get on Amazon or really any type of store you go into.
• 35:01
  Personally, I don't like Ky Jelly.
• 35:04
  I think it gets really go and can cause some chafing.
• 35:08
  So I would stay away from, and it's next to the condom, so it's a man's thing.
• 35:12
  There you go.
• 35:13
  Yeah.
• 35:13
  I feel like all of this stuff is geared towards men.
• 35:17
  Yeah.
• 35:17
  Yeah.
• 35:17
  So now we can get our own special cocktail for us.
• 35:21
  For us.
• 35:22
  Yeah.
• 35:23
  Vibrators for orgasm, vibrators are great.
• 35:26
  I highly recommend them to all my patients.
• 35:29
  Do you have one that you recommend?
• 35:33
  I have a couple of them upstairs.
• 35:34
  Really anything that works, like what works for your body.
• 35:38
  I like external vibrators.
• 35:40
  I'm sure if my husband was listening he'd be like, oh my God, are you kidding that you're saying this online to a million people?
• 35:47
  They can be small, bigger it just depends on what you like.
• 35:50
  I I didn't wanna jump ahead, but I, this is gonna be your pink spotlight of the week.
• 35:54
  So should we just go into our pink spotlight?
• 35:56
  We need to go right into it.
• 35:56
  Let's go in.
• 35:57
  So our pink spotlight is our person, place thing, tip, mantra, anything that's making life or our week a little bit better.
• 36:04
  So Erica already jumped right into it and that was gonna be your pink spotlight this week.
• 36:09
  It is going to be oh wow.
• 36:11
  It's a show.
• 36:11
  And she came with, she came prepared.
• 36:13
  It's a show and time.
• 36:13
  Okay, so just the container.
• 36:15
  But what this is.
• 36:17
  This is Uber Loop, so I sell it.
• 36:21
  You can get it anywhere, I always say Amazon'cause I feel like that's where I get most of my things.
• 36:26
  But you can get it there.
• 36:28
  And it is a silicone based lubricant.
• 36:31
  It doesn't just need to be used for sex.
• 36:34
  It's also really good for like sports chafing or if your little kids have the bathing suit, like the boys with the bathing suits and then they get really red and, so you can use like a and d ointment or Aquaphor, but this is actually really lovely, but it's really amazing for intercourse.
• 36:52
  You could use it on yourself to put inside the vagina.
• 36:56
  It's just like a pump.
• 36:57
  You could put it all over the penis or all over a different toy, whatever you're using for insertion, for pleasure.
• 37:05
  It is absolutely amazing.
• 37:06
  This is the travel one, so it just goes into this cute little container, but there's bigger sizes and so yeah.
• 37:14
  Super fun.
• 37:14
  Great.
• 37:15
  And then you can put it in your sports bag and use it on your kids if they have chafing.
• 37:19
  I'm sure my, that all in one product.
• 37:21
  I love it.
• 37:22
  Yeah.
• 37:23
  Stop shop.
• 37:24
  Yeah.
• 37:24
  One stop shop.
• 37:25
  We love a multi-use.
• 37:27
  We love a multi-use here.
• 37:28
  Oh my God.
• 37:29
  What about tea?
• 37:30
  What about you this week?
• 37:31
  We were talking before we went on air.
• 37:33
  So my twin girls are six years old and they love to shop at Sephora.
• 37:37
  And I'm like, Sephora, like I still buy my makeup at the drugstore.
• 37:41
  Like I'm a huge drugstore girl, but they're obsessed with Sephora.
• 37:44
  So we went to the mall over the weekend and we went to Sephora and my 6-year-old is picking out this stuff that helps her pores.
• 37:51
  I'm like, pores.
• 37:52
  Do you even know what pores are?
• 37:54
  Uhhuh?
• 37:54
  You don't have pores, right?
• 37:56
  You're six, your skin is perfect.
• 37:59
  But anyways, while we were in there and I was one with the teeny boppers, I got targeted to how beautiful Hailey Bieber is.
• 38:06
  Of course.
• 38:07
  And I bought all the road stuff.
• 38:09
  I bought like the milk.
• 38:10
  The milk plates.
• 38:11
  Yes.
• 38:11
  The milk is something is so good.
• 38:11
  That one's so good.
• 38:12
  I bought that and then I bought I bought a bunch of our products, but I love, love, love the peptide lip gloss.
• 38:18
  I know your lips are looking very luscious right now.
• 38:21
  It's so pretty.
• 38:22
  It's tinted.
• 38:22
  So lip peptide.
• 38:24
  And I just love it.
• 38:25
  It's so cute.
• 38:26
  And there's like this, her packaging is brilliant.
• 38:28
  It is like very sleek.
• 38:29
  It is.
• 38:30
  And clean.
• 38:30
  Yeah.
• 38:30
  And there's like a little indentation for your finger, so it just like fits so nicely.
• 38:35
  So this is my pink spot.
• 38:36
  Yeah.
• 38:36
  She thought of everything I love.
• 38:38
  I like love lip balm.
• 38:39
  I just feel like there, I have once stashed all over the place.
• 38:42
  Like I always need access to one.
• 38:44
  And I was gonna ask you,'cause I'm a summer Fridays girly.
• 38:47
  That's my favorite.
• 38:48
  Do you feel like It's different.
• 38:49
  It's different.
• 38:50
  I love the Summer Fridays pigmentation.
• 38:53
  But they're a little sticky.
• 38:55
  It's a little sticky.
• 38:55
  The color is great.
• 38:56
  And then I got the, there's a peptide, it's called a lip shape.
• 39:00
  It's essentially like a combination of a lip liner.
• 39:04
  It looks bigger though.
• 39:04
  And a gloss, like together.
• 39:06
  So you don't really need to line your lips.
• 39:08
  Like I'm doing it now on camera.
• 39:10
  I don't even need a mirror.
• 39:11
  It's like small enough to be a lip liner, but big enough to like actually give color on the kinda like a lip cream.
• 39:15
  Yeah.
• 39:16
  Love it.
• 39:16
  Oh, so I never saw that one.
• 39:18
  This is before.
• 39:19
  I know.
• 39:19
  That's great.
• 39:20
  This is in the color press.
• 39:21
  Good.
• 39:21
  Which is like a natural color.
• 39:24
  What was the lip, the peptide one.
• 39:27
  Salty tan.
• 39:28
  It's really pretty.
• 39:29
  It's like a nice pinky nude.
• 39:30
  It looks really nice.
• 39:31
  Yeah, I'll link these, but I love it.
• 39:33
  I like it.
• 39:33
  That's good.
• 39:34
  Pink spotlight.
• 39:34
  Good one.
• 39:34
  Mine this week I always get asked about these and so I figured I would share because I'm like a big custom jewelry girl.
• 39:41
  I like mixing and matching, so I like having pieces that I can share on my page that everybody can buy.
• 39:47
  But I also like custom jewelry and I always get asked about, I have two rings, one for each of my kids and they're custom, so it says their name and I'll show up.
• 40:00
  Oh, so it's one of them says Leo, one of them says Layla and they're very different.
• 40:05
  I looked all over the place for a custom ring and I thought the prices were just astronomical.
• 40:10
  And then I ended up finding both of these at Bob Bar and.
• 40:14
  They're actually part of the fine jewelry collection.
• 40:17
  So it's a little bit more than like the fast fashion bubble bar.
• 40:21
  And I wear these every single day.
• 40:24
  They do not tarnish.
• 40:25
  They're like 18 karat gold.
• 40:26
  I love them.
• 40:27
  They're beautiful.
• 40:27
  They're beautiful.
• 40:28
  They're absolutely beautiful.
• 40:29
  And they have several different kinds of rings.
• 40:31
  So one of them is more of a block with Leo's names in like Pave diamonds.
• 40:36
  And then the other one is Layla's name carved into gold.
• 40:40
  So it's I dunno how you would explain that.
• 40:41
  It looks more like cursive.
• 40:43
  Cursive.
• 40:43
  And I have them stacked on top of each other.
• 40:45
  Beautiful.
• 40:45
  So I like that they're not like the exact same.
• 40:48
  But I feel like a cool ring stack to have all of your kids' names, but they're like different.
• 40:51
  But they all stack on top of each other.
• 40:53
  I wanna get those.
• 40:53
  I love them.
• 40:54
  They're amazing.
• 40:54
  What was the price point?
• 40:55
  They're about 150 to customize, but they are 18 karat gold.
• 41:01
  So they are part of like their fine jewelry collection.
• 41:05
  And like I said I wear these every single day.
• 41:07
  They're, I don't, nothing tarnishes the color stays on them.
• 41:11
  When I was looking and kind of price shopping around, there were things at least three times to four times the price of this.
• 41:17
  So I think that this is like a very fair price for custom jewelry and something that you could wear every single day.
• 41:23
  And so I wanted to throw that out there'cause we are like a mom podcast.
• 41:27
  And I feel like people always ask about them and they're always surprised that I say it's bobble bar because they probably think I, paid out the wall to get something or had a jewelry or to make it for you I love them and I like that they're different too, so you can stack them.
• 41:38
  You don't have to get the same ring like three times, four times.
• 41:41
  Like you can you were creative that you did that you should show like the up close of that.
• 41:44
  Yeah.
• 41:44
  I'll,'cause it's really pretty how you designed it.
• 41:47
  So I love it.
• 41:48
  And I just figured that was like a really cool thing to share.
• 41:50
  I know.
• 41:50
  I love that.
• 41:51
  And we're gonna get you one that says vagina.
• 41:54
  I, yeah, there we go.
• 41:55
  You can put whatever you want on it.
• 41:56
  So I think that would make the most sense for you.
• 41:59
  Yeah, I That sounds great.
• 42:01
  I love this.
• 42:02
  And I'm honestly, I'm so thankful for conversations like these because these are all topics that yes, you might giggle to like your sister or friends about these things, but they're really important to talk about and they're really important to talk about in a comfortable way and get comfortable talking about these types of things.
• 42:20
  And like we keep saying, the more we can have these open conversations about these important topics, like hopefully something can effing be done about this, but they're never gonna get done if we just shut in and suffer in silence and we don't make our kind of case heard.
• 42:36
  I think there's a couple different ways as women, you can look at things, you can be embarrassed and stay inward and not go to an exercise class.
• 42:44
  Or you can go and make jokes about yourself.
• 42:46
  Self deprecate.
• 42:47
  Self deprecate, which, we hide behind humor a lot.
• 42:50
  I, yep.
• 42:50
  We're all guilty of it.
• 42:51
  I use humor a lot for sure.
• 42:52
  But then after a while I don't wanna laugh at myself anymore, I wanna fix it.
• 42:56
  There's certain things you wanna fix.
• 42:57
  And this, there is a remedy, there's a solution.
• 43:00
  I guess we'll close out with that, with a little rapid fire and Erica kind of help us.
• 43:06
  I think we know all the answers, but I just wanna really just push this point home.
• 43:10
  So rapid fire is this normal and.
• 43:14
  We'll go through a couple of different scenarios and we're all gonna say, no, this is probably not normal.
• 43:20
  And so I want everybody to think about these things and then use this as a resource to then go do something about it if you're answering any of these questions.
• 43:27
  So rapid fire, is it normal peeing when you sneeze?
• 43:32
  No.
• 43:33
  Zero libido after babies?
• 43:36
  No.
• 43:37
  Can't wear a tampon comfortably.
• 43:41
  No night sweats, but still getting periods that can happen, but it's not normal.
• 43:50
  Okay.
• 43:50
  And then maybe that one, there's different le variations of normal.
• 43:54
  Yes.
• 43:55
  And then like this, these are things that happen to us.
• 43:59
  They aren't normal, but they do happen.
• 44:01
  But we can fix that.
• 44:02
  That's maybe worthwhile to bring it up.
• 44:04
  Like worthwhile to bring it up.
• 44:06
  Okay.
• 44:06
  And then our last one is feeling blob but blood work is fine.
• 44:13
  It is not normal, but we, what we need to do is really investigate why are you feeling this way?
• 44:18
  So just again, one of those things where maybe cause for concern, yes.
• 44:23
  Yes.
• 44:23
  So if you're having any of these feelings, dig a little deeper, dig a little deeper.
• 44:27
  We're always giving our Pippa's permission to put themselves first in a part of life where you're always putting yourself last.
• 44:36
  And we always hope that these conversations remind you that you are the main character and I also think that, people usually know their own bodies.
• 44:45
  If you give people the space to speak, I know as a doctor or as a friend, a family member, you can usually figure out something that's going on.
• 44:57
  If something doesn't feel right and you have that feeling that you know it, it's just not right.
• 45:03
  Sometimes you can find the underlying cause and I think it's worth it to explore.
• 45:08
  I love that.
• 45:09
  Thank you so much.
• 45:10
  Me too.
• 45:11
  Yeah, Eric, I really appreciate you coming on.
• 45:13
  I appreciate you being such a good friend, such a good doctor, and sharing all of your knowledge with all of our listeners.
• 45:19
  This is amazing.
• 45:20
  Thank you.
• 45:20
  We're so appreciative.
• 45:21
  And where can our listeners find you?
• 45:23
  Because you still have a medical license in Connecticut and you can see patients remotely.
• 45:27
  How they can find you so they can see you.
• 45:30
  So I think the best way to contact me if you have any questions or wanna set up an appointment, a consultation is to actually go on my website.
• 45:39
  It's uplift medical aesthetics.com.
• 45:42
  There are all over the website.
• 45:44
  There's contact pages where it goes directly to me um, the person reading the emails.
• 45:49
  It is not going to a third party or an AI or something like that.
• 45:54
  You will hear back from me and obviously I wanna do everything as much as I can through insurance.
• 46:01
  We would work with that and see how we can set it up that it gets paid for.
• 46:06
  But I am happy to answer questions and get started with your journey.
• 46:11
  So please contact me, please take a look at my website.
• 46:15
  And I'm just like, a quick four hour drive down.
• 46:17
  Yeah.
• 46:17
  Not that.
• 46:18
  So I'm probably gonna be taking a four hour drive to see you soon.
• 46:22
  But we appreciate and honestly we would love to have you back.
• 46:24
  So Pippa's, if you have any questions for Erica make sure you can send us a text at the bottom of our show notes and t and I take a look at those all the time.
• 46:33
  Yeah.
• 46:33
  And we get a lot of your questions from their and episode ideas, so let us know.
• 46:37
  It comes to both of us same way.
• 46:38
  Yeah, it's just us reading those and we appreciate each and every one of you and you, Erica, thank you so much for giving all of your time the last two weeks.
• 46:46
  We appreciate it so much.
• 46:48
  I know.
• 46:48
  And for anybody who's in New Jersey, Erica is a master injector, she is a surgeon.
• 46:54
  She has this most steady hand.
• 46:57
  She is a master.
• 46:58
  I love it.
• 46:58
  Injector.
• 46:59
  All right.
• 46:59
  So just a little shameless plug there for my girl.
• 47:04
  I love it.
• 47:05
  Thank you so much, very much.
• 47:06
  I appreciate it so much.
• 47:09
  It's been wonderful.
• 47:10
  And we will see you guys next week.
• 47:12
  See you next week.
• 47:13
  Bye.
• 47:14
  Bye.