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Ashley Winter, M.D., is the chief medical officer at Odela Health and a urologist and sexual drugs specialist. She makes use of social media (primarily Twitter) to assist clear up misconceptions about girls’s well being and talk the reality about all issues vaginas.
Winter was exceptionally beneficiant along with her time, and our “15 minute” chat truly lasted an hour. We talked about every little thing from her viral tweet about which method to wipe after peeing (spoiler alert: it doesn’t actually matter) to the significance of vaginal estrogen for perimenopausal and postmenopausal girls.
Our interview follows, edited for readability and size.
HealthyWomen: You’ve got turn into fairly a well-known determine advocating for ladies’s well being and offering sex-med and urology tutorials on Twitter. How did that come about?
Dr. Winter: You understand, I want I might pinpoint precisely what occurred. I’ve simply tried to be constant in my messaging, but additionally an actual human, and I believe that has been interesting to folks. I keep in mind most likely three years in the past, close to the beginning of the pandemic, when folks have been simply sitting round quite a bit, an eye fixed physician tweeted his favourite folks on Twitter to comply with, and I used to be one among them. I obtained a giant following off that.
HealthyWomen: What have been some misconceptions you had about girls and urology at first of your medical research? And the way do these misconceptions persist in society?
Dr. Winter: I initially went into urology as a result of I realized about it after a female relative went to a urologist, and I heard concerning the process — a cystoscopy, which appears to be like on the inside the bladder and urethra. And I used to be like, “Oh, that sounds form of cool.” So I appeared into what urology was and I obtained interested by it.
I spotted that ladies have been additionally sufferers of urologists, which I got here to grasp that lots of people didn’t know. Folks usually thought {that a} urologist was the male equal of an OB-GYN. However they’re not — they see all genders.
Additionally, there are particular issues which can be positively not intercourse particular, like kidney stones, bladder most cancers, blood within the urine. We handle all of these issues. And along with male infertility and male sexual operate, we offer take care of feminine sexual operate, which is a large a part of my profession. It’s an area that does not have numerous possession within the conventional medical atmosphere. Lots of what girls get in healthcare is reproductive healthcare.
One other large challenge was that some folks would not wish to see me as a result of I’m a girl. However some who have been hesitant got here to see me anyway, and after that they had a go to with me, have been like, “Oh, you are actually cool.” I’ve been in a position to change sure folks’s conceptions about what a urologist needs to be simply by current in my profession and doing my job. I think about, like in any historically male-dominated discipline, for those who present up and do an important job, then folks say, “Oh, I see now that ladies can try this.”
HealthyWomen: You’re additionally doing quite a bit to dispel numerous misconceptions about urology on Twitter and Instagram. Are you able to inform us about that?
Dr. Winter: Sure, that is true. There’s a lot misinformation on social media concerning well being info, and I believe that actually got here to nationwide prominence originally of the pandemic. There have been folks saying issues that weren’t based mostly in science. That was after I actually pushed up my social media presence as a result of I spotted that many physicians direct their on-line content material towards different medical doctors. And we actually have an obligation to focus towards the broader group.
I give it some thought as a common client: How would I wish to method areas that I am not an professional in? You understand, after I’m selecting a sunscreen, I like watching YouTube movies from a dermatologist. We will all share in this type of informal change, and I am actually excited to share what the scientific info truly is.
HealthyWomen: You latterly tweeted that ladies needn’t wipe from entrance to again after they pee and it obtained fairly a response. It went viral. Are you able to inform us about that?
Dr. Winter: To make clear, what I meant by that was you do not have to wipe entrance to again over the vulva. After you pee, you’ll be able to both wipe beginning behind your vulva ahead, or behind your urethra ahead, or you can begin within the entrance of your urethra and go backwards. Actually, I do not imply that it is best to take a bit of bathroom paper and smear out of your anus all the way in which entrance. However which course you go over your urethra space doesn’t matter. I felt it was vital to dispel this delusion as a result of blaming the course you wipe could make you are feeling ashamed and would possibly discourage you from getting therapy.
HealthyWomen: There’s an concept on the market that ladies get UTIs from sleeping round with males. Is that true?
Dr. Winter: Girls have a brief urethra — shorter than males. It does seem they get UTIs extra simply. And positively there are some girls who’ve the next likelihood of getting a UTI after sexual exercise. That mentioned, UTIs will not be an STD or an STI, which means they don’t seem to be sexually transmitted. It isn’t like your associate has a urinary tract an infection and so they unfold it to you. However being uncovered to the bacterial atmosphere on a associate and having that micro organism near the opening of your urethra seems to, in some delicate folks, result in them getting a UTI.
It additionally does seem that in case you have a brand new associate, you could have an elevated likelihood of getting a UTI. That mentioned, it isn’t just like the variety of companions causes UTIs. It’s the introduction of a brand new associate. And once more, that is not the case for everyone.
HealthyWomen: Are you able to speak concerning the G-spot and finish the talk as soon as and for all: Does it exist?
Dr. Winter: Sure and no. No, within the sense that there’s not a magic button that for those who discover it, and also you simply press down on it, a girl may have an outrageous orgasm. However is there tissue that may be accessed from the within of the vagina that has relevance for sexual want? Sure.
The entrance a part of the vaginal wall, close to the place the urethra passes, has glands which can be just like the prostate in males. There are additionally a bunch of nerves that run alongside it that we expect are just like the nerves that go across the prostate in males, which is essential for sexual stimulation, erections, and many others. So, you could have all this tissue that’s actually advanced and fascinating within the entrance a part of the vagina, like a number of inches in. And that’s the world that may doubtlessly result in orgasm for those who stimulate it — and in addition to what we name feminine ejaculation or squirting. That may typically be urine, but it surely may also be precise secretion of fluid from the glands round this type of prostate-like tissue.
It isn’t like each lady has an orgasm from stimulating that space. That might be like saying each man primarily orgasms from prostate stimulation.
HealthyWomen: You wish to deal with UTIs with vaginal estradiol as a substitute of antibiotics. Why?
Dr. Winter: It isn’t a lot that I deal with UTIs with vaginal estrogen as a substitute of antibiotics. It is extra like I stop them with it. We all know that for those who take a bunch of girls who’re postmenopausal, and also you give them vaginal estrogen, it’s going to make their vaginal pH go down again to premenopausal ranges. And it’ll enable this wholesome micro organism that is speculated to stay there to return again. It additionally acts like a barrier and prevents the micro organism that may trigger UTIs from attending to the urethra.
That is one thing that has been in medical literature and confirmed time and time once more. It has a really clear impact.
However that actually clear idea is so undertaught. I do not do not suppose it was ever taught to me in medical faculty. And there was little or no, if any, schooling about that in my six years of urology residency. And then you definitely exit into apply, and also you see tons of feminine sufferers who’re postmenopausal getting antibiotic, antibiotic, antibiotic, for his or her UTIs.
What I’ve present in my function as a urologist is that individuals have been coming to me for frequent UTIs, or who have been perimenopausal or postmenopausal, and I used to be prescribing the additional vaginal estrogen and I used to be explaining that hyperlink all day, day-after-day in my clinic. It was actually beautiful to me to need to say many times that this not solely makes folks’s high quality of life dramatically higher, it truly saves lives. It will possibly stop girls from getting an an infection that travels up their kidney and finally ends up touchdown them within the hospital or the ICU or dying.
In case you’re already on vaginal estrogen and you continue to get a UTI, which positively occurs however much less usually, then, in fact utilizing an applicable antibiotic is completely tremendous.
HealthyWomen: Now let’s speak GSM. What’s it and what would you like girls to find out about GSM which will encourage them to hunt therapy?
Dr. Winter: GSM stands for genitourinary syndrome of menopause. And it’s so vital to know that time period. Once I consider all of the depictions of menopause that I realized as a child or in my younger maturity, it was like some lady within the films having sizzling flashes or saying, “I am not within the temper for intercourse.” So that you consider menopause as these complete physique signs like sizzling flashes, evening sweats and adjustments in habits.
However there’s truly an enormous element of menopause that pertains to the impact of estrogen ranges taking place and the way that adjustments the tissue round your bladder, urethra, vulva and vagina.
If we might circle again to that character on tv, that lady would say, “Hey, I am going by way of menopause. It hurts after I pee,” or, “Hey, I’ve to go to the lavatory extra regularly.” Or, “Hey, intercourse is painful and I can’t get lubricated in response to arousal.”
Now, not all people who has menopause goes by way of these signs, however many do. Oftentimes these signs can begin even earlier than durations utterly go away. So any person could possibly be in perimenopause, the years main as much as menopause, and their durations are irregular, or nonetheless taking place, however their estrogen ranges are taking place. They usually’re getting signs like urinary urgency, urinary frequency, burning once they pee, elevated urinary infections, lack of lubrication and lack of getting moist in response to arousal — all these signs could possibly be an indication of lowering estrogen.
In case you’re experiencing any of these signs, you actually ought to speak to your healthcare supplier about utilizing low-dose vaginal estrogen, as a result of that’s the major therapy for all of these signs. It isn’t the identical factor as what we name hormone replacement therapy, which is supposed to boost blood ranges of estrogen. Vaginal estrogen is basically for the native therapy of all these signs.
My important tip 1,000 instances over for ladies with GSM is to get your self some vaginal estrogen. And I promise you, I’ll use vaginal estrogen as soon as I’m going by way of menopause and I’ll use it perpetually and I might be buried with my vaginal estrogen.
HealthyWomen: Is there something we have not lined that you just want girls knew about girls’s well being?
Dr. Winter: I believe a giant one which I really like speaking about since we’re on form of the hormone factor is testosterone. Testosterone is in all people. Testosterone ranges within the common grownup lady are literally increased than her estrogen ranges. It is simply that these ranges are increased within the common man. So girls have much less testosterone than males, however all people has extra testosterone than estrogen. Hormones will not be black and white: one for males, one for ladies type of factor, the way in which we sometimes are led to consider.
And testosterone is basically vital for lots of issues. It’s vital for the genital urinary well being the identical method estrogen is. And for those who’re on treatment that may suppress testosterone, you do have a danger of getting ache with intercourse, decreased arousal, and many others. However it will probably additionally have an effect on your ranges of want for intercourse. And for those who’re experiencing low want for intercourse, and also you’re peri- or postmenopausal, utilizing low ranges of testosterone can truly be a therapy for that. I’ve prescribed it many instances. I’ve seen girls who’ve a beautiful response to it.
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