Introduction to the Libido Lounge

Dr. Diane Mueller: Welcome to the Libido Lounge, where we focus on all things love, lust, and libido. We believe that fabulous sex is as important to health as exercise and good food. Hey everybody, Dr. Diane, your libido doc here. Welcome to another episode on the Libido Lounge. I am so, so, so excited about who I am featuring today—Dr. Betsy Greenleaf. She’s a great friend of mine, and we are throwing a really cool upcoming sexual health and libido summit together. So I wanted to make sure we feature her before that. We’re going to be talking about the link today between the brain, the vagina, and your sexual health. So welcome to the Libido Lounge!

Dr. Betsy Greenleaf: Oh my goodness, thank you so much, Dr. Diane. I love the Libido Lounge—I think that’s awesome. That is so fun. We’re gonna have the best time, and someday we’re gonna start filming these in a much more loungy place, and that’s going to be incredible.

Dr. Diane Mueller: Can’t wait for that. But let’s jump in—like, just tell everybody briefly about yourself, about the work you do, about why you love this topic for me.

Dr. Betsy Greenleaf’s Background

Dr. Betsy Greenleaf: Yeah, so I’m the first board-certified female urogynecologist, and I basically went into that field because, you know, for many of us, especially in the health and wellness world, I was having my own struggles with my feminine health. And what better way to, you know, figure it out? Most people just go to doctors and practitioners and pay, and I spent, like, hundreds of thousands of dollars on a medical education myself. But, you know, in the end, it gives me really a better understanding of what my patients are going through, and I can relate—and figuring out things that weren’t being presented to me in medical school.

Dr. Diane Mueller: Yeah, beautiful, beautiful. Thank you. And let’s jump right into the topic today. It’s a really unique thing that I think a lot of people probably don’t have that awareness around—the brain, vagina, microbiome, sexual health kind of link. So can you set a big picture of those links for us?

The Brain-Vagina-Gut Connection

Dr. Betsy Greenleaf: Yeah, so, you know, it’s really interesting because we—especially in Western medicine—tend to compartmentalize our body. You know, you go to the cardiologist for your heart, you go to an endocrinologist for your diabetes, you go to a podiatrist for your foot—when a lot of the processes that are affecting your heart and your diabetes and your foot and your bladder are all connected. So it’s funny that, like, now we’re kind of taking a step back, and we’re going, wait a minute—there are connections. A lot of the integrative and functional wellness world—we’re talking about the gut-brain connection—where we’re really finding out that there are so many more interactions. And in my field, there is, like, a vagina-gut-brain connection.

How Microbes Influence Health

Dr. Betsy Greenleaf: And so really, through the microbes that are on and within our body—this is affecting our thought process, it’s affecting our sex drive, it’s affecting our fertility, it’s affecting our down-there comfort—so itching, burning, discharge, recurrent urinary tract infections, recurrent vaginal infections. You know, a lot of times, we’re just slapping medicines and pills and trying to fix it that way—when if we don’t really get to the root cause and find the connection between all these areas, we’re just kind of spinning our wheels.

Dr. Diane Mueller: And so then how is that really—you know, it’s, like, obviously if somebody is having, say, pain and discomfort—like, nobody with, like, that’s having any sort of itching or any pain or any other vaginal issues is obviously going to be motivated, typically, to have sex, right? Because it doesn’t feel very, very great. But besides that, like, what are there—some of the deeper links there that are really driving those types of abnormalities you’re talking about with, like, gosh, I just really—I’m just not in the mood?

Inflammation and Libido

Dr. Betsy Greenleaf: Yeah, well, you know how the gut and the vagina and the brain are connected when it comes to libido—I always tell patients, first of all, number one, your brain is your most important sex organ. If your brain is not there, nothing’s going to happen. But then it depends on where we—you know, where we start, refocus. There’s also tons of research that shows if the microbiomes—or the microbes—in our gut or the microbes in our vagina, if they’re off, these are creating low-level inflammation that the body’s sensing. And the body is incredibly, incredibly smart, and it goes, wait a minute—if things are not quite right or quite optimal, maybe it isn’t the time to be reproducing, maybe it isn’t the time to be having babies.

Dr. Betsy Greenleaf: And so the body is sensing this without us even knowing—and so it’s really kind of miraculous and—but frustrating at the same time—because we, you know, if we’re looking at, like, well, we don’t have a sex drive, or we’re suffering with fertility issues, and we’re, like, you know, what’s wrong with me, how do I fix it—and we’re not consciously, you know, sensing it—we kind of need to look at these areas. But what the body is doing is it goes, all right, it’s not an ideal time—we’re not in a current position where things are balanced—and so we’re going to shut down the processes of reproduction. And I always say—your brain doesn’t know the difference between you just want to have some sexy fun versus you’re actually trying to make another human being.

Dr. Betsy Greenleaf: And so the brain just goes, okay, you know what—things aren’t right in the gut, things aren’t right in the vagina, there’s inflammation in the body—we need to hold on to all our resources to fight whatever’s happening, and we don’t have any extra to put into sex drive, fertility, libido, you know, periods—you know, sometimes even, like, the period being thrown off may be a sign that something like this is going on. In men, it could be erectile dysfunction—like, all these processes start going away because the body goes, you know what, those are extra—those I don’t need necessarily right today in this moment to give birth to survive—but I do need to survive. So the body is going, let’s put all our resources into whatever I gotta do to survive, and it’s going to take away from the sex.

Dr. Betsy Greenleaf: And I always kind of connect that—sex and stress can’t coexist. So when the body’s under stress—whether that’s emotional stress or physical stress from a dis-ease state—and the microbiome—I don’t like to use the word “disease”—it’s, you know, I like the “dis-ease” better, you know, that pronunciation—because it’s not, like, you’re diseased—but when things are just not right, the body’s going to go, okay, well, we’re just going to—we’re just gonna put things on the side, we’ll table that for right now.

Dr. Diane Mueller: Yeah, yeah, it’s, like, so amazing to me—I think it’s so easy to forget, right? In our modern-day society, we feel like we’re so far away from, like, the hunter-gatherer days—so it’s very easy, I think, for people to just forget that despite the fact that we have running water and electricity, AI now, and all these, like, you know, cool new technological advances—we are still functioning, like, we are in many ways, like, we’re still in those hunter-gatherer types of days—like, a lot of this—the way the body responds—is so similar. So those are such good points.

The Role of Vaginal pH

Dr. Diane Mueller: And I want to make sure we get to the pH—because I know that’s a huge part of what you do in your work too—around just, like, one way of keeping the vagina healthy, of keeping the microbiome healthy—which is, of course, as you’re saying, related to sex drive, related to that desire, related to all of that—and so many people have these, like, slightly dysfunctional vaginal pHs. So can you talk about, like, why that’s so important and how that plays into this whole picture?

Dr. Betsy Greenleaf: Sure. The pH—that’s the acid-base balance of a solution—and the pH of the vagina is directly related to vaginal health. So what happens is the vagina is very acidic—and we look at pH—so pH of water is 7, and that’s right in the middle of the pH scale, which is from 0 to 14—but the vagina is around 3 to 4—3 to 4.5. So if it’s—and why it’s that—is because it’s a direct measurement that there’s health—the presence of healthy bacteria. And so what ends up happening is when there’s healthy bacteria that is present, the healthy bacteria—as it’s kind of living off of our tissue, which sounds kind of gross—but we have, you know, bacteria all over—we’re covered—it’s on our bodies, it’s in our body—we could actually not live if it wasn’t for bacteria—we need it—like, some of us are, like, ew, germs—and I was the mom who ran behind my kids with the hand sanitizer—was probably the worst thing I ever did for their immunity—because we need these bacteria.

How pH Maintains Balance

Dr. Betsy Greenleaf: And so it’s the presence of this bacteria living off our cells that produces hydrogen peroxide in the vagina. And hydrogen peroxide—the presence of hydrogen peroxide in the vagina—makes the vagina more acidic, and that, in turn, chases away the bad guys. So bad guys don’t want to come in if it’s too acidic—it’s, like, you know, I don’t like it, it’s not a good situation for me. But once we lose that healthy bacteria, now we start seeing shifts in the pH—and once we see shifts in the pH, the bad guys are, like, all right, now I can move in, you know—and once I move in, they invite all their friends. And so usually—usually not one bacteria—it’s usually a whole host, and the neighborhood goes down from there.

So—love the best analogies—yeah, yeah—so—and there’s, you know, people are, like, well, what changes the pH? There’s so many different things that can change the pH—some of it is hormonal-related—so some of it we don’t have a lot of control—like pregnancy, breastfeeding, birth control—and birth control also affects the microbiome of the gut—so it’s got—it’s got two bad things—it’s messing up the vagina, and it’s messing up the gut—nice not to get pregnant—but hormonal birth control is going to screw up those other areas.

pH Challenges in Menopause

Dr. Betsy Greenleaf: And menopause—unfortunately, menopause is really a problem—and going back evolutionarily, we probably were not meant to live past our reproductive years—but now we’re only spending—if you think about the lifespan of humans, especially women—we’re living into our 80s and 90s, and our reproductive years are really only from our early teens to, like, 30, 40, 50-ish—so out of our whole lifespan, we’re spending very little time in that hormonally, you know, abundant time period. So as we get older, we’re going to see more problems related to this—but thank goodness, because of modern medicine, we can extend our lives and be using hormones—and there’s regenerative therapies for the vagina that can keep the pH in balance—but the pH is actually a quick and easy way to directly measure the health of the vagina.

Dr. Betsy Greenleaf: And, interesting enough—I do have—there’s some amazing courses out there—wink, wink—on how to reboot that pH—so—and information about Dr. Betsy’s courses, you guys—we’ll make sure that those are in her show notes here—and so you’re using—you’re actually using pH, like, strips, right, into—for people as well—a way for—there’s a home way of measuring this, right?

Testing pH at Home

Dr. Betsy Greenleaf: Yeah, and you know what—I do caution people—just like I caution people when it comes to buying supplements—I know a lot of people love Amazon—I joke with my husband all the time that Amazon is my new boyfriend because they’re here every single day—I have a very intimate relationship with Amazon—but I will highly recommend not to buy personal products—vitamins, you know, testing strips, all these kinds of things—off of Amazon—because they know for a fact that there are counterfeits, and you might not be getting exactly what you’re buying. So I would look at these things from some trusted sources—you know, I know that we carry some pH paper as part of our vaginal reboot kit on the Pelvic Floor Store—so that’s, you know, pH paper that I, like, searched out, that I know is reliable.

Dr. Betsy Greenleaf: Because that’s the thing—it’s such a small window—I mean, it’s not like going and testing your pool water—where I think the pool—and I don’t do this, so forgive me if I get it wrong—I know my husband does this—but, you know, I think there’s a bigger range of that test paper—I think it’s, like, 0 to 10—so the bigger the range of the test paper, the less accurate it is—so you want to get paper that’s in a smaller range—in the range that you’re looking for—and even then, there can be slight differences if the paper is old or if the paper has been exposed to moisture—because a lot of people want to store this stuff in the bathroom—like, not ideal to store the pH paper in the bathroom—because it’s exposed to moisture, and it affects the pH—the paper itself—if the paper’s too old—you know, these papers are very sensitive—so you want to make sure you have quality paper, the right paper, the right range.

Dr. Diane Mueller: Yeah, yeah—I tell people all the time that it’s, like, really—like supplements and these lab tests and all of it that we do in our world, right—it’s, like, really comes down to the quality, but also comes down to the interpretation, right? And so understanding that as well is super important.

The Brain, Microbiome, and Neurotransmitters

Dr. Diane Mueller: And we just have a little bit of time left, so I want to make sure to also connect the microbiome and the brain as far as, like, a little bit more on, like, neurotransmitters and the drive—because we obviously know if, like, the brain’s healthy and happy, like, that is gonna impact sex drive, right—like grass—and we see that, of course, with, like, with anything—when we’re throwing the brain chemistry off—whether it’s through depression or also when trying to fix depression with things like serotonin drugs, like SSRIs—that brain chemistry can really throw off our drive—so connect that a little more with brain chemistry, microbiome, and sexuality, if you would.

Dr. Betsy Greenleaf: Yeah, so it’s so interesting—like, they’re finding out the different microbes in the intestines that affect our different—they’re actually looking at them as they’re our puppet masters—and so, combination of a whole bunch of things—like, we know our neurotransmitters are made in our gut—they actually say that—like, I’ve heard in the past them referring to the gut as a second brain, but now people are starting to say, no, it’s the first brain—and it’s actually our brain that’s perceiving what the gut is doing—because 90 to 95% of our happy hormone—serotonin—is made in the gut.

Dr. Betsy Greenleaf: So I see time and time again—women who are on medications for depression, anxiety—which unfortunately drastically affect sex drive—but I see a lot of them where they don’t—it’s not really helping with anxiety and depression—because that’s not where the source is—we need to be getting a better gut diversity of microbes and the right microbes in the gut and getting rid of the bad microbes. So we have that—we have that it’s affecting our other neurotransmitters—like our pain receptors—which can add to pelvic pain—and we see pelvic pain conditions—like interstitial cystitis and vulvodynia—drastically being associated with gut health—and people in the past, you know, didn’t really make that connection.

Dr. Betsy Greenleaf: So there’s so many things—and even hormones—a lot of times, we blame it on hormones, and we’re, like, oh, just take more hormones—well, if the gut is off, our hormones aren’t going to balance—and also, we need a healthy gut for processing of our hormones—because we do excrete estrogen, specifically, in our stool—and if we’re constipated because our microbiome is off, we could be reabsorbing some of our estrogen and recirculating—and now we get a whole host of—you know, if estrogen’s too high, we’re more prone to mood issues or even, you know, sexual dysfunction and also pain conditions—so it’s so just amazing how everything is so intertwined.

Conclusion and Wrap Up

Dr. Diane Mueller: It is—and I think that’s—I’m hoping that’s one of the biggest things that everybody’s really taking away from this talk—is, like, we really need to—when we’re talking about sexuality, when we’re talking about things like vaginal health—we really need to stop looking just in these areas, right? Because everywhere in the body can be connected. And in the show notes from today’s episode, you guys—you’re going to see something that is super exciting that I said at the beginning of this interview—which is Dr. Betsy and I are putting together this summit—it’s totally free—and we’re gonna go into this topic with Dr. Betsy even more—she’s going to talk a lot about the gut and how that’s interplayed with this, how to get more lab testing to see if these are the problems—because if everything’s connected, we don’t know what the problem is unless we test—so we’re going to go into that and so much more in the Sexual Health Summit—totally free—sign up in the show notes.

Dr. Diane Mueller: And just to make sure we’re wrapping this up nicely—tell everybody how they get a hold of you—which we will also put in the show notes.

Dr. Betsy Greenleaf: Yeah—well, first of all, I definitely highly encourage you guys—because we’ve been working on this summit, and the interviews are—I’m even blown away with the experts that we’ve been interviewing, and I’ve been learning so much—so—other places you can find me—social media—anywhere and everywhere—like, especially if you like funny videos—I have a quirky sense of humor—so if you have a quirky sense of humor, come along. Other places are the Pelvic Floor Store—I have a discount too for 10% off—it’ll be LIBIDOLOUNGE10—I’ll get you that link—and then we have courses—and there’s—and you can go to drbetsygreenleaf.com to see links to podcasts and internet shows that I have done—so that are really informative also.

Dr. Diane Mueller: Perfect—well, thank you so much for your time today, and thank you, everybody—we’ll see you next time for our next Libido Lounge episode—bye-bye! Thank you for listening to the Libido Lounge. Please don’t keep me a secret—please share this with your friends. You can find me on YouTube, on Instagram, as well as the Modern Libido Club—for so much more!