The Vaginal Microbiome: Why Hormones Aren’t Working and What You’re Missing

What’s Inside This Episode?

• Normal estrogen… but persistent dryness
• Why UTIs keep coming back
• When pH—not hormones—is the issue
• The key Lactobacillus strains that matter
• How antibiotics and HRT disrupt the ecosystem
• Urgency and leakage that aren’t a bladder problem
• The link to fertility, aging, and tissue health
• Why systemic protocols fail when the issue is local

Resources and Links

• Download the Full Transcript
• Download our FREE Metabolic Health Guide here.  
• Join the Next-Level Health Practitioner Facebook group here for free resources and community support
• Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results. 
• Check out other podcast episodes here

Dr Anna’s Resources and Links

• Dr Anna’s Website: https://drannacabeca.com

• Check out Dr Anna’s products

• Find her on Social Media 

  • Facebook

  • YouTube: The Girlfriend Doctor: 

  • TikTok

  • Podcast

Labs & Testing Mentioned in This Episode

These tools go beyond traditional testing (HPV, chlamydia, gonorrhea, trichomonas) and help assess overall vaginal microbiome balance, including beneficial Lactobacillus species.

• MDL (Medical Diagnostic Laboratories) – Vaginal testing that includes both pathogenic organisms and beneficial bacteria
• BiomeFX Vaginal Microbiome Kit – Advanced microbiome analysis to assess vaginal bacterial balance
• Tiny Health Vaginal Microbiome Test – At-home testing option for evaluating vaginal microbial health

Guest Bio

Anna Cabeca, DO, OBGYN, FACOG, is best selling author of The Hormone Fix and Keto-Green 16 and MenuPause. Dr. Anna is triple-board certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. 

She lectures frequently on those topics and shares the secret behind the ebb and flow of intimacy as she demystifies the fascinating hormonal changes over time. She will help you discover how the “love hormone”, Oxytocin can breathe life into your relationship, and how Cortisol can take it away – and how the delicate balancing act of those hormones can reignite your libido and support a healthy relationship, most importantly the one you have with yourself.

She is sassy, blunt, speaks from the heart and has a wonderful sense of humor, and this is why we call her The Girlfriend Doctor, because everyone needs a friend like her! 

She has personally developed natural products to help women balance hormones and thrive through menopause including the highly acclaimed Julva® cream for the vulva and MightyMaca® Plus, a powerful superfood blend.  She lives in Dallas with her daughters, horses and dogs.

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Transcript

 

Dr. Ritamarie Loscalzo  

What if some of the most frustrating symptoms that women experience like recurrent infections, dryness, discomfort, and hormone resistance aren't just hormonal? What if they're actually being driven by an ecosystem most practitioners were never even trained to assess? Because here's the truth, you can balance the hormones, you can optimize nutrition, you can even run advanced labs, and still miss the root cause if you're not looking at the vaginal microbiome. 

 

Today we're diving into a kind of sensitive topic. It's often overlooked, it's misunderstood, or it's simply ignored. And when you understand it, it can really change how you approach women's health. 

 

We talk a lot about the gut microbiome. You hear that all the time, but we don't talk enough about other microbiomes. The oral microbiome is coming to the forefront now, but there's another critical ecosystem that directly impacts hormone balance, immune function, inflammation, and even metabolic health, and that's the vaginal microbiome. 

 

So I'm excited to unpack this today with why it matters, why it's beyond local symptoms, and when to recognize when it's part of a picture that is putting this person in front of you as a client, as a patient, and what you can actually do about it in your practice. 

 

I'm super, super excited and honored to have here today my dear friend, Dr. Anna Cabeca. She is a triple board certified OB-GYN. She's a fellow of gynecology and obstetrics. She's an integrative medicine guru and anti-aging regenerative medicine. She's got it all together.

 

She's a best-selling author. When I first met her, she didn't have any books to her name, and now she has The Hormone Fix, Keto Green 16, and MenuPause. She has advanced certifications in functional medicine, sexual health, and bioidentical hormone replacement, and she talks all around the world on women's health, hormones, and longevity. She now lives close to me, which we don't see each other, but she's known for being direct and honest. Yep, I will tell you, she had a direct conversation with me right before we started. 

 

She got right to the point about hormones and intimacy and all those things that most doctors shy away from them. We as practitioners, in holistic health, functional health, we need to be looking at the full body, right? 

 

She's affectionately called the girlfriend doctor and she's brilliant. She's kind, she's loving, and she's one of my favorite people in the world. Some of her products are like Julva, and she's going to talk about Mighty Maca Plus. These are all really great. So thank you for being here, Dr. Anna.

 

Dr Anna Cabeca (03:13)

It is my pleasure always to sit and to talk with you, and I can't wait to see you again and hug you. We're just reminiscing about your amazing conferences in person. I remember I was saying, you were the first email list that I subscribed to. I read your email letters. So much knowledge and so much information. Thank you. Thank you for everything.

 

Dr. Ritamarie Loscalzo (03:38)

Wow. Things have changed a bit since then, but that's awesome. I always love when you say that. I've heard you say that a number of times, and I never get tired of hearing it. So keep saying it anytime. 

 

So what got you so excited about working in this area? Women's health is common, everybody's working on it, but really vaginal health, and sexual health, and all this great stuff. Tell us a little bit about that background, and then we'll talk about the microbiome.

 

Dr Anna Cabeca (04:02)

It's been the neglected piece, right? And I would say way back, I trained at Emory University in OBGYN. I did my residency there, and then I went into private practice in southeast Georgia. One of my first patients, she was in 1999. She was a 63 year old woman, five foot ten, hundred and fifty pounds, again, salt and pepper hair, black horn-rimmed glasses, president of a biotech firm, and she came into my office. Very intimidating, right? 

 

I was 30 something, young 30s. And, this beautiful woman says, I've been diagnosed with DCIS. The doctors at Emory said I can't have any hormones. I'm dry. It hurts to have sex. I love my husband, but I'd rather die than live this way. I'm a woman of the 60s. Sex is important to me.

 

And so I was like, okay, first I was intimidated.  I'm going to find an answer for her. I joke, I say, I looked at my doctor's bag, and I looked, and I looked, and there was nothing there. I didn't have anything. What do we give someone? She was not breast cancer, but she was DCIS, and we treat them like breast cancer. So, what do I do? What did the research show? And because she was the president of this biotech firm, and she was highly intelligent, she brought me research.

 

We asked questions, we started digging, and I knew I could use vaginal something, like addressing vaginal atrophy, realizing that it comes down to three main reasons that we lose intimacy. It's either issues of discomfort, and that's one thing that she was having, and that was also resulting in a secondary issue called disconnect. We're not connected, we're becoming roommates. We're no longer having this playful fun. And then issues of desire, there's no desire there to begin with anymore.

 

So, we look at these underlying reasons, this discomfort, and we started to really address it with topical hormones. DHEA, that's how I started compounding DHEA, testosterone, estrogen, progesterone. The vagina is so good. It's a good receptacle for everything hormones, and it really turned her life around.

 

I followed her all through the years, and at 73, her bones were as good as they were at 63. And at 83, she was reading her memoirs of a book she published. I mean, she was a fantastic person. She just really held my feet to the fire and said, “Doctor, help me.” And I knew that was my job. And so I took that very seriously. And then I saw patients in southeast Georgia, in McIntosh County. 

 

In my first year in private solo practice, I had a beautiful 70-year-old woman who came in, and I diagnosed vaginal cancer. Another one in her 50s with vulvar cancer. These women were told they didn't need to be evaluated, but they were having such itching, burning pain, discomfort, they came in to be seen. And I'm like, of course, we're going to do a pap smear, right?

 

I am a very big advocate of not following the ACOG guidelines on pap smears. I mean, we really have to look at what our true risks are, evaluate that. And it is easy to screen for cervical dysplasia, and catching it when it's cervical dysplasia will protect us from getting cervical cancer and is completely preventable.

 

So I really became an advocate of that and then incontinence. As I started to learn about the vaginal microbiome, I was like, that's such a missing piece in everything, not just the vaginal microbiome but the bladder microbiome. Who knew certain bacteria, or loss of certain bacteria was associated with urgency and incontinence? Are you kidding me?

 

This is so important, and we're just really only recognizing this over the past few years, past several years. I know for years I have been trying to get a vaginally targeted probiotic. And finally, we have options.

 

Dr. Ritamarie Loscalzo (08:26)

How do you know? Is there a test that people can do to know, because it could be the burning from vaginal atrophy or from menopause, and how do we as clinicians know how to guide people?

 

Dr Anna Cabeca (08:40)

Well, this is where we really need to keep demanding more studies and research. But this is what I know from being in the space and working with vaginal hormones a long time. 

 

So to give you some perspective, I started treating topically with my product, Julva, which is DHEA implant stem cells. We would see this complete improvement in the vulvar tissue, elasticity, and a decrease in urinary tract infections, a decrease in incontinence. I'm like, okay, that's a good hormonal milieu, and that helps healthy bacteria, but there are some people that were still having trouble, still having difficulty. I'm like, okay, we'll keep doing what we can do. Then I add the vaginal targeted probiotic, and patients are telling me, I sleep through the night. I don't get up with having to pee at 3 a.m. We had really worked on the hormonal piece, but we had to recolonize the healthy bacteria, the lactobacillus species, specifically, L. crispatus, L. rhamnosus, L. jensenii, L. gasseri, L. iners. Those five key strains are important for both the vagina and the bladder and the urethra. There's actually a term, the urobiome. I just learned that there was a term called the urobiome. 

 

I know we need to coin the term the vagibiomo. How's your vagibiomo doing Ritamarie? There we go. 

 

I started thinking about this even more over the past year and thinking, If we have had antibiotics, how many of us haven't been treated with Flagyl and antifungals, antibiotics, we eat out, and we get a dose of antibiotics, we know it screws up our gut, right? It causes dysbiosis, and that affects our immune system and again, all those issues. But it's also affecting the vaginal biome.

 

So if we've completely killed off the healthy vaginal lactobacillus, as much hormones as I give vaginally, it's not going, it's like there's no lactobacillus to repopulate. You have to always heal the gut, but then really give these targeted microbes. So with microbiome, vaginally targeted microbiome testing, there's a few companies that are doing it now, but we didn't have this 15 years ago. 

 

We can only look at pathologic. We could only look at pathology. We could only test for HPV, chlamydia, gonorrhea, and trichomonas. You do it with a swab. And now we can send it. It's still way too expensive, and companies need to get better. I'm really trying to work with a company to please, let's make this affordable that we can, patients can, do it at home and really make sure that we're healthy, because for pregnancy, the vaginal microbiome makes a difference. 

 

For incontinence issues, for our ladies in nursing homes, that makes a difference. 

Let's address the hormonal, get the good tissue, the good glandular, and let's repopulate the city. Let's repopulate the citadel, let's call it. 

 

Dr. Ritamarie Loscalzo (11:46)

Get the good guys in there. You're doing all the stuff hormonally, what happens if the microbiome's not there? Say you're doing vaginal hormones, and you're doing all the stuff, what happens? What's the mechanism that happens there?

 

Dr Anna Cabeca (12:01)

If we don't have the lactobacillus species, then we're not repopulating it. So it's just not there. And I'll tell you, I've tested, and this is where it was like, “My gosh! How come I didn't know this a long time ago?” How come we're not looking at this? 

 

A couple of clients who for a long time, Julva users on vaginal hormones, on bioidentical hormone therapy, were doing great, but just that there's that irritation,  discomfort. I'm like, okay, there's no infection here, but let's send off and see what's going on. Is there E. coli, or is there something bad? So we send off, and now we can do a vaginal culture for health, for the Lactobacillus crispatus, we can identify these species now. And three in a row came back negative. Negative. None. None.

 

Dr. Ritamarie Loscalzo (12:55)

Like negative for all those species? Wow.

 

Dr Anna Cabeca (12:59)

None. So not populating, I'm thinking, if we eat out, we have antibiotics. And in foods, what has glyphosate done to our vaginal microbiome? I don't know, we know it's really screwed up the gut. But, we need more information. And also you think of pads and tampons and chemicals and different things like that. But these were all three menopausal women that just didn't have it. 

 

Dr. Ritamarie Loscalzo (13:22)

But they had earlier, right? So how long would that imbalance last if somebody was using tampons in their 30s or 40s and now they're in their 60s or had been on birth control then and all that stuff? Because we know birth control wrecks with the gut microbiome. It makes sense that it would mess with the vaginal. 

 

So if someone is having these issues, and we just address them, we'll go the opposite direction. Just address the vaginal microbiome, will that help, or do they also need hormones? Does it affect the body's ability to utilize the lower dosages, so to speak, of hormones that we get in menopause?

 

Dr Anna Cabeca (14:04)

It's a really good question, Ritamarie. So I've done it backwards all this time, minus the things. I've had my crunchy, granola patients who have done the yogurt vaginal douches or putting cultured yogurt into the vagina to reseed it, like those things that especially clients with recurrent infections, those are things that historically have helped. So we knew there was a microbiome issue here.

 

Now we're in this state of, okay, what about if we repopulate. I always think these gut bacteria, and again to differentiate, gut bacteria is very critical. The vagina's an extension, but gut bacteria, higher diversity, that's good. Vagina, low diversity, predominantly these keystone lactobacilli species. 

 

If we have a lot of diversity in the vagina, it can cause infections, increased risk of HPV, increased risk of cervical cancer. 

 

Dr. Ritamarie Loscalzo (15:07)

Uusually high diversity in the gut is a good thing, but you're saying high diversity vaginally is not. Do some of those populate from the proximity of the openings?.

 

Dr Anna Cabeca (15:24)

Yes. We definitely see E. coli, and this is the next step in thinking. So addressing that vaginal, again, vaginal health, microbiome, I'm big on clitoris to anus. At least start with Julva, maybe we need some vaginal testosterone or estrogen added in, but at least start like clitoris to anus to help that glandular secretion and that can make a big difference. 

 

So address it hormonally, or pro hormonally, and repopulate with a good probiotic, targeted probiotic. And now I'm thinking, what do we need to do to treat our partners? Because technically, if you're having sex with a male partner, and he's got good lactobacilli, that should have seeded. That same species should be in the penile shaft of men.

 

Dr. Ritamarie Loscalzo (16:18)

Is it? Okay, got it. It makes sense that it would. Well, it's like with a fungal infection, you're going to treat both parties. Otherwise, it's just going to keep propagating. 

 

Dr Anna Cabeca (16:28)

And recurrent bacterial vaginosis, treat both partners. I read in the Green Journal, the Journal of OBGYN version upstairs, I have it, but it was on vitamin C vaginally for recurrent bacterial vaginosis. I was like, that's cool. That's really cool. So, you know, there's some of the things, but we do, again, vaginal probiotic, vaginally targeted probiotic, whether it's oral or inserted vaginally,get the hormones, the diet, nutrition, inflammation down.

 

Dr. Ritamarie Loscalzo (17:00)

So all the basic foundational stuff's neat. There's no magic bullet, take the vaginal stuff, and it's going to be fine. Treat the male partner. 

 

So if we're talking to somebody, and they have other symptoms, maybe they don't have those local symptoms. Are there cases where we could tell, based on their gut microbiome and lung stuff,  whether they might have an issue there, or is it really mostly local urgency?

 

Dr Anna Cabeca (17:28)

I think urgency, urinary urgency, nocturia, getting up at night to use the restroom, and incontinence, whether it's cough, sneeze. I think those issues are associated. Now we know that those issues are associated with loss of these protective colonies of microbiome of Lactobacilli. Urgency,  and incontinence.

 

Dr. Ritamarie Loscalzo (17:53)

Well, we know estrogen. We think about estrogen and doing it around the urethro opening and all, DHEA, interesting.

 

Dr Anna Cabeca (18:01)

Yep. And the DHEA, but the microbiome, here it comes in again to save the day.

 

Dr. Ritamarie Loscalzo (18:09)

Wow. We know bugs are important. We have a phobia of bugs. Bacteria and all that in our society, but there's that importance of having the gut, the vagina, the sinuses, even the oral microbiome is getting more and more popular, especially linked to cardiovascular disease. 

 

So, looking at our coexistence with our friendly little bacteria and having the right ones in the right places makes a whole lot of sense.

 

Dr Anna Cabeca (18:36)

It's really so cool. I think we're finally making advances in women's health. We're really understanding that we can make a huge difference in quantity of life, because asymptomatic urinary tract infections is a cause for misdiagnosis of dementia, that foggy brain, and then you're getting up in the middle of the night to use the bathroom, and what happens? You trip and fall and get a hip fracture and then what's the staggering statistics of 70% death within the first year? 

 

So I mean these are terrible things. Bladder health and vaginal health is really critical. 

 

Anyone listening, I want to get into a nursing home with Julva and my VB probiotic and just do an experiment, and let's get women on it, and let's see if we can't reduce incontinence issues and infections just in this very fragile population that's constantly getting antibiotics, or you know so much else. Maybe we can improve some quality of life, at least comfort from this perspective. 

 

So there's so much related to this that I'm really excited about. I'm more excited now than ever. I don't have to keep scratching my head when I have clients with a bacterial vaginitis. I don't see anything bad, but we don't see anything bad. There’s no… and how many times have I overtreated them as a young resident, or as an OB-GYN? ‘Oh, we’ll just give you Flagyl and see if that helps the symptoms, or the urinary symptoms of a UTI. Let’s just give you an antibiotic.’ Versus, ‘We’ll do D-mannose. We’ll do vitamin C. We'll do the cranberry extract, and let's add the lactobacilli species. Let's add these keystone species and really improve our defense mechanisms. That's the first line of defense. 

 

We really need to start looking at that everywhere, and we know that there's certain species, certain lactobacilli strains, that are associated with higher fertility, and if you don't have them, it's lower fertility. So that's fascinating too.

 

Dr. Ritamarie Loscalzo (20:51)

Interesting, and we have such a high rate of infertility these days in men and women. Right? 

 

So a couple of things that brings up. One is if someone is aware, and they're taking probiotics and eating sauerkraut and yogurt and all this stuff to feed their gut microbiome. Is that enough, or do we have to recommend, or is it recommended to recommend the more specific species of a vaginal probiotic?

 

I'm assuming they're having some issues down there.

 

Dr Anna Cabeca (21:24)

I don't know. And again, everything we're sharing really is such cutting edge information. Everyone listening is ahead of 99% of the population, especially the medical population, but one thing is that it's a really good question. 

 

If we give straight lactobacillus acidophilus, is that going to really help? How? Because we've been doing that for years, right? We've been given lactobacillus, bifidobacter, we've been doing these oral strains, but until we give these keystone strains that can make a difference. 

 

There's really six. So L. reuteri, which we know from good old Dr. William Davis, increases oxytocin, it's my favorite one, that can be beneficial.

 

But Lactobacillus rhamnosus is a keystone, and Lactobacillus crispatus is a keystone—and iners, jensenii, and gasseri, if I said those correctly. So Lactobacillus iners, Lactobacillus jensenii, and Lactobacillus gasseri. Those are the strains most associated with healthy vaginal and urological states.

 

Dr. Ritamarie Loscalzo (22:38)

Great to know, and I'll ask you a leading question. How do we find those? Is there a specific supplement out there that has these in it? Tell us more. 

 

Dr Anna Cabeca (22:50)

I kept working, what do you say, banging my head on the wall for years, and kept asking different companies to produce one. And so I really worked with a company to get this strain brought to the public, and it's in oral form. So the lactobacillus, so I call it my VB vaginal bladder health probiotic, VB Probiotic, and it is a complementary strain, those five keystone strains plus cranberry extract, because many clients have the UTI issues, and cranberry extract can really help binding to the bacteria. 

 

So you're getting out the bad, adding in the good. So that's the goal with that combination, and it's working really, really well. 

 

About a year ago, the company called Seed created VS01, which is a vaginally inserted probiotic. So you initially do it a couple times a week, and then it goes to maintenance at a couple times a month, and these are tablets inserted vaginally that have had good results, too. 

 

Dr. Ritamarie Loscalzo (23:57)

Great. So they break down, it's obvious how they work, the mechanism. We take probiotics, goes through our digestive tract. It might be killed off in the upper part by the acids and the enzymes and all, but they do make it to the large intestine. We know that. 

 

But how does this work? They're not connected. So is it going into the blood?

 

Dr Anna Cabeca (24:20)

It's crossing crossing through the lymphatic chains and going into the vagina. It's fascinating. I would like to see that pathway. Like bravo, little guys.

 

Dr. Ritamarie Loscalzo (24:27)

Wow, I want to figure out how they do it, right? Because it's a long way.

 

Dr Anna Cabeca (24:36)

They're determined. Well, first I was skeptical. I mean, it's easy to do things orally than doing things vaginally, but it's just as easy. 

 

I was skeptical initially, but I've tested and tested and tested patients on the oral probiotic and they do great. Especially if you're having issues, it doesn't hurt to insert one or two vaginally a couple times a week just to get that directly where it needs to, especially if we've done all the work to get the hormones right, the pH right and all that good stuff. And with my VB formula, you'll get a pinkish discharge, because of the cranberry extract.

 

And Microbiome Labs created their vaginal balance probiotic and their pregnancy support probiotic. So we've got these good options to use now. But I've seen improvements. I've seen improvements with the vaginal culture. So a lot of times in clinic, we just use MDL, because that's the one we've had the most experience with, MDL.

 

Dr. Ritamarie Loscalzo (25:38)

MDL, that's the lab. So I'm going to reach out to you and get the names of some of these labs, so we can put them in the show notes.

 

Dr Anna Cabeca (25:43)

MDL is one of the standard labs that we've used for a while, and now it's testing for the good bacteria, too, not just the bad stuff. It used to just be the bad stuff and now it's testing for the good, too. And then there's the Vaginal, there's BiomeFx Vaginal Kit, and then there's TinyHealth Vaginal Kit. So those are the three companies that I know that are doing this testing now.

 

Dr. Ritamarie Loscalzo (26:10)

It used to be just for the pathogenics. Got it. 

 

So if someone is presenting, and they're saying, oh, menopause has been a killer, and I have all the discomfort down there, and sex hurts, and I have no lubrication, and all that. I mean, you typically start with all the hormonal stuff, but if they were to say, let me give this a try, or they're already doing some of the hormonal stuff, just get some vaginal, use it, or take it orally, how quickly would they expect to see some shifts.

 

Dr Anna Cabeca (26:38)

Well, I tell you, I have heard back from so many clients that they find a difference within a couple weeks, and that's really, really nice. This is pretty new in my ecosystem. We've had it out for a few months in my private community, and we just launched it to my full list last month, so we're getting a lot more feedback now

 

Dr. Ritamarie Loscalzo (27:03)

Nice. I'm a big fan of bugs, right? I'm a big fan of getting all of it on the skin, and the nasal passages, and all those places need to, and especially someone like me with a particular FUT2 gene, a lot of them, that my body, I just need to have a constant influx of the probiotics or else it's going to go down.

 

This is certainly something to look at, and something to look at in the clients that we see coming in, because our postmenopausal clients, or almost all of them, are having trouble with waking up three times in the middle of the night, and the incontinence, and the sex drive. Well, not as much the sex drive as the sex ability or willingness to deal with the pain, right?

 

Dr Anna Cabeca (27:54)

Right. And they should never have pain. No one should ever have pain. I've seen some really challenging situations where I was able to reverse it, even in the case of lichen sclerosis. I also think the probiotics are, these targeted probiotics, are going to help with lichen sclerosis, too. I only a couple of clients that I've used vaginal probiotics with lichen on, and one is in complete remission, and the other, she's just been doing it for a couple months so far. So we'll see, but I think that's going to make a really big difference. 

 

I would say it benefits all of us. I think of my daughter, she's a rodeo champion. We'll be going to the Texas State rodeo finals, and she will eat Chick-fil-A. I'm like, okay, so she's getting antibiotics every time she eats that, right? And not to mention, I don't know about her Dr. Pepper she's drinking, but we're still working on her.

 

Mostly she's good, but there's those rodeo meals. I think she's getting a dose of antibiotics. So I give her the probiotic periodically, and I think that makes a difference. And I think for us, too, depending on how we're maintaining our health. I'm not sure how frequently we're going to need it. 

 

Once we reseed, are we good? Or are we still doing something that's killing off our vaginal bugs?

 

Well, and that's another thing why I was really big on creating a clean lubricant that won't kill the vaginal bug, so my Velvé lubricant, so we now got this FDA cleared, and it's just aloe and hyaluronic acid and in a water base, and it's just very, very clean. I can feel good for clients that can worry about everything we put on our skin, but then the garbage that's in lube is disgusting. 

 

So this is clean. Again, we want to keep the bugs healthy and happy. The good ones out.

 

Dr. Ritamarie Loscalzo (29:52)

Absolutely. You want to keep the good guys in and the bad guys out. And you said, I just want to get an idea. If you had your druthers, right? Which way to do it orally or vaginally? Some people won't do it vaginally, some, but which way do you think is going to be more efficacious?

 

Dr Anna Cabeca (30:10)

I've tried it both ways, and I honestly couldn't tell the difference. The thing for me is compliance. I can't remember the last time I used a probiotic vaginally. You know, I'm doing my Julva, getting that in the vulvar vaginal area. I'm doing other stuff, but it's just not something I think, okay, let me go and get the vaginal probiotic versus I put the VB probiotic in my vitamin box. So it's easy to take. 

 

Dr. Ritamarie Loscalzo (30:45)

So it's easy to take, but if you're taking it vaginally, is it something where you have to put it in and then just lay with your legs up in the air for hours?

 

Dr Anna Cabeca (30:54)

Leave it. No, just as if we were to use vaginal hormones, even progesterone, or whatever. No, you just remember to do it. So if you're using the VB probiotic in the capsule, it's just a gelatin capsule. It completely dissolves in the vagina. For mine, no, but you may notice a little discharge.

Whitish or pinkish discharge and that's, still getting the good probiotic in there. I think depending on the situation, using it vaginally may give us better results, but I mean quicker results? I don’t know. 

 

Dr. Ritamarie Loscalzo (31:35)

You don't know. And then what about frequency? Like you said, maybe we get to a point where it's maintenance, but when somebody is dealing with vaginal atrophy and urgency?

 

Dr Anna Cabeca (31:45)

I think the older we are, the more challenging it is to reseed that good probiotic, just like we find with hormones. So if we don't have the good hormones on board, it's going to be harder to reseed. There's some clients right now that I have that have had urgency symptoms and recurrent UTIs. I just have them on two of the capsules a day, and we're going to see two months, three months, as long as there's no UTI, everything's good, repeat cultures are healthy. I will have them take a break.

 

I would think it's like one of those things every time the season changes. Let's just get some extra vaginal probiotic in there, but I don't have it, there's not really good data on this, yet, as far as that. 

 

I think it really does depend on sexual activity, are we using condoms and KY jelly? What else is going on dietary nutrition, on hormones, not on hormones? So, but in general, I don't think we can hurt, it can't hurt us.

 

Dr. Ritamarie Loscalzo (33:00)

I mean, it's hard to do too much, right? Now, will some of those organisms colonize the gut, or do they not make it down all the way there, or how does that work? I mean, it wouldn't hurt to colonize unless somebody has SIBO that might be a problem. L rhamnosus, L. reuteri , I think those are pretty safe with SIBO. Interesting. Interesting.

 

Dr Anna Cabeca (33:30)

No, we should get that diversity added into the GI tract. Somehow it's getting into the vagina. 

 

Dr. Ritamarie Loscalzo (33:36)

I see a lot of L. reuteri  low, so it's interesting to know. When I'm doing stool cultures, I see L. reuteri  low. I see L. reuteri  low, a lot. I see Rhamnosus low sometimes, gasseri, I haven't seen, I don't know.

 

Dr Anna Cabeca (33:52)

It's interesting for me, why are these strains in the urethra and the bladder and the vagina and then, the penis too, from what I understand, again, I do mostly female health. So, how did these strains, and the decrease in diversity, why is that so important? It's so interesting to me to see. 

 

Dr. Ritamarie Loscalzo (34:16)

Totally it is. There's a lot in the mouth. I mean, I've done oral microbiome tests, and there's a lot of diversity there. Interesting. 

 

One last question for you. Do people see when they start to recolonize, do they see a shift in sexual desire, sex performance, et cetera?.

 

Dr Anna Cabeca (34:37)

Well, I will tell you, because I've been having this question a lot lately, I'm really wanting to understand how we can help. How can I be of more help, right? 

 

So I had this lovely patient in my office, and I shared her, she let me share her video on my Instagram. And she's 74 years old, she's been married 50 years, Ritamarie, God bless her, right? She's been in our functional medicine practice for years before, but I started seeing her over a year ago. 

 

I asked her, well, you've been married 50 years. How's intimacy? Are you having sex? How's sex? And she goes, let me tell you, Dr. Anna. So for the first 25 years, it was OK. The next however many years, it was OK. But this last year, it's been indescribable. It's been so much better, because we fixed things down there. 

 

So it was just a small shift of applying locally. So for me, it was just adding the VB probiotic, adding the Julva, and really focusing on those issues that made the difference. I'm trying to think, she already was on bioidentical hormone therapy. I may have tweaked it a little but just addressing the local tissue is so important. You can be on hormones, but if you're not addressing the local tissue, there's going to be discomfort. And I was like, well, how has that changed your relationship? She goes, we are so much more connected and intimate after 50 years of marriage. 

 

I know, I know it just inspires me so much, right?

 

Dr. Ritamarie Loscalzo (36:12)

That's beautiful. That's so beautiful. That makes me cry. Yes, that's great. And you said oxytocin does, I forget what you said the relationship was early on about oxytocin increases. Well, the relationship would increase, but on both sides, did they both do the probiotic?

 

Dr Anna Cabeca (36:22)

I think definitely the relationship increased in the last year. 

 

I don't take care of him, so I don't know what he's doing, but apparently he's 74, and he's doing great. 

 

Dr. Ritamarie Loscalzo (36:32)

That's pretty darn good. That's awesome. That's awesome. Anything you want to leave us with. 

 

Dr Anna Cabeca (37:47)

Sometimes we hit a certain age, and people think I  doubt they're having sex anymore. They're not going to have issues with it. or should we even address it as a medical provider? 

 

Please ask these questions, because this disconnect, or lack of intimacy, is a sign of other things, and it flows over into other areas of our lives, and there's no age limit. 

 

And again, I had another conversation with a woman today who just turned 70, and she does a lot of energy work, and energy healing, and her husband passed away four years ago. And I said, well, how are you keeping up with your sexual energy? How are you using it? Because I continuously focus on the pelvic bowl, the sacral chakra, really developing and moving that energy, because that is our creative life force energy, and that will spill into other areas of our life. The key thing is that we're healthy and addressing these issues and having these conversations, because you never know what life brings you.

 

Dr. Ritamarie Loscalzo (37:57)

I love it. And what's bringing up for me is not being afraid to ask the questions, right? To really ask. A lot of times we're like, I'm not going to ask them about that. That's too private. What does that have to do with what they're coming to me for? But it does. And I think having the courage to ask those questions and see what else is going on is just so vital. 

 

I'm so excited that you've taken a passion for this and are supporting people who are going through this where they can get some help, and most women think it's the way it happens. It gets dry and pruned up down there, and it's going to hurt, and whatever, right? Just live with it. It's nice to know that there's stuff that we can do. 

 

Dr Anna Cabeca (38:40)

Well, and this is the other piece that's so important, is that it's true, like all of us will have laugh lines and smile lines, but when they're happening down there, it's reducing our quality of life and our life expectancy, because it's increasing us to infections, whether it's asymptomatic or no tract infections, worsening incontinence symptoms. So it's not like there's the sexual health piece and then there's the pelvic health piece that really is so important to talk about, and you may be surprised who is having sex and maybe they need to realize that we have to still protect ourselves. 

 

Let me say The Villages in Florida have some of the highest retirement facilities sexually transmitted diseases. But I'm like, keep yourself healthy. It's so important. It's our responsibility, and it's those we're in contact with’s responsibility. We're responsible for them. So again, quality of life  makes difference.

 

Dr. Ritamarie Loscalzo (39:40)

Thank you. That's so great. 

 

So two things. How do people reach you and then leave us with some words of wisdom that we as functional and integrative practitioners can use to better serve our clients and patients?

 

Dr Anna Cabeca (39:53)

It’s so easy to find me. So it's dranna.com, D-R-A-N-N-A dot com. I have lots of free information. I have consumer courses, my Magic Menopause course, my Sexual CPR course. Both of them have sections on vaginal health, very important. And on social media, Dr. Anna Cabeca, or @ The Girlfriend Doctor. So easy to find me.

 

Dr. Ritamarie Loscalzo (40:17)

Nice. Yes, and we'll have everything in the show notes and especially want to get some of the testing, as well, to add to that and your product stuff.

 

Dr Anna Cabeca (40:24)

We'll get some information. I would love for you guys to share about that. That helps us in the small business world for sure.

 

 I think with words of wisdom considering what we were talking about and what you were saying, Ritamarie, is don't be afraid to ask. Have these conversations, and in a safe space, if you're creepy, just keep your mouth shut, but if you're getting, you guys are here with Dr Ritamarie, so you really care, and you're intuitive. 

 

So asking is there anything else you want to talk about? A really important part is vaginal health and sexual health or pelvic health and sexual health. And we really like to talk to you about this, and do you feel comfortable with that? And I think you could start like that and that can be helpful. 

 

Dr. Ritamarie Loscalzo (41:11)

I like that. I've used that question a lot when I kind of feel something else is there. Is there anything else you want to share? Anything else you want to talk about? And a lot of times, they spill their guts, and it really helps to get some of that out. And the questions out and to be able to be there to support them. 

 

So I thank you so much. I'm so glad to have you here. It's been wonderful. And I love what you're doing.

 

Make sure we get some links, so we can share that with people, because it's overlooked, it's not utilized enough, right? It's just not. 

 

So for the rest of you, thank you. We are the future of healthcare. Our healthcare system is broken, and we have the ability to really change that by being there and asking sometimes those hard questions and digging into the root causes that other practitioners aren't.

 

This is an area that really matters, even if it might be a little awkward or uncomfortable to talk about. I want you to understand the vaginal microbiome, and we've gotten a great starter in it. 

 

Go visit Dr. Anna's site. And always, always, always, whenever I have these podcasts, or these videos, and we talk about these things, everybody wants to jump into the latest and the greatest, but you have to have the foundations in place first. You have to get people to be eating well, de-stressing, sleeping, moving their bodies, and not having sugar swings all over the place. And these are great things to do for those people who are already doing that, but also, as part of our routines, as part of what we recommend. 

 

So I highly recommend that you check out Dr. Anna's site. And until next time, shine on.