It helps us all out because the world needs better pelvic and sexual health. So, this week, I want to talk about the gut and your sexual and pelvic health. Now, I’m going to get nerdy a little bit in this episode because I get really passionate about the fact that…

Not only do I hear the stories about my patients being gaslit when they come in, sit down, and they share stories that absolutely, y ‘all, they just piss me off. Beyond ridiculous the way that all people, no matter what your gender is, are being gaslit and being told their gut problems have nothing to do with pelvic health. But it’s not just my patients, it’s me.

I have been gaslit too. Now gaslighting only works if you believe the lie that you are told, right? So all the times I’ve been gaslit and told, gut problems aren’t associated with, you know, A, B, C, I just, you know, I don’t eye roll in front of them, obviously, but I leave the appointment, do not go back to that practitioner and roll my eyes in the car and go, well, this is ridiculous.

Now, you know, there’s a time and a place to, call a spade a spade. I guess you would say, but you always don’t want to pick every single battle. So for those of you who are listening and going, why didn’t she just say so to the practitioner to their face? Well, choose your battles. Sometimes you do and sometimes you don’t. But what this episode is about is empowering you so that you don’t have to put up with bad advice, so that you don’t have to get medically gaslit when it comes to your gut and sexual and pelvic health.

So I am going to go over a little bit of literature first, but please, if this is the only thing that you take away from this episode is gut issues show up in pelvic health practice and in your pelvic health across the lifespan. Do not let anyone tell you that you’re reproductive, gynecological or pelvic pain issues are not related to your gut health and vice versa. Period.

So let’s talk about examples. When does this apply? What does it look like? Well, when you come in as a patient, I’m going to pull out something called the Bristol stool chart. There’s an app for that. So if you’re listening, pause, download it, and you’ll see exactly what I’m talking about. Yeah, I want to know what your stool looks like.

Shouldn’t be runny, shouldn’t be, you know, hard, so no diarrhea, no constipation. Yes, we say things like this on this podcast. So it shouldn’t be one or the other, but it should be somewhere in between, like a banana, well formed. All right, so past that, that’s not the only good question that I ask about, but it is important and we do revisit it. And it’s in cases like, for example, endometriosis.

So that’s a perfect case in point. People will come in, vast majority, vast, vast majority women. Although there can be rare cases where endometriosis exists in men, it is mostly in women. So I can say women will come in and they will share their surgical reports or the reports of where their pain are. Sometimes that actually alerts me and I have sent several people to the wonderful excision surgeons across the country when they have symptoms that are more systemic in nature. 

Endometriosis is not a disease of reproductive organs only. Endometriosis is a systemic disease and you likely will have gut issues. It’s not a guarantee, but in every case that I have seen, that has happened. And I have also heard plenty of medical gaslighting where the well -meaning hands in the air. 

If you’re watching the YouTube video, you’ll see me here. The well -meaning, you know, OBGYN saying, which I have heard verbatim, an OBGYN said, your gut problems have nothing to do with your pelvic health or your gynecological issues. So that is a firm example of gaslighting. It usually happens when someone has pelvic pain, pain with intercourse, endometriosis, interstitial cystitis.

These are not the only times that it happens, but you’re probably going to have something like that told to you or chronic prostatitis if you’re a male, that kind of thing. So that’s a case in point where you will come in if you are having gut issues and they are related to your pelvic health issues, you will maybe have a cycle that gives you more gut problems and gut pain.

You will maybe cycle between constipation and diarrhea. So more like IBS type symptoms. In fact, you can often be misdiagnosed with IBS and then just written off, she has IBS, she’s nervous or anxious or eats the wrong thing. And you also have concomitant or pelvic pain at the same time.

In these cases, if someone has endometriosis, what does this look like when the surgeon gets in on the inside? Well, you can have endometriosis lesions in the abdominal cavity, in the peritoneum, in the sides of the abdominal walls, embedded in muscle, in the bladder, in the bowel, making digestion painful. 

So that you may eat a food and then sometimes you instantly feel it, sometimes it’s hard to breathe, or it is five, six hours or two, three hours as it begins to process. And if you have lesions anywhere along the route, then you start to have problems. So it’s something never to be ignored, especially if there’s a history in your genetics. So I’m just using endometriosis as an example, because that is at least a one in 10 out of every, you know, woman. With women will be diagnosed or have endometriosis. I think honestly, the rate is much higher because it takes years to be properly diagnosed, years. 

And so do we really know the true incidence of endometriosis? Probably not. So don’t let that be overlooked as a cause or source of your pain.

Also, gut issues can cause something else: depression and sexual dysfunction. Now we’re gonna talk a little bit about polyvagal theory and that your perception of stress can actually be coming out of the gut, et cetera. We’re gonna get a little geeky for a little while because I just want to explain to you what you can do to be in the know, to be empowered.

And to kind of smack down any more medical gaslighting that could happen because you know what? We ain’t got time for that. Especially in women’s health when our issues are already ignored and under researched and underfunded in the research that does exist.

So, we are a bunch of bacteria, right? Let’s get started with the geekiness. We are a bunch of bacteria. Since 2020, there’s also been an increase, I believe there was an article in The Lancet recently, one of the gold standards in publications for medical literature.  The Lancet was cited that there was a 27.6 % increase in major depressive disorder cases. I mean, we can believe that, right? COVID and everything else that happened from that. Many people lost family members. I lost a family member. It’s still very hard to come to terms with that.

And people lost jobs, everything about my work changed. I mean, it was massive. I think that we’re still feeling the effects of that. And that’s not even really measuring the impacts of depression and anxiety on children who missed out on critical developmental phases and stages and experiences at the same time. So I just gave you a statistic that’s not surprising. Okay, a 27.6 % increase in depression, like big time depression. Not just depressive feelings that are fleeting. 

And at the same time, we are these, you know, there’s trillions and trillions of microorganisms, right, that inhabits, you know, everything about us. And this microbiome, if you will, in the gut has an impact on all these far reaching, you know, these ripple effect on these, what we would say, distal organs, these far reaching organs, including the brain.
So accumulating studies have shown an association between gut dysbiosis, that means things aren’t digesting well, okay?

That’s all it really means, gut dysbiosis, and depression. So dysbiosis and depression go together. Now you begin to then consider all the reasons for that, and there’s a bunch of articles on it. I remember the first time that I was introduced to the concept of the gut microbiome, it was circa 2011, 2012.

When I was pregnant with giving birth to my last child and it really blew my mind. And the research was based on nursing and the vaginal microbiome that’s passed to the infant and how important that is and how it’s missed in C-section. So swabbing the neonate with, you know, from the vaginal mucosa, super important for an infant, a neonate’s gut health. 

So, lots of research out there, right? So if the gut microbiome, when it is messed up and we have dysbiosis. If we have now increased risk for depression, what do we do? And we know that sexual dysfunction, pelvic pain, the other diagnosis that I mentioned. Diagnoses that I mentioned that go along with pelvic pain like endo, incontinence, interstitial cystitis, that kind of thing.

We can just lump that all under pelvic pain. If pelvic pain vastly increases the risk that you’re going to have sexual dysfunction, yes, right? You pretty much do when things like this happen and that’s associated with depression, then we have multiple things on our hands to deal with in pelvic health. So as a doctor of PT and pelvic PT, I am constantly asking about gut health.

And the question that comes back to me is, okay, what do I do? I know you can’t give blanket, you know, prescription, right? So this is a podcast. It’s not prescriptive. However, I can give you a couple of things from the literature, straight out of the literature and what it says in order to decrease the likelihood that you need to see me or someone like me. 

Now, I’m going to also touch on other areas because orthopedics and pelvic health go together. So as you age, so perimenopause, menopause, for example, as you age and hormone levels shift and progesterone and estrogen and testosterone begin to tank, you also have increased orthopedic dysfunction. It’s like, ouch, we cannot escape it. Menopause is a systemic issue too, right? So what do we do?

One, if you want great sexual health and pelvic health into your 60s, 70s, 80s, right? And who doesn’t want good sexual and pelvic health? No one wants to leak out of any orifice, and we all want to have good sexual health. So this is an episode for everyone. There’s something in it for all of you. The first thing is don’t abuse antibiotics. Now this is coming straight out of the literature.

And the article in The Lancet, which I will put in our show notes for you. A recent systematic review indicated that the association between antibiotics use and subsequent development of depression is there, there’s an association. It’s largely because when you take antibiotics, and make sure they’re necessary first, right, before you just take them.
It’s largely because antibiotics reduce the diversity of the gut microbiome. So it actually harms the good bacteria too. Ouch, right?

So what do we do with that? If you have to be on antibiotics for repeated measures or a long duration, hopefully your care provider, your healthcare provider is recommending probiotics to you. But that’s not the only thing. You can’t just pop a couple of probiotics and then get over it if you’ve been on antibiotics for say a chronic sinus infection for a really long time. Or where I see it is when people come in, and they’re not getting better with pelvic health issues. 

They go back to the doctor repeatedly. Maybe they get misdiagnosed with interstitial cystitis when they, it’s actually more just like a painful bladder or painful bladder syndrome as it’s becoming to be renamed now. And what happens when you have symptoms that feel stinging, burning, urinary frequency urgency? 

What do they do? They might do a dipstick test and say, well, it’s negative for an you know, the presence of any bacterial infection. But you know what? We’ll just give you antibiotics just in case. It might not show up. Wrong. If you end up on antibiotics repeatedly, you’re actually making the pelvic health issue worse because you’re interrupting the gut microbiome, which is going to interrupt the rest of the microbiomes as well, oral microbiome, vaginal microbiome in many different ways. And you can have increased pelvic symptoms. 

So the very thing you’re trying to treat ends up being worse because of antibiotics. So make sure you’re not abusing antibiotics and that your provider is just not handing them out like candy. 

The second thing that you can do is make sure that you increase your consumption of SCFAs. What the heck is that? Short chain fatty acids. Now, there’s a double whammy with this. If you’re not getting enough short chain fatty acids, and don’t worry, I’m gonna explain how to do that in a minute. If you’re not getting enough of those, then you’re at risk for two things, okay? Depression, gut dysbiosis, osteoarthritis, and premature joint degeneration and aging. And again, ain’t nobody got time for that, right? 

So you wanna increase your consumption of short chain fatty acids. Acetate, butyrate, propionate have been strongly indicated, if they’re too low, with depression. These short  chain fatty acids are reported to be depleted in patients with major depressive disorder while their administration resulted in antidepressant effects. 

So hello, food as an antidepressant, because it’s actually improving something called the hypothalamic pituitary adrenal axis or the HPA axis reactivity. Think of that as being fight, flight, freeze. Like you have a really poor stress response and tend to freak out instead of stay calm, right? We don’t want that reactivity. So it also increasing in increasing short chain fatty acids or SCFAs, it improves depression -related intestinal permeability. 

So, whoa, what is that? That is when someone, it’s called a leaky gut, right? When someone has a leaky gut and things move through the intestinal wall in a way that they should not, you can get a chronic inflammatory reaction, albeit at a very low level, right? But still high enough to give you joint aches and pains, sexual dysfunction, and depression. Because it’s all driven by something very simple, inflammation.

So we want to improve our intake of short chain fatty acids because it, in the modulation of local gut physiology and regulation of those organs, right? Cause it has that ripple effect on all the organs. We can influence our emotional behavior, which is like huge. Now there are things, there are other ways, there are other things that have been, identified that you can do too. 

So with short chain chat fatty acids, I just want you to think simply. Eat the rainbow of foods with high fiber. Shooting for 20, shooting for 30 in terms of diversity and color. So if you’re eating the same color food, I call it brown food. You know, I’m a mom of three, so every time I would leave to go out of town, you know, I’m worried about whomever is taking care of the kids, which is less of an issue now, they’re all teenagers and growing up. But I wanted them to have diversity in their diet. And so that is where eating the rainbow comes from.

I laughed a minute ago because that was not always the case. Depending on someone’s health literacy, as a caregiver, you could have a steady diet of brown food, a steady diet of ultra -processed food, which completely destroys the gut microbiome. So think fruits, veggies, and legumes. Fruits, veggies, and legumes that are high in fiber and that you like and that are colorful and no ultra-processed food. 

So try to stay away from stuff in a box, essentially, all that brown food. That’s gonna help you control your systemic inflammation and vastly improve the diversity of the gut microbiome. And so any pain that you’re feeling, that’s emotional pain or physical pain, goes down. Any inflammation that you have goes down. Any pelvic pain and sexual dysfunction that you have improves. 

Also with things like endometriosis, that is also a mitigator for lesion growth. Because endometriosis just spreads and grows and spreads and grows. It doesn’t stop. But there are ways with integrative lifestyle functional medicine and public health that we can help mitigate that.

So that’s not the only thing that you can do, okay? Vagus nerve stimulation has long been approved for treatment resistant depression. However, you want to avoid an implant, right, of a vagus nerve stimulator. There are so many other ways to stimulate the vagus nerve and improve your gut health and pelvic and sexual health. 

So just in review, so far we have, don’t abuse antibiotics, right? Increase your consumption of short chain fatty acids and control that systemic inflammation. Again, think whole food, plant based diet. And one more thing, exercise. Your muscles are endocrine, they’re little endocrine organs. And every time you go out and exercise, even micro dosing, and I’m talking, you climb the stairs once, you walk to get a glass of water, you…you get my point, right? You only have to do a minute or two of exercise.

If you did that all throughout the day, you don’t necessarily have to put on your workout clothes and go to a gym. Totally not necessary. Functional exercise counts, y ‘all. So your diet and your exercise is going to be probably your biggest anti -inflammatory friends beyond any other supplement that you can take that you can do. 

All right, now getting up to the fourth point. That is regulation of the HPA axis that is controlling those cortisol levels. So let’s go back to that vagus nerve talk that I promised you, that polyvagal theory. Now, vagus nerve stimulation has long been improved. Yes, they can do that through implants, but there are other ways to do it as well.

The vagus nerve, I want you to think of the vagus nerve as kind of a peripheral, like ripple effect anti -inflammatory agent. Now, there is a specific geeky neuropathological process that happens to create inflammation when you have poor vagal tone. But instead of getting into that, because that’s really outside the scope of what I want to talk about, let’s just talk about what to do, okay? 

Other than big pharma, which we’re trying not to be dependent on. It’s expensive. It’s unsustainable. Then you’ve got to worry about carrying meds around with you. And the number of side effects are just sometimes immeasurable. That’s called polypharmacy. When you take so many drugs that they all start interacting with each other. And polypharmacy alone is a pathology. It’s taking too much big pharma drugs. And then you have a fallout, a negative impact from that.

I also try to minimize amount of supplements that I want to discuss with people. Although as we age, there are some supplements and prescription things that we won’t be able to avoid. Like bioidentical hormone replacement, for example, or magnesium. Those are big ones that I talk about all the time. So if you’re perimenopausal, menopausal, and postmenopausal within 10 years, and you don’t know what you should be taking, reach out, comment on this. 

If you’re watching this on YouTube. If you’re on the podcast, reach out first consults are free. We are here to help you get the care that you need and end medical medical gas lighting around pelvic health. So let’s talk a little bit about vagus nerve stimulation. Just exercising is great. You can also create sound. Humming is a great easy thing to do. Neck stretches, I know it sounds crazy, are a great thing to do. You can actually do what’s called visceral mobilization. It’s a really fancy word for abdominal massage and myofascial release. Anything in the abdominal cavity is gonna work with vagus stimulation. You can also do rocking.

Imagine, you know, you don’t have to imagine. You’ve probably been upset enough and crying enough at some point in your life that you sat, kind of wailed, closed yourself up kind of in a fetal position and rocked. That stimulates the vagus nerve, y’all. And it gives me so much compassion to think about my fellow human beings in that situation. That they are in so much physical pain or emotional pain that, you know, in our evolutionary process, we have figured out how to improve vagal tone just by doing things like that. So there’s a reason that people wail when they’re in pain, that they moan, you know, when they’re grieving, because it helps.

It helps with the HPA access. So any of those things where you can even put pressure on the sacrum, pressure around the neck and the crown of the head, that’s why massages feel so good, go get one, schedule yourself for a regular one. Pelvic PT can do wonders because we work on vagal tone there with some of the mobilizations and things that we will do. And of course, improving your sexual function as well because you can do all of those things at one time in your sexual encounters and that’s all vagal toning. 

So there’s so many things that you can do to improve vagal tone. Maybe I’ll just do a season podcast just on that. But let’s get back to the last little bits of gut health and pelvic health. So improving gut health and pelvic health, yes, vagus nerve stimulation. And then finally, we’re gonna talk a little bit about those probiotics, because that can be a little bit of an enigma to some people. 

First of all, I want you to take take seriously the notion of a simple anti-inflammatory diet, the Mediterranean diet. It’s associated with a more diverse, higher gut microbial, I think I said diversity already, but that’s what I meant to say, and lower levels of GI inflammation. It also improves the integrity of the intestinal barrier. So, hello, decreased leaky gut.
So, microbiota derived short chain fatty acids. I know I promised I would get a little too geeky and I’m sorry, but now y’all know what short chain fatty acids are, right? Fruits, veggies, legumes, especially those that have perpionate and butyrate, act as a key link between depression and gut problems. So that’s fantastic. 

One study, Yang et al, I can’t cite the title, I’m sorry, or the date, but you can go to the link, the Lancet link, and it will be embedded there. They looked at the relationship between carb intake and depression based on genetic information from almost a half a million people and found that a 16 % increase in carb -based calories was associated with a 58 % decrease in the risk of depression. But that’s not white flour, y ‘all. Okay, that’s not simple carbs. That’s not junk food. That’s complex carbohydrates. Complex carbohydrates. Okay.
So back to your short chain fatty acids again. And now probiotics, what are probiotics? They specifically look for foods that have probiotics. Now you can certainly take a live probiotic. It’s going to be expensive. They are not cheap. You get what you pay for, but you can also get it through food. So look at foods. Go and look that up. Foods with, cause I don’t have time to go over all of it, lactobacillus and biphotobacterium.

Those are the most common ones that are gonna be, they’re gonna attenuate or improve depression. Okay. And inflammation is not the only ones, but those are the most common ones. Then you have a class called prebiotics. Now, prebiotics have often been used together with probiotics and that’s called senbiotics. Okay. Senbiotics, the use of pre and probiotics together have shown better promise in treating depression.

Because again, it improves gut bacteria at an accelerated rate. So why wouldn’t it? So you’re looking at foods with polyphenols, inulin, and compounds from vegetables, herbs, and plants. Prebiotics don’t exert a direct effect on that gut microbiome, but they do it indirectly by promoting the growth of probiotics. 

So if you want to get geeky, gallacto-oligosaccharides and fructo-oligosaccharides. So FOS and GOS based foods. Now if you’re seeing me as a patient, I give you the lists of all those things, but you can certainly look those things up on your own and start increasing your intake of prebiotics. But again, in a nutshell, if you eat, no pun intended, because nuts are also healthy, but if you’re not allergic to them.

If you eat fruits, veggies, and legumes in a very colorful way, shoot for 20 to 30 different colors, then great, you know, or types, because there’s only so many colors, but types of food, so you get diversity, then you’ll be getting your prebiotics covered. Send biotics is the combination of probiotics and prebiotics, and postbiotics are something that’s a promising area, but only animal studies have been done so far, so we’re not going to discuss that currently.

But overall, overall, the take home message is dysbiosis is associated with depression and with inflammation and so is sexual dysfunction and pelvic health or a lack of pelvic health. So if you want to change your mood or your mind, change your gut first.