 Welcome to the Dr. Gundry podcast. Well, you know, we pride ourselves on covering important health issues and nothing is off limits. So a few weeks ago I answered listeners questions about a topic that's extremely important to at least most of us, sex. But due to time constraints, I could only get to about half of the questions I wanted to answer. And since that episode aired, many listeners wrote in asking for a second episode on sexual health. So today I'm picking up where I left off on this on-core episode of the Dr. Gundry podcast. I'll answer listeners questions about healthy genitals, libido, and so much more. So stay tuned. You might be surprised by some of my answers or maybe all of my answers. So you know how to take care of your heart, brain, and gut, but your genitals are important too, just as every other part of your body. So I'm going to share how you can keep your genitals as healthy as can be. So here's a few questions from Instagram on that topic. I struggle with constant yeast infections. How do I deal? So here's the deal. Yeast infections seem to be a very common problem with women. And first thing you have to know is that we now know that there is a vaginal microbiome, just like there's a gut microbiome, just like there's a skin microbiome. And that microbiome is actually a very important factor in your overall health, if you're a woman listening, and also really contributes to your reproductive ability. It turns out that one of the things that the vaginal microbiome does or does not do is make you fertile or less fertile, and it can actually kill off your partner's sperm if that's what they want to do and in the wrong bugs are living in there. And pay attention. So what about yeast infections? Well, the vast majority of yeast infections that I see in my patients usually follow number one around of antibiotics for a completely different reason, whether it was you had the sniffles and your doctor gave you a Z-Pak or anything else, or you had a bladder infection. And that, whether you knew it or not, totally changed your vaginal microbiome. Now, yeast, Candida, is a normal inhabitant of your gut and of your vagina and even of your skin and your mouth. But when you kill off all the other bacteria and fungi that keep that yeast in balance, then that yeast has a field day and overgrows. Let me give you an example. In heart surgery, we would always give patients antibiotics following heart surgery and a number of these patients would develop a yeast infection of their mouth called thrush or a yeast infection of their esophagus, which could often be devastated. I actually wrote a paper about it years ago and it was following antibiotics that this always started. Now, there are anti-fungal, anti-yeast antibiotics. Most of you know them as ni-statin is the most common one. And yes, you can kill off a yeast infection with ni-statin. And many times we have to resort to using these vaginal troches of ni-statin to do the job. But the point is that yeast infection is a sign that something's wrong with the mixture of your microbiome. And often it's from antibiotics. And often it's actually because you had a bladder infection or as many of my younger patients call it honeymoon cystitis. And that has to do with a bladder infection that comes from sudden repeated intercourse where you actually do introduce colon bacteria into your bladder during the process of sex. So the old adage is the minute you finish intercourse, get up and pee is one of the greatest recommendations that anybody can give. And no, it's not an insult to your partner. And yes, I know you want to cuddle, but get up and pee and then come back and cuddle. And it'll make a huge difference. Having said that, if intercourse isn't the cause of bladder infections, I can tell you that more and more and more evidence now shows that most bladder infections, whether they're in men or women, come from bacteria in your colon migrating through a leaky gut wall directly into your bladder. And that's why we have this epidemic of bacterial bladder infections, particularly in women, because your bladder sits even more adjacent to the rectum than men. And you are, if you're sexually active, have a constant source of introducing more of these bacteria into your bladder than, for instance, a man who has a few inches that bacteria have to travel before they can actually get into the bladder during sex. So get up and pee and then come back to bed. Now, one other piece of advice. Again, you want to change your vaginal microbiome. There are now specific probiotics for the vagina, but one of the oldest tricks that still works is use apple cider vinegar douches. And as strange as that may seem, it used to be an incredibly old trick. Even plain old vinegar was one of the best old tricks. And sometimes old tricks are some of the best. So you got to reestablish a normal flora. Next question. Is there a safe and healthy substance you can use to combat dryness or discomfort during intercourse? Painful sex is a real thing, particularly in the perimenopause and menopausal period where vaginal dryness is a real thing. Vaginal dryness occurs because you stop secreting estrogen. Now, there are numerous ways to get estrogen locally. You can actually get compounded estradiol. You can get compounded DHEA. That's different than DHA, which is the fish oil component. But these all carry a risk of topical estrogen being absorbed into your body. And I'm not going to spend any time, at least during this podcast, on the pros and cons of estrogen replacement in the postmenopausal period. That would take several hours to give you my opinion. Lubricants do work. The most common lubricant mentioned or used by most of my patients is good old KY jelly, which is available at any drugstore. It works, it doesn't stain, and it is a very effective lubricant. We use it in the operating room and in the hospital. How can I maintain a healthy prostate? So here's the deal on your prostate gland. Your prostate gland produces fluids to ejaculate sperm during intercourse, during ejaculation. And those fluids are actually produced with sexual stimulation. In fact, it's produced all the time. But the most important thing for prostate health is actually not stimulating your prostate gland with insulin. And I have yet to see a man with enlarged prostate who doesn't have an elevated insulin level. Now, we're told, guys, that as you get older, your prostate gets bigger. And that's just normal. It's a normal part of aging. Well, that's one of the great mistakes we made that getting an enlarged prostate is not a normal part of aging. And if your prostate is enlarged, almost always, at least in my experience over the last 20 years, it's because you have an elevated insulin level. And when your insulin level falls by following the principles of the plant paradox, and I guarantee you it will fall, your prostate gland will shrink. And I can't tell you the number of men who were actually on some of the prostate shrinking drugs like Flowmax, for example, who got off their Flowmax after their insulin level dropped and their prostate shrunk. So one of the best ways to keep your prostate healthy is, in fact, get your insulin level down. The same thing we found is that a great number of men develop prostatitis or infections of their prostate. And it used to be thought that this was from intercourse. But again, it's very difficult for a man to have fecal bacteria infect his prostate coming back up through the urethra, or a man getting infected by the woman's vaginal flora coming back through his penis. Instead, we're now beginning to realize that the prostate is right next to the rectum in men, and that it's a leaky gut, a leaky colon and rectum that's allowing bacteria to get into the prostate. So doubly important that if you have prostatitis, if you have an enlarged prostate, getting your microbiome back in order, getting your leaky gut fixed will do wonders to fix your prostate. It's no secret that your gut affects every aspect of your health, which leads me to the question, how does gut health affect sexual health? Well, so number one, if you've got a bladder infection or if you've got a prostate infection, quite frankly, one of the last things you want to think about is intercourse, because one of the most painful things that you can have is intercourse when you have a bladder infection or a vaginal infection or a prostate infection. It's just no fun. But more importantly, we know that your mood is so strongly affected by your gut health, and we know particularly in women that mood has so much to do with sexual desire that it's not even worth mentioning. I think all of you women listeners know that mood is really what drives your interest in sex for the most part. We've mentioned before that in general, visual cues for men is often one of things that men absolutely have to have, but mood is far more important for women, which actually brings me to the next question, how do women get in the mood if they have low sex drive? So I see a number of patients in both my Palm Springs practice and Santa Barbara practice where they have visited who I call Dr. Field Goods in hormone replacement therapy and whether this is by pellets, whether this is bioidentical hormones, whether this is in shots, whether this is in prescriptions. So many women in particular are told in the perimenopause period or the postmenopausal period that their lack of desire is because of low hormones, and particularly the hormone testosterone. There is sadly pretty good data that testosterone does not have a huge effect on women's sexual desire. About 15% of women will respond to testosterone replacement with increased sexual desire, sometimes dramatic, but about 85% of women will not respond, even at high dose testosterone. And I see sadly numbers of women who are shaving their arms that are shaving their face in an effort, and they come in with testosterone levels of anywhere from 200 to 750, which many men would think would be the most wonderful thing that ever happened to them, and they still have no sexual desire. And yet their doctors keep pushing testosterone on them to find this magic level. I have a very good friend, gynecologist, who's office is next door to me, who's taught me a lot through my career. And he says, without a doubt, and I've come to agree with him, that if a woman has low sexual desire, he wants to look at the social circumstances of that relationship, of that marriage, if it's a long-term couple, how tired both individuals are, rather than looking at giving them testosterone or any other of the sex hormones. Can women take Viagra? Well, yeah, anybody can take Viagra. It has been tried for women. There have been experiments with women. It does not increase sex drive. You have to understand that Viagra dilates blood vessels. It was developed to dilate blood vessels in the lung. And some happy researcher found out it had an additional benefit for him. But so Viagra does not stimulate sexual desire. It allows men who otherwise are not getting enough blood flow to their penis to get enough blood flow to the penis. But as I said before, if your husband is taken Viagra, it ought to be the biggest wake-up call for his otherwise health, both his brain health and his heart health, get him to get somebody who will counsel him on the plant paradox. And believe me, you'll be pleased. Let me add one other thing. It's often said that older couples aren't interested in sex. And I can tell you, with my couples in their late 70s, mid 80s, late 80s, early 90s, it continuously fascinates me, the number of women of that age who are asking me for help with their husband, because they still want sex. And that's probably one of the greatest news that anybody can have is that this getting old does not mean that you aren't interested or incapable of enjoying sex. And so, yeah, there's a lot of late 80-year-old women who are making me try to get help for their husbands because they actively want sex, which is great news. And I think I said this on the other podcast. The more you kind of engage in sexual activity, the older you get from an evolutionary standpoint to me says that you're telling your genes that you're still trying to make new copies of yourself. And genes understand that if you're still trying to do that, they ought to keep you around. That's why in the village of Aciiroli, south of Naples in Italy, we have the largest percentage of people over 100 of any town in the world, both the women and the men say that they are extremely horny. So what is your opinion on men getting vasectomies and women getting their tubes dyed? Are there any medical drawbacks to these procedures? Yes and no. The good news is that with the development of microsurgical techniques with operating microscopes, vasectomies and tubal ligations can be undone. It is not always successful. But one of the things that we all have to realize is that preventing pregnancies is a two-person job. It is not solely the woman's job to protect against an unwanted pregnancy. And so this is something that couples have to decide, which is the best option for themselves. And we all know that all methods of contraception have drawbacks, including vasectomies and tubal ligation. But the drawbacks 20 years ago, which basically you couldn't undo these operations, are now not the drawback that they used to be. So these are options in your pregnancy-preventing armamentarium, but the option of not being able to reverse it is now less and less worrisome. Okay, so that's it for today, round two. We're happy to do round three or four and keep the cards and letters coming in. But now it's time for our audience question. Arthur Levine on YouTube wrote, Is it possible that since I have been following the food recommendations on the Dr. Gundry podcast that my color blindness has decreased? You know, that is a great question. And one of the things we're learning more and more and more about eye health is, first of all, there's a lot of new exciting data that glaucoma, or high pressure in the eyes, is most likely an autoimmune phenomenon. The other thing we're learning is that macular degeneration is almost certainly an autoimmune phenomenon in the back of the retina. The third thing that's really exciting is that DHA, the component in fish oil that I talk about that's so important, is critical for number one, your brain and for nerve functioning. And it's also one of the things that most of us kind of don't realize is that your eyeball and the back of your retina and your opting nerve is actually an extension of your brain. It literally in embryology grows out from your brain. And it's where your brain meets the world. And so the effect of, among other things, fish oil and the effect of polyphenols and the effect of removing lectins from your diet will absolutely affect your eye health and your ability to see, if you will. So your observation doesn't surprise me at all. And if you look at the literature on what DHA does for eye health specifically and for retinal function, it's actually, it'll blow your mind what happens when you get more DHA for your retinal function. And that's, retina is what colorblind is all about. So great question. Okay, review of the week. Following the episode with the primal kitchen founder, Mark Sisson, Ezekiel Creature said, I just wanted to say thank you, doctor. I had never even heard of lectins before I came across you. Within two days of stopping them, my memory started to get better and a heaviness in my chest started going away. After a week and a half, my memory started to be great. I'm going to keep watching your videos. Thanks. Well, Ezekiel Creature, thanks a lot. Incidentally, Ezekiel Brad, as we talked about maybe one of the most harmful foods you can eat because sprouting increases lectin content. So thanks for writing in. This is why I do this. This is why the podcast is here. And it's letters like you that keep me doing this. So appreciate the follow up. And I'm glad you're thinking better. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts, because I'm Dr. Gundry, and I'm always looking out for you.