S12 Ep1 - Vaginal Odor: Audio automatically transcribed by Sonix

S12 Ep1 - Vaginal Odor: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to From First Period to Last Period, a science-backed health and wellness podcast dedicated to shining a light on all of the women's health topics that have long been considered taboo. From UTIs to endometriosis, we're amplifying women's needs and voices because we know there's so much more to the female experience than what happens at the doctor's office. With From First Period to Last Period, we're doing the legwork on your whole body so you can be the expert in you. Now, let's dive in.

Kristyn Hodgdon:
Hi, everyone, and welcome back to From First Period to Last Period. I'm your host, Kristyn, and I'm here today. And for the next couple of episodes with Dr. Shannon Klingman. Dr. Klingman is an OB/GYN and the inventor of Lume, and we're here today and this mini-season to rescript the conversation around female health and hygiene because you deserve to feel confident and informed. Hi, Dr. Klingman.

Dr. Shannon Klingman:
Hello. How are you, Kristyn?

Kristyn Hodgdon:
I'm doing well, thank you. So, I just came out in New York, so I can't complain. But yeah, I'm so excited to be talking about all of these feminine hygiene topics that are taboo and still stigmatized and don't get enough of the attention that they deserve because so many women of all ages and stages struggle with these different issues.

Dr. Shannon Klingman:
Yeah, I love the idea of Rescripted because there's so many narratives that are outdated and myths. So, separating the truth from misleading women about how and where body odors form on their body. I love the Rescripted nature of it. I love the name.

Kristyn Hodgdon:
Thank you, thank you. Yeah, it's a fun play on words, so in this episode, we're going to be talking all about vaginal odor. What's normal, and what should you do about it? But first, can you tell our listeners who you are and what brings you here today?

Dr. Shannon Klingman:
That sounds great. I'm Dr. Shannon Klingman; as you said, I am the OB/GYN founder of Lume Whole Body Deodorant and our men's line, Mando Whole Body Deodorant. I practice medicine as anOB/GYN for about 12 years and first had the idea for Lume when I was a resident, recognizing that it is true facts that doctors were and are indeed overdiagnosing women with vaginal conditions that they don't have and overtreating women with antibiotics that they don't need. So it was two decades or more ago when I first had the idea for Lume and any true overnight success. It takes you about 10 to 15 years to get there. So we launched Lume just about six and a half years ago and our own website, and learned a lot about our customers, and we recently launched in retail. And so I think people are now, finally, we're becoming more of a household name. And so, the interest in whole body deodorant is growing amazing.

Kristyn Hodgdon:
So, admittedly, I'm new to the whole-body deodorant concept. I recently bought Lume at Target, but can you speak to a little bit about who might be interested in that kind of solution? Can it help with vaginal odor? Like, how does that work?

Dr. Shannon Klingman:
The big myth that we'll spend some time talking about today is that the vagina is not to blame for odor below the belt, but the feminine hygiene industry and even doctors have done a really good job of making women insecure about odor below the belt. And just like we get odor in our underarms, we get external odor anywhere on our body. When bacteria digest the fluids that we find there, odors form and it might be different bacteria and different fluids and definitely landing with different odors. But there are about 100 different odor molecules that form on our skin, from our pits to underboob, thigh, folds between our butt cheeks, our feet, our belly buttons, and behind our ears like where our earrings are placed. And so I was looking for that one-and-done solution that you can use anywhere. You have an unwanted odor but wish you didn't. And it solved the concern that armpit odor is normal. Foot odor is normal. But if I'm concerned about odor below the belt, it means there's either something wrong with me or I have poor hygiene. And those are the two lies that we have been telling women for decades and misleading women. And so, by normalizing the conversation around all body odor is the same, no matter where it happens on your body. It took us a little bit of education, probably around 3 to 4 years to get the education piece of it in place. And now, whole body odor control is widely accepted because we all know that our underarms aren't the only place we have an odor, but now we're talking about it in a more healthy and productive way, and we're offering solutions that people can use at home, just like we get older in our armpits. There are no secrets there. I think body deodorant is a solution for anyone who has insecurities about odor beyond armpits. And even if you have tried products in your armpits that don't work, Lume tends to work when other products don't because it works in a really different way.

Kristyn Hodgdon:
I love it. So, diving specifically into odor below the belt, what you mentioned some of the myths that doctors tell patients, but what are the facts? So what is normal, and how might normal vary among women?

Dr. Shannon Klingman:
It depends. So, we can look at it in two different ways. I think when we're thinking about odor below the belt, we tend to dismiss it as vaginal odor. So anytime you take your pants down, you sit down to use the bathroom, and you smell that smell, and you go, do I have a vaginal odor? It's that insecurity that creeps in because most products are calling and they are anatomically not correct. The vagina is on the inside and the normal odor of your vagina. And I do encourage women to get comfortable with what is normal for them. It's slightly acidic. It's not a foul odor. It can vary after intercourse or with your period, but that's usually because there is semen, if you're having intercourse with men or blood present with a menstrual cycle, but it should never be foul. And the odors that we perceive as off-putting or foul or unwanted, more than likely day-to-day odor is happening on the outside. But what happens is there's physiology, which is just a normal part of being human. And then there's pathology when there's something wrong with you. Pathology in the vagina has a foul odor, and that's when you need to see your doctor, but it's the same kind of bacteria that are commonly found in our GI tract. So you think about our large bowels. It's why I always say it's why poop smells. It's those bacteria that are digesting protein and fats and food products that the bacteria digest those compounds, and then odors form. And that same odor reaction happens on the outside of our body. No matter how clean we are, no matter how many showers we take a day, we are never fully sanitized. And so we're covered with trillions of bacteria. So this is on a very microscopic level that these bacteria are digesting fluids that they're exposed to. Yes, it is sweat and fatty sweat. But the vagina that serves as a reservoir for higher pH fluids like blood, semen, and vaginal discharge throughout at different points in our menstrual cycle or in the peri postmenopausal period, where the pH of the vagina ticks up a little bit. When those higher pH fluids find their way to the outside of our body, bacteria digest them, and those odors form on the outside way more commonly than having an actual infection or pathology internally in the vagina. Once we understand how odors form, then we can go about controlling them in a different way.

Kristyn Hodgdon:
Okay, so how do you tell the difference? So you said get used to what your normal smell is down there. But then, how do you know the difference between the internal odor versus the external odor, as you said?

Dr. Shannon Klingman:
Yeah. So, I think you just need to get really familiar with your body and what I would recommend to my patients. And this is something that you can usually say very effectively, privately behind closed doors. But it's like the finger check, just a finger up in the vagina. Get familiar with what the discharge smells like, and now that's normal. The odors that you recognize are way more commonly happening: perianal, between the butt cheeks, on the exterior vulva. And those odors get confused with being vaginal because we're not talking about the anatomy in the right way. The vagina is internal; the vulva is external. That's the hair-bearing area, the space between the vagina and the rectum, and then the intergluteal cleft, or between the butt cheeks or perianal area. That's where most day-to-day odor is coming from. The vagina is not to blame for odor below the belt. Once you get familiar with what your vagina smells like, hell, it's just a very mild, slightly acidic odor, and it's not foul. But if you notice a fishy, a putrid, foul odor that smells off, then you need to see your doctor. And there's a lot of different causes of vaginal odor and pathology from an imbalance of bacteria called bacterial vaginosis. There's imbalance, and that's usually a gardnerella type, or there's sexually transmitted diseases that you would need to be checked for. Retained tampon is another cause. It's way more common than you think that women forget there's a tampon in. They put another one in, they take it out, and one little stinker is up there. And so, those are things that you need to be considering as well. But more than likely, odor below the belt that you notice when you get undressed or during intimacy or whatever. That's all happening on the outside.

Kristyn Hodgdon:
Yeah, absolutely. Are there certain like hygiene habits or practices that you recommend? I'm just thinking I'm a big culprit of working out. And then just like staying in my sweaty club like that, like anything that you suggest?

Dr. Shannon Klingman:
You'll read like the really common boilerplate answers like wear cotton underwear. And I think all of those things are like peeing in the ocean to raise the tide. You're not getting an infection because you're wearing synthetic underwear or you're wearing Spanx versus cotton. But I think that the normal external day-to-day odor that I was really looking to solve happens when high-pH fluids come into contact with bacteria. Those fluids can be proteinaceous and fatty sweat, apocrine sweat, semen, blood, urine, but one of the biggest culprits is soap and the cleansing products that we use. If they have a pH that's above six, they really get you into the stink zone very quickly. The way you can know this for yourself is if you soap up and then wash below the belt between your butt cheeks, vulva, and then you sniff the suds, you will notice a slightly foul-off, maybe even fishy odor. And it's because that type of bacteria that is normally there and it's there normally this isn't pathology. When those bacteria digest high-pH fluids, you get what's called an amine reaction, and it's foul, and it's off-putting, and it's not mild. And you go, oh, so this is what soap is doing. And so I would recommend that people acidify their entire hygiene routine from the products they use in the shower to wash their bodies to the lotions and creams and butters that they use between showers, to the deodorant that they use on parts of their body that are more odor prone by stacking your hygiene practices in acid, I'm going to stay acidic. That is your best defense against hitting odor formation from every single angle prevented in the shower. Control it out of the shower and then on the go with wipes and those types of things. If you're looking for an acidified product, you're going to have the best success.

Kristyn Hodgdon:
Are there specific ingredients that consumers should look for?

Dr. Shannon Klingman:
What I love about alpha hydroxy acids like we use mandelic acid, and we use a good dose of it, like in our cream deodorant. It's the second ingredient. So we're not messing around. And I don't want to turn this into a commercial for Lume. But the further down in the ingredient list, a product or an ingredient is, the lower the percentage. When you see something halfway down the ingredient list, it's likely 1% or less. It's with creams, there are a lot of ingredients, but a lot of them are at super low percentages. So, you want to look for alpha hydroxy acids and beta hydroxy acids. Something that signals to you kind of acid, but then there's also the buffering. So, product is not enough to just contain an acid. They also have to buffer it to a pH that's low enough to keep you out of the stink zone longer and on all the parts of our body. So you hear a lot about pH balance. That pH balance just means different parts of our body want, and all of our skin wants to be acidic, but how acidic varies from scalp to face to private parts and feet. Armpits are different from the flank surfaces of our abdomen. When we talk about something being pH balanced, that just means they're holding it at a stable pH. But it doesn't say anything about what that pH is. Is it acid? Is it base? Is it alkaline, or is it acidic? And I think it's important that we talk about acidifying the skin. And with what? Alpha hydroxy acids. So you want to look for the alpha hydroxy acids, and then you want to know that it's also acidified because products can contain acids, but you can buffer them to basically the pH of soap, which is super high. So it's not enough to just see it on the ingredient list. You also want to see it explained as something that's acidic. The pH balanced is a marketing, that's puffery. It means nothing.

Kristyn Hodgdon:
Okay, that's good to know. Just specifically to women. How do hormonal changes throughout the menstrual cycle affect vaginal odor? What can you expect throughout the month?

Dr. Shannon Klingman:
There's times when estrogen is higher, pre-ovulation. There are more copious amounts of discharge. And then, right around that time of ovulation, some women may notice their discharge becomes almost like really stretchy, like egg whites, and that is when your discharge is likely going to be the mildest in odor. Then when you ovulate, your estrogen levels drop, and you'll notice that your vaginal discharge gets a little bit thicker. It's more white versus clear. And so you might notice that the odors are more concentrated. But they should never be foul. They're just a more concentrated version of what you are learning about your own body as normal. And you'll notice the intensity change throughout the month, but the vagina and where the odor is actually coming from is more likely to be those shifts in the vaginal pH discharge, then finding their way to the outside of our body. Bacteria digest the discharge that leaks out the vagina is a reservoir for those fluids like semen and blood discharge. And I always say, too, that if you've carried one baby and delivered vaginally, you might get lucky and not leak urine after that baby. But usually by your second or third, if you're going to sneeze when you're walking down a hall, you have to stop, brace yourself, and then sneeze. Stress incontinence is no joke, and if you leak urine when you cough, sneeze, or laugh, that's another high-pH fluid that finds itself on the outside. I think the most important distinction between what you like, what you're taught, we're not comparing apples to apples when you talk about vaginal odor. I'm saying there really should never be a foul or off-putting odor in the vagina or coming from the vagina. If so, see your doctor. You will notice fluctuations in odor intensity throughout your menstrual cycle as estrogen ebbs and flows. Odor, body odor, and armpits everywhere else on your body tend to be a little bit more likely to happen at the second half of your menstrual cycle than the first. It's when your estrogen levels are at their lowest.

Kristyn Hodgdon:
Okay, well, you mentioned earlier that women are being overtreated with antibiotics due to the stigma around vaginal odor and body odor, specifically vaginal odor. Can you shed light on why that is? Why some doctors might even be unaware of what's normal versus not? And how the feminine hygiene industry has shaped women's perceptions.

Dr. Shannon Klingman:
Yeah, I think on a broader level, the majority of healthcare dollars, like research dollars through the National Institutes of Health, have been spent on women's childbearing years and revolving around pregnancy infertility. That's where the focus of research has typically been historically for women. Women were actually excluded from most other studies because we were considered to be too hormonally imbalanced or unpredictable, and we were actually omitted from studies up until I'm trying to think of what the year was, but it was not until the '90s. Yeah, yeah.

Kristyn Hodgdon:
A really great company that we've worked with is called AbbVie. They do a vaginal microbiome test, and we work with them every year, and they call it Equal Research Day. I think it's in June, and it's the day in 1993 when women were finally able to be included in clinical.

Dr. Shannon Klingman:
1998.

Kristyn Hodgdon:
Yeah, that just blows my mind. And we put out a fact recently about how erectile dysfunction, which only affects less than 20% of men, is five times more studied than PMS, which affects like 90% of women.

Dr. Shannon Klingman:
100% of women. Anybody who digs deeper, it's like menopause. You say what the average age of menopause onset. It's normal between the ages of 45 and 55, the average age is around 50, in mid 30s through 45. And we know that 100% of women who live beyond the age of 55 are experiencing menopause, right? And yet, only $15 million per year of the $4.5 billion that are spent on healthcare. Generally speaking, only 15 million are spent on the study of menopause. So when we talk about why do we think this is, I think that nobody cares. Nobody cared. And I made it my life's work because, for some reason, I cared a lot. I noticed that there was a disservice being done to women, and I wasn't even thinking about it from a grander, altruistic perspective. I wasn't thinking, my gosh, of all the dollars we spend on healthcare, we need more research. That's not even where I was thinking. I noticed that what happens is when a woman comes into the office and describes a concern about odor, she is more likely to end up with a prescription she doesn't need, carrying a diagnosis that causes self-doubt to creep in, and she doesn't even really have the diagnosis. The next time the odor comes back, she says, oh, that infection you treated me for is back. Then they just call into the doctor's office and a prescription gets phoned in. I saw women who were receiving prescriptions over the phone 15 times over a three-year period, and I thought, there is no way. But what happens in defense of doctors? I will say that doctors never go into medicine to half-ass it. We never intend to do a disservice to women. It's just we don't have the knowledge or the experience or the time to care more because our visits are like 10 to 15 minutes long, right? You're in and out. You want to solve the problem for a patient. And when they have a concern, and you say that odor is normal, it frustrates the patients because they're looking for a solution where one didn't exist. And if you tell women to take more showers, we know soap is a problem for external odor. The pH is too high. We really didn't have an effective solution. The double whammy is that the odors that form on the outside can be identical to the odors that form on the inside when pathology is present. So, in fairness, if you notice a mild fishy odor or if a woman is complaining of a fishy odor and you go ahead and treat her for BV, it's way more likely that it's happening because of bacteria commonly found in our GI tract, combining with fluids like semen and blood and proteinaceous sweat, and we're noticing those foul odors. And they weren't stopping to think, hey, could this just be happening on the outside? And that segue for me was like, I thought, do you guys feel, I said to my colleagues, do you guys feel like BV or bacterial vaginosis is like a scapegoat? It's like the garbage can diagnosis when doctors don't know what else to do; they treat women with Metrogel or some other oral antibiotic for BV or vaginitis, vaginosis. And I got to go see your next ten patients. Who cares? And I did not, it wasn't received well. And then, when I was trying to have a baby, and I was very sexually active as a resident, and noticing that I noticed that odor that women get concerned about when they think they have BV, and I had that thought, do I have BV? And I checked around, and I'm like, that odor is happening on the outside. And I knew enough about it that it was due to semen. And I'm like, okay, this is going to blow the feminine hygiene industry wide open, and everybody's going to want to partner with me on this. And everyone was like, who cares? So I do it myself.

Kristyn Hodgdon:
That was actually going to be my next question. How have marketing practices by the feminine hygiene industry contributed to the stigma or misinformation on traditional health, it's always you should smell better down there, but not in a way that's kind of telling people that it's normal.

Dr. Shannon Klingman:
Yeah. The dark history of feminine hygiene has been it began centuries ago. But formally speaking, we used to... So douching, douches used to look like butter churns next to the toilet, and every woman that had one was lavaging her vagina with things like floor cleaners that are currently on the market now that were originally marketed as douching agents, and people died. And it was something that then they made them more mild and portable. And then you saw that reflect more the douches that are available right now on the market. The plastic bottles where you squeeze, and there's a nozzle that lavages the vagina. And they used to be flavored in the 60s and 70s; there were poster ads that would say, John doesn't think Vanessa has a vaginal odor, but he really likes the taste of apricots. Come on. These were and then also not understanding the anatomy. They're saying, do you notice you have a vaginal odor, even products on the market today that are named in a way that would signal vag? To me, vag, it's the vagina and vulva, right? They don't understand the anatomy. The vagina is not to blame. It's just external anatomy between the butt cheeks, and men have one too, but I think it stems from not understanding the anatomy, calling the vulva the vagina, and not understanding the contribution that between our butt cheeks makes for both men and women. We think it's a hygiene issue when, really, I don't care how clean you are, your armpits are going to stink without deodorant, almost everybody, same with that odor everywhere else. And it's not too far-fetched of an idea to think that we might want to control those odors, too. And they've just continued to reflect vaginal odor. Do you have concerns? This is a remedy for vaginal odor. It's pH balanced for your most intimate areas, and we're not intimate areas. What are you talking about? Like wherever you have an odor but wish you didn't. The vulva, the butt crack. That's why I really just use the anatomical terms. And for some people, they would love to shut me up. But I think unless you are willing to use the words, you will continue to confuse people, and you need to use the correct anatomical terms. We joke around a lot. I don't always say testicles. I sometimes say balls. But I also know that you can't take yourself too seriously. We are a deodorant company for anywhere, and so that humor does write itself. You can't take yourself too seriously.

Kristyn Hodgdon:
Of course. Yeah, even with kids, I have boy-girl twins. And so I had to talk about that stuff early on because they're taking baths together and all that stuff. And just from everything I've read, it's important to teach them the proper terms. And some people think I'm crazy, but I don't know. I work in women's health.

Dr. Shannon Klingman:
My kids know everything. And in fact, I remember when my husband is an OB/GYN as well. And I remember when he had somebody in labor and it was her third baby, and we were trying to decide, do we have time to go to dinner or not? How far along is she in labor? And my daughter, who was three at the time, said, has her water broken, got his water or whatever? And my husband said, no, her water's not broken. Then we probably have more time. She understood that when you break your water, it's not your first baby. You tend to go quickly, then. And so they were very tuned in to the function of our human bodies at a very young age.

Kristyn Hodgdon:
But it's such a good thing because, as a woman who grew up in the 90s, everything was always so stigmatized. And it came to bodies and body, hair and body odor and all that stuff. And knowing that I'm raising my daughter in a way where, like, she can talk to me about that stuff and know that it's normal, and I think it's like cycle breaking.

Dr. Shannon Klingman:
I think you just really want to remove all mystery and self-doubt. So you say it out loud, right? Just like you talk about brushing and flossing teeth. Can you imagine if there was shame around oral care and that if you wake up with morning breath, that somehow means there's something wrong with you? And so when you don't talk about things, you tend to build like shame and embarrassment around it. And so I think that Lume has done a very good job of opening up the conversation and normalizing it around odor beyond armpits.

Kristyn Hodgdon:
Absolutely. To wrap up, for those who might be confused about all the things not to do, what are some natural and safe methods to manage or prevent unpleasant vaginal odor? So you mentioned, like the pH, making sure there's the acidic ingredient in your cleanser. If you want to talk about how Lume can help, basically, what would you rescript about what people take from this conversation and move forward and implement into their routine?

Dr. Shannon Klingman:
Yeah, I think the most important thing is to say that it's not likely vaginal odor that you're noticing when you notice odor below the belt. So what you're actually talking about is what are remedies to minimize or eliminate external odor. And it's all the things. I also think if semen is leaking and you're noticing odor throughout the day, I often would put a tampon in, and then you just capture it like menstrual blood, and you just need to remember that it's there and change it, but that will just quickly reduce that semen load. Douching is an absolute no-no. It rinses out the good bacteria, and it actually is more likely to force anything bad up in through the uterus and out through the fallopian tubes and increase risk for inflammation and infection there. Douching is a no-washing with a lower pH solution versus a high pH solution is going to minimize the odor. Also, wearing clothes that aren't so tight fitting. You'll notice if you're wearing Spanx or anything, or even tights or anything, you're going to notice, like a hyper-focused concentration of odor. And it's a combination of things. Your skin, you're not allowing the air to get to the area. You need a bit of a breeze between your knees, and then also the material that those articles of clothing are made from. Man-made fabrics, athletic wear, polyester, man-made shirts like anything made out of plastic bottles or that you see, they're sustainable. They are way more likely to hold on to odor that does not wash out in the washing machine. Avoiding man-made fibers and opting for more natural cotton linen, looser fitting, and then acidifying your hygiene routine, and also knowing that the vagina is not to blame for odor below the belt. Get familiar with what your normal vaginal odor is. And then if you notice something that's different from that, it's happening on the outside, and lose the shame and embarrassment around. Don't even let the thought creep in. Way more likely, you're fine. There's nothing wrong with you.

Kristyn Hodgdon:
Awesome. Thank you so much, Dr. Klingman. I learned so much, and I think everyone else will, too. So, I really appreciate your time. And until the next episode.

Dr. Shannon Klingman:
All right. Thanks, Kristyn.

Kristyn Hodgdon:
If this podcast means something to you, be sure to hit Follow or Subscribe! This helps you because you'll never miss an episode, and it helps us because you'll never miss an episode. For science-backed women's health content that meets you exactly where you are, head to Rescripted.com or follow us on social @HelloRescripted.

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