Jo Hurley on the vaginal + semen microbiome - the test, the interventions, the protocols

0:00Jo Hurley:This show is sponsored by Microbes, an award-winning liquid probiotic that's now a staple for me, because Microbes, with a Z on the end, is different. For one thing, they source directly from the soil on their Wiltshire farm, meaning more diversity, with at least 15 strains of good bacteria in every single shot. It's brewed so it can survive in the stomach, and a remarkable 92 % of customers say it makes a difference. Plus, they offer micro-friendly cleaning, gardening, and even microbes for dogs. Buy now at microbes.co.uk and use the discount code sophie20 for 20 % off. This show is sponsored by Primidine, a clean, natural and science-based spermidine supplement that's been a long-time staple in my own longevity stack because studies suggest that through autophagy, spermidine increases healthspan and upregulates a range of health markers from memory and cognitive function to heart health, hormone balance, fertility and even hair growth.

0:59Jo Hurley:Plus, you can be assured that all ingredients undergo rigorous third-party testing. Buy Primadine now at OxfordHealthSpam.com and use the discount code DrSophie, that's D-R-Sophie, for 20 % off. Hi, I'm Sophie and this is Age Well with Dr. Sophie Schotter, a space devoted to all things health, wellness, and longevity. Because for me, aging well is about looking and feeling like the best possible version of ourselves inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women and men, finding out how they age well.

1:47Jo Hurley:So this is my show. Welcome along. And as always, thank you so much for for listening.

2:00Jo Hurley:Jo, it seems to me that you're in the secret address book of so many women, and it turns out men. I know you have a high profile client list and some of these clients have very openly spoken very highly of you from the wellness writer, Melissa Hemsley, to one of my former guests, Liberty Mills. I especially loved seeing your Insta reels with Liberty where she discussed her discovery that she had bacterial vaginosis despite being completely asymptomatic. So I thought a good place to start would be for you to simply tell us what you do, how you do it and why you do it. So I probably should start with the why.

2:34Jo Hurley:I guess I've always been interested in vaginal health. Throughout my 20s and 30s I've struggled with recurrent bouts of thrush and also bacterial vaginosis so we call that BV and I felt like there's been very little support. And to be honest, I haven't found conventional or allopathic treatments to be very effective. And so when I was studying to be a nutritional therapist, I don't know, it just felt like the area that I wanted to focus in, I felt really drawn to it, that it was kind of instinctively the area that I should be working in. And to be honest, it really excites me. I think I love that it's still a very emerging field.

3:13Jo Hurley:You know, I know that we, we know some stuff, but there's still so much more to learn and particularly with the seminal microbiome there's still so much more to learn so that's what I do I also work for Screen Me so they're one of the very few currently companies doing testing in this area so they look at vaginal uterine seminal and the urinary microbiome so we look at the bacteria and yeast that live in these environments and it's great It's like my dream job working for them because I get to look at hundreds of reports, you know, and really help clients on their journey. And I also get to see a lot of clients retest.

3:53Jo Hurley:So it's really nice to see how different interventions are actually working. And it's great to have that data.

3:59Dr Sophie Shotter:Do you know, as soon as I read about you, actually, I think I saw you on Instagram, Jo, I bought a test and we actually had our follow up consultation. Was it last week at the time of recording or a couple of weeks back? Yeah, I think so. I'd love to talk about my results on the show because something interesting, but to be honest, quite unexpected came up on mine. And as you've also alluded to, yes, you do do seminal microbiome testing too for men, which we'd love to get into. But first, can you explain what you're looking for in terms of the optimal vaginal microbiome? I know that, oh, Jo, I'm about to pronounce something.

4:30Dr Sophie Shotter:I hope I can pronounce it okay. Lactobacillus crispartus is a key player. Crispartus, yeah. Oh, there we go. I know that's a key player for women, isn't it? So basically green flags, what are the green flags that you're looking for for women yeah so ideally we want a vagina

4:45Jo Hurley:microbiome to be dominated by lactobacillus we like lactobacillus because they produce a lot of acid and that keeps the ph lovely and low and that environment then keeps out more opportunistic and more troublesome pathogens so you want a nice solid amount of lactobacillus it does start to get a little bit nuanced because there are different members of the lactobacillus family and some are more protective than others. And as you've alluded to there, Crispartus is arguably the most robust. It's the strongest acid producer. It tends to not fluctuate like some of the others can. And so when we see a vagina microbiome predominantly dominated by Crispartus, we know that that's really lovely and protective.

5:30Jo Hurley:Whereas certain other members of the family take Inas, that one can be a bit more unstable. When you take a family member like Inas, that likes acidity but also likes a bit of alkalinity, that one tends to be more unstable and you tend to get a less protective environment when you've got that one knocking around and you often tend to actually see it hanging around with a lot of BV bacteria and it can sometimes actually behave a little bit like a BV bacteria. So yes, we want a lacto dominance but then it can still get a little bit nuanced when we go into the different family members of lactobacillus.

6:05Jo Hurley:and then yeast so with yeast we arguably don't want any yeast overgrowth in truth when we see candida albicans tends to be the bacteria that we see as the main driver of recurrent thrush you also can get others i see a lot of malazias crop up on our tests those tend to be skin yeasts and sometimes those they can become opportunistic if there's a sort of break in the skin they also of thrive in fat so you know if anyone's using sort of more oil-based products or anything like that down below which they shouldn't that can sometimes drive some yeast to overgrow we also do look at molds so our tests are quite sensitive they will pick up an awful lot yeah i think the whole how to cleanse is a very interesting conversation it's one i often have with patients as well i'm particularly interested in this idea of a woman's reproductive microbiome and I know that you work with a lot of women trying to conceive, whether that's through sexual intercourse or perhaps ahead of the transfer of embryos during IVF.

7:08Jo Hurley:Again, we do want to talk about the microbiome where the sperm live as well, the seminal microbiome, but more generally, can you talk to us about the reproductive microbiome and the kinds of bacteria we want to ensure that we don't have? Essentially, the flip side of Fee's last question and the red flags. For example, I saw you online talk about Fusobacterium. Perhaps we can cover women's red flags first and then we'll cover men and semen in a separate question we have a little bit later. Yeah sure so I guess yeah a lot of my work is with people on a fertility journey and ultimately my job is to shift that microbiome to a healthy state ahead of natural conception or IVF and the focus is to get that environment the best it can be to hold that embryo and then give the mother a healthy pregnancy and delivery you know that's fundamentally what we're trying to do if we stay focused on fertility and I say that because we'll focus on microbes that you don't ideally want but it's not always indicated to not have these microbes or to treat these microbes but in the context of fertility it's slightly different so there are certain microbes take for example urea plasma and mycoplasma these microbes can be quite nasty and to be honest even in small amounts we don't ideally want to see them from the research that we do have we know that they can contribute to preterm birth and adverse outcomes and then yeah as you mentioned fusobacterium nucleatum sorry these names are absolutely i think hilarious who's come up with these i don't know this is actually a bacteria that's commonly found in the mouth we are seeing it show up in the different microbiome niches and in the placental microbiome in some studies it can also be introduced to oral sex but there is evidence to show that it is reaching the reproductive tract via the bloodstream and again the research is showing us that its presence can have inflammatory responses and again are associated with preterm birth and certain pregnancy complications so while while we're still learning more it's just one of those organisms we want to pay attention to in a fertility context then you have your bv associated bacteria interestingly bv is the most common imbalance experienced by vaginal owners it's actually often thought that it's thrush but it's but it is bv and that's where we see a reduction in lactobacillus and then an overgrowth in a class of microbes called anaerobes basically these are microbes that don't need oxygen to survive the thing is they can be very pro-inflammatory but the thing is it's almost like a a silent inflammation that they can that they ensue that differs from typical infections and when we see them in high amounts they can not only complicate pregnancy but they can make it much more harder to fall pregnant and your often main characteristics I guess of BV are a thick creamy discharge sometimes it's grey particularly if things like Prevotella are present it can come with a real fishy odour that's probably one of the most well-known symptoms of BV and then you have aerobic vaginitis so this is characterized by a loss of lactobacillus and an overgrowth of anaerobic bacteria, which don't mind oxygen to survive.

10:21Jo Hurley:That will be things like E. coli, strep B, enterococcus vicalis. And then the symptoms of these bacteria will cause things, the smell is actually a bit more rotten, is sometimes what's described. You can get pain during sex, you can even get stinging and burning. The discharge tends to be more yellow and sometimes green. And you can also even get a redness and swelling around the around the opening of the vagina. But what I would like to say is that you do also get some anaerobic bacteria as part of a healthy microbiome. It's important to know that, you know, it doesn't also need to be completely lacto-dominant.

10:57Jo Hurley:And we can maybe touch on that a bit later. You know, you can get these microbes still present in a healthy microbiome. But I do think it's really important to have that information because then that will depend on the right treatment. and what you don't want to be doing is going in with say one particular antibiotic to get rid of one lot of bacteria when actually it's some others that need to be addressed so I do think having the information is really important to then re-establishing that balance and getting the getting that microbiome healthy yeah oh it's so interesting Jo I was really pleased with my

11:32Dr Sophie Shotter:results as you say at the time of testing I had a really healthy balance of good bacteria and yeasts. You mentioned that my vagina is dominated by lactobacillus crispartis, which, as you say, is the most robust bacteria. So throughout our chat, I was feeling really quite smug. And then you moved on to moulds. And my test, as you know, identified several micro strains of mould. I had no idea that moulds could even live in the vagina. Although we also saw your Insta Live with Jen Walpole, and she had mould issues too. And you talked about environmental cross contamination as opposed to having a systemic vaginal mould issue.

12:10Dr Sophie Shotter:Now we are currently living in a house with no central heating. We're in the middle of a massive renovation and we have started to notice small bits of mould in two rooms at the back that have no heaters, never have had done. This was owned by an older gent who lived in this house for years and years. So that's my story. What do we need to know about mould in the context of the vaginal microbiome?

12:31Jo Hurley:so molds produce mycotoxins which can if we just focus kind of more systemically and i'll then touch on the vagina you know they can wreck a little bit of havoc to our immune system they can cause inflammation they can in certain cases drive infection and just ultimately weaken our body's responses you know so ideally we don't really want to be dealing with mold and these mycotoxins i do to be fair i see them a lot on our vagina reports and our and our seminals too to be honest if the load is very low or below threshold you might have noticed from from our reporting fee that sometimes if there's not a number quantifiable enough to fit it will say below threshold that means it's it it's most likely the presence of that microbes in the background so you can assume it's cross-contamination so did someone swab in the bathroom and was there some condensation in the shower that was picked up you have to allow for a certain amount of that particularly with our type of testing as i as i said earlier it's very sensitive however yes if i am maybe seeing more multiple molds and particularly if i'm seeing them in higher quantities then you really do need to query with clients their environmental exposure and often clients will then say to me actually yes we have lived with mold or we're currently living with mold you know and then you need to follow you know the necessary protocols to address that you know if that is going on it's you know sometimes not as easy as it said done you know the easiest thing is to remove yourself from that environment but I appreciate that's not who can do that every okay we'll just move so you know yeah we'll move but it is I think it's interesting when we're seeing them there because I think that then can give us some indication as potentially what might be going on elsewhere.

14:18Jo Hurley:All super interesting. The other thing that was interesting from Fi's and my conversation was that her test identified low levels of a bacterium called Clostridium perfringens, which I know is more commonly seen with gut issues and is linked to things or can be linked to things like certain types of food poisoning. And as you told Fi during her consultation, while this was at low levels and for her it is in control, it might help explain the gut sensitivity issues that I know she's had since both menopause and also since chemo. And Fee has previously said that sugar can be a real trigger for this.

14:54Jo Hurley:So this all kind of makes sense and fits together. But would you mind talking about any correlation between the gut and the vagina? For example, is it possible to have candida in the gut and not in the vagina? And also, can this kind of cross-contamination occur when women are wiping their bottoms on the loo as well? so yes the candida you can absolutely have a candida overgrowth in the gut and not in the vagina and vice versa you can have an overgrowth in the vagina and not be present in the gut which i think is a really interesting people wouldn't necessarily assume that you can't assume if it's in one niche it might be in the other as far as cross-contamination goes yes we do see that you know i sometimes see lots of gut microbes present in vaginal again seminal and uterine reports and particularly if maybe someone's had as you said food poisoning or maybe they've had recurrent about recurrent use of antibiotics and maybe the gut's just a bit more compromised sometimes we can see some cross-contamination and as you said absolutely from when wiping your bottom it's really important to wipe front to back because yes absolutely that's definitely a way that microbes can be translocated is from wiping back to front.

16:13Jo Hurley:They can just get themselves in absolutely anywhere and everywhere. The clostridium is an interesting one. Again, I must caveat, the research is really limited on this in terms of its implications in the vagina, but from the research that we do have, when it's seen in low amounts, as it was for FI, it's deemed to be transient it's only when it's been observed in higher amounts has it then been linked to pregnancy complications against some of the things that I alluded to earlier so in Phi's case obviously that's not where she she was at trying to conceive so it was less of a you know a concern but yeah it can be yeah so the man's test is via a semen sample Sophie mentioned

16:58Dr Sophie Shotter:on a previous fertility podcast episode that we did, her and I, that semen is now starting to be seen as a longevity indicator, which is really interesting. And you've both said that semen has its own microbiome. So can we talk about testing in men and how when a man ejaculates inside a woman, this can impact her microbiome, just as her microbiome can presumably impact what's going on with him. I'm also wondering if antibiotics make a difference here. And another interesting comment that you made that we saw online is that couples might not want to use saliva as lube during sex, as this can create cross-contamination.

17:34Dr Sophie Shotter:You've mentioned oral sex. We'd love your views on oral sex in relation to cross-contamination. I'm loving that we're having these really open conversations, by the way. It's just like we couldn't have done this maybe years ago. So let's bring the guys into the chat. And just to caveat, apologies, this is all largely themed towards straight men and women, but I imagine that all of this can impact other couples as well. Just

17:53Jo Hurley:just want to say that yeah absolutely actually bv is very very prevalent in in lesbian couples and it's presumed largely down to that that oral sex element that's such a big part of that so for the seminal so it's quite different to the vagina which again i think it's very cool how they both have their uniqueness so the seminal as we mentioned in the vagina you want a dominance of lactobacillus so you want one family of bacteria taking up most of the space in the seminal we actually want to see a lot more diversity so it's okay to have lots more microbes present but what we don't want is we don't want one particular one or family taking up too much space so if we were looking at a pie chart like a cake you just want lots of little slices of that pie chart that's more a more optimal environment in terms of treatment quite nuanced if the male is experiencing symptoms which very few men do so that's I think one of the potentially one of the reasons that this hasn't been explored to the level that it potentially should have so you know it's many men might carry infections and have no symptoms whatsoever but if they do or potentially they've done some you know further sperm analysis and they've found out that there is some DNA damage, so that's called DNA fragmentation, that can be driven by oxidative stress.

19:14Jo Hurley:And one of the causes of that can be infection. So, and obviously I'm, remember I'm seeing a, you know, a cohort of men that are coming to me with fertility challenges. So if, if that's present, then yes, we definitely want to treat. Also, if you have their female partner, who's got a dysbiotic, you know, an unbalanced environment and has more of these troublesome microbes present and the male partner's a carrier for these then yes you would also treat the male partner to stop that recurrence in the female there was actually a really good study that came out in melbourne last year from the researchers in melbourne it was a group of women that that suffered with recurrent bv they split the two arms one group's partners were treated co-currently with antibiotics and then the other arm partners weren't treated and they actually had to stop the study early because the recurrence rate was so high in the group whose partners weren't treated so that was a really groundbreaking research yeah to come out but then if the female environment is optimal and it's clear that the male partner isn't impacting however you know the seminal microbiome could absolutely be improved and optimized then to be honest i will avoid antibiotics as best I can because they can do more harm than good.

20:35Jo Hurley:And I do refer for antibiotics absolutely as sometimes, you know, they're very much warranted. And, you know, particularly when you are working in the fertility space, you know, often time isn't on side. So antibiotics can be a quicker intervention when we're, you know, looking to clear down that bacteria. But what I should say for all the niches, the microbiome niches, reseeding of the good bacteria is key and crucial to rebalancing that microbiome but with the vagina we've got the luxury of using probiotics and different pessaries locally which we just don't have with the seminal it can be much harder to re-establish the balance post that clearance and so that's where you do have to be careful it can get quite nuanced and definitely more research in this field is needed it's actually something that we're looking at at screen me and also i should say for the vaginal and uterine the same applies not all but quite a lot of the antibiotics particularly i mentioned urea plasma earlier that antibiotic is usually doxycycline that's prescribed that can knock out the bad bacteria but it can take some of that healthy lactobacillus with it and the oral sex element it's tricky because when i'm working with these clients on these different protocols in most instances i'm asking for periods of abstinence i mean at a minimum i'm asking them to use barrier methods so something like condoms but really especially while we're clearing down that bacteria and their environments are arguably a bit more compromised than the immediate it's no sex and it's no oral sex and this is at a time when couples are you know they're trying to conceive they want to be having all the sex so then i'm asking them to not have sex but then interestingly i'm asking the males to ejaculate every two to three days to make sure that they're clearing out that bacteria because that's a really important piece but luckily most of the men don't seem to have a problem with that with that ask but you can cross contaminate sorry yes

22:36Dr Sophie Shotter:via oral sex through sex yes yes yes and that's one of the ways i said that's one of the ways

22:41Jo Hurley:fusobacterium can end up in the in the vagina yes we you know i said in you know same sex in lesbian couples bv microbes can get around cheeky little buggers for once less of a scientific explanation for them but you know they can but yeah get themselves around everywhere and definitely yeah oral sex is that's why i asked couples to i said it to a couple the other day and they were about to get married and they were like really but we don't want to do that and i was like look it's just short term please just just for the moment and then you can go back to having all the oral sex she wants. It's quite fun conversations you are having with people, maybe at nine o 'clock at nine o 'clock in the morning.

23:24Jo Hurley:So we know that lactobacillus should be a woman's dominant vaginal bacteria in the perfect world. And we also know that this is driven by estrogen, which is why when women go into perimenopause, so many of us start to struggle with symptoms. One of our earlier podcast guests, Katie Ward from microbes, which is a soil-based probiotic, told us about a lot of gut bacteria being swing voters, so good that could turn bad. I wondered, could lactobacillus, bearing in mind there are many forms of lactobacillus, ever turn rogue? And if so, what makes that happen? And tacked onto that, is there anything else that you would like to say more generally about vaginal issues during peri and post-menopause?

24:05Jo Hurley:So I guess, as we kind of discussed, ironers can act a little bit rogue. In terms of collectively lactobacillus going rogue, I would say what can happen is you can get, you can have too much lactobacillus. And then that's when you, you'll have something called cytostolic vaginosis, which is basically where the environment becomes too acidic. So that can happen, less so going rogue, but more, you know, you also don't want too much of a good thing. and actually that can be you know sperm like a little bit more alkalinity it's a balance also not to have an environment that's too acidic that then could be detrimental to sperm and also this is really really cool and i've probably worth mentioning here is around ovulation our ph will shift ever so slightly to become that bit more alkaline to accommodate for the sperm like how cool is that yeah yeah so yeah i think that's fascinating and then i regarding peri and postmenopause as you mentioned estrogen helps to drive lactobacillus estrogen is wonderful at keeping the vaginal tissue thick elastic and lovely and well lubricated so when we lose that estrogen the tissue can become thinner drier and and more fragile which is why many women when they move into that next phase will experience dryness a lot of them experience discomfort in sex with sex and there's definitely a higher risk for urinary tract infections you know and then throw in some low testosterone which we know plays an important role in desire and libido and sadly like it can

25:48Dr Sophie Shotter:for some it can really feel like game over yeah i mean which all of this could be an entire an entire podcast in itself yeah couldn't it it really could it really really could thank you for that. In terms of interventions, let's look at the positives. What are the options? Because we've heard you talk about everything from time tea and probiotics to biofilm disruptors and antimocribles, microbials? Yeah, crikey. Obviously, I'm out of my wheelhouse here, you can tell. Obviously, there'll be different interventions for different things. But can you give us an overview? And we're also curious to know how you and Liberty work together on eradicating her bacterial vaginosis, because I know she's very openly discussed this online, hasn't she?

26:27Jo Hurley:yes she has so intervention wise as you mentioned biofilm disruptors i'll quickly just explain what biofilm is they're basically like a little house that the microbes can live in so they've got the heating they're electric they're kept lovely and toasty so when an intervention is used whether that's an antibiotic and antimicrobial herbs whatever it is you use to clear out that bacteria if we don't basically do something to break down that little house first and expose more bacteria then we're just not going to get to as many. And that is one of the reasons that we can see higher rates of recurrence, particularly with BV bacteria.

27:03Jo Hurley:They're quite famous for nestling in these biofilms. So yes, not in all instances, but in most, I will probably go in with a biofilm first. There are different biofilms that you can get. NAC's actually quite a well-known one. But then again with NAC because NAC contains sulfur and some BV bacteria can actually thrive in sulfur rich environments we have to be careful because we don't want to kind of inadvertently be feeding the bacteria that we're trying to get rid of that's a consideration I will then when we're talking about kind of clearing down that bacteria it might be yes antibiotics that are indicated I might refer on for herbs I might use antimicrobials they can be really effective and then i'll use things like acidifiers to keep the environment nice and acidic while we're clearing down these microbes and then we'll use probiotics vaginally and orally and then yes which brands for vaginal probiotics i really like vitanica i recommend them a lot i also recommend vagi biome i think vagi biome definitely is a u.s based company but you can get them here in the UK and then oral probiotics I really like microbiome labs they actually do a wonderful range of probiotics across the board but they have a great one a vaginal balance and a pregnancy support in vivo do some good probiotics for this in this space and as does activated to probiotics they're an Australian brand they're my go-tos for oral and vaginal thank you and then filibitie so i didn't actually want to recommend an antibiotic filibitie particularly as she wasn't you know at a stage in life where she was trying to conceive and she also wasn't symptomatic one of my recommendations was a referral back to the gp for vaginal oestrogen as that can be really effective for helping to drive healthy lactobacillus and the wonderful thing about vaginal oestrogen is it stays quite nice and localized it's on it's doesn't behave in the in the same way as other as other HRTs it does stay quite close at affecting just that area and as I said it can be really really good at driving the the lactobacillus so I recommended that I also recommended some vaginal pessaries which Liberty actually had a really bad reaction to and then from there she went back to working with her GP I mean it's very rare to have this kind of reaction but it absolutely can happen particularly if the environment is inflamed and and tissue is already fragile, which is why any vaginal intervention really should be done with the oversight of a practitioner.

29:40Jo Hurley:You know, always do really strongly anything vaginal. I was actually chatting to Liberty and she said she's on the estradiol and she's going to retest soon to see what impact that's had in shifting things. So yeah, watch this space. If we don't have any issues, but we want to keep our vaginas healthy and in good balance, what would be your protocol for example I loved your Instagram post where on slide one you ask how should we clean our vagina and on slide two you simply say don't I discussed this on my vulva and vagina focused episode where I talked about the vagina being a self-cleaning oven and I know that this is a message that so many experts are now trying to teach women especially young women who might be drawn in by these ridiculous and in my view unethical vaginal cleaning products but can you talk to us a bit more about your thoughts on all of this and again your healthy vagina protocol yes i agree wholeheartedly on some of the products currently on the market 100 don't the vagina is self-cleaning all it needs is warm water warm water only funnily enough i did a post about this last week at the start of the weekend if there is a smell or there's some unusual discharge or there's some symptoms that don't feel right you know and you are using warm water the bodies are wonderful it will tell you that something's not quite right and that you then need to maybe look into that you know the last thing you want to do is mask any smell with a product that ultimately nine times out of ten is actually only going to make things worse a lot of these products that say they're ph balancing they actually do the opposite they don't balance your ph and they can actually cause more of these more troublesome microbes to come and you know have an opportunity to take up more space and and overgrow so definitely warm water only in terms of if things are good and you want to keep it nice and healthy so from a dietary perspective you want to feed the good stuff so if tolerated ferments ferments are great so things like kimchi sauerkraut kombucha the microbes love a bit of fermented food they love pro and pre-bartics and particularly if yeast is present you really want to be avoiding sugar they absolutely love particularly candida absolutely loves sugar so when i am working with clients to clear you know particularly yeast you know you do have to be quite strict when it comes to sugar and then from a lifestyle perspective wipe front to back kind of you want to avoid tight clothing obviously as best you can that isn't always possible I encourage clients to wear bamboo or cotton knickers I would avoid anything synthetic you know if you're exercising change out of your gym clothes quite quickly you know the kind of classic one don't sit around in a swimsuit all day because yeast can they thrive in these warm moisture conditions I encourage clients to use organic cotton products and you know and to change them regularly I do find that pads changed regularly are a better option than cups or tampons.

32:43Jo Hurley:I think it's worth mentioning that cotton is one of the most heavily sprayed crops. So choosing organic brands is definitely best. And then use water-based lubes. My favourite is Yes, it's a really good brand. You know, and particularly, you know, we touched on perimenopause and particularly when there's that fragility to the tissue. And even, you know, when women are suffering with recurrent bounce of thrush and again there's real sensitivity lubes can be really really valuable so definitely a water-based lube and then particularly if i'm asking clients to abstain i know this is kind of slightly off question but just i think worth mentioning you know condoms like the brand hanks is a good one to mention they're made from sustainably sourced latex and they don't have those harsh chemicals and spermicides and all the things that not only bloody disrupt the ph but also can affect sperm health.

33:35Jo Hurley:I mean, it's nuts that you have products on the market for your sperm health and they kill sperm. Yeah. Yeah. It's quite crazy to me, but anyway, I could talk about that all day as well.

33:47Dr Sophie Shotter:Yeah, I can tell. And I think looped onto Sophie's question, and this is more of a, this is continuing with the products and brands. I mean, you've already mentioned the probiotics. Thank you so much. Any others you can think of, go ahead and mention those too. You also mentioned to me that it might be an idea for me to take oh I can't pronounce this one Jo under under psilic acid right you know I can't pronounce it either I say under clinaic acid but I think I'm picking up my own word no let's go with you you I'm sure that yours is better and that was to treat the low levels of yeast present in my microbiome especially because I'm prone to sensitivity after sugar but especially stress and actually when we talked I was having a bit of a flare-up so maybe talk about that and also my go-to DIY remedy if I'm having any pain is to drink a little bit of bicarb of soda and water.

34:32Dr Sophie Shotter:I heard you talk about the Vitannica vaginal pessaries. So you've mentioned those, any other brands and products that you rate basically that you haven't already mentioned would be great.

34:42Jo Hurley:I've mentioned the Vitannica and Vagibiome. I've mentioned the oral probiotics I like. As I said, I've mentioned the lube and the Hanks condoms, the underclinic acid. So that's, I do tend to use that and I'm finding it to be very effective, particularly when I'll not use it in recurrent RVVC, so recurrent thrush. So that's if someone is experiencing one or more bouts of thrush a year. When we're dealing with something like that, then really, you know, that's longer term work. We're having to address lots of different components in the immune system. Is there a histamine issue? What hormonal element is driving that?

35:17Jo Hurley:It's more of a systemic work. But when I am seeing some yeast present, sometimes in higher amounts, but maybe that's not accompanied by that many symptoms or there's not loads present. I'm finding unclinic acid to be really effective. It's predominantly an antifungal to clear candida, but it is also effective for other yeasts and in some instances has cleared down some moulds. I also wanted to say that the test is really easy and straightforward. For women, it's literally a quick vaginal swab, totally painless. for men they'll need to do a semen sample what makes your testing different to what else is out there i think you also offer uterine testing if you wouldn't mind giving us a quick overview of that yes we do offer uterine testing so that is that's a menstrual blood sample so we'll often ask clients to capture the first six hours of their menstrual flow and we'll use that to sample i think the thing to say about screen me is that we use next generation sequencing so basically it's a method of analyzing DNA at scale so it means we're not just growing bacteria in a lab dish which can miss a lot we're sequencing the genetic material directly from the sample so instead of maybe seeing five to ten organisms on a culture and often a culture is what you might get if you go to the GP we can detect hundreds you know including bacteria that don't grow well in lab conditions so I think that's kind of what stands us stands us apart with that with our testing yeah amazing joe there are so many other things we'd love to talk to you about but your instagram is a treasure trove of brilliant thoughts advice and information i know that fee got so much from her experience with you because she immediately emailed me and our colleague emma to say that we must get tested and i certainly plan on doing so but i haven't at present because of being pregnant but for all of you listening if you're interested please do find out more over at all the w's joanne hyphen hurley.com and do also follow joe on socials at feed your fanny i think that has to be the best instagram handle thank you so much joe for sharing so much knowledge no thank you for having me i've really enjoyed it thank you