December 2020
This month we talked with Dr. Aimée Gould Shunney, ND, about the benefits of a naturopathic approach in addressing the root causes of vaginal conditions. She shares expertise on balancing hormones, the link between diet and the vaginal biome, hygiene tips, and more.
Dr. Aimée is a naturopathic doctor in private practice at Santa Cruz Integrative Medicine in California. As an integrative practitioner, she blends conventional medical diagnosis and treatment with evidence-based natural therapies including diet, exercise, lifestyle coaching, nutritional supplements, and herbal medicine.
Dr. Aimée specializes in women’s health and bio-identical hormone balancing as well as menopause, menstrual issues, sexual medicine, thyroid optimization, stress management, and digestive health, including small intestinal bacterial overgrowth (SIBO).
SHWI: As a long-standing naturopathic physician focused on gynecological care, you often see patients who’ve tried allopathic (or conventional) options unsuccessfully. What kinds of alternative treatments seem to be helpful for these patients?
What conventional treatment often ignores is how we got here in the first place. Take vaginitis as an example. We isolate an organism that has overgrown and then treat that with the appropriate antibiotic or antifungal. Sometimes it works, but often it doesn’t, and our patient relapses or comes back with a different imbalance.
At some point, we need to look beyond what will kill the bug du jour, and focus on what is happening in the underlying terrain to make the environment so hospitable in the first place. So while my treatment protocols may include traditional prescriptions or boric acid or herbals, it will also include dietary and lifestyle recommendations, stress management, testing and treatment of any gut issues, and steps towards overall hormone balance.
The same idea applies to menstrual cramps. I will recommend herbs and natural anti-inflammatories for the pain, but I will also work to identify why the pain is so bad – diet, stress, or hormones? In naturopathic medicine, we always strive to address the cause.
SHWI: What is the naturopathic approach to maintaining the vaginal biome?
1. Diversity in the gut
The gut biome seeds the vaginal biome, so I always start there. I like spore-form probiotics because they have been shown to actually make it through the stomach to colonize in the large intestine and equally important, they are able to increase the population of many cornerstone species, creating more diversity. And diversity is the key to optimal function…in the gut.
2. Specificity in the vagina
The vagina is different. Here the Lactobacillus species reign. Several types have been shown to decrease frequency and duration of urinary tract and vaginal infections, and I have recommended those for vaginal use as long as I have been in practice.
More recently, I have transitioned to Good Clean Love's BiopHresh suppositories which I find even more effective, probably because they contain all the key Lactobacillus species players in addition to homeopathic support. These have been a real game changer for my patients with chronic vaginitis symptoms! For my ladies who are less symptomatic, in “recovery,” or just trying to stay ahead of any issues, I recommend using pH-balanced products (washes, wipes, and lubricants) that contain lactic acid. This will help maintain/restore the acidic pH of the vagina after exercise, sex, menstruation, etc.
3. Consider estrogen
Particularly for peri- and post-menopausal women, but for women of any age, estrogen decline leads to changes in the prominent flora (and pH) of the vagina, specifically lactobacillus species that are crucial for their antibacterial and anti-inflammatory effects that act as a first line defense against invading pathogens.
You can replace these Lactobacillus species, but for many women, using some vaginal estrogen can solve the issue (and help with vaginal dryness and painful sex). I recommend Bezwecken’s Hydration Ovals that use vaginal estriol and/or DHEA with cocoa butter, beeswax, and Vitamin E.
SHWI: How is a patients’ diet important not only to their gut biome, but also their vaginal biome?
What you eat feeds different species of the gut, creating better balance and diversity or adding to dysbiosis (imbalance). Including fermented foods in the diet like sauerkraut, kefir, and kimchi can support diversity, while enjoying 8-10 servings a day of fruits and veggies (and the loads of vitamins, minerals, and antioxidants they contain) can nourish all those good gut bugs. Minimizing sugar and refined carbs (bread, pasta, crackers) prevents overfeeding of candida and other opportunistic species.
SHWI: What other important lifestyle/hygiene habits besides diet do you counsel your patients to maintain their vaginal biome?
Get rid of your soap! Using perfumed products with harsh chemicals can dry and irritate your vulva and disrupt the vagina’s acidic environment. The same goes for lubricants. Look for products free of parabens, phthalates, and fragrance, and especially those that include lactic acid to support pH. Make sure your lubricant is “iso-osmolar.” The vast majority are “hyper-osmolar,” literally crushing and dehydrating healthy skin cells, and significantly increasing risk for developing bacterial vaginosis.
I also recommend cotton-crotch underwear, minimizing thong-wearing, and choosing organic cotton tampons (or even swapping tampons for Thinx panties).
Good Clean Love’s Rebalance wipes are my favorite for post-workout, after intimacy, or during menstruation. They’re perfect for your purse/glove compartment/nightstand!
Last, but not least,…peeing after sex can help flush the vagina and reestablish the pH, but it’s best to wait until 20 or more minutes afterwards so your pelvic floor muscles are relaxed and you can have a complete void. If you tend to get UTIs after sex, once you urinate, you can use a lactic acid infused moisturizing lubricant internally.