Interview Series with Julie Spencer: Functional Medicine and the Vaginal Microbiome

Interview Series with Julie Spencer: Functional Medicine and the Vaginal Microbiome

July 2024

1) As a functional medicine nurse practitioner what is your approach to women's health?

I am a Family Nurse Practitioner, (FNP), certified in Urology with over 20 years of experience in women’s health and urology. I became certified in Functional Medicine three years ago, as I loved the functional approach of digging deeper to get to the root cause of the health issue. I think it’s important to listen to the patient and understand what is bothering them, what they would like to change, and how they are affected by the issue at hand. This helps me formulate a customizable treatment plan to help them improve their quality of life and help them optimize their health.

2) You specialize in urology and pelvic pain. What is your approach to diagnosis and treatment, and what recommendations do you have for women who suffer with pelvic pain?  

For pelvic pain, it is important to listen to the patient to better understand when their pain flares, what aggravates their pain and possibly what alleviates it; trying to get to the root cause of the issue. I find a multimodal approach is key in treating pelvic pain patients. In my experience, I find a lot of pain is caused by pelvic floor dysfunction, whether a hypertonic pelvic floor (pelvic floor that is too tight) or muscles surrounding the pelvis are tight (hip flexors, and other supporting muscles). I refer many if not most of my patients for pelvic floor therapy to work with a specialized physical therapist to help with this issue. I also often find that pelvic pain is caused by lack of lubrication. This can occur for many different reasons. Hormonal imbalance as well as vaginal microbiome imbalance are two large factors I see and treat. Restoring the pH of the vaginal tissue is key. I use Good Clean Love products to help with this, as well as estradiol cream. I also spend time talking to my patients about the gut microbiome and how an imbalance their can also affect their vaginal health.

Risk for urinary tract infections (UTIs) and other vaginal infections that can cause pain often come from imbalance within the gut microbiome affecting bowel movements and nutrient absorption. Deficit of nutrients can lead to many different compounding issues within the body, and even lead to pelvic pain issues. I also recommend patients use Epsom salt baths to help relax their pelvic floor muscles and quiet the pelvic floor. I also use compounding valium suppositories to help with pain. After treating pelvic pain in females for over 20 years, I have learned that getting to the root cause of the source of their pelvic pain is essential and not always easy, but by involving the patient in the decision-making process and explaining to them their options in great detail, and having them understand the process of healing, resolution of their pain happens more often than not.

3) What cases do you see that are affected by imbalances in the vaginal microbiome? 

I see recurrent bladder infections that continue, vulvovaginitis, vulvar pain, chronic vaginal yeast infections, vaginal dryness (especially breast cancer patients), pain with intimacy. Many go missed and undiagnosed, until the patient is miserable, and has tried every cream out there.

4) How does stabilizing both the gut and vaginal microbiome help to stabilize these issues? Additionally, how do you help women improve and heal their gut health? 

By regulating the gut microbiome, you are helping with overall immune health and well-being. Having a happy and healthy gut microbiome decreases your risk for urinary tract infections, helps regulate bowel movements and overactive bladder symptoms specifically.  Many women I treat are constipated, and do not realize how the imbalance in their gut can affect their bladder and vaginal issues. By regulating the gut and vaginal microbiome, you help create homeostasis and restore gut health to optimize evacuation of toxins, putting less pressure on the bladder wall to maintain a happier bladder and create a vaginal environment that is more comfortable.

As mentioned above, having a healthy gut microbiome is essential to maintaining good overall health. Our gut supports over 2/3 of our immune health, as well as helps to regulate our dopamine and serotonin receptors (which help in regulate mood and happiness). I spend a lot of time with my patients working on their gut health. I frequently recommend a specific test to determine any overgrowths in the gut that need to be removed (SIBO and h pylori are the two most common). Focusing on eating hygiene and evaluating the patient's diet is key to resetting the gut and helping the patient maintain a healthier gut microbiome.  I also recommend certain probiotics to help maintain balance within the gut. This not only helps with removal of toxins (helps with frequency of bowel movements) but also helps regulate the flora in the vagina, reducing risk for infections.

5) Do you see patients maintain their vaginal health with the use of our sample program?

Yes! My patients love your products. I feel you have so many different products to offer for many different issues. I place pessaries (helps support the vaginal vault when a prolapse is present) and recommend the Balance Moisturizing Wash regularly to help maintain vaginal balance. I also have my vulvodynia patients use the Relief Pain Gel; it has worked wonders for them. The BioNourish Ultra Moisturizing gel with Hyaluronic Acid is ideal for my breast cancer patients that are unable to use estrogen-based products, but are lacking vaginal moisture, especially when they wish to regain their intimacy. I have recently started using Restore Moisturizing Vaginal Gel for my post-menopausal patients that need additional lubrication.

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