Ashley Winter, MD, Talks Urology, Intercourse & All Issues Vaginas

Ashley Winter, M.D., is the chief medical officer at Odela Well being and a urologist and sexual drugs specialist. She makes use of social media (primarily Twitter) to assist clear up misconceptions about girls’s well being and talk the reality about all issues vaginas.

Winter was exceptionally beneficiant along with her time, and our “15 minute” chat really lasted an hour. We talked about all the things from her viral tweet about which strategy to wipe after peeing (spoiler alert: it doesn’t actually matter) to the significance of vaginal estrogen for perimenopausal and postmenopausal girls.

Our interview follows, edited for readability and size.

HealthyWomen: You’ve got turn into fairly a well-known determine advocating for girls’s well being and offering sex-med and urology tutorials on Twitter. How did that come about?

Dr. Winter: You understand, I want I may pinpoint precisely what occurred. I’ve simply tried to be constant in my messaging, but in addition an actual human, and I feel that has been interesting to individuals. I keep in mind in all probability three years in the past, close to the beginning of the pandemic, when individuals have been simply sitting round so much, a watch physician tweeted his favourite individuals on Twitter to comply with, and I used to be considered one of them. I obtained an enormous following off that.

HealthyWomen: What have been some misconceptions you had about girls and urology initially of your medical research? And the way do these misconceptions persist in society?

Dr. Winter: I initially went into urology as a result of I realized about it after a female relative went to a urologist, and I heard concerning the process — a cystoscopy, which appears on the within the bladder and urethra. And I used to be like, “Oh, that sounds form of cool.” So I appeared into what urology was and I obtained curious about it.

I noticed that girls have been additionally sufferers of urologists, which I got here to know that lots of people didn’t know. Folks usually thought {that a} urologist was the male equal of an OB-GYN. However they’re not — they see all genders.

Additionally, there are specific issues which are positively not intercourse particular, like kidney stones, bladder most cancers, blood within the urine. We tackle all of these issues. And along with male infertility and male sexual perform, we offer take care of feminine sexual perform, which is a large a part of my profession. It’s an area that does not have numerous possession within the conventional medical setting. A number of what girls get in healthcare is reproductive healthcare.

One other huge concern was that some individuals would not wish to see me as a result of I’m a girl. However some who have been hesitant got here to see me anyway, and after they’d a go to with me, have been like, “Oh, you are actually cool.” I’ve been capable of change sure individuals’s conceptions about what a urologist must be simply by current in my profession and doing my job. I think about, like in any historically male-dominated area, for those who present up and do an amazing job, then individuals say, “Oh, I see now that girls can do this.”

HealthyWomen: You’re additionally doing so much to dispel numerous misconceptions about urology on Twitter and Instagram. Are you able to inform us about that?

Dr. Winter: Sure, that is true. There’s a lot misinformation on social media relating to well being data, and I feel that actually got here to nationwide prominence firstly of the pandemic. There have been individuals saying issues that weren’t based mostly in science. That was after I actually pushed up my social media presence as a result of I noticed that many physicians direct their on-line content material towards different medical doctors. And we actually have an obligation to focus towards the broader group.

I give it some thought as a basic client: How would I wish to method areas that I am not an skilled in? You understand, after I’m choosing a sunscreen, I like watching YouTube movies from a dermatologist. We will all share in this sort of informal trade, and I am actually excited to share what the scientific data really is.

HealthyWomen: You lately tweeted that girls need not wipe from entrance to again after they pee and it obtained fairly a response. It went viral. Are you able to inform us about that?

Dr. Winter: To make clear, what I meant by that was you do not have to wipe entrance to again over the vulva. After you pee, you’ll be able to both wipe beginning behind your vulva ahead, or behind your urethra ahead, or you can begin within the entrance of your urethra and go backwards. Definitely, I do not imply that it is best to take a bit of bathroom paper and smear out of your anus all the best way entrance. However which path you go over your urethra space doesn’t matter. I felt it was necessary to dispel this delusion as a result of blaming the path you wipe could make you are feeling ashamed and would possibly discourage you from getting remedy.

HealthyWomen: There’s an thought on the market that girls get UTIs from sleeping round with males. Is that true?

Dr. Winter: Ladies have a brief urethra — shorter than males. It does seem they get UTIs extra simply. And positively there are some girls who’ve a better probability of getting a UTI after sexual exercise. That stated, UTIs will not be an STD or an STI, which means they don’t seem to be sexually transmitted. It is not like your associate has a urinary tract an infection and so they unfold it to you. However being uncovered to the bacterial setting on a associate and having that micro organism near the opening of your urethra seems to, in some delicate individuals, result in them getting a UTI.

It additionally does seem that if in case you have a brand new associate, you’ll have an elevated probability of getting a UTI. That stated, it is not just like the variety of companions causes UTIs. It’s the introduction of a brand new associate. And once more, that is not the case for everyone.

HealthyWomen: Are you able to discuss concerning the G-spot and finish the controversy as soon as and for all: Does it exist?

Dr. Winter: Sure and no. No, within the sense that there’s not a magic button that for those who discover it, and also you simply press down on it, a girl may have an outrageous orgasm. However is there tissue that may be accessed from the within of the vagina that has relevance for sexual want? Sure.

The entrance a part of the vaginal wall, close to the place the urethra passes, has glands which are just like the prostate in males. There are additionally a bunch of nerves that run alongside it that we expect are just like the nerves that go across the prostate in males, which is essential for sexual stimulation, erections, and so forth. So, you’ve got all this tissue that’s actually advanced and fascinating within the entrance a part of the vagina, like a number of inches in. And that’s the world that may doubtlessly result in orgasm for those who stimulate it — and likewise to what we name feminine ejaculation or squirting. That may generally be urine, however it may also be precise secretion of fluid from the glands round this sort of prostate-like tissue.

It is not like each lady has an orgasm from stimulating that space. That will be like saying each man primarily orgasms from prostate stimulation.

HealthyWomen: You wish to deal with UTIs with vaginal estradiol as a substitute of antibiotics. Why?

Dr. Winter: It is not a lot that I deal with UTIs with vaginal estrogen as a substitute of antibiotics. It is extra like I forestall them with it. We all know that for those who take a bunch of ladies who’re postmenopausal, and also you give them vaginal estrogen, it should make their vaginal pH go down again to premenopausal ranges. And it’ll enable this wholesome micro organism that is speculated to dwell there to come back again. It additionally acts like a barrier and prevents the micro organism that may trigger UTIs from attending to the urethra.

That is one thing that has been in medical literature and confirmed time and time once more. It has a really clear impact.

However that actually clear idea is so undertaught. I do not do not suppose it was ever taught to me in medical faculty. And there was little or no, if any, training about that in my six years of urology residency. And then you definately exit into observe, and also you see tons of feminine sufferers who’re postmenopausal getting antibiotic, antibiotic, antibiotic, for his or her UTIs.

What I’ve present in my position as a urologist is that individuals have been coming to me for frequent UTIs, or who have been perimenopausal or postmenopausal, and I used to be prescribing the additional vaginal estrogen and I used to be explaining that hyperlink all day, day by day in my clinic. It was actually beautiful to me to must say many times that this not solely makes individuals’s high quality of life dramatically higher, it really saves lives. It might probably forestall girls from getting an an infection that travels up their kidney and finally ends up touchdown them within the hospital or the ICU or dying.

When you’re already on vaginal estrogen and you continue to get a UTI, which positively occurs however much less usually, then, in fact utilizing an applicable antibiotic is completely tremendous.

HealthyWomen: Now let’s discuss GSM. What’s it and what would you like girls to find out about GSM which will encourage them to hunt remedy?

Dr. Winter: GSM stands for genitourinary syndrome of menopause. And it’s so necessary to know that time period. After I consider all of the depictions of menopause that I realized as a child or in my younger maturity, it was like some lady within the films having sizzling flashes or saying, “I am not within the temper for intercourse.” So that you consider menopause as these whole physique signs like sizzling flashes, night time sweats and adjustments in conduct.

However there’s really an enormous element of menopause that pertains to the impact of estrogen ranges taking place and the way that adjustments the tissue round your bladder, urethra, vulva and vagina.

If we may circle again to that character on tv, that lady would say, “Hey, I am going by way of menopause. It hurts after I pee,” or, “Hey, I’ve to go to the toilet extra continuously.” Or, “Hey, intercourse is painful and I can not get lubricated in response to arousal.”

Now, not everyone who has menopause goes by way of these signs, however many do. Oftentimes these signs can begin even earlier than intervals utterly go away. So any individual might be in perimenopause, the years main as much as menopause, and their intervals are irregular, or nonetheless taking place, however their estrogen ranges are taking place. And so they’re getting signs like urinary urgency, urinary frequency, burning once they pee, elevated urinary infections, lack of lubrication and lack of getting moist in response to arousal — all these signs might be an indication of reducing estrogen.

When you’re experiencing any of these signs, you actually ought to discuss to your healthcare supplier about utilizing low-dose vaginal estrogen, as a result of that’s the main remedy for all of these signs. It is not the identical factor as what we name hormone substitute remedy, which is supposed to boost blood ranges of estrogen. Vaginal estrogen is actually for the native remedy of all these signs.

My foremost tip 1,000 instances over for girls with GSM is to get your self some vaginal estrogen. And I promise you, I’ll use vaginal estrogen as soon as I’m going by way of menopause and I’ll use it ceaselessly and I shall be buried with my vaginal estrogen.

HealthyWomen: Is there something we’ve not coated that you simply want girls knew about girls’s well being?

Dr. Winter: I feel an enormous one which I really like speaking about since we’re on form of the hormone factor is testosterone. Testosterone is in everyone. Testosterone ranges within the common grownup lady are literally increased than her estrogen ranges. It is simply that these ranges are increased within the common man. So girls have much less testosterone than males, however everyone has extra testosterone than estrogen. Hormones will not be black and white: one for males, one for girls form of factor, the best way we usually are led to consider.

And testosterone is actually necessary for lots of issues. It’s necessary for the genital urinary well being the identical manner estrogen is. And for those who’re on remedy that may suppress testosterone, you do have a danger of getting ache with intercourse, lowered arousal, and so forth. However it may additionally have an effect on your ranges of want for intercourse. And for those who’re experiencing low want for intercourse, and also you’re peri- or postmenopausal, utilizing low ranges of testosterone can really be a remedy for that. I’ve prescribed it many instances. I’ve seen girls who’ve an exquisite response to it.