Ashley Winter, M.D., is the chief medical officer at Odela Health and a urologist and sexual medication 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 truly lasted an hour. We talked about every part from her viral tweet about which approach 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 grow to be 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 know, I want I might 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 folks. I bear in mind most likely three years in the past, close to the beginning of the pandemic, when folks had been simply sitting round quite a bit, an eye fixed physician tweeted his favourite folks on Twitter to observe, and I used to be one in every of them. I obtained a giant following off that.

HealthyWomen: What had been some misconceptions you had about girls and urology initially of your medical research? And how 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 in regards to the process — a cystoscopy, which seems on the within the bladder and urethra. And I used to be like, “Oh, that sounds kind of cool.” So I appeared into what urology was and I obtained excited by it.

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

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

Another huge situation was that some folks would not need to see me as a result of I’m a girl. But some who had been hesitant got here to see me anyway, and after that they had a go to with me, had been like, “Oh, you’re really cool.” I’ve been in a position to change sure folks’s conceptions about what a urologist ought to be simply by present in my profession and doing my job. I think about, like in any historically male-dominated subject, in case you present up and do a terrific job, then folks say, “Oh, I see now that women can do that.”

HealthyWomen: You’re additionally doing quite a bit to dispel a whole lot of misconceptions about urology on Twitter and Instagram. Can you inform us about that?

Dr. Winter: Yes, that is true. There’s a lot misinformation on social media relating to well being info, and I feel that basically got here to nationwide prominence originally of the pandemic. There had been folks 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 normal client: How would I need to strategy areas that I’m not an professional in? You know, after I’m choosing a sunscreen, I like watching YouTube movies from a dermatologist. We can all share in this sort of informal alternate, and I’m actually excited to share what the scientific info truly is.

HealthyWomen: You not too long ago tweeted that girls need not wipe from entrance to again after they pee and it obtained fairly a response. It went viral. Can you 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 may 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. Certainly, I do not imply that it’s best to take a chunk of bathroom paper and smear out of your anus all the best way entrance. But which route you go over your urethra space doesn’t matter. I felt it was necessary to dispel this fable as a result of blaming the route you wipe could make you are feeling ashamed and would possibly discourage you from getting therapy.

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

Dr. Winter: Women 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 mentioned, UTIs aren’t an STD or an STI, which means they are not sexually transmitted. It’s not like your companion has a urinary tract an infection and so they unfold it to you. But being uncovered to the bacterial surroundings on a companion and having that micro organism near the opening of your urethra seems to, in some delicate folks, result in them getting a UTI.

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

HealthyWomen: Can you speak in regards to the G-spot and finish the talk as soon as and for all: Does it exist?

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

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 predict are just like the nerves that go across the prostate in males, which is essential for sexual stimulation, erections, and many others. So, you’ve all this tissue that’s actually complicated and attention-grabbing within the entrance a part of the vagina, like a number of inches in. And that’s the realm that may doubtlessly result in orgasm in case you stimulate it — and in addition to what we name feminine ejaculation or squirting. That can typically be urine, however it can be precise secretion of fluid from the glands round this sort of prostate-like tissue.

It’s not like each girl has an orgasm from stimulating that space. That could be like saying each man primarily orgasms from prostate stimulation.

HealthyWomen: You prefer to deal with UTIs with vaginal estradiol as an alternative of antibiotics. Why?

Dr. Winter: It’s not a lot that I deal with UTIs with vaginal estrogen as an alternative of antibiotics. It’s extra like I forestall them with it. We know that in case you 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 should permit this wholesome micro organism that is purported to stay there to return again. It additionally acts like a barrier and prevents the micro organism that may trigger UTIs from attending to the urethra.

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

But that basically clear idea is so undertaught. I do not do not suppose it was ever taught to me in medical college. 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 folks had been coming to me for frequent UTIs, or who had been perimenopausal or postmenopausal, and I used to be prescribing the additional vaginal estrogen and I used to be explaining that hyperlink all day, daily in my clinic. It was actually gorgeous to me to need to say many times that this not solely makes folks’s high quality of life dramatically higher, it truly saves lives. It can 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.

If you are already on vaginal estrogen and you continue to get a UTI, which positively occurs however much less typically, then, in fact utilizing an applicable antibiotic is completely wonderful.

HealthyWomen: Now let’s speak GSM. What is it and what would you like girls to learn about GSM which will encourage them to hunt therapy?

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

But there’s truly 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 might circle again to that character on tv, that girl would say, “Hey, I’m going through menopause. It hurts when I pee,” or, “Hey, I have to go to the bathroom more frequently.” Or, “Hey, sex is painful and I cannot get lubricated in response to arousal.”

Now, not everyone who has menopause goes by means of these signs, however many do. Oftentimes these signs can begin even earlier than durations fully go away. So any person might be in perimenopause, the years main as much as menopause, and their durations are irregular, or nonetheless occurring, however their estrogen ranges are taking place. And they’re getting signs like urinary urgency, urinary frequency, burning after 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 lowering estrogen.

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

My principal tip 1,000 occasions 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 means of menopause and I’ll use it ceaselessly and I might be buried with my vaginal estrogen.

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

Dr. Winter: I feel a giant one which I really like speaking about since we’re on sort of the hormone factor is testosterone. Testosterone is in everyone. Testosterone ranges within the common grownup girl are literally increased than her estrogen ranges. It’s 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 aren’t black and white: one for males, one for girls form of factor, the best way we sometimes are led to consider.

And testosterone is basically necessary for lots of issues. It’s necessary for the genital urinary well being the identical manner estrogen is. And in case you’re on remedy that may suppress testosterone, you do have a danger of getting ache with intercourse, lowered arousal, and many others. But it might probably additionally have an effect on your ranges of want for intercourse. And in case you’re experiencing low want for intercourse, and also you’re peri- or postmenopausal, utilizing low ranges of testosterone can truly be a therapy for that. I’ve prescribed it many occasions. I’ve seen girls who’ve a beautiful response to it.

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