Bacterial vaginosis (BV) is a common vaginal infection in women in their reproductive years. In the United States, the National Health and Nutrition Examination Survey (NHANES), estimated the prevalence of BV was 29% in the general population of women aged 14 to 49 years and 50% in African-American women.

BV is characterized by a shift in vaginal flora from an acidic environment with acid producing lactobacilli to a mixture of anaerobic and facultative microorganisms. This shift alters the ability of the pelvic floor muscles to function optimally. The more basic pH affects the venous and nervous system in the pelvic floor resulting in inflammation and hypertonicity of the pelvic floor muscles. Your patients with recurrent BV should be assessed by a pelvic floor therapist to get a full picture of the pelvic floor muscles and if they could be contributing.

Have you considered?
Vitamin C vaginal tablets taken 6 days per month safely halves the risk of BV

After treatment of BV with antibiotics, recurrences are common and about 60-70% of women will have a recurrence in 3 months. While research shows the effectiveness of oral probiotics for gut health and yeast overgrowth, emerging research is starting to show the benefits of vaginal/rectal probiotic suppositories AND vitamin C to help improve the vaginal microbiome and prevent recurrences.

Vaginal vitamin C is available as silicon-coated tablets containing 250 mg ascorbic acid. This formulation is able to release the vitamin over hours, allowing a statistically significant vaginal pH-lowering effect.

How it’s done: The vitamin C is inserted vaginally at 250mg, 6 times per month. This cut recurrence rate from 32.4% to 16.2%.

Advise your patients to find ascorbic acid in its purest form (no additives).

Vitamin C acts as a natural antihistamine so in the least, it will reduce any inflammation caused by BV and improve the homeostasis of the vaginal microbiome!

You can find the research article here:

Are you and your partner’s desires mismatched?
Are you struggling with low desire?

Low libdo in the reproductive years, the perimenopausal years, and menopausal years is REAL. You are not alone.
The solution is multifactorial:
1. A conversation with your primary care provider (pcp) or gynecologist (GYN)
2. Possibly a referral to a sex therapist (certified by the American Society of Sexuality Educators ASSECT)
3. Prescription help

There are 3 prescription options available.

Addyi or flibanserin: FDA approved for premenopausal women with HSDD (hyopactive sexual desire disorder) and totally fine for menopausal women too.

Vyleesi or bremelanotide: FDA approved for premenopausal women with HSDD (hyopactive sexual desire disorder) and totally fine for menopausal women too.

Low dose testosterone: FDA approved in Australia- lots of unwarranted fear in the US about prescribing. The International Society for the Study of Women’s Sexual Heatlh (ISSWSH) has a position statement on the use of testosterone to help low libido.

Reach out to Kathy Kates, a nurse practitioner AND pelvic floor therapist.
She can do a virtual consult to see if you are a candidate for prescription medication for low libido.
If you’re in the Boston area, you’ll do a virtual consult first, and then come in to the clinic for an in person examination.

You’re not alone, there is NO shame and there IS help!

At our clinic, we have tried MOST lubricants and this one is by far our favorite! Good clean love is a certified organic water based lubricant that is pH balanced. It’s made with aloe vera and NO chemicals. Why is lubricant so important? Because we’re using it INTERNALLY! The vaginal wall is highly permeable and soaks up all things. Listen to your pelvic floor therapists at the Institute for Pelvic Health when we say, invest in your lubricant. We have done the research for you:)

And we love that Good Clean Almost Naked lubricant is the first carbon neutral personal lubricant. For every bottle purchased, Good Clean Love donates to a project that reduces greenhouse gases and that makes us feel GOOD!
Helping your patients maintain their pelvic health is key to maintaining both their sexual and overall health.
-Pelvic health fact: Healthy vaginal pH is 3.8 to 4.5 and rectal pH is about 7.0. Lubricant should have a pH value similar to your tissues or slightly higher to prevent infections.

-Pelvic health fact: Osmolalities of less than 380 mOsm/kg or at most 1200mOsm/kg are recommended by the World Health Organization. Lubricants that meet this criteria include: Good Clean Love and Sliquid and have osmolalities less than 316 mOsm/kg.

We have no affiliate relationship with Good Clean Love

Do you feel dry? Do you have burning with urination when there is no evidence of a urinary tract infection? Do you feel dry during sex? Have you recently had a baby? Are you going through or have you gone through menopause? If so, please do consider some lubrication for your labia; try vital vulva, a wonderfully soothing salve made from wild yams. Also consider a vaginal moisturizer, like Hyalo Gyn, made from hyaluronic acid 2-3 times a week. And do use a lubricant for intercourse; a lot inside of you and also on your partner. Try Slippery Stuff. Visit the resources page of to learn more. And let’s lube it up!

Does it hurt to have something inside of your vagina? It is hard to put something inside a vagina that isn’t quite ready. Foreplay, masturbation, kissing, gentle touching…..all promote blood flow to the vagina. Think about a cold day; you start your car ahead of time and let it warm up; it is exactly the same thing of the muscles inside of the vagina.
Whether or not you reach orgasm, promoting blood flow to your vagina is healthy for the muscles of your vagina (ie your pelvic floor). And it most likely feel good:) Another bonus!

Pelvic pain and the pelvic floor are difficult to talk about. Pelvic Health Support is here to help women, men and transgender people learn about the pelvis both externally and internally, to alleviate pelvic pain. If we have shoulder pain, we go to our healthcare provider and have a thorough exam; we are given a stretching routine; some patient education; perhaps a referral for physical therapy and/or massage therapy. Why isn’t this happening when we go to our healthcare provider and tell them we have pelvic pain? The mission of Pelvic Health Support is to raise awareness of the pelvic floor!