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Urogynecologist Dr. Betsy Greenleaf on the BV-UTI Connection

Updated: Mar 23, 2022

SHWI medical advisor Dr. Betsy Greenleaf, DO, FACOOG (Distinguished), MBA is a premier women’s health expert, entrepreneur, inventor, and business leader who specializes in female pelvic medicine and reconstructive surgery for over 20 years. Dr. Greenleaf, is a trailblazer as the first female in the United States to become board certified in urogynecology.



Dr. Greenleaf possesses a professional reputation that has led to being sought after by medical societies, associations, and corporations to provide lectures, teaching, and advanced training. In 2018, she was honored with the title of distinguished fellow of the American College of Osteopathic Obstetrics and Gynecology (ACOG) for her service and dedication to the field. She holds committee positions on many national women’s health organizations.

Dr. Greenleaf takes a holistic body-mind-spirit approach to healing and wellness. She believes many of the answers to a healthy life are found within.


SHWI: As a urogynecologist, there’s some recent research that demonstrates how recurring bacterial vaginosis (BV) also impacts the recurrence of urinary tract infections (UTIs). Can you explain this connection?


Dr. Greenleaf: The BV-UTI connection ultimately has to do with a combination of changes in vaginal pH and loss of a healthy vaginal microbiome. Now, what causes that is chicken or the egg. But once the pH and microbiome get thrown off, it can cause either vaginosis/vaginitis or a urinary tract infection or both. Ultimately, getting the vagina back in balance or preventing it from not becoming off balance by living a healthy lifestyle, using healthy products like Good Clean Love's lubricants or washes, and supporting self-care are the best options.


SHWI: You’ve done some very interesting genetic analysis of the vaginal biome. Can you tell us what you learned?


Dr. Greenleaf: It wasn't until approximately 15 years ago that laboratories started to offer testing to look at the DNA presence of bacteria in the vagina. Scientists were amazed to find out there were more bacteria there than they had ever imagined. Many of these bacteria still don't have names, but they have been named things like “Bacterial Vaginosis Associated Bacteria Number 2.” This became an interest in what is the normal bacteria or microbiome of the vagina. Scientists have discovered that "healthy" bacteria in the lactobacillus family keep the vagina at a nice healthy acidic pH and fight off the "bad guys" by killing them with hydrogen peroxide. This testing has drastically changed how I care for my patients. In the past, we thought only one bacteria caused bacterial vaginosis but we now know there are many types of bacteria along with the loss of healthy bacteria.


If a patient is suffering from recurrent infections, I have the ability to boost their healthy bacteria at the same time, targeting the specific type of bacteria causing the problem. In the past, women would suffer endlessly using antibiotics that did not address the problem.

SHWI: What kind of recommendations do you make to your patients to maintain their vaginal biome, and have you seen this impact their urinary tract health?


Dr. Greenleaf: The easiest answer, but the hardest thing for most of us to do, is to live a healthy lifestyle. We know there are many factors that throw off our microbiome from stress to poor diet, to taking antibiotics, or using soaps or poor lubricants. Seventy-five percent of Americans are chronically dehydrated.

Here are some tips: focus on staying well hydrated (or drink until your urine is clear), stay away from inflammatory foods such as dairy, gluten, and sugar, and use stress-reduction techniques such as meditation, yoga, a hobby, or exercise. Adding fermented foods or taking probiotics can help with boosting the amount of healthy bacteria in the gut, which in turn can help support the vaginal microbiome. Individuals also want to do what is healthy for the vagina by letting it breath from time to time. Spending all day in sweaty yoga pants is a big no-no. I know everyone wants to feel clean, but using harsh soaps and detergents actually worsens the vagina microbiome. Use either just water or a trusted wash such as Good Clean Love's Balance Moisturizing Wash. The same goes for lubricants. Many of the lubricants on the market are not pH balanced and actually strip the vagina of its moisture and can cause microscopic lacerations. What I love about Good Clean Love is that they have done the research to make a healthy product. Anything that supports a healthy vagina also supports a healthy reproductive tract.


SHWI: If you could reinvent reproductive and urinary tract healthcare for women, how would it be different?


Dr. Greenleaf: The biggest problem in pelvic health is training. The focus is on the vagina as a birth canal and that is it. I wish I could say it is changing but medicine is a snail, slow at looking at health in an innovative manner. It is not the fault of my colleagues, they are just doing what they are taught.


The problem is that very few practitioners look at the vagina. The vagina has so much to tell us about our overall health. The lining or mucosa can provide hints to other medical conditions. The color of the tissue can point to autoimmune or cardiovascular disease. Recurrent infections can be the first sign of adrenal fatigue or even diabetes.


The vagina is talking and we need to listen. And the vagina is the keystone of the pelvis. If the vagina is not healthy then neither are the bowels or the bladder.




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