😱Your Pain Is NOT Normal, Vaginal odor, Period pain,Egg freezing|Dr Maalavika Appasani | Honest Hour

😱Your Pain Is NOT Normal, Vaginal odor, Period pain,Egg freezing|Dr Maalavika Appasani | Honest Hour

Author Name:The Honest Hour with Shashank

Youtube Channel Url:https://www.youtube.com/@TheHonestHourwithShashank

Youtube Video URL:https://www.youtube.com/watch?v=CyH1WO4CCPI



Transcript:
(00:00) Pain at any point of time is not normal. Any pain happening on a routine basis, it's not normal. They had to go to the doctor for the reason that they were unable to consummate the marriage. >> Sometimes I also see couples who are 9 years down their married life. But the basic thing is I'm not able to consummate the marriage.
(00:21) But these topics are such topics that there is no clear picture unless and until a doctor themselves they talk about it. >> Some people also go through that mental trauma or psychological trauma. It's randomly to everyone. It's important to know their body. Sexual intimacy is something which both the partners should enjoy. They live [music] longer also.
(00:39) >> What exactly is the age when the fertility starts to decline? 20 to 25% [music] before 30 years of age. It will slowly decrease to 15% [music] like that post 30. And by 35 it will come to 5 to 10% and 40 it will become 1%. [music] As a doctor, it's very advisable for a woman to conceive before she is 30.
(01:02) Or women like senior police officers or young police officers or any challenging situations or some sportswomen. >> [music] >> In that situation it becomes very difficult. >> That is why they say women are great. >> [laughter] >> Because they handle so many things. [music] >> Absolutely. Welcome to the Honest Hour, Dr.
(01:31) Malvika Appasani. Thank you, Shashank. So nice to be here. Same. Pleasure is mine. Usually when it came to Fair and Lovely. Now there's a severe backlash, you know, when we talk about fairness creams and the stigma around it or the prejudice attached to it. But these days another unspoken about thing is about lightening or using lasers, using some pigmentation or hyperpigmentation creams for intimate areas.
(02:00) What they call as the bikini bodies, etc. So what are the side effects of this and what are the, you know, right approach in this? So firstly, what every girl or woman should understand is their intimate parts are a little darker than their other skin like some face and all they are more lighter in color. And [snorts] it when it comes to intimate parts, they are little darker than their normal skin. And that's normal.
(02:23) >> normal. Yeah, that's normal and they become more dark when, you know, when they attain the process of menarche and all because of the hormonal surge it will become. But few people who are having conditions, hormonal imbalance, hypothyroids or PCOS issues, it's more darker. Okay.
(02:41) Or few people who are into some athletic thing and they have a lot of friction in the intimate area. Obviously because of the friction and all it will get more darker. Okay. Or for some people who are repeatedly doing something like shaving or anything something like that, then it gets pigmented or irritation and they get acne and like that it gets infected and recurrent repeated things make it more and more pigmented.
(03:04) So when it is like that they are obviously insecure. They'll come and tell us priorly it was not like that. Priorly it was fine. Now it is like that. So now what to do? Mhm. So then again we have to explain them. First thing is first. First stop the cause. So whatever is causing it, we have to tell them now stop it. Right.
(03:22) Then comes the treatment part what we can do. So if we are not treating the cause, there's no point, you know, going for treatment. How much ever they do, how many ever products they apply they are applying more and more but finally there is no result. It's no good for them also. And there are also reports that they are applying bleaching creams, chemical peels, etc.
(03:39) What is the long-term damage that it can have on the So um the all these bleaching and all that they irritate skin. >> methods. Ah. So and when they don't know what to do, where to stop, how to go about and all that, obviously there's a lot of skin irritation. That's intimate area also. Once it gets repeated irritation, it get inflamed and it causes more and more pigmentation.
(04:01) So when they want lightening, it can get hyper also, not hypo. So the skin part gets more irritated. The pigmentation might improve. It can cause infections. So a lot of things are there if they go for themselves treatment rather than going to a doctor and taking it properly. Mhm. Having understood that like you mentioned about sometimes shaving, etc.
(04:24) So many people do not know what is the right direction to deal with pubic hair. Right? So some people apply razors, some people apply some kind of chemical ingredients, etc. So what is the right approach according, you know, as a gynecologist, what is the right approach? So initially the human body is it's well curated. I don't know how it's curated.
(04:46) Maybe by God it's curated but it's well there. So the pubic hair is there for a reason. Mhm. So generally pubic hair is also support it's it's supposed to provide the hair follicles have that nice oil which produces from the follicle. So it's supposed to keep that area a little bit of oily, not too dry and it's supposed to help them from the impact like it's supposed to be protective. Okay.
(05:12) So people who are comfortable with the pubic hair, no need to do anything. They can just leave it like that. Right. And then so but people who are not comfortable with the pubic hair, they are going for other modalities like either waxing or shaving at home. >> Salon waxing. Or some using products which are like it's a cream after just applying the cream the hair is supposed to fall off chemically removing the hair. Mhm.
(05:39) So this thing might cause irritation of the skin, more dryness. And when they are doing shaving sort of a thing, there might be micro cuts in the skin which might get infected because it's an intimate area. It might get infected. And then repeated shaving on top of it like next after a month or whatever there is a small acne, then again it will spread in that area.
(06:00) It can cause we we see conditions where the where we see big big cysts also and abscess. Right. And it spreads in the pubic area also. The pubic area is so that it the infection can easily spread there. Mhm. So we see all these conditions. So we tell them that please don't do all that. So if you really don't like that hair, then come for laser hair reduction where we can reduce the hair follicles with laser.
(06:26) It is not completely removed. We just reduce the number of hair follicles with laser. You still have a little bit if you wish to. Mhm. So doing knowing about the body, knowing what you want and what you don't want, taking the right choice is very important. >> Any home remedy for this? Home remedy for hair removal? >> Yeah.
(06:44) Uh no. I think >> Not everybody prefers to come to the hospital for this. >> Yes, yes, yes. There won't be any That's an intimate area. So we can't just use any products or sometime people just hardly scrub it. All that is very dangerous and it can cause more damage than required. So obviously intimate area is never supposed to be fiddled with.
(07:06) The pH of that area, everything is supposed to be maintained. That area is supposed to be self-maintained. Vagina is a self-cleansing organ. Even outside area is supposed to be maintained like that. Mhm. There's also something called urinary [clears throat] tract infections, UTIs, right? So there is one viral reel going on that if you have cranberry juice regularly, it will treat UTIs.
(07:27) Is it true? So not cranberry juice per se but actually they say cranberries are good and they maintain little health of the epithelial tissue. Okay. So [clears throat] related to that there are some products also which have cranberry, probiotics all together. It's like a healthy capsule what they take. Okay.
(07:48) But people don't realize that when they go for cranberry juices, they take preservative juices and it is sweetened also. Mhm. So when they take all those juices on a routine basis, they are going in a line for diabetes. Mhm. So they are not treating any issue. And once there is urine infection, no matter what we do, we have to find out what that infection is, what is that bacteria. Then first take antibiotic.
(08:10) Mhm. Then preventing the infection is what they have to take care. For preventing of infection, we have to give them proper hygiene of intimate area and tell them all that intimate area health and hygiene and finally go for it. But cranberry juices per se, we tell them have dried cranberries.
(08:29) That's good for overall health also. Unsweetened dried cranberries, just a fistful. Right, right. Yes. So raw cranberries are Yes. Then like talking about hygiene like hygiene in the intimate areas. Like people are using various products that are available in the market. Now is it better to go for them or is there any solution per se? Because I've also heard some cases or seen as part of the research, there are some people who suffered burns or severe, you know, distress situations.
(08:59) So how do we deal with this? And also in in the market there are some products available like V Wash, you know, etc. etc. So base The whole concept is that that area, the vagina and the outside vagina, it's supposed to have an acidic pH. So if it has an acidic pH because vagina is directly open to outside environment.
(09:24) So if it has acidic pH, it's supposed to protect itself from outside bacteria. The moment it gets alkaline, it's more most easy for the infections to come and, you know, tackle get infected. So that is why to maintain an acidic pH is what the market is suggesting. The V Wash and other washes and all are only to maintain an acidic pH for the outside area.
(09:48) So now outside area cleaning with just water doesn't make sense. Right. So because as as we are having bath on a routine basis also, we are using some body washes. these body washes are more of alkaline nature and we want a different pH for the intimate area. So, that is why all these products have come. So, it's fine to use the product, but you have to make sure it's only for external use, not to go inside the labia and only once a day.
(10:15) Sometimes I know some people who have been using it every time they use the restroom. All that is very bad. So, we have to use it just once a day for external use and that too with cold water. Some people think it is, you know, people who have OCD. Like they think that they're maintaining extreme hygiene. >> Some people use Dettol also.
(10:32) Yes, yes, [laughter] yes, yes. We have to tell them that the whole body has bacteria covered for us. It's just not visible. So, these are all good bacteria, probiotics like that, you know. So, we keep taking also now the curd what we take and all these are probiotics. So, if we have good bacteria in the body, it will protect us from harmful bacteria.
(10:51) So, even the intimate area, it maintains its pH. It has some bacteria to protect itself. So, if we are using Dettol and all on a routine basis, they kill the external bacteria, the protecting bacteria. Then outside things will come. From another, you know, thing that is going on on social media with filtered Instagram stories or Korean dramas and also, you know, OTT platforms like Netflix, Amazon Prime, etc.
(11:20) We see that people want, you know, a beauty standard has been set. Secret beauty standard has been set when it comes to intimate parts also, intimate parts. So, you know, you talk you specialize in cosmetic gynecology, right? So, what is the line like, you know, when should people go for cosmetic gynecology? Is it only for this beauty standard or some kind of peer pressure or are there any genuine cases per se, medically? So, where do you draw the line per se? So, generally when it comes to cosmetic gynecology or when it comes to plastic
(11:55) surgery, Many people don't know what is cosmetic gynecology. >> Yeah, yeah, uh So, if you could give us a brief on that. Uh so, it's not just like cosmetic gynecology. Cosmetic means as you said, it's more of beautifying. So, it's not just cosmetic what I deal with. Right. So, I deal with cosmetic, functional gynecology and sexual gynecology.
(12:17) So, these are all the parts which I deal with. So, I deal from adolescent health till menopause. Okay. So, in this point of time, they can come to me with anything related to cosmetic issues like maybe pigmentation. Sometimes PCOS clients, they have hormonal imbalance. So, that is when they have pigmentation around their neck or other body parts, even intimate area, underarms.
(12:40) They'll have more pigmentation because of insulin resistance there in that condition. So, they they can go to dermatologist also, but when PCOS clients go to a dermatologist, they will club with a gynecologist and then take it forward. >> Okay. Because they want the innate the hormonal conditions to be corrected. So, like this, clients can come for something related to pigmentation or sometimes their intimate parts like labiaplasty.
(13:08) They don't like their labia. I had a client [clears throat] where a mother brought her baby also saying that baby is not like a baby, it's a child who is just about to get married saying her labia is, you know, she's not confident. Why don't we I have Googled about it. I have seen. So, she wants a labiaplasty.
(13:30) Like that a mother >> insecure like, you know, it's not a symmetry or something. So, it is very important for the women to feel confident in her body. So, as long as she's confident, uh she can, you know, once the women is more confident in her body, she is more confident in the relationship or just like, you know, inside out confidence sort of a thing.
(13:51) So, if it is something like a labiaplasty and sometimes it's not just about the look of it. Sometimes the when they come for a labiaplasty, it's so much of hypertrophy that they have other issues like irritation, yeah, functional issues like irritation and repeated infections because it's sticking to each other or they are not if they are athletes or something like they are not confident enough to wear, you know, those garments and perform and such other things also will be there.
(14:20) So, we deal with these things or we deal with even laxity post delivery if they have a lot of laxity, we do a vaginal. All these come under cosmetic. When it comes to functional, this vaginal laxity or any urine leakage issue or any hormonal thing postmenopausal, so we deal with all these and sexual medicine comes like vaginismus or related to sexual health and all that.
(14:42) So, it's a wide big umbrella what we take care of from adolescent till menopause. Lot of things where people don't know, but then we are there waiting for them. Right, right. Many a times people do [clears throat] not have the awareness, you know, they they might be undergoing this condition, but they don't know where to approach, whom to approach, where to go.
(15:03) That's where the problem comes in. And ma'am, like having understood what are the areas that you cover, like you mentioned about labiaplasty. What exactly is the treatment for that? So, labiaplasty, labia are something like a lips of vagina. Vaginal opening is covered by labia. So, when it is too much of hypertrophy, either related to hormone or congenital from birth or a little later on because of pregnancy hormones it hypertrophies or anything, any reason if they are not comfortable, we do do a labiaplasty. Labiaplasty is
(15:35) correcting the shape of the labia. So, when we do that, they attain a good shape so that even the women is confident and she can just have it. So, like also there are some, as you mentioned, laxity and dryness. So, there are some non-surgical procedures. How effective are they? So, when it comes to non-surgical procedures, so we have to see which works, which doesn't works and the beauty of it is right now we are having lot of options.
(16:06) Priorly, we hardly had any options. So, right now we have vaginal lasers or for urine leakage, we have a magnetic chair called Emsella chair which nicely strengthens their muscles also. In India, are they using Emsella, ma'am? Yes, I have it in my own clinic. So, I have a chair. Many people don't know about it. Yeah, yeah.
(16:25) But now because we are talking openly. So, these are all so much of intimate things and hardly spoken about and all that. So, now as the as doctors, we are talking more about it openly and we are telling that is when people are at least knowing and now people I have started to browse also online.
(16:45) Like they know, they see everything what it is. At least if they don't know the terminology, something they'll be browsing and they'll finally get to know. Like vaginismus, uh many people told me I didn't know there is a term called vaginismus. I have this issue, but I haven't seen it online. So, slowly they browse and finally they come to it.
(17:02) Then they see, sometimes they go somewhere else, then they go somewhere else. Finally, they have to navigate and come. But these topics are such topics that there is no clear picture unless and until a doctor themselves they talk about it. Ma'am, recently I was going through one blog on Reddit, right? Over there there was a discussion.
(17:19) There was a young couple. That couple married after lot of struggle. In the sense like it was a love marriage. So, it was a long association of love. They got married, but they had to go to the doctor for the reason that they were unable to consummate the marriage. Though they were, you know, liking to get intimate with each other, whenever they were trying to do so, there was severe pain.
(17:43) So, what is this condition, ma'am? So, medically, this condition is called vaginismus. So, vaginismus, this is a condition where a couple comes to our clinic saying, "Doc, we are not able to consummate the marriage." Right. And it's not just that the couple is just if you know, they are freshly married and maybe I see them sometimes I see the couple in just 15 days of their married life. Okay.
(18:08) Sometimes I also see couples who are 9 years down their married life. Yes. But the basic thing is I'm not able to consummate the marriage or they sometimes say that sometimes even push or avoid intercourse just because the thought, the fear of consummation of marriage, they have this thing in their mind that it is painful.
(18:29) Maybe because of their personal experience or maybe they heard it from somewhere or maybe sometimes there is case of some child abuse, so it's just stuck in [clears throat] their mind or some other news, some friend told like that, all that. So, they build up stories and they have that lot of fear in their mind. Okay. But when they come to a gynecologist saying that I am not able to consummate, it's my duty to first see is there any physical obstruction or is it just the fear part? So, I am supposed to tell if it is primary vaginismus, secondary
(19:01) vaginismus. >> Okay. So, primary is till now they are not able to do. Secondary vaginismus is they have been intimate to before Okay. and after the delivery or something because of pain again they are not able to do. Okay. >> So, there is primary and secondary also to it. So, in these conditions, But is it psychological or a physical condition, ma'am? Both might be there also. Okay.
(19:26) But when they come to us, they don't know what it is. So, some people there will be a tight hymen which they are not able to break. So, they don't know. So, then they come to us. But still because they have a tight hymen and they have tried for intercourse and it was very painful and they don't know what to do. So, these intimate matters, the most of the time is like they don't know what to do.
(19:47) They don't know whom to tell. They don't know if it's normal or or it's abnormal. So, they waste a lot of time. >> Like you said, 9 years they didn't even address the tissue. >> Yeah, and it So, when they waste so much time, obviously they'll build in fear. So, there is one obstacle. They can't move it.
(20:04) So, again money the fear keeps increasing. So, it just builds up over a time. So, now I'm dealing with the problem and fear also or sometimes it's just fear. Okay. So, both the elements might be there. And this condition actually priorly I hardly saw [clears throat] any case prior in my practice when I was with everything obstetric. >> Initially,
(20:24) yes. Initially. But later on when I completely said exclusively I'm seeing only these cosmetic functional or sexual medical problems. Now I have so many vaginismus clients. Almost daily I see one of a patient coming in and they take lot of time for the consultation also because they have fear element. I have to convince them it's okay.
(20:43) I will see then lot of counseling then slowly assessment. And it goes on. So, now it's a common phenomena amongst Indian marriages. How effective is the treatment for this? What kind of treatment they have to undergo? So, again this depends on when they meet the doctor. Suppose they it's a new case like they are freshly into marriage and they have come and they are seeing me just 15 days through.
(21:05) >> [sighs] >> Then it's easy to tackle their fear also and for me and I'll give them some training exercises and all that. It's easy to crack it. But it's a group effort. So, there will be counseling involved. There will be a physical exercises involved and they will see me if needed.
(21:24) We will do examination also under anesthesia sort of a thing. Okay. Okay. So, if it is recent phenomena which they they have been experiencing and they immediately come to us then it's easy to crack. But it's been long standing like 9 years. So, it's very difficult to break such fear and in such conditions we even see that the couple is no more interested in each other or they are moving apart or something like other elements are also there because it's been a long standing relationship which is not going forward.
(21:54) Mhm. Sometimes it can also lead to divorces etc. Yes and and some couples will be like okay now I have vaginismus but for the society sake let me have a child. Mhm. You know not wanting to go and finish off the vaginismus issue. So, I have to convince them also that see if you want to have a child then IVF is enough.
(22:17) But as such after that you'll be even more busy in taking care of your kid and the later on career and all. So, tackling this problem will again it will be like a shelved issue. Once it is shelved because there should be that intimacy between the couple for a long standing relation relationship or else it doesn't work out. Mhm. And ma'am like what is the most damaging thing a [clears throat] partner can say in this situation that you have heard? Damaging for the couple? Yeah, yeah.
(22:44) So, both of them should be understanding. See, I have seen lot of issues like after 5 minutes of pacifying the client. First of all when the client comes she is so terrified to talk to me. Okay. >> [gasps] >> First what they do they take a consultation then they cancel it. They postpone it then again they cancel it.
(23:01) So, this keeps happening. So, the moment I know that they have been pushing I I'll have a hint that maybe it's a vaginismus case. So, the moment they come first they'll be silent for some time or they'll think where to start from because it's difficult even for them to open up. So, that is why we first ask some basic questions like routine gynae stuff so that they first open up and then you know we can move forward.
(23:26) Then sometimes the husband will start talking before the wife can open up because he wants to say because maybe it's their mutual understanding. And we have also seen the women break breaking down like she'll just pour down and then she'll she she goes through a lot of emotional outburst in my clinic also. But if the husband is not cooperative enough and if he is like demotivating or little bit of you know I'm not satisfied sort of a thing then women is even more crippled from inside because all these are little bedroom issues. They are
(24:02) little emotionally attached. Yes. Yeah. So, they also need some kind of counseling. Counseling is it's the important thing in vaginismus cases. So, vaginismus my consultations are almost like an hour or 2 hours also. Because counseling itself talking to them finding out what is the core issue till where have they come through is this the first doctor they are meeting or they have seen like so many other doctors because everyone if they by chance go with an old timer so, they might just say the old timer might just say listen that's all normal
(24:39) just just go home and do everything is fine. Right. And they are not able to tell anyone else because they have already visited a doctor. Someone said nothing. So, it's a lot of thing going in their mind also. So, they have to come to the right person go in the right path to finally find a solution. >> You know to prevent smell people also use some scented products. Yes.
(25:02) So, we there is a natural smell for vagina which keeps changing during menstruation it will become a little metallic smell. So, this keeps changing throughout the menstrual the cycle what we say 28 days cycle. But this is a natural odor of the intimate parts. So, that thing should be there. If we are using external perfume for this intimate area it causes lot of rash and vaginal infections is what we see.
(25:27) Vaginaitis is what we call for vaginal infections or outside area infections. It cause skin irritation, redness, inflammation finally leading to infection and obviously they keep using undergarments so it keeps rubbing on that area. It just becomes more and more and using wet undergarments moist ones and all that will just trigger fungal infections.
(25:50) Any specific case that you remember because we have discussed several issues. Like any specific case where due to the use of this do-it-yourself methods or any kind of chemical products the situation went out of control out of hand? So, it's it's not because of use it yourself or more of unaware this razor case is what we see more frequently.
(26:11) They keep shaving that intimate area and they already have a folliculitis. Okay. That's a folliculitis is one hair follicle getting inflamed and then finally leading to little pus and then when they do they cut it and that will spread and little bit it will become more or just spread the entire area. Entire that pub mons pubis is what we say that part.
(26:32) So, where the pubic hair is there. So, that entire area is highly inflamed and they are not able to walk. That's how in that state they come to my clinic saying I'm just not able to walk. I have fever. It's just throbbing and then we have to give them a high dose of antibiotics to just get that to normal level because in the huge area we can't do anything.
(26:56) The infection just spreads further and further and it's not just that you will also see vaginal infections. We'll see urine infections. It's just multiple infections repeating every one or two months. Mhm. Yeah. >> [snorts] >> Yeah, moving on ma'am like uh there are some women who have a condition. Right? The sensitivity and the pleasure factor has significantly reduced sometimes due to age or sometimes after childbirth we see this issue.
(27:23) But recently I have seen that there is something called as O shot and G shot. Like usually this PRP is something you know I have heard like when cricketers have some injury you know that is used. Now here to increase sensitivity or for that so-called term called orgasm people are going for these treatments. What exactly is are these treatments and are they effective? So, what we say is that PRP it's platelet rich plasma is what [clears throat] we extract from patient's own blood. Achcha.
(27:52) So, if the patient is young Mhm. they have good PRPs. And what what they do so in sports people when they inject this PRP wherever they are injured to the place it's supposed to if the healing process it's supposed to enhance the healing process like fasten the healing process so they are healed better. So, the same way when it comes to pleasure points or whatever the we say when it comes to orgasm there is short orgasm clitoral orgasm.
(28:24) There is a long orgasm which is a vaginal orgasm. So, when it comes to these as you are saying maybe with age or after childbirth or gradually people do come. So, we also anatomical issues also could be there. Anatomical issues might be there but then this PRP won't help in those cases. Okay.
(28:48) This can only help when they were previously fine every the part is all completely fine and then naturally they are having that less of orgasm compared to previously. Achcha. Not because of any anatomical issue here per se. [clears throat] So, when they come like that and they clearly tell and we actually we what we have noticed is sexual health is so important and off late many people are realizing that also that the as they are maintaining the sexual health their whole emotional health everything physical health is also being maintained. So, nowadays people are
(29:22) coming and asking and talking to us related regarding all these issues. So, when they come to us one thing what we can do is the PRP shots what we do for the either clitoral area that is the short orgasm or the G spot is what we call for the vaginal area. So, what it is supposed to do is these platelet rich plasmas they are supposed to trigger a nice inflammatory response and cause rejuvenation of the nerves there.
(29:50) So, as we are aging even the nerves also get tired and you know, they take time. So, this PRP is supposed to enhance the nervous stimulation also. So, we have a case studies also for O-shots what we do. So, lot of our clients are happy with the O-shots what we do. That is for the shot or Yes, yes.
(30:09) The PRP shots what we do for the clitoris. When it comes to vaginal orgasm, that is where they are supposed to tell us. That's again a thing where half the people don't know where it is. Like the women basically they don't know where the orgasm points are. Most of them they don't know. Only few people know. So, regarding they come and talk to us.
(30:27) They tell and then during the examination, talking, all that we figure it out and then we go for the procedure. Okay. What is this G-shot, ma'am? So, it is It's basically G-spot area. It's not a G shot. It's a G-spot area that is there on the anterior surface of the vagina wherein it's supposed to cause orgasm for the female. Okay.
(30:53) It's a long orgasm what we say. So, but half the people they don't know that spot. You We can Many ladies they do palpate their anterior vagina and they try to find that spot. It is little more sensitive spot what they say. So, they can figure out their thing or else they come for examination also and they ask us, "Can you also help us how to figure out?" So, that is where we also can give or we can give other boosters to enhance the spot.
(31:22) So, in your clinic, ma'am, like what kind what age group of patients come for these kind of treatments? So, we have lot of age groups. It's It's not of not just this age group. We can't name it like that. So, from 20 I also have a 45-year-old patient who is wanting to you know, take the shots. So, that's basically in my clinic I am the We We don't I know what is the importance of sexual health.
(31:49) I know what is the importance of how their intimate area should be you know, they should take care of it and how their pelvic floor muscles should be fine so that they don't have any urine leakage and all the I know the importance of women body. So, that is why we do talk more about it so that people first they come and discuss with me.
(32:08) See, I am facing this issue. As a couple I am not sensing anything. So, doctor, can you help me? So, that is when we go through walk through her entire condition, see what she requires and finally prescribe her the treatment. Let it be vagina loose vagina. Let it be relaxed pelvic floor. Let it be orgasm shots or let it be any other condition.
(32:28) Okay. So, all these come under that umbrella of sexual health. We deal with everything. So, when you give treatment for it, does it last forever or it's a temporary phenomena? So, nothing of these will last forever. All these are recurrent things. So, even if we give an O-shot we tell them it lasts 6 months to 9 months because the nerves have to keep regenerating and all that.
(32:50) So, after that if they have a good I mean after the O-shot if they like it, they do come back after 6 to 9 months saying, "Hey doc, I want to repeat PRP injections." So, like that we have clients who are coming back again and again. And when it comes to pelvic floor muscle strengthening like the Emsella chair what we do also, it's like doing intense gym and strengthening your pelvic floor. Okay.
(33:15) So, when we do that, obviously it has a time with which it acts. So, after like I they do a nice gym for some time and then they stop it. There is muscle wasting which happens annually every year and postmenopausal women it's enhanced. It's doubled that muscle wasting. So, that's why we also tell postmenopausal women to do muscle strengthening exercises, not just cardio, not just walking.
(33:38) Do muscle strengthening so that these muscles will support your bones. Right. That's how muscle And you have muscle wasting happening every year. So, that it will also little cut down that muscle wasting and all that. So, all this protein diet and muscle strengthening, all that we tell them on a routine basis. Ma'am, like though it might be a sensitive topic to discuss upon, like many women like now that you we've spoken about O-shot and G-shot etc.
(34:02) , many women do not know what is an orgasm. They don't You know, there are also reports which say that they fail to realize or recognize their own bodily needs. So, as a gynecologist, what is the suggestion or what is the awareness that you'd like to give them? You know, some people also go through that mental trauma or psychological trauma.
(34:22) Actually we have some couple also. They'll come and tell us also that I am getting a I want my husband to feel satisfied with me or else you know, I'm scared where you know, he'll have some extra marital affair or something like that. So, it's not I mean if someone wants to have an extra marital affair, no matter what they do, they will have. It's about the mindset.
(34:42) I can't I am not here to you know, do a mindset training. But then But then we do talk to the couple. But the couple themselves they come and tell us that you know, we are looking at this vaginal laxity. If it's a loose vagina, they can't feel anything. Obviously the vagina should be a little on a tighter side for them also to feel something.
(35:04) So, when they come and talk to us about it, both the wife and the husband or just a partner. So, that is when we know and we also tell the women it's it's randomly to everyone it's important to know their body. And only if they sexual intimacy is something which both the partners should enjoy and that is why I mean that's more important for even emotional health, mental health and overall dealing with stress also.
(35:30) There are studies which say that people who are sexually active for a longer period of time they live longer also. Longevity also increases. You know, there are studies which say that. So, that's why it's very important to know their body. So, usually there's a taboo in Indian society, you know, they do not discuss about it and they're also clueless on whom to speak about these issues.
(35:53) Like that years together they suffer silently suffer. Yeah, that's why nowadays I mean now awareness has been increasing. So, mothers are getting adolescent girls for you know, menarche talking discuss about menarche with the doctors, gynecologists. Menarche is when they attain first period.
(36:11) So, that you know, they can talk and then they'll have someone in their life to talk to about these matters. When mother will introduce her daughter to a doctor, then she will have the doctor. But then the the connection should be there. So, like that we have girls who are coming before marriage also to ask us how it is, what's it going to be and all that when they can't discuss it with their own family members and all that.
(36:33) So, but now awareness is slowly increasing. First of all, they have internet. They are browsing everything. They know better than before. Before it was like that. And many people are trying to explore their own body which is absolutely fine if they go in a proper way. Yes. Like just now you were mentioning about pelvic floor issues etc.
(36:53) You know, there could be a person working in a software company. Many a times it happens that the washroom is untidy or unhygienic. So, like they have back-to-back meetings in corporate offices and that person is not going to the washroom for hours together like urine holding. So, what impact does it have on the bladder muscle and pelvic floor? This is a very common thing also.
(37:17) And Even during travel. Yeah, yeah. Travel though they won't drink water. >> [laughter] >> They are scared to scared to use and that to elderly women they actually suffer more than youngsters. So, elderly women they they have other issues also so that they can't get out and go and get up and go and all that. So, firstly dehydrating is a very bad thing.
(37:39) I mean they don't drink water because avoiding the bathroom and so they are dehydrating the body on a routine basis which is a bad thing. Hydration is very important for all the tissues. And second thing is if young girls are holding their urine for a lot of time, there'll be lot of fatigue for the muscle. Muscle will get tired.
(37:59) Obviously it's stretched for a long period of time. The contraction and relaxation of the muscles are should happen on a routine basis. So, 3 to 4 hours is fine. Okay. But more than that if they are obviously they are not drinking water, bladder is not full, that's a different story. But if they are drinking water, if the bladder is full, they are having sensation, they are trying to hold it for a long period of time, that will lead to muscle fatigue.
(38:22) Finally, the nerves also will get fatigue after you know, a prolonged usage and all that. Prolongedly doing the same thing for a long period of time. So, right now the toilet hygiene has become it got its importance right now. So, even there are a lot of other products also what we say. There are some companies which give them you know, stand and pee products or you have sanitary wipes for the western commodes or you have the cover sheets what it is there.
(38:52) So, I tell my clients if you are traveling, that's when they come. >> [clears throat] >> Some people have urine infection. So, when they are traveling they are more anxious. So, they come to me saying, "I'm traveling now. What to do?" So, I suggest them some products but I tell them you please hydrate properly because again dehydration will again lead to infections.
(39:09) So, hydrate properly and do your thing. But right now even the quality of India is improving. The standards are improving. So, it's no more that bad. But then we can manage with these products. There are many times like a work you know, they're busy with their work, held up with their work or sometimes lazy. For that also they hold.
(39:27) Right? But this is going to have a long-term impact on the muscle. 100% it will have an impact and that too sitting on one place and doing so much work is as such bad. We advise them you know, every half an hour get up, drink a half glass of water. Once in every 2 3 hours use the restroom, come back, feel fresh. obviously mood is also important.
(39:44) So, it's not just about one part. I think it's about the overall body also what mind and body all coordination should be there. So, we have a lot of software people only coming with PCOS because it's a desk job obviously. There is no physical activity involved and lot of food is readily available in the cafeteria.
(40:06) They easy access, yeah, easy access. And then by the time they have these night shifts, so their sleeping pattern is disturbed. Their hormonal imbalance finally they come. So, so we tell them, you know, this you might be doing it. You can't do it for a long time. If you take this for a long time, your health will deteriorate and you'll stop it.
(40:24) So, might as well, you know, either balance it or you give more priority to your health. Right. Now, many girls during their growing up stage, you know, they might undergo severe pain, you know, due to the menarche or the menstrual cycle. >> [gasps] >> And they are told that this is normal, you know, after a few years it will get sorted.
(40:44) Or sometimes people in our households they say that like when you get married things will get sorted. So, when is this pain considered to be normal and when should people be cautious that it requires medical intervention? I think pain at any point of time is not normal. So, let it be mild pain, moderate pain, severe pain, any pain happening on a routine basis, it's not normal.
(41:08) So, someone is having pain, the first thing they should do is first go and meet a doctor. First know what is that pain, what what do you have that it's causing pain. If everything is normal, then that's a different story. Then we have to think what to do. Maybe change the diet, make the period more friendly because some many people have lot of sugar.
(41:28) So, it's inflammation in the body. Sugar is directly proportional to inflammation, redness in the body. That will lead to more pain. Or some food they are not suitable like some dietary food. Some people they are not suit for meant to be for dietary thing or gluten like that. The moment they change their diet, the inflammation reduces and there is less pain.
(41:48) So, these are food related or diet related changes they have to make. Some people, very young girls, they have pain. What we say is if there is little I mean the blood loss it's negotiated through a tight opening. So, when the blood is passing through the tight opening, then they are supposed to have the pain because it has to push through it and all that.
(42:11) But that happens when they have more bleeding. They have more bleeding, it formed a clot. Now, clot is trying to negotiate not just the normal flow. Then we have to see why there is heavy bleeding. So, like that we have to see is it heavy bleeding causing pain or is it something like endometriosis causing pain? >> What is endometriosis? So, endometrium is the lining of the inner lining of the uterus.
(42:35) It it lines the endometrial cavity. So, this endometrium if it is present in its normal location, it's just fine. But sometimes this tissue can be there outside in the body like in the PODs what we say or on the ovary. It can be elsewhere in the body. So, if it is there elsewhere, then this body this endometrium tissue because it's reacting to hormones.
(42:59) So, it will react to hormone at the time of menstruation, it will hurt more because it's reacting to hormone and the normal endometrium is shedding but this is not shedding, it's elsewhere. It's stuck there. So, it's high inflammation. Endometriosis is an inflammatory condition. So, in that also we are supposed to reduce the inflammation.
(43:17) So, that's how it works. And it's only a progressive disease. It only keeps increasing. It does it it never reduces unless and until we take some aggressive steps. And other conditions also sometimes people might have pain when they have some fibroids, polyps. There are other conditions.
(43:35) So, first we have to see is it any pathological condition? Is it something like heavy periods or something like this? Is it because of dietary inflammation caused hormonal imbalance and finally inflammation and So, we have to figure out what is it and then act accordingly. Sometimes we just give them everything is ruled out then we just give them magnesium supplements to relax the uterus.
(44:01) We tell them during that time please don't have high inflammatory food like in the movies they show they just keep indulging ice creams or sweets and all, high inflammation. So, don't do that. Little bit of dark chocolate is fine. So, they change their lifestyle and all, it can be done most of it. But pain any point of time to anyone, it's not normal.
(44:22) Like does it also happen aggravate due to stress like exam stress, job stress, etc. or you know, during breakup situations? Anything is So, the when the body is going through a lot, let it be any condition. When body is going through lot of stress, it's an inflammatory condition as such. Again it's triggered.
(44:42) And that's because even the hormones like cortisol and all they are released, they again increase sugar levels in the body. So, any stress condition leads to lot of inflammation and they'll have irregular cycles and they might be associated with pain. Or sometimes they just push the period for some temple visits or something like that.
(45:01) That time also because they have been pushing the periods because of hormone, finally withdrawal thing will be little painful more than before. Like this pushing the period they use some tablets, right? Is it advisable to take those? So, as a gynae obviously I won't recommend it at all because gynaes like regular cycles. So, when you have regular cycles, you are monitoring it.
(45:20) So, you know your health is fine. So, for a woman having regular normal cycles is very important. That shows her her health status. So, pushing it doesn't make any sense. And as such I personally don't believe in those things. In olden days, they used to have bath in a river or something like that.
(45:41) They have to go outside and they didn't have such sanitary napkins. Such good system they didn't have previously. So, to cut down they must have put some restrictions and all that. Right now we have lot evolved from those days. So, right now I personally don't take it so much seriously. But obviously if for important events like marriage or going to temple visits and all people do push.
(46:06) And in fact once they'll come to us, they'll see the medication, next time they just do it by themselves. But you have to take it correctly. You can't take it at any point of time very close to the periods. It's no point taking it. But these are capsules also should be taken under Any medication is under guidance. We just Many times you know, as you said, people come once and they later on they do it by your them themselves. That's the problem actually.
(46:31) Yes, yes. And also ma'am, irregular period cycles, why do these happen? Any people suffer because of that? Yeah. So, any irregular So, it's all a hormonal play as I said. So, we have a nice FSH LH hormonal play for So, a 28 days of cycle is divided into two halves, 14 days and 14 days. In between happens ovulation, egg release.
(46:53) So, first half is one hormone, second half is another hormone. So, anything which will disturb the hormonal play, they'll have irregular cycles. Okay. So, the most common cause is lifestyle, not having a proper lifestyle. So, for many conditions like let it be PCOS, anything, first thing and first and foremost thing what we say is lifestyle modification, you know? Check your diet, have a proper limited diet, not too much of junk food, not too much of sugars, have a balanced meal, sleep on time, eat on time, stay well
(47:29) hydrated, do a normal exercise. Exercise causes insulin sensitization also, blood supply will all be better. So, first do this. Along with this take medication because after a point of time, okay, you'll take medication for 6 months, 1 year, 1 and 1/2 year. Finally when they stop, it should go back to normal.
(47:49) That can only happen with lifestyle changes. So, that's very important thing which people miss. They'll be like, now doctor you do something. >> [laughter] >> It's very difficult for us to do everything. Any peculiar cases that you have come across? PCOS is like obviously any gynaecologist can give you some zillions of >> [laughter] >> patients. There are some nice patients.
(48:11) I mean who follow the instructions. So, we we give when we give them medication also, they do proper exercise, they do dietary changes, everything and they take control. So, once they are PCOS, they are PCOS forever. So, it can only be kept under check. So, the moment again their lifestyle changes or they get some stress factor into their life, again periods can get irregular. And it'll nicely show also.
(48:36) First it's little bit instead of 28 days period, it might be 40 days, then slowly 2 months, then it'll become 3 months and then it won't come. So, it'll give nice hints also where they have to pick it up and then go. But some patients, if I tell now, after 3 months they'll come back again to me and say, doctor I didn't start, now what should I do? Or I took it for 1 month and I stopped it.
(49:00) Or they took my medication but they never did lifestyle modification. But only patients who take care of their health will actually Many people think I'm taking medication, why should I bother about lifestyle? This is the lifestyle that I live. Yeah, easy thing is that OC pills what they take, 21 day tablets they take.
(49:18) So, the moment they take 21 day tablets, you get your periods on 28 day. So, like that they keep continuing. So, whenever they stop it, their periods are again gone. So, that's that's just a symptomatic thing. So, when you actually do the cause treatment like you deal with insulin resistance and you deal with your lifestyle modification.
(49:38) So, you take OC pills also if you want. Take it for 6 months, but in 6 months correct the cause and finally stop the pills so that you can take take off in life, you know? The PCOS will be under check. What are the hygiene protocols that female should follow during the menstrual cycle? Many people are confused today.
(49:56) You know, even you know, there's a report stating that lot of Google searches on what to use, whether we should go for a sanitary pad or a menstrual cup or something like a tampon. Or in earlier times, people used to use cloth. So, what is you know, an efficient way way There's lack of awareness even till date. Yeah.
(50:17) So, all these are different modes of like how we say different modes of transport. >> [laughter] >> Like that, you have different options on plate, but I don't think anyone is using cloth anymore. It's obsolete. >> [laughter] >> I think so, it's obsolete. Uh in you know, rural areas and far-fetched areas. Akshay Kumar's movie also, no? >> [laughter] >> So, lot of awareness is there.
(50:40) So, even we are getting low-cost cotton pads. So, they are moving on to cotton pads rather than you know, using cloth. Because how much ever they wash the cloth, there is a time for the cloth and how much ever they think they are washing it properly or whatever, it's more scope for infection. Not maybe internal vaginal, even maybe external triggers might be there.
(51:04) So, when it comes to using a sanitary pad, it's perfectly fine. Only thing is you have to change it every 4 to 6 hourly. Okay. [snorts] So, you the people can't keep it for more more time like 12 hours or more than that or I just say I forgot and all that. >> The sanitary pad advertisements are showing 12-hour protection, 24-hour protection, etc.
(51:24) So, it depends on how their flow is. That's what they are saying. So, you know, my my pad soaks better. So, it's giving you 12-hour protection. It's like that thing what they are trying to say that it's soaking better. But if it's soaking better, that means they might be using more gel also, which is again not good.
(51:44) We are not suggesting again these microplastics and all. The pads will have all that. It's again not good for health. So, go more for cotton stuff. When you go for more cotton stuff, it won't soak so well like a highly gel-based things. Okay? But we are getting better and better at it. And but the base bare minimum thing is they have to change every 6 hourly. Okay.
(52:06) Because the old blood will irritate the area. Now, obviously they are wearing it for 6 hours. The first hour only it must have stained. So, that blood lasting for more than 6 hours there in that area, it will irritate the skin. And blood is a good medium for infections. If you leave blood anywhere, it attracts bacteria.
(52:25) It's more infective medium. So, we have to eliminate that medium. That's how the intimate hygiene is. So, but these pads again, they are lot of burden on earth also. So, that's why they are saying see every woman needs to use at least two pads for 5 days bare minimum every month. From age of 12 years to age of 50 years.
(52:47) Imagine how many pads per woman they are using. But menstrual cup if they come to, it's nowadays we are getting silicone-based menstrual cups. So, this one cup can come for 10 years. 10 years? 10 years. It's what they say. So, it's silicone material. It's inert to our body. It doesn't react with human body. Like breast implants are silicone.
(53:09) They don't react with human body. So, they just they can keep the menstrual cup for 4 hours. After that, they need to empty it, wash it, and reinsert. And again store it. They have some sanitary things also how to save the menstrual cup and all that. Again redo it next month. Like that, they can keep that same cup for 10 years if they want to if they are keeping it well.
(53:33) Okay? So, look at the burden. It's coming down. Like no menstrual pads, so the burden on earth is less. So, that's why many people consciously are moving to menstrual cup if they can, who are not scared. So, tampon is again same thing like pads. They have to change every 4 hourly, maximum [clears throat] 6 hourly.
(53:53) More than And if they don't change the tampons, they get one serious infection also. So, it's very important. Sometimes they forget. It's inside the vagina. They might scope for forget. So, tampons is very infective if they forget. At least silicone cup is inert material. It's their own blood. So, they have to keep changing or else it leak obviously.
(54:16) But yeah, you are not supposed to forget. And when it comes to just perineal hygiene, we just tell them wash your area morning, evening, whenever you can. With just some lukewarm to cold water. Cold water is good for the skin. The more hot water they use, the more dry the skin gets. More dryness, more irritation, more redness, more infection.
(54:36) So, we say use cold to lukewarm water. Use the If you want, use intimate washes. No need to use Dettol. So, like that, routine hygiene. Like now that you're saying about 4 hours it has to be changed, there could be women who are working or women like senior police officers or young police officers or any challenging situations or some sportswomen.
(54:58) You know, in that situation it becomes very difficult, you know, to you know, bother about the time. And there could be some circumstances, you know, in some remote areas or some difficult terrain you are. In that situation, how should they tackle this challenge? >> That is why they say women are great. >> [laughter] >> Because they handle so many things.
(55:19) >> Absolutely. So, not just some women in some situation. Like if you just take me also. So, when I travel, obviously I'll carry an extra thing in my bag. I will make sure the moment I enter, I'll make sure where is a restroom. All these things go back like undercurrent in our head. True.
(55:38) So, they just figure out with their time how they do. That's why they are >> [laughter] >> they say that women are great. If not four, they can wait for six, but depends on their flows. Think it's heavy bleeding. Right. So, that's why they it's better for them to just, you know, take a little on a lower workload on first 2 days.
(55:56) But not everyone can do it. Like even I can't do it. Let's say you're in the midst of a surgery. You can't do it. You know, at the time you have to >> In the middle of the surgeries, we we get the periods also where you have to deglove and run and then come back. That will also be there. So, you can't help it or else priorly only you should be well prepared. Right.
(56:15) [laughter] Yeah. So, all these are part and parcel of life. And nothing is disgusting. It's everything is fine. That's quite phenomenal. You know, you know, tackling these challenges on a day-to-day scale. >> [snorts] >> I'm like in recent times, most of the elders they say that PCOS, infertility, and the sexual problems are a recent phenomena.
(56:38) Especially in the past 10 to 20 years, they have grown because of the faulty lifestyle. So, according to your experience, how important is it to have a proper lifestyle to rectify all these issues? And because of you know, neglecting lifestyle issues, what are the challenges that people are facing? Let it be women or young couples or anybody that comes up to you.
(57:01) What are the challenges? Any peculiar cases that you can share with us? So, as you are saying, lifestyle is damn important. We are only seeing the shift in all the diseases, right? So, PCOS is increasing and infertility is increasing. Um so, um Um when you ask me about some cases, so we have some nice young couples also who are less than 30.
(57:28) They come to our clinic and they say we just got married. But nowadays marriage was also on a later note. They are getting married at 30 or little later when they whenever they are ready. But they are after that, they are like I need some more time for myself. See, I want at least 2 years. Now, my career is at peak. We just got married at 31.
(57:50) Then how should how am I supposed to react to it? So, I have two caps. One is my doctor cap, one is my women cap. So, as a doctor, it's very advisable for a woman to conceive before she's 30. Because that's when she's very fertile. After that, little fertility rates keep decreasing. After 35, it's even more. Until and unless their lifestyle is very good and they are having regular cycles, everything is tip-top.
(58:17) So, as a woman when when she comes and says at 31 I'm just married, I want 2 years gap, I can understand that. She's newly married. She wants to know her family. She wants her career to take off and all that. So, our advice is will be very much, you know, using both the things.
(58:36) So, we do tell them, okay, you can push it, okay? But then you make sure your lifestyle is fine. So, that with lifestyle you're trying to get some 2 years extra for yourself. So, before that we'll advise them some tests any which ways because we are doctors. Now, we have to do it. So, we'll advise some tests just to make tell her that here is where you're standing.
(58:56) So, now you have your options. Now, your option is do a proper lifestyle, wait for 2 years, and then conceive. Then after 2 years, if she has any issue, then she has to decide as per it what to do. Some people are also considering freezing their eggs and all that. Mrunal Thakur also, Bollywood actress and Tollywood actress Mrunal Thakur, she said that she's considering freezing her eggs.
(59:21) Because she wants to focus more on her career and work. There was also an Oxford embryologist who also mentioned the real cost of freezing eggs. And that video went viral. Now, coming to egg freezing, like what is the cost of it? And what is the I mean is there a need for egg freezing? So it's again now as we are moving forward in life now women are obviously doing equal things compared to men.
(59:47) It's not like they are they are also wanting to go excel in their life. Now no more like just getting married early. So it's up to their own what they want to do. I mean their choice is matter I mean it it's having a little weightage. So when they want to take a good decision in life. So there are different platforms.
(1:00:11) I can't say some women want to concentrate more on their family and have kids on time and all that. Some women want to concentrate more on their career. Some women want to balance it well also. So when when it comes to balancing it's like they will take a step back to have kids and then again move forward in their career. That's how it's balancing.
(1:00:30) But some women don't want to compromise also. They want to have babies when they want to have. And I think we need to appreciate every mindset. I am no one to judge who wants what and it's their life finally they are living it. I'm not living their lifestyle. So people who want to have it later in life obviously it's like when a woman is born suppose think she's born with so many number of eggs. Okay.
(1:00:56) This is a fixed number and it only keeps depleting through her age and finally once the eggs are done like the body is done with the eggs you attain menopause. Right. So as we are aging so the first few years are first come a stoppers. So the eggs are highly fertile I mean the quality and quantity is good. So as we are moving forward the quality decreases. The quantity might be fine.
(1:01:23) I mean what we can see in the blood test is the quantity. But the quality might decrease because these eggs have been 20 years of stress, 30 years of stress, 40 years of stress. The eggs are same. The life is having so much stress. So when it comes to that Yeah. You know having to freeze eggs by itself will not guarantee fertility.
(1:01:47) So no no having to freeze egg at the right time. So when you freeze the eggs before your 30 that means it's a good quality eggs. So the fertility rate is high. When they freeze the eggs when they decide slowly they think I will freeze my eggs and they freeze the eggs at 35 to 40 years.
(1:02:06) That time the egg quality also decreases. So the embryo quality will decreases. So freezing the eggs before 30 is better because the quality is good. Then they can decide whenever they want to. Some people they freeze their embryos also the wife and husband they freeze their embryos. So it's completely their call what they want to do.
(1:02:25) And coming to the cost of it it's not like abroad cost. This is India no everything is cheap in India. >> [laughter] >> So I don't think it will cost much in India maybe just few. The procedure itself might take a lakh or two. The procedure because you have to inject hormones to the women finally make sure the eggs are in a quantity then do a procedure to collect the eggs and then freeze them.
(1:02:51) So the freezing they will tell per annum you need to pay so much. I think it will be in thousands. Freezing part will be in thousands but the procedure might be one or same like IVF. You know they are marketing also I will do IVF in less than 1 lakh or So it depends >> [laughter] >> yes yes because number of centers have increased no so like that everyone is doing the marketing.
(1:03:12) But people say the procedure is very painful for this egg freezing. Is it true? So it is like normally on a monthly basis suppose you think this much hormone is being released to but when it's an IVF instead of one egg we need how many ever eggs possible. So generally one egg from one side will be ovulated for every woman like one egg this ovary one egg this ovary.
(1:03:38) But for ovum pick up you will do pick up only once. So obviously you'll make 10 eggs this side 10 eggs that side collect 20 eggs. So imagine how much hormones they are giving to her so that the eggs the ovaries are you know the follicles are becoming such a big size only then we can take because if the follicle is small you can't take it aspirated.
(1:04:00) So it has to become good number of follicles and in good size for them to take the pick up. So that's why a lot of hormone load is there on that body so obviously she will also feel much bloated. She has to take a break from work for that month. Yeah she can't do working on that month because ovaries are also loaded they are too big so she has to rest herself.
(1:04:23) And after pick up the pain as such it's done under anesthesia. So pain part is little less because it's under anesthesia it won't be too much of pain but body is going through a lot of hormones in it so it's going through a lot. Quite a tedious procedure. It is but that's what the woman is wanting to take for her future so it's you weigh the risk you weigh the benefits then you take a call. Right right.
(1:04:48) So like what exactly is the age when the fertility starts to decline? So if the fertility is 25 to 20 to 25% before 30 years of age it will slowly decrease to 15% like that post 30 and by 35 [clears throat] it will come to 10%. 5 to 10% and 40 it will become 1%. >> [laughter] >> Because they are very close to menopause.
(1:05:18) Average Indian age for menopause is 48. Okay okay. What is this AMH test? It's anti-mullerian hormone AMH is what we say. It will give us a rough estimate of how much egg storage is there in the body. So with age obviously the eggs number of eggs keeps decreasing so it gives a quantitative number of eggs that measure it will give for the patient not the quality of eggs.
(1:05:45) So some people will have AMH is less even the quality also will be less quality quality also will be less. So obviously if they go for IVF also the quality of the embryo might all be less. Yeah. And like let's say some woman has gone for egg freezing before 30. Can they be 100% sure that you know they will have a fertile face? So again it depends on what is the age of the mother when she's pregnant.
(1:06:12) What is the health of the mother when she's pregnant. So embryo might be good quality. Again it's implanted into the mother. So mother's health is very much important. Suppose now she's just 25 or something she did her egg freezing. Now she wants to get pregnant the age of 40. 35 to 40. At that time what how is the health of the mother? Because diabetes, hypertension all these are mother's body maternity things also right.
(1:06:39) So she how is she how fit is she is also very important. And obviously when you are it's not a natural pregnancy so obviously you'll boost some hormones at that time for the take up of the embryo into her to body to feel natural. You push it for some time. So is she in a position to take everything all that is very important. Because there are a lot of misconceptions you know people just get knowledge or information half cooked.
(1:07:01) That's what they think is a reality. There's several other parameters going by what you say egg freezing per se will not guarantee a baby. It might but there are also several risks when it comes to your age factors, health related issues, hormones and also your situation at that point of time which nobody knows.
(1:07:18) Right right. Talking about menopause you know many of the women in their late 30s or early 40s you know they suffer too with this issue menopause and many people don't know that these are the conditions that they are facing or circumstances that they are facing due to menopause. So what exactly is this menopause and how to tackle with it.
(1:07:39) You see most of the mothers or you know people in their late 40s they face the situation. So the symptoms what they face is they get cranky. They are more emotional sometimes you know there is emotional outbreak or they are more angry or upset. Even family also obviously suffers because when the lady is little upset even the family suffers but at the same time even the lady feels bad that this is not what I want to say but I couldn't control myself then.
(1:08:08) Or sometimes they'll just you know this they have sweating. They feel cold once immediately hot they'll again feel cold there's temperature fluctuation what's happening. Yeah hot flashes that's what we say. So they have this they'll have when it comes to again body slowly they'll have osteoporosis the calcium level keeps decreasing muscle wasting keeps happening with menopause.
(1:08:32) All these things also will be there. But when it comes to symptoms the most irritating symptom is that hot flashes and mood swings. These are the most irritating symptoms what they come with. So we say menopause is like I said once the eggs are depleted that's when the body slowly sets into menopause. Finally When does it usually happen? What is the time frame for that? So it can happen differently with different people.
(1:08:56) Suppose one So the age is average 48 years for Indian women but that doesn't mean every woman will attain menopause at 48. Some people will have menopause at 55. Some people will may have menopause at 45. So it keeps varying depending on when their family history when their mother had the menopause when the you know aunts had their menopause or how is their lifestyle.
(1:09:22) Okay it's also to deal with genetics. Yes yes. 100% because the number of eggs everything is also directly genetically done. Some people have history of early menopause also. Premature ovarian failure is what we say. Before 40, they attain menopause. So, but then the symptoms happen to be they can come 10 years prior to menopause also.
(1:09:46) And they can last for 10 years post also. That's all a wide range of age. We we call it perimenopausal age, pre and post perimenopausal age. So, that's when when they initially So, all these things are like we have to grasp them when they come initially and then we have to find a solution with the lifestyle also. Okay. So, many of the issues we we tell them also for many ladies try yoga, try meditation, do dietary changes, you know? These are the natural way and it first starts with simple symptoms and slowly the symptom becomes more.
(1:10:22) So, when it starts slowly only they start their lifestyle modification, they can enter it very well. And we give them lot of supplements like omega-3 fatty acids we give them. We'll give them some protein boost also. We'll give them some magnesium tablets to calm their nerves. So, all that we'll check their vitamin B12 levels, D3 levels, calcium supplements.
(1:10:42) All these things will be there. But then on a routine basis they'll also do lifestyle modification. Apart from this, if they want more help, that is when hormone replacement therapy will come. And ma'am, like in this menopause menopause phase, like what are your suggestions? How should women handle themselves? It is a it's easy to say than to handle it.
(1:11:05) That's what it is because the women facing it will know much better than, you know, we advising it to anyone. But then always they have to follow a routine protocol. So, something This is again the what is lifestyle modification is what I mean. You know, getting up at proper time. Obviously, they'll also tell me I'm not able to sleep.
(1:11:27) I'm having sleepless thing and my I'm having fatigue. So, they they'll do some blood investigations. We try to rectify their condition. Some people are anemic also. So, we will try to rectify and we'll give them proper protocol. Do some walking every day. Go for nature walk like you know, something like walk in a park, not in a gym.
(1:11:47) Do some weights exercise, muscle strengthening because again the most common thing what a postmenopausal thing the most common they fall and they fracture themselves. So, if they don't want to do that, they have to maintain a good calcium level in their body. And they have to go have good muscle strength so that they are more active also. So, active women and all they can deal better than a non-active more sedentary lifestyle is what not we won't suggest.
(1:12:14) And if they want to go for HRT also, it's better for active women. Right. Because again, when you take some hormones it it will carry some risk. Everything carries a risk. There is nothing which doesn't carry risk. So, again more active people can deal with it better. But thing is you have to start early.
(1:12:31) Like at 40 years of age you you flag some condition, you take a call on it and then you move forward. So, by the time you attain menopause, you're already in control with it. And so, you handle it better. Suddenly, you neglect everything. You just, you know, have that spurts of issues and finally a full-blown condition will come.
(1:12:48) Then you have to take treatment with hormones. There's no other What is the efficacy of this HRT, ma'am? In which way will it help? HRT is actually good. Immediately, something like someone comes with hot flashes, we give HRT. The symptoms just go. Okay. So, she'll get very used to it also. But at the same time, we have to make sure, you know, her lipid profile is fine.
(1:13:12) Her she she does small amount of walking every day because hormones are again they carry risk of blood thickening like you know, the strokes and all are also there, right? So, we have to Nowadays, we are getting a very safe friendly HRT with low dose of estrogen and progesterone in them. And we are moving towards bioidentical hormones also. Okay.
(1:13:34) So, this bioidentical hormones is something like you test the levels of the lady and finally you give them only so much of hormone which the lady requires and you titrate them on a regular note. So, this is more healthy for her rather than just taking a rough dose every day. Right. You know, just like yesterday we were discussing that tomorrow Mother Be Coming Mama's Coming.
(1:13:57) And menopause was one of the issue with a you know, one of the topic that we wanted to discuss. Now, one of the team member was saying that, "Sir, I've seen some cases in the news where a woman is conceiving at about 80-year-old, 70-year-old giving birth to kids." So, why does this happen? It is with IVF.
(1:14:18) I mean, now you are we There are so many inventions, new things which are happening with life. So, obviously new new things everyone is trying. So, when a 80-year-old woman I don't know how far it's possible, but whatever, when a elderly lady when she wants to conceive, you have to obviously she's attained menopause already.
(1:14:41) There is she doesn't have any hormones. So, you the embryo should be either hers or you go for donor ovum, donor egg. So, if she did her egg freezing at a younger age, then she can use her own egg. But if she doesn't have an egg right now, she has to take a donor egg. And then make an embryo. And then go for IVF.
(1:15:06) And IVF involves a lot of hormonal boosting and top of that her health condition. So, all that maintain finally she needs and finally the baby also will be young. There's lot of age gap. So, depending on what they want, they'll take a call. Who [laughter] are we to judge that? Okay. Thank you so much for this insightful conversation.
(1:15:25) Lot of issues that women per se are hesitant to discuss with their own families or their own friends. So, all those issues, most of them you have tried to spread some awareness and given them genuine advice. Thank you so much. Thank you. Thank you, Shashank.