Adapted from episode 164 of The Perfect Stool podcast and edited for readability with Dr. Diane Mueller, ND, DAOM, a board certified sexologist and the owner of My Libido Doc and Lindsey Parsons, EdD.
Lindsey Parsons:
It’s my pleasure to have you back. So I had you on episode 43 in March of 2021 talking about Lyme disease and mold illness. So I’m curious how you made the transition to talking about sexual wellness and libido?
Dr. Mueller:
Yeah, it’s a great question, and I would say I haven’t completely made the transition. It’s more like I have my foot in both arenas now. If people go back and listen to that episode, they’ll hear my story of Lyme and mold, right? And so I went through crazy illness with Lyme and mold, and that was a large part of what led me into pursuing that as a niche in my clinical career. And if we go back even further than that original story, we get to a story from about 2001 and probably even a couple years earlier than that, 2019. I was in college, and I had this very, very strange vulvar pain. And so this was before I was in medicine. This was before I really even knew anything about holistic health, and I did not know what to do with this pain. So I went to the university doctor and they ran tests and everything was normal, just like the same thing that we’ve talked about a million times on your podcast before, and I was left with this pain. The medical community doesn’t know what it is. It’s keeping me up at night, and it’s really disturbing. And so I was talking to my roommate, a very dear friend of mine at the time about it, and she handed me a book that was extremely shocking to me at that point in time, which was the book called “Sex for One” by Betty Dodson. And it’s all about self pleasure and masturbation. And it was very shocking to me, because I grew up extremely Catholic. There was a lot of shame I had around sex and my sexuality, and so when I got this book, I honestly didn’t even know what to do with it, but I was desperate one night, so I started reading it, and it was very interesting.
These stories that Betty talked about in this book, and some of them talked about women who had experienced severe pain that had gone away through self pleasure. So one very desperate evening, I tried it, and the pain went away. This is kind of cool. And I tried it again the next day, because the pain came back. Pain went away again. And that went on for about a week, and then the pain was just completely gone. So that was really the first intro into just being curious about sex and about libido, about the wellness side of things. And it really led me to a quote, that I say numerous times throughout my book, which is pleasure is not just about desire, but something we require. And so really, for the past two and a half decades, it’s just been something that is like a side reading hobby, reading about relationships, reading about sex, reading about tantra, reading about different relationship styles. And it wasn’t until several years ago when I got divorced and was really going through just the trauma of divorce, that I asked different questions. And some of the questions I started asking were like, well, what really causes people, from a standpoint of relationships, to stay separate or get divorced or break up or whatever?
And one of the things I found is in survey after survey after survey, intimacy, or lack of intimacy, came up as one of the top five reasons. And so, fast forward then even to 2023 when Harvard put out a study on longevity and on wellness. And what Harvard found in their study was, and this was a longitudinal study over, I think it was like 75 years, a very, very long study where they looked at diet, lifestyle. They lab tested for a ton of different biomarkers. They looked at sleep. They looked at all these things that we talk about in holistic wellness. And one of the things they found, the number one thing they found that was the peak, the number one reason for people living a healthy life was the quality of their relationships.
So, I had already made the decision before that study came out that I wanted to start talking out about sex and sexual wellness. And then, knowing that study came out, that really further propelled me to wanting to do this. So, I still do have my Lyme practice and my mold practice, and I still love that and care for those people very, very dearly and still am very much involved in that world. But I do also have a foot in this other world, in part because I am, like you, very, very interested in holistic wellness. And I feel like this side of relationships and sexual intimacy is one of these things that is still sadly so taboo, even though we’re seeing these surveys and these research saying that, actually, this is one of the most important things. And for whatever reason, Lindsey, I seem to have a knack for wanting to talk about the things; Lyme and mold are also kind of like this that are a little on the edge that people don’t want to always talk about in the public eye. So it really was just a perfect fit for another pot to play in, so to speak.
Lindsey Parsons:
So that’s interesting. Your story, when you look back now with the knowledge you have, how do you make sense of what changed for the pain? Was it the orgasms? Was it the blood flow? Or was it a mental thing?
Dr. Mueller:
I think it’s a little bit of all. And I appreciate the question, because yes, obviously I’ve gone back and reflected upon this. I think, as anybody in the profession would, my best guess as to what was happening is, I think it was a level of interstitial cystitis, which, in wellness, we sometimes call leaky gut of the bladder, where that bladder wall is a little bit inflamed and that pain can radiate. And we see, oftentimes, there’s a pain with that. There’s a neurological dysfunction where the brain is, or the bladder is, sending the signal to the brain through its being irritated, and that sort of thing that it is needing to urinate even though it doesn’t. And there can be this radiating kind of pain and these radiating sensations from it. So that’s what I’ve been best able to hypothesize is what was going on. And we do see that orgasms that change the neurological reprogramming, which orgasms can do, can actually reset neural pathways. So I believe that’s my best hypothesis at this point. And I’m always changing hypotheses as I learn more information, but at this point, that’s what I think was going on back then.
Lindsey Parsons:
Okay, interesting. So tell us about how sexual health and gut health interact?
Dr. Mueller:
Yeah, there’s a couple things that I think are so important. And when we talk about, and I know you talk so much about the microbiome on your show, and it’s important for everybody to understand we have a genital microbiome as well. So men have a microbiome on their penis. Women have a microbiome of their vagina. And we don’t know quite as much, unfortunately, in science, what’s going on with the male genital microbiome, but for women, we do know that the microbiome of the vagina is a huge part of what is keeping it healthy, what is keeping it from infection, and also what is helping sex to feel good, for the lubrication to happen, those sorts of things.
We also know that the gut is a reservoir for the vaginal microbiome, so the Lactobacilli species that we see so prevalent in the vagina actually are stored in the gastrointestinal tract. So we see that when people have common abnormalities of the GI tract, anything from our SIBO to our imbalances and our good bacteria are the ones that overgrow a little bit too much and all of our commensals. Or when people have infections, parasites, those sort of things that we can get a change in those species, especially those Lactobacilli, because those are the really important species of the vagina, and therefore a change in the vaginal microbiome. And all of a sudden, somebody might experience more infections. They might experience pH issues, they might experience odor issues, they might experience things that just don’t feel as good from an insertion perspective. And so we can see all of that.
And when things aren’t functioning very well down there, we tend to not have as much desire for anybody to go there, or ourselves. So that is one thing. And then I know you’ve talked about this on your show before, but I think because of the context, it’s good to at least drop this again for people to hear that we do know that part of the proper recycling and re-utilization of hormones such as estrogen requires a proper gut hormone balance. And when those gut hormones are out of balance, we can run into situations where we are not recycling estrogen as properly, sometimes we can lead to too much estrogen in that scenario, and it can throw off our hormones, and therefore throw off our libido and sex drive due to that as well.
Lindsey Parsons:
Let’s talk a little bit more about that, the estrogen dominance-beta glucuronidase connection.
Dr. Mueller:
So we know that beta glucuronidase is that enzyme. Anytime we see that -ase, we know that’s an enzyme, and we know that in certain situations, gastrointestinal infections, SIBO, these scenarios, we can see an increase in that enzyme. And so what’s supposed to happen with estrogen is that it is detoxed through the liver through our Phase one and Phase two pathways, and when it’s detoxed, we are essentially getting rid of any sort of recycled components. And what this beta glucuronidase enzyme does is once these recycled components are broken down in the liver, they make their way into the gut, and we are excreting them. But if people have too much of this enzyme, which we see in certain gastrointestinal infections, and they have too much of this enzyme, then we can actually see those estrogen components that are recycled. They actually will start to reform back together into whole estrogen and then be reabsorbed. And so the body was trying to get rid of them for balance, and now we reabsorb them. So now we have a higher amount of estrogen, and that’s when we get into that estrogen dominant scenario.
Lindsey Parsons:
Yeah, I know that I had estrogen dominance my whole life, and I still do, even now, when I’m having to supplement with estrogen with patches now that I’m in menopause. But the funny thing is, I still don’t have ideal estrogen metabolism. But anyway, what are the symptoms of estrogen dominance?
Dr. Mueller:
You know, that’s really interesting, right? It can be anything from bloating to acne to irritability to mood swings to changes in sleep. I feel like these hormones when we look at them, it’s almost similar to when we talk about the gut. A lot of people will say the gut is the root of all illness. And we say that because there’s so many different symptoms that can come from gut imbalances and hormone imbalances; I really feel they are very similar. We can have symptoms of headaches or migraines, right? There’s so many different things that can come from these imbalances. It’s very, very, very widespread. Which is why I think it’s important, when we’re looking at things, to say we need to test for sure, because a lot of the things that are going to be an estrogen imbalance, can also be symptoms of many other scenarios.
And I think the point that you brought up too around like, oh, you’re in menopause, you’re taking supplemental estrogen, HRT, and then you’re noticing that you’re still in estrogen dominance, is a really important point to make. Because I think a lot of people, when they are on hormones, and I’m in perimenopause, I’m using estrogen patches, they are saving my life. I love, love, love, love estrogen patches. Really, it’s like making all the difference with sleep and mood and so many things. And for me, when I look at hormones, and I’m regularly running my Dutch test and there’s other tests similar to that on the market, of course, just our urinary hormone test. And for me, what’s super interesting is when I break down estrogen, I have a real, and I’ve known this for years, I have a real high tendency to break down estrogen into the 4-OH or the 16-OH pathways. And, for your listeners, those are the pathways that tend to be more problematic if you make too many of these recycled components of estrogen, like the 4-OHs. If you’re making too much of it, it can damage your DNA, for example.
So we want to be very, very careful that when we are taking hormones, that, yes, we’re looking at markers. And a lot of times, people are only measuring and monitoring their progress with these symptoms and by serum markers. And serum markers, honestly, are a great way, in general, when you’re on HRT, to monitor the levels of HRT, but you’re going to miss these breakdown, recycled components of estrogen. So for some people it’s not even an estrogen dominant thing, where it’s like, you have good amount of estrogen, you have good amount of progesterone, but it’s a problem where you’re not metabolizing the estrogen quickly enough and well enough where it could even present, even like an estrogen dominant scenario in the body, even though that’s not what we would classically label it as.
Lindsey Parsons:
Yeah. In fact, I was mislabeling so I have the exact same problem, although for me, it’s just the 4-OH pathway. I just did the Vibrant Hormone Zoomer. I’m waiting to take the results to my naturopath to get an official recommendation, but in the meantime, I started taking DIM* and Calcium D-Glucarate* and extra NAC*. What do you do for your excess 4-OH and 16-OH pathways?
Dr. Mueller:
Yeah, yeah. DIM is definitely huge. You know, Calcium D-Glucurate’s going to help a little bit more with that phase two process. So, just for the listeners too, it’s like estrogen, just like anything else in the body. We have our Phase One part of our liver breakdown, which is kind of doing that first part of detox, and then we have that phase two. So that works for hormones as well as all of our toxins, chemicals, etc. So DIM tends to work more on that phase one. So that’s when we’re saying, hey, we want more of this estrogen to turn into the healthy 2-OH version and away from the 4-OH or 16-OH versions. And then phase two is where we further break down estrogen and when we get into the processes known as glucuronidation, methylation, and that’s a little bit more where that Calcium D-Glucarate tends to come in. So DIM is super interesting, because DIM is absolutely what I have found in studies to be the best. Indole-3-Carbinol*, I3C will also work pretty well.
Lindsey Parsons:
…which is literally the worst tasting supplement I’ve ever taken. It’s so bad, it’s like eating moth balls.
Dr. Mueller:
It’s really bad. It’s true. It’s true. The only thing that I think is worse than that are some of the really bitter herbs that we have in Chinese medicine, some of those can be, yeah, really pretty nasty. But, yeah, you’re absolutely right on.
Lindsey Parsons:
If DIM does the same thing, I’ll stick with the DIM.
Dr. Mueller:
Totally, and that’s what I use. And so, the tricky thing about DIM is that DIM will both lower estrogen and it will help estrogen go down the 2-OH, the better pathway. But as far as actually converting and getting the estrogens to go down that better pathway. There’s just really nothing that compares to DIM, so it is what I’m using at this point, both for myself and for patients, and the results are just phenomenal. I am moving, honestly, like mine is moving slower than I see a lot of patients move, and I think that’s probably just due to genetics from that estrogen detox pathway, but it’s still moving. I still think that it was really bad. I had 76% of the 4-OH and 16 OH. I only had 24% of that 2-OH, and we want between 60 and 80% of that 2-OH. So I saw, in about a three month period, the last time I saw it drop by 17%, which was great. So my point is it’s moving slower, because I do see other people move even faster than that, but it’s still moving.
The other point to make here is that 16-OH is actually useful for people to have. You do want small amounts of it. It is proliferative, meaning it does call cells to multiply. So there is some sort of link with cancer on that one. However, it also causes bone cells to multiply. So we also do want enough 16-OH to make sure that we are stimulating our bone cells to grow, which we all know is so important with menopause. And that’s another reason for people to consider, especially if you are using HRT, but even if you’re not to run these urinary hormone panels, because you do want to make sure, not only are you majority detoxing through the Healthy estrogen pathway, that you’re also making a little bit of that 16-OH because you do need it to really stimulate that bone growth.
Lindsey Parsons:
I assumed, because, well, first I have, a grandmother who died of either ovarian or uterine cancer. My sister’s had uterine cancer, my cousin had testicular cancer, so I know the cancer is in the family. So I knew I needed to be careful when I started HRT. But also I had all the symptoms. I had all the hot flashes and all the night sweats and the poor sleep, so all of that told me probably you need to look in deeper. Is that an accurate assessment that, if you’re having all the symptoms, you’re probably somebody who’s not processing hormones in the best way?
Dr. Mueller:
I mean it could be that you’re not processing in the best way. It also could be that you just don’t have the right amount of hormones in you, right? So sometimes it’s the one, sometimes it’s the other and really, as far as dosing on hormones, for people that are on HRT in general, the way to start it is, typically, most doctors will start people on more of the lower dosing side of things and see how people respond. And from that standpoint, yes, it’s good to look at labs to make sure you’re not off the charts, high in crazy amounts when you take these things. But you also want to make sure that you are looking at and really paying attention to symptoms. So your symptoms, when you are properly hormonally balanced, you will see a lot of these symptoms go away. So it’s really the combination of both the symptoms and the labs that you want to consider here.
Lindsey Parsons:
Yeah, yeah, no, I had to go down. It took a while to get to what I needed, and really persisting and looking for new experts and stuff to recommend, but I have to take 300 milligrams of progesterone a night, plus I’ve got some testosterone, along with moving up my estrogen dose, but the higher dose, without the progesterone, was causing bleeding. So it was like trying to figure it all out and going through a whole basically DNC because of the bleeding before, we figured out it was the hormones, which I can’t believe we didn’t start with instead of sending me through this horrible surgery. But anyway..
Dr. Mueller:
Yeah, yeah, sadly it happens. And I think it’s like an important reason to talk about this, because I think oftentimes too not only do women not know, but even if they do, there’s still so much fear around the cancer thing, even though there’s so much of hormones causing cancer that really has been demystified. And when we look a lot at the Women’s Health Initiative research that came out a couple decades ago ago, and we really look at that with that research was saying, and that was the main study, and there was a few of them, that was the main study that a lot of the cancer warnings were based off of. But when we’re actually looking at the stats, and when you read the study, you realize that the way the media portrayed this, the way the CDC and the doctors picked this up, was a big misrepresentation of what was in that study.
In fact, what was really interesting in that study that is so opposite of what we oftentimes, even say in medicine, is that when estrogen was given without progesterone, so many times, it’s thought in medicine that, estrogen is proliferative, and you give progesterone to protect against that, and there is, like, some level of reason for that, right? We see, for example, when people have things like endometriosis and they have all these cells growing outside of the uterus, that balancing that estrogen/progesterone ratio and adding progesterone in tends to really help. But what that study found was that when women were just on estrogen alone, cancer risk actually went down, and that wasn’t even told, it was the combination of estrogen and progesterone that saw an increase in cancer risk. But the way the study was analyzed, they made it sound like it was a 20% increase. But if you actually really look, go back and look at the data, it was only one in 1000 increase, and the people that did have cancer in that one in 1000 you know, we don’t even know for sure if that was caused by that right? So it’s like so small of a risk when you’re looking at the numbers. But they also had better survival rates. They also had better long-term health as far as cardiovascular and brain health. So, it’s like when these studies are just taken out context like this, and we’re isolating this one random value and not explaining to the public the entirety of the study, people get scared, and I think they make a lot of really bad decisions just based upon not understanding and being fed bad data.
Lindsey Parsons:
Yeah.And then it was that Premarin made from horse urine, right?
Dr. Mueller:
Correct
Lindsey Parsons:
Not bioidentical progesterone they were taking.
Dr. Mueller:
Exactly.
Lindsey Parsons:
Yeah, there’s an entire generation who, that includes my mother, people who were taking hormone replacement therapy. They stopped, and they never went back, and now they’re kind of too old to do it
Dr. Mueller:
Exactly. And that’s definitely another thing. I’m glad you bring that up, because it is another important thing that we really realize. The best health benefits are absolutely if you start this within the first 10 years of menopause, and menopause being that single day in time when it’s one year past your last period and and even earlier starting, the better. So I’m in that weird perimenopause stage of, am I having a period this month or next month? Or when it was like, I’m in that weird stage, but I’ve started now. I’ve been on HRT for, I guess, about eight months or so now, and I’m starting now, not only because of the symptoms, but also because we see that the sooner you start, when you get to this age, and really balance that, the better you are cardio protected, the better you are cognitively protected, the better you are bone protected. So we really do want to maximize this and get the best benefits. And you’re absolutely right. Those poor women that were fed this real inaccurate information now it’s like, largely too late for them. You know there might still be some benefit. I’m not saying not to do it, but from that bulk of that huge benefit, we really know that earlier starts make a huge difference.
Lindsey Parsons:
Yeah, and I mean, the other piece, of course, is that it’s hard to find doctors who are experts in this. So if you’re just starting into perimenopause, just starting to have symptoms, get that appointment now, because it may take you one or two providers, three providers, before you find the right one who gets it right and fixes this for you and knows enough and all that. So, it’s a project for everybody heading into menopause.
Dr. Mueller:
I agree, start early and I’ll tell everybody real fast about my book, Want to Want It, get this book too, because it’ll help you. The biggest thing with this is self advocacy. And so in my book, one of the things I talk about is, these are the tests you really need to run. And I break it down very simply as to why, so you can actually interview doctors and say, are you going to be able to run these appropriate tests that I really need to have run so that you can get the information? Because a lot of times doctors are not. And we know other things, like we know that usually with menopause, it’s another time that we see the thyroid hormone and the thyroid system also start to falter. Oftentimes, it can happen at menopause. So, making sure you’re getting proper thyroid testing, and the thoroughness of that and all of that we cover in the book, so you can self advocate.
Lindsey Parsons:
Yeah, I love that title, “Want to Want It”, because I think a lot of times when women hit points of low libido, and if they are in a relationship or not, but sometimes the partner just kind of goes along with it and it just sort of fades away. But, I mean, it is like the beginning of the death of a marriage.
Dr. Mueller:
It is!
Lindsey Parsons:
You want to want to want it. That’s an important part of a relationship. And so that leads into my next question, which is, how does having a healthy sex life help with hormonal balance and general health?
Dr. Mueller:
Yeah, it’s these very vicious cycles we get into, I think, in health, one of the biggest things are these vicious cycles of the chicken and the egg, right? So we see that in order to have a healthy libido from a physical side of things, we need good circulation. We need the thyroid balance. We don’t need too much stress. We need our hormone balance. We don’t need too much neurological inflammation, so we don’t have many toxins in our body. We need proper gut health, as we talked about. So all of these things and more will play into that healthy libido. And then you also get into like, are you sexually bored in bed? Do you trust your partner? Do you have an element of safety? Can you communicate? Can you talk about your sex life? Because we do actually see surveys that showed 92% of people that say they’re satisfied with their sex life talk about it. So we know we need to talk about it if it’s going to be good. So all of these things can play into why a libido is low. Now what’s interesting is, stress, for example, is one of the big ones for people, and this is the overwhelm of midlife, right? Where it’s like this midlife is oftentimes the time where it’s like things start to go haywire. Here, people are together with their partner, oftentimes, for years, they are in their career, they have kids.
Oftentimes, they’re balancing so many things. And, sex is that thing that’s like, maybe at nine o’clock at night. It’s like it comes through the passing thought of, should we do this? No, I’m so tired I’ve got to get up at 4:30 a.m. the next day and start it all over again. And so what’s interesting in answering your question here is that we see that orgasm is one of the best ways, and oxytocin that is secreted with orgasm, is one of the best ways of actually lowering stress hormones. So I really believe that God, Spirit, universe, whatever we want to call, anybody wants to call this energy, gave us as humans the power of orgasm, in part, as a way of actually regulating ourselves and our stress. So, you get an orgasm and all of a sudden your cortisol goes way down. It really helps to rebalance that. And so what’s interesting about this is, sometimes, when I’m talking about this, people will be like, well, you know, I’ve read online about a 20-second hug or a 6-second kiss, and we can do these things to raise oxytocin. And those are great, like petting an animal raises oxytocin. There’s all these ways. But to give an example, like this 20-second hug will raise oxytocin in the blood, maybe like 20, 30, 40, 50% is what we see. Sounds pretty good, well, until you realize that an orgasm is going to raise it 200 to 500%, so what we actually get from our body rebalancing with oxytocin is so much better with an orgasm. And one of the movements in the natural health space is compounded intranasal oxytocin, where you actually use that to get a compounded agency to prescribe oxytocin. It’s prescribed and given intranasally. That works really well from an absorption standpoint. That’s why it’s prescribed that way.
But I’m telling you, I have never seen anybody take that, I’ve used it, it’s great. I’ve worked with other people who’ve used it, and you can feel a little bit of a shift, for sure, from a standpoint of, like, oh, there’s like, a little shift in calmness. And I think it’s a great tool. Compared to what I’ve seen in myself, as well as women that I talk to that are having profound orgasms and really helping them with stress and resiliency, it’s just not even close as to what I think can come from those orgasms. So that’s a little bit of that chicken and the egg around then, okay, so I’m too stressed to have sex, but I’m not having sex, so then I’m not using my fundamental, own, innate, non-prescribed, just made for my own body, chemical way of actually balancing that stress and helping me regulate.
Lindsey Parsons:
Indeed. So what are some of the most common gut health issues that are impacting people’s sex lives?
Dr. Mueller:
I think a lot of what we mentioned, right? So anything that’s going to really bother the microbiome, anything that’s going to bother that beta glucuronidase and increase that enzyme production. So anything that we’re looking at as far as our SIBO, our parasites, our H pylori, you know, our infections, GI wise. But I also think another big thing that we also want to mention are proton pump inhibitors, right? Anything that is changing the stomach acid of our body, because not only are we more subject to infections that way, but we’re also not going to absorb a lot of nutrients. So we know, for example, that we need iron, manganese, zinc, copper, right? These are some of our top nutrients that we need in order to make things like sex hormones. We do need some B vitamins in there as well. And so if we’re having any stomach issues that are leading to anything around proper absorption or in absorption of nutrients, that’s going to actually impact our hormonal levels.
We know that too low fat diets, people that are on too low fat diets, or even on things like statins, there’s a concern, because cholesterol turns into the nutrient DHEA, and DHEA is what we make estrogen and testosterone out of so, potentially, if we’re eating these really low fat diets, or if we’re seeing our cholesterol numbers be really low, I see sometimes people that are on these cholesterol lowering statin medications, and their cholesterol comes in at 120, 130, 140, these are, way too low of numbers. Not only is cholesterol good for us from a standpoint of cell health and brain health, but it’s also important from a standpoint of hormone health. So if we’re doing this work, you’re keeping our diet too low, and we’re not working with those proper nutrient balances. Or if we have things like leaky gut, maybe we’re eating too much gluten, maybe we are eating things that we have food allergies or food sensitivities to. Maybe we are eating non-organic food in high quantities, and that’s disrupting the microbiome. Maybe there’s heavy metals in our gut and throughout our body, which have also been shown to cause leaky gut.
With any of those things, and we have a huge tendency in that arena, to not have the nutrient absorptions we need, and not being able to make those hormones in the way that we need and keep our body balanced throughout. We also know that certain nutrients, a lot of our greens, a lot of how the things we have to chew can help to generate things like nitric oxide in the body. Nitric oxide is an essential vasodilator, so it’s an essential thing to dilate those blood vessels, to get that circulation to the penis and also to the vagina. A lot of people don’t realize, it’s like we have our little blue pills for the penis, which can work very well acutely. They don’t really fix any root cause issues. But a lot of people do not realize that as women, we also need circulation to the vagina and to the vulva, to all of our erogenous tissue, and that sometimes things like vaginal dryness is actually not a hormonal problem. It certainly can be, but it’s from a circulation problem. So we really want to get that blood flow not only to the penis, but to the vaginal tissue as well, and it’s equally as important for women.
Lindsey Parsons:
And a clue that you might have that problem would be, probably, that you had high blood pressure?
Dr. Mueller:
That’s definitely a big one, right? Because it’s like when I talk to cardiologists about erectile dysfunction, for example, it’s a very common thing that cardiologists will say that the first time a man actually gets diagnosed with something like a heart problem or a blood vessel problem is when they have erectile dysfunction. That oftentimes is annoying enough and it’s causing a man enough stress to say, okay, I’m ready to get this checked out. And of course, as we know, these things that affect one part of the body often affect the whole thing. And if it’s a circulatory problem, it’s not like it’s like only blood flow to the penis. It’s going to be blood flow everywhere else, right? So blood pressure is an important one, Apolipoprotein B on a serum panel, so that cholesterol marker. Oftentimes people are just looking at total cholesterol, your good and bad cholesterol, the ratio of those sorts of things. But the Apolipoprotein B, or Apo B for short, is a better marker that you can get, pretty cheaply, added on if you can get your doctor to run it. That is a blood marker that will talk about, it’s a cholesterol marker. But what we’ve seen in studies is it’s very correlated to plaque on the arteries. And if you have plaque on the arteries, there’s probably an element of that hardening, or just restriction of blood flow from that side of things. So you know definitely blood pressure is good, but I would also really advocate, at a minimum, to also get that Apolipoprotein B, because it will tell a lot about that arterial health as well.
Lindsey Parsons:
Yeah, at risk of being slightly off topic, I did do that test, and my Apo B was elevated, and I kind of have just blown it off because my sister has had high cholesterol for years, and she got a calcium artery scan and it was zero, and I thought it’s probably going to be the same thing for me, because I exercise, I eat well, like I do all the things, why should I have plaques in my arteries? But am I being naive?
Dr. Mueller:
I personally like doing either the CAC score, like you’re talking about, or something like a CIMT, which is an ultrasound of the carotid artery. Those types of tests are great, and I do think it’s worth it, they’re going to be more accurate for sure than the Apo B, but I do think they do correlate really highly. So if I was in your position, I would still do my due diligence and just go and get one of those basic things done, just to be safe, because it is your heart. Note for listeners, it’s so interesting, right? Like, some of the things that are most used commonly for lowering Apo B are things like red yeast rice, CoQ10*, those kinds of things. Red yeast rice is the natural version of a statin.
Lindsey Parsons:
Yeah, I’ve got some in my closet that for some reason I just can’t bring myself to take. I don’t know why.
Dr. Mueller:
Yeah, well, and it’s interesting, it works in the same mechanism of a statin. So it’s what’s known as an HMG CoA reductase inhibitor, which just means you don’t make as much cholesterol. And just like a statin, red yeast rice can lower the CoQ10 in your body. So it’s better that it’s natural, but it still has some mechanism that can be a level of concern. But what I wanted to share with you is plant sterols*. I’ve actually seen more clinical results that I’ve been happy with, especially in people with familial hypercholesterolemia, where there is that genetic high cholesterol. I don’t see people that have that genetic tendency respond with red yeast rice near the level as they do with plant sterols. And not saying I don’t still use red yeast rice, I do. But really, the plant sterols for that group of people have just blown me away more than red yeast rice.
Lindsey Parsons:
I’ll have to look into that. So back to the topic at hand, yes, the most obvious intersections of gut health and sex would relate to anal sex. So I’m curious first, whether anal sex causes gut health issues like hemorrhoids or anal fissures or other issues, or if there’s a healthy way to do it for avoiding those problems?
Dr. Mueller:
So if we already have a level of vascular fragility, especially intra anally, it’s probably not going to help the scenario. The biggest thing is, many people have anal sex without any source of problems, as far as causing any sort of hemorrhoids or fissures or those kinds of things. There’s a few things, though, like wanting to use a ton of lube, is like the most obvious one. So your silicon-based lubes, or your oil-based lubes are going to work the best. Your water-based lubes are very . . . I love water-based lubes for certain things, but water-based lubes, they’re just not, as their viscosity is lower, and so they don’t tend to have the level of slipperiness that is needed for anal sex to actually not cause pain. So it’s a lot of things. We want to follow your body, and if your body is saying this hurts, this is a big area where you don’t just suck it up and be like, all right, we’re going to figure this out anyways, because if you’re getting any sort of pain at all, that can be a big sign. Anal sex, if done well, should actually be pleasure and not pain.
A lot of how people start with anal sex is doing something like, there’s a few different things to start. One, it’s always good, from a hygiene perspective, to bathe before, bowels are evacuated before, people will even use anal douches sometimes. These are basically just water inserted into the anus via a bowl that you squeeze up there. You want to use lube for this and make sure it’s clean, but that can help take care of any sort of concern around microbiomes and infections spreading. You clean out the orifice before you actually do that act.
Once people have done that, starting really slowly, like a finger. Sometimes people even use gloves or finger condoms for this. Then you use a little bit of that silicone oil lube, and you really just go around the anal sphincter muscle very, very lightly, just like a light touch, a light pressure. Put a finger there, and a lot of breathing and a lot of slow insertion and a lot of pausing. Oftentimes you’re just doing that with a finger, and you’re getting that anal canal there, you’re getting that rectum and the tissue there, you’re getting that cavity used to the sensation.
Because a lot of what can happen for people is if this is done too quickly and too intensely, it’s a very sympathetic type of response. Things constrict and tighten. I think that’s when people run into a lot of problems, versus that parasympathetic, relaxed type of state that keeps proper blood flow and does not overly constrict the muscles.
If we’re doing that correctly and slowly, with the right lube and in the right way, I see many, many people do this effectively without ever getting any sort of hemorrhoids or fissures and having zero problems. That being said, if you have a tendency to that and you have a history of it, this is something that you might want to be careful of. Talk to your doctor about this. I would definitely recommend asking, are you cleared for this? Have these hemorrhoids been gone for a long time? Have you had any signs of them?
If you have had them gone for years, then hopefully the vessels have healed. But again, just going really, really slowly when you do it tends to help people a lot more.
Lindsey Parsons:
And so the anal douching doesn’t remove your microbiome?
Dr. Mueller:
I mean, it’s just a small effect. It’s going to probably be similar to doing just a little bit of an enema, right? So you’re not getting far up. It’s really largely just like a small amount into the rectum, so you’re not really getting into that large intestine much at all. So there is not much of a risk of really impacting the microbiome and anything. It would be extremely small just because of the locality of it.
Lindsey Parsons:
And are there any supplements that you recommend for people who practice anal sex regularly?
Dr. Mueller:
Supplements, not as much. But obviously I always keep up with the microbiome from that standpoint. But I would say more things like hygiene, washing, and getting really good quality lube.
Now I mentioned silicone and oil-based are two that I like. The most common natural oil that people tend to use when they’re reading things online is coconut oil. We do want to be a little bit careful about coconut oil, because things can get sloppy and messy, and coconut oil, when you’re rubbing it around there, will probably get a little bit near the vaginal canal. Coconut oil is very antimicrobial, and that’s great when you have an actual infection, but when you don’t, you really don’t want to be using something antimicrobial near the vagina, especially because of the microbiome issues we talked about earlier.
So even though coconut oil can be lovely from a standpoint of smell and viscosity, it’s really not the best oil-based lube to use. What works a lot better is MCT oil. I have MCT oil with CBD. CBD is another amazing thing to use. I have product discounts on that, so I’ll give you my product page for your links so people can get some great MCT oil with CBD in it that’s used for these types of sexual play.
I’d say the one thing in answer to your question that you might want to consider, I guess a couple things. I don’t generally find that people need supplements with anal play. But if you wanted to do something, you might consider something like witch hazel, which is very healing to the veins, or something like vitamin C. We do see that when vitamin C levels are low, veins and blood vessels can be a little more fragile. Vitamin C is an important nutrient for the strength of those blood vessels. Those are a couple of things that, if people are worried about it and want to make sure their veins and blood vessels all over their body and in particular the vasculature of the anus are strong, they could consider as well.
Lindsey Parsons:
I’m just thinking about that because I’ve seen advertisements for fiber supplements that were hinting at anal sex, and they were gummies. And when people take fiber gummies, I’m like, yeah, there’s really not going to be a ton of fiber in those gummies!
Dr. Mueller:
Correct, exactly!
Lindsey Parsons:
If you want some fiber, you’re going to need a scoop of it. It’s going to be bigger than the size of a gummy.
Dr. Mueller:
Yes, exactly, exactly. It’s some of these things, I think we can get really gimmicky, and that’s why I think shows like yours are so important, because without the knowledge, it’s easier to just be like, oh, we have all these things that taste bad and like, I get to take fiber as a gummy, great!
Lindsey Parsons:
Right? A candy, and it’s good for me? Totally.
Dr. Mueller:
But those things, from an efficacy standpoint, are probably like a healthy version of a candy at best.
Lindsey Parsons:
So can you talk a little bit about the pH of the lube you use in a vagina versus in a butt?
Dr. Mueller:
Yeah. So pH is really important, and pH actually comes into play a lot in our water-based lubes. So in our water-based lubes, what is important is that a lot of the chemicals in these types of lubes can really throw off the pH of the vagina. And so when you’re just getting your standard thing at a sex store or just on Amazon, you really are at risk. And when you throw off the pH of the vagina, you run into the risk of infections, and those things we talked about earlier. So one of the best things from a water-based lube perspective to really preserve the pH of the vagina, I have found to be our aloe-based products. And, I’m sure it will make a lot of sense to you as a gut expert, because we know aloe, for the guts and for all mucous membranes, is incredibly healing.
And so what the researchers of aloe-based products have found is that these are good for the health of the membrane of the gut, but aloe can also help the health of the membrane of the vagina, and it helps the microbiome of the vagina. It helps preserve that, it helps keep the pH really consistent. And so a good aloe-based lube is going to consider all of these things. And so that’s a really important thing to consider there. It’s really the water-based lubes that tend to have the most emphasis on pH that I have found. I haven’t found as much of the conversation on pH on some of the oil-based lubes or those kind of things, because I don’t think they throw off the health of the microbiome so much and so anally, you’re not even using the water-based lube, so that’s not as important. And you know, again, if people want a good one with product discounts, you can find all of that on my product page, on my website, at mylibidodoc, and I’ll give you that link like I said.
Lindsey Parsons:
Yeah, right, but you wouldn’t want low pH, right, an acidic lube in an anus, right?
Dr. Mueller:
But you’re typically not going to find that in like an oil- or silicon-based lube.
Lindsey Parsons:
Right. So I have a number of clients, both male and female, who admit to having a low libido. So other than obviously working on their relationship, their communication, all of the psychological parts and their overall physical health, is there anything you recommend in terms of supplements or anything else to help with libido?
Dr. Mueller:
I really find that low libido is a combination of three pillars, and so pillar one is all of our physical root causes. So people can go take my free quiz there at libidoquiz.com. If you take that quiz, it’ll spit out answers for your ideas on testing as well. So that, again, that’s at libidoquiz.com so that’s a great resource. That’s the physical root cause pillar.
Then the second pillar is the personal root cause. So the personal root cause is, how well do you know your own body? Do you have any body shame? Do you have any sexual shame? If you are finding yourself in bed and making love or doing anything in the intimacy space, and find yourself checking out a lot where you’re like, oh man, my mind was wandering. Some level of that is normal, right? Some level of, oh wow, I was having sex, and the grocery lists started going. Most women, if you talk to them, they’re going to admit that that happened to them, because we are multitaskers by nature as women.
But if you’re finding that goodness, every time you’re getting closer and closer to pleasure, you’re just constantly checking out and you can almost never be present, that’s, I’m not talking about the random thing, oh yeah, I shouldn’t be doing the list. I’m bringing myself back. That can happen. But if you’re like, wow, yeah, every time I get touched here, I’m disassociating, I’m checking out of my body. That can be a big sign that there’s some level of trauma. And it doesn’t have to be big T trauma. This can be as simple as somebody performing oral sex on somebody and giving a weird face when they did it, and all of a sudden you’re thinking, oh my goodness, they gave a weird face because I look funny there or whatever, right? There can be these very simple, small t traumas that lead to a lot of shame. So we definitely want to consider that.
And then another big thing in the personal root pillar is, how well do you know your own body? Meaning, if we’re looking at the vulva, right and so it’s like if we’re looking at the vulva and we look at the clitoris, a lot of people think of just this nub at the top, but the clitoris actually has these long legs. And these long legs extend, and that is a huge part of the female pleasure, the legs of the clitoris, which is not the part that you see with the naked eye. And so a lot of this comes in understanding one’s own body through personal exploration around, oh, this part of my labia, this part of my outer labia, my inner labia, the space between my labia, this is actually a huge point where the uniqueness of oneself gets turned on, right? So we don’t know that. It is impossible for our partner to know that.
And then the third pillar really is in that intra communication, am I safe? Do I feel trust? Do we have desire mismatch? Are we able to talk about that and find ways of getting back on the same page? What happens when I ask for my needs, wants, preference and desires, those kind of things.
So it’s a long-winded answer to your question. I mean, there are some herbs we can try, our damianas* and our Horny Goat weeds*. And there’s herbs like that. I don’t get into the aphrodisiac world because, personally, I have found aphrodisiac foods to at best be another marketing thing. The example I give is that oysters are an aphrodisiac. If you look up common aphrodisiacs, oysters will pretty much always come up, probably because they have high amounts of zinc and zinc is helpful for testosterone, which is helpful for the libido.
But if you don’t like oysters, and people have a love hate relationship with oysters generally, and you don’t like oysters, and you’re sitting there and you’re just trying to get it to slide down your throat, and it’s disgusting and it’s vile, and it’s taking you out of your presence and pleasure, probably not going to do much for your libido, right? Just take some zinc. Get your zinc in other ways.
And so from that standpoint it’s a healthy diet, free of toxins, balance, just all the normal things that people have heard so many times on your show, are really supportive. And yes, we can do things supporting testosterone. Tribulus* works very well. Shilajit* as an herb works really well. Tongkat Ali*, all these herbs can be very supportive of testosterone, and I have seen clinical results with them. The studies are really positive. So there, yes, there are some things we can do to support.
But the number one thing I see, and why I’m answering this in relation to the three pillars, is because the number one thing I see is that just about anything that we talk about in health, it’s not one root cause. And so it’s very easy for people to get on a supplement and be like, oh, I didn’t notice anything from this. And it doesn’t mean it’s not helpful. It means that if there are ten different pieces of the root pie all in these three different pillars, that if we just address one of these ten, it’s probably not enough for us to notice that improvement in libido and desire. We really do need to make that shift.
Lindsey Parsons:
Those supplements you mentioned, it seemed like most of them were ones for men, is that accurate?
Dr. Mueller:
No, not at all just but thank you for clarifying. Most of those things are things for testosterone, but they absolutely work on women. And as you know, from being on testosterone, like we need testosterone as women too. So those are more testosterone building supplements, but they are going to be great for libido, for women or men, right?
Lindsey Parsons:
Because testosterone helps with libido and women.
Dr. Mueller:
Exactly. And that’s a huge misunderstanding.I’m glad you brought that up, because I think a lot of people just think testosterone, men, testosterone, men and they do have more testosterone than us women, but if you look at estrogen, progesterone and testosterone as women, what we actually have the most of in our body is testosterone. We have more testosterone than other sex hormones. We just have way less than the guys.
Lindsey Parsons:
So totally separate topic. But on our previous recording, you talked about having had positive CdtB and vinculin antibodies, and therefore having post infectious IBS. So I’m curious if your vinculin antibodies have normalized. And if so, how did you do it?
Dr. Mueller:
They have normalized. And it’s hard to say how I did it, just because of the standpoint of, like, I do so many things. So I wish I could say, oh, this is so clear. But I think it is probably a combination of healing the gut and doing things like a lot of our demulcent herbs, our aloe, our marshmallow, those kinds of things. I did some glutamine as well. Did a lot of our serum bovine immunoglobulin. So definitely a lot of work on the gut. I did a round of Rifaximin for SIBO as well, as well as followed up with a low dose erythromycin, so worked on my migrating motor complex that way. So I imagine also, since we see that vigilance is tied in with the MMC, and we see that that low dose erythromycin can help with that, that that was a portion of that. It was also getting out of a moldy environment, getting the mold out of my body. You know, there have been a couple run ins I’ve had through my life with mold. Once, very early on, which is where my career was launched. Sadly, that’s not the first time I’ve ended up in a house that had mold. So I think some of that too, is just like detoxing some of that out. So I wish I could have a straight answer, this was the thing, but my feeling was, it’s a combination.
Lindsey Parsons:
Yeah, it’s good to know, yeah. Okay. Well, I think that was everything I wanted to ask. Any final parting words you’d like to share with us?
Dr. Mueller:
I think the biggest thing is it’s so easy to think about sexual wellness, and I think the number of people will say, well, I’ve just decided that that’s not something that me and my partner do anymore. And like, we’re best friends, and we don’t need that. And I think a really important conversation to have is to ask your partner what sex and what sexual intimacy provides for them. And a lot of times, people will say, connection, love, stress release, all these different things, and to really get a sense of is this truly impacting your relationship or not. And for some people, maybe it’s not. I mean, just because surveys say all sorts of things doesn’t mean that you’re part of the survey, right? There are anomalies. There are people that fall out of those normals, all those things. So it’s entirely possible. I believe that some people are incredibly happy in their relationships without this.
But I think oftentimes that comes from an acceptance of like, well, we’re not having it so we’re just going to make peace with this, where there’s this subtle resentment that is actually building up. And that’s what I really hope to help couples work through and get stronger in their relationship together. So I really do encourage you to have a conversation around like, what does sex provide, as well as, is there anything in your life from a connection, communication, emotional support and just feeling good in your body and your relationship, that maybe a lack of it is there? And the whole point of this conversation is not to throw anybody under the bus, not to shame anybody, but to get a sense of just like anything else, it’s just data, and to say, are we off track by not working on this in our life, and is it impacting our relationship? And if so, the goal there is to find the motivation then to start making this a priority. And it’s no different than having a conversation with a nutritionist around like, what do I need to do to really make sure I’m choosing good food and start prioritizing that. Or with a personal trainer, or anything else, you’re just really looking to say, what is the level that this choice is actually causing an impact on myself, my wellness and my relationship, and is it important enough for me to come together with my partner and work on it? So I think it’s a really good step for people to consider so we’re not just shoving things under the rug because these conversations are things that we’re not taught to deal with. And you know, if you need any help, definitely grab my book at wanttowantit.com and I’d be happy to help you all.
Lindsey Parsons:
Yeah, no, I, I agree that healthy sex life just brings such good feelings of well being and the skin to skin contact and oxytocin release and just like such a bonding thing when it’s working well, and such a source of stress when it’s not, so it’s definitely worth working to get to the place where it’s working well. So thank you for bringing this conversation to this gut health podcast.
Dr. Mueller:
Thank you for having me, Lindsey, it’s always a pleasure.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.