Ashley Winter, M.D., is the chief medical officer at and a urologist and sexual drugs specialist. She makes use of social media (primarily ) to assist clear up misconceptions about girls’s well being and talk the reality about all issues vaginas.

Winter was exceptionally beneficiant along with her time, and our “15 minute” chat really lasted an hour. We talked about every thing from her viral tweet about which method to wipe after peeing (spoiler alert: it doesn’t actually matter) to the significance of vaginal estrogen for perimenopausal and postmenopausal girls.

Our interview follows, edited for readability and size.

HealthyWomen: You have turn out to be fairly a well-known determine advocating for ladies’s well being and offering sex-med and urology tutorials on Twitter. How did that come about?

Dr. Winter: You recognize, I want I might pinpoint precisely what occurred. I’ve simply tried to be constant in my messaging, but in addition an actual human, and I feel that has been interesting to individuals. I keep in mind most likely three years in the past, close to the beginning of the pandemic, when individuals have been simply sitting round quite a bit, a watch physician tweeted his favourite individuals on Twitter to comply with, and I used to be one among them. I bought a giant following off that.

HealthyWomen: What have been some misconceptions you had about girls and urology in the beginning of your medical research? And the way do these misconceptions persist in society?

Dr. Winter: I initially went into as a result of I discovered about it after a female relative went to a urologist, and I heard concerning the process — a , which appears to be like on the within the bladder and urethra. And I used to be like, “Oh, that sounds type of cool.” So I regarded into what urology was and I bought interested by it.

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

Additionally, there are particular issues which might be undoubtedly not intercourse particular, like kidney stones, bladder most cancers, blood within the urine. We deal with all of these issues. And along with male infertility and male sexual perform, we offer look after feminine sexual perform, which is a large a part of my profession. It’s an area that does not have a whole lot of possession within the conventional medical surroundings. A variety of what girls get in healthcare is reproductive healthcare.

One other large challenge was that some individuals would not wish to see me as a result of I’m a lady. However some who have been hesitant got here to see me anyway, and after that they had a go to with me, have been like, “Oh, you are actually cool.” I’ve been in a position to change sure individuals’s conceptions about what a urologist ought to be simply by present in my profession and doing my job. I think about, like in any historically male-dominated subject, in the event you present up and do an incredible job, then individuals say, “Oh, I see now that girls can try this.”

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

Dr. Winter: Sure, that is true. There’s a lot misinformation on social media concerning well being info, and I feel that basically got here to nationwide prominence initially of the pandemic. There have been individuals saying issues that weren’t based mostly in science. That was once I actually pushed up my social media presence as a result of I spotted that many physicians direct their on-line content material towards different medical doctors. And we actually have an obligation to focus towards the broader group.

I give it some thought as a common shopper: How would I wish to strategy areas that I am not an skilled in? You recognize, once I’m choosing a sunscreen, I like watching YouTube movies from a dermatologist. We are able to all share in this type of informal trade, and I am actually excited to share what the scientific info really is.

HealthyWomen: You lately tweeted that girls needn’t wipe from entrance to again after they pee and it bought fairly a response. It went viral. Are you able to inform us about that?

Dr. Winter: To make clear, what I meant by that was you do not have to wipe entrance to again over the . After you pee, you possibly can both wipe beginning behind your vulva ahead, or behind your urethra ahead, or you can begin within the entrance of your urethra and go backwards. Actually, I do not imply that it’s best to take a bit of bathroom paper and smear out of your anus all the way in which entrance. However which path you go over your urethra space doesn’t matter. I felt it was essential to dispel this fantasy as a result of blaming the path you wipe could make you’re feeling ashamed and would possibly discourage you from getting therapy.

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

Dr. Winter: Ladies have a brief urethra — shorter than males. It does seem they get UTIs extra simply. And undoubtedly there are some girls who’ve the next likelihood of getting a UTI after sexual exercise. That stated, UTIs aren’t an STD or an STI, that means they don’t seem to be sexually transmitted. It is not like your associate has a urinary tract an infection they usually unfold it to you. However being uncovered to the bacterial surroundings on a associate and having that micro organism near the opening of your urethra seems to, in some delicate individuals, result in them getting a UTI.

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

HealthyWomen: Are you able to discuss concerning the G-spot and finish the controversy as soon as and for all: Does it exist?

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

The entrance a part of the vaginal wall, close to the place the urethra passes, has glands which might be just like the prostate in males. There are additionally a bunch of nerves that run alongside it that we predict are just like the nerves that go across the prostate in males, which is essential for sexual stimulation, erections, and many others. So, you’ve all this tissue that’s actually advanced and attention-grabbing within the entrance a part of the vagina, like a number of inches in. And that’s the realm that may probably result in orgasm in the event you stimulate it — and likewise to what we name feminine ejaculation or squirting. That may generally be urine, nevertheless it may also be precise secretion of fluid from the glands round this type of prostate-like tissue.

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

HealthyWomen: You wish to deal with UTIs with vaginal estradiol as a substitute of antibiotics. Why?

Dr. Winter: It is not a lot that I deal with UTIs with vaginal estrogen as a substitute of antibiotics. It is extra like I stop them with it. We all know that in the event you take a bunch of girls who’re postmenopausal, and also you give them vaginal estrogen, it’s going to make their vaginal pH go down again to premenopausal ranges. And it’ll permit this wholesome micro organism that is imagined to dwell there to come back again. It additionally acts like a barrier and prevents the micro organism that may trigger UTIs from attending to the urethra.

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

However that basically clear idea is so undertaught. I do not do not suppose it was ever taught to me in medical college. And there was little or no, if any, training about that in my six years of urology residency. And you then exit into observe, and also you see tons of feminine sufferers who’re postmenopausal getting antibiotic, antibiotic, antibiotic, for his or her UTIs.

What I’ve present in my function as a urologist is that folks have been coming to me for frequent UTIs, or who have been perimenopausal or postmenopausal, and I used to be prescribing the additional vaginal estrogen and I used to be explaining that hyperlink all day, each day in my clinic. It was actually beautiful to me to should say time and again that this not solely makes individuals’s high quality of life dramatically higher, it really saves lives. It could actually stop girls from getting an an infection that travels up their kidney and finally ends up touchdown them within the hospital or the ICU or dying.

For those who’re already on vaginal estrogen and you continue to get a UTI, which undoubtedly occurs however much less typically, then, in fact utilizing an acceptable antibiotic is completely fantastic.

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

Dr. Winter: GSM stands for . And it’s so essential to know that time period. After I consider all of the depictions of menopause that I discovered as a child or in my younger maturity, it was like some girl within the films having scorching flashes or saying, “I am not within the temper for intercourse.” So that you consider menopause as these whole physique signs like scorching flashes, evening sweats and modifications in habits.

However there’s really an enormous part of menopause that pertains to the impact of estrogen ranges happening and the way that modifications the tissue round your bladder, urethra, vulva and vagina.

If we might circle again to that character on tv, that girl would say, “Hey, I am going by menopause. It hurts once I pee,” or, “Hey, I’ve to go to the toilet extra regularly.” Or, “Hey, intercourse is painful and I can not get lubricated in response to arousal.”

Now, not everyone who has menopause goes by these signs, however many do. Oftentimes these signs can begin even earlier than intervals fully go away. So someone could possibly be in perimenopause, the years main as much as menopause, and their intervals are irregular, or nonetheless occurring, however their estrogen ranges are happening. And so they’re getting signs like urinary urgency, urinary frequency, burning after they pee, elevated urinary infections, lack of lubrication and lack of getting moist in response to arousal — all these signs could possibly be an indication of lowering estrogen.

For those who’re experiencing any of these signs, you actually ought to discuss to your healthcare supplier about utilizing low-dose vaginal estrogen, as a result of that’s the main therapy for all of these signs. It is not the identical factor as what we name , which is supposed to boost blood ranges of estrogen. Vaginal estrogen is de facto for the native therapy of all these signs.

My predominant tip 1,000 instances over for ladies with GSM is to get your self some vaginal estrogen. And I promise you, I’ll use vaginal estrogen as soon as I am going by menopause and I’ll use it ceaselessly and I shall be buried with my vaginal estrogen.

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

Dr. Winter: I feel a giant one which I really like speaking about since we’re on type of the hormone factor is testosterone. Testosterone is in everyone. Testosterone ranges within the common grownup girl are literally greater than her estrogen ranges. It is simply that these ranges are greater within the common man. So girls have much less testosterone than males, however everyone has extra testosterone than estrogen. Hormones aren’t black and white: one for males, one for ladies type of factor, the way in which we sometimes are led to imagine.

And testosterone is de facto essential for lots of issues. It’s essential for the genital urinary well being the identical method estrogen is. And in the event you’re on medicine that may suppress testosterone, you do have a threat of getting ache with intercourse, lowered arousal, and many others. However it could possibly additionally have an effect on your ranges of want for intercourse. And in the event you’re experiencing low want for intercourse, and also you’re peri- or postmenopausal, utilizing low ranges of testosterone can really be a therapy for that. I’ve prescribed it many instances. I’ve seen girls who’ve a beautiful response to it.