You're listening to a mom with mea podcast.

If you tell medical stuff that you slipped and fell on something and it went up your butt, no it didn't.

Just tell the doctors the truth.

No matter how embarrassing you think it is or how much you think you'll be judged, Trust me, they've seen it before.

Hi friends, I'm Claire Murphy.

Welcome to Well Australian Women.

This is your full body health Check.

I am very invested in today's episode because I am an itchy, scratchy gal.

I have had EXMA and dermatitis and when I was very recently given the wrong medication, I broke.

Out in hives.

It's really awful.

And I have been told to blame my Irish ancestry for that.

Hi Mariam, and I'm doctor Mariam and I've dealt with EXMA on and off my entire life.

My biggest trigger is stress, so exams like oh Med school, I'd always have outbreaks, chaos of balancing home and work, and yes, even having a husband.

They are stressful.

You shouldn't get one.

Do not recommend.

From my ITCHI flare up.

I'm allergic to my husband and yet you still kid dim.

Today we are talking about skin conditions.

So everything itchy and scratchy, weird colors, bumpy, blistery, all those kinds of things will be tackling exma and.

Roseace, shir psoriasis.

And a few more, asking how to best treat them, whether you can actually cure them, because I've been.

Told a lot of them you can't, which.

Is disappointing, and what you should never do if you have some of these conditions.

So stick around for that.

Today's quick consult Alyssa's having trouble keeping on top of infections and sheet is over it.

She would like some advice on that.

But next, I've got a funny, not funny message from some of my nurse friends who are all in agreement about a certain medical emergency that sees patients lie to them quite a bit, where the truth would potentially work out much much better for you.

So that's next.

We're going to med school.

Welcome to med school, Mariam.

Today's med school is a little bit more like a public service announcement.

I have some nurse friends.

They've been listening to the show.

They are deeply in love with you, Mariam.

They think of you like this glorious ray of sunshine that comes into their life once a week.

But they've also been telling me that there is a certain type of patient that comes into their er or surgery rooms with a very common problem who will give the same or very similar reasons for this medical condition existing, but that not one single nurse or doctor actually believes is true.

First, I would like to preface this with this is a no judgment zone.

What you choose to do with your own body is on you, as long as you are safe and are not hurting anybody or yourself.

However, if you tell medical stuff that you slipped and fell on something and it went up your butt, no it didn't.

There is a medical imaging professional on Instagram.

I think your handle was just radiographer.

They post X rays of things like ultrasounds of babies when mum is laughing it's hilarious, or the hand that didn't let go of the firework fast enough.

So like really.

Interesting looks inside our body.

Also just another public service announcement.

Never look at an mr right have a baby.

It is so weird, terrifyingly weird, scary, so so scary.

But there is also a selection of things on her account that are things that have gotten stuck inside of people that should not be there.

So things from like a billiard ball to a full set of Babushka dolls still inside one another.

Were they all?

Are they separated?

No?

No, the big one.

And there's coke bottles and various sex toys and things like that.

Cucumbers, yeah, the silet brushes, there's yeap, you've.

Seen a lot, I imagine, But the common thread, he's more often than not, they'll come in and say that it was an accident, or they don't know what happened, or they're not quite sure what's happening.

Whereas, for example, this is just one story that I've heard.

I don't know how true this is, but I have been told that a guy came in with a jar of Domo pasta sauce inside, and he claimed that he was cooking pasta.

Some splashed onto his clothes.

His laundry was outside.

He took his clothes off, put it in the washing machine.

The door had locked behind him, so he had to climb back in through the kitchen window, which is where he says he slipped and fell and the dormio jar went up his butt.

Yeah, but the problem with that is especially if it's something like glass, if you don't tell people the truth about what's happening or what's going on, then that could shatter inside of you and cause major damage, or getting it out could break it or.

Do a Dolemo grin.

I mean, there's an incredible story, but just notice.

The effort behind the story, Like dude, you want climbing through the window, spreading those butt cheeks apart?

Very well, they will listen to you and they won't judge you.

But as we've heard it all before, exactly, just tell the doctors the truth, no matter how embarrassing you think it is or how much you think you will be judged.

Trust me, they've seen it before.

The best thing you can do is tell them the truth, and then they will be able to fix it, hopefully easier and faster with the more information that you give them, so it's easier on them if they get to the bottom of it.

Pun intended, Yes, just tell us here's the thing, whatever ended up where it shouldn't be.

We need to know the real story because it affects how we approach the removal, which is very important.

So did it go in base first or tip first?

But it's a lid on is a lid down?

Yea?

And what's made of glass?

Has it shattered?

Is there you know, pertent for injury?

How long has it been there?

Is there a risk of infection or perforation?

These details matter for your safety, So yes, just be honest.

Honestly, nothing surprises us anymore.

We've seen it or we've seen worse.

Whatever you think is bad, you have the worst thing ever.

Yep.

And when they're seen worse yep.

So to my nurse friends, thank you for listening.

Oh bless your nurse friends, and thank you for the PSA.

It is check up time today.

We're talking about skin conditions.

So let's get our.

Itchin scratchy on.

It's time for the check up.

So Mariam, it's red, it's inflames, it's itchy, angry, it's angry, it's hot.

Sometimes, to be honest, I feel like I'm going to struggle having these conversations because whenever we talk about it.

Right now, I've just realig.

I have had EXMA on and off, had it quite bad when I was a kid, so in the elbows, in the back of the knees, and then it went away for a long time, and then it came back in my late twenties early thirties, and at one point I had xmau on one of my nipples that's nassy, which was so horrible because it was painful and itchy.

And then in a spot where you're kind.

Of judged if you scratch.

Yeah, yeah, which I feel like we should be more like men in this instance, because I see men scratching bits all the time and they feel.

I think it's unhive.

It avolver dermatider.

So yeah, God, like enough of this, like walking around just trying to casually, like put your elbow up and outside inn let me scratch my nipples, just scratch it in public, please, But I do know tons of people who seem to grow out of it over time.

I'm presuming marrying.

This is something you see pretty commonly in your clinics.

So yeah, you've just described classic atopic exma that I see constantly in my clinics.

So childhood onset often in those folds and the seeming for remission that you go through in your teens and early twenties, then bam, it comes back with a vengeance in your late twenties or thirties, and yeah, can we acknowledge how awkward it is when it comes to certain locations because nip exma is real.

It's awful.

The skin there is sensitive, and yeah, not being able to itch it is also not fun.

But here's what's fascinating about the growing out of it.

Myth about sixty percent of kids with exma dou sea improvement as they hit their teens.

But that doesn't mean it's gone forever.

Unfortunately.

What often happens is life stress, hormonal changes, environmental factors, or even just changes in our skin barrier function as we age can trigger it to resurface.

Actually, our expert today, Rodney Sinkler, has a theory about the growing out of exma thing, Yeah, which is really interesting, awesome.

Yeah, and I see this pattern often.

You know, patients in their late twenties to forties coming in saying I thought I'd grown out of this.

So triggers in ADUHOLT are often different too, So work stress, pregnancy is a massive one.

That's when I got X ME was when I was pregnant.

Yeah, it's like pregnancy, the gift that keeps on giving moving houses, new skin care products, even seasonal changes we didn't react to when we were kids.

So good news is that adult onset recurrence often responds really well to treatment once we get on top of it, and honestly, adults are much more compliant with skincare and pits.

Putting down a child and forcing cream onto them is not always easy.

It's frustrating when it comes back, but no, it's completely normal and very treatable.

So definitely see your GP.

This is something I've struggled with because I've had dermatitis and I've had x men.

But how do you tell the difference between the two.

So brilliant question.

It's one that comes up often.

It confuses a lot of people and even health professionals, so I hope I make it clear for everyone.

So break it down and break it down.

Okay, So here's the key thing to understand.

Dermatitis and XMA often use interchangeably, but there's an important distinction.

All XMA is a dermatitis, but not all dermatitis is an exmak So dermatitis literally means inflammation of the skin.

It's the broader umbrella term for any inflamed, irritated skin.

Okay, and there are types of dermatitis.

Exma comes from a Greek word meaning to boil over and it refers to a specific pattern of chronic itchy dermatitis.

So there are several types of dermatitis.

And when we talk about XMA, it's something we refer to as an atopic dermatitis.

So exma and atopic dermatitis are the same thing, they're just different names.

And that affects about twenty percent of Ozzie kids.

Typical pattern that loves the creases like we mentioned inside the elbows, behind the knees, around the neck in babies, often starts on the face and the scalp.

But there are other types of dermatitises as well, like contact dermatitis for instance, And that's.

What I get wash my hands too often and not moisturizing them.

That's right, when your skin reacts to something it's touched, like gardening.

We often see that happen with plants.

You get an itchy red rash exactly where the contact occurred.

Atop you're listening to this in South Australia, she means plants, Yeah, plants, plant plants.

Atopic XMA or atopic dermatitis has that intense itch we call the itch that rashes and tends to be chronic and recurrent often runs in families with allergies asthma and hay fever.

So practical takeaway.

If it's in those typical creases persistently itchy and there's a family history of allergies, think atopic dermatitis or exma.

If it's confined to contact areas, think contact dermatitis.

Either way, both respond well to proper skin care and the right treatment approach.

So see your GP.

Can I ask you to what's the best way to approach your doctor when you think you probably need to go a step further, like if you need to go and see a dermatologist, and we don't mean with like just x me.

It could be dermatitis orriasis orization, any of the itchy, scratchy culprits.

Yeah, so such a great question.

Or gps are going to be your first part of core.

Honestly, we've got really great experience with skin conditions and we can manage most of them effectively.

We just see so much of it.

There are even gps who have done sub specialized training in skin, so they've done like dermatology courses, and their bread and butter is like lesions and skin, so they're great to see as well, so always check their buyer for that information.

But here are red flags that make me think, right, it's time for referral to a specialist.

So diagnostic uncertainty.

If I'm scratching my head after a few visits, scratching, yeah, I love it.

Yeah.

So if I'm unsure treatments aren't working as expected, that's when I'm going to refer.

If you have resistance to treatment, and manage lots of EXMA with a lot of my patients, and we will have treatment changes every couple of weeks, but if we're not getting on top of it, and we've tried a few different approaches, then I will refer.

If there's a significant impact on your quality of life, like you can't sleep, you're missing work, you're avoiding social situations, that's time to escalate.

If it looks suspicious, anything that's changed shape, color, or size, or just looks wrong, I will fast track that.

And if there's complex cases like you've got multiple skin conditions.

You know you've got widespreads or isis or severos, so you sure, and it's affecting your eyes and multiple things are happening at once, then yeah, a referral would be warranted.

Don't feel awkward about asking for a referral if you're concerned.

Something too that sometimes you just feel a bit weird about, like social what he's saying to your GP, Like, I thank you Bert.

Can I go see someone on that period?

That's completely fine, Like if you like, look, I've seen doctors, I've done this journey, I want to see a specialist.

Just advocate for yourself.

That's really important.

Be brave ask the question.

Yeah, it's fine.

It's not going to hurt our feelings like we're tough cookies.

Cheat on you with your dermatologist.

Okay, yeah, it's fine, but just be prepared.

There might be a bit of a weight with the referral, so trialing treatment until you see the domain and they.

Might be just attached to it.

That's right on the way.

Alyssa is absolutely fed up with downstairs infections.

She needs to know how to get on top of them once and for all.

But up next dermatologist doctor Rodney Sinclair.

He's going to run us through the causes and the triggers and the treatment for some of these skin conditions that we've just talked.

About and find out why your choice of bed cover.

Might be contributing to that itchiness.

So skin conditions are a pain in the butt.

Yeah, they are itchy, They are uncomfortable, sometimes painful, and they can be embarrassing.

I know they shouldn't be.

I know we've been told to accept everyone in all their beautifulness, But if you have a rash on your face, it makes you feel something Saku and I can't explain to you why walking out into the world when you have something on your face makes you feel like you want to be the smallest person you can.

Possibly be, so no one looks at it.

So Professor Rodney Sinclair is a professional Fellow in the Department of Medicine at the University of Melbourne and the director of Sinclair Dermatology.

He's going to answer a bunch of questions we have about our skin issues today, starting with what actually causes exma, what's xma's origin story, Why are some of us more prone to it than others.

Well, KMA is in part a genetic disorder, and over the past twenty years we've started to understand that and it appears that the missing gene is a gene that produces a protein called flagon and that's what produces the waterproof seal on the outer layer of the skin.

And normally you have two copies of that gene in every cell, but if you've only got one copy, it means that your skin barrier is a essentially going to be normal until it's disrupted, and then when it's disrupted, it doesn't have the same ability to repair itself.

Now, what that means to you as a person is that if your skin barriers disrupted, you've lost your waterproof seal on the outside of your skin and you'll lose water, your skin will dry out, and also allergens things that you're allergic to, will enter the skin, activate the immune system and trigger the X amount.

So it's a genetic condition where if your skin is disrupted, you just don't have the same resistance as people who don't have that gene.

Change what kinds of common things would disrupt that skin barrier and allow those allergens in well.

In Australia, the top three would be long hot showers, soap and detergents, and ducted central heating.

So deducted central heating often has low humidity.

When I was a kid, room temperature was eighteen degrees these days people set their thermostat to twenty one, twenty two, twenty five, twenty six sometimes, and that's going to take out the humidity in the air, and that's going to be another trigger for water loss from the skin.

Soap is a detergent, so it takes out the oils that contribute to that water seal.

Just like when you drop that drop of detergent into the greasy frypan, that disperses the oil.

The soaps take the oil off the skin, which is of course how we clean our skin.

And then the long hot showers also disrupt the water barrier.

And the trap is that when you're itchy, the thing that feels better than anything else is a long hot shower.

And so it's a bit of a self perpetuating thing that the itchier you get, the more you want to have a long hot shower, the more you disrupt the skin barrier, the worse your expagates.

What's the best way to treat flare ups when they occur, because sometimes when you go to the chemist, your face with a wall of lotions that or claim to be able to help, and some of them generally do.

And there's a lot that focus on oatmeal products, for example.

So how do we make a decision on what's going to be the best to help treat it for us?

So I think we've got to divide the treatment into induction of remission and maintenance of remission.

And so what you need to induce the remission is an anti inflammatory and they come in all different sizes and strengths.

There are some that are available over the counter in the pharmacy, and there are others that are available on prescription, and they need to be site specific.

There are some that are suitable for their arms and legs, but a little bit too strong for the face.

So that's where you need the guidance from the doctor and the prescription, but the pharmacists can help you.

You've also got to try and re establish the skin barrier where it's been disrupted, because if you just reduce the inflammation but your skin barriers disrupted, more ellergens are going to get in.

They're going to reactivate the inflammatory system and you're going to be back to square one.

And so ointments which have a greasy base, ointments look like vasseline, they're going to be much better vehicles for your topical steroid.

So that you can help induce the remission in your EXMA.

One of the problems that we have is people often stop too soon.

So just because the rash has gone away visibly so you can't see it, doesn't mean that it's gone away under the skin.

And so when we have someone who's got a patch of ex ME, what we would recommend they do is they apply the ointment once a day until it's completely clear, then add another seven days and then cut down to maybe every second day for another two to three weeks, and then maybe even just once a week for five or six weeks to stop it coming back again.

If you stop too soon, you're riding a roller coaster.

Flare up, treat it, stop flare up again, treat it.

And so you want to get off that roller coaster by going a little bit longer.

The second part are the lifestyle changes that stop it coming back again, and that means cutting the showers down to about five minutes, having at lukewarm, not really singing hot, using a gentle soap, or even avoiding soap at all.

And when you do use the soap, mainly focus it on the armpets and groin.

You don't need it all over the body, turn down the thermostat on the ductor central heater, and the other thing you're going to hate before is get rid of the doner because the doners trap the heat under the blanket and so as soon as you hop into the bed, they're instantly warm, but they don't release the heat.

And one of the things that anybody with XMENT will tell you is when you get hot, you get itchy, and so a lot of the scratching your curves in the sleep.

If you've got x MA and you scratch it, it tends to go away for about five minutes then come back one hundred and one percent of what it was.

So overheating in bed at night triggering you to scratch in your sleep is where a lot of the damage is done.

And so the best thing is a cotton waffle blanket and train yourself to sleep a little bit cooler, take advantage of your body's natural variation in temperature so that you release the heat, you don't build it up at night, and you'll actually end up sleeping much better, because that's one of the reasons why people with EXMO wake up so often in the middle of the night because they get hot, they get itchy, they scratch, and it disrupts their sleep as a constant.

Ques of that, well, let's have a look at a condition that is often confused as exma, but is a different thing again, and that is siiasis.

Can you tell us what the difference between the two are.

So both of them are red scaly rashes.

The difference with x MA is it's itchy in such a way that you want to scratch it with your fingernails, where siasis is itching a way that you want to just rub it with your knuckles.

And so you never see scratch marks on the skin of people with siasis, but you do with people with exma.

If you look at the actual red scaly spot on your skin in siasus, it's well demarcated.

In other words, if you've got your pen, you could draw a line right around the circumference, because there's a very sharp demarcation between where the siasis starts and where the siasus finishes.

If you try to do that with ExM, you'd get about halfway around and then it just sort of blurs off into the distance.

And the third is that there are certain sites that are favored by XMA, and certain sites are the body that are favored by siasis.

So x mea occurs in the front of the elbow.

Siasis occurs on the back of the orbit.

Xma occurs on the back of the knees.

Siasis occurs on the front of the knees.

Sarasis is very common in the scalp behind the ears and comes as flaky dandruff, and so there are certain other features that help us distinguish.

But the other thing that's really important for patients is that when you treat exma with cream, it's usually fifty percent better in twenty four hours, seventy five percent better in three days, and pretty much gone within five to six to seven days.

Sarasus, if you put the cream on, nothing happens for forty eight hours, and then it starts to lose a little bit of a scale, starts to fade up, and it can take five to six weeks for that spot to disappear.

So they behave quite differently in response to the treatments, and that's really important because you can be using the right treatment for sarasis expecting it to be gone within a week.

Nothing's happened within three or four days, and so people throw it in the bin, not realizing that they're on the right path.

They just needed to wait a little bit longer.

That's where the diagnosis is important, so that people use the treatments correctly.

And is cericis like exma also genetic?

Yes, with exma, we often see it predominantly in children who then can grow out of it.

I'd like to understand why that is and is it the same for cerisis?

So I have a theory as to why the children grow out of the XM.

For the young children, they get dressed by their parents.

And if you've got a young child and you're going out and you put two layers on yourself, you'll father your gender put three to four layers on your child.

And when they get old enough to take off their jumper where they've been running around and get hot, that's when I think the exma starts to go away, because this poor child that's got that extra layer or two of clothing, they're much more active than you are.

And then the other factor is they get hot in bed at night and they throw off their dinner, and what does the good parent do.

They come back in and they put it back on.

And so I think there's some of the reasons why they grow out of it.

When they learn to be able to regulate their own temperature much better.

Then what tends to happen is they grow out of it up until the time they become adolescents, and then they're spending thirty minutes forty minutes in the shower stinging, hosh, listening to the music, whatever they're doing, and you can't get them out of the shower, and that's then often the trigger for the X men to come back again.

Now, sarasis is a little bit different in that it does fluctuate a little bit.

It's quite common for people to have a plaque of sarasis and they'll have one or two parks that might go for six months and they might just go away.

It might be clear for five or six years, and then it might come back again, and it really varies.

But the triggers for siasis are much less obvious.

We have to do a lot more detective work to try and find the triggers so that we can try and find something meaningful that we can modify in their environment to make it go away.

But again with sarasis, if you treat it and you keep going with that treatment, a little bit longer than just making the rash invisible.

Then you tend to get a much more prolonged, long lasting remission and tends to stay away much better.

I know you've mentioned the treatments for both exmorencirisis and they are similar.

But when you're in the throes of that ridiculously itchy moment where you just cannot stand it, I know that I've been told to go into a cool to lukewarm bath, maybe with some oats in it, or some other kind of topical.

Treatment that like a pine tar kind of vibe that helps to reduce the itchiness.

Would you recommend when you are in that moment where you like literally cannot handle it because you just want to scratch all day long.

Absolutely.

I think if you're in that state of itch, cool compresses are okay.

So if you don't have a bath tub, you might be able to just get a face washer and put that in some cool water and put it on the skin.

Similarly, ice cubes can be really good for controlling the itch and cooling it down.

And one of the things to remember is that once you've done that, it's really important afterwards to put the moisturizer on your skin, so if you're having a cool bath, you're putting it as soothing moisturizers with the other thing that's a bit of a trick is keep your moisturizing cream in the fridge so that when it goes on, the skin is extra cooling.

And that will also help relieve that itch in that emergency situation where you just want to scratch.

And then again applying cortizone creams the cordzone ointments can also be very helpful.

Just finally, I want to touch on roseaesia, which might for some people be the most annoying because it tends to impact your face and so it's always on display.

But who's the group who are most likely to develop something like roseasia and what's its origin story?

So roseasia historically used to be called acne rosasia because it was like an adult form of acne.

So just when you think you've grown out of your teenage acne, you come down with the pimples on the face, these red blotches.

Nowadays we realize that the mechanism is quite different to ordinary teenage acne.

Now the roseasia has a number of different types and appearances on the skin.

Some people are just red.

Some people are just easy blushes, easy flushes.

Some people have lots of pins and spots that become very spotty on the face, and some people can get some swelling of the skin around the nose or sometimes even the chin.

So there's different forms at the core of it.

There's lots that we don't understand.

But one of the culprits seems to be a friendly mite that normally lives on our skin harmlessly, called demodex.

And when the might proliferates and becomes overcrowded, overpopulated, then the body's immune system tries to regulate that and in doing so produces some of the inflammation that causes the rosasia.

So the common thread in all those types of roseaesia seems to be this might, and probably the common thread with exma is that the might loves moisture and heat, and so if you're getting really hot in bed at night, you tend to get flushed in the face.

That can be one of the triggers for roseaesia.

So again, staying cooler in bed at night can be a really important way of reducing the burden of the roseatia.

But then there's of course, there's a number of other treatments.

One is a medication, so many of us will be using it for the fleas on our dogs, and you can get it as a tablet, you can get it as a cream, and that seems to be one way of tackling it.

The other way we tackle it is with some antibiotics, so you need that course of antibodic for six to eight weeks, and then we also have a number of other ages.

We have topical agents, even though we change the name of roseesia away from acne rose asia.

For the people who are really struggling with it, one of the highly effective treatments is a medication that we use for teenage acne.

The dosages are very different, so for a teenager they might need two three tablets today.

For someone with rosesia they might need one tablet once a week or once a fortnight, just to sort of ease it and bring it under control.

I'm so upset that.

I won't have to cool my bed down because we've talked about sleep before and how protective.

I am of the environment.

I like it to be freezing.

Do you still use your water bottles?

Yeah?

Are you really my hot water bottle, apparently, Doctor Sinclaire told me was fine because that cleans down over the night you dona seals in the heat.

And keeps you hot for longer.

So do you think the hot water bottles just to help you get to sleep?

I think it's a bit of a yeah, like a dummy for a baby.

That's my whole.

It's like your comfort.

It's part of my routine.

And if I don't have it, like in the middle of summer, I find it a lot harder to go to sleep.

I'm such a baby.

But summer has arrived.

We just need to crank up fans now, keep your skin cool at nighttime.

Thank you.

And and if you go through our sleep podcast, how important sleep is for you?

So exactly keeping the room cool, get those fans on, no bras, no.

No don okay on the way.

It is time to answer Alyssa's question about some nasty critters invading her vagina, and she is over it.

It is quick consult time, marym.

You know what to do.

The doctor will see you now.

Just through here to consort room one.

Thank you for waiting.

How can I help you today?

So Melissa said she wanted to be brave today and she wanted to ask this question because she didn't want other women to feel like they just have to put up with it too.

Yeah, so she wrote this.

I've gone to my GP numerous times in the past year to treat bacterial vaginosis and multiple cases of thrush.

I have had my cervical screening.

I do have an IED so I don't have a period, and I just use shower water to clean myself.

But what else can I be doing to prevent it from happening so frequently?

Frustrating cycles something I see fairly often.

You're absolutely doing the right things by seeing your GP and keeping up with your cervical screening.

Recurrent BV and thrush can be really annoying, so let's look at what might be going on.

First.

Good news is that you're spot on with the water only cleaning soap.

Even gentle ones can disrupt that vaginal pH and make things worse, So all those vaginal soaps please.

Stay clear of them.

And you're not alone in this.

BV recurrence is incredible common, so we know that more than fifty percent of woman experience post treatment recurrence in three to twelve months.

So don't feel like you're doing something wrong.

It is generally a challenging condition to manage.

So let's understand your risk factors and how we can approach them.

So, something interesting about your situation is thrush is more likely to affect women who have periods because of higher estrogen levels.

Since you have an iod, you no periods.

That might actually be protective, so that's great.

However, you can still get thrush as a side effect from antibiotic use, from health conditions which can cause immunosuppression like diabes, iron deficiency, immune disorders, or even volvle skin conditions like a Liken planets.

So they are things that I'd want to exclude with you as well.

For BV specifically, certain risk factors can increase your risk of having recurrent infections, and that includes having an IUD, though research shows that's more common in people with a copper ID as opposed to a hormonal iod that's an intrauterine device for our listeners.

Other risk factors include multiple or new sexual partners and also recent anybody use.

If you do have a regular partner, get him checked.

That's good, Yeah, giving it back to you, that's right.

Here's the really exciting part for BV, so we know that new data suggests that BV reinfection from partners is likely contributing to these high recurrence rates.

So bacteria can live in the male eurogenital tract without causing any symptoms to them, but they keep reinfecting female partners.

So partner treatment should definitely be offered to individuals in ongoing relationships.

So next step for our lovely listener, Lissa, is I suggest having a comprehensive chat with your GP about excluding any underlying causes that might be contributing.

As mentioned, this should also include discussing safe sex measures, potential partner treatment if appropriate, and lifestyle changes.

Other things to consider is avoiding perfumed soaps, bubble baths, centered tampons, webs on genital skin, fabric software on underwear for instance.

You might also benefit from some long term treatment strategies, so for people who have recurrent thrush or a current BV, we can put them on a longer course of treatment and if needed and we're not able to get on top of it, a specialist referral to a guyany or sexual health specialist should be considered.

You've mentioned something there and I would like to get your take on it.

Scented tampons.

Now, I have seen scented pads, and I've seen why we I mean, I don't know.

We're always told that there's a smell that we should be covering up, which like, honestly we don't have to.

But anyway, I've seen scented tampons.

I've seen scented pads.

I've also seen pads with probiotics in them, and I've seen mint pads that are supposed to be like refreshing.

Like where do you stand on us taking sanitary items sort of to this next sort of perfumed injected with other things level.

I just think it's not necessary and can also disrupt that vaginal pH barrier, can also contribuee dermatitis and skin conditions.

It's not really necessary.

So there's one of those menthol in it, and I feel like that would be Bernie.

But why It's just plain simple pads, playing simple tampons.

It's all unique and plain simple hygiene.

Yeah, that's all sim Yeah.

If you would like to ask doctor Mariam a question, there's a few ways you can do it.

Send us an email well at mamma mia dot com dot au.

You can hit us up in the DMS on Instagram.

I have great chats with people there, or you can do it anonymously if you like.

There's a link in our show notes to what we call the waiting Room.

It's an online form, so it takes a couple of extra steps, but it will get your question to us.

Thank you to everyone who's been doing so.

I've been really enjoying reading everyone's questions.

People have such great humor when it comes and I think this is where us women, when we're talking to each other about our health issues.

Where we are so funny.

Yeah, we are funny, like we just will like, oh god, here's another one.

A reminder though, that all of the information you've heard here today is general, including from our lovely doctor Marriam.

Yes she is a doctor, but she's not your doctor, which is the really important part.

So we're not meant to solve all your problems today.

We're arming you with information that you can take to your own doctor to try and figure out what your particular issue is.

So get yourself an appointment with your own healthcare professionals and sort everything out with them.

And before we head off, can we ask you a little bit of a favor If you rate and review us in your podcast apps, it actually really helps us out, like it helps us get into other people's ears and fight off these nasty algorithms.

Trinactly, people want to know about recurrent BB and thrush.

So if you wouldn't mind, just go rate and review us in your favorite podcast app, we'll see you here for your appointment next week.

We are talking about our relationship with Sun and how sometimes that relationship between Sun and Skin.

Is out to get us, so we will be talking about that.

We'll catch you then.

Bye Bye Well is produced by me Claire Murphy and our senior producer, Sally Best, with audio production by Scott Stronik, video production by Julian Rosario, and social production by Ellie Moore.

MoMA acknowledges the traditional owners of the land.

We've recorded this podcast on the Galligill people of the Urination and the Wannaroa people.

We pay our respects to their elders past and present, and extend that respect to all Aboriginal and Torrestrat islander cultures.