You're listening to Amma mea podcast.

We have a catch phrase at Melanoma Institute Australia and that is a nother skin you're in, and that is true for melanoma and other skin cancers.

So not all melanomas look like a mole.

Not all of them have color and pigment.

But certainly if you see a mole that's changing rapidly, asymmetric borders, mixed colors in it, itchy, evolving, then you need to get that checked out.

Well, hi there, azie, women, welcome to your full body health check.

I'm Claire Murphy.

And I'm doctor Marriam.

Today is all about Australia's a fun relationship with the sun.

It's so much a part of our identity.

If you ask anyone from anywhere else in the world what they think Australians are, and they think of them as these kind of white people with blonde hair who exist only at the beat and who surf.

That's not true.

Whereas some of us can't go out into the sun even for a minute because the thing is us fair folk are more prone to getting sun burnt, and the UV radiation from the sun is not anyone's friend.

And so that is why today we are talking about skin cancer.

We're also going to check in with Sarah.

Sarah's got a very tense issue with her vagina, which is getting in the way of things like managing her period, her sex life.

She's very stressed by it or so she's asking for your help with that.

But next, Mariam, we're going to pay our respects to some women whose bodies and lives were literally put on the line in the name of women's health.

Let's go to med school.

Welcome to med school.

Now, Mariam.

We know throughout history women have been contributing to medical research, even if they didn't get the recognition that they deserved, or sometimes not even the treatment they should have at the time.

There is a lot being said now about how under a searched women are, and we are working to address that.

But there are some women that we would like to pay our respects to today.

So you have probably heard about doctor Papa Nicolau's wife.

Her name is Mary.

She was a lab technician in Greece and who over twenty one years had daily perhaps mears in order to help further her husband's research far out.

Yes, now, that is why it's named after doctor Papa Nicolau.

It's called a Papsmere, but it's not named for her, and she did not get a lot of recognition for the fact that she put her body on the line to help us end things like cervical cancer.

There are thousands of stories like Mary's throughout history.

Some are actually worse than that.

So let's talk about for example, Anarka Westcott.

She was a biracial slave in Alabama in the mid eighteen hundreds.

She suffered from fistulas, which.

Are the openings and connections.

Yes, so from your vaginity rectum or to your bladder.

Yeah, this can happen in things like traumatic childbirth.

They can open up between your vagina and areas that shouldn't be Yeah, open.

Up to conditions like endo as well.

Yeah, exactly.

So she underwent experimental surgeries to help fix them without anesthesia.

What the doctor who did those procedures would learn would go on to benefit so many women, mostly white women, who were his actual patients.

So while she is known as the mother of modern gynecology, she did not have the right to refuse.

But what she did by putting her body on the line has helped all of us to this day.

And there are a ton of women whose work has been overlooked as well, in something that's called the Matilda effect.

So Rosalind Franklin, for example, the British chemist and X ray crystallographer whose work helped us understand how DNA functions the molecular structure of it.

So her work was overlooked when three male scientists discover the double helix, so the structure of DNA, and they won a Nobel Prize for that, but it was on her work that their research was able to be in the first place, but she wasn't credited for that.

Nettie Stevens, who co discovered the xx xy chromosomes, which determines the sex of a lot of different species, she got no recognition for her work either.

Alice Ball is an African American chemist.

She discovered the treatment for leprosy and how to make it work.

A man published her work after she died and claimed it as his own.

So today for med School, we just wanted to do a bit of a shout out to all of the women past and present who are working hard to make women's health a better place, and the stories we don't even know about, and those we haven't mentioned here today.

We know women have worked in this space.

We know women have put their bodies on the line for us to learn what we know today about the conditions that we are still struggling to fully understand.

So just wanted to say a shout out to all of those women who have done that in the past, who are still doing that today.

And if someone else is trying to take credit for your work, you come talk to mar him and I.

We'll fight them for you, don't you.

Yeah, these women save the way for all of us and we owe them everything.

Yes, So if this is still happening, tell Clara and I we've got you back.

Yeah, all right, med school done, Let's talk about sun's safety.

It's time for today's checkup.

It's time for the checkup.

If you grew up here in Australia in the eighties and nineties, you're probably very aware of the old slip slop slap sid the seagull say that five times without stuff and it add from the eighties.

If you're not listen to.

This slop slip barner, shirt, clap on sunscreen and slab barna hat.

So that message of slip slop slap, which is slip on a shirt, slop on sunscreen, and slap on a hat was extended in the early two thousands to include seek and slide yep, which was seek shade and slide on your slenties, and that has had an impact on all of us, like we know what sun safety is, we know why we do it.

But despite the messaging, Australia still has one of the highest rates of skin cancer in the world, accounting for around eighty percent of all newly diagnosed cancers in Australia every year.

The majority of those are due to our sun exposure, so here our rates of skin cancer are two to three times those of countries like Canada and the US.

The survival rate for melanoma when it is caught early enough, is really high and better for women than men.

It's ninety two point nine percent compared to ninety five point eight percent.

Caught early enough, the survival rate is almost one hundred percent.

But we don't always catch it early enough.

And the problem with melanoma, which we'll discuss with doctor Long in a little while's time, is its love of spreading, so we'll talk about that.

But that messaging slipstop slab has seen melanoma rates in under forties here in Australia decline.

The no play policy at school has actually helped us understand even earlier about Sun's safety.

Can I add something to that?

This is off topic.

In my primary school we had the Nohart no play police, but then we also had a no tub, no play policy.

So on top of our hats, we had to we had to wear ice cream tubs because we had all these magpies I would come and attack us, so we had to we had to make this makeshift ice cream tubs with like this elastic.

So you were wearing your Sun's safety hat with an ice cream container over the top with spikes on it or something or just like it.

Was just it was just the tub just for an extra air of protection.

So like diy helmet.

Essentially, I grew up pre no hat, no play policy.

Yeah, And it's funny how much we have changed our ideas on what some safety is.

Because there is a photograph of me, I must be about three, a photograph if you're New South Wales and I've got big blisters on my face And I said to my mama what was going on there?

And she goes, oh, you got really something.

We talked you to the beach more there for hours, but they didn't even think about it.

They didn't understand fully how much that was damaging me.

Mariam, I do need to ask you a question.

Are you a Moley girl?

You know what?

I am?

A Molly girl.

I can see and the odd in all the odd places.

I was just telling Claire, I've got one on my laby.

Yeah, yeah, so my moles actually make me a little bit more vigilant about my skin checks than I otherwise might be.

But yeah, whether you've got one or twenty, skin checks are crucial.

Yeah, and we'll talk about that a bit more with dropped along too, about what to look out for.

I found sometimes hard to explain to your GP when you go in about the skin changes.

What do you want us to tell you when we go in with weird.

Sure, it's hard to articulate skin changes completely agreat, especially when you're trying to remember what they look like weeks prior.

This is where photos are your best friends.

So seriously take photos of all the ones that you have at the moment as they are, and date it so those photos are going to be so helpful.

Some of my colleagues here at Muma Me have been taking that very much to heart.

So am Vernon, who works on some of her other podcasts.

She has a stye and she was showing me the other day like she's been taking photos and putting like the date on it.

Social Winsy goes back to a gps'll go, this.

Is what like on Thursday, what it looks like today, and you remove the language of pussy red.

I don't know, and it takes all the guesswork out of I think it's changed as well, because you'll take a photo three months down the track and you can see you can see the change.

We have as doctors an ABCDE rule for moles, so it gives you language to describe what's concerning you.

So a's for asymmetry, so where one half looks different to the other side.

B's for border, that's the edges have become irregular or blurred.

C's for color.

It's got new colors, darker bits, red bits or red areas, or it's lost its color.

D's for diameter it's bigger than a pencil raiser, for instance, or it's grown e evolving, so it just different from before.

It's more rays or whatnot.

There's other helpful descriptions like it bleeds when I barely touch it, or when something comes into contact with it.

It's raised up like before it was flat.

It's crusting or scabbing but not healing.

It's itchy, 're painful, but it never was before.

Or my partner or family noticed it and said something.

That's a big one as well, especially for moles and lesions that you can't see.

That's something my friends pointed out to me.

I was on FaceTime with them and I've got what looks like a mole on my eyelid yep, And they were like, hey, hey, what's that thing on your eye?

You should go get that chet And I did, and don't worry, it's not a melanoma.

My doctor said, that's just aging.

So fun time.

Well, you know what, that's a good result, to have best results.

Yeah, but you'd be surprised how many melanomas are picked up because someone has said something, especially for ones we can't see or haven't noticed.

Even if it just doesn't feel right, whether you don't have the language or the pictures, that's fine.

Just go the doctor.

We'll see it.

And I'd rather you not avoid the doctor because you don't have the language.

But photos will be your best friend here.

Okay, take a few snaps, monitor it.

Yeah, when do you go next level with something like a mole that might be changing shape or something.

What does that process look like when you need to escalate it.

Yeah, So when I refer for moles, so any suspicious features where I'm like, oh, if it ticks any of the ABCD boxes, it's going to get referred.

It's grown bigger than six millimeters, or it's just evolved in any suspicious way, new moles in adults, new pigmented lesions that don't look normal and need expert assessment.

I will refer if there's patient or family concern.

That's a big one where I've picked up melanomas like mums said this wasn't here before, or mums really concerned high risk patients, So family history of melanomama, lots of moles, fair skin, previous skin cancers, or significant sun damage history, and they come in with an evolving mole, that's going to be a priority for referral.

And if there's uncertainty my diagnosis as well, if I can't confidently say this is a benign mole, then off you go.

But for more complex cases a referral to a plastic surgeon or a dermatologist might be needed.

And those referral types they could be urgent for suspected melanomas that's generally within two weeks, semi urgent where it's suspicious, but there's less concerning features or routine and that's just monitoring for high risk patients where they have regular skin checks.

The beauty is we've got options, whether it's an experienced GP for straightforward cases or a specialist when needed.

All right, Next we are speaking to doctor Georgina Long to ask some questions about skin cancer, including and this is something I've always wanted to know the answer to being a very fair person.

Are you at lower risk for melanomas if you have brown or black skin?

Doctor Georgina Long is the medical director of the Melanoma Institute Australia.

She is a specialist in medical oncology, in particular drug development and therapies, and she also knows a hell of a lot about skin cancer.

We started off at chat with her by getting the low down on the main types of skin cancer.

I know there's three different basic types of skin cancer.

Can you give us a quick rundown on the differences between the three.

So there are many types of skin cancer, but the three main types are basal cell, squamous cell, and melanoma.

Melanoma is the deadliest of all three and the least common out of those three.

Having said that melanoma is austraight as cancer, we have the highest incidence of melanoma in the world.

We also have a very high incidence of basal cell and squamous cell.

They differ because they are a cancer in the different cells of the skin.

Our skin is made up of many different types of cells.

The melanocytes give us pigment, and when they become cancer are melanoma caratenous sytes.

They are a normal part of the skin architecture.

We have three layers to our skin, the top epidermis layer, the dermal layer, and then we have the hypodermis the fat underneath our skin.

There are three big layers.

Caratenous sites are where squamous cell comes from, and then we have the basil cells.

And so if they get cancer or develop mutations that result in cancer, that's a basal cell carcinoma.

What do I mean by cancer?

I mean uncontrolled growth.

So that is what happens.

The cell gets mutations and then has uncontrolled growth.

So the most common is basil cell and squamos cell, and melanoma is the least common, but melanoma is the dead list.

Why because melanoma cancer cells tend to have a proclivity or desire to spread, so it gets into the bloodstream and spreads around the body, can hit the brain, the bone, the liver, the lungs and that stage four melanoma, and that kills people.

With the other two the squame cell and the basil cell, they eventually spread.

Is that that they can spread, they just don't do it as quickly.

That's a really important point.

They can spread, they tend not to spread.

Basil cell has the lowest proclivity to spread, and squamous cell can spread, but not that frequently.

So those two cancers are the most common cancers in Australia, yet they don't kill as many as melanoma historically used to kill because they don't spread as much as frequently, but cutaneous squamous cell can spread.

In fact, the numbers of people dying now from spread of cutaneous squamous cell is starting to match melanoma debths because we've got so good with the drugs.

That's where I hang out that the pay down.

Down right, So they're meeting in the middle squad of not yet.

Not yet, but yes, they're getting there.

Do we use the same more similar treatments for the different types of care and at the different stages.

We're starting to the main stay of treatment in general for stage one, two, and three is surgery and then you may add on other treatments as needed.

And that's for all of those skin cancers in general.

Be because the common ones basal cell and squamous cell don't tend to spread.

They are very much surgically managed because they don't have that same proclivity.

And the good news is you're cured often with those two skin cancers simply with surgery.

We use a lot more drug therapies in melanoma because it likes to spread.

So now even in early melanoma, we're using drug upfront, so even before the surgery to remove that first melanoma on the skin to stop it from spreading.

Can I ask you about skin color and skin cancer, because there is a well discussed fact that people with darker s geared that their risk is cancer is incredibly low, if not nonexistent.

Then Australia is such a broad variety of skin tones.

We know that very white people very prone to skin cancer, but what does that look like as you get darker.

Another really important thing to keep in mind.

If you have skin of any color, of any type, you are at risk of skin cancer.

It is the largest organ in our body, our skin.

However, you're correct and people are correct that the risk is highest in those who are the most fair, and the risk is lowest in those who are more dark.

However, it does not mean that they can't get skin cancer.

It's difficult to give you a precise risk because even amongst very fair people, the risk differs based on a little bit of their genetics and family history and exposure to sun.

And some people are more sensitive to sun, not in terms of sun burmb which their genes, their genetics are more sensitive to sun.

You're very at risk if you're fair.

But if you have another sort of genetic abnormality or mismatch repair, or you don't repair things as well as others, you're then even higher risk.

Our greatest predictor in the easiest thing to look at is the color of your skin.

The more fair you are the higher risk.

The dark you are less risk, but you still can get it.

So aside from the sun and genetics, are there other things that increase your risk for skin cancer.

Radiation exposure can increase your risk for skin cancer, drug therapies, so immune suppressants can increase your risk of skin cancer.

When you say radiation exposure, do you mean like how many X rays you might have had in your lifetime with that increase your risk of skin cancer.

X rays not so much, but we know, for example, pilots and it's probably unfiltered UV and immunosuppressance is a big one for people who have diseases where they require So if you've had a transplant, kidney transplant, lung transplant, liver transplant, you're on heavy doses of immunosuppression.

If you're young and haven't had any UV exposure, let's say you're a little baby, then you probably wouldn't get a skin cancers.

It's more the UV you've had in the past, and then the immunosuppression, and then the other thing is sun beds and solariums.

All of those they increase your risk.

And in fact, anyone who's had more than ten sessions on a sun bed at less than age of forty has seven times the risk of skin cancer.

And does that matter that you've stopped using them at some stage and it's been years.

That's a great question to reassure people, because one other thing is people think, oh, oh, it's all done, I'm finished, so I can't do anything about it.

Now I'm fifty, I'm forty five.

What do I do now?

Good news, you get some safe at any age, and you will decrease your risk of skin cancers.

So if you've had more than ten less than forty, it does matter.

You are at higher risk than if you hadn't had them.

But the good news is that if you stay out of the sun and stay sunsafe as an older person, your risk of skin cancer drops.

It's like smoking.

If you smoke until you're thirty, you're at risk of lung cancer, but when you stop.

The years you stop, they decrease your risk.

Can we focus in on melanoma for a moment, because obviously there was a lot of education campaigns going around for many years about how to spot a melanoma.

But we're all told there's a kid to look at your moles, and if they start to stop being a circular shape, or if they start to grow beyond a certain size, is that still the case of the motivation to go and get it checked by a GPS.

If that mole increases in size at all or becomes a funny shape, is that what we still know to be true.

Yes, we still know that to be true.

We know more as well.

We have a catch phrase at Melanoma Institute Australia and that is a nother skin you in And that is true for melanoma and other skin cancers.

So not all melanomas look like a mole, though not all of them have color and pigment.

That's what we call pigment like a mole.

But certainly if you see a mole that's changing rapidly, asymmetric borders, mixed colors in it, itchy, evolving, then you need to get that checked out.

They are still really important parts of it.

So that's the ABCD for a symmetry, border, color, diameter and evolving changing they're the really important facts.

But at the same time, if you have something that doesn't look like a mole but looks a bit like a pimple, maybe or no maybe not, but it's changing and growing and not going away.

That needs to be checked out too, because sometimes melanomas don't look like moles and other skin cancers can look like that.

So basil cell carcinoma or squamous cell carcinoma often don't have pigments, but they're evolving and changing.

They don't go So the general principle is anything that's not going away and is changing, get it checked out.

I would like to then ask you about who to go and see when you do notice something has changed, should you first of all seek out a GP who might be a specialist in skin for your first initial visit.

I've noticed a lot of skin clinics have popped up around Australia in recent years.

Are they a good first port of call to go and see?

Who would you suggest to go and speak to?

So a skin clinic is a GP clinic.

They're gps who have done extra courses in looking at skin.

Then we've got gps with skin expertise, and they operate in two ways.

They may operate within their practice or they may have joined a skin cancer clinic, but they're essentially very similar.

So if you have a skin lesion and at your GP's practice.

They have a GP who has a special interest in skin see them.

If you go to a skin cancer clinic, they're similar training to the GP in the practice who has the skin cancer knowledge.

What do you want to see as a patient when someone who's going to get you down to nothing just your undies.

This is for a skin check.

If you see something, and then they check your skin all over, check between your fingers, between your toes, your palms, and your souls.

Even though they're rare places to get melanoma, and down to your undies.

Basically it can be actually very rapid.

They'll make you a lift up a boob just to make sure there's nothing underneath exactly.

And if your hairdresser find something, get it checked out, so checking the hair as well, and the scalp that's really important, behind the ears, etc.

A dermatologist can do a skin check in less than ten minutes.

Now we're talking the next level up.

So you've got your GPS, you've got your GPS with skin training, and then you've got a dermatologist.

Someone who knows what they're doing.

Will have a dormoscope and.

That's a little microscopy thing they'll put directly on your skin.

That's it.

That's it.

Do you think skin check should start to become part of the yearly roundup or the five yearly round ups of things that we do, you know with cervical screening and then after fifty the bow cancer at home testing kid or going to get a mammogram.

So we're now in the midst of launching a roadmap to skin screening and that's with some government funding we got last year as a strain of the year.

And what we're finding and we have evidence they've done this in Germany, is you do a skin check on every person in the country, you're not going to save lives.

A lot of people detect their own melanoma or skin cancer and get it treated that way.

It all depends your risk of developing it.

So the higher your risk of getting that disease, the more likely screening or having a skin check is going to save your life from that.

So maybe, like the people who have a history of bow cancer will go in for regular colonoscopies.

For example, if you have people in your life who've had melanoma and you happen to be fas skinned, then maybe you should be one who gets.

Screened correct, got correct.

The truth is, if your risk is low of skin cancer, you're going to pick it up when you see a change faster and sooner than getting a once a year skin check.

That's how it happens.

The other thing is the melanomas that kill the really bad ones.

By the time the person's found it on their skin, scarily, it's probably already bolted.

You need to know the skin you're in.

I think that's the best message.

If you're at high risk, there may be a role for regular skin checks, and certainly that's true for my patient who've already had melanoma.

They have regular skin checks because they're at very high risk of second new home melanomas.

To Jenny, you mentioned this at the start of our conversation that Australia is leading the way of the world where it comes to rates of skin cancer.

Why is that?

Is it the fact that we have a large number of fair people living in a country that is very, very sunny.

Preserving the hole in the ozone layer is no longer a thing.

But what is it about our sun in particular that's causing us to have such high rates of skin cancer?

So you hit the nail on the head.

It is because we have a large number of fair people and we have a lot of sun, and so there are weather patterns about cloud cover, et cetera.

Our sun produces UV and it's the ultraviolet radiation which causes skin cancer, and so sometimes cloud cover and other things can augment that risk a little bit.

But it's also the tilt of the earth where Australia sits, it gets a lot of UV.

The ozone.

You're right, it's not a thing anymore, so we don't have to worry about that.

But the way the Earth is positioned and our weather patterns, cloud cover and the UV exposure.

But you work correct.

It's because we're got a lot of fair people and we've got a lot of UV.

And the most commonplace to get basal cell carcinoma and squamous cell castinoma, which are the most common skin cancers.

They cost our health system two point eight billion dollars a year and they're often on the head and neck.

Melanoma is again caused by the sun, but it's got a less of a direct relationship, so it's multifactorial, like I was saying before, So the common places for melanoma for women are on the calves for instance, men on the trunk and those patterns are starting to change a little bit, and also head a neck for men and scalp as well.

Well.

I was going to ask you there's been a social media trend in the last year or two of girls showing off their handlines from being out in z and I mean like very distinct hand lines.

How much damage does that do to young ossie girls in particular.

Massive, massive, massive.

It's bad for their skin cancer and even if you're dark, risk of skin cancer as we were discussing before, but also aging.

So there are many ways to target and get the message across.

The problem is in my clinic, I see people dive melanoma.

Although we're doing a great job, and I have been part of that journey with my colleagues around the world developing drug treatments.

I've lived that hope with my patients.

I've seen them go from dying to living basically over my whole career, we still have fifty percent of patients dying from melanoma and dying badly, meaning quickly, and people who are young are dying from melanoma.

So anyway we can try and get that across about sun's safety can save lives, would be worth it.

The other thing this brings up is where are we with facts?

Where are we with social media and looking for truth?

And can we say too you and you mentioned the calariums earlier.

Some of the facts I've been seeing about them is that they are safer than solariums because they're builders collagen boosting.

But that's not true, right.

No, because collagen doesn't have color in it.

If you're going brown, that's melanosites.

Collagen does not protect you from skin cancer, so it's rubbish.

And if your skin's going dark, you are at risk of skin cancer full stop.

And I also mentioned this a couple of weeks ago that we did speak to dermatologists doctor Karen McDonald, who spoke to us about anti aging, about the concerns we've been having about sunscreen in recent years, and this is what she had to say about that.

We're seeing headlines about sunscreens not actually being the SPF that they supposedly are on the bottle, and then there's all this conspiracy that sunscreen causes cancer, and there's a very anti sunscreen movement at the moment.

How do we navigate sunscreen through all that.

It is so complicated at the moment, And of course it's just really difficult in my position because I see every single day skin cancers on sun exposed areas.

I do a lot of skin cancer work, and every patient I see, their skin cancer is ninety nine percent of the time on an area that has excess sun exposure.

And you can see the difference in their skin right.

You can see that their face and arms are severely photo damaged compared to their trunk, which is white, healthy looking skin.

And they get the skin cancers on the areas where they've had the sun exposure.

And these are not people who have been wearing sunscreen their whole life, so we can't blame the sunscreen for their skin cancers.

So there's very good evidence in the literature over the last twenty thirty forty years that sunscreen reduces our rate of skin cancer.

Now that doesn't mean that sunscreen has no issues, okay, but we know that when it comes down to risk benefits, there is certainly a benefit in sunscreen for skin cancer.

Every individual needs to weigh up what's right for them.

There's really no strong evidence that sunscreens are toxic.

Sunscreens are designed to really stay in the outer layers of the skin and not be absorbed into the body.

But I understand everybody has their own opinion and concerns, so it's about looking at your health risks and making the decisions that are right for you about sun exposure versus sunscreen, and choosing the best sun protection you can for your skin, your environment and your preferences.

There are other ways, of course to protect yourself from the sun, avoidance, shade and so on, but we know sunscreen is the most effective and if you have one little bit of worrying about anti aging, then you're just shooting yourself in the foot if you're doing other things and not putting sunscreen on.

With regards to the SPF factor, and can we rely on that, it's difficult.

I think the general public should be reassured that the vast majority of sunscreens offer very high protection against UV damage and UV light, and that despite the recent media coverage, we are still getting excellent sunscreens in Australia, and that any sun protection is going to be vastly better in terms of long term skin health than not using any at all.

It can be difficult to know exactly where to turn to.

And it may be harder to find a sunscreen that you like the fear of if it's a physical blocker at very high SBF, because they can be a little heavier on the skin.

But I think the vast majority are very high protection either way, and that you should really look for a sunscreen that you're happy to wear every day.

So, although we know that any sunscreen offers more protection than none, and the higher the SBF you have, the higher the protection you're likely to be getting.

The Cancer Council does recommend SBF fifty plus broad spectrum sunscreen for best protection, so you're always best off starting there, but knowing that you are going to have good protection if you are wearing a sunscreen either way, so it's less important to panic so much about whether it was SBF fifty or thirty.

It's more important to use something.

But of course we would like to know that our sunscreens are reliable, and hopefully the authorities will take control over that and make it a little bit more reassuring for the consumer in the near future.

The Cancer Councel does recommend you go SPF fifty and above, but some SPF is better than no SPS no that's right, is what she's saying.

Just make sure you do actually SPF every day.

Your skin will thank you.

The daily habit is honestly one of the most powerful things that you can do for both cancer prevention and keeping your skin looking good as you age.

And I have to add my little GP disclaim.

Of course we still recommend regular skin checks even with perfect some protection, especially here in Australia where our UV is so intense.

But you're absolutely right that daily sunscreen use.

Having those habits dramatically will reduce your risks.

So the key message just spf it every day.

Make it as automatic as brushing your teeth, all.

Right, So go slip, slop, slap, seek and slide.

Yeah, all the guys still ESA's please look after yourself.

On the way, it is quick consult time.

Sarah is having a really stressful time with her vagina and she needs some help to get it.

Just to chill out, Let's get this patient into your rooms already, marry him.

The doctor will see you now.

Just through here to consort Room one.

Thank you for waiting, Sarah.

How can I help you?

So?

Our friend Sarah contacted us with an issue she's having with her vagina not being very cooperative.

She wrote, I have been diagnosed with vaginismus and I feel helpless and just don't know where to start.

It's impacting my relationship because the sex is really painful and I just want to be normal again.

But it's so overwhelming that the course to resolve it is mental and not physical, like there's no pill to cure it, and I just don't know what to do anymore.

I'm going to spend a lot of time on this response just because I don't think vaginismus gets the spotlight it deserves, and there are a lot of females that are suffered in silence, so I'm hoping my response can help a lot of females.

Yeah, we would be good to know what vagina.

So let's start with number one.

Sarah.

I'm really sorry that you're going through this, and vaginismus is a real and genuinely distressing condition, and I want you to know from the outset that it's not all in your head.

While treatment often involves addressing the psychological and emotional factors, the pain you're experiencing is very real, the muscle response is real, and most importantly, you're not broken and this condition is very treatable, although unfortunately there is no quick fixed pill.

So for our listeners and for you, Claire, So who might not be familiar.

I know someone who has it, but I don't know exactly what it is.

So.

Vaginismus is when the vaginal muscles automatically contract tightly.

It's usually triggered by any touch to the volver or vaginal opening.

It can happen before sex, when trying to insert a tampon, or during a pelvic examination.

It's your body's automatic protective response to fear of paw pnetration, causing pain, discomfort, and sometimes making sexual penetration impossible.

Okay, So it's fight or flight for the vagina.

It's essentially clanching.

Okay.

So there's no single cause and researchers don't exactly know why it develops, but we do know that physical and psychological factors can be involved.

So things like recurrent UTI's yet infections, endo, trauma during childbirth, previous painful pelvic exams, uncomfortable sexual experiences, sexual assaults, fear of pregnancy, or simply fear that penetration is going to hurt.

And it's crucial to understand that many women are wrongly told this problem is in their head, when actually the issue is very much physical.

It's about the pelvic muscle response that has become automatic.

So where to start?

I always say number one, validation.

Validation is everything.

There's nothing like being told you're not crazy.

You're not crazy and it's not in your head.

So understanding that this is a real, treatable medical condition is so important.

It's not just about relaxing or trying harder.

I've had patients tell me that some doctors have said, just, you know, have a wine or two before having sex just to relax, which is so dismissive.

Also using alcohol to treat any.

No, So we know vaginismus is a learned automatic reflex, whether the vaginal muscles tightened into that response of fear of penetration or anticipation of pain.

But like any reflex, it can be retrained, but it's going to take time, patience, and the right support.

So building your support team is crucial, and you're going to need a team.

This isn't just a doctor patient approach.

Treatment works best when you have the right people in your corner.

So number one, you're going to need a woman's health or a sexual health doctor who truly understands vaginismus and pelvic pain and can coordinate your care.

You're going to need a woman's health pelvic floor physio who will work gently and at your own pace to help retrain those pelvic muscles and reduce that reflexive tightening.

They'll often use guided muscle relaxation.

There's these bio feedback techniques, and they'll teach you how to gradually use dilators, which is a big part of the treatment process.

A psychologist or a sex therapist who's experienced with sexual pain or trauma to support the emotional side and address any anxiety, fear, or past trauma, and also understanding that you're not alone.

So many women experience this, but they don't talk about it openly.

I did a post about it on my Instagram page.

My dms were flooded with so many females asking do you have any suggestions on who I should see.

I've had this for the last ten years, and to think that you've had females like experiencing this for like a decade and just the silence around sexual pain can make it feel incredibly isolating.

I mean, if you think about it too.

The issues that we have that are very physical and can be seen and experienced, even they have been sometimes overlooked.

So if you've got something like that genismus, where there is a psychological element to it, it's easy to kind of go, well.

Yeah, and invalidate that again, invalidate it.

Yeah.

I want many women who are listening that have this condition to know that I have had many patients fully recover and go on to have comfortable, fulfilling sex lives with the right support and a gentle approach that onors both your body and emotions.

I also want to say something that's really crucial.

Partner support matters.

Okay, So where possible partner support can help rebuild that intimacy and take that pressure off.

Non penetrative intimacy is really important.

Open communication is important, and emotional support are key parts of healing.

So having a partner who's not on board and is quite pushy for intimacy that involves penetration is really going to delay that healing process.

So speaking to the psychologist or sex therapists and having them as part of your management is really really important.

Self care practices like mindfulness, relaxation, exercises and learning to pace yourself can really help reduce that anxiety and muscle tension as well.

My advice would be to take the pressure off completely.

I'd suggest removing the goal of penetration entirely for now, focus on rebuilding connection, trust, and intimacy without any pressure through touch, massage or non penetrative intimacy.

So that's something you and I have laughed about.

Yeah, And it's when your partner is like, oh, I'm coming for you and you're like, oh, good, like you've already.

Got these kind of cheapest creepers.

It's not that you don't love them or want to be intimate with them, but we sometimes have automatically kind of gone, I'm just not ready for this yet.

And sometimes you don't voice that because you don't want to hurt the other person's feelings by telling them no or rejecting them.

But at the same time, for your own well being, sometimes you have to put up some really good boundaries.

And this is where we say sex starts before the bedroom right now.

That intimacy and physical connection and emotional side is very important, especially for patients with VIRGINISMUS.

So for our lovely Sarah here I would start by finding a GP or a sexual health physician who has a lot of experience with virginismus, have a conversation, let them coordinate your care, and let's get you on the road to recovery.

You can do it, Sarah, thank you so much for sharing that.

This is a real eye opener for people like me who've surface level known about vaginismus.

But I think it's really important that you feel comfortable and safe coming to us and asking that question.

So thank you for hanging out with us today.

And remember, general advice is good advice.

Doctor Marriam here gives it amazing advice.

We absolutely love that she does, but it's not specifically for you.

So take what you've learned here today and get yourself off to your GP.

Have the conversations, let them know what you think is happening to you so you can get the right treatment underway for yourself.

Next week, we're catching up with Carl Finlay, and award winning writer, speaker, and self described appearance activist who's done incredible work in disability advocacy.

Those of you who know Carli may know she lives with a rare and very severe genetic condition called ichthiosis, which makes her skin red, scaly and painful.

But instead of hiding, Carly's built an incredible platform.

We're going to be talking about what it's like to live with a skin condition that very few people understand, and how she's working to challenge all of our ideas about beauty and disability.

You don't want to miss it, and if you haven't already, tuned into our exclusive episode with Tammy Hembro where we hear her first ever detailed discussion about her melanoma diagnosis.

Have a great day, Stay well.

We'll see you for your appointment next week.

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

Mamma Mia acknowledges the traditional owners of the land.

We've recorded this podcast on the Galligall people of the Urination and the Wonnarooa people.

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