Episode 258: Vaginal Botox for Painful Sex: When Your Pelvic Floor Won't Relax — with Dr. Chailee Moss

Episode 258: Vaginal Botox for Painful Sex: When Your Pelvic Floor Won't Relax — with Dr. Chailee Moss

She's been told to have a glass of wine. To just relax. That the pain is in her head. And she is still in pain — every time she has sex, every time she uses a tampon, sometimes just sitting at her desk. What she may have is a hypertonic pelvic floor: muscles stuck in a state of tension they cannot release on their own. In this episode, Dr. Carolyn Moyers sits down with Dr. Chailee Moss, board-certified OB/GYN at the Centers for Vulvovaginal Disorders in Washington, DC, and one of the country's leading experts in sexual pain — to talk about a treatment most women have never been offered: vaginal Botox. In this episode: • What a hypertonic pelvic floor actually is — and why it is so often missed • Why painful sex in midlife is not always "just hormones" • Who is a candidate for vaginal Botox, and what has to be tried first • What the procedure is really like: units, timeline, results, and side effects • Whether pelvic floor physical therapy is still necessary alongside Botox • Dr. Moss's current clinical study on incobotulinumtoxinA for pelvic floor dysfunction • Her published JAMA research on medical gaslighting in vulvovaginal care If sex hurts, tampons hurt, or exams hurt — and no one has been able to tell you why — this episode is for you. 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] 🔗Connect with Dr. Moss 📸 Instagram: @drchaileemoss 🎥Podcast: https://podcasts.apple.com/us/podcast/vulva-talk/id1800293848?l=vi 🌐 Website: https://vulvodynia.com/ [https://vulvodynia.com/] Study refererenced: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711?__cf_chl_f_tk=OLsdlLvt_yGlGELQw_cAXUG3OvtyeWEIHUOmORJNnKg-1783169445-1.0.1.1-pul.JSpT5O0ZhZ3a2S4.ewkDiByn6Lwj3LUpBR3DIng [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711?__cf_chl_f_tk=OLsdlLvt_yGlGELQw_cAXUG3OvtyeWEIHUOmORJNnKg-1783169445-1.0.1.1-pul.JSpT5O0ZhZ3a2S4.ewkDiByn6Lwj3LUpBR3DIng]

Episode 257: Estrogen, Your Brain, and Alzheimer's Risk: What Lifetime Hormone Exposure Actually Does

What does your hormone history — birth control in your twenties, hormone therapy at menopause, or even the age you went through menopause — actually do to your brain? A landmark 2026 brain imaging study gives us a structural answer. Published in NeuroImage (Honea, Watts et al., 2026), this secondary analysis from the IGNITE trial scanned 459 women ages 65 to 80 using high-resolution MRI and measured gray matter volume and cortical thickness — two markers directly tied to brain aging and Alzheimer's disease risk. The paper is open access, meaning anyone can read the full text for free. Link below. Key findings: Women who had used hormonal birth control had significantly larger gray matter volume in the temporal lobe, inferior frontal gyrus, and parahippocampal gyrus. The longer the duration, the larger the fusiform gyrus volume. Women who used menopausal hormone therapy had larger volumes in the cuneus, precuneus, inferior temporal cortex, and inferior parietal cortex, plus thicker cortex in the middle temporal region. Women who used both showed the strongest structural brain picture of all. Later natural menopause onset was associated with greater cortical thickness across multiple regions. Dr. Moyers covers: What gray matter volume and cortical thickness tell us about brain aging and why they matter for Alzheimer's risk, which specific brain regions were affected and why their anatomy is relevant, how this connects to Dr. Lisa Mosconi's work on exercise and dementia risk (Episode 185), what the Critical Window Hypothesis says and where this study lands, the real limitations of this research, and what it means for hormone decisions today. Study: Honea RA, Watts A, et al. NeuroImage. 2026;334:121974. doi:10.1016/j.neuroimage.2026.121974 (Open access — free to read) Episode 185: What's the Brain Got to Do with Menopause? - https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000662974536 [https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000662974536 ] 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] #menopause #hormonetherapy #brainhealth #alzheimersprevention #womenover50 #skywomenshealth #estrogenmatters

Episode 256: Misdiagnosed for Years: Lichen Sclerosus & Lichen Planus with Dr. Jill Krapf

Burning. Itching. Tearing during sex. Told it's "just dryness" or "just menopause" — but the treatment never works. It might be lichen sclerosus or lichen planus — two skin conditions that affect the vulva and are diagnosed late (often years late) because they get mistaken for recurrent yeast infections or normal aging. In this episode, I sit down with Dr. Jill Krapf of the Center for Vulvovaginal Disorders to talk about: 🔹 How to tell LS and LP apart from "just" dryness or yeast 🔹 Why untreated lichen sclerosus carries a real (small) cancer risk 🔹 What effective treatment actually looks like 🔹 When surgery or further intervention becomes part of the picture 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] 🔗About Dr. Jill Krapf: Dr. Jill Krapf is a board-certified OB/GYN and founder of the Center for Vulvovaginal Disorders, specializing in the diagnosis and treatment of complex vulvar and vaginal conditions, including lichen sclerosus, lichen planus, and pelvic pain disorders. 📸 Instagram: @jillkrapfmd 🌐 Website: https://jillkrapfmd.com/ [https://jillkrapfmd.com/]

Episode 255: Your UTIs Might Not Be UTIs — What Your Bladder, Your Vestibule, and Your Hormones Have in Common

If you've ever had urinary symptoms that antibiotics didn't fix — and your cultures kept coming back negative — this episode is for you. A new 2026 study in the Journal of Sexual Medicine followed 253 women with recurrent UTIs and persistent urogenital symptoms despite negative urine cultures. What researchers found reframes everything: 85% of these women had hormonally mediated vestibulodynia, 75% had pelvic floor hypertonicity, and only 15% had a classic urologic cause for their symptoms. This isn't a bladder problem. It's a hormone problem — and the vulvar vestibule, urethra, and bladder are one integrated, estrogen- and androgen-responsive system. Whether it presents as genitourinary syndrome of menopause (GSM) in a postmenopausal woman or hormonally mediated vestibulodynia in a younger one, the tissue-level pathophysiology is the same. In this episode, Dr. Carolyn Moyers breaks down: • Why persistent urinary symptoms after negative cultures have a hormonal explanation • The shared embryologic origin of the vestibule, urethra, and bladder trigone — and why it matters • How androgen deficiency drives vestibular inflammation, pelvic floor guarding, and bladder dysfunction in a self-perpetuating cycle • Why this affects premenopausal women too — 98.9% of premenopausal patients in the study had below-range free testosterone • What the Rubin et al. 2025 data adds: vaginal prasterone (DHEA) was associated with meaningfully lower UTI rates in women with vulvovaginal atrophy — treating the hormone environment changed the urological outcome • What integrated treatment looks like — vaginal estrogen for GSM, compounded estradiol/testosterone gel for vestibulodynia, pelvic floor PT for hypertonic muscles • The honest limits of this research: selection bias, non-uniform hormonal evaluation, absence of long-term outcome data — and what prospective studies still need to answer This episode builds directly on Episode 149 — When Sex Hurts with Dr. Jill Krapf. If you haven't listened to that one, it is linked below and is essential companion listening. https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731 [https://podcasts.apple.com/us/podcast/sky-womens-health/id1541657642?i=1000630939731] 🔗 References & Resources: • Agrawal et al., Journal of Sexual Medicine, 2026 — Hormonally Mediated Vestibulodynia and Persistent Urogenital Symptoms • Rubin et al., Menopause, 2025 — Prevalence of UTIs in Women with Vulvovaginal Atrophy and the Impact of Vaginal Prasterone • Sky Women's Health Podcast — Episode 149: "When Sex Hurts" with Dr. Jill Krapf [link in show notes] • skywomenshealth.com [skywomenshealth.com] 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 254: Lift Heavy, Live Longer: Muscles, Menopause & Midlife with Dr. Di

Muscle loss in midlife is real, it is measurable, and it starts earlier than most women are told. Declining estrogen during perimenopause directly affects skeletal muscle — reducing mass, impairing muscle protein synthesis, and accelerating a process called sarcopenia. By the time many women notice it, they've already lost meaningful ground. In this episode, Dr. Carolyn Moyers is joined by Dr. Dianah Lake — emergency medicine physician, fitness and weight loss coach, and menopause wellness expert — to talk about what's actually driving muscle loss in midlife and what the evidence says about reversing it. 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] 🔗 Connect with Dr. Dianah Lake Schedule a complimentary consultation Instagram: @drdifitlife Facebook: Dr. Di Fitness Free Community: Professional Women Getting Fit