DRA. MARIANA AMALIA (GINECOLOGISTA INTEGRATIVA) - PODPEOPLE #133

[Music] [Music] Our guest today is a gynecologist specializing in hormonal implants and laser intimate surgery aiming to improve women's quality of life and focusing on self-care issues her motto is women cannot get used to living poorly Let's explore different topics related to female health such as menopause and the demystification of hormone replacement, we will also learn a little about tima laser surgery and various gynecological care with you dout Mariana Amália [Music] [Music] Hello everyone, welcome to another episode of pod people a place where we meet to see and hear people People who Do People who

happen People who inspire Our guest today is a gynecologist Doctor Mariana Amália Everything is good my dear Everything is great I'm glad you accepted our invitation I thank you for the invitation It's an honor to be here with you for so long watching you on the screen and now in person it's very big, I'm glad it's good for all of us so we want to learn and people also want to learn, share knowledge, okay, good night, my darling, good night Mariana evening, welcome, thank you Mari, you are a person who speaks very objectively about women's

health and you started with traditional gynecology, then you evolved into integrative gynecology, yes, and then you also have aesthetic gynecology, yes, that's not it, so I wanted you to Tell us a little bit about your story in relation to this choice of gynecology Why did you say that gynecology isn't missing something, I'm going to do the integrative one, then something is missing, I'm going to do aesthetics, tell us a little bit about that, yes, in fact, I left the residency 5 years ago, right? I'm new, I 've only been a gynecologist for 5 years and

I left and was very disabled. I confess that I left with little knowledge of my residency, right, with general knowledge of gynecology and obstetrics, which is actually the strength of the residency. more Obstetrics more than gynecology much more and I left the residency without knowing how to treat a woman in menopause It's shameful to say but it's true I knew how to do prenatal care very well you knew how to bring a child into the world but you can handle the woman, not just the woman who stop but the woman who lives Yes you had

this deficiency yes because of my preceptors all very old gynecologists against hormone replacement that Cancer hormone causes thrombosis in short all that story that you are already tired of hearing And then not but a lot of people aa There are a lot Doubt we, doctors who like to seek knowledge, are tired, yes, but in general people see this as an absolute truth, there is exactly this taboo still in relation to hormones, that's right, and then I finished the residency, I said no, I'm not going to talk. For my patients, what I heard during these three

years of residency is that this is how women have to get used to the fact that menopause will all pass and that in a while they won't feel anything anymore and that they have to get used to it, I saw nothing else will become a vegetable, right? I said no, I'm not going to tell my patients that, and then I started studying hormones, right? I entered the world of integrative gynecology, I started taking courses in the area of ​​hormone replacement, and then I started studying intimate aesthetics. which is also a need that I saw in

women, few gynecologists address women's satisfaction with their intimate region, they don't even ask or say anything. They are ashamed to talk, right ? Shame on you, sir, do something to improve, no, and then I said, I'm going to study that too. And then I also entered the universe of intimate aesthetics, especially the area of ​​intimate surgery, right, which is something I do a lot today in the laser office and the part of integrative gynecology which is the science that studies women , right? Sometimes there are patients who talk like this, Doctor, you also take care

of men, I say people, taking care of men is very easy. It's difficult to take care of women, women are much more complex than men right, our hormonal part is much more complex And then I work a lot in this area of ​​integrative gynecology that takes care of women in an integrative way, right, the name already says it when you say it like that What are these great challenges for women that are much more common in men? Simple, let's talk a little bit to our audience like this What are these major Challenges that women face

? We have many hormones that need to be aligned for us to be well, right, our thyroid, our cortisol, our sexual hormones, right, testosterone, estradiol, progesterone, men I joke that man is all about testosterone, man Look, there was a friend of mine who said the following, look, woman, it's like a control, a control panel with 1 buttons, man is on and off Exactly, it's a simpler control, isn't it? a BO that's difficult to fly, the man is a monkey that you take off in a good way, let's go and let's come, it's in the woman

that we are all here through a woman, we all already inhabit a uterus, so it's only up to her to generate a life in there and having to feed your hormones and also feed a veto, right, a little being, so for me, women are passionate, yes, beautiful, and we see you talk about M n in this beautiful way, in this passionate way, Yes, I say that I am a defender of women, right? I'm passionate about women and I always say a phrase that you may have seen on my Instagram that women can't get used to

living badly, that's your motto, your motto here we go, women can't get used to living, that's my flag and I hammer I say this phrase a lot every day, my Story, I'm always saying it in my videos because women, Bia, they get used to living poorly, especially because they are told that that's just the way it is, that's just the way it is, they hear it from their doctors, right? There's the story. from the mother of the great-grandmother's grandmother who have no longer had hormone replacement therapy who have already gotten used to menopause And then

there's all that culture, you know, negative and passing from generation to generation And then poorly assisted by their gynecologist and gynecologists too because I see a lot of female gynecologists yes, it also contraindicates many, right, replacement, it's sad to say, but I say that most gynecologists do not assist their patients in an integrative way and leave a lot to be desired in this part of the hormonal issue, which I say that what moves us are the hormones, right, they are our messengers , right, cell phones? So if we have our hormones out of alignment, that's

it, the woman's life is over, right? No, she can be physically beautiful, all the surgery, which nowadays women do a lot of plastic surgery, right, but inside they are destroyed, psychologically, physically, Living very badly and that's what I preach a lot, day to day, women can't get used to living badly and it's a lot of work, but it's work that makes a difference to those who watch me because I get a lot of feedback from women talking Doctor, listening to you so much saying that women can't get used to living poorly, I looked for an

integrative doctor, I'm taking care of myself, I started doing physical activity, I'm eating better, I lost weight, I'm responding to my hormones, it changed my life, so that's what that moves me day to day, right? Let's say that a 55-year-old woman arrived at your office, okay, you should receive 50, 40, okay? And she arrived without doing anything, how do you start approaching her, there's a lot of taboo too? relation to the time we can start hormone replacement uhm any time is time as long as this woman does not have an absolute absolute contraindication exactly which

is a personal history of breast cancer This is the only absolute contraindication, right ah the mother had it the grandmother had it the sister, the aunt is not an absolute contraindication Uhum And then this 55-year-old woman arrives at my office, she has been in menopause for 10 years, she has never replaced her hormones, I'm going to do a complete screening of this woman, right, I'm going to evaluate her entire metabolism, all her hormones, no only the sexual ones, we have the thyroid, we have the cortisol, we have to evaluate How are your inflammatory markers What

are your habits, do you practice physical activity, are you overweight, and how is your mental health, we evaluate everything, right, integrative medicine and then the Let's see if there are any formal contraindications There is no such patient, she is able to undergo hormone replacement therapy, of course, it is a different scenario from when a woman immediately enters menopause, right, she has been there for 10 years, the dose is different, sometimes there was, so we evaluate each patient on their own. phase of life, right, with its particularities, for example, you were saying that at any time

is the time to do the replacement and that it depends on the dose, it depends on how long the person is and all their markers, this issue that I think women are very worried, it's like, they have a family history of breast cancer, so I'm not even going to think about doing that, it's the collective concept, okay, of not doing replacements, then you talked about her own history of having a history of breast cancer herself. breast , these people who T have a previous history of breast cancer are people who T that G that already

predisposes to cancer or not necessarily can or can't, right? which has no genetic influence, right? It's not due to genetic mutation, it's due to habits, right? In fact, the main cause of breast cancer is bad habits, right ? uh, overweight, obesity, it forms a lot of a hormone that is not good, which is estrone uhum, right And these patients They have a much higher risk of breast cancer, right, smoking, overweight, sedentary lifestyle and alcohol, alcohol, right, alcohol That's a lot, at least the which I have read a lot, studied in England ISO is highly correlated

with alcohol in women Yes and women today are drinking the same as men or even more, right? rich in carbohydrates sugar and other foods that inflame our body a lot, which are dairy products, gluten, right, because in fact, cancer starts from inflammation, all diseases, right, subclinical chronic inflammation, which is that inflammation that people talk about like this, oh, but I I don't feel any pain, I'm not sick , but inflammation goes far beyond Pain, right, inflammation, acute inflammation It hurts, right, and people correlate inflammation with pain Oh, if I don't feel pain, I'm not inflamed,

but I'm overweight, I'm smoking, I'm drinking, I'm eating everything wrong Of course, it's inflamed, right, and it's deficient in hormones , which is also a risk factor for inflammation. The lack of hormones inflames our body, right? will increase the risk of breast cancer, the genetic part is very small and people face the epigenetics of external factors, for example, it is what determines whether we will get sick or not, it is not our genetics, we are not hostages to our Genetics , right ? epigenetics and when you started to address this with patients What was their

reaction of not believing No, it's not quite like that because I have a relative, I have an aunt, I have a grandmother, right? And then you will see the grandmother is that grandmother who was gaining weight, right? Grandma loves to make sweets, right? For everyone, a very sweet man, right? Grandma Benta's archetype is Grandma Benta, right from Sítio capal Amarelo? Do you remember that she made millions of foods and sweets and was also very full, right? So, Grandma Benta I would also be predisposed there, right, aunt Anastásia and grandma Benta, aunt Anastásia also used to

put sweets on the kids, so Bia, there in my region, I'm a Pioneer in the area of ​​integrative gynecology, you must have had a lot, eh, how is it that resistance from colleagues to this day and also from population I believe today they try to say in a certain way Oh that's not real Ah that doesn't exist, you know that my patients say that to me but Doctor, every doctor says it can't be done, only you say it can be done, right, in my region I say Look, I'm studying a lot, I don't know if

my colleagues aren't studying, but I study a lot, so I say everything I say It's based on science, it's not my opinion, it's not Dr. Mariana who's talking, I'm just transmitting knowledge that's there for anyone who wants to approach it. patients in cheris they have studied a lot, right? Much more thank God and I'm very happy with that because I have less work of having to teach PR patients in the consultation because she often comes knowing many things that she has already studied today I think that with that, we already had this habit, while I

had to wait for them to arrive, I subscribed to the magazines, they took a long time to arrive, it was like that, about three arrived a year, yes, access is much more difficult, right, it was much more difficult and even so, we sent ch Xerox, right, of the article to take home today, I think this is better, I like this patient who arrives, I read about this, I read about that, I really like it, it's not so much that, for example, if you look in the literature, even within your gynecological area and There are many

articles that talk about the association of cancer and hormone replacement, but they are articles that are completely distorted because it wasn't exactly a hormone, it wasn't the hormone that was given, it was something similar to the hormone that was said to do the replacement Exactly exactly the biggest study on women taking hormone replacement therapy was that study whi, right, ah, it was a study that stopped prematurely, it was scheduled for 10 years, it stopped halfway through because it really increased the risk of breast cancer and thrombosis a lot. And then they had to stop the

study, a study with more than 15,000 women in the 1950s or 60s, in the 1990s in the 1990s, in 2002 he stopped he stopped and in this study, hormone replacement was carried out in women with hormones from pregnant mares, right? So, can you imagine taking hormones from the urine of mares that were there, look how crazy, they went to the laboratory and extracted the female hormone and gave it encapsulation and gave it to the woman to take. Of course it would be bad , right ? bioidentical, you know, it was the ac setap of neither

the mare's nor the mare's, but the synthetic one that was created in the laboratory, the progesterone medroxy acetate called provera And then it added the estrogen from the pregnant mares' urine to the mare's urine get pregnant together with medroxy progesterone acetate, people, it's very simple to think that it wouldn't work, right? But that's what they had at the time, right ? had to do And then there were women over 50 years old women aged 50 79 years old many hypertensive diabetics obese smokers already had chronic inflammation which is already the combo to cause breast cancer

and thrombosis And of course it increased the risk of cardiovascular diseases and breast cancer so much so that they stopped the study halfway through, right, to stop women from dying, and then after that, Bia, the results of this study were played in the media, right, and then all the gynecologists stopped giving hormones to their women, hormone replacement ended, And Then, from then on, cancerophobia, exactly, and then, that's it, it ended, the decade of the 90s, the beginning of the 20th century, right, 2000, 2000 came, it's coming, right, that's still a mistaken idea and it's still

in women's minds. study, in fact, women don't know what the study is, but it's in their minds that hormone replacement causes cancer and thrombosis and it's in the minds of gynecologists, although that's what I think is the saddest thing, right? information is there on the internet, just see that this study had several and there were several criticisms, several errors, anyway, that's what they had at the time and hormone replacement must always be done with bioidentical hormone, right? hormone that we have, which is identical, it's the same as the one we have, right, or ISO, right,

which today is called molecular ISO, its molecule is the same as our hormones, it is not a natural hormone because it was not produced in our body, but it is an isomolecular hormone that has the same molecule as our natural hormones, right? It is extracted from we think the following if we were to get cancer due to hormone a we would have it our whole lives because we produce a lot of hormones, exactly, it's really cool that you said that, ours, right? peak so let's do the following let's take the ovaries out of young girls

because cancer the hormones don't cause cancer So let's take out their ovaries so they stop producing hormones Of course not, right we're not going to do that but castration is castration but it's not but if but if it causes cancer, the hormone causes cancer So I'm going to take the hormone away from the young girl because she's going to get cancer If you follow this reductionist reasoning, right ? and women They have much more post-menopausal breast cancer they are without hormones in their body it has reduced too much the majority of women with post-menopausal breast

cancer they are not taking hormone replacement they are not taking it and in other words there is no hormone correlation With breast cancer, it's interesting how long it takes to change this mentality, exactly, I think it will be many more years, I also think that a few decades are decades I think Marana we have something happy there, at least in your region, I mean in Rio of January in the big cities, I think we are seeing a huge change in this relationship with Integrative Medicine. But what I think is making a difference for you in

your field is being a doctor a little further ahead because when We think about Women's Health, it's something that I've always been thinking about and talking about a lot, I defend women a lot because I have a mother and I come from a woman, you know, and having a doctor with that look at me, I'm like very happy because because many women still don't have the mindset of going there for preventative care because they are always on the front line of having to take care of the house, work, take care of the children, the priority

is always the children o husband takes her home and where she still pays a little attention is to go to the gynecologist once a year and at that moment she meets a doctor like Mariana who has this historic look, this integrative look, so I feel more comfortable. It's as if I If so, I'm speaking here as a son who would like me to take my mother and I knew that you would be watching my mother not only for her to have a mammogram or just to have annual preventive exams, right, so I think that's very

It's cool to have a doctor with you who has this look at women that goes way beyond the normal, you know, the average normal, because from there a lot of things can come out that can help you, which may not even be in your area, but only in you having that look. for her, you may be looking at her so that she has to go to a cardiologist, she has to pay more attention to an endocrine doctor, although because the first place women go is not to the endocrine doctor, they will look for a gynecologist

and from there you will take that walk No, I can still adjust it and so on, but I think you have to go to this other colleague here, so look how happy I would be to have my mother in the hands of someone like you, so yes, I really appreciate it and I say, multiply Mariana in Brazil because women need integrative gynecologists and I always say that when we take care of a woman, right? Especially during menopause, right ? right, so that's why I always say when we take care of a woman in menopause, we

take care of a family because women in menopause often end a marriage, right, the husband no longer tolerates his wife's intolerance towards children, patience is the children don't tolerate it, but the mother is super stressed , right ? caring for these women in menopause means transforming families and you experienced this, for example with your mother, my mother did not take hormone replacement therapy, she She tells me that she had hot flashes but they soon went away and then she even used a little bit of a synthetic hormone but soon stopped because the genilogist also removed

it And then she had a drop in quality of life, definitely not clear, definitely overweight, right? other things came up and today she doesn't take any type of hormone replacement because luckily my mother had breast cancer uhum without hormone replacement hormone replacement I understood without hormone replacement three years ago Thank God I diagnosed it early on and had the surgery the knot wants say, you were already having this different look at her three years ago and it helped a lot, that's for sure, then we discovered the 1 cm nodule, she had surgery, just the sectorectomy,

she only removed the region of the nodule and had radiotherapy, no chemotherapy was needed, thanks To God, she's doing great, really well, now she can't do it. There's a story, her story, exactly, right? And at the time, I remember I started taking her exams. Exactly so we could start thinking about hormone replacement and so on, and then, unfortunately, we I had this diagnosis but for example I have a family history I have no contraindication I can replace hormones when I reach menopause So it's not a contraindication family history but my mother is a contraindication especially

since in her case it was estrogen breast cancer dependent , right ? I was assisted 10 years before, maybe I wouldn't even have cancer, right? And my mother was also sedentary for a long time, overweight, eating wrong, even during post-menopause, she gained a lot of weight, so all of this contributed to the pattern, which was a pattern for almost all women. they evolved into this, that's exactly what my mother smoked for decades, drank for decades, so there was every inflammatory factor, I'm talking about mom, you had the cancer development combo, unfortunately, that's exactly it, but

she's fine, thank God, and today you're still beyond this. there in the office and going a lot to this integrative gynecology you You still give birth, don't you, I almost didn't, I left the residency, eh I'm sure I didn't want to be an obstetrician, it's not like that, I think the birth is beautiful, I've had many births in the residency but I didn't want the life of an obstetrician, it 's not that I don't like obstetrics, I don't like the life of an obstetrician, you know, there's no birth date, you can't travel, you always have

to leave a colleague on notice, right? And then I chose not to do it. Obstetrics and I never did Obstetrics I did very little, right, you always did more gynecology gynecology 99% and and 100% now gynecology obstetrics has been over 3 years since I, you haven't had a birth in a month, I haven't had a birth and this look at, let's say, we welcomed Rafael here who spoke very well about the male organs and this aesthetic part Cira, he is a urologist, urologist welcomed him here and then we joked that it was the Pintos program

and now we, yours, right, is already different. yours , how do you like the name of the precious women ? started trying like this, in addition to this, this internal health of the woman, the function that you are bringing to life, it is bringing joy, right, because it is a joy for a woman to start to meet her again with her body, to have this look at her and then together you came to attach this aesthetic part, what was that where it came from, what is that like, I'm very curious to know, he thought you

were going to bring it, I was also disappointed That precious model, Mod Bruno, Bruno wasn't there either, I was there I think it's so didactic I think the way you talk is so didactic but we separated because you explain it in a really cool way, even to men, we were here, Bruno and I, talking about it like that, wow, I've never had that look asking me questions, it was save it We asked a lot of questions and there's me and bro, right bro, so eh Just like I said before, when I left the residency, I

wanted to do things that few people did, you know, first of all, watch this woman in menopause, especially and watch these women who are ashamed of their intimate areas, I say that they are women left aside, and the women who TM ashamed of your precious, they hardly say that to their gynecologists because they don't talk about your precious, right? And then I started taking courses in this area of ​​intimate aesthetics, the main procedure we do is intimate surgery, we can do everything I say everything you do on your face you can do there on the

precious pile collagen stimulator microneedling filler everything people everything there on the lips I can't believe everything on the lips everything we do here on the face this technology all those machines thing than P even microfocused ultrasound radiofrequency everything Oh I want to know everything now look now you will explain all this in detail because this way we Liberating for many women for sure because we get older we lose collagen and there whole body in the whole body including there seeing Bru I said that's why that one was so ugly and then she made it so

beautiful, exactly so we age not only in the external part of our precious but also inside our vaginal canal we lose collagen there as well, which takes internally it can also be treated not only a aesthetic thing on the outside that also leads to pain during penetration, a lot of pain, even the woman stops having sexual intercourse. Because in addition to the lack of hormones, which already dries out everything, she loses collagen, so the vagina becomes like a PVC tube, right? the penetration there she feels like she was literally being raped I had a patient

who said something she said like it feels like my husband is putting a Cactus inside me, that's right And then she was one of the first patients so Doctor I started doing a laser I really said it was rare here, it's been over 10 years and then she said it's improved a lot, it's incredible, I have the laser in my office, it's the fractional CO2 laser because there are several lasers, right Uh, And the laser, what does it do, it stimulates the our vaginal mucosa intensely produces collagen by fibroblasts so we increase the production of

collagen and hyaluronic acid, we increase it, right? And then at the time of penetration, we have the accommodation of the penis, right ? It's a bottom, it doesn't have it, it's not a hole, right? It has a blind bottom there, so when it comes to penetration, we have a dilation and narrowing there, right, the vagina accommodates the penis and in menopause, when a woman dries out everything, she doesn't have it. this acod more So it really turns into a PVC tube, it doesn't have much movement, it doesn't have collagen, it doesn't have hormones, it doesn't

have lubrication, it doesn't have anything and the laser stimulates production, it's much more flexible, right? And the laser is incredible, exactly for women too that they can't do hormone replacement therapy, it's not easy, there's Tom anesthesia. No, you don't need it there, but it's doctor's talk 5 minutes before the thing burns, then no laser burns. Oh, but then, people, I'm going to defend it. that she is very hyper sensitive, it really isn't people, it's calm, that's how we think, the laser burns, I don't know what No, you don't even need anesthesia, I pass it like

this at the beginning, at the entrance to the vag, remember Dr Mariana who started that thing at that time Ah, let's do a laser for the beard, then it was still starting, right, that Beard here didn't have it and so on, so then I did that, it burned like hell, laser burns people, laser burns, it's because it depends on the type of laser, they are different technologies, but so the CO2 milk when You do it on your face, it burns and hurts, there's no way to do it without anesthetic in the vaginal canal, it's different.

Our enervation is different so it's much more tolerable, uh, believe me, it doesn't hurt, it's not just doctor's talk, but I think you can make a proposal for those who have hypersensitivity. you can do it under anesthesia you can do sedation No need, but you can, you have to have this option, you have to give it Of course, she's desperate, no, she has it, she has a lot of everything, I don't have a phobia, no, I have hypersensitivity Even my own perception is an absurd thing, we make an anesthetic cream ready 30 minutes beforehand, I

guarantee you, you will feel nothing, it's calm and the law transforms your sex life, we won't have to, if we say no, we won't. will sedate you Then she'll be fine, we'll boo, let's go, let's leave her aside, let's go, look, you talked about the Laser, you talked about microneedling, you talked about pulsed light, this collagen stimulator, microfocused ultrasound, which is there's Ultraform, right, the stimulator is well known. Collagen is Radi, there's everything, everyone, they all stimulate collagen, and what's more interesting is that we're not just talking about aesthetics, we think, we're going to shape

it, we're going to change it, something, but you're talking about Besides In addition, you are touching the part of restoring physiological function devv ISO, this to the laser, in the case of the laser, it is not just for aesthetics, it is also to restore the functionality of our precious Uhum So it is not, people think it is just for aesthetics Ah, it is to improve aesthetics is not to restore a woman's sexual life, for example, it also increases lubrication a lot, it also increases lubrication a lot, not only aaaa flexibility, compliance but also lubrication, yes,

and it also treats urinary continence, which is something that women have a lot of today nowadays Bia, mainly post-menopausal, every three post-menopausal women, one has some degree of urinary incontinence, be it mild, moderate or even severe, and in the past it was said that you had to do the perineum, right? nowadays it's not very rare for a patient to need surgery, today I hardly hear people talk anymore and there 's a smaller proportion of patients who go for surgery, I do very little surgery, I do gynecological surgery, hysterectomy, period sling, but very little. The majority

of patients are treated with the incontin oer laser, which provides a response, so we improve lubrication, atrophy to narrowing, women who feel their vagina is looser and also urinary incontinence and on the external part of the external lips, we carry out procedures to improve collagen , all the things we do on our faces, we can do there to improve that sagging that we get as we get older, we lose the fat on our outer lips and we're just left with skin, right? people confuse a lot , right? What are the labia majora? right, that's where

I always talk about my videos, you know, the excess skin, the women, they talk about it internally, the intimate surgery that we do is 90% of it is internal lips, which is to remove the excess hair and this surgery is not outpatient, it has that being in a surgical center is in the office in Vigo Maria, the laser, right, we have the same laser device that performs the intimate laser, it is the same device that performs the intimate surgery with different power, with different power with the tip, we change the settings there on the device

and it's the laser, that little red light, right? So with the little red light, we go there and make the cut, we do all the marking and cut it right to make it as small as the other photo there, here, that's it, they're just the same. that inner lips or labia minora, major labia minora and here look how it has already changed that the labia majora don't change, right no, they become flaccid and we undergo treatment to improve flaccidity ten but surgery is hardly necessary to cut it, there is no need in Most cases only

in post-bariat patients who lose a lot of weight actually end up with a lot of skin But in general, it's not the inner lips that we operate on uhum and Guys, you have no idea how much a surgery like this empowers a woman, eh and I say no Intimate surgery is just aesthetic, it goes far beyond aesthetics, it transforms the life of that woman who dies of shame for her partner during sexual intercourse who doesn't even go to the waxing machine because she is ashamed of herself who has difficulty even riding a bike, for example

doing physical activity difficulty with hygiene, pain during intercourse because during penetration these little hairs enter the canal, there is a lot of Flá, it's very big, I have a patient who says that she has to open the little hairs for the penis to enter the relationship, so people look at it, it's just immense, right? And the embarrassment, right? and the embarrassment, the shame, there is no sexual intercourse in Claro, sometimes they don't even let their partner have oral sex out of shame, so look, it just interferes with the sexual life, the intimacy, the automatic pleasure

Totally, there are women who have it, eh, on top of the clitoris, we have one skin called hood clitoral hood is and this skin has an image of this hood Bru there are women whose hood is so big that her clitoris is completely hidden as if it were phimosis phimosis no that woman has phimosis ah phimosis of the clitoris So what? this woman Many of them have their clitoris so hidden by this hood that she has never had an orgasm in her life Look there, that's the hood she's talking about, it's completely covering the clitoris,

you can't even see the clitoris there after the surgery we can already see his little tip, it's there, look, there's his little ball below there, so the woman improves the sensation of pleasure, which is the fear that women have, thinking that intimate surgery takes away the pleasure for Contri, otherwise it improves, it doesn't change on the clitoris, no, we don't touch the clitoris, we touch this Skin That covers it, ask Exactly that if there is any loss of sensitivity, none just temporary due to the swelling, it recovered, it's over, there's no improvement, here's a picture

of the before and after of a lip surgery that women know as nymphoplasty, right, but we call it minor labiaplasty so there is labiaplasty and capus plasty surgery so there were two surgeries more sensitivity it seems that closing sensitivity increases because it exposes more this improves sensitivity it improves eh her empowerment, you know, she gets much more hygiene, also hygiene, sexual life, the woman starts going to the epilator after that, so it transforms the lives of women who really need it And there's also Alex, clitoral surgery, okay, that's the woman who has it the clitoris

is very large, generally women who use anabolic steroids, right? And then the clitoris grows, we do surgery to reduce it, but we don't cut it, this surgery is no longer done, we reduce its ligament, so we pull it to inside we shorten the ligament so we embed the clitoris inside this skin, true it is the ligament that pulls it, we shorten the ligament so its exposure is reduced, we place it inside this skin there on the hood, it's interesting, are you? saying that the use of anabolic steroids by women makes the clitoris huge, it becomes

very big, sometimes 1 cm becomes very big and so the little capo no longer covers it, it is always exposed and it is an even more interesting thing because it reduces sensitivity, this constant exposure seems to You get used to it , exactly, extremely uncomfortable, so there are many women who use anabolic steroids , deal with this and don't tell anyone about it. I remember this over 20 years ago. I had a super cool young patient who worked out a lot. I would take the pump, don't take it, she said no, I don't need it

and she was completely straight, like that, with a great shape And then one fine day she calls me Bia, I need you to get back to me urgently, she was missing for about three months but I knew she had a new boyfriend, I said oh Now she's going to take a while to show up, she was doing great and then when she arrived she said, close the door, I said, what do you mean? Then she closes the door, I said, it's ok, I passed the key in the no no in my room and then she

said, Look, I'll show you one For the love of God, don't look surprised, I said, my God, what was that woman, she pulled down her panties, she said, look at this, when I looked, I said a mini dick, what did they do to you, I said, it's always been like this and I said, sorry, I'm not laughing, I'm shocked, then she said, I started taking the anabolic steroid, my boyfriend takes it, he applied it to me, look at this, this thing doesn't work, it doesn't work, it's okay, I'm like, I can't be weird, jeans feel

pain like that. It's rubbing against me, it's giving me pain, so I said, woman in heaven, and the worst part is that things don't go away that easily, no, right, not until When using anabolic steroids , it can deflate a little bit, but it doesn't go back to what it was before. that she feels pain that it's rubbing, she doesn't even want to touch it much, she's scared, it's pleasurable ex, so that's us, that's it, women are going through this, they're quiet, today we have these resources, right, now the doubt that I'm going to come

with the doubt from leico I go there to do a facial harmonization ahem facial no calm facial I'm not going to her to do a harmonization people she's not she's not Rafael So I went for a facial harmonization and from time to time Ah if I work out a lot if I don't do it I know what if I really look at my face and so on, I have to do something from time to time that you're saying that I want to know if it's the same way as harmonizing the face from time to time

we we have to go because everything goes back to normal Yes, right For example, there are women who have these droopy outer lips, so we fill them with hyaluronic acid, which is the same as what we fill our face with, at a thicker density, it will be absorbed because we have a enzyme in the body called hyaluronidase will eat this hyaluronic acid the way it eats from our face, so we have to have at least annual maintenance, it has to be there always for more or less the time that Rafael said it was for the

penis exactly, right? I always tell patients PR We're not going to wait for everything to wither to start from scratch , it's because it's much more prod, but the product becomes more expensive, right ? from what you got, right? The patients ask, but how long does the collagen stimulator last ? It's maintaining all the aesthetics exactly and the intimate surgery you asked just now, right? If it's done in a hospital, there's no need, we do it in the office with local anesthesia, I apply an anesthetic cream, the patient stays for about 40 minutes with us,

we believe in anesthesia, everything. anesthetic cream and then I reinforce it with infiltrative anesthesia but the patient no longer feels it, it's because then you already have that sensitivity from the anesthesia needle, also with the cream I have already removed that sensitivity from the needle . I remove all the excess skin in 1 hour and a half 2 hours. I can also do fillers along with the intimate surgery, laser collagen stimulator, everything is over, the surgery is over, you go home, there is no hospitalization for observation, it is swollen, it will fill up the next

day, it will be there, double triple what was left in the post, but nothing absurd, is there anything like that you need to put ice on something you have to put ice on it for two days you can't have sexual intercourse physical activity for 30 days but usual activities like going to college to work in the room that fifth day, it can be four, I tell the patient to stay at home for at least three days, quietly, right, any pain when going to the bathroom, calmly, take medicine and Novalgina takes anti-inflammatories, the pain goes away

cold, calm, happy and Bouncy, for a month, beautiful, wonderful, empowered, you can date Look, you said something It's such a cool thing that this black guy kills me, I'm going to kill my patient's doubts because she is, she became a widow at 35, okay, and now she's 42 and she 's recovered, she wants to go back and then she wants to look for it but she said it like this But will it be which takes a long time because the process of getting to know the boy is starting but she is like that but I

think it will take me about six months to recover Capable is not a thing R 30 days you are free to date to be happy 30 days tell her to say that I'm going to go on a study trip that was already in the cron I liked it I liked the idea 30 days I go and come back and everything is fine you won't even know you won't even know already test it, test it, understand exactly if it will support staying for a month, make a package, right? of fidelity, I have many women, you talking

about your widow patient, right? many post-menopausal women who have divorced or are widows who seek intimate aesthetics is a way for them to improve their self-esteem, I'm sure you're not sure it improves a lot, I say that it really empowers women, aaa, intimate aesthetics really because I'm a very precious organ for us, that's why which I call precious precios it's very precious I love it precious now you're doing something that people are always in doubt about, it's going to affect sensitivity and hey you answered us perfect because no no you don't cut the clitoral you

reduce the ligament which is totally different which is already a thing in the case of clitoral surgeries, most of them to remove excess hair, the vast majority talking about these women who took a lot of hormones and did this thing of having their clitoris become hypertrophied, right now, it's important for us to say what women have to know this, I had a patient who had her clitoris pierced, it was a disgrace, wow, because then you lose sensitivity, that's crazy, people, so we have to talk about it, but it's much more common in the nipples, and

that's also very common for teenagers, right? I had a teenager Bia arrived, I need to talk to her urgently about everything that is urgent for men and women, if it's not something like that, I'm thinking about killing myself, it's related to sex, I already know the tone of the voice, so it's there, she arrived like this and She had PC in her nose and here I said, it hurts, I said, but you have to be careful, you know, because the mouth has to be cleaned more because it inflames those things, but I never thought the

girl would put it on her clitoris, and then one day she comes to me. I said so, I have to tell you, I got my clitoris pierced, I don't feel anything anymore. I said, you got your clitoris pierced . imagining during the procedure how crazy, you know, so I said how did you do it, no, I drank, you know, anesthesia or alcohol, you must have been almost in a coma, right, it wasn't anesthesia, it was then the pain, you know, and then she had no sensitivity anymore never the same Look how crazy, right? And there

was one that was put in your mouth that also reduced horrors, so for the love of God, people don't need this, people don't do this, you know, like, eh They are fads that give rise to the issue of daens, don't think about The consequence of losing sensitivity is very bad, it's very bad and so speaking of sensitivity Bia, the clitoris is our organ that brings us the most pleasure, right in the clitoris, right in this Ball, in fact I don't know if you know our clitoris, it's more or less this size here it's about 7

cm long, but it goes inwards, it enters our muscles there on the pelvic floor and hugs our vagina ex it always opens both sides Exactly, it's beautiful Flit AB here, it's beautiful, it's as if he It's funny that he does Ass Yes and if we remember the one from embryology classes, it's practically a penis if you can put these two sides together, oh orqu So yes, it's beautiful guys and I saw the clitoris in its entirety in a course I took in Las Vegas, it's intimate surgery with training on fresh cadavers, we did a dissection

there in the area of ​​the precious and we saw the clitoris internally, I say it was one of the greatest emotions of my life to see all these parinas and the little ball that we see it, it calls it, it calls it glans glans Du clitoris, this little ball is the tip of the iceberg So there's a lot more inside, but it's the most sensitive region Look, people, no , but there we can't see it, we can't see it, we can't see it you have to see the view, the frontal view of the clitoris, put

the anatomy of the clitoris there, the figure will appear and the little ball that we can see, which is the age of the clitoris, it is the most sensitive region of the clitoris, which is the region that has 8,000 sensitive nervins. look at all the nerves just to give us pleasure, imagine the creature getting a huge piercing, pulling it out, he must have lost, I don't know, 4,000 nerve endings, the G-spot that people talk about so much is not our most sensitive region, the G-spot is the internal part of the clitoris that we touch when

both sides oh come on, man, the structure is beautiful, so the most sensitive region is the glans of the clitoris, which is the little ball that everyone sees What if we Realize here it even looks like a penis exactly the same, that's why women who use anabolic steroids grow, it grows it looks like a penis and the G-spot is when we touch the internal part of our clitoris there through the vaginal canal there but passing through the labia majora through the Sorry through the internal lips , we actually enter the vaginal canal, we touch the

anterior wall of the vagina, we touch this internal part of the clitoris, so the G-spot is nothing more than the internal part of the clitoris, but it is much more difficult to access it region PR to the sides, right, you'll be on one side or the other, you'll be taking it there, it's just that it's much more difficult to have pleasure, that's why there are women who have orgasms just by stimulating the glans of the clitoris because there it's easy, it's there on the face region where there is more nervin, the vaginal canal, you have

to search for the clitoris there internally, so a search is much more difficult, right? So there are many women who do not have orgasm and penetration, they only have it by stimulating the glans of the clitoris and that's it. OK, there's nothing wrong with that, but if you can put it all together, of course, we want everything, right, you can be a little greedy, you can have an orgasm during penetration , stimulating the clitoris, right? Ah, I don't have an orgasm during penetration, but penetration stimulates at the same time, I'm sure you said everything ,

it's important to be happy, there are several ways to get to heaven, right? our hormones so that we can have an orgasm, right, and it's a complaint from menopausal women, they say, doctor, I can't have an orgasm anymore, I no longer have libido, I no longer want to have sex with my husband Oh, I don't even want him to touch me because then there's no way we can even want to invest in the aesthetic part, we first have to take care of this part that will solve this ex intimate surgery it only makes sense if

the entire metabolism you won't have life for sure and hormone replacement it transforms a woman's sexual life transforms estradiol into testosterone. I say that testosterone is a pleasure hormone, for sure, so a woman who replaces testosterone and has adequate levels is a woman who sometimes has an even better libido than her I had a patient like this when I was young, I have a patient like this in menopause, says our Doctor, I'm in such good shape sexually today, when I was young, I didn't have all this pleasure, you know, a woman who is well hormonally

modulated transforms her sexual life, I completely agree with eee, it's very important for life this sexual side of a woman because she feels more feminine, she feels useful to her husband, right? Because we are a couple, we have to satisfy each other, right? So it is very frustrating for a woman when she can no longer satisfy her partner and not even her, in fact, you know, they tell me Doctor, I don't even want to masturbate, I don't want to, I don't want to, it's not just about having sex with my husband, I don't even want

to masturbate, I don't want to, I don't want to be touched. Men had more right to this pleasure exactly and I say that menopause can be the best phase of a woman's life, right? left home, most of them are already graduated, there 's no risk of getting pregnant, there's no more risk of getting pregnant, there's no more PMS, right? work is already well advanced, well developed, already graduated, finally, everything is OK, then suddenly menopause arrives, her life is over, it's supposed to be the best moment, right, it's over, pleasure becomes depressed to be the best,

Ready, it's over and hot flashes begin, insomnia Depressives don't have libido and I say no, we can't get used to living with this, everything has a solution Surely, right, all of this has a solution Bru, do you have any questions Bru, you young man are asking me so many questions, I said, talk to Mariana, wait, Mari now I made some I still have some but I'll leave it to you do you have women in your life now did you talk about Taboo de concept of the person seeking, or the woman seeking this treatment, I would

like to know if you could talk a little about where you can apply this awareness of the woman seeking and this harmonization where it is necessary where it separates the aesthetic from the necessary, so in physiological need, I think I always say that there is no vulva pattern, the vulva has to be like this, the external lips have to be like a tangerine gum, the inner lips have to be tiny, the clitoris has to be no, there is no vulva pattern, there is that vulva that pleases you that displeases you, right? Sometimes the patient arrives

like this, Doctor, see what needs to happen to improve, I say, it won't work, I won't be able to, I say, what bothers you, Doctor, it doesn't bother me at all. No, but oh, I don't know, you have to do something, I'll say, if it doesn't bother you, you have to do nothing, but you have to see if that person looks at you, your precious, most women don't look, they don't exactly look, there isn't a mirror. there, to give one, it's a mirror, right, it's not a little mirror, it's a mirror, I think it's important,

we have to look at our precious, right, see so many things happen there, right, we feel pleasure there, we Every month we menstruate, there we there are children there during normal birth, right? It's such a special region for us, there's a little hole in the urethra where we pee every day, it's a very noble region for us, very precious, very precious, but when the patient doesn't have a chin, Bia, I never I say, look, I think you have to have surgery because your lips are too big. Look, I think you have to have a collagen

stimulator, everything is saggy. I never say that ever. So I'll tell you something, start buying those mirrors, you know. Do you remember that double mirror that we had for makeup in a hotel, right? We do it like that, then we give it to women as a gift, they say, look, go home, get used to it every day, take a look from here, you come and tell me what you, what bothers you Why people don't look, don't look, it's not surreal, but I also ca n't awaken in them a complex that they don't have, right? Look,

this is a great gift that you will give, this idea is not just for this look in the mirror, I don't think it's just for this aesthetic look , but I think that there are many people, I have one, I mean, I have several cases, right ? of Hospital Psychology, which I think should grow more and more every day, but I had a case of a lady, I mean lady, right, I can't even say that, but at about 65 years old, she was hospitalized and then the people in the gynecology area called me from sector

, right, and they said that she wasn't healing a certain wound that she had close to her vagina and then she had already done several things with antibiotics and she was very closed off, even for the nurses to do the treatment and apply the dressing there. And then I started to come in, me and my my partner, right, because I wanted to see why she might not want to open up to me as a man, right, but I went to the person she talked to most about it and she said a lot about it in

her time, right guys, I'm 20 years old . I graduated, I started with hospital psychology 20 years ago and she didn't like to talk about any of this and said that in her childhood everything was very strict and her father wouldn't let her go home with her boy friends if the boys called to ask her a question. In the classroom, they didn't let him, he said, Oh, she's doing something, she's not at home, if she was taking a shower, that was very noticeable . On the street, they never said that she was taking a shower

because the boy could imagine, so this father had a very mentality, this lady, this lady, he was using a psychiatrist, right? And this lady with so much rigidity, so much rigidity, and she started saying that she I couldn't touch her precious one And then she started to develop an illness in an unconscious way so that she could touch her vagina without feeling guilty because there she was exactly and from there she opened a whole psychosomatic where we entered into work, the gynecologist entered the clinical doctor, I, the Psychiatrist, everyone in the group started working on

this and so we really began to see a work evolving there, she improved a lot about it, so and this mirror thing that the Bia brought, I think it's not just PR for us to discover, I think it's starting to get to know your body because that lady doesn't know people, if we stop and go to the countryside that we have in this beautiful Brazil, there are women who don't know, don't know the your body, right, and I see a lot of women complaining of lack of libido of all ages It's not just during menopause,

not young women too And then when a young woman arrives complaining that she doesn't have libido, I say Wow, but she's so young, people, I don't think so. having libida I start to ask about her life and there are a lot of these stories my father was very strict with me my mother and religious issues of the Church and you have to get married as a virgin and Sex is wrong and you are a girl and you can't touch yourself that's a boy thing right, she grew up with all that in her mind or was

abused by someone in the family or by a classmate at school, very much not from the family, the probability of it being abuse always and always has a story, it's always incredible, young women without libido always have a history, and it's psychological because something that she went through in the past and then she often develops vaginismus that she can't even have penetration Exactly exactly And then vaginismus is a very difficult thing to treat, you have to have the whole team involved there, right, you have to have the your work and we can do a botox

there to relax the muscles at the entrance to the vagina, a botox has no aesthetic purpose, it is just to relax the muscle right at the entrance to the vagina, which can help, but that's not all, it has to be treated here to take away all that trauma, sometimes even things that even she doesn't have with us, like young people, we have a much better mentality, much more advanced, right? that he was abused by his father for years, he only told his mother when he was 12 years old and his mother still stayed with his

father, yes, and she still has contact with her father today and she has no libido, so that's how it is, it's very sad. There are always stories, let alone Early abuse, more likely to develop vaginismus, yes, from this contraction Ahem Then you get married, you're a virgin and then you don't know, that's it, then I think the problem is the husband, wow, it's really bad, really bad, I had a vaginismus patient who was married for a year. and a half ago and they hadn't had any penetration and she was embarrassed to go to the doctor

to talk about it because she thought the problem was her, she didn't like sex, what am I going to say to the gynecologist after watching things so much? On the internet I said oh I must have vaginismus so she looked for me and I sent her to a pelvic physiotherapist who greatly improves the physiotherapist M Yes, we then start dilating with the dilators, you know, increasing the caliber And then therapy we didn't even need to do botox In her it was Botox, it's the last thing, first you have to treat this whole part, it's really

cool, you remembered the physiotherapy well, we also had a physiotherapist here, in the intimate area, which was really cool, wasn't it Bru, it was SOS perío Cláudia Cláudia That was recorded, right? Claudinha asked a lot of questions that day, that 's right, let's go, what do we have there, Bruno, we're not going to pass that on now, Mari, we talked about a lot of cool things about the gynecology part of the care you have with women, right? and aesthetics, but we also have some diseases, you know, because the penis is something that we can see,

anything that happens, we can visually see, but a lot of the diseases in women don't have that, so we can only see it with a secretion. something that is different I would like you to also talk a little bit about this yes you say in relation to transmi infections or also no because not all discharges which sometimes you can think is a normal thing the vaginal infection so the champion is candida Uhum And every day It seems that recurrent candidiasis is more prevalent , right, and I see many women who have recurrent candidiasis than those

women who have more three episodes in a year is not easy to treat, it is difficult, it is a challenge for gynecologists, it is not treated with vaginal cream, just like people think that just using a vaginal cream treats the crisis but does not treat the cause of the problem and vaginal candidiasis does nothing It's more than just a scream from our body that is extremely inflamed, I say repetitive candides, it's not the problem, it's, it 's not the consequence, we have to treat the cause, it's not the problem, the consequence of the problem, so

we need to treat it. inflammation, right at the intestinal level, it all starts in the intestine, right, we know that, so we have to treat this intestinal inflammation, this intestinal dysbiosis, to treat vaginal dysbiosis, that our vagina also has a lot of little bugs there, right, so we have to change our habits a lot. This woman has to replace vaginal lactobacilli, she has to take lactobacilli, she has to supplement it, reduce inflammation and cut out excess carbohydrate sugar. So there are several things we have to do. It's a challenge, it's not easy, but it's possible

to treat it, right? I hear women saying they are I've been having candidiasis for years, every month, every month, every month, I tell people what is this, Doctor, I've been to several gynecologists and I've used all the pharmacy vaginal creams, I say it won't solve it, there's no point, it's no use until you treat the cause. It's not going to solve your problem, right? They're women who have high insulin, insulin resistance, you have to treat insulin resistance, they say, they look like this when I talk to them, uh, I've never heard of that. right, it's

a multidisciplinary approach to improve a repeat candidacy, but it's possible for us to have a repeat candidacy, and for us to start characterizing it as a repetition, we're going to start realizing that in a year, around three times Three of me, there are women who have it every month every month for over a year and then it could be something much more, yes, they are not extremely inflamed women, they are generally overweight, stressed women, and they have high insulin, they have insulin resistance, sometimes even thin women have resistance. insulin, there's an intestinal dysbiosis, they're women,

many of them are sedentary, very stressed, so they eat a lot of carbohydrates, a lot of carbohydrates, a lot of sugar, milk, so it's a combination of things, and a consultation for us to treat a woman with recurring candidiasis doesn't last less than an hour. There's a lot of things we have to say to women, it's not a recipe for a vaginal cream that will solve the problem. Many times, I don't even give a recipe for a vaginal cream, right? For this woman, I supplement her completely to reduce inflammation, she replaces her vaginal lactobacilli And

then we're ready to feed exactly for a long time there giving guidance And then she comes back and says never again I've had C for diesel and it's also worth not sleeping in panties Definitely, definitely fungus loves sleeping without panties, just please, it's not a wonder Fungus is very good, he You like the place, right? Can you imagine that bread that you keep in the cupboard? It's dark there. The bread gets moldy. Why? Because the fungus likes the warm, humid, dark place. Same thing, our precious girl, you're wearing panties there. You 're leaving the environment

conducive to growth. do Fungo ex very dry, right? If you can use the Zinho dryer in the cold, there may not be any need, you dried well, but you can. Of course, you want to warm up, right? Without panties? It's definitely better, of course, it even helps with getting involved with a couple, right? You already have to have dryer panties. It's also a little hot, it's a little hot, right, it tickles the clit , right? Bru, no, because the best thing is also for us to enjoy and laugh. It's already out Miguel It's already out

of the CTO Oh Jesus Christ guys, but in this photo here it's showing it coming back, right candid, let's go back here, it's showing it, right, a vagina with white discharge looking like curdled milk, plaques, right, an inflamed red vagina, that's it inf, you can see that red is completely different here, it's more pink there, but the woman has a relationship that burns, itches, she doesn't even want to date because it hurts a lot, it's horrible, people, I say again and again that it's like menopause, it's a horrible thing in a woman's life, yes, but

there is treatment, there's a way to get rid of it, it's a bad common infection, it's very common, very common, much more common. treat not only her repeated candidiasis but her entire system, right, we're going to improve the disposition, the intestine, it's related to everything, that's where it absorbs everything into the blood, the whole body, ex, I say that an inflamed intestine is the worst thing that a person can have in their life because everything they eat passes through. So if they are extremely inflamed, they won't absorb anything, then they won't absorb the vitamins, the

nutrients , the proteins, they won't absorb the minerals. It's not something linked only to sex, not at all because sometimes people are embarrassed to look for a professional. That's precisely why, oh, do I have a disease here? Could it be that I caught it in the bathroom while sitting? I don't know what the husbands think, right? There are patients. They say that, doctor, this is my candid, no, Sara, my husband thinks I'm doing something, I say, people tell him that he has nothing to do with it. He's eating a lot of bad sugar, cheating, he's

cheating on you for the chocolate, for the skin, you understand, you're being cheated on. color is exactly what you're doing a lot of things wrong ex and you have to correct all of this when it has to do with sex Because during sexual intercourse in the candid it is very painful it is burning it is confusing isn't it that due to the friction there from sexual intercourse it becomes more inflamed It's more inflaming and even awakens candidiasis right after sexual intercourse, right? There are women who say, Doctor, every time I'm going to have a candid

relationship and then I don't even want to have a relationship for Candid, I haven't seen it, I tell people, look how crazy, right? it starts to interfere with the woman's sexual life, how crazy that in reality that friction only causes the Candido that is there to inflame more and proliferate exactly eh I say that inside our vagina we have a zoo, right we have several bacteria eh We have fungi, but there is a balance between them, right? Our vaginal flora is the lactobacilli, which are our little protective vaginal soldiers, and in Candida, the one who

is on the rise is the candida, the lactobacilli are down there , so we lose our little soldiers, we lose our defense, so we need to increase these little soldiers and to increase them we have to do all this multi treatment, right? are you listening to us who live on candidiasis and on repeat it is possible to live without it? Bru Let's go to our questions or is there something here ? a disease that is very much on the rise, right? Because of this whole scenario of bad habits, right? Once again, we're focusing on this

part, people, habits are very important. Endometriosis is an autoimmune inflammatory disease, in fact, we don't know much about the cause. exact endometriosis but there is a correlation with our immune system and that's when the woman starts there is a migration from the internal part of the uterus, which are the endometrium to the outside of the uterus, right, cells from inside the uterus come out there and go out through the Channel. it comes out through the tube and falls into the pelvis, right, it's the endometrial cells , right? There's even a theory of retrograde menstruation, right,

a woman actually menstruates into the cavity. bladder in the ligaments until it reaches the diaphragm and then this woman starts to menstruate in the pelvis too, so in addition to her menstruating out there, these endometriosis points in the PVA also bleed, you know, an internal bleeding there in the part of the na in the pelvic region and then it generates pain because there wasn't supposed to be bleeding there and women have a lot of pain in endometriosis, right ? women's life women with endometriosis are women who feel a lot of pain and they end up

becoming depressed, so it really affects their quality of life, but there's this whole inflammatory system that generates this endometriosis and feeds it there every month, so once again you have to treat the inflammation in the body, not just block this process. right, that which generates endometriosis but also blocking menstruation is an estrogen-dependent disease, it is fueled by estrogen, right, the female hormone, so in our treatment list we also use drugs that block this, anti-estrogenic drugs, which can be, for example, with the hormonal implant, right, we have a very good medicine for this purpose, which is

gestrinone, which people call the beauty chip, but there is no beauty chip, but gestrinone is a medicine that generates a lot of controversy, right? From time to time release some reports talking bad about the Beauty chip, anyway, but gestrinone is not a Beauty chip, it was created to treat estrogen-dependent diseases, among them, endometriosis is treated very well with excellent results, and it takes many women out of the queue for multiple surgeries because Endometriosis generates multiple surgeries Sometimes a woman has to have a piece of the intestine removed, a piece of the bladder has to be

removed, the uterus has to be removed, the ovaries are young women, I have a 30-year-old patient who was not my patient at the time when she had the operation, she removed everything she took out a piece of the intestine the uterus took out the tubes took out the ovaries she went into endometriosis menopause is surgical because she took out her ovaries and she continued to have pain why Why did she remain there with some pockets of endometriosis still inflamed her doctor At the time, there was no approach to reduce inflammation and she came to me

and we placed a gestrinone hormonal implant. We started a whole integrative medicine program in her life to reduce inflammation, changing her habits, physical activity, good nutrition, she is doing great in the best phase of her life. her very well, she's also replacing the hormones during menopause, right, because we removed the ovaries, so we use a little bit of gestrinone But the main focus is hormone replacement during menopause, which is bioidentical estradiol, bioidentical testosterone, progesterone, progesterone is also in the In this patient's case, we use testosterone and estradiol hormonal implants and gestrinone and progesterone, she takes

it orally, right? There are also these differences in hormonal replacement routes for each objective, exactly in menopause, returning to menopause, right, I'm passionate about menopause, you noticed, right? It's a menopausal woman who has to replace these three hormones, estradiol, testosterone and progesterone, uhm, all of them are molecular molecules, right ? you can replace it in transdermal gel uhum oul hourly we don't replace Vial there is no benefit in replacing estradiol orally, right when it passes through the liver it undergoes some some metabolization and some it causes some interference there in the liver increasing and the

risk of us having thrombosis and it is not legal, it can increase blood pressure and promote diabetes, so oral estradiol that is transdermal is not replaced. It has to be transdermal in gel or hormonal implant, right, and testosterone also in gel or hormonal implant and progesterone we replace oral or in gel transdermal, we have these two routes, transdermal, transdermal and oral gel. The only difference is that in transdermal gel we do not protect our uterus, our endometrium and one of the functions of progesterone is to protect our endometrium so that it does not thicken right,

when we use estradiol we have this risk and it doesn't protect our bones. So it has to be oral progesterone, right? There are countless studies already showing that it has to be oral to protect the endometrium and bone, but the transdermal route It's an option too But there aren't these protections there, perfect, perfect, close expert, Bru, let's move on to the questions, do you have any questions, Bru, for now, enjoying it, right, you don't want to change any precious ones, right, everything is fine, let's see if no questions appear here, at the end, he gets

excited until at the end he gets excited I know it Because there's one he wants but I think he's leaving it if people don't show up here I'll do it for him I already know what he wants to ask I also think he said he said the size of the labia minora, that too, let's go, let's leave it Look here, we have a community called sustainable human being and this community is made up of people who like knowledge, like knowledge, so we always send it to them 15 days before you come here their networks are

where they find you and they probably drink a lot of your content and generate questions like I drank your content and asked my questions. There's still more, right, but in a little while we'll see if they have it. And then we have these questions. that are made by them, okay And then we'll start with everything first ladies, right, because it's a women's program today, not predominantly, right, you don't have precious prose for precious, it's from precious to precious and The Precious here is embedded, stay quiet Miguel too So Miguel, let's go , when should I

start hormonal programming and how implants are made Our excellent question, women have a lot of doubts about when to start hormone replacement therapy when I enter menopause, first of all, what is menopause, right? What is menopause, right? We say it wrong Even as doctors, we use the term menopause a lot as climacteric to facilitate language and communication, right, with lay people, menopause is actually a woman's last menstruation, it's a date, right, and it's a retroactive date, right, My menopause was H um year ago, right, so if the woman menstruated in February of last year, it

was only in February of this year that she could say my menopause was February of last year, right, one year later, it's a retroactive diagnosis, so menopause is the last menstruation as the first menstruation is Menarche, menarche, which happens between the ages of 10 and 14, is the last, the completion of a woman's reproductive state . An old car broke down, died, it's over, it won't come back to life, but it's an organ that dies and we have the climacteric, which is that phase that precedes and also after menopause, which is the climacteric, right, from

the age of 40, which is the climacteric, and pre- menopause which is from 40 to more or less 50 years of age which is more or less the age at which a woman enters menopause and goes on until 69 years of age which is the post-menopause climacteric, ok, so there is this difference in pre-menopause climacteric climacteric and post-menopausal climacteric, so when we talk a lot about menopause, menopause, we want to say climacteric , climacteric, climacteric, but women don't know much about this term, right ? We already have to think about hormone replacement Because from the

age of 40 we start to see a huge decline in our hormones, right ? to have an intensification of your PMS, more abundant flows, more cramps, right, pain in the hands, we are already having a significant drop in our quality of life, so it is now time for us to start hormone replacement, you know, progesterone and then after 40 we a drop in our estradiol begins, it is often necessary before menopause to start estradiol in low doses, right? It depends on the woman, it depends on the woman, she starts with insomnia and a change in

mood, she starts some sporadic hot flashes, right, not so many, right? As for menopause, hot flashes start from time to time with memory problems, so we can also start replacing estradiol and testosterone also starts to reduce libido, enjoyment of life, testosterone also has a lot to do with our mental well-being , right ? start a hormone replacement schedule from 35 onwards from 35 we generally start with progesterone Uhum And then testosterone and estradiol is generally the last one we start replacing and a way of resting hormones is through hormonal implants, right the implants they are

a way administration of hormones, such as the tablet, the injection, the patch, the implant is also a route, right? So we have implants that we place in the subcutaneous region in the gluteal area, right under the skin, it 's not the implant that you put here, it has nothing to do with it. that there the implan uhum and just now he put a photo there it is of the implant here in the arm it is not the implant that we use it has nothing to do with that it is the implanon which is an industrialized

implant with a hormone called etonogestrel which is for And contraception, so we use it in younger people to keep women from menstruating, it can even help in the treatment of endometriosis, but it's not a good choice, okay, it's not a good choice, but many gynecologists put endometriosis in these women. I don't put zero and then the implant. hormonal that we do hormonal replacement It's not that, it's not the implant, they're not implants and manipulated, they 're made by a masterful pharmacy, an appropriate pharmacy to make the implants, they're all sterile, individualized dosage, exactly what changes

from one patient to another is the dosage the milligrams the quantity Sometimes we use several very cool tubes photo here to show the difference between the two types of implants that we have on the market which is the sás implant which is this long tube it is a silicone we me I always show it in my videos like this, stretching it and this smaller one is the absorbable implant, it's like a little pill, okay, it doesn't have anything protecting it, it doesn't have silicone like the other, the difference is that the nonabsorbable implant, which is

the silicone one, has duration of one year Uhm and it doesn't absorb the silicone in a year we 're going to take out these empty tubes, they don't have to take them out, but imagine a woman renewing her implants every year. No, it's not Of course, it forms a bit of fibrosis there, when we go to remove it, we have a little difficulty, we have to give it a little pull there, we do local anesthesia, everything is fine, but it doesn't, it doesn't, it won't deform the region, it won't happen with time the body won't

want to expel them, there isn't , there isn't, but every year we take them out and put in new ones . absorbable They don't need to be removed, but they only last for months, on average, it's 5 to 6 months, and what's the disadvantage of both, this little pill, if I want to take it out before months, I can't. So, if the patient doesn't adapt or If, I don't know, she develops breast cancer, I have nothing to do, I can't take it off, I have to wait for its effect to wear off, the other one

doesn't, I have the patient in my hands, I can take any time off, so the patient hasn't adapted, she doesn't want to. come and have anesthesia shot right away So this is the great advantage of the silicone implant which lasts for a year and the bioidentical one too, right And they are both bioidentical, okay, I'm not talking about gel, the little gel I didn't understand the question so you're not answering Ah for You also have the control of not needing it, no, it wasn't great, for yes, it's a gel in relation to the implant, right,

right? Exactly, everything has its pros and cons, right? Forget it, it really depends on the work of the pharmacy that is handling it. There are months when it is legal, there are months when it isn't. Then it's over, there was no time to handle it. I forgot, so I ran out of the house, I didn't pass by, there is a risk of cross-contamination if you touch someone passing by. the hormone but you have control in your hands I don't want to use it anymore I stopped using it mine is with gel with gel and I

don't forget I don't forget the skinc how come V forget everything is there perfectly I travel I travel everything is beautiful there in the backpack in that little handbag it's all there without hormones it doesn't stay Oh that's right but that's discipline it's discipline we have to have it, right, hormone is life, right, hormone transforms ours life how are we going to be without him, we're going to forget that he has to have this affection with us Of course it's not even care, it's definitely affection So we have this replacement route, it's hormonal implants and

the others that I've already explained next Bru you What are the main health risks associated with hormonal regulation there is evidence that hormonal regulation increases the risk of cancer that you explained wonderfully well people at the beginning explained the hormone taken from the arrived now go back to the beginning she explained Mariana explained it very well. I say that the risks are related to hormonal deficiency, not hormonal replacement, so let's change the word, the risk is related to hormonal deficiency, which are numerous, right, the increased risk of cardiovascular diseases, right, the lack of estrogen, eh?

it causes vasoconstriction due to reduction of nitric oxide So this woman has a higher risk of heart attack due to vasoconstriction increases the risk of osteoporosis decreases the absorption of calcium in the bones so the woman has a much higher risk of post-menopausal bone fractures and increases the risk of dementia because hormones also have an effect on our brain, right? All of them, estradiol, progesterone and testosterone, we have an increased risk of hypertension, diabetes, we increase insulin resistance, with hormone deficiency, it increases uric acid, making the body even more inflamed, so like that. If we're

going to talk about everything that a lack of hormones causes , we'll have a separate podcast just to talk about the evils of hormone deficiency. I never took hormone replacement therapy due to my predisposition to breast cancer Is there any safe hormone therapy for me to consider and it's the same question I think I think the predisposition she means must be someone in the family in the family exactly she didn't have I think and there is a safe hormonal therapy to consider, it is safe with bioidentical hormones Exactly, look, the doctor also talked about this,

her mother had cancer and she and that is the only contraindication, the mother cannot but she because her mother had it mother having had cancer there is no problem she can use it only contraindication next Bru What are the essential hormones that we need to replace during menopause I already said, right estrogen estradiol progesterone and testosterone exactly the three are perfect pass BR the dosage of testosterone is essential to increase female libido how can doctors prescribe testosterone to women funny people, right, many doctors say that testosterone is a male hormone, you've heard of it before,

but come here, we only have testosterone, the male hormone is for men, there's nothing, women don't need testosterone Guys, I say it's a crime to say that to a woman, right, testosterone is a male and female hormone. The only difference is that men have more testosterone than us, 10 to 15 times more, that's why men are stronger, generally men they have much more sexual appetite but it doesn't mean that we don't have it and don't need it, we need testosterone, it's the hormone that has more than 200 metabolic functions in our body. So you can

imagine the lack of it in our body will harm 200 metabolic reactions, it's a lot and the Testosterone goes far beyond libido But it is essential for libido, without testosterone, you don't have libido, muscle mass or muscle mass, exactly post-menopause, women atrophy, they lose a lot of muscle mass due to the lack of testosterone, they lose muscle, they lose bone, right? Then she gets there in her 60s or 70s, she's all atrophied, full of pain, walking very slowly, sedentary, can't even do physical activity, zero hormones because the hormone causes cancer, right in her head Poor

thing And that's what happens, eventually, women end up having to replace testosterone, yes, ok And a good way to replace testosterone is with the gel or with the hormonal implant, which we've already talked about both, right, both ways are excellent, always bi Identical or molecular ISO, always bi identical, it's not legal to replace intramuscular testosterone uhum, that 's it. which men use a lot, right, and to get strong, intramuscular testosterone gives a lot of spikes and fall, right, we get that mon, that rollercoaster effect So it's not cool, it's not a good replacement, okay, and

in these peaks, women have a lot of side effects, right ? it's a legal replacement route not even for men, in fact the ideal is more the gel, the gel or personalized hormonal implant with the dose for your weight according to your exams your age we evaluate several variables to replace to prescribe the perfect hormonal implant next Bru how I can alleviate the symptoms of menopause with hot flashes like hot flashes like hot flashes people have hot flashes, right? It's the most common symptom of menopause . It's the symptom that takes away a woman's peace,

can you imagine here, we're on the podcast, suddenly you have a hot flash crisis, you started having hot flashes a lot, because I started before but like that. There was a time when I forgot, I didn't have this discipline, I became a Time without Nosa is a horrible thing, it's horrible, but I replaced it soon and came back quickly the woman is here chatting all of a sudden, sweating is sudden and suddenly it comes up It seems like a stove was turned on and it's usually from this region up here and the sweat is terrible

It's terrible, so it feels hot and after a second or minutes it gives you a chill, the skin becomes cold exactly And then you dry it, which is an adrenergic discharge, right? Exactly what happens in a hot flash, estradiol, right ? in menopause it has an action on our thermoregulatory center of our temperature there in our hypothalamus and with the lack of estradiol we lose the finesse of controlling our temperature so suddenly our thermoregulatory center detects that our temperature has increased a lot Uhmm And then it causes that rush of noradrenaline, an intense vasodilation and

that's where that heat wave comes and it's sudden, it can't control our thermoregulatory center, it can't control it subtly when we used to do it when we had adequate estradiol. so the lack of estradiol makes us lose this control and we have that very intense vasodilation to throw this heat out because our temperature has increased a lot and soon after we have vasoconstriction to be able to hold back this intense heat that we lost in the wave of impressive hot flashes But it's not just a hot flash Bia, every time we have a hot flash

crisis we have microthrombi in our brain, in the heart, so the hot flush increases the risk of us having a stroke But why because of the vasoconstriction due to the vasoconstriction that we have very intense, we don't have the subtlety there to do this vessel dilation and vessel constriction first is very intense vessel dilation that very intense vessel dilation loses that heat and the vessel constriction is very intense and this leads to microthrombi and microthrombi in our brain and heart, so hot flashes are correlated with increased risk of cardiac risk and cerebral vascular cereal, this

is a perfect stroke. Okay, so it's not just a hot flash, we have to treat people and treat them with correct hormonal replacement, mainly estradiol correct for sure correct next Bru How the laser intimate surgery procedure is done does it cause pain how long does it take on average for healing after intimate surgery I'll answer because you've already explained This you already know everything about it look it's 30 days it's zero Zero it can't maintaining sexual intercourse for 30 days is the cause She says no but you ask for local anesthesia ok because they always

say no So ask for local anesthesia, right, for the girl to look great in the surgery, we do it, I don't, we don't do it at the intimate laser, at the laser of the canal which is not really necessary but in surgery Yes we do it it causes pain no no so how long does it take on average 30 days it's ready 30 days you're perfect perfect Okay, good people did it, see, you can tell your patient there it says take a course out, it's close Bru, the skin involved in intimate surgery has innervations that

can affect sensitivity and pleasure, she also answered this and responded very well, saying no It will also greatly improve your sexual relationship, your self-esteem, your security as a woman and depending on the clitoris, the glans will be more protruding, we will even work with it there, hey, I got two accessories, take off the hood, right, and the clitoris will be much more prepared. so better more likes delicious Cheerful willing empowered woman that's what I loved next Bru, you are, I am, how can I alleviate thyroid-related symptoms Ah, I'm passionate about the thyroid, we talk very

little about it, right, you said at the beginning C, I had to see the tests See how the thyroid was, you said that, thyroid, there's no way to take care of a woman and not look at her thyroid, it's impossible, thyroid, it produces an extremely important hormone, which is the hormone T3, which is the hormone of metabolism, right, so there is no metabolism without T3. Therefore, there is no quality of life without adequate thyroid hormone. So we have to take care, the thyroid is a gland that is located here in our neck, which is extremely

sensitive, so many things interfere with thyroid hormone production, right? For example, nutritional deficiencies, lack of iron , zinc, selenium, iodine, metal poisoning, lead, Mercury, chlorine poisoning, fluorine, bromine, inflammation, all of this interferes with our thyroid hormone production and subclinical hypothyroidism is very common, which is a person who has hypothyroidism whose tests show normal and they have all the clinic all the symptoms of hypothyroidism are often even replacing the thyroid hormone T4 and even so it continues with all the signs and symptoms of hypothyroidism why Because she doesn't have T3 which is the active thyroid hormone

uhum right the thyroid she produces T4 80% of production is T4 which is a pre-hormone uhum and only 20% of T3 but the rest of T3 is produced in the periphery there in the liver in the kidneys in the brain in other locations and T4 In fact it is a pre-hormone, it is a precursor to form T3, but it does not have hormonal action, we do not have hormonal receptors for T4, we only have them for T3, so for T4 to become T3, we need some enzymes called deid dominas and we need zinc selenium magnesium

so a simple selenium deficiency can lead to hypothyroidism Quad the person cannot convert T4 into T3 and it is also important to repol T3 Bia in people who have hypothyroidism you use T4 right T3 and T4 are you you use T3 is also T3 but you spent a while using only T4 because until today the knowledge of most doctors is only T4, although it is considered normal, but it makes a difference, you know, because thyroid tests show normal and Even so, the person has a deficiency because when it is time to capture these hormones in

the laboratory, the machine measures all the T4 and T3 that it sees in the blood, but many of these T4 and T3 do not have hormonal action because they are not connected to iodine they are connected to fluorine, chlorine and bromine Uhum So the machine doesn't know how to make that distinction so many times you see your Laboratory test of normal free T3 but there in that environment it's full of aberrant T3 T3 that doesn't have iodine which is linked instead of T3, it is a tyrosine linked to three iodine, then you have your T3

with a tyrosine linked to three chlorine, three fluorine, three bromine which has no hormonal action, but in the exam it will be normal because it will measure everything The world is going to put everyone in the same bag, understand, and one of the ways we can assess our thyroid is by measuring our temperature in the morning when we wake up, right? body temperature then in the morning Give in or wake up before getting out of bed under the blanket don't turn off the air you leave the thermometer there put it in your armpit measure your

temperature for five mornings in a row your temperature has to be between 36.6 to 36.9 if it's in that range it signals that your T3 is at adequate levels, it is doing one of its functions, which is to maintain your basal temperature, if it is below that, you probably have a low T3 and there could be countless reasons, all of those that I have already mentioned, okay? It is also very important when replacing thyroid hormones to always replace T4 and T3, we also don't replace only T3 because it has a very short half-life, right around

5 to 6 hours, this also affects the dosage as well and T4 remains like a reservoir there so it is important to replace both together and those who do not have a thyroid are recommended. replace thyroid extract have you ever heard of thyroid extract no no it is a form of bioidentical thyroid hormone replacement Uhum it is extracted from the thyroid of pigs and sheep which molecularly speaking, biologically speaking is similar to our thyroid so extracts are taken from that thyroid and it is made, it is made modified there in the laboratory and the thyroid

extract is manipulated, so the person who does not have a thyroid is recommended to replace it with the thyroid extract Because in addition to T3 and T4 there in that manipulation there is T1 and T2 which also they are hormones produced in the T oid have no hormonal action but they also serve to convert into T3 then there is calcitonin which is another hormone that we lose when taking the thyroid, right so it is a more complete replacement when we use the thyroid extract it It can be manipulated, you can buy it imported, it 's

widely used in the United States, and it's a bioidentical replacement . from pigs, it's biid, it's bioidentical, ahem, biologically, it's bioidentical, it's at the level of a perfect bioidentical molecule, that's good, and we don't talk about the symptoms, right ? It's part of it, part of it, they're not diagnosed, right? They start taking antidepressants. In fact, he has a T3 hormone deficiency, hair loss, slow intestine, slow thinking , anxiety, it can change our blood pressure, swelling, so there are many symptoms, there are many negative things, a drop in libido. that happen due to a lack

of T3, everyone thinks, thinks, a slow person is a person with hypothyroidism and is very close to Bru, there are vitamin and mineral supplements recommended to improve women's intimate health It depends on the person, right, that's what you said if you have it candidiasis has to be in the intestine and there are supplements that are kind of standard for most people, which is what you supplement with omega-3 and we end up having a dietary deficiency so we need to take omega-3, it is a supplement that helps a lot with this. deinflammation of our body in

general, right in the functioning of our brain, our brain It needs omega3, right, to function, uh, magnesium, we have a magnesium deficiency in Brazil, right, Because of our soil, so it's also important to replenish what we need. in many cases, supplementing with vitamins from the B complex because they participate in our entire metabolism, exactly in the methylation process, right, repair of our DNA and in the production of our energy, so there are some things that kind of pattern that we use turmeric, very important, right? Doctor, what is turmeric for? What is it for? Anti-inflammatory and

PR? Everything? Everything is good for memory? It? s good ? Wow Fantastic anti-inflammatory antioxidant creatine without even me, I take it every day turmeric with piperine with piperine exactly, you see, all women should use it, seeing uhum, there the shozin No, mine is already in the Zinha capsule, it is with 98% curcuminoids, very concentrated Zinha capsule, I don't I like to take it in powder form, I don't, I don't like the taste, I prefer the capsule. My capsule is very comfortable, but the dose is that of my deil Lui in four, right, but I take

it, I think four capsules. Yes, yes, and then vitamin D, right? hormone D is very important, right? Forget laboratory reference People, for the love of God, that reference simply tells us what the person's risk is for rickets, that's all, nothing, right, but above 20 there is no risk below 20 there is a risk but it It's much more than just rickets, right? We have 200 genes in our DNA that are activated directly by vitamin D, so so it's so important that it has to be taken, you have to leave it at high levels [Music] uhum,

it's very likely to happen Man, vitamin D is over 80 important, so you have to see there creatinine urea cysteine ​​also do you have doubts about urea creatinine watch this, it's not simply take , right, the supplementation, it has to be directed by a doctor, no, I'm going to give a command to buy D said no, not like that, ca no, cystatin catin, compared to us, we need to have medical monitoring, right, so it's important every six months, exceeding one year We have to do our periodic exams, we are evaluating, I say every six months,

please, a year. A lot of things happen in our body, we get stressed a lot. We can have a lot of stress every year . at optimal levels, right, vitamin, it doesn't have to be within the laboratory reference, it has to be at optimal levels, right, vitamin B12, forget the laboratory reference, oh, 180 and I think up to 800, which the laboratory says on average today, up to 500, I don't say people. for the love of God vitamin B12 its optimal level is above 800 great level ex ex to start the game to start for

the love of God above 800 same thing Ferritin you will look at the Ferritin reference it says that above 10 is normal and it goes up to 390, I mean people, what do you mean? 390 the person is totally inflamed and is already on the verge of death and 10 the person is totally iron deficient, right? the hormone converts the T4 hormone into T3 to produce your sexual hormones for the functioning of all your cells, right, the body cannot function without Iron It's true, so Take care of your Ferritin too, especially next Bru, what are

the essential tests that every women should do it regularly to evaluate the functioning of each of our organs, our kidneys, liver, there are more than 50, right, they are quite a lot, and the imaging tests for us to evaluate the structure of our organs, look at the liver, if there is no fat in the liver, which is something like that It's very common, it's difficult to have an abdominal ultrasound without hepatic steatosis, I always tell patients, look, your liver is extremely inflamed, oh, doctor, the liver is so common for people to have it, yes, people

have it so much, but it wasn't supposed to, right, it's a liver that's asking for help you imagine your liver which is your detox organ that everything happens there it is inflamed who is going to do your detox if it is inflamed imagine the rest who is going to defend you if your liver is completely inflamed so take care of your liver, right? and hepatic steatosis, it leads to cirrhosis of the liver, which leads to a liver transplant queue. So people joke a lot, people are very worried about alcohol, alcohol is also a lot because

alcohol is also a sugar, so it also contributes to this, but there is this Rose of people who never drank non-alcoholic for this ató aló for orange juice saw people for juice excess of fructose, right people they they don't they think that the fat in the liver is due to fat from food, right from frying oh oh but Doctor I almost don't like frying there is fat in the liver, isn't it people, it's from excess carbohydrates the body is so saturated with carbohydrates it has already saturated the glycogen which are our carbohydrate reserves and then

it started to accumulate inside the hepatocytes inside our liver cells and then it it's overflowing so I say this, imagine a liver cell like this, no, the excess, the excess sugar turns into fat, exactly the excess carbohydrate turns into fat, it is deposited in the liver, it lasts and then leaves it extremely inflamed and this is due to the excess carbohydrate in the liver. soda from processed foods from alcohol from juice, right, people have a lot of fun with juice, right, but juice is from fruit, fruit and fruit that the person, I had a patient

whose insulin shot up, I said what What's going on, she doesn't look, I'm not eating this, I'm eating, I'm not eating something, let's go, fruit Oh, no fruit, Doctor, it was persimmon, she bought the box, bought six and ate it with everything, okay, I told her, I don't believe it, you can't do it For the love of God, it's bad for the love of God, it's fructose, it 's much more harmful than glucose itself . fiber connected to fructose The worst thing is the juice that the fiber was once Bel n only has sugar S

sugar So if you suck on an orange it's one thing it's messy with the fiber now drinking a glass of orange juice there's four five orange and only sip in a matter of seconds you have a spike in glucose a spike in insulin goes to your liver to deposit it as fat, right, fructose, it has seven times more power than glucose to create glycation, which is what rusts our hemoglobin and which is the protein that carries our oxygen, so you can imagine glucose, it binds to our hemoglobin, that hemoglobin, it becomes rusty, it becomes glycated,

it can no longer carry oxygen, so the person becomes inflamed, generating oxidative stress and the Fructose has seven times more glycation power than glucose itself, so seriously orange juice also causes hepatic steatosis. in the morning, beautiful, right in the soap opera, right, breakfast with orange juice, people, be very careful with this, people. Hotel, also, not for love, don't do this next time, Bru. What are the most effective causes and treatments for candidiasis? Diaz, we talked and it was beautiful, beautiful, beautiful I even said that I think it's good to sleep without panties I think it's

good to use the dryer to play it was a moment a laughed b we called miguel miguel had already left, right out of shame, that's when we talked about the part about sleeping without panties you weren't here love where were you I was using the hairdryer in the bathroom so I wouldn't get damp, you know, playing with the hairdryer also makes it itchy, you see, without underwear, I practice what I say, people have to practice. I also sleep without underwear, I was going to say what do you mean, not without underwear, and Dr Rafael taught

this here Rafael Siqueira was also Ch de dick talking about C diesel I'm going to teach a homemade recipe that frees women from a crisis of c diesel, okay Sometimes the woman is at night, there's no way to talk to the gynecologist, there's no prescription to buy vaginal cream but she has bicarbonate at home, every woman has bicarbonate at home, it's not easy, go to the market and buy that bicarbonate that is sold in the market. There's a tablespoon of bicarbonate, add 1 liter of lukewarm water from the shower, you really need it Sterile water,

okay, we put a penis in the vagina, you put it in the vagina, ex I think it's hypocrisy, there's no need for that, there's a lot more going on, that's it, that's what God solves. So take 1 liter of lukewarm water from the shower, a tablespoon of baking soda, give it a little stir. with your hand, take a 20 ml syringe without a needle Of course, fill it for the love of God, it has to be clear, fill the syringe and sit on the toilet, fill the syringe and inject it into the canal, right inside

our precious essence lying down with the little leg up because then Go down but it will get everything wet, right? You have to sit on the toilet and stay there for about 10 minutes, fill the syringe, inject, fill the syringe, you don't need to inject 1 liter, ok People, for the love of God, so you will never leave the bathroom for another 10 minutes. Soon, the woman leaves the bathroom without candidiasis, it's not CS, it's because of the candida, she likes an acidic environment, so the more acidity, the more the candida throws the bicarbonate at

you. there that crisis alleviates, oh guys, I say that I make changes myself until you make the changes, it's not to cure the repeated candidiasis but it will get rid of that crisis there That moment that discomfort until you proc noina for fever that and beyond then to finish you do this you can do it twice a day when you are going to do it and at night you go to bed to sleep it ends up passing a little of coconut oil inside the vagina, there is extra virgin coconut oil, you can get it really

hard, you take that paste like this, put it in the canal, make a That's right, that's right, make a 360 channel there in the vaginal canal and leave it there and lie down to sleep or take it if it has liquid with the syringe there 1 ml inject it into the canal already read what coconut oil turns into an oxide it has lauric acid which turns into monolaurin that's lauric acid which has antifungal properties so guys Treat, treat you, then you will tell me, send me a direct message on Instagram, it saved me from the

crisis, I can say, I can tell my daughter in Bahia, all women put coconut oil in their vaginas during intercourse, in the greatest peace of mind, wonderful people, relationships to lubricate to lubricate for Don't give candidi after prevention, as well as being antifungal, it's also antibacterial, so you can use it every day, look at that Mercado Modelo in Salvador, we learn a lot, no, I'll even give you a tip, you can get an empty pill card and fill it with coconut oil. there liquid and put it in the freezer make some coconut oil capsulin and

then you put it in it precious put it to sleep Salvador the blessed land Ah I love the people of Bahia I go there every year to the Hormone Implant Congress am they give this tip ok they are wonderful They are really close Bru What is the relationship between HPV and cervical cancer a lot of relationship in fact it is the main risk factor for cervical cancer it is HPV that is caught in unprotected sexual intercourse, right these days until Ana Maria Braga was talking on television about the cancer she had in years, right in

Fantástico, which was caused by HPV. So it can cause cancer in the cervix, in the vagina, in the vulva, in the penis, in the throat, in the mouth, okay, she said it came to light I even recorded a video talking about this report of hers so and it is prevented with condoms, right, it's not just in oral sex, it also catches secretions contaminated with HPV ex exactly, right, so it's not just there in na na penetration, it wasn't good for you to say that, right? Because people think it's just the uterus, the uterus, the anal,

the throat, the penis and the HPV, until it reaches a point where cervical cancer takes many years, it's not like that, I got it today, next month, no, it doesn't, it takes more than a decade, so that's why it's important for women to do preventative care every year, right, because we detect pre-cancer lesions, the lesions that can lead to cancer, right, the intraepithelial lesions there, how is it? colonoscopy, right? It's definitely those little polyps that can turn into cancer that you also need to treat And then everyone discovers these lesions, cauterization ends there, the momentary

problem continues with monitoring, right, because HPV can continue in the person's body exactly calization doesn't eliminate it, it eliminates the injury it caused, but what will eliminate it? It's your immune system, right? That's why it's important to take care of the immune system, which involves taking care of the inflammation, treating the inflammation, right ? tried, right? It's excessively inflamed because we have the level of inflammation, to live is to become inflamed, right, you breathe this infl, you breathe, you inflame, there's no way oxygen, right, now you have a level of inflammation Of course, the level

that your liver can eliminate, right? the liver has hepatic steatosis and it's ruined everything, he's dead, let's go, Doctor, what every woman needs to know before taking birth control pills Is there a contraceptive method with less risk to health ? a woman who is known to have a regulated cycle is Exactly and it was cool, we hadn't talked about the contraceptive pill yet, right, and the contraceptive pill does increase the risk of breast cancer and thrombosis and it's on her leaflet that day I recorded a video showing the leaflet, I say people, these pharmaceutical companies,

watch my video, they're not going to sue me, but it's in the leaflet that it increases the risk of stroke, thrombosis, breast cancer, diabetes, tension, insulin resistance, thyroid changes, okay, people, it's not me what am I talking about and if woman take a sink and smoke, my dear, don't prepare the coffin because the thrombosis will come. And if she has a migraine, then it's worse than women who have migraines and take pills. They have a greater risk of having thrombosis, right? Especially if it was a migraine with Áurea that she see all those little stars

there Okay, for the love of God, don't use pills for migraines, okay, that's poison, that's what increases the risk of disease and it's funny that people are afraid of taking hormone replacement therapy for menopause but they're not afraid of Exactly take the greatest happiness every day, right next Bru ah Mariana We arrived at the moment pipinho pipinho is our brain this is our mascot our wonderful symbol he is always with headphones because he likes content like yours he must have learned a lot of things he is getting into teenagers are going to have to get

their HPV vaccine HP, sure, we're going to take him to take it, God willing, a condom for a condom too, dear, because that's health, and then he certainly likes ping-pong a lot, he asks some questions that the His mother plays it for you and you answer what you see in your head, okay, simple and quick, if you don't want to answer, pass it, it's okay, democracy Come on, I love it Come on, love, love, I think it's the basis of everything, right, when we is a Loving person when we have love in life I think

everything flows and generates kindness generates generosity when we have love for others we have to have a lot of love for God I say that God is the basis of everything in our lives right, and self-love, right, how many people don't have this self-love, their self-esteem is very low, and when we don't have self-love, nothing flows in life, right, it's important, love, you have to take care of it, it's the fuel of life, right, motivation, motivation, what motivates me It's the feedback I hear from my followers, my patients, how much I teach, how much they

learn, how much my teaching or treatment has transformed their lives and this motivates me to continue on the path I'm studying every day. But I don't listen to criticism from people who aren't on the same path, right? I say that I'm completely out of the box of doctors in my specialty, and I don't care about criticism, that's already part of the past, today what matters to me are the people that I really help in some way to transform their lives This is my perfect daily motivation God God is everything in my life it is my

basis for everything I have a very great intimacy with God I love God so much Jesus he is everything In my life, it's the moments that I kneel down, I ask him, in the good times, the bad times, for protection, I asked God a lot for this podcast here today, look at these people who come here, they're praying, right? I prayed a lot to God, asking him to give me wisdom because you are two beasts, right ? God and you, thank you very much, thank you, first of all, I miss you, I miss my father

very much, my father is deceased, I lost my father when I was in the fourth year of college and I was very attached to my father, I lived with him at the time So I suffered a lot, I lost my father to lung cancer due to smoking and bad smoking habits and I miss him very much because he was very proud of me, where he said my daughter is studying medicine and is going to be a doctor, he was more proud of me. pride and I'm sure that today he would be very proud of me

or he is, right, I am, I believe he is seeing all this, yes, so I miss him very much, like his name Durval Durval died very young at 57 years old and was very suffering For me, I was like this at the height of college, the year where we're studying all the clinics, it was class in the morning, in the afternoon, at night, that madness, so it was a huge blow in my life, but I remained firm in college, eh, resilience, eh, I'm very resilient, right? I think we have to always pursue our goals, never

give up, regardless of the circumstances, always put God before us everything and persevere, right, be resilient because when we sacrifice, we commit, we have discipline, we conquer, right, the result comes, right, so I have it in my head and as a PR in life, resilience, happiness, happiness is doing my job exactly the way I work, I talk like I'm already in my career. My professional happiness is my family, my daughter, my family is healthy, I have a 19-year-old daughter who is studying medicine, that's my greatest pride, my happiness, my husband, who is my partner is

with me everywhere so much so that he is here behind the scenes of the podcast hey my my family is my base my grandmother my mother my brother so Eh everything in my life is perfect innovation innovation I consider myself an innovative person, right Eh I've never been inspired no one in my field, I don't know if it's Audacity of me to say this but I'm very authentic I really do what comes from my head I wasn't inspired Ah I was inspired by this gynecologist it's not really I am what I show by building I

was building and I I consider myself innovative because I carry out a very different treatment from doctors in my area, I am even criticized by many doctors for my authentic spontaneous way, but I am highly praised by lay people who are the people who move me, right? Just like I said at the beginning, so I work for them for them I don't work to make my colleagues happy but rather to make my audience happy and transform lives perfect if I could enter a time capsule in which moment would you like to go past or future

the future no because I think that could cause me fear of seeing something there in the future or it could change my path and I wouldn't reach that future there but in the past I think it would just be to meet my father again, right? If I could meet my father today the way I am in the past I would be very happy, you see, who knows, right, Doval, but when we think, we come back, right, and the last one, complete the sentence, being a woman is everything because we women are, we are everything, right,

we are multivalent, we are a working mother, a student, we We can handle the world, we fluctuate every month and even so, we can generate lives, right? Just like Alex said at the beginning, only we have this power to generate lives, and we, we have to be strong at all times because our family You need us, you know, it says that men are the basis of the family, but in reality I think it's the woman, the man provides the support there, but I think the basis is women. So that's it, women are everything and women

can't get used to living poorly , that's her motto, my dear, I wanted to offer you here as a gift the book Happiness o gratitude o depressive minds which I also talk about the hormonal issue there and windows of the mind which are stories based on real cases that I have seen and we just you changed names , right ? to be so I'm very proud to be here for having received this invitation, I can say enough is enough for the person to do the work of dedication that this chair is not for the privileged,

it's not chosen because it has a thousand likes because it has, I don't know how many, it doesn't, it doesn't have that really criteria, right? And it's also not for anyone to pay, no, you see, and you know because there are people who have already paid me, they think, right? We like to tell the truth, I wish you would now use this camera here, this one for you, to give all your messages, your networks, if there is a course, where can I find you ? No [Laughs] I'm an integrative gynecologist who loves women, loves helping

women transform their lives, right, there's this flag, this is my motto Daily, that women can't get used to living badly, I say this daily on my Instagram, I love teaching, I love through my videos know that I'm going to touch any woman wherever she is, anywhere in the world, women that most of them won't be my patients but I know that a word I gave in the video Can IMP is positively in her life because I receive this feedback from many women, right? for those of you who need to take care of yourself, have self-care,

take care of your health, your diet, physical activity every day, it is important for us to have this practice of physical activity, this self-care, right, eating well, supplementing, replacing your hormones when necessary, but for that you need to be care by a professional who is up to date and is integrative and I am an advocate for women in menopause because they are women who I consider to be very unassisted who need this support and women in menopause can live the best phase of their lives, believe me, you are in menopause suffering, living poorly, but guys,

I'm so bad, but it's possible to live well in the best phase of your life during menopause. You're post-menopause, yes, I have a project now that's in the works for a course for lay women about menopause so you can understand everything about menopause, women don't understand, they don't really know what menopause is, what hormones are missing, what do you have to do, what can you do, what are the risks and I want to teach women through this course so that they know why Don't depend on doctors to learn and know but soon more information about

this and gratitude is about that Follow me on social media I have an Instagram which I am very active every day I show my daily life my habits I talk about integrative medicine who is doctor Mariana Amália Follow me there and you will learn not only about medicine but also about life about care you will know about my personal life my family my cat everything is perfect dear we are finishing another episode of POD today was with this wonderful person here, if you don't know it, you should know it if I were you, follow her

on Instagram D Mariana Amália and there you have all the information about the courses she will take, the things she recommends, what she recommends, what she even material for you to study because here in our pod people community only those who like the knowledge of self-knowledge are worth it because we believe that this is the only way for you to have freedom and achieve the health that you deserve who doesn't follow follow here touch the Bell for you to receive all the news from the channel, thank you very much and see you in the next

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