You Ask. I'll Answer!

Why shouldn’t I twist the Julva® 30-day cap?

This cap is made to protect the applicator and has to be pulled off. If you twist the cap you risk unscrewing the applicator and possibly spilling the contents.

What will I receive when I order your feminine vulvar rejuvenating cream, Julva?

You’ll receive a 1-ounce tube of Julva.

What is the dosage for Julva? How long do I use it?

Please begin using Julva at ⅛ tsp (0.6ml) daily.

Some women will need less or more cream as time goes on. You want to use the smallest dose possible that provides relief.

Use Julva for 30 days at the recommended dose. We expect you will see improvements in 6-8 weeks although many of our clients experience more immediate results. After 30 days, if you have not experienced any improvements, it is generally safe to increase your Julva dose up to ¼ tsp daily. We suggest you consider twice a day dosages at ⅛ tsp daily. We don't recommend more than a ¼ tsp daily.

After the initial month of use, and once you’re experiencing improvements from daily use, you can go into a “maintenance” mode. Maintenance dosing is typically 5 times per week. You should continue at this maintenance dose. Note that if you discontinue use of the product you will return to your baseline.

You may notice a warming and/or tingling sensation at first, which should not last longer than 10 to 20 minutes (It’s a similar sensation to a lip-plumper).

If the warming and/or tingling sensation lasts for longer than 20 minutes, discontinue use of Julva for 72 hours or until symptoms subside. Restart Julva at ½ the dosage. If symptoms re-occur, discontinue use.

How should I apply Julva?

You can safely apply Julva with your fingers or with tissue paper and wipe. Wash your hands afterward.

The cream will be well absorbed within 20 minutes.

If you have children in your house that could use your hand towel, please keep one separate for you only so they are not directly exposed to the cream. While Julva is very safe, it does contain DHEA and this is for you and not them! (This is the same advice I give to any man or woman using any hormone creams). It is safe for your partner however!

Here's an informational video I made about Julva. You can see it on YouTube...

https://youtu.be/CSk-7vmC4pA

Where should I apply Julva?

Apply it to your vulvar area from your clitoris, along the labia, to the rectum.

These tissues need the most nourishment. You can also apply to the delicate skin of the urethra.

Julva is safe to apply to skin anywhere on your body. Before first use, it is advisable to test Julva on your inner arm for 24-48 hrs to make sure you don't have a sensitivity to it. Few people will, but it is always a good idea to test for sensitivities with anything you put on your skin.

If irritation does occur, discontinue use of Julva for 72 hours or until symptoms subside. Retest at ½ the dosage. If symptoms re-occur, discontinue use. Note that for a very few women, use of Julva may cause itching due to yeast. The issue is that when you start using Julva you go from an incredibly dry environment in your vulvar area and surrounding tissue, to a very moist one. And moist environments can initially result in increased levels of yeast (as they just love moist environments!). Should this occur, simply start on an anti-yeast protocol: Use an over-the-counter antifungal (such as Monistat), bump up your probiotics (either eating fermented foods and/or using a probiotic supplement), and be sure to avoid sugar (that yeast love).

Does it matter when I apply it (morning or night?) Can I apply it prior to intercourse?

Apply it daily at any time of the day that works for you. Many women do well applying it first thing in the morning.

Yes, it can be applied before intercourse, and many women using Julva prior to intercourse have found it to increase their ability to achieve orgasm. It is not harmful in any way to your partner.

Note that Julva is not a spermicide and does not provide protection against pregnancy. We are not aware of any issues relating to the use of Julva with condoms; however, Julva contains natural emollients, so please refer to your condom packaging to determine if it has any warnings relating to the use of oil-based lubricants.

How long should my tube of Julva last?

Your tube of Julva should last 6-8 weeks depending on your dosage.

How do I know when my tube has expired?

Expiration dates are stamped on Julva packaging. Keep your Julva cream in a cool, dry place under 40° C (104° F).

Can I place Julva inside the vaginal canal?

Julva is for external topical application only, around the vulvar tissue, and is not intended to be inserted into the vagina. It is, however, safe for all of your skin.

How much DHEA is in 1/8 tsp of Julva?

Approximately 10 mg DHEA per ⅛ tsp.

I am already taking a sublingual DHEA daily...should I discontinue that while I'm using the Julva cream?

The DHEA in Julva is absorbed locally and should not affect the DHEA you are taking sublingually.

We recommend you consult with your primary care medical doctor regarding any concerns they may have given the specifics surrounding your DHEA levels and sublingual dosage. They may wish to run a DHEA-S test to determine your DHEA baseline level prior to starting Julva (optimal DHEA levels are noted below).

Optimal DHEA levels

DHEA is a natural hormone secreted by your adrenal glands. Normal levels drop with aging (see graphic) starting at around age 30. DHEA is important to the integrity of skin, muscle, and bone (in both males and females). It leads to the production of active sex hormones. Healthy levels of DHEA improve mental alertness and energy levels, and it has a role in maintaining libido. It is important in heart health and many other vital health functions.

For these health benefits, many people supplement with ingested DHEA to increase their serum blood levels. After age 45, we like to see optimal blood levels of DHEA-S in men of 250-450 mcg/dl. In women, we like to see optimal blood levels of DHEA-S of 100-300 mcg/dl. To increase deficient DHEA levels as they age, men typically are recommended oral DHEA doses of 50 - 100mg daily after age 45. Women may benefit from 5-15mg daily.

The recommended daily dose of Julva is only ⅛ of a teaspoon. This dosage contains approximately 10 mg of DHEA along with the other valuable ingredients of Julva and is locally applied. Based on research we are not expecting a significant transfer of DHEA to blood serum. If you are interested in seeing what your existing levels of DHEA are prior to or while using Julva you can easily be tested. Your doctor simply needs to test your DHEA-Sulfate in your blood or DHEA in your saliva.

You can also order the blood test yourself for your own reference or to share with a medical professional or other practitioners, at www.ultalabtests.com/drannacabeca

Do I need to test my DHEA levels while taking Julva?

No, not at all. Julva is not intended to increase serum levels of DHEA. As mentioned above, DHEA levels naturally decline and many people are interested in increasing their blood serum levels. Your DHEA-S level is an interesting reference that you may wish to track over time.

Can Julva be used during my period? Can using Julva cause a delay in my menstrual cycle onset?

Yes, Julva can be used during menstruation. Although, we have not received any feedback relating to shifts in cycles while using Julva, typically when administering any type of hormone therapy (DHEA, testosterone, estrogen, progesterone, etc.) there can be a shift in cycle (timing, duration, or even breakthrough bleeding). Should you have specific concerns, please discuss with your primary care medical doctor.

Who shouldn’t use Julva?

• If pregnant or breastfeeding, consult with your doctor before using this product.


• If you are taking the prescription Tamoxifen, do not use this product.


• If you have a vaginal infection, consult with your doctor before using this product.


• If you have had or are being treated for breast cancer, consult with your doctor before using this product.


• Keep out of reach of children.


• Discontinue use if you experience discomfort or irritation.

Can Julva be used by men?

Julva is very safe and contains wonderful nourishing, soothing, and moisturizing ingredients for the genital skin for both men and women.

It has been specifically designed to be gentle to vulvar skin but that does not mean that it can only be used there exclusively. The cream is well absorbed thoroughly and locally into your skin within 20 minutes.

Should I stop using any of my current medication before using Julva?

We do not recommend discontinuing any medication without your doctor’s guidance.

What will help me if my ovaries have been removed?

When our ovaries are removed, with them went a predominant source of estrogen, testosterone, progesterone, and DHEA. Our adrenals also produce DHEA which is a precursor to testosterone and estrogen. Many women who have had their ovaries removed feel significantly better by adding progesterone, like my Pura Balance PPr cream, and adding Julva. Consult with your physician about prescription bio-identical hormones as well.

Finally, always remember, that lifestyle can improve most obstacles to optimal health. Follow my online programs for guidance.

Can I use Julva if I have Lichen Sclerosus?

Lichen sclerosus can leave the vulvar tissue sensitive, tender, and easily irritated.

In therapy, steroids are often given with mixed results. As a GYN, Lichen Sclerosus is probably one of the most difficult conditions to treat. My Julva feminine cream has had great success with clients who have Lichen Sclerosus. They report increased comfort quickly and are thrilled with the results.

Julva is a nourishing formula and I recommend you try it. I give you a 60-day money back guarantee. With Lichen Sclerosus, you should consider starting at half the dose and on the healthier tissue surrounding the Lichen Sclerosus to allow some gentle nourishing of the delicate vulvar skin to start.

This is conservative as we've had many Julva users with Lichen Sclerosus start out with the full amount directly with benefits, however, I don't know your situation or skin condition. Follow your doctor's advice, and slowly begin with Julva. Be patient though! It takes time.

What if I have a bad reaction?

Should you experience a bad reaction, please discontinue use of the product.

Julva was developed using the highest principles and healthiest natural ingredients. For that reason, as well as testing and feedback from beta users as well as recent clients, we do not anticipate people will experience any problems using the product; but as with any skin-related product, there is always a small percentage of people who may experience a reaction.

We offer a 100% money-back guarantee within 60 days.

Try Julva for 60 days. If you experience any kind of unpleasant reaction, please contact us at team@drannacabeca.com for a return authorization. We will ask you to complete a simple questionnaire about your skin reaction experience, and then we will ask that you return the unused portion to our Georgia address.

We will not accept returns without the return authorization and the submission of our Julva skin reaction form.

Once your returned products are received, we will refund your purchase price, minus shipping and handling. Please ship to: Golden Isles Medical, Po Box 30062, Sea Island, GA 31561

Phone number: 904-452-8432

Can I use Julva if I have had breast cancer?

My number one intention for all women is to optimize their quality of life and to always do so safely, taking into consideration their unique medical history and current health status.

Women having had a history of breast cancer need to be particularly diligent about anything – even natural products – that they put in or on their bodies.

I always recommend that women discuss any new prescription, supplement, or over-the-counter product with their primary care doctor. In the case of women having a previous breast cancer diagnosis and/or treatment, I suggest women talk with their oncologists.

Julva is a topical anti-aging cream intended for the vulvar area containing pure, natural ingredients to improve vaginal dryness and reverse the symptoms of aging.

DHEA is the only ingredient in Julva that may concern women with breast cancer because it is a bio-identical hormone and women may fear using a ‘hormone’. DHEA is naturally secreted by the adrenal gland and ovary and is a very protective hormone with research indicating it is beneficial for brain health, bone health, and breast health.

Here I share with you some of the research which is very supportive of DHEA in regards to women having had breast cancer:

• ​Local versus systemic effect: Research shows that “topical DHEA (even when applied vaginally) does not cause an increase in intrinsic estrogenic or androgenic activity, however, it is transformed intracellularly into androgens and estrogens only in the cells in the vulvar and vaginal layers physiologically in need of these sex steroids.” * What does this mean? It means that DHEA impacts local cells and tissue where it is applied and has not been found to circulate systemically throughout the blood.


• ​DHEA may provide a protective role against cancer: According to a recent paper published in Cancer Biology & Therapy (September 2016)** "DHEA, an adrenal hormone, has a protective role against cancer.” The authors go on to state, “that DHEA inhibits the proliferation and migration of cell lines derived from breast cancer."


• DHEA was determined to be “useful in the treatment of breast cancer” in yet another study published in Eur J Pharmacol, in 2011. In this study, researchers concluded that "DHEA also suppressed the migration of all breast cancer cell lines, independently of the presence of estrogen receptors and decreased the expression of the ECM-1 protein in Hs578T cells. These results suggest that the mechanism of DHEA actions against breast cancer involves the inhibition of cell proliferation and the suppression of migration, indicating that DHEA could be useful in the treatment of breast cancer."


• ​Vaginally applied DHEA has been shown to treat vaginal dryness, pain, and other vaginal atrophy symptoms (including libido) especially in women having had breast cancer.
  This study has not yet been published however I am including a link to the ASCO (American Society of Clinical Oncology) abstract presentation^ as well as an article on the study.


• I also wanted to share a snippet of one terrific discussion that I had with Mike Riepl, a pharmacist and researcher, about this study. You can find our video discussion: Using Julva Cream if you've had breast cancer In earlier research (1999), women with uncontrolled PCOS and abdominal obesity may be associated with late promotion of breast cancer stimulated by prolonged intake of DHEA. Typically women with PCOS have elevated circulating levels of DHEA and additional oral DHEA would not be warranted.

What if I am a breast cancer patient taking the prescription Tamoxifen? Can I use Julva?

As a precaution, if you are currently using Tamoxifen I do not recommend using Julva without your oncologist’s approval.

The research on Tamoxifen has shown:

ORAL DHEA (systemic) converting to estrogen can interfere with Tamoxifen use and can decrease its effectiveness when blood serum levels of DHEAS are > or = 90 microg/dL.

Once off of Tamoxifen, I have no hesitation in recommending Julva to breast cancer survivors.

Femara/Letrozole (an aromatase inhibitor) does not appear to be affected by DHEA use and may be a better alternative should your oncologist agree. Some studies have in fact shown that breast cancer patients on aromatase inhibitors appear to benefit from higher levels of DHEAS and experience less musculoskeletal pain.

If you are concerned about the risk for blood clots: Consult with your primary care physician before trying Julva. We know that oral estrogen can increase blood clots; however trans-dermal estrogen, progesterone, & DHEA have not been shown to increase blood clots at all.

Final thoughts on breast cancer survivors and Julva:

Certainly all women having had or having breast cancer need to be super proactive about their health. I highly recommend these women have a serum Vitamin D (25 OH) test and maintain a level of 80 in the blood. You can get a blood test to check that along with other key markers at: https://www.ultalabtests.com/drannacabeca/Item/Item/Dr-Anna-s-Key-Marker-Panels

Mighty Maca™ Plus and our Keto-Alkaline protein shake are great additions to your nutrition regimen and checking your urine pH to keep it alkaline is also recommended for optimal health. You can use our Keto-pH urine test strips to measure urine pH.