Welcome to Reader’s Request Fridays. As a reminder, I’ll be addressing one reader email per week, so if you have a specific question you’d like answered or a topic you’d like covered, please email me. If you’re interested in counseling, call (415) 658-5738 or visit my Appointments page to schedule a consultation.

This week’s question comes from Karen*, who writes:

“I avoid appointments with my gynecologist like the plague. What can I do to make sure I’m healthy ‘down there’???”

Hi Karen,

OB/GYN exams shouldn’t have to be so uncomfortable, but they just are. For so many women, this yearly visit is an experience fraught with fear, anxiety, and discomfort.

Most women haven’t taken a look at their own genitals up-close-and-personal, so the idea of a near-stranger doing so can be pretty embarrassing.

Plus the tables always seem too cold, the paper gowns too flimsy, the stirrups too far apart, and the instruments too harsh.

It can also be hard to ask your doctor the questions you really want answers to. While your OB/GYN may be totally comfortable with looking at genitals all day, the unfortunate reality is that most doctors only get a few hours worth of training in human sexuality.

Your doctor may be able to tell you how to get rid of a yeast infection with a straight face, but you’re likely to see an entirely different look if you ask if those yeast infections are being caused by your partner’s use of dildos.

The best way to get more savvy about vaginal health is to educate yourself. Let’s talk about what can go wrong with the vagina and vulva.

 

Period problems

One of the main sources of genital-related problems is menstruation.

Dysmenorrhea is pain during menstruation. It is caused by the overabundance of prostaglandins, chemicals that cause the uterus to contract. Dysmenorrhea can also be caused by improperly placed IUDs, pelvic inflammatory disease, endometriosis, and uterine tumors.

Metrorrhagia is defined as an irregular menstrual cycle. The number one cause of skipped or irregular periods is stress. Dieting, exercise, or thyroid problems can also cause you to have irregular periods.

Amenorrhea is the absence of menstruation. Even if women have previously menstruated, they can still experience amenorrhea. Like metrorrhagia, it is also common amongst athletes and women with eating disorders.

Menorrhagia occurs when you have an abnormally heavy period.

 

Endometriosis

Endometriosis is a complicated condition that occurs when tissues adhere to the wall of the pelvic cavity and engorge with blood. Endometriosis usually leads to pain and severe cramping.

 

Toxic Shock Syndrome

This condition can occur with the misuse of tampons. TSS is caused by a naturally-occurring bacteria that adheres to the tampon and starts producing toxins. It can lead to fever, vomiting, nausea, diarrhea, and dizziness.

Tampons should never be worn between periods or during pregnancy, or for longer than the directions state, and you should always use the lowest absorbency possible.

 

Urinary Tract Infections

UTIs can be divided into two subcategories: cystitis and pyelonephritis. Both are typically caused by sex, diaphragm use, or blockages in the urinary tract.

Cystitis occurs when bacteria travel from the colon to the urethra, causing inflammation, painful sensations during urination, and increased need to urinate.

Pyelonephritis occurs when the bacteria spreads to the kidneys. It can cause fever, nausea, and vomiting. Both types can be treated with antibiotics.

 

Yeast Infections

These kinds of infections are caused by a naturally-occurring fungus that becomes too prevalent.

Changes in the vagina’s pH levels can also lead to a yeast infection. Pregnancy, diabetes, hormonal changes, contraceptives, antibiotics, tampons and sex can all cause yeast infections.

Many women who have yeast infections are asymptomatic, but it typically causes an abnormal discharge and odor, swelling, redness, irritation, and pain during sex or urination.

Yeast infections can be treated with over the counter creams and suppositories, or prescription medications like Diflucan.

 

Bacterial Vaginosis

BV occurs when the balance of healthy, naturally occurring bacterial in the vagina get thrown off balance. The causes of bacterial vaginosis are unclear, but douching can definitely lead to it. BV causes abnormal discharge and odor, and can be transmitted sexually. It can be treated and cured.

 

Trichomoniasis

This condition is caused by a naturally occurring parasite.

Most women who have trich do not have any symptoms, but those who do may experience, itching, irritation, pain during sex, and abnormal discharge and odor.

It can be passed on by towels, underwear, bathing suits, and even toilet seats.

 

Genital inflammations

These include vaginitis (or vulvovaginitis) – swelling, itching and redness around the vaginal opening, cervicitis – swelling of the cervix, vulvitis – itching, redness, and blistering of the vulva, and endometritis – inflammation of the uterine lining (not to be confused with endometriosis). They are caused by other vaginal infections, as well as external irritants, STIs, or sex.

STIs are a final category. There are so many STIs that I will devote the next Reader’s Request Fridays to the topic.

A lot of things can go wrong with the vagina, and a lot of the symptoms are similar across infections, so it’s important to pay attention to your normal bodily functioning.

It helps to be familiar with the usual color, odor, menstruation cycle, discharge, and sensations of your genitals. Be aware of any sudden or dramatic changes to your usual patterns.

 

Easy ways to maintain vaginal health

• Go in for your yearly exam. Sorry, but there’s just no getting out of this one!

• Eat foods rich in calcium and iron, especially during your period.

• Drink pure cranberry juice to prevent UTIs and eat yogurt to maintain levels of bacteria (especially if you’re on antibiotics).

• Try to avoid wearing tight clothing, and wear 100% cotton underwear when possible.

• Don’t lounge around in wet bathing suits.

• Wash your genitals after a vigorous workout, and try changing out of your workout clothes as quickly as possible.

• Don’t use vaginal deodorants or douches.

• Wipe from the front to the back.

• Never have unprotected sex.

• Make sure you’re well-lubricated before inserting fingers, penises, or sex toys into your vagina. Anything that goes into your vagina should be washed immediately beforehand.

• If you choose to shave or wax the hair off of your genitals, make sure you do so as sanitarily as possible. Don’t go to salons that “double-dip” with their wax applicators, make sure your esthetician is wearing gloves, and don’t use old or rusty razor blades.

• Urinate immediately after having sex.