Category Archives: Female Genitalia

What your gynecologist wishes you would do

By Linda S. Mihalov, MD, FACOG

No matter a woman’s age or how comfortable she is with her gynecologist, she may still be unsure about a few things — like which symptoms are worth mentioning, how often to make an appointment and how to prepare for an exam.

Based on my 30 years of providing gynecologic care to women of all ages, I thought it would be helpful to provide a few tips about how to make the most of your care visits.

Keep track of your menstrual cycle

Dr. Linda Mihalov

Menstruation is a monthly recurrence in women’s lives from early adolescence until around the age of 51, when menopause occurs. Because of the routine nature of this biological process, it’s easy to become complacent about tracking your periods. Thankfully, there are numerous smartphone apps that help make tracking periods easy.

Keeping track of your period is important for numerous health-related reasons. A missed period is usually the first sign of pregnancy. Determining the due date of a pregnancy starts from the date of the last menstrual period. Most forms of birth control are not 100 percent effective, and an unplanned pregnancy is best recognized as soon as possible.

Conversely, women attempting to get pregnant can use period tracking to learn when they are most fertile, which may greatly increase the chances of conception.

In addition, a menstrual cycle change can indicate a gynecologic problem, such as polycystic ovarian syndrome, or even uterine cancer. It is also often the first obvious symptom of health issues that have no obvious connection to the reproductive organs. When a regular menstrual cycle becomes irregular, it may indicate a hormonal or thyroid issue, liver function problems, diabetes or a variety of other health conditions. Women also often miss periods — or experience menstrual changes — when adopting a new exercise routine, gaining or losing a lot of weight or experiencing stress.

One late, early or missed period is not necessarily reason for alarm. But if menstrual irregularity is accompanied by other symptoms, a woman should schedule an appointment with her gynecologic care provider.

Get the HPV vaccine

Human papillomavirus, or HPV, is a very common virus. According to the Centers for Disease Control and Prevention, nearly 80 million Americans — about one in four — are currently infected. About 14 million people, including teens, become infected with HPV each year. Most people who contract the virus will clear it from their systems without treatment, but some will go on to develop precancerous or even cancerous conditions from the infection.

The HPV vaccine is important because it protects against cancers caused by the infection. It can reduce the rate of cervical, vaginal and vulvar cancers in women; penile cancer in men; and anal cancer, cancer of the back of the throat (oropharynx), and genital warts in both women and men.

This vaccine has been thoroughly studied and is extremely safe. Also, scientific research has not shown that young people who receive the vaccine are more prone to be sexually active at an earlier age.

The HPV vaccine is recommended for preteen girls and boys at age 11 or 12 so they are protected before ever being exposed to the virus. HPV vaccine also produces a more robust immune response during the preteen years. If you or your teen have not gotten the vaccine yet, talk with your care provider about getting it as soon as possible.

The CDC now recommends that 11- to 12-year-old girls and boys receive two doses of HPV vaccine — rather than the previously recommended three doses — to protect against cancers caused by HPV. The second dose should be given six to 12 months after the first dose.

Teen girls and boys who did not start or finish the HPV vaccine series when they were younger, should get it now. People who received some doses in the past should only get doses that they missed. They do not need to start the series over again. Anyone older than 14 who is starting the HPV vaccine series needs the full three-dose regimen.

Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21. Also, women who have been vaccinated should still have cervical cancer screenings (pap smears) according to the recommended schedule.

Do not put off having children

Fertility in women starts to decrease at age 32 and that decline becomes more rapid after age 37. Women become less fertile as they age because they begin life with a fixed number of eggs in their ovaries. This number decreases as they grow older. Eggs also are not as easily fertilized in older women as they are in younger women. In addition, problems that can affect fertility — such as endometriosis and uterine fibroids — become more common with increasing age.

Older women are more likely to have preexisting health problems that may affect their or their baby’s health during pregnancy. For example, high blood pressure and diabetes are more common in older women. If you are older than 35, you also are more likely to develop high blood pressure and related disorders for the first time during pregnancy. Miscarriages are more common in older pregnant women. Losing a pregnancy can be very distressing at any age, but perhaps even more so if it has been challenging to conceive.

So, women who are considering parenthood should not put off pursuing pregnancy for too long or it may become quite challenging.

See your gynecologist for an annual visit

For women to maintain good reproductive and sexual health, the American College of Obstetricians and Gynecologists recommends that they visit a gynecologist for an exam about once a year. Generally, women should have their first pap test at age 21, but there may be reasons to see a gynecologic care provider earlier than that if there is a need for birth control or periods are troublesome, for instance. Although pap tests are no longer recommended every year, women should still see their provider annually for a gynecologic health assessment. This may or may not involve a pelvic exam.

Other reasons to visit a gynecologist include seeking treatment for irregular periods, sexually transmitted diseases, vaginal infections and menopause. Women who are sexually active or considering it can also visit a gynecologist to learn more about contraceptives.

During each visit, the gynecologist usually asks about a woman’s sexual history and menstrual cycle. The gynecologist may also examine the woman’s breasts and genitals. Understandably, a visit like this can cause discomfort among some women. However, periodic gynecological exams are very important to sexual and reproductive health and should not be skipped. The patient’s anxiety can be significantly decreased if she knows what to expect from the visit. Prepared with the knowledge of what actually occurs during an annual exam, women often find it can be a straightforward, rewarding experience.

There are several things women should do to prepare for a gynecological exam, including:

  • Try to schedule your appointment between menstrual periods
  • Do not have intercourse for at least 24 hours before the exam
  • Prior to the appointment, prepare a list of questions and concerns for your gynecologist
  • Since the gynecologist will ask about your menstrual cycle, it will be helpful to know the date that your last period started and how long your periods usually last

The pelvic exam includes evaluation of the vulva, vagina, cervix and the internal organs including the uterus, fallopian tubes and ovaries. Appearance and function of the bowel and bladder will also be assessed.

The gynecologic provider will determine whether a pap test is indicated, and order other tests as necessary, including tests for sexually transmitted infections, mammograms and screening blood work or bone density studies. Even a woman who has previously undergone a hysterectomy and, as a result, no longer needs a pap test can still benefit from visiting her gynecologist.

Primary care providers, including family practitioners and nurse practitioners, internists and pediatricians can also provide gynecological care.

Menopause

Menopause can be a challenging time. Changes in your body can cause hot flashes, weight gain, difficulty sleeping and even memory loss. As you enter menopause, you may have many questions you want to discuss with your gynecologist. It is important that you trust your gynecologist so you can confide in them and ask them uncomfortable questions. The more open you are, the better they can guide you toward the right treatment.

Complete Article HERE!

Heightened Awareness: Anxiety Can Lead to Pain During Sex

Clearly anxiety can be an obstacle to a healthy sex life and needs to be talked about.

By Carrie Weisman

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Vagina Dispatches episode one: the vulva

Think you know about vaginas? Think again. In the four-part series running from now through November, we find out that even the most basic of body knowledge is lacking – people still don’t understand what vaginas look like or how they function. In episode one, we build a giant vulva, then talk to a gynecologist, a labiaplasty surgeon and a trans woman, to find out what vulvas really look like.

 

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Could my wife’s circumcision explain her lack of interest in sex?

Our sex life has been underwhelming. I wonder if what happened to her as a child could be to blame

By Pamela Stephenson Connolly

I cannot even try to guess your wife’s experience’

I cannot even try to guess your wife’s experience’

I am in my mid-40s and have been married for 16 years. Our sexual life has been very underwhelming. I have tried everything I know but my wife seems to have little or no interest in sex. I do know that she was circumcised as a child. Could that have affected her sexuality?

A person’s sexuality is created through a complex combination of physical, psychological and physiological factors as well as the messages about sex they received from childhood onwards – religious beliefs, parental warnings, societal judgment and formative experiences. You have told me little, but the fact that she was circumcised suggests that she may have been raised in a society where the notion of female sexuality was not exactly appreciated. In many of the world’s societies – including our own – it is judged by some as inappropriate, and even feared, suppressed, or punished.

I cannot even try to guess your wife’s experience, or the motives of those who performed it, but I am sure it has had some effect on her conceptualisation of sex and her ability to experience pleasure. This would be particularly true if her clitoris was removed. Gently ask her if she could try to express what the circumcision was like for her, and how it might have affected her ability to enjoy sex. A gynaecologist could shed some light on how nerve loss or damage might have affected her ability to orgasm or even become aroused, and a psychosexual counsellor could suggest alternative sexual approaches. After 16 years, your wife and you deserve some understanding and hope.

Complete Article HERE!

This Long-Lost Study On Victorian Sex Teaches A Very Modern Lesson

By Sara Coughlin

female-sexuality

What comes to mind when you picture Victorian-era sex? Corsets? Marriages of convenience and social bartering? Repression? Maybe, like, a lot of repression?

Turns out, how we view that time in sexual history might be more than a little warped. We can start to get a better idea of what women of the time really thought about sex by looking at the work of Clelia Duel Mosher, MD. Years before Alfred Kinsey was even born, Dr. Mosher was already researching and discussing the sexual tendencies of Victorian-era women. (This, it should be noted, is in addition to her research that proved women breathe from the diaphragm, just like men, and that it was the corset and a lack of exercise that was to blame for many women’s health issues.)

Her sexual survey work started in the 1890s and spanned 20 years, during which time she talked to 45 women at length about their sexual habits and preferences, from how often they had an orgasm to whether they experienced lust independent of their male partners (Spoiler alert: They totally did).

Unfortunately, the report was never published in Dr. Mosher’s lifetime. It’s only thanks to Carl Degler, an author, professor, and historian, that we know of it at all. He stumbled upon Dr. Mosher’s papers in Stanford University’s archives in 1973 and published an analysis of her findings the following year.

As others have noted, Dr. Mosher’s research has played a major role in changing how historians think of Victorian attitudes around sex. Then, like today, a variety of perspectives on the subject existed. While this one report doesn’t sum up everything there is to know about how people had sex at this time, it certainly deepens our understanding of Victorian women, who are all too often painted in broad strokes at best.

Below, we’ve listed some of the most interesting findings from Dr. Mosher’s groundbreaking survey.

Not having an orgasm sucked back then, too.
One of the survey’s respondents said, “when no orgasm, [she] took days to recover.” In what might be an early description of blue balls for the vagina, another woman described a lack of climax as feeling “bad, even disastrous,” and added that she underwent “nerve-wracking-unbalancing if such conditions continue for any length of time.”

Yet another woman had something to say about the 19th-century orgasm gap, claiming that “men have not been properly trained” in this area. It seems that women have been taking their own sexual pleasure seriously for hundreds of years — even if the culture at large hasn’t.

Sex wasn’t just for procreation.
In keeping with Victorian stereotypes, one woman said “I cannot recognize as true marriage that relation unaccompanied by a strong desire for children,” and compared a marriage where the couple only has sex for pleasure to “legalized prostitution.” But several others disagreed completely.

One woman said that “pleasure is sufficient warrant” for sex, while another added that babies had nothing to do with it: “Even a slight risk of pregnancy, and then we deny ourselves the intercourse, feeling all the time that we are losing that which keeps us closest to each other.”

One woman even explained that sex helped keep her marriage strong: “In my experience the habitual bodily expression of love has a deep psychological effect in making possible complete mental sympathy, and perfecting the spiritual union that must be the lasting ‘marriage’ after the passion of love has passed away with years.”

Period sex was pretty cool.
Over a century before we threw around the term “bloodhound” like it was nothing, at least one trailblazing woman believed that sex was always on the table — whether or not it was your Time of the Month. She added that she was fine with getting down at all hours, too: “during the menstrual period…and in the daylight.” If anyone reading this just happens to be this woman’s lucky descendent, we’d like to send her a posthumous high-five through you.

Why This Is More Than A History Lesson
In his analysis, Degler writes that of course “there was an effort to deny women’s sexual feelings and to deny them legitimate expression” back then, but the women who participated in the survey “were, as a group, neither sexless nor hostile to sexual feelings.” They didn’t let any societal expectations or restraints stop them from having those feelings — and acting on them.

Though we may not live with the same barriers (or dress code) that women did back then, it’s reassuring to know that these women defied their time’s moral code to speak frankly about their sexuality. As frustrating as it is, women still deal with stigmas surrounding sex today, whether they’re at risk of being called prudes or sluts, or being discriminated against because of their sexual orientation. This is what we’ll remember most about Dr. Mosher’s work — that, in the face of whatever shame you may be harboring about your own sexuality, or whatever pressures you may be feeling, you are most likely totally normal and definitely not alone. So why hide it? After all, you never know whom you might end up proving wrong a couple hundred years down the line.

The gap between what we learned in sex ed and what we’re learning through sexual experience is big — way too big. So we’re helping to connect those dots by talking about the realities of sex, from how it’s done to how to make sure it’s consensual, safe, healthy, and pleasurable all at once.

Complete Article HERE!