What’s Going on with My Vagina?

January 9, 2017

At one point or another we (including men) have all wondered what’s going on down there.  Problems with the vagina are very common and not an issue you should be embarrassed about. Think of me as your sister who just happens to be a medical doctor.  No topic about the body is taboo and I feel it is my duty to be honest and open with you.  

I can’t tell you how many times women have called my office to complain about a vaginal discharge, vaginal bleeding, vaginal pain, vaginal dryness, vaginal odor, vaginal itching, vaginal sore……so much seems to happen down there and yet many women know so little about their own anatomy and why certain things may be occurring.  

The most frustrating patient is the type that insists she does not need a visit or exam because she knows what’s going on and just wants something called in. If your doctor wants to see you go to the appointment! You can’t afford to miss something important.  I can not tell you how many women have insisted their vaginal discharge is just a simple yeast infection “I know what it is, I get it all the time, just call in some Diflucan for me” only to  come in for an exam after my insistence and learn it was not what they thought but an STD ( sexually transmitted disease)! Or the  patient  who insists she needs a cream called in for a rash on her “private” after sitting on a dirty toilet. Her description of the “rash” and where it was located was vague and given her history of unprotected sex I told her she had to come in for an examination. Of course she was not happy but I needed to know what I was treating or what the real diagnosis was.  It turns out the poor young lady had painful shallow ulcers all over her mons pubis (the flat area below your abdomen above your vagina). She also had ulcers on her labia consistent with genital herpes. Clearly she needed an antiviral not an antibiotic.  

Then there are the women well past their 50’s  who present with vaginal bleeding and casually remark that “ oh my period came back”  Please see your doctor as soon as possible with any vaginal bleeding after menopause! It should not be dismissed! Of course any abnormal bleeding from any orifice should be reported to your doctor. I have seen women who thought they have vaginal bleeding and it was coming from their rectum or vice versa.

There is also another type of patient – the one who is obsessed with her vagina.  The one who wants me to look at it at practically every visit!  “I think I have a cold but since I am here can you check me down there” or  “ I think it looks strange down there” or “ I think it smells funny down there and I think other people can smell it”  This patient may need frequent reassurance despite a normal exam and negative tests.

It is important to know your body and what is normal. I am not trying to be funny but I have met women who still do not realize they have three openings down there! Yes three:

  1. Where you urinate ( urethra which opens into your bladder)
  2. Where you have sexual intercourse and your period comes out from ( vagina)
  3. Where you defecate or poop from ( anus that leads to your bowels)

I encourage you to lay on your bed with your knees up and with a mirror look and learn about your body and what is normal for you. Where is your labia majora or clitoris in relation to your anus? Culturally most of us have been raised to not talk about the area between our legs, not to touch it or even look at it. We feel shame discussing it and all that does is promote ignorance about your own body.

A few related things I often tell my female patients:  If you feel you are old enough to have sex then you should be comfortable enough to examine your partner with the lights on before you have sex! Why should you miss not noticing his or her genital warts or other STD related lesions because you were too shy to look !  Understandably your partner may not always show any obvious signs but clearly sometimes they do! Always protect yourself. Having your partner use a condom or dental dam can significantly cut down your risk of most STDs – but not all! For example you can get Herpes from an exposed sore or skin to skin contact while having vaginal, anal or oral sex. Cut down your chances of exposure by getting tested for STDS and insist your partner get tested too. If you are having a non-monogamous relationship then you are significantly increasing your chances of an infection or STD.

Any painful intercourse should be evaluated by your PMD or gynecologist to make sure you do not have an injury, infection or abnormal mass or growth. If you suffer from frequent yeast infections please get evaluated for diabetes or a compromised immune system. In some people yeast infections are common and harmless and in others  they happen after taking steroids or antibiotics. Candida (yeast infections) and bacterial vaginosis are common causes of vaginal discharge and are not considered an STD. See your doctor for the right treatment. Yes it is still important to wipe from front to back after a bowel movement to avoid bacteria from being carried from your anal area to the front urethra, which results in a bladder infection (UTI)  or bacterial vaginosis.

Don’t share adult toys. Where am I going with this? Years ago a young female patient kept having vaginal infections despite frequent treatments.  One day she called to ask if the non-sterilized dildo she was sharing frequently with a friend was responsible? Unfortunately, it was. If you are going to share, be safe. Your vagina does not need the drama!

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