By Lauren Streicher, MDAsst. Clinical ProfessorObstetrics and GynecologyThe Feinberg School of Medicine
While you might think your problem is unique and beyond humiliating, your gynecologist has doubtlessly heard it many times and regards it as standard fare. Trust me, it’s virtually impossible to shock your gynecologist. Here are a few questions that my patients have asked me, every single one prefaced by, “I’m really embarrassed to ask this, but …”
Embarrassing Question: “The only way I can have a bowel movement is to put my fingers inside my vagina and press down."
Answer: This is typical of a question that doesn’t come up when having lunch with your girlfriends. You most likely have a rectocele, a condition in which the tissue that supports the floor of the vagina becomes so thin that the rectum actually bulges into the vagina, much like a hammock that has become loose over time. It’s the equivalent of a dropped bladder, except it involves the back of the vagina, not the front. Instead of stool going down a straight tunnel, it gets trapped in a “turn in the road” – hence the necessity to push down. “Splinting” is the term we use to describe the need to put manual pressure on the vagina or perineum in order for the stool to come out. You would be amazed at the number of women who, like you, splint routinely. Mild rectoceles require no treatment, but if it is bothersome, a minor surgical procedure can put things back where they belong.
Embarrassing Question: “I’ve been married for six months, but I’m still a virgin. My husband and I attempted to have sex a couple of times, but it was too painful, so we stopped trying. Now, I feel like something’s wrong with me, and I don’t want to tell anyone.”
Answer: Unconsummated marriages are more common than you might think. The first step is to tell your gynecologist. Some women have an unusually thick hymen or another easily correctable physical condition that makes intercourse difficult or painful.
If everything is anatomically normal, you might have vaginismus, a condition in which vaginal muscles spasm when you attempt to have intercourse. There are many reasons why women suffer from vaginismus, but it’s particularly common in women who have a history of sexual abuse or trauma. The brain will send a “no” message to the vaginal muscles, causing them to spasm. In fact, if a woman had pain with intercourse in the past for any reason, her body and mind can remember that, causing her vagina to clamp down in an attempt to protect itself from further pain.
Gynecologists generally work in conjunction with pelvic physical therapists and psychotherapists in order to identify and eliminate both physical and psychological causes of an inability to have intercourse.
Embarrassing Question: “I’m nervous about having oral sex with my new partner since my last partner said I tasted bad.”
Answer: Sounds like a sensitive guy … good thing you are rid of him. Many women have concerns about the way they smell or taste. What may seem unappealing to you might actually be very attractive to the man in your life. Many guys are aroused by genital taste and smell.
If there truly is an unpleasant odor, the most likely culprit is bacterial vaginosis (BV), an imbalance of vaginal bacteria resulting in a watery grayish discharge with an ammonia or fishy odor. Metronidazole or clindamycin are the two prescription medications (given orally or intravaginally) used to treat bacterial vaginosis. One of the frustrating things about bacterial vaginosis is the high recurrence rate. Thirty percent of women have a second episode within three months of treatment. If you are prone to BV, maintaining a normal vaginal pH will keep things in balance (see my blog, When Your Vagina's in a pHunk.)
What are some other causes of a less-than-pleasant odor? If there’s a really strong smell, make sure you haven’t left a tampon inside. (It happens more than you think!) Sometimes, even a new vitamin pill or change in diet can cause a change.
Embarrassing Question: “I have never had an orgasm. My husband and I have intercourse a couple of times a week, but frankly, brushing my teeth gives me more pleasure. Is there hope for me?”
Answer: Virtually any woman can learn to have an orgasm. In medical circles, the term anorgasmic has been replaced with pre-orgasmic. Many experts (and most women!) know that clitoral stimulation rather than vaginal stimulation is required to orgasm. In other words, for the majority of women, intercourse alone won’t do it.
Masturbation is usually the best way to discover what creates the most pleasure and to find out about your own sexual response. In addition, if you have never used a vibrator, run, don’t walk to your nearest erotica store.
Sex toys are not for lonely deviants. In fact, it’s more likely than not that your neighbor and your sister use one. Sex toys fall into two basic categories: those that are inserted in the vagina and those that are used for external stimulation. Most women require external stimulation to reach orgasm.
So where do you get these toys? No, you don’t have to go to a questionable neighborhood wearing a disguise and dark glasses. Most major cities have perfectly respectable erotica stores intended for normal women to go and comfortably shop. The staff is usually very happy to help, and will go out of their way to make you comfortable. Go with your partner or a girlfriend. It’s easier, and more fun. If all else fails, you can always say you’re buying a gift for a “friend.” If the only toy stores in your area are for children, or you are on the shy side, there are terrific websites where you can shop without wearing a disguise.
Once you’ve achieved orgasm using your hand or a vibrator, it’s easier to tell your partner what will satisfy you. It’s increasingly common for couples to incorporate a vibrator into their love life. Some women worry that the guy in their life will be insulted or upset if they introduce a mechanical aid. On the contrary, most guys are thrilled to have some help making sex pleasurable for the woman they care about.
Embarrassing Question: “I think my labia are abnormally long. I read about a procedure to shorten them. Do you do that procedure?”
Answer: What you are referring to is labioplasty, a type of plastic surgery to shorten labia minora. This certainly isn’t in the top 10 surgical procedures I perform, but it does come up at least a few times a year.
The real question is, when are labia so long that they require surgery? While there’s a huge range of what’s considered normal, the average labia measures about one inch from base to tip. Most of my patients with excessively long labia request a labioplasty not because they care about the cosmetic appearance, but because they experience discomfort and irritation during sexual or athletic activities.
Certainly there are those women who desire “a trim” based on their idea of what’s attractive, even when reassured that their labia are perfectly normal. I have had a few patients who were so self-conscious about the appearance of their labia that they avoided sexual intimacy altogether.
Labioplasty is an outpatient procedure that can be performed by a gynecologist or plastic surgeon. Most women are sore for a couple of weeks and develop an affinity for boxer shorts. Bike riding and sex are generally out of the question for about a month. Most women who have this procedure are highly motivated and say that the end result was worth it.
Embarrassing Question: “My mother taught me to douche after each menstrual period and after sex. I mentioned it to a friend, and she looked at me like I was out of my mind. Now I don’t know what to do. I feel ‘dirty’ if I don’t douche.”
Answer: Like your oven, the vagina is self-cleaning. Even though a douche may make you feel fresh for a short time, it doesn’t eliminate discharge or odor, nor does it provide any contraceptive benefit.
In fact, douching promotes the growth of bacteria and may increase your risk of pelvic inflammatory disease by transporting chlamydia or gonorrhea up into the uterus. In addition, vinegar and betadyne in douches can dry vaginal walls and increase inflammation. In spite of the fact that it’s ineffective, unnecessary and potentially harmful, a surprising number of women still douche.
This is one of those rare instances in which your mother is not right.