Female Sexual Health Q&A
By Hilda Hutcherson, M.D., REDBOOK
I grew up in a time and place-1960s, the South-where ladies did not talk about their vaginas. Not with their mothers, their sisters, or their best girlfriends. Not with their doctors. Not with anyone, really. We didn't look or touch. We knew those parts were down there somewhere and assumed they were okay. That was not a good thing. We didn't have the basic information we needed to keep ourselves healthy, let alone the kind of knowledge that would help us have a happy sex life.
Things started changing for the better in the '70s, when the seminal health book Our Bodies, Ourselves was published, with its diagrams and feminist outlook. But the biggest shift came with The Vagina Monologues in the late '90s. That one-woman show was a sensation: Women of all ages, all across the world, rose up to acknowledge and proclaim their love for their lady parts. We could actually say the word vagina. In fact, saying it was encouraged, and became the chic thing to do!
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Fast-forward to 2012, and the conversation is still going strong. But I confess, I'm alarmed by the new direction that some of these talks are going. Women are being told by marketers, manufacturers, and even some medical professionals that they really should try to have a "better" vagina. You've seen the ads, the news blurbs, the segments on medical talk shows in which doctors hawk odor-removing products or go on about how sad and weak vaginas supposedly get as women age. Twenty to 40 percent of women still douche (a bad idea, because it increases risk of infection), and sales of "freshening" wipes are skyrocketing. Salons want to remove all your hair from front to back so you're as smooth as a baby's bottom... then add stick-on jewelry! Who would've thought that in addition to thinking about wrinkles, belly pooch, and bat wings, a woman would ever have to worry about how pretty-or sparkly-her vagina is?
These cosmetic trends aren't necessarily dangerous. What concerns me most is that women are also being sold the idea that they need to change the size of their openings and surgically sculpt or plump their vulvas. Yes, I said plump. As women age, we lose a little fat in our outer labia, and the inner ones become more visible. The solution to this complete non-problem? Surgical trimming of the inner lips, and injections of collagen or the face-plumper Restylane in the outer ones. Then, of course, there are the G-shot and the O-shot, two injections that fatten up areas inside your vagina, supposedly increasing sensation there during sex. (Neither is worth a darn.)
All of this-society's newfound focus on a "perfect" vagina-is insane. And it's making women a little crazy about a part of their body that's not even out in the open! I'm seeing the increased insecurity in my own patients. One young woman admitted that she couldn't bring herself to have sex anymore after an ex-boyfriend told her she didn't look "right" down there. (He must be a major porn-watcher who doesn't realize that those actresses' Photoshopped, tweezed, and makeup-covered body parts have nothing to do with real life. My patient was perfectly normal.) Others have obsessed over the idea that their vaginas would be "ruined" by childbirth. I see women who are so distracted by their presumed abnormalities that when they do have sex with their partners, they can't relax, and they have arousal problems, lack of lubrication, pain, and difficulties with orgasm. If a woman's body esteem falls far enough, she may even avoid Pap smears and annual pelvic exams, putting her health at risk.
I am fed up with opportunistic companies, doctors, and industries taking advantage of women's insecurities-and stoking those anxieties-for their own financial gain. I'm here to stand up for women's vaginas. To tell you the real deal. To get you to put down the rhinestones and appreciate what God gave you! Please, let me reassure you about the five issues women stress about most.
HILDA'S TOP 5 VAGINA FAQs
1. Will childbirth "ruin" my vagina?
It will challenge it, but no, having kids won't leave your vagina in a permanent shambles. I had a woman come in, six weeks postpartum, who was freaked out about having sex with her husband again-she said, "I put my finger down there and it feels huge. He's going to get lost!" No, I told her. If he's bigger than a pencil, he's not going to get lost. It's true that the pelvic-floor muscles may be taxed during a vaginal delivery, which means the opening may feel looser and sex can feel different for some women for a few months, but the vagina is an amazing, elastic organ that can stretch enough to bring a 10-pound baby safely into the world and then snap back to its normal size. And you can help bring the tension back more quickly by exercising the muscles that surround and support your vagina with Kegel squeezes. Kegels work fastest if you've done them throughout your pregnancy, but it's never too late to start. Try 50 squeezes a day, simply contracting the muscles you would use to stop the flow of urine. After a few months of daily exercises, you'll notice that your vagina feels stronger and that sex feels better. Occasionally, a woman may suffer a severe tear in the muscles that support the vagina, bladder, and rectum and may have incontinence or a painful hernia after childbirth. Those women actually do need surgery. But in general, a healthy post-baby vagina does not need to be "rejuvenated" or "tightened" by lasers or a surgeon's scalpel, no matter what advertisements may say. In these cosmetic procedures, surgeons basically remove tissue, making the vagina smaller. It doesn't always work out well: I've seen patients for whom the surgeon removed too much tissue; their vaginas ended up too small and didn't stretch as well because of scarring, leading to painful sex. I've also seen women who got serious infections after such procedures. These cosmetic surgeries are simply not worth the risk.
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2. Is the smell okay?
Somehow, women have become convinced that our natural scent is unpleasant and needs to be changed, covered, or removed completely. But the truth is this: Your vagina is not meant to smell like a flower shop, a summer breeze, or spring rain (whatever spring rain smells like). The vagina has a natural musky scent, unique to each woman. You may notice that it becomes stronger right before or during your period, or after you take certain medications, smoke, or drink alcohol. That's normal. If you wear multiple layers-underwear, stockings, and tight jeans, for example-or if it's very hot outside, you may sweat more down there. Bacteria that naturally live on the skin of your vulva may overgrow in this warm, wet environment and cause an odor at the end of the day. To combat that, just wash with a mild cleansing bar like Dove, wear cotton panties (which allow moisture to evaporate), and don't wear underwear to bed. Using unnecessary products like douches or harsh scented soaps can upset the pH balance of your vagina and cause bacterial vaginosis or yeast overgrowth. Speaking of infections, if you ever notice a strong unpleasant smell, especially if there's discharge, see your doctor to get it checked.
3. Do I look weird down there compared to other women?
Unlike men, who use urinals, most of us don't have an opportunity to compare ourselves with other women. One of my patients in her 20s asked me if she should have some of her labia removed after a man pointed out that hers were "long." But labia come in many sizes, shapes, colors, even textures, and it is common for one side to be longer or bigger than the other. All women are different, and if you ask me, vive la différence! Scarring is a big risk of labial surgery-the cuts are made so close to your clitoris and vagina that scar tissue can interfere with orgasm and general pleasure. The only time surgery may be truly necessary is when a woman's labia are so long they get pinched by underwear and pants and cause pain. It happens, but it's rare.
4. Why don't I have vaginal orgasms? Can I change that?
Once, women were happy just to have an orgasm. Now we feel pressured to have a specific type! The truth is that more than 70 percent of women don't experience orgasm from intercourse alone. For most of us-though not all-the clitoris is the most sensitive zone, and intercourse isn't the most efficient way to stimulate it. If being able to climax during intercourse matters to you, here's what I recommend: Have more foreplay, so you can be closer to orgasm before sex; choose positions that stimulate the clitoris, like woman on top; and try using a vibrator during sex. In general, though, it's good not to be overly goal-oriented-it's called "lovemaking," after all, not "orgasmhaving."
5. Why does my vagina sometimes hurt when I have sex?
Pain during sex is more common than you might think, but women often don't talk about it because they fear they're the only ones not having mind-blowing romps. Most often, the culprit is dryness. Birth control pills, antidepressants, and antihistamines can cause it, as can illnesses such as heart disease and diabetes. Stress and depression can make it difficult for you to relax and lubricate as well. The fix can be as simple as using a good, water-based lube, but to be safe, anyone who's having pain during sex should see her doctor.
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YOUR OB/GYN SAID WHAT?!
Sure, doctors are allowed to be blunt, but some things cross the line. So if you ever have an experience like these when you're in the stirrups, it's time to find a gyno who respects your body.
"During an exam, I had a female gynecologist look up from my un-Brazilian-ed nether regions and offer, 'You know, we do electrolysis here.' I responded, 'Thanks, but I don't mind looking like an adult.'" -J.Y., New York
"When I told my gyno I was having strong cravings for sweets, he replied, 'Say you were walking down the street and were suddenly very horny. Would you immediately go and have sex with the next person who walked by? No. So be as judicious with these lips'-and here he pointed to my mouth-'as you are with those,' indicating my lady parts." -P.A., California
"I had an abnormal Pap smear and had to get a cervical biopsy. The ob/gyn took a sample, but he must have dug in a little too deep. Besides unbelievable pain, blood started gushing out. While I was trying to get over the pain and shock, he shouted out to the hall, 'We've got a bleeder in here!'" -A.F., Washington, DC
"I was on the table, legs spread, anticipating the duck bill (as I call the speculum), and I heard the doctor flipping through the pages of my chart. Then, out of nowhere, he mentioned that he'd noticed I'd gained weight. Really?! Could you have said that before I was seated uncomfortably at the edge of this table, naked? I told him I was there for him to examine my vagina, not my waistline. I never went back to him again." -J.B., Ohio
-REPORTING BY MELISSA WALKER
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