This week’s question comes from one of our blog readers.
"Dr. Susan, how can I protect myself and reduce my chances of getting cervical cancer?"
With the rise of HPV infections & lesions showing up in places like the tongue, throat and anal and labial areas, everyone is becoming concerned. HPV (Human Papilloma Virus), is in the condyloma (genital wart) family. But unlike other genital warts, HPV warts are flat and cannot be detected without placing a special solution on the area. The solution reacts in such a way that the HPV lesions turn a whitish color, and this helps in diagnosis and treatment.
Since HPV is transmitted sexually, the best way to protect yourself from infection is to ensure safe sexual practices. Condoms are the best way to prevent most STD's, but it is thought that the HPV virus is so small that it can escape through a condom’s tiny pores. The addition of spermicidal foams and jellies can help.
The biggest breakthrough in the past few years has been the introduction of a vaccine initially approved for females age 8 to 27. Now the vaccines approval has been extended to males of the same age. This will hopefully be the #1 way to prevent transmission.
Women are typically at higher risk for acquiring these types of STDs as we are the semen recepors. Men, on the other hand, are depositors. Because we are the receptors of the semen, if the semen is infected, we serve as little incubators.
That is why it is so nice to use the WaterWorks cleansing system. WaterWorks can be used immediately after sex to rinse out semen quicklyreducing the time HPV can sit in vagina. Not only does WaterWorks function to reduce vaginal odors, it can also be used for daily feminine cleansing.
If you have not spoken to your healthcare provider about getting the HPV vaccine, it is a good idea to at least get information to read about it.
Please send me an email if you have any more questions about HPV or any other topic.
Dr. Susan Boyd
This week’s question comes from one of our blog readers.
This week’s question comes from a reader who is experiencing many problems as she goes through menopause. And like many of you, she has begun to experience some of the long-term side effects of hormone imbalance that go way beyond hot flashes, night sweats and irregular menstrual cycles.
Q: Since I started menopause sex has become more and more painful. Is there anything I can do to make it better?
I love this question. Why? Because it illustrates that menopause makes such an impact on a woman's life that it can even affect the way she experiences intimacy. Some women may go from enjoying an active, loving sexual relationship with their partners, to wanting to avoid sex altogether. This can be frustrating, as it puts strain on relationships, and can be scary as women wonder if there is any hope of restoring what they once had. The answer to this, of course, is yes, but it is important to try to stay positive and share what you're going through with your partner. No one said it would be easy, but if other women have survived this journey, I know you will too.
During menopause, as the levels of hormones drop, it causes the tissues of the vagina to thin significantly and become very dry due to lack of normal lubrication. It is the combined effect of these changes that eventually causes shrinkage of the vagina, and the loss of its ability to stretch.
During the excitement phase of intercourse, the normal response is an increase in vaginal moisture. This enables the erect penis to enter the vagina without difficulty, and the normal elasticity allows a pleasant stretching sensation as the man enters. However, in menopause this elasticity/stretchability is absent, as is the normal lubrication, so after penetration there is no moisture. That is why so many women experience intense burning pain - it is caused from the thrusting motion without lubrication.
The use of vaginal lubricants can help a little bit. Always choose water soluble lubricants rather than lotion, creams or oils, as these can cause vaginal infections. The best thing to do is make an appointment with your doctor to discuss this problem and make sure (through blood tests and exams) that there are no other problems going on. Because the tissues are hormone deficient, it is important to get on a good program of hormone replacement. Women have so many choices today, from traditional estrogen vaginal cream to forms like Bio Identical hormones from compounding pharmacies. After about 4-6 weeks on hormone replacement, you will start to notice the healing and restoration of the vaginal tissues back to pre-menopausal status.
Menopause can be a rough time, but if you work with your doctor and are open to share with your partner, sex can be enjoyed for a lifetime.
Hope you have a great week, and be safe out there!
Dr. Susan Boyd
The vulva, labia, vaginal opening (vestibule) and mons pubis (top part where most of the hair grows) are the most sensitive areas on a woman's body. This is why we notice any bump or rash right away, and may worry that it could be something really bad. So let me describe the many lumps & bumps that can show up down there.
Most women never look at themselves in these areas until there is something wrong. I've had many women come in because they have a fungal infection and felt bumps inside their vagina. When I examine them there are no abnormal bumps (because the vaginal walls are bumpy). But when we have an infection they can be swollen and irritated so they are much more noticeable.
The vestibule can have mucosal cysts, which are small, soft and painless lumps which can be removed if desired but can also be ignored if it is causing no pain.
There are many cysts that can form from blocked sweat glands. They tend to occur along lines of friction, especially where our panties rub throughout the day. These can be simple pimple-like cysts, sebaceous cysts, or even small skin tags like we see under the neck line or armpits in many people.
Fordyce spots are small white or yellow lumps, 1-3mm in diameter on the labia minora. They are painless. These are slightly enlarged sebaceous (oil) glands and are completely harmless. They often become more easily seen at puberty and with pregnancy and hormone treatment. They are benign and will often come and go or rupture after awhile. Some women are more prone to them and can even get them on their inner thighs. Antibiotics can help clear them.
Vestibular papillomatosis is a condition where the surface of the entrance of the vagina and inner labia minora becomes a bit thicker following puberty and in pregnancy. This gives a very fine, frond-like, slightly warty appearance to the skin, so it can be mistaken for warts. This is a normal variance for some people and doesn’t need or respond to treatment.
Angiokeratomas are tiny clusters of dilated blood vessels with a scaly top, seen after puberty and usually on the labia majora. They tend to become more numerous in older age. They are bright red initially but can become darker, almost black later on. Very occasionally they can bleed slightly if bumped or rubbed too hard. Other than that they don’t cause symptoms and are harmless. If they are causing problems they can easily be removed in the doctor's office.
Hymenal remnants are vaginal skin protrusions from the stretching and friction that occurs during intercourse and vaginal birth.
It is common to have irregular protrusions around the area of the hymen, the outer ring of the vagina. These rarely cause problems, but can be removed if they are bothersome.
Seborrhoeic keratoses are harmless warty-looking lesions found all over the skin in increasing numbers as we age. They are found on the labia majora and mons pubis in women from the thirties onwards. They are often dark in color and small (less than a centimeter). They can be solitary or multiple. They are benign and can be removed if you don't like how they look, but will never become cancerous.
Varicose veins are very common, especially during and just after childbirth. They can give the vulva a purple look, and may cause aching, especially at the end of the day. The veins in the labia majora or minora can become enlarged and tortuous. They rarely cause problems with delivery of the baby and will often shrink back after delivery. It worries some women as they see dark and black veins and just were unaware that this happens.
Hidradenitis suppurtiva is a big name for clogged sweat glands, and we have a lot of sweat glands down there. Women notice them during yeast and bacterial infections because of the increased puritis and swelling.
Waxing and shaving can cause an infection of the hair follicles causing swollen red spots and itching. These can be prevented by not sharing your razor and changing the blades after 3-4 uses.
The other common lumps come from clogging of Skene's glands or Bartholin's glands. Skene's glands are up around our urethra and Bartholin's sit lower at the opening of the vagina on both sides. They are usually painless but if they become infected will cause horrible pain. These are easily opened and drained, and then treated with antibiotic therapy.
Regardless of the lump, it is important to see your doctor to make sure all is well. Lumps and bumps do not always mean herpes or condyloma (warts).
I Hope you are having a wonderful week. Be safe and take care.
Dr. Susan Boyd, MD
The word 'douche' has been around for centuries. While it may be a French word, douching did not originate in France. Women have used methods to wash out the vagina in every part of the world since time began.
It is usually a mixture of water and lemon juice, vinegar or local herbs and flora. Today, we can find douches in most grocery or drug stores, which can give us a feeling that it must be a good thing that women do - a routine part of feminine hygiene. But, the truth that we know now in the 21st century is that douching can actually create more odor, recurrent vaginal irritations and increased vaginal discharge - the vagina's way of healing itself from the side effects of harsh chemicals in douches.
In America, around 30% of women between ages 15 and 44 admit to vaginal douching regularly and more admit to using them once or twice over their lifetime. Higher rates are seen in teens of all races and socio-economic backgrounds.
Besides making themselves feel fresher, women say they douche to get rid of unpleasant odors, to wash away semen after sex or menstrual blood after their period, to avoid getting sexually transmitted diseases, or to prevent a pregnancy after intercourse. But, these are false hopes. Douching can actually worsen infections rather than heal them and can cause PID (pelvic inflammatory disease) by pushing the infections further up our female genital track. Remember women, unlike men, are completely open to the outside world (unless pregnant, because the cervix is closed when pregnant, blocked by the mucous plug and the membranes - amnion and chorion - of the amniotic sac).
Otherwise, bacteria and semen can travel from the vaginal opening up through the vagina and the cervix into the uterus, the fallopian tubes and into the abdomen and pelvis. With semen, this can carry the semen up closer to the egg, making pregnancy more likely. But, if this happens with bacteria from our own body or an STD, it can damage our insides by producing "Super Infections" called PID, which require IV antibiotics and hospitalization. Some women can struggle with infertility, chronic pain and the risk of ectopic (tubal) pregnancies after getting PID because it can form scar tissue that blocks and twists the tubes.
The increased acceptance of multiple sexual partners, early first sexual experiences (as young as 12), and the increased popularity of anal sex all may be contributing to the increased infertility and ectopic pregnancy rates over the past few decades. You may be surprised to hear that it is not unusual for teens and young women to have 50 plus partners before settling down to one or getting married. Don't worry if this is you, because now we have become much better at treating infertility and ectopic pregnancies.
Remember, the vagina requires no special cleaning. Plain water without soap and chemicals can be used to "rinse" the vagina if needed. Douching with store bought or homemade solutions just destroys the natural vaginal flora and acidity which actually encourages the growth of abnormal bacteria that are alien to the vagina. So odor keeps returning as well as discharge and irritation problems. Because douching will actually cause, rather than improve, vaginal odor and increase discharge, rather than improve it, this keeps women returning to buy more and more douche products. Keep in mind that women who douche more than once a week have more difficulty getting pregnant than those who don't douche.
Many women feel the need to clean up inside their vagina, especially after sex and during and after their periods. It is OK to wash the outside of your vagina, in between your labia, areas of pubic hair, and of course around your anus. These are the areas that normally become smelly after exercise or a day of work and play.
Even if you can smell yourself and know the outside is sweaty and smelly, if you put your finger into your vagina there should be no smell at all. That's how you know there is no infection. But it is embarrassing to know you smell.
WaterWorks is a favorite way my patients clean inside their vagina. This is because it is an FDA-cleared green product that is reusable and has replaceable parts. It uses plain water, usually shower water, that is placed in a reusable bag that is attached to a medical grade stainless steel nozzle that is placed up inside the vagina. The water then flows by gravity and sprinkles into the vagina. The stainless steel reacts with the water on the vagina mucosa to remove vaginal odors (similar to stainless steel chefs bars used to remove garlic and onion odors from their hands).
It has no chemicals and is all natural. You may never have to use pills or vaginal gels again to remove odor. Many of my patients won't leave home without their WaterWorks as it gives them confidence during sex, gives them a way to rinse out blood or semen, and can be used daily.
I hope you are doing well and are happy.
Stay safe and please let me know if you have questions.
Dr. Susan L. Boyd, MD
There is a myth that it's dangerous or morally wrong to have sex during your period. This comes from certain beliefs passed down for many years when women were thought to be impure while on their period. Now we know that there are actually several good health reasons to do so.
For instance, having an orgasm creates a natural painkiller in our body called endorphins. Amazingly, these endorphins not only relieve pain but also muscle cramps & tension!!! So…WOW!! This means that orgasms, since the Uterus is a muscle, can actually relieve menstrual cramps and help with headaches. So much for using the excuse of having a headache to avoid sex! Endorphins also function as natural antidepressants and help with anxiety and PMS.
I feel really sad for women who do not enjoy sex or have never had an orgasm because they are missing out on so many benefits. Some women just endure sex and feel isolated because they don't understand what the "Big Deal" is. They do not know that they are not alone. It is common for women to feel let down as they never felt the awesome release of an orgasm. Many women have a hard time having an orgasm during vaginal sex and need oral (not the best idea on your period) or anal sex and nipple stimulation.
Because I am an Ob/Gyn, I listen to women everyday who enjoy sex but find they need to sneak away to use a vibrator or if comfortable, let their partner do it. Lots of couples use sex toys to spice up their love making. I recommend all women to have a vibrator not only for orgasm after sex, but to use in private as a way to get to know your own body so you can guide and teach your partner. It's funny, but men often find it exciting and like it when their woman "takes charge" and teaches them. It's the same for us as well. Vibrators do NOT desensitize women or make it harder to have an orgasm. That is just another old-fashioned myth.
It's just difficult for some women to relax enough to have an orgasm with their partner, and find it easier when alone and completely uninhibited. If you can orgasm alone, then you can communicate to your partner what it will take. Remember, orgasms with release of endorphins create relaxation and a sense of well-being. If the blood bothers you, then have sex in the shower or bath.
Also, don't forget, WaterWorks is wonderful to use to cleanse the blood and semen from your vagina. This can reduce the chance of extreme pH imbalance and abnormal odor and itching.
Be safe and have fun this week.
Dr. Susan Boyd, MD
Why is it that, no matter what we do, yeast and bacterial infections (and vaginal odor) keep returning over and over?
Many of you have probably used over-the-counter medicines, homemade concoctions and prescription medications from a doctor, yet still battle with chronic, recurrent yeast/bacterial infections that cause vaginal odor and irritation.
The bottom line is this: If the conditions that make us vulnerable to these issue are not corrected, unhealthy organisms, odors, and infections can continue to show up. So what can we do to create a healthy vaginal environment?
Many studies now show that restoring healthy probiotic flora significantly protects against chronic infections. Probiotics are healthy, disease-fighting bacteria that live in our colon, mouth and vagina. And, studies show that taking probiotics daily can help prevent recurrent, chronic infections. Once established, friendly bacteria (especially of the Lactobacillus genus) produce natural disinfectants that help maintain an optimal pH and a healthy balance of beneficial microorganisms in the vagina by excluding harmful bacteria and other pathogens.
For example, certain specific strains of Lactobacilli produce substances such as lactic acid, hydrogen peroxide, and bacteriocins, which inhibit the growth of bacteria implicated in bacterial vaginosis. Furthermore, these friendly acid-making bacteria may inhibit the adherence of harmful bacteria responsible for bacterial vaginosis.
Numerous factors may upset the delicate balance of friendly microflora. These include antibiotic therapy, dietary changes, cigarette smoking, sexual activity, and oscillating stress levels.
According to one report, there are more than 300 million cases of urinary tract infections, bacterial vaginosis, and yeast vaginitis worldwide every year. Yeast infections alone affect 75% of American women and 40-50% of these women will endure recurrent, chronic infections. So you are not alone.
Standard treatment for the common Candida yeast calls for antifungal therapy, either with an oral agent, such as fluconazole or vaginal creams and suppositories, which may require multiple applications. Bacterial vaginosis is commonly treated with an antibiotic, such as metronidazole or clindamycin.
Given the high prevalence of these infections, and the high rate of recurrence, it is clear that most adult women could benefit from preventive care and hygiene. Lactobacillus, when consumed orally daily, is especially effective at establishing and maintaining healthy vaginal microflora.
This is great news, because with the use of WaterWorks and probiotics, you could find that the recurrence of infections and odor will become less and less.
I hope this helped you.
Take care and be safe.
Dr. Susan Boyd, MD
Vaginal discharge is normal and it changes color and consistency throughout the month during the menstrual cycle. After our period it changes from thin and watery to thick and pasty, and during ovulation it becomes like mucous and very gooey, but not smelly or itchy.
It is naturally odorless and has the purpose of keeping the vagina clean and healthy. It fights off abnormal bacteria and supplies the perfect lubrication during sex. If we had no vaginal discharge, the vagina would feel dry and itchy (which is common in menopause or any times of hormone imbalance). Sex would be impossible or extremely painful because the vagina would not be able to stretch.
When vaginal discharge becomes odorous and itchy, it is usually caused from an imbalance of the vaginal pH. This change suppresses the healthy bacteria, called Lactobacillus, and it is unable to do its job of keeping the vagina clean and healthy. This imbalance causes an overgrowth of a variety of microorganisms such as yeast, bacteria and fungi - producing yeast and bacterial infections (BV). With these come odor and itching or burning.
Why does this happen? Many of us feel we did something wrong or we are dirty, so cleaning more will help. In fact, that will just make it worse - continuing the cycle of it feeling better for a day and then recurring, sometimes coming back even worse. Most of the time, excessive washing and douching is the cause of reoccurring infections and odors. Wearing tight or non-absorbent panties can also prevent healing.
Vaginal odor may also worsen after sex, due to the mixing of semen, sweat, and vaginal fluids. Semen has a neutral pH of 7.4, which is the same as period blood. But the vagina has to maintain a lower pH than that of the rest of our body - somewhere around 7.2 - in order to kill the abnormal bacteria that would cause infections and odor. The normal/'healthy' Lactobacillus vaginal bacteria, likes a lower pH. When semen is deposited into the vagina, the vaginal flora can be disrupted as the pH rises. It is this rise of pH that allows the yeast and abnormal bacteria to grow and overpower the Lactobacillus. Then, abnormal bacteria and yeast produce odor and irritation.
So make it a habit to jump out of bed after sex and rinse the semen out of the vagina with plain water only. Do not ever let soap get into your vagina, as it is very alkaline and can bring on recurrent infections and odor. Soap should only be used to wash your skin and the outer part of the vagina - the labia, and the anal area.
WaterWorks makes feminine hygiene easy. It is FDA cleared to help reduce vaginal odor. It is reusable and uses just ordinary tap water only. The unique design helps us easily rinse inside the vagina, and it can be used daily. Most women use it every day and have overcome their recurrent odor and discharge problems.
Water alone is better than anything to rinse the vagina. We should never use dilute vinegar, lemon juice or other chemicals. WaterWorks is designed with a stainless steel nozzle that is inserted into the vagina, causing a reaction as it comes in contact with the vaginal mucosa to facilitate the removal of vaginal odor.
I hope this helps you all have a better understanding of how our bodies work and what keeps us healthy.
Have a safe and wonderful week,
Dr. Susan L. Boyd, MD