Do I Need to Cleanse Inside My Vagina Before My Yearly Exam?

The yearly gyn exam can be very stressful for most women. We can worry about our health, the outcome of tests, how to ask uncomfortable questions and sometimes worry about having the most private parts of our bodies examined. The purpose of the yearly exam, as we've discussed previously, is to do an annual pap test to check for cancer and HPV virus, do the breast exam (and schedule a mammogram if needed), do a pelvic exam to check for any ovarian, uterine or pelvic masses, answer questions and do lab tests.

Your doctor will examine the external genitalia and inside the vagina, inspect the cervix and perform a pap smear. This makes many women wonder whether they need to clean inside their vagina before the exam, and if so, how to do so in order to assure the best exam results. The best answer to this from a gynecologist viewpoint (and as a woman myself) is: of course....but do it properly! We all want to feel clean and be ready for the best exam, but it’s important not to clean so much that there is nothing left to be examined and sent to the lab.

For the best exam, prepare starting 48 hours ahead of time abstain from vaginal sex, use of lubricants, gels, foams, feminine deodorant sprays, or using soap internally. Cleansing externally is fine as is shaving or waxing excess pubic hair. It is best to shave or wax a few days before your exam is to reduce sensitivity or irritation during the exam. Just do what makes you feel comfortable.

All of you by now have heard about WaterWorks Vaginal Cleansing System, which is a wonderful way to clean your vagina naturally without the use of drugs or chemicals that can cause more irritation and more infection. The chemical cleansers can cause a cycle that never ends, where you think the odor is gone for a day or two, and then it coms right back and harmful to the vaginal eco-system! With WaterWorks, getting ready for your annual exam is easy. WaterWorks can be used every day or even two to three times a day if you shower that many times. It can be used after vaginal sex to rinse out semen and prevent odor and persistent discharge afterwards. Unlike the 48 hours restriction we place on other vaginal products or activities, but with WaterWorks you only need to abstain for 24 hours prior to your exam.

The reason for this is that WaterWorks uses only tap water and medical grade stainless steel nozzle to cleanse the vagina. Women who have struggled for years with vaginal discharge and odor have had results the first time they use it! No more spending money on pills, medication, vaginal gels, or douches. WaterWorks can be used again and again and you never need to buy any extra parts or solutions because it uses only tap water. How wonderful. As a physician, this made me so happy for my patients.

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Tips For a Healthy Vagina

When our vagina is healthy, we feel healthy. But when we notice abnormal discharge or odor or abnormal periods, we worry about our overall health. That's because vaginal problems can affect our fertility, desire for sex and ability to reach orgasm. Ongoing vaginal health issues can also affect other areas of our life, causing stress or relationship problems.

First it is good to know some details about our bodies. For example, the vagina is a closed muscular canal that extends from the vulva (the area where the hair grows on top) and goes to the area of the uterus called the cervix. Certain things can affect your vagina - some we can change and some we can't.

Taking care to use condoms during sex to protect against infections is one thing we can control. Also, be aware that aggressive or forceful sex can cause pelvic fracture or other injury to the pelvic area as well as vaginal trauma.

Certain health conditions like diabetes and Sjogren's syndrome, an autoimmune disorder, can cause vaginal dryness. Certain antihistamines can cause also cause vaginal dryness. Prolonged use of antibiotics increases the risk of a vaginal yeast infection. Superabsorbent tampons can lead to toxic shock syndrome which is a rare, life-threatening complication of a bacterial infection.

Intra-vaginal birth control products like Spermicides, diaphragms or contraceptive sponges may also cause irritation and painful sex.

Anxiety and depression can contribute to a low level of arousal and resulting discomfort or pain during sex. Trauma, such as sexual abuse or an initial painful sexual experience can also can lead to pain associated with sex from scar tissue and anticipated pain.

Changes in your hormone levels can also affect your vagina. For example, estrogen production decreases after menopause, after childbirth and during breast-feeding. Loss of estrogen can cause the vaginal lining to thin (vaginal atrophy) and this can make sex painful.

But, honestly, there are many other common conditions that can affect your vagina. These might include persistent or recurrent genital pain just before, during or after sex (dyspareunia). Pain during penetration might be caused by involuntary spasms of the muscles of the vaginal wall (vaginismus). And, sexually transmitted infections, including genital warts, syphilis and genital herpes, can affect the vagina, causing abnormal vaginal discharge or genital sores.

Also, a bacterial or yeast infection can cause inflammation of the vagina, called vaginitis. Symptoms usually include vaginal discharge, odor, itching and pain.

Women at any age can also suffer from prolapse of the uterus, bladder, and rectum, which can put pressure on the vagina. This happens when the supporting ligaments and connective tissues that hold the uterus in place become weak and can cause the vagina to be pulled down as well.

The vagina can also form cysts and abscesses, which will cause pain during sex or make it difficult to insert a tampon.

Vaginal cancer is very rare, but unexplained bleeding or pain should always be checked out by a doctor. Look for changes in the color, odor or amount of vaginal discharge and vaginal redness, itching or irritation, bleeding between periods, after sex or after menopause, a mass or bulge in your vagina, or a sensation of pressure or heaviness in your vagina

You can take steps to protect your vaginal health by being sexually responsible. Use condoms or maintain a mutually monogamous relationship with a partner who's free of sexually transmitted infections. You may want to consider being vaccinated to protect yourself from human papillomavirus (HPV) as well as hepatitis A and hepatitis B. Practice good hygiene by not douching, using perfumed soaps, feminine sprays or scented tampons. Change tampons frequently (do not leave them in for longer than 5-6 hours). If you use sex toys, clean them after every use.

Using WaterWorks is a wonderful way to maintain vaginal hygiene naturally, without disturbing your natural vaginal flora. Check out the Website to see how it works!!

Kegel exercises can help tone your pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Once you've got the hang of it, do at least three sets of 10 a day.

Limit the amount of alcohol you drink and don't smoke or use drugs. Smoking increases the risk of bladder cancer and alcohol increases the risk of breast cancer. Alcohol and illegal drugs can cause sexual dysfunction. Nicotine can inhibit sexual arousal and if you're under the influence, you're more likely to take sexual risks.

Just remember to see your doctor if you are having unexplained vaginal pain. It may be something simple, but you want to know so it can be taken care of.

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Vaginal Discharge

You know, so many women are bothered by vaginal discharge and are often confused about what constitutes 'normal' changes.

A clear to whitish discharge from the vagina is normal and will fluctuate in consistency and amount throughout the menstrual cycle. It is actually a way by which your body gets rid of bacteria and dead cells in your vagina - keeping it clean and healthy. However, if you notice vaginal discharge that is unusual in color or odor, itching and burning in the vagina, or blood-stained discharge, it could indicate an infection or disease of the reproductive organs. Abnormal discharge always has an unusual odor or will cause swelling and itching in the vaginal area.

Urinary tract infections (UTIs) are common in women and are caused by bacteria which are usually either transmitted from the sexual partner or from the woman's anal area. The first symptoms of a UTI can be abnormal vaginal discharge, pain with sex or urination, and urinary odor. Sometimes there will even be vaginal and urinary bleeding.

The majority of women know that a UTI can cause a burning sensation while voiding and a constant urge to urinate, although only a few drops may be produced. The urine is usually cloudy and often strong smelling, but few women associate their abnormal discharge with a UTI.

As a doctor seeing a woman present with all these symptoms, it is hard for me to know which came first, the vaginal infection or the urinary tract infection. So, after we talk, I will check vaginal cultures and send a urine sample for testing at the lab. Most UTI's are caused by a bacteria known as E.Coli that comes from our rectal and anal area (lucky us that everything is so close together down there), as it is easy for that bacteria to get in the bladder and vaginal area from intercourse, and floss-type panties.

If you find that you are getting more than your fair share of these type of infections, it is good to know that they can be avoided by drinking lots of water and cranberry juice. Cranberry juice acidifies the urine, and bacteria don't like that. Do not use feminine hygiene sprays or douches, as they can make it worse. Also, urinating right before and after sex is an important habit in helping prevent infection.

I hope the next time you have abnormal vaginal discharge and urinary pain/pressure, that this information will help you.

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When Should I Get a Pap Smear?

So what is the truth about pap smears? Everywhere we read, it says something different about how often we need to get a check-up with the gynecologist. And we hear, “. . . if you've had a hysterectomy you never need to have a pap again.”

The so-called guidelines suggest that no one needs a pap smear until age 18 – 21, regardless of the age of the first sexual experience. But, consider how prevalent HPV is, and how easily it is transferred to women during sex – and knowing it is the #1 cause of cervical, anal, and oral cancers.

There is also the worry of infertility that can be caused by STDs. When exams are encouraged at an early age, this can be minimized and treated, if necessary.

Pap smears may be discontinued after surgery for a total hysterectomy, unless it was performed for cervical cancer or any type of pre-invasive diagnosis found on pap smear. This includes high risk HPV, uterine, ovarian, breast, bladder or anal cancer. Yearly paps and pelvic exams should be continued if you have ever had, or currently have, any of these cancers.

Having a compromised immune system for any reason – from diabetes, HIV, Lupus or other auto-immune disorders – can put you at risk for cancer and pre-invasive disease, even if you have never been diagnosed with it. It is so important to get yearly exams and not assume that you are not at risk just because you are too young, too old, not currently having sex, or because you have had a hysterectomy.

The most important thing is to put yourself first. We, as women, can easily ignore our own needs and health as we take care of our families. Let me say this, it's not worth it, because you deserve to be healthy and feel good. Most cancers, if caught early, are curable and never advance to the point of even needing drastic treatment like chemotherapy or radiation. You and your family deserve to have you happy and healthy.

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Can I Use WaterWorks to "Clean Up" After Sex?

A great question came this week from JMW. She has noticed that after having sex with her husband, she 'leaks' his semen for a day or two, and wondered if using WaterWorks after vaginal intercourse would stop this from happening. She also wondered how long it take for the water to drain out of your vagina after using WaterWorks. I'm assuming the last part comes from a worry that water, instead of semen, would 'leak' out for a day or two.

Your question is one of concern for so many women, and one that I am asked quite often. Women tell me that even bathing or showering after sex doesn't seem to help. After awhile, it's hard to know if the “leaking” is still semen, or perhaps the beginnings of an infection. How many of you have experienced this? WaterWorks is a perfect way to clean-up after vaginal sex. With proper cleaning between use, WaterWorks is designed to be used time and time again, so you don't have to keep spending money once you've purchased it. Plus it uses only plain tap water; no chemicals and no special solutions.

It is the design of the stainless steel nozzle that makes WaterWorks unique. The reaction of stainless steel and water with the vaginal mucosa removes any odors. Also, because it gently sprinkles water in a downward direction within the vagina (no high pressure or shooting action), the water drains out immediately. So, it will rinse out the semen or any vaginal discharge with no 'leaking' after use. WaterWorks can be used daily with no side effects.

We know from our previous answers that it is important for the vagina to maintain a low pH to stay healthy and keep yeast and bacterial infections away. That is why hygiene after vaginal sex is so important. It is important to rinse the semen out as soon as possible as it has a higher pH. The longer it stays in the vagina, the more likely it is to cause unusual vaginal odors, and destroy the delicate vaginal environment that keeps infections away.

You may be interested to learn that the vagina does not go straight up vertically. When a woman stands upright, the vagina actually lies in a slanted, horizontal plane; it goes up, in, and back towards your tailbone and this is why it takes so long for semen to drain out. Also, semen and discharge are thicker than water, and therefore take longer to drain out

One of the top uses for WaterWorks is to help with daily hygiene, especially rinsing out semen after vaginal intercourse. And with WaterWorks this can be done safely without disrupting the vagina's own defense like douching does. Don’t forget, douching with traditional disposable douches can actually create an environment that can lead to yeast and bacterial infections. So I hope this answers your question. I hope you are all having a great summer! It is hot, hot here in the Southwest, but lots of blue sky and sunshine.

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Is It Normal to Have Vaginal Discharge?

Vaginal discharge is the one thing, other than the menstrual cycle, that women notice and use to judge wellness in their bodies. If your cycles are regular and on time, and your vaginal discharge is normal, you feel your body is healthy, right? But, if a woman starts skipping her cycles or having too many cycles or bleeding heavily, she knows something is not right with her body. Okay.

Still, so many of you come in (most of you for other female problems) and I find out that you are constantly dealing with abnormal vaginal discharge or odor. You and your partner feel it is just 'normal' for women to have a fishy or strong odor all the time. Isn't that what all those tuna fish and fisherman's wharf jokes are all about? Men know it, and they talk about it, and think that's just the way it is – so, just grin and bear it.

Women don't know what to do. It's embarrassing, right? Three showers a day, and you still worry if everyone else can smell you. You can't wash it away, and that SUCKS because you know he's going to smell you during sex. But feminine sprays, lotion or soap and water do not help.

It is normal to have vaginal discharge. Some women produce more vaginal discharge than other women, and this is due to hormonal fluctuations. Teenagers and pregnant women both have higher than normal hormone levels which causes an increase in vaginal discharge. Women who are dry and lack discharge may have low hormone levels, like in menopause or during breastfeeding. You may also notice changes in the amount of vaginal discharge, changes in its consistency, (thick, thin, watery, sticky), and sometimes find it necessary to wear a pad or panty liner. Birth control pills will change vaginal discharge because it balances the female hormones and is a good therapy for women who feel too 'wet' all the time.

But, no matter the amount or consistency of discharge, it should never have a foul or fishy odor. At times, discharge may have a slight odor, due to hormonal changes during the month or during the final day of your cycle – due to pH changes from the menstrual blood. Normal discharge should not be accompanied by pain, itching, burning or redness.

Vaginal discharge is very important to the female reproductive system. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection. A change in your normal vaginal discharge may be a symptom of a vaginal infection.

Most of the time, vaginal discharge is perfectly normal. The amount can vary, as can the odor, and the color can range from clear to a milky whitish, depending on the time of your cycle.

Important things to watch for to determine if there is an infection include the length of time you have had the abnormal discharge, the color/odor of the discharge and the presence of any itching, pain, or burning in or around the vagina. Different infections present with different types of discharge and symptoms:

• Chlamydia and gonorrhea are obvious, as there is a copious amount of cloudy, yellowish discharge, sort of like having a period of discharge, with an awful odor that is so different from the normal everyday discharge that it can alarm most women. In addition, they can cause urinary incontinence, painful sex, severe pelvic pain, bleeding and irregular cycles if not treated quickly. Also, they can be the cause of PID (pelvic inflammatory disease) which can cause severe illness, fevers, blockage of fallopian tubes and eventually lead to infertility.
• Trichamonas is a parasitic infection typically contracted and caused by having unprotected sex, with grayish frothy discharge.
• Yeast Infections can have two kinds of discharge: either thick and clumpy like cottage cheese or thin, whitish discharge that causes intense itching and swelling.

Infections require medicated vaginal creams or antibiotic medications, but here are some tips for preventing vaginal infections that can lead to abnormal discharge:

• Keep the outer vagina area clean by washing regularly with a gentle, mild soap and warm water. DO NOT WASH INSIDE THE VAGINA WITH SOAP. Never use scented soaps, feminine products or douche. Also avoid feminine sprays and bubble baths.
• After using the restroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection. It is a good idea to have baby wipes or other 'wet' wipes near the toilet as they work much better than toilet paper for feminine cleansing.
• Try to wear 100% cotton underpants; switch off wearing floss panties and regular panties; and avoid overly tight clothing all the time.

We are lucky enough to have WaterWorks, which is FDA cleared for feminine cleansing and to reduce vaginal odor problems. Everyone loves this, as it functions just like a douche, but isn't. It is made of medical grade stainless steel and uses no chemicals (only plain tap water) and it can safely remove vaginal odor with the first use.

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Is There Treatment For HPV?

 " I've been told I have HPV and I wanted to know if there is any treatment for it?"

HPV is a virus that is acquired through sexual contact. There are over a hundred types of HPV. Some can cause visible condyloma (a growth resembling a wart) and other types infect cells internally. When the cells are infected internally, the virus can take over the cell & start causing tissue changes consistent with early signs of cancer. These early changes are called dysplasia, and are not cancer, but if left untreated can eventually become cancer.

Condyloma are seen on the labia majora and labia minora, mons pubis, vaginal opening and around the anus.  These can be treated with prescription solutions that can be applied at home. Many women choose to have them removed surgically using a CO2 laser. This is much quicker, less painful and works better when there are multiple condyloma in different areas.

When the HPV infection shows up on your pap smear, the virus cannot be seen as a visible lesion or a wart.  In this case, it has infected the cervical cells internally. When this happens, your OB/Gyn will call you to notify you of the abnormal pap test and the high risk HPV status.

At this point, further testing will be ordered. If your pap test is otherwise normal, but is positive for high risk HPV, it is ok to return to your doctor for paps every six months. If your pap test is positive for dysplasia (mild, moderate, or severe) then it is usually best to have a colposcopy done with a biopsy.

If this test returns from the pathologist showing no underlying cancer cells, then the next step would be to remove the infected tissue. This can be done in two ways: 1) If the biopsy and pap show only mild dysplasia, the tissue can be frozen off (cryotherapy), and a follow up pap done is in three months to make sure it has cleared and healed; 2) The other option is to perform a LEEP procedure, which is done by numbing the cervix with lidocaine and shaving off the abnormal tissue with small instruments that have wire loops on the ends . The tissue can then be sent to pathology for evaluation. If no cancer is seen, the patient can return in 3 months for a repeat pap and continued close survellence.

When these procedures are done, HPV can be completely removed, however there is always a chance of reinfection from the male partner. Many women worry because they have a misconception that HPV is in the blood and can circulate throughout their bodies, but in reality HPV can only infect the areas it comes in contact with.

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Should I be Tested For an STD?

For many of us this may be an uncomfortable and embarrassing question. I know many of my patients will tell the staff they are coming in for a different reason, and only when they are finally in the exam room with me they are comfortable enough to share their concerns about possible STDs. 

Some of them have just discovered that their partner has been cheating on them, and are emotionally devastated. Maybe you or someone close to you has recently experienced this and can understand how scary it can be not knowing if you might have contracted something serious from an unfaithful partner. Even if you are single and dating and are careful to use condoms everytime, the worry is still there as condoms don’t protect from all STDs. 

Testing for STDs should begin when you become sexually active or have symptoms that make you worry that something may be wrong. Symptoms like vaginal bumps, blisters or open sores should be shared with your OB/Gyn.

So should vaginal discharge that is odorous, itchy, bloody, or higher volume than normal. If the infection gets to your kidneys or fallopian tubes and into the pelvis, it can cause fevers, severe pain and possibly PID (pelvic inflammatory disease). PID can cause scarring of the fallopian tubes and eventually infertility. I would never want to think that any of you or my patients would suffer from this and try to self- treat because they were too embarrassed to see their doctor. We are here to help you and want to see you get better. 

The home tests that you can get from the drug store can be used, but will often read positive when no infection is present at all. So a follow-up with your doctor is still a good idea. 

The best time to screen for STDs & STIs is during your annual exam. It is also a good time to ask questions and get information on prevention.

Some STDs (like HIV, Hep B, & Herpes or syphilis) may not show up right away on initial testing and take a few months to pick up on a blood test, so follow-up in 6 months to confirm that tests are truly negative.

I hope this helps. I know a lot of my patients ask me if douching helps get rid STDs and I have told them that it can actually force the infection up further through the cervix and into the uterus and fallopian tubes. This in itself can cause PID as discussed above.

A much better way to clean out your vagina is to use the WaterWorks Vaginal Cleansing system. It will rinse out excess discharge and infection-causing bacteria. [Note: this will not cure any STD or prevent an STD]. WaterWorks uses only fresh water (no chemicals!) and is FDA cleared. It does not use a shooting action so will not push the infection further up into the uterus or fallopian tubes. It may help you heal faster along with taking the prescribed medications. Don't share your WaterWorks with anyone else!

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Can You Get Pregnant During Your Period?

A woman CAN become pregnant if she has intercourse during her menstrual cycle. This topic has been debated for many years, and most of us have heard stories from relatives or friends about someone getting pregnant during a period. In fact, I believe my own mother said she got pregnant with me during her cycle - I obviously was not planned!

While menstruation may be the least likely time of the cycle for conceiving, many studies, including one funded by the NIH (National Institute of Health), suggest that women have the potential to get pregnant at virtually any time during menstruation. Just like every woman is different, so are her hormonal balances and timing of her menstrual cycles. Any women using 'natural' birth control, like the rhythm method or checking basal body temperatures, knows how varied one’s own physiology can be from month to month. The basic rule is that there is no predictable time during the month when the risk of pregnancy is totally absent.

So let's talk about the menstrual cycle. A woman's cycle begins on the first day of menstruation, which is counted as day 1. Most cycles that are discussed are calculated on a 28-day cycle. A woman is typically most fertile on days 10-17, with ovulation usually occurring on day 14. However, only 30% of all women fit this model, and even fewer have regular periods. Even the women with the most predictable cycles do not always ovulate at the same time each month.

The fertile period in a woman lasts for about 4-6 days each month. Men are always fertile, as they have sperm readily available, and sperm can survive inside the woman's cervix for up to 4-5 days. The egg is viable for 48-72 hours after ovulation. All of these variables can create a wide range of days for pregnancy to occur. If the sperm is deposited early, it can wait around as the period finishes and conditions become perfect for conception. During lower fertile periods, a woman is most likely to become pregnant if sexual intercourse occurs at the end of her cycle, just prior to ovulation.

Unfortunately, women are under more stress now than ever, which can cause irregular bleeding during menstruation and especially at ovulation. This can be mistaken for a period, causing confusion and miscalculation of cycle length and ovulation. Stress can also lengthen the duration of bleeding, and ovulation can actually happen before the bleeding stops.

So my advice for all of you is: if you do not want to become pregnant, always use a reliable form of birth control even during your period.

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Still a Virgin. Do I Still Need to See a Gynecologist Yearly?

The yearly exam is a time to screen for overall health, and keep up on any changes that may be occurring. For a lot of women their gynecologist may be the only doctor they see on a regular basis, so this makes it even more important.

For some women who are still virgins, coming in every other year may be OK, if their gynecologist agrees and if they have normal pap smears. But few women fit into this category.Most gynecologists recommend that a young woman, regardless of whether or not she has engaged in sexual activity, should establish care with her doctor no later than 18-21 years of age. There are many reasons to see your gynecologist.

Many women have a family history of breast and/or ovarian cancer and need to be followed more closely. Their family history may require that they have special tests at specific intervals or start testing earlier, than someone with no family history.

Others, regardless of whether you're a virgin, may have menstrual pain or irregularities that need to be looked into. Ultrasounds to screen for ovarian cysts or cancer can be a helpful screening tool for this, or to evaluate abnormalities like PCO (polycystic ovarian syndrome). PCO is a syndrome of symptoms that can be distressing and cause many health problems, like abnormal hair growth, insulin resistance, and irregular menstrual cycles due to difficulty with ovulation.

Still others among you may have pain with your cycles that interfere with your ability to work or go to school and need special care and treatment. Causes can include endometriosis, ovarian cysts, uterine fibroids and all of these can interfere with future fertility.

It is important for all women, even if you decide to remain a virgin, to come in on a yearly basis to maintain a quality relationship with your gynecologist and keep up on all your important health issues.

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Orgasms Are Causing Excruciating Pain - Why?

Sex should not be painful, right?  So why is it painful for some women and not others?  For most women it can be a shock the first time they experience it.  It usually happens during ovulation when the ovaries are swollen and tender with maturing follicles.  If one of the ovaries is bumped or tugged with deep penetration or thrusting this can cause significant sharp, stabbing pain. 

You know it's common for women to have pain like that, and now and then with sex.  But for some of you, it has become a regular thing, and every time you are intimate with your partner, it causes significant pain.  Then afterwards the pain continues long past orgasm.  In these cases, sex can really become a scary experience rather than exciting and satisfying.  This was how Kelly felt, and orgasm changed from wonderful and satisfying to painful all the time:       
                                                                                                                          

“In the past couple of months, whenever I have an orgasm, it is excruciatingly painful.  The pain is only on my outer pelvic area. It's like all the muscles from my pubic bone all the way down to the rectal area goes into painful spasms. Just like bad menstrual cramps, only external. 

The pain is awful, and the worst of it lasts for about 5 minutes (feels like an eternity), and then gradually starts to get better.  I have to sit on a heating pad to get a bit of relief, and I can still feel it the next day.  This happens even without intercourse. Just having a clitoral orgasm is enough to cause the intense pain over the whole groin area. I'm single anyway, and not married, so sex is pretty rare these days.”

There are so many reasons that women can experience pelvic pain and sexual pain, that is why it is so important to see your healthcare professional if you are concerned.

Pain at orgasm can occur because of the contractions of the uterus, and this can expose underlying problems that would normally be ignored or thought to be from something else like gas pain, IBS, constipation, bladder infection, or ovulation pain.  It's only when it happens time and time again that professional help is sought.

Clitorism is a continued, painful condition in the female with recurring erection of the clitoris.  The word is also used to describe an abnormal enlargement of the clitoris. Clitorism is painful, much like its male counterpart, priapism. 

Clitoral phimosis is a condition in women, whereby the clitoral hood cannot be retracted, limiting exposure of the clitoris.  Imagine an uncircumcised man not being able to pull back his foreskin during intercourse, this is similar to this condition in women.  It is rare, but some baby girls are born this way and feel that they do not have a clitoris when they become sexually active.  

This condition is one of the reasons some women are unable to have an orgasm, due to the clitoris being 'buried' under so much tissue.  The usual treatment is surgery to unbury the clitoris so it can be normally stimulated during intercourse.  Care has to be taken not to expose too much of the clitoris by removing too much skin.  That is why it should always be done by an experienced professional. 

Some women have been found to have clitoral adhesions which can be congenital (present since birth) or acquired from recurrent infections or injury.  In this condition, the clitoris and clitoral hood are connected by little adhesions or pieces of scar tissue.  Again, this requires surgical treatment with the utmost care, as removing them can promote more adhesions. 

Endometritis refers to inflammation or infection of the endometrium, the inner lining of the uterus - which is the portion that releases during the menstrual cycle and also remains should implantation occur.

The most common cause of endometritis is an infection from compromised abortions, delivery, medical instrumentation, and retention of placental fragments. Cesarean section or prolonged rupture of membranes and long labor with multiple vaginal exams during labor are important risk factors.  

Symptoms include lower abdominal pain, fever and abnormal vaginal bleeding and discharge. Treatment is usually with broad-spectrum antibiotics.  Menstruation after acute endometritis can be excessive and scary, but should improve after a couple cycles. 

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Leukorrhea - What is it and Should I Be Concerned?

        Leukorrhea is a term that has been used for many years to describe vaginal discharge, whether normal or not.  It has classically been used to describe the increase in vaginal discharge that occurs during pregnancy and continues into the postpartum.  The term leukorrhea, when used now, is almost exclusive to the post-partum period, which is the 4-6 weeks right after having a baby.   

      It usually consists of a thick, whitish or yellowish discharge, or a thick, clear, blood-tinged discharge and is usually due to hormone imbalance & continued uterine involution (shrinkage). Most of the time it goes away completely after the post-partum period is over, and discharge returns to pre-pregnancy status.  For a select few, it may go away for a while, only to return from time to time.  It may even keep re-occurring for years.

     Now, most of us just say "vaginal discharge" to refer to any fluid coming from the vagina, whether pregnant or not.  Vaginal discharge plays an important role in maintaining a healthy vagina. The secretions are designed to flush out bacteria and other tiny organisms to prevent infection.  It is the natural defense mechanism the vagina uses to maintain its chemical and pH balance, as well as to preserve the flexibility of the vaginal tissue.  Vaginal discharge is normal for a woman and it would definitely not be normal to not have it.  Normal vaginal discharge is odorless and a clear or a pale milky color.

     Vaginal discharge does increase during pregnancy, as there is a baby growing in the uterus, which causes increased blood flow to the vagina and increased estrogen levels. Even female infants can have discharge for a short time after birth, due to their in-uterine exposure to estrogen from mom; many times it is period-like.  

     Discharge changes during the month.  It can be heavy at times and it can change to clear and watery - that's normal. Other reasons for change include infection, female malignancies, and hormonal changes. In pre-teens, an increase in discharge will happen about 2 years prior to puberty and the onset of the first period.    

     Abnormally heavy discharge (way too much flow that makes you feel wet all the time) that looks and smells normal, is caused by an increase in hormone levels, particularly estrogen, that causes excessive secretions from the cervical glands. These secretions help to clean your vaginal area, so even if they are uncomfortable, they are a sign that your body is doing what it needs to stay healthy. Some women have enough discharge that they need to wear panty liners all day long. This is the type of discharge we discussed earlier that can always come and go for no reason and would respond well to minimal treatment.

     Abnormal discharge will be thick or even cottage-cheese textured, yellow or green, or tinged with blood. It may have an unpleasant odor. You may feel itching or burning in your vaginal area. These are more likely signs of an infection or a sexually transmitted disease.  If you have a sense that your discharge is not normal, it is a good idea to check in with your doctor. Generally, your doctor can test it with a simple swab (Q-tip) test for culture.

       Chronic vaginal discharge always involves one or many parts of the reproductive organs. Whenever the body is loaded with toxins due to poor dietary habits and the eliminative organs such as  bowels, lungs, skin and kidneys are unable to eliminate the toxins, the body produces a profuse discharge or elimination through the vaginal walls and glands of the uterus.  In the case of advanced, chronic inflammatory conditions, it leads to discharge with pus, offensive odor and color varying from cream to yellow or light green.  

       Usually, what happens is you may begin feeling like you are getting a cold and find you also have an increase in vaginal discharge.  You may start to feel irritable and develop black patches under your eyes or some face discoloration, due to the skin weeping that occurs as the body rids itself of toxins.  You may feel weak and tired, a lot of pain in the lumbar region and the calves and a dragging sensation in the abdomen.  Arthritis syndromes can pop up, causing all-over body aches and pains and stiff joints, young & old alike. 

       Backaches will come on for no good reason making it difficult to get comfortable and you may have pain that shoots straight down your vagina or into your leg, especially the thigh and calf muscles.  It is common to have lower abdominal pain from the swelling and inflammation of the uterus and vagina that makes them ache and throb.  If it is an infection, then it has a very good chance of moving into the bladder due to close proximity of the vagina.  Then comes the burning during urination and frequent urge to go, but only a tiny amount of urine comes out.  MISERABLE FEELING!!  

      These are only examples of bodily malfunctions that can accompany female problems or how other organ systems can affect the female system as well.  It is so common to see women suffering with gastric reflux, heart burn, constipation, diarrhea and IBS (irritable bowel syndrome), when their struggling with pelvic pain, heavy periods and painful sex, it's like their whole body is sick because of the way their female system is all off.   So now you feel wiped out, and all you thought you were battling was a little discharge, yeast or bacterial infection.  It's amazing what our body does when it wants to flush out toxins, we usually don't think it will use our vagina and other female organs to do this along with skin and everything else.  Amazing.    

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Vaginal Discharge: What is Normal and What is Not?

Vaginal discharge in women is normal,and what is normal changes throughout a woman's menstrual cycle, pregnancy,and a woman's lifetime. Thankfully we will be covering this topic in detail for all of you over the next several weeks.

As a woman and a physician I think it is so important for each of you to get to know your own bodies and how it functions. As your body cycles through the month, the change in hormones that cause ovulation and allows for menstruation, also will change the consistency and amount of vaginal discharge. After our menstrual cycle ends, women will notice a thick, creamy whitish discharge for the next week. This is normal and should not have an odor or cause itching, burning or any type of vaginal pain or irritation.

With ovulation comes a clear, sticky discharge that is very distinct in that it can look and feel like a stringy mucous. For fertility purposes,this discharge can be graded in its stretchability. This has a name called 'spinnbarkeit'. The better it stretches, the more likely is ovulation and fertility! Once ovulation has ended, (about 72 hrs) then the vaginal discharge will become clear and watery due to the post-ovulation progesterone effect as the egg passes from the body. Some women can also have a transient change in odor.

In menopause women will have a reduction of female hormones and this causes a decrease in vaginal discharge. Pregnancy, because there is such an increase in estrogen (the primary female hormone), will significantly increase vaginal discharge.

If you can begin to trust and understand how your body functions normally, then it will be easier for you to know what it means when you see changes. When there is abnormal discharge, the change will be significant.

Sometimes there will be an abnormal amount of discharge and the color may change to yellow, green, brownish, gray or may have some blood in it, that is not associated with menses. Also abnormal discharge is usually accompanied by an unusual odor that
causes distress. This is because it is usually associated with infection.

So, I hope this helps you to begin to understand your body better as a woman. Normal discharge is usually clear or white and rarely has an odor. It is normal to have vaginal discharge.

All women have it, just be aware of any changes and don't be afraid to ask questions.

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Recurrent Vaginal Yeast and Bacterial Infections.

These type of infections are common, and they tend to increase in frequency and recurrence as the weather warms up. Several of you have had these off and on for awhile, but are now coming in because of "little cuts" that you are noticing around the labia and vaginal opening.

The skin around the genital area is so sensitive and delicate that it is common to see areas of breakdown associated with constant infections and moisture. Clothing can trap moisture against our skin, preventing it from breathing, and cause a yeast-based rash to occur externally. This can occur over the mons pubis (where most of the pubic hair grows), down around the labia and vaginal opening, groin & leg creases, under arms, breasts and tummy folds.

These rashes can cause extreme irritation and itching called genital puritis, and this can lead to skin breakdown and little cuts forming where clothing rubs or skin stress occurs during intercourse. These are not serious and will heal with time as the vaginal infections clear. There are wonderful creams that can be used to help facilitate healing and relieve the itching and temptation to scratch that area.

In extreme cases, it can be beneficial to wear underwear similar to men's boxers so that the elastic bands do not continue to rub and injure the skin. Keeping the area as dry as possible helps, as can using a blow dryer on medium heat to gently dry all the creases after showering and before putting any creams or medications on the area. This can also help to clear boils, ingrown hair follicles, and sebaceous cysts that pop up in that area.

It sounds silly to do all this, but we take so much care to keep the skin on our face clear and healthy, yet forget that a little extra care in the vaginal area can prevent recurrent problems. It can be a source of embarrassment to have "blemishes" all over the labia and upper thighs, and it can interfere with intimacy and confidence with our partners.

It is such a common problem, but with a just a little care, it can be completely cleared. I hope this saves you from a little worry and helps you to know how common this problem is. You are not alone, as so many women struggle with this. My next blog will continue to provide more information on this problem so we can continue to learn more and more.

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Can I still get pregnant after a Leep procedure?

“Dear KnowYourV, ,

My husband and I have been trying to get pregnant and now with my abnormal pap results my doctor wants to do a ‘LEEP procedure’ to remove the abnormal tissue from my cervix. Will this interfere with my ability to get pregnant?”

I hear this from so many woman because, with the ‘LEEP procedure’, a very small portion of the cervix is actually removed. Therefore, many women worry that this will weaken their cervix and cause them to miscarry their pregnancies.

The Loop Electrode Electro-cautery Procedure (LEEP) is done in the doctor’s office. It replaced the cervical cone biopsy which was performed in the OR (Operating Room) under anesthesia. The LEEP procedure removes a small, flat, nickel-sized portion of tissue. By contrast, the Cone Biopsy was developed for cervical cancer diagnosis and evaluation, so a very large, deep biopsy was taken, and often it did extend so deep that the risk was higher.

Once the tissue is removed with the LEEP procedure, it is sent to pathology to be examined by the pathologist. It is important to determine if there are any cancerous cells present and also if the margins (or edges) of the specimen are clear of any abnormality. That way, healthy new tissue can replace the diseased or infected tissue, so the next pap results should be normal.

The other popular method for cervical tissue removal is ‘cryotherapy’, where the cervix is frozen, causing the abnormal tissue to be destroyed. Again, healthy tissue will generally take its place. This is done in only mildly abnormal cases, because all the tissue is destroyed in the freezing method, leaving no specimen for the pathologist.

So, in answer to your question about pregnancy, the ‘LEEP procedure’ is not going to interfere with your body’s ability to become pregnant or maintain the pregnancy. I have had many women have successful pregnancies over and over after having this procedure done.

I hope you all stay safe, and enjoy life and work wherever you may be this week. Write to us if you have anything on your mind that we can help you with.

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What does HPV and Dysplasia mean, for me?

Dear KnowYourV,
I just got the results of my pap smear back and it showed 'high risk HPV with mild to moderate dysplasia'. I'm worried because someone told me HPV is an STD and that dysplasia is pre-cancerous."

Well, Vanessa let's back up a little bit. First of all, the reason you come in once a year for your pap is to screen for cervical cancer. And since so many more women do get tested yearly now, we rarely see advanced cases of cervical cancer like they saw years ago.

These days, if a woman has an abnormal pap, we do repeat paps or biopsies immediately to evaluate the cervical tissue. If necessary, any abnormal tissue with HPV can be removed so healthy tissue can grow in its place. This way, dysplasia or high risk HPV never have a chance to progress to a cancerous condition.

HPV (Human Papilloma Virus) is transferred through sexual contact and belongs to the wart family. It can show up as visible genital warts or flat 'invisible' kind that can cause cervical cancer. Men harbor it in their semen and women carry it in their cervical tissue and cervical/vaginal fluids.

There are two types of HPV: 'low risk’ and ‘high risk'. High risk is the one reported on pap smears and is responsible for cervical Cancer. It can also cause penile cancer, anal cancer, vulvar cancer and oral cancer. Therefore, it can be transferred though anal sex and oral sex as well.

It's possible to get HPV from your first sexual partner and not know you have it. There are no symptoms and it can lay dormant for years. Just like the herpes virus, it may erupt during times of stress or during pregnancy. When HPV begins to flare up, it causes cellular changes in the tissues. When your pap specimen is taken, the cells are looked at under a microscope and the clinician can see the HPV infection and any affects it is having upon your cervix.

Dysplasia is not cancer; it is not even pre-cancer. It is only a descriptive name given to tissue at a certain point in time so that it can be compared with another point in time to note changes. With dysplasia, the terms ‘mild’, ‘moderate’ and ‘severe’ are used, and then it may go to cancer. Most of these changes take several years to happen, and most women choose some form of treatment long before cancer would become an issue.

What about the men? That's what women worry about when they find out they have HPV - shouldn't the men be tested too? Unfortunately, it doesn't do much good, because HPV is in their semen, and there is no way to treat them. They are not at risk for cancer the same as we are.

Fortunately, the new HPV vaccine, which can be given starting at age 8 to boys and girls, should start making a huge impact in the future.

The most important thing is keep getting your pap smears on a regular basis. Over 75% of the U.S. population has HPV, and it is as high as 85% worldwide. So, you are definitely not alone in this. It is a battle we've been working hard to win, and the vaccine is one step along with regular pap tests.

As I've told you, one of the best things you can do daily to help yourself feel fresh and clean is use the new WaterWorks feminine cleansing system. This is so wonderful because it can be used when you shower, and does not require special formulas or chemicals - just plain tap water. And, it can be used more than once a day. Most women will use it right after sex to rinse out semen, which helps them feel clean and fresh right away. Plus this can also immediately rinse away any semen infected with HPV or other STDs. This is important, since a woman's body acts like a little incubator for bacteria or viruses. That is why so many women love using their WaterWorks - it gives them confidence and they feel they are working towards better health with better hygiene. Plus WaterWorks is FDA cleared for vaginal cleansing to remove unwanted odor with or without discharge.

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Watering the flower...

Dear KnowYourV,  

Since there are many microorganisms and bacteria in tap water, can it cause infections internally with the WaterWorks system?

I'm so glad you asked this question, as there are probably many others that have wondered the same thing. In recent years there have been several reports and comparisons made between tap water and several brands of bottled water. I am not referencing them here, but these were done by Consumer Reports, ABC and NBC NEWS.

What they found is that the purity of municipal tap water in places like Los Angeles and New York City exceeded that found in the most popular brands of bottled water like Evian, Crystal Geyser, Arrowhead, etc. Also, on random taste tests by offering water to shoppers on the street in various cities, 9 times out of 10 they picked city tap water over bottled water for better taste.

Bottled water has very few or no regulations on purity standards, unlike the requirements placed on our municipal water systems, which must comply with strict regulatory standards.

However, the most shocking fact for me is that many bottled water companies actually use regular tap water in their bottled water product and just put a fancy label on it for resale as expensive bottled water.

We are fortunate in the U.S. to have a great municipal health and water system to give us clean water into our homes. The bottled water companies have certainly done a great job to convince us otherwise. According to the makers of WaterWorks, if your water is safe enough to brush your teeth with, then it is safe enough to use with the WaterWorks system. If not, then distilled water would be the water of choice.

The vagina itself is full of its own bacteria, good and bad, as we've discussed before. Have faith in the strength of your own body to fight bacteria and heal.

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Post-Menopausal Bleeding

How is everyone this week? Hasn't it just been so exciting with everyone decorating for the holidays. To me, it just makes usual places look so cheery and welcoming. I recieved a really good question this week from one of my readers, and I know it is something that many of us women struggle with.
Dear KnowYourV,   I am 54 yrs old and have not had regular periods for 4 yrs and know that I have been told I am in menopause. I also have diabetes, high blood pressure (HTN), Irritable bowel syndrome (IBS), and high cholesterol all of which are now under control, and I have recently lost 28 pounds since August.
About a month ago, I had a bad episode of constipation which caused me to strain too hard and I even tried to help it by trying to pull my butt cheeks apart. Afterwards, I noticed I started spotting and have cramping and pressure for the past four weeks.

I did see my internist as my appointment with my gyn was a few weeks out. My internist checked to make sure I had no tears and that my labs were all normal but I left feeling very confused and scared. I felt like because I was menopausal the only answer he had for me was uterine cancer -- post-menopausal bleeding is cancer.

My dad's sister died of it at age 28 when I was very young, and all my mom can remember is she had very heavy bleeding. Now I'm so scared, and upset I don't know if you can help calm me down until I get to my gynecologist.

I read your bio and I noted that you are involved in church, so maybe as one believer to another you could help me.

-Liz

---
Well, menopause is an extremely difficult time, and many women feel very different due to the hormone changes. The missing periods can make some women feel healthier but some say they miss their monthly cycles because they felt like their bodies functioned better with them. It may be the hormone changes, not the actual periods that are making them feel less than optimal.
Some feel a worsening of their health due to weight gain and hormone imbalance that lowers the metabolism. This can cause fatigue, constipation, IBS, sleeplessness, body aches, emotional up and downs, anxiety and other symptoms.

All the sudden changes can worsen health and existing medical illnesses like diabetes, high cholesterol, and hypertension.

This is one of the best times to take a proactive part in your health, and like Liz, work on losing weight and dietary changes, because everything we do now will just make the years ahead so much easier. Many women have seen improvements in their menopause symptoms, blood pressure, cholesterol, and diabetes with weight loss and a healthy diet. I know a lot of you already know this, so keep up the good work!

Constipation seems to be a lifelong problem for many women due to hormone changes we experience with our monthly cycles or during and after childbirth and also menopause. But constipation can also have a mechanical component due to weakness of the muscles between the rectum and vagina. This is found commonly as the pelvic floor muscles can be damaged during childbirth or due to aging and gravity . If this has happened, it can make it very difficult to push out your bowel movements. This is called a rectocele, and requires surgery to correct it, so it is something to be discussed with a gynecologist.

Post-menopausal bleeding can be very alarming and definitely needs to be evaluated by a doctor.

Uterine or endometrial cancer usually happens in post-menopausal women over aged 50. It is usually diagnosed very early as the symptoms are bleeding after menopause. Risk factors include diabetes, weight changes and family history. It is usually treated and cured by doing a hysterectomy and rarely requires radiation or chemotherapy.

Estrogen can thicken the lining of the uterus and when there are no periods or other hormones to oppose the estrogen to thin the lining or release it as a period, it can result in abnormal bleeding or spotting. This does not mean cancer just because there is bleeding, and that's why getting the proper tests is so important.

Sometimes cervical cancer will be confused with uterine cancer as the cervix is part of the uterus. However, cervical cancer is not passed through genetics; it is caused by HPV. Unlike endometrial cancer, cervical cancer cure rates are low and do require radiation and chemotherapy.

Now if a pap smear has been normal, and that's how cervical cancer is diagnosed, then that's good! So why all the spotting? Well, hormone imbalance during menopause can make spotting and bleeding happen now and then, and then just suddenly stop. If this becomes too frequent and tests have been done that have verified that there is no cancer, then this can be corrected with hormones or a procedure called an endometrial ablation.

Sometimes there are other conditions that can cause post-menopausal bleeding, like uterine fibroid or polyps, ovarian cysts and other pelvic cancers like ovarian, anal rectal or bladder cancer. If any test or ultrasounds point to these then they should be followed up.

Of course, any potential endometrial cancer should be discussed with a gynecologist for proper testing. Usually the tests are very simple and can be done in the office, like an endometrial biopsy or an ultrasound. Endometrial cancer causes very heavy bleeding, not just spotting -- soaking through tampons and 2-3 pads in an hour. But whether spotting or bleeding, it needs to be checked by a doctor.

I know there is so much more we could say on this subject. So let me hear from you if you have any questions or something on your mind.

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What should I know about HPV, human papilloma virus, and what are its signs and symptoms?

Dear KnowYourV,  

What should I know about HPV, human papilloma virus, and what are its signs and symptoms?" 

This has become one of the most commonly asked questions recently, since HPV is a sexually transmitted virus and the #1 cause of cervical cancer worldwide.

As women come in for their annual exams and pap smears, questions arise about HPV testing and detection. Infections by genital HPV are very common. In fact, over 70% of people who are sexually active will contract the virus at some point in their lives. Yet many will not know it because they will not have any symptoms.

Whether or not symptoms occur has to do with the type of HPV, and there are more than 100 types of this virus. Some types of HPV are associated with genital warts, either visible or flat and not visible. Other types of HPV are associated with cervical and other cancers, with no warts nor other noticeable symptoms. Still more common forms of HPV produce warts on other parts of your body like your hands and feet. Many people who get genital HPV will clear it spontaneously over time, however, the longer it stays in your body (and depending on which type of HPV you have), the higher the risk for cervical, anal or oral cancer.

Since HPV infections are contracted through sexual contact, many women have concerns about their current partner and how to find out when they contracted the virus. Women in monogamous relationships who have tested positive for HPV worry about re-infection from their partner, if their partner is positive, or protecting a negative partner.

For most women, it is an abnormal pap smear that first alerts them to a positive HPV test. Like most viruses, HPV has an incubation period, and it is possible to be infected with the virus even years earlier, only to have it lay dormant. During times of stress to the body, either emotional or physical, the HPV can re activate, just like we experience with cold sores or acne outbreaks.

As I've explained previously, the prevalence of HPV and its dormant period can make it impossible to know who the infection originated from – a current partner or a previous one. We can contract it during our first sexual experience and it may not be detected until years later on a pap smear.

Concerns about HPV are increasing, as they are now finding oral and throat cancer on the rise due to viral infections from oral sex . There has also been recent publicity about celebrities that have battled throat and anal cancer.

HPV has become the most important reason for women to come in for their annual exams and pap smears. Also, good dentists will screen for any suspicious or HPV-type oral lesions during your routine exams. Thankfully, most gynecologists now report that cervical cancer has been on the decline in America due to early detection of High Risk HPV.

Women tend to be at an increased risk as their bodies tend to function as incubators for such viruses when semen is deposited. So, it is best to get up after sex and rinse out that semen with the amazing WaterWorks System. It may look and act like a douche but works nothing like it. It is completely reuseable, and uses only natural tap water, no chemicals. The stainless steel nozzle coupled with the downward gentle sprinkling action of the water makes it unique. The stainless steel reacts with the water and vaginal wall to remove unwanted odor, and the gentle sprinkling action of the water cleans and rinses out any remaining semen. This has helped so many women feel cleaner, fresher and odor-free without the use of medication or douching, which can be harmful to the natural environment of the vagina.

So keep up the good work, stay healthy, eat right and get out there and move your muscles around. You will start to feel much better.

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What tips do you have for someone who is looking for a new gynecologist? What should I look for?

Choosing a new or first gynecologist can be very stressful for women. This health care provider consults us about some of the most intimate areas of our health. It's our Ob-gyn's who see us through some of the most emotional transitions in our lives with conversations including contraception, conception, childbirth, PMS, and menopause. For many women, the gynecologist is their primary or only physician and, therefore, needs to be someone with whom she feels comfortable sharing a lot of information. I know in any health crisis, the Ob-gyn physician is the first doctor most women turn to, so trust is critical.

The gynecological exam is a highly private and personal experience that can leave women feeling very vulnerable, so women need to decide if a male or female doctor will be more appropriate for them. One of the best ways to find a good Ob-gyn is to ask friends or family, or get a referral from another doctor you've known and trusted. You can ask them questions ahead of time about the Ob-gyn and you may feel more confident knowing they have had a good experience with their doctor.

However you choose your new Ob-gyn, always remember to prepare for the visit before the day of the exam. Make a list a questions that you need to ask, and prepare to review what tests you need to do and how often you should have them done. Just remember, your Ob-gyn knows it is a stressful exam and expects you to have questions. If you don't ask then it is assumed you are OK, with no questions. But, no question is too silly to ask. If you are worried about it, then it is important.

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