Editor’s note: Dr. Jessica Shepherd is back! This time, she’s tackling all of those embarrassing, intimate questions that make us feel all squirmy when we have to bring them up to the doctor, but are really, really important to ask.
So it’s that time of the year … you know, the annual trip to the gynecologist. Some of you may be twitching already and some of you may be shrugging your shoulders as in “no big deal.” Either way, it’s time to talk vagina. And not just vagina but pelvic health and sex!
These next eight topics are the ones that I think, as a gynecologist, you should be comfortable discussing with your doctor. So let’s talk pelvis and get down to the important issues.
“Why are my periods so heavy and irregular?”
While not every woman will experience changes in their menstrual cycles, changes can affect at least 30 percent of women during their childbearing years. Many times, women think that irregular and heavy periods are ‘normal,’ or something they should grin and bear. If you have significant changes in your cycle for more than four to six months consistently, speak up! Your doctor can help you find a treatment plan that’s right for you. There are factors that contribute to changes as well and can be addressed such as stress, obesity, thyroid abnormalities and infections.
“Why does it itch down there…all the time?”
Vaginal itching can be embarrassing and troubling. Many times the culprit is a yeast infection; however there are other causes, too. If a woman has an irritation in the vaginal area, it is important to take note of: how long it has been there, if there are any new sexual partners, if there is a history of diabetes or chronic diseases, and if there a discharge or odor. These important questions help to diagnose the problem and what tests to order when you visit the doctors office. Many times women end up spending money on yeast medications that may make their problem worse. The important point is to not be embarrassed to talk about these issues or changes in your sexual habits as itching can also be a sign of a sexually transmissible infection, a vulvar skin disorder, a bacterial infection, or an early sign of vulvar cancer.
“I’m concerned about testing for a STD?”
Concerns about sexual transmitted infections are common in the gynecologist’s office and should be discussed at every annual visit, or each time there is a change in sexual partners. Establishing a comfortable relationship with your gynecologist can reassure you of difficult discussions and also help you to feel comfortable and confident with your body. As a gynecologist, relationships with my patients are paramount so any subject can be discussed. In the end, if you have any excessive discharge or burning and itching, your gynecologist needs to know. Many times it can reflect a bacterial imbalance or an infection that can be treated.
“Sex is painful for me, what are some causes?”
When it comes to sex, this can be the one topic women do not want to divulge in and can feel embarrassing to bring it up with your gynecologist. Difficulties in sex can be caused by sexual disorders, vulvar skin disorders, fibroids, interstitial cystitis, endometriosis, menopause or pelvic muscle spasms. Your gynecologist should be the first person you should talk to, as they can do the proper exams and evaluations that will it ease your mind and help improve your sex life! Which unknown to many is what we want you to have: Better sex.
“The skin near my vagina appears to have bumps and is painful—is this a problem?”
Hair grooming in the pubic region is very typical for women and occasionally there are concerns for bumps or irritation in that area. Being aware of the changes in your genital area is important, and to be able to discuss this with your doctor is important. Some of the changes to take note of is how long have the changes been noticed, are there any lesions involved, changes in sexual partners, recent waxing or shaving, history of herpes or changes in skin color or texture. If you suspect that there could be a possible infection with herpes, it should be addressed as soon as possible so testing can be done and medication can be started to decrease the length of an outbreak. For most causes of vulvar irritation and disorders there are successful treatments available, so early detection is key.
“Why do I have such a hard time getting pregnant?”
If you have tried to conceive and have not had any success, it could be a sign of many things. Most times it is due to the missed time frame of ovulation. Did you know an ovum, or egg, is only available for 24 hours to get fertilized? Not much time, huh? That’s why it is so important to know ovulation cycles, and they differ for every woman. With age, it can also be hard to detect them, leaving many women to think they are infertile. Other disorders may also cause infrequent ovulation or abnormal ovulatory cycles such as Polycystic Ovarian Syndrome (PCOS), thyroid disorders, obesity and endometriosis. That is why is it important to see your doctor if you have difficulty getting pregnant after having sexual intercourse when you are ovulating for over one year in women under 35 and over six months for women over 35. Women shouldn’t assume that all ovulatory cycles are the same and other ways to track your ovulation are with ovulation predictor kits that can be purchased in the pharmacy over the counter.
“I do not feel in the mood to have sex as much as I used to, is this normal?”
Many times, especially after menopause, women have decreased libido and do not feel like having intimacy or sexual intercourse as much as they did before. Many women experience problems with sexual function at some point in their lives. There are various types of female sexual dysfunction which can include: low sexual desire, sexual arousal disorder, orgasmic disorder or sexual pain disorder. These can be addressed with a gynecologist and also treated with psychotherapy, medications and pelvic physical therapy. This can also occur when there are changes in stress, lifestyles and relationships. Make sure to identify these symptoms early and address them with your doctor to have them discussed thoroughly.
“Is it okay to have sex in pregnancy? Especially towards the end?”
Sex during pregnancy is an issue often discussed in the obstetrician’s office. Is it safe? Will it hurt the baby? Very important questions and very valid to ask. Luckily for most women, sexual intercourse in pregnancy is safe right up until the due date. It may become uncomfortable as the months pass, there are also different positions that may make it more pleasing.
In some high-risk cases, however, sex during pregnancy should be discussed with your practitioner. Any conditions that may increase a woman’s risk for preterm labor should be discussed as semen contains substances that can cause the uterus to contract.
To avoid feeling embarrassed in your gynecologist’s office, remember to
- Find a gynecologist who you are comfortable with.
- Keep a good medical history and keep track of your monthly cycle.
- Help your doctor by coming with questions beforehand.
- Remember to get a pap smear once you turn 21 and ask for STD testing.
- Be honest about your social habits or any health information.