I just started a two month rotation in obstetrics and gynecology this week. And OB\GYN is just a wonderful celebration of creative science and women's health.
The OB part is where I get to coo over new babies and listen to new parents roll the name of their new wee one around in their mouths for the first time. The OB part is where the gravity of raising a human in this crazy world, basically without sleep, sinks in for young people. The OB part is just joyful, 99% of the time.
But today I think we should talk about the GYNE part. As someone training in family medicine, I covet the opportunity to teach young women, and men, about their nether bits and how they work. Young women and men sort of know how the bits work and high school health classes do a decent job covering the very basics.
But when it comes to caring for the vulva and vagina, a little advice can go a long way.
I am so fortunate to be working with a great OB\GYN generalist. I watched him discuss genital hygiene with a patient this week and was really quite pleased to know that a lot of the advice he gives is stuff I've figured out on my own. But that same advice is rarely discussed in routine primary care visits with family doctors. Let's talk about it now!
First, grab a hand-held mirror and follow this tutorial from Women's Health to get your bearings.
Seriously, go. I'll wait. My guess is that less than 25% of you reading this sentence take a regular gander at your anatomy. So, really, no time like the present.
Now that you can see your mons pubis, labia majora (the ones with hair), labia minora (no hair there), urethra and clitoris, we can start talking about taking good care down there.
#1: When you shower, water is all your vagina needs.
You can use a gentle soap on the parts of the vulva that grow hair, but nothing inside. If you're worried about the way your vagina smells, soap isn't going to fix that but it might make it worse.
#2: When you sleep, air it out.
Vaginas, like fine red wines, need to breath. There is no reason to wear underwear to bed, unless you're on your period. Then you can do whatever you want. Loose, breathable cotton pants, a gown or nothing at all will do. In the winter, I sleep in socks and socks alone.
#3: When you remove hair, don't shave.
Shaving is a recipe for ingrown hairs which suck. I myself have had an ingrown hair that got me concerned enough to ask my doctor about it. This was before I became a doctor and could tell myself that it wasn't anything to worry about. Ingrown hairs are painful and can get infected. Also, they're making sure your mons doesn't win any beauty contests.
So please heed my calls and either trim your pubic hair with scissors designed for that purpose, or save up for waxing or electrolysis. Or do nothing at all, I don't care, just don't shave.
#4: When you're worried about something, take look, take a smell and take a feel.
You know how you normally smell. So if you start smelling differently, don't just shower more, go to your doctor. They will probably give you a swab, shaped like a long q-tip, and ask you to insert it into your vagina briefly and then cap it. The microorganisms will be cultured and if there is anything nasty, you will get a prescription. You may just get a prescription right away but practices vary. Interestingly, the OB\GYN I am working with right now has started to tell women to take a probiotic to help maintain normal vaginal flora - advice typically aimed at maintaining healthy gut flora. But sure! He even mentioned that women could just put yogurt up into their vagina but both myself and the patient crooked our brows at that one. I am not putting cold yogurt into my vagina on the reg.
If there is something growing on the vulva or the lower third of the vagina, you are best positioned to see it, not us.
If your vulva or vagina is itchy, starts to bleed or has some new spot, go to your doctor. Itchiness is a pretty good heads up from your body so heed the warning. And here's the thing: Women are supposed to go for their PAP smears - where we take samples of the cervix to look for cell changes that might be concerning - every three years. That means if there is something growing on the vulva or the lower third of the vagina, you are best positioned to see it, not us. If your vulvar skin becomes itchy, take a look. If the skin has changed in any way, ask your doctor to take a look. That's our job. We will not judge you. This is important.
#5: Life is too short for tight underwear.
Tight underwear strangle your vagina and your pubic hair follicles, leading to bacterial overgrowth and ingrown hairs. Wear underwear that fits you because you are in charge of feeling good.
#6: Just because you're not having sex or not menstruating, doesn't mean all of the above doesn't apply to you.
The greatest risk factor for vulvar, vaginal and cervical cancer is having the HPV virus, much of which is prevented by the HPV vaccine. This is a vaccine we give to young people for free in school. So it seems like most of the conversation around cervical cancer is a conversation about young people and all the sex they're having. But the HPV vaccine is approved in women up to 45 years old and there is no actual reason why it can't just be for everyone. The newest HPV vaccine covers nine sub-types of the virus, including the ones that we know cause cancer and genital warts.
People over 50 are still the most commonly affected by neoplasia or cancer of the vulva, vagina or cervix. If they are positive for HPV, it's likely that they picked the virus up ages ago and it has persisted which means it might have triggered a concerning cell transformation, especially in women who smoke.
But also, people over 50 are still having sex. Sometimes they're having sex with new people (yippee!) and picking up new forms of the HPV virus (oh crap). So this is where the vaccine comes in AND this is where regular peeks at your genitals makes a difference. Sex or no sex, hysterectomy or no, keep looking at your parts.
Onwards, ladies, in the name of comfort and pleasure.