Ever wondered if your discharge is ‘normal’ or what you can do about down under dryness?
Tania Adib, a Harley Street gynaecologist is asked a number of vagina-related questions every day. As a consultant at London’s
integrated women’s wellness clinic and Queen’s Hospital, she’s seen and
heard it all and isn’t the least bit shy about sharing her wealth of
knowledge.
From post-baby sex to vaginal douching, in the piece for Get The Gloss, a gynaecologist answers the ten questions she’s most commonly asked in clinic.
A must read for anyone with a vagina.
London-based gynaecologist Tania Adib answers ten of the most intimate questions that women ask her during clinic
I am having a great deal of discharge. Is that normal?
“Yes.
Discharge is a really good sign that your vagina is behaving as it
should do. These mucous secretions are cleaning your vagina, and keeping
it in a healthy state. The mucus should be clear or white and not have a
strong smell to it.
The amount of
discharge you produce depends on which point of your menstrual cycle you
are at. Discharge is usually more plentiful and can be quite stringy
when you’re ovulating, breastfeeding, or are sexually aroused. However,
if you experience changes to your discharge, you should book an
appointment with your GP or gynecologist.
For
example, if it becomes curd-like and thick and you’re experiencing
itching, it’s a sign you may have thrush. If there is a strong odour,
like fish, it may be bacterial vaginosis. Any accompanying pain or other
symptoms – such as blistering around the vagina need to be checked out.
This may indicate a sexually transmitted infection.”
I get clots in my period. Is this something to worry about?
“Clotting will be normal for some women, however, it does show that your periods are heavier than they probably should be.
So
why do clots happen? When it comes to menstruating, your body usually
knows that this kind of bleeding is non-harmful, so it doesn’t need to
clot in the usual way, as say when you cut your knee. Anti-coagulants
usually thin the blood, allowing it flow freely. A heavy period
overwhelms the natural anticoagulants – hence the clots.
Heavy,
clotty periods can be very inconvenient, they can also be harmful to
well-being. If a patient came to me with blood clots, I would be
concerned she might be anaemic due to the heavy blood loss.
The
first line of treatment would be tranexamic acid, which has a chemical
action that reduces bleeding. Controlling your periods with oral
contraceptives or the Mirena coil is another option.
The coil provides
contraception and can lessen periods, although you should be aware that
symptoms may get worse initially. If that doesn’t work, and you don’t
wish to have children, there are other surgical options, such as an
endometrial ablation. The latest techniques mean they can be done under
local anaesthetic in day surgery, or if you prefer under a general
anaesthetic. The overall success rate of this operation is about 80 per
cent in stopping or lessening periods.”
I am worried that I smell when I have my period- should I use a bidet or douche?
“A
bidet, fine. A douche, never. Douching – the practice of sluicing water
up your vagina with a pumped device – is associated with a range of
health problems. Douching upsets the natural balance of bacteria in the
vagina (called vaginal flora), which can cause infections such as thrush
or bacterial vaginosis. Even more worryingly, some studies have linked
douching with increased rates of cervical cancer and ovarian cancer. Use
unperfumed, gentle soaps to wash the vulva area daily, or more if
needed during menstruation. It’s important to remember that the vagina
itself is self-cleaning. The mucous discharge all women have is doing
the job of keeping it clean and healthy. When it comes the inner mucosa
of the vagina (the part inside the vulva) just water to wash away any
menstrual blood or sweat is fine. This could be via bathing, a bidet, or
the shower.
Just don’t douche! The vagina will sort itself out."
Why do I get a headache after sex?
“If
you feel a bit headachey after sex, the first line of management would
be to ensure that you have drunk enough water, as vigorous sex can cause
dehydration. There is a phenomenon known as benign HAS (headaches
associated with sexual activity). HAS is a rare condition – less than 3
per cent of all headaches reported – and it generally affects men more
than women, although nobody can be certain how common it is, because
people may be embarrassed about reporting it.
One theory is that the
exertion of sex leads to the blood vessels dilating. Headaches can last a
minute or two, or up to day.
If you do
suffer from HAS, it’s important to discuss it with your GP – although
headaches are usually benign, your doctor will want to rule out more
serious conditions and there may be treatment available.”
Is it possible to be allergic to semen?
“Absolutely
– it’s considered quite unusual, although one study has suggested the
incidence could be as high as 12 per cent. Semen allergy, also known as
seminal plasma hypersensitivity, generally affects women more than men
and is caused by antibodies in women’s bodies recognising semen as
harmful, and going into an overdrive response.
Women
may experience inflammation, an itchy sensation and swelling of the
genitals shortly after contact with semen. Luckily reactions tend be
localised, and I’m not aware of any cases where women have gone into
anaphylactic shock, although theoretically, this could happen.
For
women who experience semen allergy, I usually recommend they stick to
condoms. However, it can be tricky when women want to get pregnant. They
may experience discomfort until conception. In severe cases, assisted
reproductive technology has to be utilised.”
Does post-baby sex hurt?
“It
can do. Often there are issues like bruising from birth trauma, or an
episiotomy. You should only attempt to have sex when you are ready – six
weeks is usually recommended as the healing process should be well
under way, although some women will have sex before then, while others
will wait longer. The other thing to bear in mind is that just after you
have given birth your oestrogen levels are very low, which can thin the
vaginal skin making it drier and causing discomfort. Breastfeeding also
dampens down oestrogen, so that can be an issue for nursing mothers.
Use a water-soluble lubricant to lessen problems with post-partum sex.”
When I’m having sex I often get ‘fanny farts’ - any ideas how to stop them?
“This
is simply air getting trapped in your vagina. It happens when air is
pushed in during penetrative sex and then released, like a cork being
released from a bottle. Women who have had babies are more prone to
fanny farts and certain sexual positions, such as when the woman is on
all fours, means it’s more likely. You can expect that embarrassing
sound during fast, furious sex, so taking it slow might reduce the
likelihood. Learning to laugh about them might be easier!”
I’m 60 and still want to have sex, But I’m so dry. What can I do?
“Vaginal
dryness is a real issue post-menopause. A vaginal moisturiser can help,
alongside a water-based lubricant to be used when having sex. HRT
containing oestrogen may also restore moisture levels, however, not all
women can take HRT and many are wary because of the small but elevated
risk of breast cancer associated with taking hormones. Another option is
to use topical oestrogen. This can be applied straight to the vaginal
area, which although not ideal, has the advantage of being effective at
lower doses. Anyone wary of oestrogen may prefer this as a smaller
amount reaches your bloodstream and it can be more effective than oral
hormonal regimens at getting to the place that needs it to be.
For
those who want to avoid oestrogen completely, and find that creams and
lubricants work for them, a new treatment called The MonaLisa Touch
could be the right choice. The laser works on the tissue of the vaginal
mucosa, boosting collagen and restoring function. This simple procedure
is performed in clinic, with three treatments often required alongside a
top-up treatment once a year. Success rates are about 85 per cent.”
Can you get blackheads on your vagina?
“The
vagina is skin, just like anywhere else. As it’s usually quite warm and
damp down there, you can get blocked pores and lumps and bumps, as you
can in other areas. Pimples or blackheads on the vulva area (where your
pubic hair grows) can be caused by shaving and waxing in particular. As
blackheads are blocked hair follicles, it’s unlikely that you would get
them on the inner mucosa of the vagina (the moist part of the vagina
within the labia majora, the outer lips of the vagina), but there are
other reasons for lumps and bumps, such as blocked glands for example,
or ‘Fordyce spots’, which are small white or yellow bumps in the inner
part of your vulva and the labia minora (the smaller lips surrounding
the vagina). These are not harmful, and they can accumulate as you age.
Then
there are varicose veins, which are associated with pregnancy and age,
which look like bluey raised lumps. Although most lumps and bumps are
not serious, it is essential that you see your GP, who may refer you to a
gynaecologist. In rare cases, a darkening patch may indicate pre-cancer
cells, so it needs to be checked by an expert in gynaecological
cancers.”
I’ve got a huge spot ‘down there’. Should I squeeze it?
“It
sounds like a Bartholin’s cyst. There are two glands at the entrance of
the vagina that secrete a fluid by means of a duct that keeps the
mucosa inside the vulva moist. On occasion, this duct can become blocked
and a cyst will form. About two in 100 women will develop one of these.
It may not be painful initially, however, it can become infected. If
that happens, the cyst will become uncomfortable and start emitting a
smelly discharge. My recommendation would be not to squeeze, as this may
spread the infection. Go to your GP and ask for a referral to a
gynaecologist who will be able to treat the cyst. This will be done by
either marsupialisation or a word catheter.
Marsupialisation
simply refers to the surgical drainage of the cyst and is usually
performed under a general anaesthetic, so you’re asleep throughout. A
small incision is made by the doctor, and the cyst is allowed to drain.
Dissolvable stitches are then used and healing occurs over a month or
so.
Alternatively, the cyst can be
drained using a small rubber tube called a word catheter under local
anaesthetic. A small cut is made in the swelling to drain the fluid or
pus and the catheter is then inserted into the gland and held in place
by a tiny water-filled balloon. This stays in place for four weeks to
allow complete drainage and healing.”
This article was originally published by Get The Gloss and reproduced with their permission.
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