Genital Hygeine Care Part 2

My BF told me one of my labia minora is 2 times larger than the other one. He asked if that normal? I am curious too!

No two snowflakes are exactly alike, right?

Well, the expression could just as easily refer to the vulva. The labia, or lips—which vary from person to person—seem to be under the greatest scrutiny by my patients.

There is no one right way for the vulva to look, meaning, there’s no such thing as a perfect one. The labia, or lips–which vary from person to person–seem to be under the greatest scrutiny by my patients. The fact is the two lips of the vagina are not identical on the same person. Just as our two eyes are not identical, nor our ears or breasts, the lips of our labia are neither identical nor symmetrical. Likewise, a man’s testicles are neither identical nor symmetrical, but we don’t comment on how irregular a man’s balls are, do we?

Do women realize that variations in labia is considered “normal”?

Shockingly, 50% of women wonder if their vagina is normal looking.

You know what’s normal? Different is normal. Women are in search of the perfect vagina. The only qualities that make a vulva and vagina “perfect” are personal confidence and good health.

As a result of social media and porn, some women have been made to feel vulva/vagina insecurity. And I’m not just seeing this in patients, either, although it’s definitely something that comes up regularly in my examining room. It’s everywhere. An internet search of the word “vagina” brings up a variety of links, many leading to everyday women showing off their vaginas: You Tube videos of women talking about vaginal rejuvenation, websites devoted to discussing and examining anything vagina-related, and, of course, porn sites. These are the reference points that young women—women of all ages, really—now use when seeking the ideal of the perfect vagina. Adolescent boys are having the same issues regarding the size and length of their penises, even though, like vulva’s and vaginas, no two penises or scrotums are the same.

If women are really uncomfortable by how they look, what are some steps they can take?

Variations of the vulva are completely normal as is variations of a man’s genitalia. Understanding what is normal makes variations in size and shapes “normal”.

Educating women on a women’s anatomy is helpful along with explaining that different is normal. You need to get to know and love all parts of this fascinating area of your body. Know what your “normal” is so you will know when something is not normal or when a potential problem arises.

While a wide range of variety is the norm when it comes to vulva’s, there are women out there who do have abnormal labia. But, again, this has nothing to do with aesthetics. For most, there’s no denying that something isn’t quite right. The most common symptom is the need to fold up their labia and push them into their vaginas in order to reduce the appearance of excess tissue or a bulge in their underwear or bathing suits. Other symptoms include labial pain, swelling, irritation, poor hygiene, and interference with athletics or sexual activity. Oversized or enlarged labia can impact athletics, such as running, bicycling, horseback riding, and swimming. Surgical procedures are available to improve these symptoms, as well as the appearance of the vulva and clitoral hood if disruptive and life changing behaviors occur.

Discuss your concerns and complaints with your gynecologist. The primary procedure to repair such abnormal labia is called labiaplasty. A trained plastic surgeon or gynecologist can perform this simple outpatient procedure, and the results can be life changing. As with any surgery, however, complications can occur. The most seen side-effect of this procedure is painful scarring that can lead to discomfort during sex. As always, it’s important to have a candid talk with your doctor and maintain realistic expectations.

If labiaplasty is being considered, make sure you get a second or third opinion before undergoing any surgery.

What would you say to a woman who is concerned about this part of her appearance?

I try and reduce my patient’s anxiety about their vulva and vagina’s and reassure them that different is normal. I frequently pull out the mirror during a pelvic exam and go over my patient’s vagina and all its glory and let me know their vagina is completely normal. While a wide range of variety is the norm when it comes to vaginas, there are women out there who do have abnormal labia. The most common symptom is the need to fold up their labia and push them into their vaginas in order to reduce the appearance of excess tissue or a bulge in their underwear or bathing suits. Other symptoms include labial pain, swelling, irritation, poor hygiene, and interference with athletics or sexual activity. Oversized or enlarged labia can impact athletics, such as running, bicycling, horseback riding, and swimming. Surgical procedures such as labial-plasty are available to improve these symptoms, as well as the appearance of the vagina if warranted.

The conversation of how women “size up” to others happens a lot more often than actually needing the surgery to change the appearance of the vagina. In truth, I perform very few labial-plasty of the vagina each year. Education provides comfort and confidence.

How can/should women talk to their partners about this?

Women first have to be comfortable talking about their own vulva and vagina first and foremost before they can talk about it with their partner. Embrace all parts of your body especially your vulva and vagina. Talking about this sensitive part of your body will allow you to comfortably talk about it with your partner.

Once a woman feels empowered to talk about her body, vulva and vagina she will be able to communicate with her partner with the same voice of confidence.

Why are these conversations about the vulva so important to have with yourself and your partner?

We need to get the “V’ out of the closet. Women need to talk about their specific health care issues, issues that are often ignored and not dealt with.

Talking about vaginas will lead to conversations about the health and welfare of women.

I am counting on our younger generations of women to help lead the way and change the narrative on how we talk about our health, our bodies, and especially, our vulvas and vaginas. Women need to take control of their bodies in every way. We cannot be afraid to ask uncomfortable questions. We need to learn and explore the changes our bodies experience throughout our lifetime.

How can your doctor help you with the conversation if you think your vulva looks abnormal?

I feel strongly that doctors have to lead the fight to bring back communication with our patients. We need a dialogue, a community, a movement, which is why I plan on creating a platform with ongoing dialogue, related articles and blog entries, in order to make women feel heard and supported. Everything is connected: in life, in love, and in medicine. So, let’s say the awkward words and ask the hard questions. Let’s have the conversations. It’s okay to blush or giggle or be totally serious. We can also have a good time. Make it a party. All that matters is that we create a dialogue with each other about our vaginas and ourselves.

Talking about vulva’s and vaginas will lead to conversations about the health and welfare of women. We need to change the status quo of our healthcare and make significant changes so that our daughters and sons, will benefit. We need to start saying the word vagina loud and proud. We need to start a vagina revolution…now!

I keep reading about vaginal rejuvenation. How do I know if I truly need it?

Women’s obsession to look perfect goes from head to toes on the body. Porn and social media has created vulva and vaginal insecurity which has helped moved vaginal rejuvenation to the forefront. It used to be that doctors were not tempted to take part in a lot of smoke and mirrors when it came to medical procedures but the tide has turned and now this term of false advertising has ramped up. This has become deceptive and misleading medical marketing at its finest.

Some of them include:

Plumping up the labia
Removing skin discoloration of the labia
Improving elasticity of the labia
Making the entrance to the vagina tighter
Making the entire vagina tighter
Reshaping the size and shape of the labia

Just like any other part of your body with skin, glands and hair follicles, the appearance of the vulva is affected by the aging process and how well you care of it. The skin of the vulva is as sensitive as the skin on the face. Keeping it hydrated, moisturized and clean will help in slowing down the aging process of the vulva and vagina.

Hydrating, moisturizing, and cleaning the vulva and vagina daily are the 3 best feminine rituals you can do to keep this delicate area healthy and beautiful. Using vulva and vagina friendly feminine washes and moisturizers is my best recommendation to allow the vulva to age gracefully.

I have problems putting tampons in and having sex with my BF. My vagina tightens up even when I try to relax, my gyno told me I have Vaginismus? Not sure what to do about it.

Vaginismus is a condition where the muscles of the vagina contract involuntarily, tighten or spasm causing vaginal pain, sexual discomfort, burning and penetration problems. Vaginismus commonly occurs during sexual intercourse, with insertion of a tampon or during a pelvic examination. These symptoms are ongoing and lifelong disrupting intimacy, personal relationships and daily life activities.

A diagnosis of vaginismus can feel overwhelming to women suffering from this condition. Everyday behaviors such as sexual intercourse or having to insert a tampon can create anxiety and fear for women with vaginismus. Vaginismus is a devastating, confusing and traumatic condition often ruining relationships and self-esteem. It’s responsible for sexless, unconsummated marriages.

Possible causes of vaginismus can be due to an abnormally low sexual desire, phobia, lack of sexual knowledge, cultural and religious beliefs, genital and sexual trauma, abuse and sexual aversion. There are also situational and psychosocial causes of vaginismus. Chronic medical conditions such as urinary tract or yeast infections, a traumatic vaginal delivery, menopause or problematic vaginal surgery can also cause vaginismus.

Women ultimately avoid any activity involving the vagina. Many suffer in silence.

The incidence of vaginismus ranges from 5 to 42%. This wide range is due to women not openly discussing symptoms related to vaginismus especially as it relates to sexual dysfunction. Talking about sexual problems or topics involving the vagina is not easy for women or health care providers to bring up.

The treatment strategies for vaginismus are personalized depending on the cause. Treatment involves cognitive and behavioral psychotherapy also known as desensitization. Desensitization therapy teaches women to control pelvic muscle tone and relaxation. Kegel exercises and using vaginal dilators helps women control their pelvic floor muscles. Other treatment options include sex therapy, progressive relaxation, electromyography, biofeedback, hypnotherapy and use of benzodiazepines and botulinum injections.

For women experiencing any type of sexual dysfunction or pain in the vagina it’s important to discuss these symptoms with a trusted health care provider. This should never be anyone’s status quo.

It’s a complicated medical condition that is both emotionally challenging and physically painful.

I have always had very painful sex and my doctor just diagnosed me with Vulvodynia. Any non-medical treatment options?

Vulvodynia is an extremely painful condition involving the vulva or lips and vagina. Pain in the outside of the vagina that last for 3 months or longer not caused by infection, skin disorder or other medical conditions. The exact cause of vulvodynia is unknown. Some believe it can be caused by damage of the nerves of the vulva, inflammation of the vulva, genetic disorders, sensitivity to certain food, long-term reactions to certain infections.

Symptoms of vulvodynia include burning, stinging, irritation and rawness at the entrance of the vagina or the entire vulvar area. Of the Women suffering from vulvodynia describe aching, soreness, throbbing and swelling involving these same areas.

If you have vulvodynia exercise, tampon insertion, the ability to wear jeans, sexual intercourse and various other everyday activities can become impossible with the onset of this condition.

Treatment for vulvodynia varies from person to person and may include a combination of methods, which may last from weeks to months. The treatment strategies for vulvodynia are individualized. Treatment involves cognitive and behavioral psychotherapy also known as desensitization. Desensitization therapy teaches women to control pelvic muscle tone and relaxation. Kegel exercises and using vaginal dilators helps women control their pelvic floor muscles. Other treatment options include sex therapy, progressive relaxation, electromyography, biofeedback, hypnotherapy and use of benzodiazepines and botulinum injections.

Non-medical treatment includes icepacks, cool gel packs and Vaseline to relieve the pain and swelling. Physical therapy, biofeedback, dietary changes, couple and sexual counseling have also been utilized in treating vulvodynia.

Topical medical treatments may include lidocaine 2.5% ointment (a local anesthetic), for use especially before sexual contact (applied 30 minutes prior). Other numbing ointments that have been proven successful are Emla cream, LMX 4% cream and topical estrogen.

Oral medications include antidepressants such as Amtripyline, Nortripylline and Prozac and anticonvulsants such as gabapentin and carbamazepine (which are also used to treat neuropathic pain). In the case of unbearable and unrelenting symptoms, surgery is often a last resort.

Vulvodynia is a confusing and frustrating medical condition for both the health care provider and patient. Emotional and psychological support goes hand-in-hand with medical treatment options.

Vulvodynia is ongoing and lifelong disrupting intimacy, personal relationships and daily life activities. Sex and intimacy is turned upside down if diagnosed with vulvodynia.

Women are often embarrassed and ashamed to discuss these symptoms with their partner. Many will avoid sex and relationships all together. It’s incredibly frustrating and heartbreaking when these women are given a diagnosis of vulvodynia.

Vulvodynia can be cured depending on a woman’s motivation and determination not to allow this condition to run her sexual and everyday life. It may be challenging and depressing to treat but it can be done!

I have an ongoing itch for the last 6 months on my V and my doc just told me I don’t have a yeast or bacterial infection, what’s going on?

Just because you have itching of the vulva doesn’t necessarily mean you have a yeast or bacterial infection. The truth is that anywhere on our bodies where there is skin, nerve fibers, hair/hair follicles and sweat glands there is a potential for itching. The vulva can be delicate and temperamental, often affected by everyday routines including diet, medications, stress, fragranced body and laundry soaps, douching and sex. Anything that disrupts the pH balance makes the vulva and vagina a not so happy place. Once you have ruled out a yeast or bacterial infection and that vulvar itch won’t go away it’s time to look at more common causes. Fragrant body and laundry soaps, sanitary pads and stress are some of the common culprits.

Typical symptoms of an itchy vulva, unrelated to a yeast infection, include an inflamed vulva and vagina with itching, burning, redness and swelling.

Seeing your healthcare provider is important to rule out any kind of infection, STI, pubic lice or skin disorder and help identify other Treatment is finding out the cause and removing it from your daily activities. Using a hydrocortisone cream, coconut oil baths, cotton underwear and patience.

What are some of the common feminine hygiene products to avoid that can cause an itchy vulva?

Vulvar skin dryness and irritation can cause chronic itching of this delicate area of the vagina. A condition called the “scratch-itch” cycle can occur as a result of wearing sanitary napkins and panty liners every day. Even the most organic and natural panty liners can disrupt the delicate skin of the vulva.

Avoiding daily use of these disruptive pads and panty liners and only use them to collect period bleeding as needed. Following use taking pads and liners it’s helpful to soak in a warm water bath with extra virgin coconut oil to sooth and moisturize the skin of the vulva.

Other common vulvar irritants you may or may not realize are problematic:

Fragrant soaps, bubble bath liquids, bath salts, talcum powder
Detergents, fabric softeners and dryer sheets
Sanitary wipes and pads
Warming gels and scented lubricants
Nylon underwear or bathing suits
Rubber products such as diaphragms and condoms
Saliva or semen (I kid you not)
Spermicides such as foams, creams and jellies
Feminine hygiene sprays, tampons or deodorant pads
Creams or ointments applied to the vulva

A useful tip for all is: best to wear cotton or microfiber underwear during the day. At night, give your vulva a chance to breathe and get rid of the panties altogether.

When should someone see a healthcare provider for chronic vulva itching?

If your symptoms persist despite trying easy at home remedies, it’s time to follow up with your health care provider. They can take vaginal cultures checking for yeast and bacteria, and get a comprehensive history to ensure certain feminine hygiene habits or other irritants are not the primary cause of persistent vulvar itching.

Can the vulva develop varicose veins?

Varicose veins are stretched out and enlarged veins in your body, mainly in the legs and feet, but can also occur in the vulva. Those prone to vulva varicosities include women who are obese, pregnant, or experience excessive pressure from prolonged standing, walking and exercise.

Vulvar varicosities can be supported by wearing compression underwear or nylons, avoiding prolonged standing or squatting and reducing excess salt intake in your diet.

If varicose veins in the vulva become disruptive, there are surgical procedures and helpful injectable medications to help manage them.

I notice the lips of my vagina changing color as I have gotten older? Why is that happening?

Hormonal changes associated with estrogen, including puberty, pregnancy, and menopause, increase pigment in the skin of the vulva and vagina.

Skin trauma from sex, shaving, ingrown hairs, folliculitis and recurrent infections can increase the pigmentation to the skin, changing the color.

Aging can also cause changes of the skin color of the vulva and vagina.

What will happen to my episiotomy scar and pelvic floor after having a vaginal birth over time?

Childbirth probably has the most dramatic effect on the vagina, especially if you have a vaginal delivery. A recent statistic showed that “30% of women who have a vaginal birth will have some form of trauma to the tissue and muscles in the vagina and pelvic floor”. The vagina and all its elastic glory can only stretch so much during childbirth. With each vaginal delivery there is a little more stretching which has an accumulative effect that ultimately changes the outward appearance of the vagina. The pelvic floor muscles that stretch, distend and tear in the vagina to allow the baby’s head to come through this tight space will never be quite the same over time. The more vaginal deliveries you have, the more the vagina stretches, especially in the vaginal opening. Women often chose to have an elective cesarean section to avoid any trauma caused to the vagina from a vaginal birth.

There is a definite correlation between having a lot of vaginal deliveries and big babies that permanently stretch the outward appearance of the vulva and vagina.

Is vaginal dryness tied to the hormone estrogen?

There are 3 main hormonal assaults on the body causing a drop in estrogen leading to vaginal dryness is breast feeding, perimenopause and menopause. Breastfeeding occurs during your reproductive years while perimenopause and menopause typically happens in your 40’s and 50’s years old. These hormonal conditions lead to vaginal dryness which can be reversible. Once you stop breast feeding the vagina will return to its normal healthy and hydrated state. During perimenopause and menopause, vaginal estrogen will reverse the dryness caused by erratic and low estrogen.

Does the vagina get smaller and more narrow with aging?

Expect the unexpected as your vulva and vagina transition from peri-menopause to menopause. With menopause and the loss of estrogen stimulation in the vagina, the tissue can become dry, pale and smaller. Some vagina’s become shorter and narrower if there is no sexual activity including penetration with a penis, dildo, sex toys or fingers.

With menopause my vagina has gotten smaller and dry making sexual intercourse impossible? What are treatment options for me?

The opening of the vagina, also called the introitus, can become smaller or shrink for a number of reasons. Vaginal dilators can be used to help gently enlarge a small vaginal opening (introitus) over time. Vaginal dilators increase the elasticity, strengthen and revitalize vaginal muscles and tissue, keeping it from becoming too short or narrow. Dilator sets come in a variety of shapes, sizes, colors, and materials, while all sharing a common goal – helping restore vaginal capacity, stretching the vaginal opening, and making intimacy, sexual intercourse or self-stimulation more pleasurable and comfortable.

What are the reasons someone would need vaginal dilators to help stretch the vaginal opening?

Some women discover the involuntary tightening of their pelvic floor muscles, and the ensuing pain, from the first time they attempt vaginal sex. It could also be a tampon, or a gynecologist’s speculum, that triggers the pain. The choice becomes burning spasms or impenetrability, as if a wall blocked the vagina. It’s a physical problem, but psychological issues often accompany vaginismus.

Main Reasons people would need to use vaginal dilators include:

Peri-Menopause and Menopause
Painful Intercourse
Infrequent Sexual Penetration
Vaginismus
Vulvodynia
Partner with large Penis Girth & Length
Neo-Vagina Patient
Breast and Other Female Cancer Patients
Cancer radiation patients
Virgins
Sexual Trauma

What are the types of vaginal dilators on the market?

There are a number of vaginal dilators on the market today. Ideally you want to purchase dilators made of medical-grade plastic or silicone. Why you need the dilator(s) may determine how long you need them to be. Dilators come in many different size, shapes and lengths. All of the dilators on the market you have to be lying down to use except ones I designed that allow women to be mobile. I have created wearable vaginal dilators that provide more comfort, mobility and compliance. You can find them on my drsherry.com website if interested.

I also recommend pre-moisturizing the vagina with an internal moisturizer nightly for 2 weeks nightly before using vaginal dilators, then using every 2-3 nights.

You want to use water-based lubricant when inserting the dilator for best results. Avoid using petroleum jelly since it can cause vaginal irritation. Using silicone or oil-based lubricants is acceptable but they may break down the silicone material faster.

How to use a vaginal dilators?

I am not gonna lie, using vaginal dilators to help restore the vaginal tissue and elasticity can take some work…what I like to call “homework”. For those that have a small vaginal opening due to lack of sexual penetration, it may have been a few years since there has been any activity. With this in mind, it may take some time, usually months, following the below recommendations to get the vaginal opening functional again. The process has to be slow, steady and filled with patience.

Premoisturizing the vagina with an internal moisturizer (I like recommending Key E coconut oil suppositories-inexpensive and can be purchased on Amazon) nightly for 2 weeks nightly before using vaginal dilators, then use every 2-3 nights.

Find a time and a quiet place where you can be comfortable, either alone or with your partner. The most natural position for insertion is with one leg placed on top of the toilet seat or lying on your back with your legs in a “frog-leg” position. Relax your pelvic floor muscles, take some deep breaths, and gently insert the dilator.
Start with the smallest size dilator in your kit. Insert a well-lubricated dilator into the vagina until the base is flush with the vaginal opening. A water-based lubricant is recommended. Wearing a pair of snug-fitting underwear will help keep the dilator in place, especially in the upright position.
The goal of using a vaginal dilator is to increase the size of the dilator slowly and comfortably to retain, expand, and gently stretch the entrance and canal of the vagina for additional comfort and pleasure. When you can insert one size of a dilator completely without any discomfort, then you should start using the next size up. The goal is to insert the largest size dilator without any discomfort. The longer time it’s in the vagina will give best results.
Enhance dilation by inserting a vibrating bullet into the base of your dilator. This added stimulation and sensation may help relax your muscle when increasing dilator sizes.
Start with the smallest dilator size and insert the rounded end into your vagina, the way you would with a tampon. This first, smallest dilator should not feel uncomfortable when inserted; if it does, go to a smaller size.
Put on underwear to secure the base of the dilator in place. You can move around and do simple activities or sit at the computer while the dilator is in place
It is recommended to use dilators 2 to 5 times per week for 5 to 30 minutes as needed and depending on your comfort level for best results.
After using the dilator wash it with warm water and anti-bacterial soap or a sex toy cleaner.

Restored vaginal capacity can be a huge source of joy! Pain should never be an option.

Why you should pre-moisturize the vagina before using vaginal dilators?

I highly recommend pre-moisturizing the vagina for at least 2 weeks before starting to dilate the vagina. The inside of the vagina must be moisturized before inserted a lubricated dilator. This is necessary for comfort while doing your “homework”. When a lubricated dilator is inserted into a vagina that is moisturized, the dilator will feel more comfort when inside the vagina and will not stick to the walls of the vagina if left in for longer periods of time.

I recommend the following to my patients:

Please pre-treat and moisturize the vagina or anus, with an internal moisturizer for 2 weeks nightly, and then use every 2-3 nights while using the vaginal dilators. Use an over-the-counter Hyaluronic Acid, Replens, Me Again, Prohydrate, Feminease or Key-E before using a well lubricated vaginal or anal dilator. You can also use a prescription vaginal estrogen if you are in perimenopause or menopause.

How can work out clothing affect the vagina?

Selecting the best clothes to work out in is particularly important when it comes to the vagina. Active sportswear or clothes to work out in can be a confusing topic. The days of baggy cotton sweats have been replaced with high tech swag to help your skin breath, absorb moisture and prevent you from getting soaked in sweat. To keep it simple, pick fabrics such as nylon, spandex and polyester that are comfortable, nonabsorbent and flexible. Some materials are even known to be “antibacterial, enhance your physical performance and provide attention support.”

Just remember yeast and bacteria thrive in a warm and moist environment. As long as your workout clothing has built in panties or liners with special antibacterial fabric that can absorb the extra sweat you should be fine leaving the undies at home.

Is it okay to go commando when I exercise?

To each your own when it comes to wearing underwear or not when you work out. When you don’t wear underwear the vagina (and buttock) is completely unrestricted and free. The unrestricted vagina doesn’t have any underwear or panty lines or fabric to add discomfort to this sensitive area. If your workout clothing has built in panties or liners with special antibacterial fabric that can absorb the extra sweat you should be fine leaving the undies at home. In addition to comfort there is no buildup of heat and moisture which can increase the risk of a vaginal infection.

What are some tips for keeping things optimal down there when you are a frequent exerciser?

Just remember yeast and bacteria thrive in a warm and moist environment. As long as your workout clothing has built in panties or liners with special antibacterial fabric you should be able to avoid any unwanted infections.

Wearing clean sportswear to allow your skin to breathe is an easy remedy in lessening the sweat, bacterial and foul odor build-up while working out.

Where there are sweat glands, hair follicles and hair, there is sweat and with excessive sweat and heat a rash can occur.

A heat rash is common if you sweat a lot, especially in a hot or humid environment, and leave your sweaty workout clothes on long after you leave the gym. Sweat traps bacteria on the skin, blocking sweat glands causing a stinging or burning rash with small itchy red bumps, also known as “prickly heat rash”.

Ideally after a long workout it’s best to get out of your sweaty clothes and take a shower where you can clean the sweat and bacteria of your body, especially the vagina.

If you don’t have time to shower, I would bring a travel pack of vaginal hygiene wipes in your gym bag that can be used after working out. A quick wipe, front to back, of your vagina and bum, will remove excessive sweat and unwanted vaginal odors. Vaginal hygiene wipes are alcohol-free and hypoallergenic, clean dirt, germs and odors from all the right places and won’t increase your risk of getting a yeast or bacterial infection.

What exercises can be traumatic to the vagina?

Women experience more vaginal trauma when it comes to bicycling, horseback riding and spinning. The way the vagina is positioned on the bicycle seat exerts unfamiliar pressure on certain parts of the delicate soft tissue of the labia majora and minor, better known as the “lips” of the vagina. With prolong bicycle rides the intense pressure on certain parts of the vagina, tailbone, lower back and groin creates restriction of blood flow, skin irritation, and ultimately numbness of the area, especially the clitoris. These are referred to as “saddle sores”. Some women even report disruptive genital pain and discomfort with reduced genital sensation.

For those who like to shave it all off, saddle sores are more likely. Pubic hairs serves as a cushion and brings softness when you are on the saddle. Avoid long cycling rides during your menstrual period. The string of a tampon can also cause irritation to the vagina tissue. Cleaning the vagina with antibacterial soap can help prevent vagina cysts, acne and other skin related infections.

Other problems that are associated with cycling, spinning and horseback riding include vaginal infections such as yeast and bacterial due to the poor vaginal ventilation and moisture buildup that occurs with these sports. With constant pressure on the vagina, skin cysts can develop as well. Your cycling posture and the way you sit on the bicycle seat also affects the pressure that is exerted on the delicate parts of the vagina.

What exercises can be easiest to the vagina?

The best exercises for the vagina include recumbent cycling, jogging, elliptical machines and swimming. These forms of exercise do not create the same problems on the vagina and may be easier on the vagina but really every woman has their own form of exercise that is easiest on the vagina. I suggest finding the one that works best for you and your vagina and stick with it. You overall health and wellness depends on it!

What are the best exercise to strengthen the vagina?

Kegel excises are meant to strengthen, stabilize and tone the pelvic floor muscles which support the uterus, bladder and rectum. There are many reasons why you can weaken your pelvic floor muscles including pregnancy, childbirth, menopause, aging, chronic coughing and obesity.

When women enter menopause, the loss of estrogen has a negative and weakening effect on the vagina and bladder, causing loss of urine and urinary frequency.

The effect of weakening the pelvic floor results in your pelvic organs dropping and creating a bulge in the vagina. Symptoms from a prolapse range from an uncomfortable pelvic pressure to leakage of urine. Other symptoms of a weakened pelvic floor include stress and urge incontinence and fecal and gas incontinence.

Kegel exercises can help delay or even prevent pelvic organ prolapse and symptoms related to pelvic floor dysfunction. Kegel exercises also make sexual intimacy and intercourse more enjoyable for you and your partner. For those with a vagina and clitoris, doing Kegels while trying to orgasm can actually enhance the orgasm. Contracting your Kegel muscles with sexual arousal and orgasm helps you not lose urine and also feels good, for a partner with a penis, during penetration.

How do Kegel exercise work on pelvic floor muscles?

As with any muscle in the body, if it’s not exercised or worked out in any way, it will become weakened and lose its function and strength. The pelvic floor muscles are no different. These critical muscles should be given more attention since weakness of these muscles create so many disruptive and embarrassing symptoms for people with a vagina and penis.

I feel as though people who are able to perform Kegel exercises on a regular basis will have less disruptive symptoms of loss of urine or stool. Knowing there is a cause and effect, will empower people to continue this positive mind-body connection.

How do you perform Kegel exercises correctly?

The easiest way to identify your pelvic floor muscles is to urinate, and while doing so, stop the flow of urine midstream and hold it. Hold the contraction of these muscles for 3-5 seconds, then relax them allowing the flow of urine to continue. Repeat this a couple of times and until you are confident that you have identified the pelvic floor muscles. Another way to identify these muscles is to insert your first two fingers in the vagina, squeeze your pelvic muscles as if you are holding urine. You should feel the vagina tighten and the pelvic floor moving upward. Then relax these muscles and feel the pelvic floor return to the starting position.

Once you have identified the pelvic floor muscles you can perform Kegel exercises regularly. Before you do them, empty your bladder and sit or lie down. Contract your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least 3 to 5 sets of 10 repetitions a day. You will notice a benefit to your pelvic floor strength in 8 to 12 weeks when done faithfully.

Kegel exercises are easy to do and can be done anywhere without anyone even knowing. Finding the right muscles to tighten or squeeze at first can be tricky but with practice you will find success.

Not all Kegel exercises are done the same way, right?

You can definitely do traditional Kegel exercises on your own. Some pelvic floor conditions need these purposeful muscles to be more relaxed and less contracted, so doing the traditional Kegel exercise would not be recommended.

For persistent and disruptive pelvic floor conditions, working weekly with a pelvic floor physical therapist is often the best approach to learn the best way to perform Kegel exercises. Not all Kegel exercises are done the same way. Pelvic floor PT often use Kegel exercise variations depending on their in-dept evaluation. These specialized PT may have you do a quick or short contraction of the pelvic floor, holding the contraction for 1-2 second and then relaxing with a breath. Another variation is the long hold muscle contraction where you are taught to hold the contraction for 10 seconds and relaxing for 10 seconds.

High tech Kegel apps, devices and weights can be helpful for compliance and having a more interactive experience. But the truth is your hands-free DIY homework in being successful and seeing results.

There are absolutely no downsides to doing Kegel exercises. Once you learn how to do them correctly Kegels should be a permanent part of your daily routine. You are never too young to start learning your Kegel exercises and flexing your pelvic floor muscles.

I have heard of women having an orgasm while they work out. Is that true?

There is an undeniable connection between abdominal wall and pelvic floor muscles that allow women to orgasm while exercising. Whether you are aware of it or not, contracting and tightening your abdominal muscles also involves, contracting and tightening the pelvic floor muscles which is the pathway to a coregasm. It’s well known that contracting your pelvic floor muscles, as you would doing Kegel exercises, helps women achieve an orgasm.

What are some exercises that someone could try to attempt to bring on an exercise-induced orgasm?

Exercises involving the abdominal muscles including weight lifting, yoga, spinning/bicycling, running, hiking and walking are the most exercises associated with coregasms. Some women can have coregasms while doing sit-ups, pull-ups, chin-ups and climbing poles or ropes.

Are there differences between exercise-induced orgasms and those that occur during sexual activity?

With its 10,000 highly sensitive nerve endings, the main function of the clitoris is to give pleasure to a woman in the form of an orgasm. Whether the clit is stroked with light or hard pressure or aroused with a tongue, an orgasm is achieved by stimulating a woman’s female version of the penis.

The pathway of how coregasms occur during exercise is not completely understood and more research is needed for a clear explanation. It’s possible that exercises that cause the pelvic muscles to contract and the mental high from exercise endorphins work together to achieve coregasms.

Working out has health benefits and so does orgasming, if you have an orgasm during workout aren’t you getting more bang for your buck?

There are multiple health benefits of having an orgasm including relieving stress, reducing anxiety, building a stronger immune system, lowering blood pressure, increasing heart rate, blocking pain and boosting confidence and sense of well-being to name a few. Exercising and coregasms could be considered the perfect and healthy way of multitasking!

Can vaginal Steaming help with my uterine fibroids?

The Mayan women and traditional healers started vaginal streaming long before Gwyneth Paltrow made it a popular Hollywood beauty treatment. The idea is having a medicated steam with mugwort and wormwood sprayed at the vagina will ultimately be a uterine cleanse as well. The end result, so they claim, is help in treating irregular periods, vaginal cysts, bladder infections, yeast infections, uterine fibroids, infertility and even hemorrhoids. Medical research studies are still needed to really prove these benefits from a vaginal steaming to recommend this ancient ritual to my patients.

My concern would be that steam cleaning could have a similar consequence of douching. It’s important to clean the vagina on the outside but you don’t have to do too much internal cleaning. The vagina has its own internal washing machine that keeps it cleaned and balance. It’s really all about the pH balance. As soon as something disrupts this balance such as extreme heat or taking antibiotics, you can get a yeast or bacterial infection similar to douching.

There is no doubt an herbal steam on the outside of the vagina has a relaxing, calming and cleaning effect which clearly is beneficial to your mind and vagina!

How healthy are Vagina Facials?

Everyone looks forward to a good facial or a good “Vajacial” as it’s called when it’s done down south. The same steps of a full extraction, scrub and toner are applied to the vagina. A trained esthetician will also extract ingrown hairs, apply anti-freckle, anti-acne, and lightening creams for an added bonus to the va jay jay. If your vagina needs to feel calm, a calming mask can also be applied. Vajacials are thought to be beneficial for those who have had any kind of Brazilian wax treatments. I am sure “Vajacials” are safe in the hands of a trained esthetician who is comfortable and experienced in working in this sensitive area. For those women who have ingrown hairs and rashes from other forms of glamorizing their vagina, a healthy cleaning certainly can’t hurt.

Are there any long-term risks to Yoni Steaming?

Having the steam temperature be too high could potentially burn or irritate the vulva and entrance to the vagina.

Are there any things people can do for immediate relief for funky discharge?

A cold compress or taking a warm water bath with extra virgin coconut oil may relieve vulva swelling, burning, irritation or itching. I would avoid washing out or douching the funky discharge out of the vagina since it may make your vaginal infection worse. The best thing you can do asap is to see your healthcare provider or local urgent care clinic to make the correct diagnosis to ensure the best treatment plan.

How can you really tell if your vagina is “clean” in the end?

Daily washing of the vulva and external vagina with vagina friendly feminine hygiene products ensure your lady parts will be clean in the end. Just like your face, you know a clean fresh feeling, even down south.

What should a healthy vagina’s scent be like?

The key is to know what your “normal” smells like. All of us with a vagina usually know that awkward feeling if a new and strange smell comes our way. The smell and taste of the vagina comes mostly from the fluids inside it. The taste is not quite sour, but somewhat astringent since the vagina is normally acidic. The normal pH balance is slightly acidic which helps protect the vagina from infections and odors.

Some describe the taste as being metallic due to the high levels of acidity. Ultimately, the taste and smell of the vagina depends on its pH levels.

The vagina is especially sensitive to different changes in your daily environment. Anything that affects this delicate balance will affect the smell, type of discharge and its consistency.

Does pineapple make my vagina taste better?

You are what you eat is an idiom for all things body-related.

The good news is that there are foods that can combat offensive odors and actually add a sweet smell or taste to the vagina. Take note of the groceries to have handy in your refrigerator:

Fresh fruits -Pineapple, Kiwi, Blueberries, Mango, Green Tea, Cucumber, Lemons
Fruit juices
Vegetables-Definitely Cucumbers and Lemons!
Whole grains
Greek yogurt
Plenty of water

 Foods high in Probitoics

What foods make my vagina taste badly?

Pungent foods and spices seem to take a fast lane in our bodies through the blood stream, lungs, sweat, and vaginal secretions creating especially intense smells under arms, on the scalp, in the genital area… everywhere. Foods that may give off a notably offensive odor include: garlic, onions, mint, turmeric, curry, blue cheese and other fermented foods, cabbage, cauliflower, Brussels sprouts, broccoli, asparagus, vinegar, red meat and, perhaps, other foods such as eggs, liver, kidneys, seafood, fish oil, milk, peas, and soy!

If you’re a smoker, nicotine is a detectable flavor in urine as well as sweat. Too much garlic the night before a big gym workout and you’re reminded (in your perspiration) how garlic is the spice that keeps on giving.

If my partner notices a different taste in my vaginal fluids what should I do?

If your partner notices a different taste in your vaginal fluids, focus your first detective work on your diet. Has anything changed? Are you eating more beef, more fruits or vegetables, or are you focusing on one specific food group or single food (possibly in some new fad diet)? New medications, especially antibiotics, may factor in taste and smell changes. Rule of thumb: If a food gives you foul-smelling urine, farts, or breath, chances are it will affect the taste and smell of your vagina! After a thorough examination of possible dietary changes, I would suggest seeing your healthcare provider to eliminate the possibility of vaginal infection.

Are there any ingredients that it’s actually okay to put inside your vagina to fend off yeast and bacterial infections?

Vaginal boric acid capsules have been used for decades in combatting chronic yeast infections. Boric acid has antifungal abilities in treating yeast successfully. Using boric acid 600mg vaginal suppositories placed inside nightly for 14 days has been an effective alternative to traditional medication.

The most popular and common go to natural probiotic and remedy is yogurt. Eating more yogurt or applying it to the vagina has often been used for decades by many women. The lactobacillus acidophilus cultures in yogurt are thought to be an effective way of removing the excessive yeast built up in the vagina. Medical studies have found using yogurt to treat yeast is more effective than a placebo. For those women looking for an alternative, yogurt should be at the top of your list.

Other alternative approaches include eating certain foods that encourages the growth of yeast in the vagina. Garlic is a known immune boosting food and often thought of to treat yeast infections. Taking garlic orally or using it intravaginally is an option for some women. The medical studies have not shown garlic to be a consistently effective treatment for a yeast infection but for those looking to try something non-prescription it may be worth a try.

Apple cider vinegar either by ingesting or soaking in it with bath water may help treat and prevent a yeast infection. Apple cider vinegar diluted in fresh water and used as a vaginal douche twice a day has been shown to be an effective treatment of yeast infections. Using the apple cider vinegar applied to the outside of the vagina has also been shown to relieve common symptoms of a yeast infections such as burning, itching and swelling of the outside of the vagina. If this treatment remedy doesn’t get rid of the infection, it’s time to see your health care provider.

Baking soda with its alkaline base can help the vagina return to its normal acidic environment. Balance in the vagina is important and adding baking soda may help return the vagina to its natural environment getting rid of the yeast overgrowth. Baking soda is added to the list of natural treatment remedies for yeast infections. Some women drink it and some soak in it. Medical studies do not show that baking soda is a reliable or consistent treatment remedy.

Extra virgin coconut oil seems to be effective for just about anything these days. There is a new study suggesting that coconut oil may be an effective treatment for a yeast infection.

A word of caution. If there are not medical studies to support the products mentioned above benefits, you may want to see your healthcare provider first and get the proper workup.

Genital Hygeine Care Part 2

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