February 08, 2018

2 comments

comfort ›   intimacy ›   vaginal health ›  


Q: Can I have sex again? It’s been a few decades...

Sounds like you’ve been doing a number of the right things: You’ve been using dilators, a vibrator, lubricant, and vaginal moisturizer. It sounds like you’re at a point where localized estrogen, Osphena,  or Intrarosa would be helpful for you to achieve your desired outcome.

You asked. Dr. Barb answered.Any of these prescription drugs will provide elasticity, a critical factor for getting the “stretch” needed with the dilators. Take your dilators in to your health care provider and have this conversation, too. He or she can help you determine whether you can get further capacity with the methods you’re using or whether, as I suspect, you need to take the next step and add a prescription to your routine to restore health to the vaginal tissues.

It’s hard to get to the final goal without that option--and that final goal is definitely one worth working for! Good luck.

Got that “Not-So-Fresh” Feeling?

Humankind has been trying to cover up its natural odor ever since we crawled out of the cave. Maybe this made sense when bathing was considered dangerous and soap was made from animal fat and wood ash. But in our obsessively hygienic and more enlightened time, why all the fuss about odor, specifically that of our nether regions? And why all the products meant to make our bottoms smell like a spring breeze, whatever that means? (Watch this Saturday Night Live clip for a hilarious take on the topic.)

As far as I can tell, these products follow a long, inglorious line of more or less successfully convincing women that they stink. In a 1930s ad, the “Love Quiz” asks why her man is avoiding his lovely wife’s embrace. The answer is that he’s no longer happy in the marriage because she’s neglected “proper feminine hygiene.”

The solution? “Every wife can hold her lovable charm simply by using ‘Lysol’ disinfectant as an effective douche.” Yeah, that Lysol.

You can’t make this stuff up.

Eighty-odd years later, have we really come such a long way? We may not be squirting floor cleaner up our yoni, but there are no lack of products on the market to camouflage our natural odor. Now, just as back in the day, the intent is to make us feel self-conscious and embarrassed about ourselves. To shame us into buying products we don’t need and that sometimes aren’t good for us.

Dr. Barb's book, Yes You Can: "Sound, reassuring, medically approved advice."Our vaginas don’t smell like a spring breeze, nor should they. Our vaginal smell comes from a delicate balance of certain bacteria called lactobacill—the same bacteria found in yogurt. When you think about it, a natural vaginal odor has that same slight pungency. In the vagina, lactobacilli produce lactic acid and hydrogen peroxide, to give us a slightly acidic garden that works with our bodily ecosystem to keep out bad bacteria and the fungi (yeast) that produce the really smelly stuff, sometimes accompanied by a ferocious, burning itch.

While our vaginas are quite resilient, if enough lactobacilli are killed off by medication, those nice-smelling douches, excessive sugar in our diet (encouraging sugar-loving yeast), trapped moisture in our crotch, or even blood or semen, which are fairly alkaline, the resulting bacterial mash-up can cause both odor (fishy or foul) and itch.

In that case, your doctor may advise treating the bacterial or fungal infection or using an over-the-counter product, like Balance Moisturizing Personal Wash, to restore the natural pH balance in your vagina.  

Vaginal smell can also be affected by:

  • Sweat glands. We have a lot of them in the crotch area—the same kind as those in our armpits. Just so you know, sweat is basically odorless, but the bacteria living on our skin like our sweaty selves and produce yet another substance that gives sweat its distinctive odor. Wear cotton panties, take a shower, and change underwear after a workout. Let your crotch breathe—don’t wear tight clothes or pantyhose; go pantless when you can.
  • Medications. Obviously, antibiotics can change vaginal flora. If you take antibiotics, ask your doctor about replacing vaginal (and gut) flora with probiotics, yogurt, or RepHresh. Antihistamines can dry the vagina. Some herbal therapies can change vaginal odor.
  • Foods. If certain foods, such as asparagus, garlic, or curry, make your urine smell, they could also affect vaginal smell. No reason not to eat them, they just create a temporary odor.
  • Hormonal changes. The vagina is exceptionally sensitive to hormonal changes, as you probably know all too well. Menstruation, hormone therapies, birth control, even sex can change the bacterial garden. Loss of estrogen during menopause makes vaginal tissue thin and dry, thus more susceptible to bacterial and yeast infection. With menopause, we may have to adjust our vaginal housekeeping somewhat with regular use of vaginal moisturizers, topical estrogen, and sexual lubricants.

Left to its own devices, our vaginas are hardy and self-sufficient. They wash away dead cells and grow new ones. They don’t require special hygienic measures—just the normal shower wash of the external parts with warm water and a gentle soap. Just make sure the soap is fragrance-free and not antibacterial.

I’m betting that by now most of us have grown comfortable enough in our own skins and with our own natural smells not to be overly influenced by commercial messaging. Not that it is any less relentless, nor is there any lack of products and procedures to alter our appearance. By and large, we’ve just become wiser and less susceptible to the barrage. So maybe pass along the message to our younger sisters that they are beautiful and smell fine just the way they are.  

Q: What’s causing my yeast infections?

You say you’re using a vaginal estrogen cream, and using Kegel weights with an aloe vera gel. You’ve had two yeast infections since you started using both.

You asked. Dr. Barb answered.If you are fairly new to using estrogen vaginal cream, it may be the cream that is causing the vaginal yeast infections. The estrogen cream lowers your vaginal pH (and a lower pH is a healthier status; here’s a summary of healthy pH levels) over the first 8-12 weeks of use. The transition from the higher pH (atrophic) to the lower pH puts women at risk for yeast infections. This should not persist, and in the end the estrogen cream is likely to be beneficial to you.

Using the kegel balls shouldn’t cause a yeast infection, but if you’re prone to yeast infections, a pH-balanced lubricant like Yes WB may help prevent them. pH matters!

 

 

June 13, 2014

2 comments

learning ›   vaginal health ›  


Q: Remind me about healthy pH levels.

You ask about vaginal pH (the abbreviation stands for 'potential hydrogen,' a measurement of acidity). The scale for measuring pH is from 0 to 14, with a lower number meaning more acidic and a higher number meaning more basic. The normal pH of the vagina is 3.5 to 5.0. Being on the acidic end of the range means that the environment is unfriendly for unwelcome bacteria--and therefore more resistant to bacterial infections. There are a plethora of bacteria that belong in your vagina, the most predominant being lactobacilli. They produce lactic acid, resulting in an acidic pH and vaginal health.

A number of things can disrupt normal pH. Semen has a pH of 7 to 8, so after intercourse there will be a brief change in pH. Menstrual periods, with blood with a pH of 7.4, will also disrupt normal pH levels, and not so briefly; susceptibility to bacterial infections rises during menstruation. Douching can also disrupt healthy pH by flushing the healthy bacteria.

Perimenopause and menopause are major disruptors of pH, because the decline of estrogen causes the pH to rise (less acidic, more basic). This change is not brief at all; instead, it's the new normal. Not all women are sensitive to changes in pH, but some are; we're not sure why it varies from woman to woman. The most common infection related to the pH change is bacterial vaginosis (BV), caused by the bacteria gardnerella vaginalis, typically apparent because of discharge and odor. It's inconvenient, but easily treated with an antibiotic.

To avoid that infection or its recurrence, maintain healthy vaginal tissues and a healthy pH, which keeps the lactobacilli around to do their job. Vaginal moisturizers help; avoid douching; and if you have recurring issues, use a condom during intercourse to minimize the effects of semen.

June 11, 2014

2 comments

comfort ›   vaginal health ›  


Q: Can I use an organic olive oil-based cream with dilators?

While the cream you describe would be fine with the dilators themselves, we doctors recommend against using oils in the vagina. Oils tend to promote the growth of bacteria and break down or weaken tissues. Lubricants especially made for vaginal use are worth the investment.

If you're using silicone dilators, use water-based lubricants with them. Silicone lubricants on silicone products (dilators or vibrators) will cause the surface to degrade over time.

October 31, 2013

0 comments

hormones ›   vaginal health ›  


Q: Does the Estring estrogen ring affect pH?

Estrogen--and vaginal moisturizers--generally lower the pH level, making it a more healthy environment. The vagina is typically slightly acidic, like tomatoes or wine. The loss of estrogen with menopause can throw off our pH levels, reducing circulation and lubrication. Being able to generate enough moisture is part of what allows our vaginas to reregulate pH level after intercourse, when semen, which is more alkaline, is temporarily disruptive.

(To ask your own question of Dr. Barb, use the "Let's Talk" button top and center on our website.)

Fifteen Facts about Your Vagina

Out of sight; out of mind. That’s how it is with the vagina. As long as it’s working and isn’t causing a fuss (which, granted, becomes more iffy at this stage of the game), we forget about it.

Nothing wrong with that.

But, ladies, your vagina is a marvelous thing, so in the interest of a little community ed on this underappreciated organ, here are some fun and quirky facts—maybe things you didn't know—about your vagina.

  1. The word vagina comes from the Latin word for “sheath” or “scabbard.” Those Latin lovers were all about their swords. The word orgasm originated with the Sanskrit word for “strength.”
  2. The hymen is named after, um, Hymen, the Greek goddess of marriage. It’s a membrane that partially covers the vaginal opening before puberty to protect it until normal changes during puberty. It’s broken with a girl’s first sexual penetration, and the attendant show of blood is the traditional “proof” of her virginity.
  3. As you might imagine, the vagina has accumulated many colorful names over the centuries. A few of the, ahem, more decorous are: camel toe, honeypot, cock pocket, vajayjay, meat wallet, muff, bearded clam, fish taco, crotch mackerel, hot pocket, bikini biscuit, panty hamster, yum yum, twat, hoo ha, and, of course, pussy and cunt. Enough already!
  4. The vagina proper begins at the mouth of the vulva and ends at the cervix, which is that bottlestopper at the base of the uterus. So the vagina is the conduit—the “potential space,” the empty sock without a foot in it—that leads from outside the body to the small opening in the cervix that allows sperm to pass through.
  5. While the vagina is only 3-4 inches long, it balloons to 200 percent its normal size (to accommodate those Latin swords as well as babies of various sizes). This impressive ballooning effect happens because the vagina is pleated like a skirt with a bunch of folds, called rugae, which expand when extra space is needed.
  6. We talked about the normal variations in the way your outer genitalia may look, but for the most part, vaginas all look the same.
  7. Like your oven, your vagina is self-cleaning. So, for heaven’s sake, don’t douche. You’ll upset the delicate balance of good bacteria that live in there. Wash your external genitals with warm water and some gentle, unscented soap.
  8. Your vagina has its own unique odor, which is determined by your diet, the normal variation in bacteria, sweat, and hygiene.
  9. Your pubic hair isn’t just an annoying decoration. In days of yore, it was a “reproductive billboard” announcing that over yonder was a fertile female. It also traps your scent, leading suitors to the honey pot. Times have changed since caveman days, and a healthy mat of hair may not be quite so irresistible today. Pubic hair has a life expectancy of only three weeks versus head hair, which stays put for about seven years.
  10. The normal pH balance in your vagina is slightly acidic, similar to wine or tomatoes. That normal balance can get out of whack if you have an infection, douche, or through exposure to semen, which is more alkaline.
  11. Sex keeps your vagina moist and flexible, especially after estrogen levels drop. “Safe vaginal intercourse can help keep the vagina healthy and dilated,” says Dr. Courtney Leigh Barnes, a gynecologist at the University of Missouri in this article.
  12. Vaginal farts (also called queefs or varts) happen to every female at one time or another, especially during sex or exercise. So don’t be embarrassed.
  13. Gravity is as hard on your vagina as it is on your breasts, face, and buttocks. It sags, and sometimes, it falls out. This is called a prolapse. While it may be uncomfortable, it’s usually painless and can be fixed.
  14. Most women (about 70 percent) don’t orgasm through vaginal stimulation alone, but through a combination of clitoral and G-spot action.
  15. The first two inches in the vagina have the most nerve endings and are the most sensitive.
Don't say we never told you.
August 12, 2013

0 comments

conditions ›   vaginal health ›  


Q: Would condoms prevent yeast infections?

Yeast infections occur when there's an overgrowth of yeast that inhabits the vagina normally. Yeast isn't transmitted from men to women.

A healthy vagina is slightly acidic, measured by pH level. A pH level of 4.0 to 4.5 is healthiest for women; menopause sometimes affects pH because the loss of estrogen reduces circulation and lubrication. Semen has a higher pH level, which means it makes the vagina briefly and temporarily more alkaline and more hospitable to bacteria.

Condoms will prevent that brief pH disruption, which may be helpful for some women. Others use RepHresh, a pH balancing product, to prevent bacterial infections after intercourse, but note that only condoms provide an effective barrier against other sexually transmitted infections.

Estrogen Where It’s Needed

Okay, so you’ve tried everything. You regularly use a good, natural moisturizer, plus a lubricant during sex. No soaps, sprays, scents, dyes, or synthetic underwear ever touch your bottom. You’re the queen of vaginal hygiene. And still you’re troubled by dry, itching, or inflamed genitals and painful penetration.

What now?

Talk to your doctor about using a localized estrogen product for your vagina. These medicines deliver low dosages of estrogen right where it’s needed: the vagina and vulva. Not only is localized estrogen medication very effective at relieving the discomfort of vaginal inflammation or atrophy, but it also restores natural vaginal lubrication and elasticity. In fact, while it won’t relieve other menopausal symptoms—like hot flashes—low-dosage vaginal estrogen is sometimes more effective in relieving menopausal genital problems than systemic hormone replacement therapies (HRT). Moreover, the dosages are so low, the side effects and complications so negligible, it is often used by breast cancer survivors.

Vaginal estrogen comes in several forms: a cream (used twice a week), or slow-release tablets (used twice a week), or a ring (which needs to be replaced every three months). Don’t, however, confuse the Estring vaginal ring with Femring, which is the high-dosage HRT in a vaginal ring form. (Confusing? It can be.) Your doctor will tailor the amount and frequency of application for the maximum effect at the lowest possible dose. It may also take several weeks for treatment to become fully effective.

A few precautions:

  • Avoid applying your estrogen cream right before intercourse, since your partner can absorb it through his penis. Estrogen rings and tablets are meant to stay in place and don’t have this effect.
  • Continue to use non-hormonal lubricants and moisturizers if necessary.
  • Have regular vaginal intercourse to augment natural lubrication and a healthy vagina.
While localized estrogen may not be the first line of defense against the unpleasant genital changes related to menopause, it’s an important option when simpler methods (like vaginal lubricants or moisturizers) fail.

Taking Care of Yourself. Intimately.

As a medical doctor, I try to provide a place where uncomfortable or unfamiliar topics can be discussed in an open, honest way, without inhibitions or worries about “what people might think.” For lots of people, both men and women, self-stimulation or masturbation falls into that “uncomfortable” category. Some of the myths surrounding masturbation—like it causing blindness or hair to grow on the practitioner’s hands—have faded, thank heavens! But there’s still a lingering perception, I find, that self-stimulation is somehow less acceptable for women than for men. MiddlesexMD_OnlyBody

For post-menopausal women, self-stimulation is especially helpful, whether or not they have partners. It can solve problems with vaginal dryness or tightness: Stimulation causes your clitoris to swell, helping to maintain healthy blood flow to the walls of the vagina, which in turn can help keep your vagina open, strong and responsive. (It’s the old “use or it lose it” rule.)

If vaginal dryness or tightness is a problem, self-stimulation can also be a way to temporarily feel sexually satiated if intercourse is too painful. I say “temporarily” because I don’t recommend that you think of it as the solution to painful intercourse. Always seek medical attention if you’re experiencing any kind of vaginal pain, because there are lots of remedies.

Another benefit of stimulating yourself is the way it helps you to get to know your own body and what satisfies you best. As hormone levels decrease and effect other changes in your body, what’s worked in the past may not be as satisfying now. It’s great to be able to experiment with your partner to find your new best experience, but that’s not always possible, for all kinds of complicated reasons. Old habits die hard, and either you or your partner may feel tense or intimidated about changing things up. You can experiment to see what works for you and then share that knowledge with your partner to make your sex lives more mutually satisfying.

If you don’t currently have a sex partner, self-stimulation is a great way to enjoy the side benefits of sex, like tension and stress release and the feeling of calm and relaxation that immediately follows a sexual session. Fantasy can be a fun part of it; picture yourself with a former lover—or George Clooney (or Dean Martin… or… you tell us!). And taking care of yourself in this way keeps open the possibilities in case you do find yourself in a relationship again. In my decades of practice, I’ve learned never to say never!

If your sex life is suffering from other issues—a rough time in your relationship or it seems to hard to get your love life back on the right track—I caution patients against replacing intimacy with a partner with self-stimulation. It may be the “easy” thing to do, but it can compound problems if you turn to self-stimulation instead of your partner for satisfaction.

Self-stimulation is a normal part of a healthy sex life. At this point in our lives, the last person we need to be shy with is ourselves. Who knows what we’ll learn?