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Ten Questions You Might Be Afraid to Ask Your Gynecologist (But Shouldn’t Be)

There’s nothing like a trip to the gynecologist to make you feel glamorous, right? There’s the expertly tailored paper gown and the equally fashionable paper throw to drape over our knees. And who needs high heels when we can slip our dainty feet into cold, metal stirrups?

Okay, so maybe the thought of visiting the gynecologist ranks somewhere between getting a root canal and being audited by the IRS, but it’s an important part of your overall health. Anyone who’s had a yeast infection can attest to the importance of keeping one’s vagina healthy, but there’s much more to women’s health than care for down there.

In honor of National Women’s Health Week, we reached out to Dina Bastawros, M.D., Female Pelvic Medicine and Reconstructive Surgery Fellow at Carolinas Medical Center in Charlotte, North Carolina, with ten questions we shouldn’t be afraid to ask our gynecologists. So wear those paper gowns proudly, and go to your next appointment armed with the bravery to broach burning questions such as:

uBiome: How can I keep my vagina healthy?

Dina Bastrawros: There are many things that you can do to keep your vagina healthy that don’t require a ton of effort. First and foremost, it is important have exams with your gynecologist. At these visits, they will do Pap smears to screen for cervical cancer and provide you with an opportunity to discuss other related issues, such as STI screening, fertility, contraception, and any other general concerns that you may have.

Additionally, the vagina is a self-lubricating and self-cleansing system. It contains many (healthy) bacteria that help keep its pH in check. Washing with warm water is all that is necessary to clean the vagina. Avoid scented soaps and gels as they may disrupt the natural microbiome of the vagina (and can be very drying, too). Including yogurt with live cultures in your diet can help maintain the good bacteria levels in your vagina, which can help prevent infections. Additionally, cotton underwear is the best to wear. The material is breathable and it also absorbs moisture, preventing an imbalance in the vaginal microbiome.

UB: Is douching healthy?

DB: Douching was once thought to be a helpful way to maintain vaginal cleanliness, however the vagina is a self-cleansing system. The vagina has its own community of many different bacteria, including the genus Lactobacillus. This community of organisms help keep the vaginal pH balanced. Douching can disrupt this normal vaginal bacteria, and can lead to conditions such as bacterial vaginosis or a yeast infection due to the disruption of normal bacteria, so it isn’t recommended.

UB: What role does the vaginal microbiome play in my vaginal and overall health, and what are some signs that it might be out of balance?

DB: The vagina has many organisms which make up its microbiome, including bacteria, fungi, and viruses. The majority of the organisms are bacteria called lactobacilli that help maintain an acidic vaginal pH, and therefore discourage other bacteria, fungi, and viruses from thriving.

There are many disturbances to the vaginal microbiome on a regular basis. This can be due to menstruation, antibiotics, hormonal contraception, vaginal lubricants, semen, and sexual activity.

Increased vaginal discharge, foul odor, or itching are some signs that indicate that your vaginal microbiome may be out of balance. Talk to your doctor if you experience any of these symptoms.

UB: How do I do a proper breast self-examination?

DB: A self-breast exam is a step-by-step approach to examining your breasts on your own. Although it is not recommended as a screening tool for breast cancer, it is still very important to become familiar with your breasts to know how they look and feel. Knowing this can help you identify any changes and have an evaluation by a medical professional sooner. To do a breast exam, examine yourself a few days after your period ends, as they will be less tender and swollen at this time. It is important to examine all aspects of your breast, including your nipples, areola and armpits. Bring to the attention of your doctor any changes that are persistent or getting worse with time. Don’t forget, if you are 40 or older, you should begin getting mammograms every 1 to 2 years, as recommended by the American College of Obstetrics and Gynecology.

UB: Is it normal that I leak urine when I laugh or sneeze?

DB: Urine leakage with laughing or sneezing is a condition called stress urinary incontinence (SUI). This often occurs when the pressure exerted on the bladder by laughing or sneezing is greater than the pressure required to keep the bladder outlet closed, thus resulting in a leakage of urine during these activities. This is a common condition, especially in women who have been pregnant or given birth, as this causes a weakness in the muscles surrounding the bladder. SUI is a manageable condition. You should visit with your gynecologist, uro-gynecologist, or urologist to discuss possible treatment options if it is bothersome to you.

UB: What does it mean if I have discharge?

DB: Vaginal discharge is a normal part of vaginal health. It is normal to produce clear or white discharge. This is usually from the cervix. The consistency and color of discharge can change throughout your hormonal cycle. It can be clear or white, and range from thick and stretchy to watery. Healthy discharge typically doesn’t have a smell or color. It should also not be associated with any itching or soreness.

Changes in your vaginal discharge, such as color, foul odor, vaginal irritation and discomfort, can all be signs that there may be an infection. See your gynecologist if any of these changes occur.

UB: I’ve been having hot flashes – does that mean I’m menopausal?

DB: Menopause is the time in a woman’s life where the ovaries no longer produce estrogen. It is defined as the absence of menstrual periods for 12 months. Some women that are undergoing the menopausal transition will experience hot flashes. However, this is not exclusive to menopause. Other reasons that a woman may experience hot flashes include: anxiety, thyroid conditions, or prescription medications. See your doctor if you are experiencing hot flashes consistently.

UB: Why do I have pain after sex?

DB: Pain during sex is a very common problem, affecting nearly 3 out of 4 women sometime during their lifetime. This can be a temporary or long-lasting situation. There are many things that can cause pain with sex. This includes: emotional responses such as lack of desire, vaginal dryness, endometriosis, fibroids, or pelvic infections. Consult your OB/GYN if you have frequent or severe pain with sex.

UB: Why are my periods sometimes so heavy?

DB: Most women are aware of what a normal menstrual cycle is for them. However, not every cycle is created equal, and there may be some that are heavier than others. There are many reasons that may account for this. If a woman was on oral contraception, this typically lessens the monthly menstrual flow. However, upon cessation of hormonal contraception, some women will see their flow become heavier.

Other causes of heavy menstrual periods include uterine fibroids and polycystic ovarian syndrome. These conditions can be ruled out by an ultrasound performed by your gynecologist. Additionally, some women that are perimenopausal, or transitioning to menopause, may also notice some heavier periods. Consult your gynecologist for evaluation and treatment options.

UB: How often do I need to be tested for STD’s?

DB: If you are sexually active, it is very important for your health to be screened for sexually transmitted infections (STIs).  The Centers for Disease Control and Prevention recommends these guidelines for testing:

  • All adults and adolescents from ages 13 to 64 should be tested at least once for HIV
  • Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection
  • Annual gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection
  • Syphilis, HIV, and hepatitis B screening for all pregnant women, and chlamydia and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants

uBiome’s SmartJane test can help you and your healthcare provider better understand the unique balance of your vaginal microbiome, as well as identify HPV and other STIs.

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