Here's what's going on down there...
If the thought of lying back on the bed with your legs spread before the eyes of a total stranger fills you with dread, you're not alone.
A trip to the gynaecologist is hardly at the top of a woman's bucket list but it's a necessary procedure for anyone who is sexually active, or over the age of 25. Really, we should always be keeping a careful eye on what's going on down below.
But rather than trying to self diagnose, or turning to the dark depths of Google in between your next trip to the gynaecologist, we've enlisted Tania Adib, a Harley Street gynaecologist, and Dr Shree Datta, gynaecologist for intimate healthcare brand INTIMINA, to answer the most common vagina-related questions. The good news is, what's going on down there is probably much more normal than you realise.
Tania and Dr Shree aren’t the least bit shy about sharing their wealth of knowledge so read on for the answers to all your vagina-related quandaries.
1. Yes, that discharge is normal
"Discharge is actually a very good sign of your vaginal health – clear or milky discharge is completely normal," says Dr Shree. "It provides an important function," adds Tania. "Glands in the vagina produce normal secretion, including discharge, which helps to cleanse the vagina, get rid of natural bacteria and any dead cells; it provides natural lubrication. Discharge keeps the vagina clean and helps prevent infection."
"For that reason, internal douching of the vagina isn’t recommended," says Dr Shree, "as this can actually alter the natural bacterial balance you have in your vagina. Using soap and water on the outside skin is absolutely fine. The type and amount of discharge you pass can depend on where you are in your menstrual cycle – for example, it’s often thicker and more jelly-like in the second half of your cycle [when you're ovulating]," says Dr Shree. "Discharge can vary between thin and sticky to thicker with an elastic texture," agrees Tania. "However, if you find yourself feeling itchy and there is a curd-like consistency to the discharge, it could indicate there is a yeast infection, so you'll need to get tested."
"If you experience a persistent change in colour, consistency or smell of discharge, it’s worth getting checked over by your Gynaecologist," adds Dr Shree.
2. Vaginas can smell of all sorts
"There can be a slight odour, but this shouldn't be unpleasant," says Tania. "Typically, there could be a slightly acidic aroma (think vinegar). Your own vagina's smell could be dependent on your body chemistry and your diet can influence it too - you might notice a change after eating strong foods, such as spices, onions or asparagus."
3. This could be what's causing heavy super heavy periods
"It goes without saying that the frequency and duration of periods varies from person to person, so it’s worth monitoring what’s normal for you," says Dr Shree. "Make a record of the number of sanitary products you are changing and if you are leaking through them. Remember, the type of sanitary wear you are using may make a difference - period cups are great for monitoring your period flow. For example, you may need a large menstrual cup for the first two days of your period and a smaller one for the other days. If you have a heavy flow Intimina’s Lily Cup B can hold up to 32ml of blood so you can feel safe and protected while wearing it - bear in mind the average blood loss during periods is 80ml in total."
"Having long heavy periods – with flooding, clots or heavy bleeding with hourly or two hourly changes - would suggest it’s a good idea to get checked over by your Gynaecologist," adds Dr Shree. "Factors that may cause heavy periods include fibroids and polyps, which can grow in your womb. Sometimes you may be on medication which can alter the flow of your periods, or have a hormonal imbalance in your thyroid so these are other things we would check for."
4. Sex won't make your vagina loose
"Despite various myths, sexual intercourse will not loosen the vagina. As for childbirth, for young women (late teens and twenties) who give birth, there may be some looseness in the first few months straight after delivery, but things should return normal within six months," says Tania.
"However, giving birth many times can make the elastic less likely to snap back. Likewise, ageing causes the elastic quality of the vagina to become less efficient. Kegel exercises can improve tone in many cases. If you feel looseness is still an issue, you should discuss options with your gynaecologist - there are treatments which can help firm and tone the vaginal walls," Tania adds.
5. If you're peeing often, try some kegels
"Going to the toilet to wee over 8 times in a day can be incredibly disruptive to your lifestyle," says Dr Shree. "Firstly, I would take a look at how much alcohol and caffeine you’re taking in, as well as how much water you’re drinking. Remember, if you don’t drink enough water, your urine is more concentrated and this can irritate the bladder leading you to go to the toilet more often."
"You may also have a urine tract infection, or an overactive bladder. Certain medicines or medical conditions – including constipation – can affect how often you’re going to the toilet. As well as this, anything that puts pressure on your bladder – a fibroid in your womb or pregnancy, for example, can also lead to frequent urination. After monitoring your fluid intake and the number of times you go to the toilet, it’s time to see your doctor for further investigations to find out the exact cause and correct treatment," adds Dr Shree.
"You might also benefit from strengthening your pelvic floor muscles, which support the bladder, bowel and affect sexual function, by regularly doing kegel exercises. Intimina has developed the KegelSmart™ - a personal pelvic floor trainer which sets a routine that is simple to follow, safe to use, and completely tailored to your individual needs."
6. This is what causes bleeding between periods or after sex...
"There are lots of reasons why you might get bleeding in between your periods or after sex, but to help clarify the cause, note down when you get the bleeding, how heavy it is and how long it lasts in relation to your periods," says Dr Shree. "Remember, it’s not uncommon to get bleeding if you’ve changed your contraception to a new pill or coil and for some women, a slight bleed at the point of ovulation (mid cycle) can be normal."
"Some sexually transmitted infections may cause bleeding unrelated to periods, as can stress or pregnancy. You may also have some cell changes to the neck of the womb (cervix), so make sure you have an up-to-date smear. When consulting your Gynaecologist, we’ll also explore whether you would benefit from an ultrasound scan to look for fibroids or polyps in your womb, which can affect your period length, frequency and heaviness as well as bleeding in between periods," says Dr Shree.
7. Your vagina is normal, whatever shape and size it is
"There is a huge variety in the way vaginas and labias appear. Unless it's uncomfortable or hurts, it's normal," says Tania. "The labia minora (the inner lips of the vagina) can be asymmetrical, enclosed within the vulva, or hanging outside of the vulva. It's all absolutely normal. If you're still not sure, ask your doctor to check."
8. The real reason sex is hurting
"Believe it or not, it’s common to find sex uncomfortable at some points in time and there’s a pretty long list of possible causes," says Dr Shree. "It could be as simple as having sex for the first time with a new partner, feeling stressed or trying a new position. You might find sex more uncomfortable at certain points of your menstrual cycle or need more lubricant."
It could be psychological. "A condition called vaginismus is caused by a negative association with sex, and can make women close up, triggering pain when penetration is attempted," explains Tania. "This can be treated with specialist counselling. And lack of arousal is another reason sex may hurt. That's why spending time on foreplay and discovering what is enjoyable is important."
“However, there are other physical causes for pain during sex," says Tania. "These can include dryness caused by the menopause or oral contraceptives, infection, such as thrush or STIs, over-sensitive nerves at the base of the vagina, surgery such as an episiotomy during childbirth and abrasions to the vagina."
"Medical problems such as fibroids or endometriosis may also cause sex to be painful, so it’s important to see your doctor if sex is persistently uncomfortable," says Dr Shree. "If sex has always been problematic, it’s worth seeking help to see whether there is an underlying physical or emotional connection."
"There are treatments which can help, and it's important certain medical conditions are ruled out," agrees Tania.
9. If you've had your HPV vaccination, you still need a smear
"Human papillomavirus (HPV) is a common sexually transmitted infection, with over 100 different types, which can cause warts and cervical cancer," says Dr Shree. "Infection with HPV doesn’t usually cause any symptoms, so those with HPV don’t know they have the infection and it generally takes 18-24 months to clear. The vaccination programme, although effective, does not protect against all of the strands of HPV which can cause cervical cancer and you must complete the course of vaccinations on time. As the vaccine does not protect against all types of HPV, it’s still important to go for cervical smears once you reach the age of 25," adds Dr Shree. "Remember, it’s free and it can help detect any problems early, so it’s worth attending – you will usually receive a reminder from your GP to attend every 3 years until the age of 50, after which it’s every 5 years."
10. Allll the reasons why your period might stop
"Apart from being pregnant, there are lots of reasons why your period may stop. We’ll always go back to reviewing your period cycle and whether they were regular before they stopped. Things we think about when periods stop include a change in hormonal contraception – for example, the Mirena coil can lighten and even stop periods for some women – and stressful life circumstances, such as finals exams or a divorce," says Dr Shree.
"This can often affect your weight, which believe it or not, has a massive impact on your periods. So sudden weight loss, doing too much exercise or being significantly overweight can impact your periods. Medical problems such as poorly controlled diabetes or an overactive thyroid can also influence whether you get periods and how frequently. Of course, we will always check your hormones to make sure this is not the first sign of the menopause, but having an early menopause is uncommon – only 1% of women go through the menopause under the age of 40," adds Dr Shree.
11. This is why your vagina has changed colour
"If you've noticed the inner mucosa of the vagina has changed colour, you may have gone through the menopause," says Tania. "Pre-menopause, the vagina within should be pink and moist. When oestrogen decreases, the skin becomes paler. Lack of oestrogen also causes the vagina to become less plump."
"There may be other reasons for the skin around the vagina to alter in appearance," adds Tania. "For example, white patches accompanied by itchiness indicate you might have developed the auto-immune disorder, lichen sclerosis. Discuss treatment options with your doctor. If there are other changes, such as spots or markings that have developed, you should definitely get a doctor to take a look. Although these are likely to be nothing to worry about, in certain cases, change in appearance may indicate cell changes linked to cancer so discuss any concerns with your GP."
12. What's behind lower tummy pains
"Whilst it’s not uncommon to get period pains, pelvic pain in the second half of your menstrual cycle and painful periods can suggest endometriosis. This is a medical condition where the womb lining is found elsewhere – often in your ovaries and around the womb as well as within it," says Dr Shree. "We don’t know the exact cause but we do know it’s hormone dependent and runs in families. Endometriosis can cause regular pains, which worsen in the time leading up to and during your period."
"However, pain can also be due to infection or IBS, so it’s important to see your doctor to make sure the correct diagnosis is made so that we can give you the right treatment," adds Dr Shree. "In the first instance, keep a diary of your pain, in relation to when you are getting your periods – if the pains are not related to your periods, causes of your pain could include an ovarian cyst or IBS."
13. How to tell if you've got thrush or Bacterial Vaginosis
"Thrush manifests itself as thick, white curd-like discharge, which causes itching and discomfort. There may be a yeasty, sweet smell to the discharge," says Tania.
"Bacterial Vaginosis, on the other hand, smells distinctly unpleasant, with a fishy odour. The discharge is thin and watery and sometimes grey and there'll be itching and burning when you go to the toilet," she adds.
If you're worried that something's off, "you should book an appointment with a doctor, or consider using Canestest Self-Test for Vaginal Infections, which can help you find out if you're suffering from Thrush or Bacterial Vaginosis," says Tania.
14. Your gynaecologist doesn't give a hoot if you've had a wax or not
"There is no need to shave or wax your pubic hair if you’re coming to see us, we’re able to examine you with or without pubic hair," says Dr Shree. "The only time we may consider removing hair is if we are performing an operation on the skin around the vagina – and even then, we will only remove hair in the operating zone as is needed."
This originally appeared on GLAMOUR UK