First, thank you to everyone who submitted questions about your V! We complied your questions and had urogynecologist, Dr. Maria Canter, answer them.
Dr. Maria Canter is board certified in Female Pelvic Medicine and Reconstructive Surgery as well as Obstetrics & Gynecology. Also, she was one of the FIRST surgeons in the country to be boarded with both specialties—talk about some serious V power!
Dr. Canter has her own practice in Reston, Virginia, (Urogynecology Center NoVa) just outside Washington, D.C. Plus, she is so kind, funny, and easy to talk to that you’ll want to be her best friend. We chatted with her to answer your vaginal health questions for V-Day month.
Q1. Why do I have hair down there?
Simply put, there are hair follicles on your labia (external lips of your vaginal area), and they are stimulated to grow based on your hormones. Around puberty, the female body begins to produce hormones that stimulate growth in those follicles, which produces hair. Also, pubic hair provides a level of protection for your vaginal area.
Q2. What about shaving/waxing/lasering the hair?
Overall shaving, waxing and lasering your vaginal hair are safe procedures when they are performed by a professional. Any time you are manipulating the area, there is a risk of trauma —which could introduce infection, and discomfort.
For instance, in laser hair removal, sometimes numbing may be required before the treatment to make the patient feel more comfortable. There shouldn’t be any type of long-term damage if the treatment is performed by a trained professional.
Q3. Why does asparagus make my pee smell?
Not everyone notices that their urine smells after eating asparagus, but quite a few people do. There is a compound in asparagus and other sulfur-containing foods, that when metabolized by your body, gives off an interesting odor. This isn’t bad, it’s just a substance that your body is releasing.
(Here’s a list of other food that have sulfur and may make you release strong smelling urine or gas.)
Q4. Why does my vagina feel like it farts sometimes?
This often happens when there is some laxity at the opening of the vagina (everyone who read last week’s blog knows it is also called the introitus!). This laxity, or looseness at the beginning of the vagina, sometimes makes air get caught. With certain physical movements—like in a yoga class while you bend—there can be a slight compression of the vagina that causes the air to release.
Q5. Do all vaginas look the same? Why/why not?
Absolutely not! Everybody is made in their own special way. In fact, an artist created casts of 400 vaginas to make the statement that everyone is different and unique! Your vagina looks different depending on your genetics, hormones, age, and family traits.
As someone who does exams all the time, I already know this to be true. But, it’s great for women, like my patients, to see this and know there is a variety of ways a vagina can look.
(Check out The Great Wall of Vagina and see how it is “changing female body image through art.”)
Q6. What is vaginal douching and is it good for me?
Vaginal douching is when a liquid product is used to wash the vagina, with the liquid stored in a bottle with a tip that it is placed into the vagina. Then, the bottle is squeezed so the liquid shoots up into the vagina.
(By the way, the word “douche” just means to wash or soak.)
This is not recommended, because each person has their own special vaginal flora, which is a collection of bacteria that lives in the vagina. We all have bacteria that lives on our skin, mouth, organs, etc. which help us maintain a healthy balance. The vaginal bacteria (flora), helps us stay healthy too. But sometimes the flora can shift and that can cause bacterial or yeast infections. When you’re douching, you’re wiping some of the important bacteria, along with the bad. Also, if you are douching and you already have an infection (even if you aren’t aware of it yet), the douching can push the infection up higher into the uterus or pelvic area.
(Learn more about the history of vaginal douching here.)
Q7. Can the vagina really get stretched out?
I’ve heard women ask this question a lot, especially in relation to childbirth. I mean, how do you get a bowling ball through a pinhole right? In general, the vagina usually stays the same size, unless something else stimulates it to stretch.
If a woman has pelvic organ prolapse, the organs such as the bladder, uterus and rectum, start to drop. If they drop far enough, they can put pressure on the vagina causing it to stretch. When you correct the prolapse, the vagina will stop stretching, and should return to its normal size.
During vaginal delivery, certain hormones in the body stimulate the vagina to stretch and accommodate a baby. After this, the vagina should shrink back to its same size, but the tissue isn’t the exact same. This is where vaginal laxity can occur. But your vagina will not stay as stretched as it was when the baby was delivered.
On the opposite side, some women’s vaginas are too tight, and this can make intercourse uncomfortable. In these cases, we can stretch the vaginas using dilators. The dilators are little cylindrical-shaped devices, that are placed in the vagina for a certain amount of time. We insert dilators increasing in size, until intercourse is no longer uncomfortable for the patient.
Q8. How does the vagina change during menopause?
For women in a perimenopausal and postmenopausal state, the amount of estrogen decreases in the body. This causes a decrease in blood supply to the vagina, and in the lining of the vagina, the tissue changes. As a result, you can see that the vagina becomes a little bit paler, thinner, and can become more tender. (This change is called vaginal atrophy) Even using an applicator with a little medication or having intercourse can cause discomfort.
Usually, we can resolve that discomfort by treating the patient with vaginal estrogen, lubricant, or devices that help with lubrication and sensation.
Q9. What causes my vagina to be dry?
As we just talked about, vaginal dryness can be a result of decreased estrogen in the vagina, and the thinning of the vaginal lining. But, for younger patients, vaginal dryness can be a side effect of birth control or medication.
If you’re taking an oral contraceptive (pill), your body is getting just enough estrogen to prevent pregnancy, but not quite enough estrogen to keep the tissue supple. Or, there are certain medical conditions, like autoimmune diseases that can cause dryness of all skin not just the vagina.
Q10. Can tampons really get stuck “up there?”
As I say to my patients, a vagina is a like a sock—it ends. The vagina just leads to the uterus, nothing can escape. Also, tampons have strings attached to the end which makes it easy to remove.
However, I have seen patients who forget about their tampons, and come into the office because of an infection and an unfortunate odor. Now-a-days, tampons are made better, so the risk of TSS (Toxic Shock Syndrome), is quite low. But leaving a tampon in for long periods of time can still cause a bacterial infection. These infections are usually easy to treat with antibiotics.
I’ve also seen a patient who got a condom stuck in the vagina, but I was able to remove it quite easily. I’m not quite sure how that happened, except maybe it was their first time and it was a bit of an epic fail?
Q11. What is the point of a pap smear?
A pap smear is a screening test, that looks for abnormal cells on your cervix. We test mainly because of the virus HPV (Human Papillomavirus) which is an infection in the cervix that may over time, (years and years), turn into cancer.
If you’re doing your regular wellness routines and exams as directed by your doctor. According to the American College of Obstetricians and Gynecologists (ACOG), you should receive a pap smear every three years (depending on your history) after you turn 21.
If you do have HPV and it causes an infection, you can usually catch it earlier enough to take care of it. But HPV doesn’t always cause a problem and doesn’t always cause cancer. Many women have contracted HPV, but their immune system takes over and fights it off without them ever knowing.
However, it is very important that you keep up with your routine care, and checkups so you can stay healthy.
Q12. What is the difference between a UTI and a yeast infection?
A yeast infection is a fungal infection in the vagina when there’s an imbalance. We all have small, healthy amounts of yeast in our vagina. But, elevation in blood sugar or antibiotics, can sometimes reduce the healthy flora in our vaginas, and allow the small amount of yeast to grow out of control. These are very treatable with anti-fungal medication.
A UTI (Urinary Tract Infection), is a bacterial infection in the bladder that is typical treated with an antibiotic. But, ironically, the UTI antibiotic can sometimes cause a yeast infection for women who are prone to yeast infections. Not every woman who takes antibiotics for a UTI will contract a yeast infection. Only those women who are already prone to yeast infections.
Fact: UTIs are rather common in women, with 8.1 million women experiencing UTIs every year.
Q13. What do you wish your patients knew?
As a UROGYN, I wish my patients knew that there is nothing wrong with having quality of life issues like urinary incontinence, sexual dysfunction, and pelvic organ prolapse. Also, it’s okay to ask questions and to talk about these issues. There are many great treatment options that work! We can improve their quality of life.
Q14. How can we normalize women’s intimate health?
We can normalize women’s intimate health issues by just talking about it more. Everyone is busy—patients and physicians—and it’s hard to bring up personal, intimate questions. But if we are asking questions whether it’s in a private questionnaire, or we’re talking in person, or in the media, or even in our circles of friends, that would help normalize it.
I see a difference in generations and their openness to talk about intimate health. The older generations come in and usually do not know anything about their mother’s health; when she went through menopause, if she had pelvic organ prolapse, or if she had urinary incontinence (bladder leakage). Everything was a big secret. Whereas, the younger generations come in knowing a lot more and are savvier.
But, there’s still a long way to go to make everyone more comfortable in talking about their intimate health issues.