Women often have a lot going on BTS that we don’t think about unless something feels off. Many of us come up with excuses to put off going to see the doctor, whether it’s because we’re uncomfortable laying everything out there (literally) or afraid of the answers we might get. Long story short, going to the gyno isn’t exactly a walk in the park (anyone else shudder at just the thought of the scary-looking—not to mention, cold—speculum?). But we’re here to normalize regularly seeing your OBGYN if you have a vagina, as well as creating dialogue around all the topics related to female wellness.
Enter: Dr. Alyssa Dweck, a practicing gynecologist in Westchester County, NY and advisor to Tru Niagen. From vaginal odor to birth control and everything in between, I probed (pun intended) Dr. Dweck on the most important questions to ask your OBGYN, and we left nothing off the table. Read on for her answers to questions you may be embarrassed to ask your own doctor.
Meet the expert
Dr. Alyssa Dweck
Gynecologist
Dr. Dweck provides care to women of all ages and has delivered thousands of babies. Voted “Top Doctor” in New York Magazine and Westchester Magazine, she has a special interest and expertise in female sexual health and medical sex therapy. Dr. Dweck is co-author of three books, including the newest release “The Complete A to Z for Your V (Quarto Press 2017),” and has appeared on The Today Show and Good Day LA.
1. What is my vagina supposed to look like?
While every vagina is unique (just like the person who it is a part of), Dr. Dweck explained what you can generally expect: “A healthy vagina, the internal canal, is typically a shade of pink, lush, sometimes glistening with normal clear fluid and with many folds called ‘rugae.’ The vaginal opening might have darker pigment and variable skin folds depending on history of childbirth, previous surgery, and/or sexual activity, for example.” Take a cue from Charlotte in Sex and the City and grab your trusty handheld mirror to get up close and personal with your vulva.
2. Is it normal to have vaginal discharge and odor? What causes them?
Before you go down the Google rabbit hole, slow your roll. Dr. Dweck assured us vaginal discharge and odor are typically not causes for concern: “Most vaginas have a natural physiologic discharge made up of mucus from the cervix, vaginal fluid and cells, and cells/fluid from the uterus.” However, there are instances in which vaginal discharge and odor can raise red flags. “Infection with viruses, bacteria, and other microbes, including STIs (sexual transmitted infections), hormone changes, and/or external irritants, can disrupt the normal vaginal pH and microbiome and cause infection. In these cases, an atypical vaginal discharge or foul odor can occur.” The main takeaway? If you’re not sure and can’t decipher what’s what, it’s best to consult your doctor.
3. Why do I have urinary or fecal incontinence, and what can I do to resolve it?
If you experience loss of bladder or bowel control (AKA leaking urine or poop), you’re not alone (it’s more common than you may think). “Both can occur due to weak or relaxed pelvic floor muscles,” said Dr. Dweck. “Genetics, prior childbirth (especially for big babies or instrumented deliveries), and obesity may play a role.” So how do you address urinary incontinence? Dr. Dweck encouraged taking into account treating any underlying UTI (urinary tract infection), minimizing or eliminating caffeine (which can create urgency and frequency), practicing Kegel floor exercises, engaging with a pelvic floor physical therapist, and consulting with a urologist/urogynecologist for more intensive testing. “Similarly, for fecal incontinence, one may consider increasing fiber intake to bulk up stool, Kegel exercises, pelvic floor physical therapy, or seeing a colorectal or gastrointestinal specialist.”
4. How many yeast infections or UTIs are too many? When should I see a doctor?
One yeast infection or UTI is enough to send anyone into a frenzy. So how do you know when an OTC remedy will do the trick or it’s time to pay your doc a visit? “Recurrent UTI typically refers to greater than or equal to two infections in six months or three infections in a year,” Dr. Dweck clarified. “Recurrent yeast infection implies more than four infections per year. Both scenarios are best addressed by a HCP [health care provider]. Severity of infection is also a reason to check in with a HCP.”
5. Why is it painful to have sex?
PSA: Sex should only be pleasurable. So if you’re experiencing any discomfort between the sheets, seek help from your gyno or a pelvic floor therapist. As for what’s the culprit behind painful sex? “Painful sex could occur for a variety of reasons, including vaginal dryness, infection, hormonal changes, and mechanical or anatomic issues, such as fibroids, cysts, endometriosis, scar tissue, vaginal muscle tightness, and/or traumatic sex,” Dr. Dweck elaborated.
6. Can I have sex while I’m on my period? And is it possible to get pregnant during my period?
While you may not feel the sexiest during that time of the month (there are ways to flip the script, BTW), if the mood strikes, Dr. Dweck gave the green light: “One can engage sexually while menstruating if comfortable and, in fact, period sex may relieve cramps or enhance pleasure for some. Precaution should be taken since blood-borne infection, including HIV, can be transmitted. It is possible, although unlikely, to get pregnant from sex while bleeding since some have irregular menses and unpredictable ovulation.”
7. How do I determine what type of birth control is best for me?
It goes without saying that birth control is a personal choice. It can be overwhelming and confusing to choose a birth control method that checks all the boxes for your needs and lifestyle. When deciding the best method for you, talk it out with your physician “[Determining the right birth control] is a shared decision made between patient and HCP based on menstrual habits, desired permanence of contraception or future fertility, medical history, and medications, lifestyle, and insurance coverage,” stated Dr. Dweck. “Keep in mind, condoms prevent against STIs while most other forms of contraception do not.”
8. If my state outlaws abortion, what are my options for unintended pregnancy?
In light of the reversal of Roe v. Wade, it’s no surprise there’s a lot of confusion and fear around reproductive health and abortion (it’s OK to feel all the feels, BTW). Whether or not you’re pregnant, arming yourself with information and resources from a trusted source (read: your OBGYN) is never a bad idea. But if you find yourself at a loss as to what safe recourse you have in the case of an unplanned pregnancy, Dr. Dweck pointed us in the right direction: “There are several online sites that will provide services, though travel may be required. Hey Jane is one example of a virtual clinic.”
9. Why can’t I have an orgasm?
According to the Cleveland Clinic, only 10 percent of women easily climax. So if you’re part of the other 90 percent, Dr. Dweck shed some light: “This can be complex, but some reasons include not enough direct clitoral stimulation, pain during sex, medications (most notably antidepressants), medical conditions, prior surgery, or psychological factors.” Whatever the root cause may be, you can rest assured your OBGYN can help you find the solution that works best for you. Because we all deserve orgasms.
10. How do I talk to my partner about STIs/STDs?
Sure, we can list a hundred things we’d rather do than get tested for STIs/STDs—let alone talk about them—but think of it as a form of self-care. And as awkward as it may be, Dr. Dweck emphasized that having a direct conversation about STIs/STDs with your partner is necessary. After all, you can’t go wrong creating a safe space for open and honest dialogue surrounding sexual health. It may just bring you and your SO closer and make the sex even better (talk about a win-win).
11. I feel lumps in my breast. How do I know if it’s something more?
If you’ve ever done a breast self-exam, pat yourself on the back. Familiarizing yourself with “your girls”—from their appearance to how they feel—is a healthy habit to add to your wellness regimen. While breast lumps are common and most often non-cancerous, it’s nonetheless unnerving to find one (or more). So knowing what to look out for can help calm a bout of the jitters: “Lumps that are approximately 1 centimeter or larger are palpable,” Dr. Dweck pointed out. “A clinical breast exam with a HCP and imaging, including mammogram, sonogram, or MRI, are potential next steps.” During your next check-up, don’t hesitate to get some pointers on at-home protocols to maintain from your doctor.
Please consult a doctor before beginning any treatments. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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