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ATROPHIC VAGINITIS: A real thing or just another term to make women feel bad about themselves?

ATROPHIC VAGINITIS: A real thing or just another term to make women feel bad about themselves?

Did you know that up to 15% of premenopausal women have symptoms of vaginal atrophy, or atrophic vaginitis, while almost 60% of menopausal women experience symptoms? With so many women affected by atrophic vaginitis you would assume that most are familiar with it; however, the reality is that atrophic vaginitis isn't discussed as often as it should be, so many women are not prepared if it happens to them. Before getting into what atrophic vaginitis is, let's start with the definition of atrophy: at·ro·phy /ˈatrəfē/ verb 1. (of body tissue or an organ) waste away, especially as a result of the degeneration of cells, or become vestigial during evolution. Similar: waste away, wither, shrivel, dry up, decay... 2. gradually decline in effectiveness or vigor due to underuse or neglect. If you're like me, you don't appreciate (and maybe even feel a little bad about yourself) if someone were to use phrases like "waste away" or "dry up" to describe your vagina. Unfortunately us vagina owners are stuck with the term atrophic vaginitis when referring to the normal effect of low estrogen levels, mainly menopause, on the vagina. So what is atrophic vaginitis? Basically it's thinning and loss of elasticity of the vaginal walls that can result in painful sex, irritation, and increased risk of vaginal and urinary tract infections. The most common reason atrophic vaginitis occurs is because of low estrogen that naturally occurs with menopause, but other causes of low estrogen levels include breastfeeding, prolonged birth-control pill use, and anti-estrogen medications used to treat conditions such as breast cancer and endometriosis. What can be done about atrophic vaginitis? Despite the bothersome symptoms of atrophic vaginitis, approximately 70% of women do not discuss or get treatment for their symptoms. This is likely due to embarrassment and/or bad advice if they did ask about it. Hopefully some of the 70% of women who haven't been treated are reading this so that they can learn about their options. One of these options is vaginal estrogen replacement that can come in the form of a cream, vaginal tablet (suppository), or vaginal ring. The advantage of using vaginal estrogen is that no significant amount ends up in the bloodstream so that even women who have a history of breast cancer can use certain vaginal estrogens. For those who don't want to use vaginal estrogen, a vaginal moisturizer or lubricant that doubles as a moisturizer can be used (may I suggest GLISSANT FDA-cleared water-based lubricant???). Another option is vaginal laser treatment specifically for atrophic vaginitis. You can think about it in terms of how lasers for the face increase collagen and make the skin younger appearing. Laser treatment of the vagina can make it "younger" too. The only downside is that it's not usually covered by insurance.) Why are most things that make us feel prettier and younger not covered by insurance?!?) If you have symptoms of atrophic vaginitis, don't feel bad about yourself -- take charge and fix it just like you do with everything else in your life. You got this.

HOW TO USE A LUBRICANT

HOW TO USE A LUBRICANT

Your initial reaction to this might be, "Duh, I know how." But do you really, and are you getting the most out of your lubricant? Before even getting to the "how to", let's start with the basics like what type of lube is best for you: water-based, oil-based, or silicone-based. In general, owners of a sensitive vagina should opt for a water-based lubricant because they tend to be less irritating. And if you use condoms or toys, water-based lubricants are the best option because they are compatible with most condoms and toys. Water-based lubricants wash off easily and usually don't stain, but they do need frequent re-application. Oil-based lubricants are more slippery (FUN FACT: GLISSANT means slippery in French) and longer-lasting than water-based lubricants. The main downsides are that oil-based lubricants cannot be used with latex toys and condoms and don't clean off as easily as water-based lubricants.
Silicone-based lubricants are even more slippery than oil-based ones, but they don't wash off easily. Silicone lubricants can break down silicone toys making them more difficult to clean because of the uneven surface. controversy exists So how to use a lubricant? I know you are going to roll your eyes when you read this: there is no "right" way to use a lubricant---but there are some tips you may not have thought of: 1) Use as much as you want where you want. The only disclaimer here is you should avoid lubricants with possible irritants such as glycerin, parabens, propylene glycol or phthalates. 2) Use your lubricant as part of foreplay. Pour (or spray in the case of GLISSANT) a generous amount of the lubricant in your hand and rub on your own intimate parts and/or those of your partner. Doing this not only lubricates all the necessary parts, but it also gets all parties involved in the mood. 3) Oil-based lubricants can double as a massage oil (you'll appreciate this if you're a multi-tasker like me). 4) If you're feeling a bit cool, warm up your lube by rubbing it in your hands before applying to yourself or your partner to get things heated up faster. 5) "Lubricated" condoms do have lubricant on them, but it's usually added after the condom is rolled up so the shaft of the condom can still be dry. Water-based lubricants can be applied to the condom after it's been put on to decrease friction. Less friction means less possible tearing and transmission of sexually transmitted infections. 6) And most importantly, the best way to use a lubricant is any way that makes you feel good.

5 COMMON MYTHS ABOUT PERSONAL LUBRICANTS

5 COMMON MYTHS ABOUT PERSONAL LUBRICANTS

Now that I am of a certain age, I am even more aware of those jokes about the "dried up old lady." Many women (and men) think this is the only scenario that a lubricant is needed. Let's dispel that myth and a few others... Myth #1: Only old women with vaginal dryness use lubricants. When it comes to sex, in general the wetter the better. Isn't that why the term WAP is so popular?!? A study of almost 2,500 women age 18 to 68 years (average age 32.5) found that 70% of the time, lube made sex pleasurable and more comfortable. The most common reason cited for using a lubricant was to avoid tearing of the vagina. Avoiding tearing obviously means more comfortable sex, but reduced friction and tearing of the vagina can also decrease risk of sexually transmitted infections (STIs). Myth #2: A woman is dry only when she isn’t turned on. Just because a woman is in the mood (libido) doesn’t mean her body always responds the way it should (arousal). There are multiple reasons a woman might not be able to lubricate -- certain hormonal birth control methods, postpartum hormonal changes, breastfeeding, (peri)menopause, medications such as antihistamines or some antidepressants, diseases that cause overall dryness such as Sjogren's syndrome, and even stress. For all of these reasons and more, many women of all ages can experience vaginal dryness that has nothing to do with desire for her partner. Myth #3: I can just use any body oil as a lubricant Technically you could, but it might not be the best or healthiest thing for you. Because oils don’t wash away easily, if the oil is too thick and/or the pH isn’t optimal for the vagina it may cause irritation or infection. If you use condoms or toys, oils and oil-based lubricants are not a good choice as they can weaken latex condoms and break down silicone toys. Myth #4: Lubes are all the same That’s like saying all lipsticks are the same! Look for quality ingredients and avoid ingredients like glycerin (can make you prone to yeast infections), propylene glycol (used as an ingredient in antifreeze), parabens (linked to infertility and may mimic estrogen so probably breast cancer patients should avoid), and phthalates (can affect thyroid function). At GLISSANT we protect your vagina by making lubricants without harmful chemicals! Myth #5: Lubricated condoms are just as good as using lubricant Interestingly, the lubricant is usually added after the condom is rolled up so the shaft of the condom is often dry so adding lubricant after the condom is unrolled can reduce friction. More important for you to consider is what the condom is lubricated. One common ingredient is the spermicide nonoxynol-9 that can make a woman more prone to irritation and infection. Parabens and glycerin are also commonly used. Other ingredients are unknown because condoms are not required to disclose this information. Ridiculous I know, but stay tuned on that matter...

WHAT'S THE DEAL WITH UREAPLASMA?

WHAT'S THE DEAL WITH UREAPLASMA?

Were you ever sure you had a UTI, but your doctor tells you that all of your tests are normal? It's possible you had a ureaplasma infection. Mycoplasma are the smallest living organisms of which 17 species are found in human respiratory and urogenital tracts. Mycoplasma hominis, mycoplasma genitalia, and ureaplasma urealyticum are the genital mycoplasma organisms that are generally regarded as opportunists, i.e. they don't bother most people but can cause problems with impaired immune systems, such as when you're sick and your regular defense mechanisms are down. Mycoplasma hominis and Mycoplasma genitalium have been associated with salpingitis (infection of the tubes) and pelvic inflammatory disease (PID), and both Mycoplasma hominis and ureaplasma can cause infections in pregnant women. The controversy around ureaplasma is that it is often found in the urinary tracts of healthy adults, so the question is do they really cause disease? Although most people who have ureaplasma don't have any symptoms, ureaplasma can cause urethritis (infection of the urethra or tube through which urine passes). Typical symptoms of urethritis are pain with urination, a general burning sensation, or urethral discharge. Ureaplasma can be passed genital to genital or mouth to genital. Although urethritis due to in men is well-described, there isn't clear evidence that it can cause urethritis in women. Because of this, I have to admit that I am often faced with a dilemma as to whether to keep treating a woman for ureaplasma when she has urethritis symptoms such as urethral pain or burning with urination, and she hasn't improved with treatments that are known to get rid of ureaplasma. Are her symptoms really due to ureaplasma? Or has no one found the real cause of her symptoms, and ureaplasma is a convenient scapegoat since it's normally present in a lot of people anyway? To add to the confusion, ureaplasma isn't routinely tested for because standard urine cultures don't detect ureaplasma. The most reliable way to make the diagnosis is swabbing the urethra (yep, when your urethra hurts already, your doctor is going to kick you when you're down by putting a little brush in there). The bottom line is knowledge regarding ureaplasma and the urinary tract is incomplete. Personally if I can't find the reason for a woman's symptoms, I think it's reasonable to treat her for ureaplasma and see if she gets better (although keep in mind many antibiotics commonly used to treat UTIs, or urinary tract infections, will also treat ureaplasma). What I don't support is treating a woman for ureaplasma over and over without any improvement. You know what the definition of insanity is...

USE IT OR LOSE IT: Penile rehabilitation is a thing...why isn't there vag rehab?

USE IT OR LOSE IT: Penile rehabilitation is a thing...why isn't there vag rehab?

For over two decades, the concept of penile rehabilitation to improve recovery of erectile function after prostatectomy (prostate removal) has been recognized. It's relatively standard in urologic practice that after a man has a prostatectomy he starts penile rehabilitation. Before you get funny images in your head of a certain man's body part lifting weights, penile rehabilitation is regular, usually daily, use of medications to increase penile blood flow during recovery from prostatectomy to promote nerve recovery and prevent penile scarring (fibrosis). Nerve damage that occurs with prostatectomy can result in decreased erections. The decreased erections can ultimately lead to fibrosis of the penis because of lack of blood flow (that carries oxygen to tissues) that is normally associated with erections. Over time, collagen increases which isn't desirable (no pun intended) because collagen isn't as elastic as normal penile tissue, and the penis can actually shrink in size. This doesn't happen under normal circumstances because most men have daily erections. It's not necessary to climax to benefit from penile rehabilitation, the blood flow just needs to be increased. Guess what happens to the vagina after menopause without hormone placement? Blood vessels can become smaller and result in changes in the collagen composition that make the vaginal wall thinner and weaker. Increased collagen has also been associated with prolapse. Unfortunately women don't have daily erections to increase pelvic blood flow, so what's a woman to do? Sex can definitely increase pelvic blood flow, but most people can't or don't want to do this every day. Women can also take medications like men do, but because these medications are specifically for erectile dysfunction they are usually not covered by insurance. Vaginal rehabilitation may be as simple as daily use of a vibrator. Like penile rehabilitation, using a vibrator doesn't have to result in climax (although that's certainly not a bad thing), it just has to increase blood flow. Although there isn't hard (no pun intended) scientific evidence to support this (yet), it makes sense to me as there are multiple medical conditions in which vibration is an accepted treatment. Regardless, if there's one thing you should take away from this blog it's use it and don't lose it.

WHAT HAPPENS WHEN YOU GET TURNED ON? One of the first things is blood flow increases down there...

WHAT HAPPENS WHEN YOU GET TURNED ON? One of the first things is blood flow increases down there...

The human sexual response as described by Masters & Johnson includes desire (libido), arousal (excitement), orgasm and resolution. Assuming you have desire, meaning you are interested in sexual activity (loss of libido deserves its own blog), what actually happens when you get excited? A lot of things really. In addition to more rapid breathing and heart rate, one of the first things to occur with arousal is an increase in blood flow--including to the genitals. When blood flow to the vagina increases, fluid through the vaginal walls increases which is how lubrication occurs. Not only does arousal result in vaginal lubrication, the vagina also lengthens. Yes, you read that correctly. Our vagina actually "grows" during arousal. The external genitalia, including the clitoris and labia (inner and outer lips), also become engorged with blood. You probably haven't thought about it, but the clitoris is similar to the penis in that it has erectile tissue that expands when blood flow is increased during arousal. In fact, the clitoral hood is equivalent to the foreskin. The glans, or head, of the clitoris contains a dense collection of nerves which is why the main function of the clitoris is pleasure. As you can imagine, it takes more than a hot minute for all of these physiologic changes associated with arousal to occur which makes taking your time during foreplay a legit necessity. (This is great information to share with your partner...) Ideally arousal results in the big "O" which is the climax of the sexual response. Sadly it only lasts a few seconds, but it's an intense few seconds as the pelvic muscles rhythmically contract. Finally, resolution is when the body returns to its normal level, and after a refractory period (time between orgasm and when you are ready to have sex again) the cycle can start again. LOVE. REPLENISH. REPEAT. .

Breast cancer is not the end of your sex life

Breast cancer is not the end of your sex life

I've heard it so many times: "Sex is so painful since my breast cancer treatment and I can't use any estrogens." The first part of that sentence is 100% true, the second part is partially true. Why is sex painful after breast cancer treatment? The most common reason is atrophic vaginitis. (Yet another complimentary medical term for women.) Basically atrophic vaginitis is thinning of the vaginal walls usually because of low or absent estrogen. The thin vaginal walls are more sensitive, don't lubricate as well or at all, and are prone to tearing during sexual activity. It's no surprise that a woman who experiences this loses any remaining libido she had following her breast cancer treatment. A woman with a current or past history of breast cancer should not take systemic estrogen (pill, patch, or cream meant to go through the bloodstream), but she can safely use certain vaginal estrogens. In 2016, the American College of Obstetricians & Gynecologists published their opinion that "Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms." Over the years, the best analogy I have used to get this point across to patients is topical versus systemic steroids. A steroid pill is meant to go throughout your body to treat an allergic reaction or other condition wherever it is in your body. On the other hand, a steroid cream will only work where it is applied (assuming you use the recommended amount). Similarly, an estrogen pill or patch will distribute estrogen throughout your body while a topical vaginal estrogen will have effects only in the vagina. Along those lines, while a vaginal estrogen can significantly improve vaginal dryness, it doesn't improve things like hot flushes or your mood. Right now you might be thinking, "That's interesting, but I'm just not comfortable with using any type of estrogen." No problem! There are plenty of other alternatives. Non-prescription alternatives include regular use of over the counter vaginal moisturizers and lubricants at the time of sexual activity. There are many different moisturizers and lubricants, and my advice regarding these is to stay with chemical-free, natural products to avoid further irritation of the vagina. I have to give a plug for GLISSANT lubricants. They aren't just lubricants--they contain natural ingredients that improve a woman's own lubrication and sensation by increasing blood flow to the vagina (yep, that's what happens during arousal and what Viagra does for men). Another option is ospemifine. This daily tablet is a SERM (selective estrogen receptor modulator) that stimulates the walls of the vagina to thicken, similar to estrogen. It's a once daily pill that is generally well tolerated. As a potential added bonus, it has antiestrogen effects on the breast like tamoxifen, which is also a SERM and is commonly prescribed to prevent breast cancer recurrence. And for those of you ladies who don't want to deal with putting something in your vagina all the time or taking a pill, there is a fractional CO2 laser treatment (Mona Lisa Touch) that induces collagen production to improve the function of the vagina. It's a quick, relatively painless procedure performed in the office. Many of my breast cancer patients have seen significant improvement after just one treatment (which makes me very happy for them). Breast cancer is hard enough to deal with let alone the negative impact it can have on your sexuality and relationships. I just wanted you to know that there are ways to deal with it, and breast cancer is NOT the end of your sex life.

VAGINAL HEALTH PRODUCTS: What the vagina really needs?

VAGINAL HEALTH PRODUCTS: What the vagina really needs?

There are a lot of products out there that are supposed to be for vaginal health, but based on their descriptions either the products aren't really made for the vagina, or some people are confused as to where and what the vagina needs. So here is some info on what's going on down there: First things first: WHERE is the vagina? (You're thinking, "Duh.") Yes, I know you know that it's down there, but do you know where it officially starts and where it ends? The opening of the vagina, called the introitus, is the entrance to the vaginal canal and it ends at the cervix. Technically the vagina is just the internal area and does not include the external genitalia (labia minora and labia majora). My point is that a product called a "vaginal wash" should be used to clean inside the vaginal canal, otherwise it's really a "feminine" or "intimate" wash. Products meant to clean inside the vagina have traditionally been referred to as douches. The skin of the external genitalia (vulva and labia) is different from the vaginal canal, and sometimes even more sensitive, so if your goal is to care for what is outside the vagina, then any gentle cleanser is probably fine. In fact, the vagina is acidic so a wash for the labia and vulva is better to be pH balanced for the skin (less acidic) rather than the vagina itself. And the same applies to vaginal wipes. They should be called labial or vulvar wipes unless they are meant to wipe the inside of the vaginal canal---and wiping inside your vagina is pretty hard to do. WHAT does the vagina really need? The vagina is far from sterile, and the less disruption from its normal state the better. There vagina's normal state is a balance of good and bad bacteria, and maintaining normal levels of the good bacteria prevent things like yeast infections, bacterial vaginosis, abnormal discharge, or just not feeling right down there. Common causes of disrupting the balance are antibiotics and...wait for it...douching. Washing away the very important good bacteria allows growth of the bad bacteria. So even if the products that claim to be vaginal washes really are vaginal washes, they aren't really needed or even good for your precious vagina. As many of us who care for the vagina often say, the vagina is a self-cleaning oven so no extra cleaning needed.

SEX IS LIKE SKIING...

SEX IS LIKE SKIING...

No, I'm not referring to the rush you get when flying down the hill or the heavy breathing from exercising at altitude, I'm talking about how actually getting on the slopes takes work and motivation but once you get there you usually enjoy it. Let's face it, over time and with age (and frankly it's human nature) we become less enamored with doing anything that takes significant effort. Exercise is a great example in general, but in my case skiing is something that I have had a love-hate relationship with. Unbeknownst to me, I was subjected to the "Telluride Test" by my then boyfriend, who despite this secret test is my one and only husband. The test was administered under the guise of being invited to join him and his friends for a ski weekend. Apparently if I couldn't ski or wasn't willing to try I was going to get dumped. Although I wanted to spend time with him, making the weekend happen was somewhat of a chore. At that time I rarely skied so I had to borrow ski clothes, rent skis and fly by myself to meet him. I arrived late in the day and the next morning I still had a terrible headache from the altitude. This combined with the temperature in the single digits was really a deterrent from going skiing, but my then boyfriend was very persuasive. Needless to say, it was a great day skiing and despite all the hurdles I thoroughly enjoyed myself. Where am I going with this? Here goes the analogy: at some point in our lives (and I am envious of those of you who are the exception) most of us view sex like skiing---somewhat of a chore but usually in the end glad we did it. It's definitely easier and a lot less work to just roll over and go to sleep than have sex, and without someone motivating us that would likely happen the majority of the time. But even with a motivated partner, getting in the mood to "ski" can be difficult. What can women do to get motivated to have sex? Basically the same things you do to get motivated to ski. Stay conditioned. Sex and skiing are easier when you stay conditioned. Practicing a sport on a regular basis not only makes you better, but it often reduces your risk of injury. It's also beneficial to stay "conditioned" for your sexual wellness. For instance, if you haven't been exercising at all and you get on the slopes, chances are you will feel stiff, tire out easily, and possibly even hurt yourself. If a woman hasn't been sexually active for a while, and especially if she is menopausal and not taking hormones, chances are sex won't feel good and possibly even hurt. Regular sexual activity, either by yourself or with a partner, is the best way of treating and preventing dyspareunia (pain with intercourse). Sexual activity increases vaginal blood flow which helps keep the vaginal tissue healthy and maintain elasticity. Get the right equipment. One of the reasons I used to dread skiing was that I hate being cold. When I finally got a really good ski jacket and well-fitting goggles, I actually started enjoying skiing, even during a snowstorm. If you dread sexual activity because of pain or vaginal dryness, then get the right equipment. For dryness, keep a lubricant in your nightstand (hint: GLISSANT). If you have pain then get a lubricant with CBD (hint: GLISSANT). You might even try a CBD tincture or gummies. Other equipment to consider: candles, music, super soft sheets. Plan your trip. With work, kids, and all of life's responsibilities, spontaneous sex is pretty much nonexistent. There's nothing wrong with planning to have sex. If people plan date nights, why not plan sex nights? Text your partner in the morning so that you can both plan your evening around turning in early, or make one (or two, or three) night a week your designated "really make an effort to do it" night. Make apres ski plans. Near the end of a hard day skiing I look forward sitting in front of the fire with a glass of wine followed by soaking in a hot tub. You can make your own apres sex plan so that you have something else to look forward to after the main event. One idea is to draw a bath just before sex so it's ready and waiting for you afterwards--maybe even two glasses of wine. After almost 25 years of skiing with my husband, I still enjoy it. Although I need motivation sometimes, I can honestly say that every time I do it I am happy that I did.

G-spot: Ero"G"enous zone or sexual myth?

G-spot: Ero"G"enous zone or sexual myth?

Where does the term “G-spot” even come from? The “G” in G-spot refers to Dr. Ernst Gräfenberg, a German physician. In 1951, Dr. Gräfenberg reported that the female urethra is surrounded by erectile tissue similar to a man’s penis, and that with sexual stimulation the female urethra enlarges and swells. He did not describe a specific spot in the vagina associated with orgasm nor did he describe a female prostate or female ejaculation. Those concepts originated in 1981 when Dr. Gräfenberg’s research was misrepresented, and the term “G-spot” was coined in reference to an erotically sensitive area (the “female prostate”) along the urethra that was the source of female ejaculation. Since then, G-spot amplification has been touted as a procedure to enhance sexual sensitivity of this area despite lack of convincing scientific evidence that a G-spot even exists. In 2012, Dr. Adam Ostrzenski, a gynecologist, reported on finding the G-spot in one 83-year old cadaver while a later study of 13 cadavers ages 32-97 years failed to identify a G-spot at all. (It’s probably worth mentioning that Dr. Ostrzenski performs G-spot injections.) G-spot amplification, or augmentation, is a cosmetic procedure that involves injection of a filler in the alleged G-spot to temporarily increase its size and sensitivity. Fillers include collagen, fat, platelet-rich plasma (PRP), and hyaluronic acid. It’s important to note that G-spot amplification has not been approved by the US Food and Drug Administration, and the American College of Obstetricians and Gynecologists states that for G-spot amplification (and other genital cosmetic surgery) “safety and effectiveness have not been established.” As a woman I would love for there to be a G-spot that could reliably be stimulated to achieve amazing orgasms. Unfortunately, as a surgeon who has operated on thousands of vaginas, I don’t think there is an anatomic G-spot. Hundreds of pelvic floor surgeons, including myself, regularly operate in this exact area all the time, and I have never seen any structure that I would think is the G-spot. I imagine if the G-spot was a discrete area, the majority of women would report impaired orgasm after vaginal surgery. But does the debate over whether the G-spot exists or not even matter? Different women are stimulated by different areas of their genitals, so frankly I don’t care what the name is of any area as long as stimulating it feels good. Regardless of whether the G-spot is a myth or reality, the only important thing is that a woman finds whatever her G-spot is so that she can fully enjoy herself. And on that note, if a woman wants to amplify her G-spot or have vaginal rejuvenation—more power to her…as long as she is informed of the risks and benefits.

AS IF YOU NEED ANOTHER REASON TO AVOID SEX

AS IF YOU NEED ANOTHER REASON TO AVOID SEX

Are you avoiding sexual activity because of fear of wetting yourself or your partner? Or because your doctor told you that your bladder or uterus is falling? Incontinence (involuntary loss of urine) and pelvic organ prolapse (pelvic organs “falling” into the vagina) are common conditions, usually the result of childbirth, and are not barriers to a satisfying sex life. A lot of women have told us that they avoid sex because of these conditions. The advice we give is to get the condition treated if it is negatively impacting your life. If treatment isn’t possible or a woman just isn’t ready for treatment, then she is given tips on how to enjoy sex despite prolapse and incontinence: If you have incontinence: · Empty your bladder before sexual activity—if your bladder is empty it’s unlikely you will leak. · Let gravity work for you, not against you. When you are on your back, you will have much less chance of leaking while if you are upright (i.e. on top) you will have a higher chance of leaking. · Consider moving the action to the shower or tub. If you have prolapse: · Think of prolapse as a hernia and use gravity in your favor. When you are upright, the prolapse may bulge down and when you are on your back the prolapse will fall back inside. Regardless of position, anything that enters the vagina will simply push the prolapse back in and will not harm you or make the prolapse worse. · Don’t worry about your prolapse getting worse with sex. It is quite the opposite as having regular sex and orgasm actually improves your pelvic floor muscles. Your clitoris is the key player in the orgasm game. Pelvic organ prolapse or incontinence should not physically impact your ability to have an orgasm although these conditions might mentally affect orgasm. Many women are so worried that they might leak or their partner will feel their prolapse that orgasm is inhibited, but you should know that you can still experience satisfying sexual activity with incontinence and prolapse. Your focus should be on enjoying the intimacy and finding what works for you. It may help to experiment on your own first—being able to achieve orgasm on your own will give you confidence when you are with your partner. The bottom line is that common conditions like incontinence and prolapse should not be a barrier to a satisfying sex life. And if you feel that they are, these conditions can be treated which is why we are here for you. Dr. Dubinskaya is an ob-gyn who is currently completing a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cedars-Sinai.

Any "-itis" is irritating, but especially when it's vaginitis...

Any "-itis" is irritating, but especially when it's vaginitis...

We've all had some type of "-itis" in our lifetime—cystitis, sinusitis, mastitis. But one of the more annoying “-itis” conditions is vaginitis. You know what I’m talking about. For some women it’s just feeling aware down there, other women notice a change in vaginal odor or discharge, and for others it's actual pain. When a condition ends in “-itis”, is usually indicates that there is inflammation. The inflammation can be in response to an infection, or it can simply be irritation such as an allergic response without any infection. Vaginitis is a term that describes all of these situations and more. Atrophic vaginitis I hate to tell all you ladies, but that myth about your vagina drying up with age is true. Atrophic vaginitis is thinning of the vaginal lining that results in a variety of symptoms, the most common being vaginal dryness. I can't tell you how many women compare sexual activity with vaginal dryness to rubbing sand paper on your skin. When should a woman seek treatment for atrophic vaginitis? First of all, the need for treatment is determined by how bothered a woman is. For example, if a 30-year old woman had premature menopause or a 60-year old woman had natural menopause and both have vaginal dryness that is causing enough pain with sexual activity (dyspareunia) that they avoid it, then they should be treated. On the other hand, if a woman has vaginal dryness but is not sexually active or bothered by it, then she doesn’t need any treatment. In addition to dyspareunia, atrophic vaginitis can also cause an imbalance of the vaginal microbiome (mix or normal bacteria, yeast, and other organisms) that makes many women feel “aware” down there (you really shouldn’t be aware of your vagina). This imbalance can also predispose to things like bladder infections because it can cause a decrease in the number of good bacteria. A common treatment for atrophic vaginitis is vaginal estrogen. Traditional estrogen replacement such as with a pill or patch can often help, but women who don't want to take systemic estrogen (such as with history of breast cancer) or women who take systemic estrogen but are still dry can benefit from additional vaginal estrogen that is available as cream, suppositories, or a time-release ring. Specific laser treatments for vaginal dryness are also available. Vaginal moisturizers and lubricants (hint: GLISSANT) are also helpful. Vaginitis due to infection The vaginal microbiome works in such a way that actual vaginal infections are not as common as an imbalance. What I mean by that is when there is an excess of certain bacteria, the vaginal discharge can change in odor or even color but there is no associated pain or fever as with other types of infections. This is referred to as bacterial vaginosis or BV. When the microbiome is significantly altered such as after taking antibiotics or excessive douching, then the “bad” bacteria or yeast have a chance to grow and cause vaginal pain, itching or other symptoms. Rather than take more antibiotics, the microbiome can often be restored by simply waiting for Mother Nature to work (assuming no severe symptoms) or use something to restore the normal acidic vaginal pH like vaginal estrogen or boric acid. Vaginitis due to inflammation Pain, burning, and/or discharge in the vaginal area isn't always due to infection, it can also be due to an allergic type reaction to things like condoms, lubricants with certain chemicals (not GLISSANT lubricants of course!), or even douching. Regardless of the cause of vaginitis, you should get the right care for down there...it's a very important place.