The Gynae Geek: Your no-nonsense guide to ‘down there’ healthcare. Dr Mitra Anita

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СКАЧАТЬ cuts, burns and ingrown hairs may occur as a result, but they’re rarely severe enough to require medical attention. The most commonly reported reason given for removing pubic hair is for hygiene purposes,² however there isn’t actually any evidence to show that it improves hygiene or reduces the risk of infections. I think this belief is perpetuated by the myth that your vulva and vagina are dirty and teeming with germs. As doctors, we don’t judge or have a preference about the terrain down there, so don’t feel you have to schedule a waxing/shaving session before an appointment. I’ll take it as it comes, thank you!

       Will having lots of sex make my vagina loose?

      No. Regardless of what the teenage boys in the playground may have said, this is not true. Your vagina is very elastic and can expand enough to let a baby out (and other objects in) but it always shrinks back. While having a baby may change the shape of your vagina slightly, having sex will not because a penis is not large enough to do so. Having sex will also not change the size or shape of your labia minora.

       Do I need a labiaplasty?

      Absolutely not! Labiaplasty is surgery to trim the labia minora and/or clitoral hood. It is largely performed for cosmetic reasons. I think that the sudden interest in ‘neatening up’ one’s labia may be an undesirable offshoot of the current obsession with aesthetic ‘perfection’. There are numerous plastic surgeons around the world advertising labiaplasty as a quick and simple procedure to make your labia more symmetrical/neat and tidy, etc. But symmetry is overrated – no other body part is truly symmetrical: we’ve all got one foot that’s bigger than the other, eyebrows that don’t match. And it’s the same with labia. It’s also normal for your labia minora to be visible on the outside, although Barbie and the porn industry may tell you otherwise. There is minimal evidence to show that the surgery actually improves pain, sexual function or how women feel about their genitalia, plus there is a risk of pain after the surgery due to nerve damage or resulting scar tissue, so it’s really not a decision to take lightly. And it cannot be reversed in the same way that you could, for example, have breast implants removed. As a famous professor once pointed out: ‘If you think your labia are too long, stop shaving off your pubic hair and you’re unlikely to think so.’

       When should I start doing pelvic-floor exercises?

      Right about … now! Also called Kegel exercises (see here), everyone should be doing them, regardless of whether they are pregnant or have ever had a baby, because that’s not the only thing that weakens them. They generally weaken with age, so you want them to be as strong as possible from a young age. Doing pelvic-floor exercises in pregnancy, especially from an early stage, has also been shown to reduce the amount of time it takes to push your baby out, and the risk of leaking urine after the birth.^{3, 4} Many people think having a Caesarean section prevents pelvic-floor weakness, but that’s not the case. Carrying around several kilos of extra weight for nine months will put extra strain on the pelvic floor whether you push out that watermelon or it comes out the sunroof!

      THE GYNAE GEEK’S KNOWLEDGE BOMBS

      The female vulva can generate a great deal of anxiety, but I hope you now feel more comfortable with describing the different areas should you ever need to talk to a doctor about it.

      The following are the key facts that I would like you to take away from this chapter:

       Your vulva is on the outside; your vagina is on the inside.

       Your vulva looks normal. Don’t let anyone tell you otherwise.

       Pubic hair removal is safe but doesn’t carry any health benefits, so don’t feel you have to do it.

       You do not need a labiaplasty if it’s purely for appearance reasons. It’s normal for your labia minora to hang below the labia majora and for one to be longer than the other. It’s Barbie who got that part wrong, not you.

       Your pelvic-floor muscles are the lifelong friends that you need to get to know. Kegel exercises (see here) are the most underrated workout that we should all be doing, not just in pregnancy.

CHAPTER 2

       Internal female genital anatomy

      (While I’m performing a vaginal examination to look at a patient’s cervix):

       ‘Doctor, do my ovaries look healthy?’

      To be clear, I can’t see your ovaries when I’m looking up inside your vagina. Yet I’ve been asked this question on multiple occasions, which tells me that many women may need a refresher of that uninspiring biology class that we all sat through at school. I’ll tell you about the cervix – what even is that? And a cervical ectropion, which is actually very common and completely healthy, yet one of the most anxiety-provoking things that I find myself explaining again and again. I’ll also tell you about a few of the interesting lumps and bumps that I spend a lot of time talking about in clinic that can cause a lot of confusion, usually made worse by my rogue friend Dr Google.

       The uterus

      The uterus is also known as the womb, and we often use the terms interchangeably. I’ll use the word uterus from now on, you know, in the name of being proper and all.

      The uterus is a muscular structure found in your pelvis, behind your bladder and in front of your bowel. It’s roughly pear-shaped, although I often describe it to patients as an upside-down wine bottle, with the large part of the bottle representing the body of the uterus and the neck representing the cervix (or neck of the womb), which acts as a passage for sperm to enter the uterus and menstrual blood or babies to exit. The wall of the uterus is made of smooth muscle, which moves in a ripple-type motion as opposed to striated muscle, which is the type you flex on demand in the gym. You might think that your uterus only contracts during labour, and while this may be the time when it performs its most vigorous workout, it also contracts during your period, helping the menstrual blood to escape, and during female orgasm. Given that these contractions are what cause you to have period pain, it’s not unusual for some women to experience a similar kind of pain for a few hours after sex, either due to orgasm-induced contractions or just because their uterus actually gets a bit irritated from being poked about.

       Endometrium

      The endometrium is the lining of the uterus, and is at its thinnest around your period, gradually thickening throughout the month to make a nice, soft, juicy landing for a fertilised egg. If this doesn’t happen, the lining is shed when you have your period. The thickness of the lining at the end of the month will determine how heavy your period is, and also, to some extent, how painful it may be – because the more there is to shed, the more the muscle of your uterus may need to contract to help move it out through the cervix and down into the vagina.

The cervix

      The cervix or ‘the neck of the wine bottle’ is the gatekeeper to the uterus. Not only does it have a mechanical function of keeping your uterus shut during pregnancy, it also has a pretty complex immune function. A large quantity of the vaginal discharge that you produce comes from the cervix. Discharge is clever and anxiety-provoking in equal measures, which is why I have given it its own chapter (see СКАЧАТЬ