Read My Lips (10 page)

Birth-Control Pills

Birth-control pills are widely used by women around the world. Some women who take low-dose estrogen pills notice that they lubricate less than they used to (estrogen plays a role in vaginal lubrication). Also, keep in mind that birth-control pills are to be taken orally, meaning swallowed by mouth. We mention this only because every now and then, we hear about women who mistakenly believe that birth-control pills work by inserting them into the vagina. This is not the case! Please do NOT insert your birth-control pills into your (or anyone else’s) vagina. If you have questions about how to take birth-control pills or any other medication, please check in with your healthcare provider.

Diaphragms

Diaphragms are less commonly used in the United States, but they are still an important barrier method of birth control, meaning they help keep semen from reaching the cervix, uterus, and fallopian tubes. Women who use diaphragms appear to be at increased risk of urinary tract infections (UTI), which are infections of the urethra, bladder, the tubes that connect the bladder to the kidneys, or the kidneys themselves.
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Any time you suspect that you may have a UTI, it’s worth checking in with a healthcare provider who can advise you on possible home treatment and/or prescription treatment.

Cervical Caps

Cervical caps fit over the cervix, thus serving as a barrier to keep sperm away from the cervix, uterus, and fallopian tubes (just like diaphragms and condoms, in this regard). If you’ve had a baby since you last used a cervical cap, check in with your healthcare provider, as you may need to be re-fitted for one.

Spermicides

Spermicides may come in foams, jellies, or films. Spermicidal lubricant may also be used on male condoms. Although many women tolerate spermicide just fine, some women experience vulvovaginal irritation, such as vaginal burning, itching, or pain, when they use spermicidal products. If you experience genital irritation, we recommend asking your healthcare provider for recommendations about birth-control methods that may be a better fit for your vaginal and vulvar health.

WHAT TO EXPECT WHEN YOU’RE EXPECTING (TO GO TO THE GYNECOLOGIST)

Going to the gynecologist. Whether you love or hate it, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women—even women who are not sexually active or who are past their childbearing years—go to the gynecologist. Nervous? Try not to be. We’ll give you all the information you need to prepare yourself or someone else for a visit to the gynecologist, whether it’s your first time ever or your first time in a long time.

When Should I Go?

As we said previously, the most recent guidelines recommend that young women have their first appointment with a gynecologist between the ages of thirteen and fifteen, though not necessarily for a pelvic exam or Pap test (those often come later; in fact, at this writing, Pap tests are recommended for most women beginning at the age of twenty-one).

Where Should I Go?

If you feel comfortable discussing it with your mother/female care-giver/relative/teacher, they will likely be able to provide you with a good local recommendation. With over eight hundred health centers across the United States, you are also bound to find a Planned Parenthood near you (see Resources). The nice thing about Planned Parenthood is that they do their best to provide affordable care for everyone. This means that you do not need health insurance or permission from a parent, in most cases, in order to schedule a visit.

I once had an amazingly considerate female gynaecologist who asked about my sexual experiences before examining me, took them into consideration with the diagnosis and was so careful when examining me that although my health issues have not [ever] been resolved and probably never will be, that consultation stands out as the most positive doctor’s experience I have ever had. I think all gynaecologists should be trained like she was. I can’t stress enough how much better I felt about my body and my health after seeing her.

—
J
OSIE,
26, United Kingdom

How Do I Prepare for My Visit?

There is not much that you need to do before you visit the gynecologist other than trying to schedule an appointment during a time when you are not menstruating. Other than that, there are a few things that you should try
not
to do. You should try to refrain from having unprotected vaginal intercourse for a day or two before your exam. If you douche, it is best not to douche within the week before your appointment. Also, try to stay away from using vaginal wipes, foams, and sprays during the week before your visit. All of these things may make it more difficult to interpret your Pap test results.

What Happens during the Exam?

• Prior to meeting with your healthcare provider, you will be asked to fill out a comprehensive medical history. Try not to let shyness or embarrassment get in the way of reporting your sexual or health history. Also, be sure to list all of your genital symptoms (e.g., itching, burning, pain). Providers need accurate information in order to make informed decisions about your health. If this is your first visit, or if you’re nervous or scared, you may want to indicate that on the paperwork or tell the nurse during the initial intake.
  
• Prior to beginning the exam, your healthcare provider will hopefully take some time to talk with you about your history and what you should expect from your visit. This is a great time to ask lots of questions. Some clinics will automatically test you for STIs, while others will not, so be sure to ask. By asking questions, you will be informed about what is going to happen, and your healthcare provider will have the information necessary to tailor the exam in ways that will maximize your comfort and health. If you feel more comfortable, you can have a family member, friend, or partner stay in the exam room with you.
  
• After answering your questions, your healthcare provider will likely bring you to a private space where you will be provided with a paper or cloth gown to change into. Some gowns are made differently than others, so don’t be afraid to ask how to put it on.
  
• If these have not already been done during the intake, the exam will begin as most doctors’ visits do: measuring your height, weight, blood pressure, etc. Next, the provider will likely begin with a breast exam to look for any tumors. You will probably be asked to lift one hand up as the provider feels for tumors in your breasts. After your breast exam, the provider will likely feel your abdomen for pain or other indications of abnormalities.
  
• Finally, you will be asked to move toward the edge of the exam table and place your feet in stirrups in order to provide an ample view of your vulva and vagina. Your provider will begin by doing an external exam of your genitals in order to check your vulvar skin, examine any discharge, or look for potential abnormalities. Next, your provider will insert a lubricated speculum (it looks a little like a duck’s bill) into your vagina in order to separate the walls of the vagina so that he/she can view your cervix and swab it quickly with a long cotton swab (similar to a Q-tip). This is done to test for cervical changes and may also be used to test for some infections. This is not painful for most women. If it is for you, make sure to tell your healthcare provider because the solution may be as simple as using a speculum of another size. After your speculum exam, your provider may insert one or two lubricated fingers into your vagina while pressing down on your abdomen. This is done to check for potential issues with your uterus or fallopian tubes. Then, your provider may conduct a rectovaginal exam by inserting a single lubricated finger into your anus and one into your vagina in order to check for tumors behind the rectum or the lower wall of the vagina. After the exam is done, your healthcare provider may ask you to change back into your clothes while he or she leaves the room. When he or she returns, you may have the chance to talk more about the exam, to ask additional questions, and to further talk about your personal health.
  

A few tips:

1. If you want to see your vulva and cervix, ask your practitioner to hand you a mirror. It can be fun and informative!
   
2. If you are nervous during the exam, give your provider a few tips about the best ways to help you relax. Do you want upto-the-minute details on what he/she is doing? Perhaps you would prefer to be distracted by some small talk? It is best for you, your provider, and your health if you are relaxed, so speak up!
   

That’s it; all done! Now that wasn’t so bad—was it?

RAISING A DAUGHTER

When women finally learn about their vulvas and vaginas, they are often well into adulthood. We envision a future in which more parents feel comfortable and confident taking care of their young daughter’s genital health and raise them with correct information as soon as they begin teaching them to speak. If you are raising a daughter or are otherwise caring for a young girl, we hope that this information will be helpful to you:

Although very rare, it is possible for a girl to be born without a vagina or with a very small vagina.
In many cases, a vagina can be surgically created when she is older (genital surgeries are only very rarely recommended for babies or young children, such as in cases where they are medically necessary).

Her clitoris may appear unusually large.
When a baby is first born, she has estrogen from her mother’s blood supply. As estrogen is linked to a range of vaginal and vulvar features, this means that she will likely experience vaginal lubrication and discharge during the first few weeks of life. Her labia majora and minora may also be noticeably plump. After several weeks, when she no longer is impacted by her mother’s estrogen, her mons and outer labia will likely shrink in size. This may make her clitoris and inner labia look larger than before, but that is a normal occurrence. Girls often “grow into” their genitals around the time of puberty. However, if you have any questions about your daughter’s genital size, ask her pediatrician.

Even a baby may experience vaginal bleeding.
When a baby no longer has her mother’s estrogen supply, her uterus may shed some of its lining due to the drop in estrogen levels. As such, some female babies experience small amounts of vaginal bleeding during their first few weeks of life outside the womb.

Her labia may stick together.
Without her mother’s estrogen supply, a baby or toddler’s inner labia may stick together, a condition called “labial adhesion.” In the United States, it happens to about 2 percent of female babies and children up to the age of six.
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The inner labia may stick together just a little or a lot, covering some or much of the vaginal opening or urethra (which can be problematic in terms of having urine pool there). If you have a daughter and notice this when changing her diaper or helping her go to the bathroom, you should mention it to her pediatrician. Sometimes no treatment is needed and the inner labia separate on their own. Other times, an estrogen cream is prescribed, and a girl’s parents or caretakers are asked to apply it to her labia, often for a matter of weeks. The cream often helps the labia to separate. In rare cases, if the cream is ineffective (as it is for approximately 20 to 50 percent of girls), a quick surgical procedure should permanently resolve the problem.
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It is not usually an ongoing medical problem, but it is something to speak with one’s pediatrician about.

She may touch herself.
Young babies, both male and female, often touch their genitals. Then again, they touch many of their body parts. This is not unusual. Studies of parents and caregivers indicate that the vast majority of young children touch their own genitals. Many children, as we’ll discuss later, also play games that involve comparing their private parts. This is also common and a normal part of exploration. Some children touch their genitals with their fingers. Others stimulate their genitals by rubbing their bodies against toys, bedding, pillows, stuffed animals, or the floor. Many pediatricians and child psychologists recommend that parents respond in a way that assures their child that touching one’s genitals is okay and that their genitals are not dirty. For example, a parent might say something like, “That’s okay to do, but please do it somewhere private, such as in your bedroom or in the bathroom.” Of course, this may be more appropriate for older children (often aged four and up) who can understand the message.

Vaginal insertion.
Some young girls insert objects into their vaginas for reasons that are unclear. One mother, whose daughter was found to have inserted part of a Bratz doll into her vagina, wondered if perhaps her daughter had seen her insert a tampon and tried to imitate this action with her toy.
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For other young girls, the vaginal insertion of objects may be linked to sexual abuse. Other times, girls may have just found their vagina one day, inserted a finger, and then wondered what else could be placed in their “special hiding place.” For some, inserting toys or objects into the vagina may be a form of self-stimulation. Mostly, though, we just don’t know why some young girls do this, as research has largely been focused on taking care of these girls’ health needs. When you teach your daughter about her genitals, it is worth teaching her how to care for them, including that her vagina is not a place to keep things. We say this only half-jokingly, as it cannot be emphasized enough that there are dangers associated with girls putting objects into the vagina and leaving them there. Some girls who have had ongoing fevers and/or abdominal pain were eventually brought to the emergency room, only to find that they had inserted batteries into the vagina.
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These have resulted in serious health emergencies, very careful removal by skilled physicians, and (in some cases) hospitalization.