health

ASK AN EXPERT: From painful sex to discharge, a gynaecologist answers your pressing questions.

This is Dr Brad Robinson. And he's here to talk about your bits.

Well, not yours specifically...

The Brisbane-based obstetrician and gynaecologist kindly agreed to help answer some common queries people have about female anatomy, from odour to dryness and pain during sex.

So let's get down to it.

Dr Brad Robinson. Image: Supplied. 

‘What does a normal vulva look like?’

Vulvas come in all shapes and sizes, with differences and variations that mean no two are the same. As an individual’s face is unique due to subtle but distinct variations, so too is the vulva.

The vulva is the external and visible region of the genitalia comprised of the two sets of labia (inner and outer vaginal lips), the vaginal opening, the clitoris, and the urethral opening. Some people have more pronounced labia, some are more subtle. Some have a broad vaginal opening, others smaller. Some have a large and extruded clitoris, while for others it may be smaller and hidden under the clitoral hood.

So don’t let anyone tell you that your vulva is abnormal — there is no one ‘look’ that it should match up with.

'Vaginal odour. How do I know if it’s normal? And is it preventable?’

The really important thing to know when it comes to vaginal odour is that you should not assume that having no smell is healthy and having a smell is unhealthy. This myth, for whatever reason, has grown in recent years to the point that increasing numbers of women are being made to feel that their ‘scent’ is abnormal.

The truth is the vagina has different and varying odours. These can change at different points in your cycle, with different diets, with exercise, with the commencement of medications, or for absolutely no reason at all. 

ADVERTISEMENT

If anyone tells you that your vaginal odour is not normal or differs from what they consider to be ‘standard’, then you should douche THEM right out of your life.

Vaginal odour can, worst-case scenario, reflect an underlying pathology which needs medical attention. It may herald the presence of an uninvited ‘guest’ such as an infection that has set up home in your vagina, so if you are concerned you should see your doctor.

‘Are feminine-wash products necessary for genital hygiene? If not, what should women use instead?’

When it comes to medical advice and theories that are popularised online these days, there is not much that surprises or shocks me. I will, however, make an exception for the growing list of objects/substances/toxic agents women are told to insert into their vaginas. All that nonsense talk of ‘cleansing’, ‘detoxing’, ‘purifying’ — lordy! They advocate for the insertion of jade eggs, cucumber scrubs, vaginal glitter. Hell, I’ve even seen Vicks VapoRub put forward as a worthy vaginal occupant!

Wrong. Wrong. Wrong. 

Listen: The question about female anatomy that a surprising amount of men get wrong. (Post continues below.)

As the amazing Canadian gynaecologist, Dr Jennifer Gunter, says, 'the vagina is a self-cleaning oven,' and it looks after it's cleaning all by itself. Feminine wash products are not necessary and should not be used. These products are in fact harmful to the vagina. Disruption of the normal vaginal ecosystem through use of these products can actually lead to the development of vaginitis.

‘What does normal vaginal discharge look like? How often should it occur?’

I know I am getting repetitive here (sozzy!) but when it comes to vaginal discharge, there is again no ‘normal’. In fact, there is such a natural variation in discharge from woman to woman, day to day, cycle to cycle, that it can be hard to distinguish normal from abnormal at times.

But let me try to set up a framework for what you should expect. The starting point is understanding that the vagina is meant to be ‘wet’. Indeed, discharge is the expected by-product of the natural process that keeps everything functioning as it should.

For a woman of reproductive age, normal vaginal discharge consists of 1–4 ml of fluid per 24 hours. Now, if you were to put this volume of a visible fluid in a syringe and discharge it onto a pad or liner, you’d see that it can actually look quite significant in amount.

The discharge itself can be white, transparent or yellowish. It can be thick or thin. It is commonly — but not always —odourless. It can also be more noticeable at times, such as around ovulation or during pregnancy.

‘Since giving birth, I feel like my vagina is weaker than it used to be. What can I do about it?’

The vagina is an astonishing bodily organ. It is the organ of sexual intercourse for women, and it also has the ability to increase its usual diameter of 2.1–3.5 cm to accommodate a baby’s 11–12 cm diameter head at delivery. This will, obviously, cause changes.

ADVERTISEMENT

After delivery the vagina will feel different, and it may in fact never feel quite the same as it did prior to vaginal childbirth. But this isn’t necessarily a problem. It may feel structurally different, wider and more ‘open’. The uterus may sit lower into the vagina, giving a feeling of ‘bulge’ or prolapse. 

If these changes cause discomfort or pain which doesn’t resolve satisfactorily with the passage of time, pelvic floor exercises should be commenced. A tailored program will improve prolapse, vaginal integrity, and bladder function.

‘I’ve been sexually active for several years, but I still find penetrative sex painful. What might be causing it?’

A common cause of pain during intercourse, or dyspareunia as we call it, is tightening and spasm of the pelvic floor muscles which surround the vagina. This is called Vaginismus and is incredibly common. The tightening occurs involuntarilty due to pain, or often just the anticipation of pain.

Strategies for overcoming this may include increasing the amount of foreplay and deferring actual penetration until arousal has reached a peak.  Pelvic floor focused physiotherapy plays a crucial role in ‘down-training’ and desensitising the muscles which are spasming.

Endometriosis is another cause for painful intercourse, with this pain more commonly feeling deeper and more internal than the more superficial pain of Vaginismus.

‘Since starting menopause, I’ve been experiencing vaginal dryness. Is that treatable? And will it eventually go away?’

The loss of oestrogen that occurs when a woman becomes menopausal commonly results in vaginal symptoms including dryness.  This can make intercourse more uncomfortable.  The good news is that this is eminently treatable.

Initially women are encouraged to try non-hormonal vaginal moisturisers and lubricants.  Moisturisers are used routinely, typically 2-3 times per week, with lubricants intended for use during intercourse.

If symptoms are not improved sufficiently commencement of a topical oestrogen cream or pessary is recommended. This replaces the hormone lost with the decline of ovarian oestrogen production at menopause. After nightly use for two weeks a maintenance dose of twice weekly application is required. This medication actually reverses the thinning of the vaginal tissue which occurs at menopause, resulting in a thicker and healthier vaginal lining.

For more from Dr Robinson, follow him on Instagram @drbradrobinson 

Feature Image: Getty.


The above is general information and should not be substituted for personalised medical advice. If you have questions or concerns about your vaginal health, consult your doctor.


Have a question of your own for Dr Robinson?

Comment below and we'll pass it on.

00:00 / ???