Lets face it.  Most of us don’t like being seen naked – especially by someone that we don’t really know. So, before you take to the stirrups again, I am going to share the answers to some of the questions you are to embarrassed too ask.

 

First, let me say this – 

 

Stop with all the apologies when I walk in your exam room. 

 

I seriously don’t care that you haven’t had a pedicure in months or that all that leg hair that you didn’t have time to shave, makes your skin tone appear different than your natural coloring.  These items have no bearing on your exam, I promise.

 

Warning:  Reading further may be offensive to those of you who are either prude or faint of heart.

 

Hair We Go.

Let’s talk about something that we ladies seem to take a lot of pride in – pubic hair.  There are all sorts of depilatory templates for vulva readiness and I think I have seen them all. For all that time and effort, the question is –

 

Do we even care about your most intimate grooming? – the answer is yes, sort of. 

 

If I have to make an effort to get around your pubic hair, it’s a problem.  If it is long enough to braid, or style it in any way – we don’t like it. 

 

Toilet paper doesn’t like it either. When your Charmin becomes entrapped in your pubic hair, I’m faced with an invariable dilemma—do I gently try and free this toilet paper, or pretend I never noticed?

 

Crawling through pubic hair to find something that should be obvious, feels like a violation to us both. So please, tidy things up before your visit. Its only once or twice a year.

 

Common Scents

So let’s talk about your smell.  And I’m not talking about the fragrance that you purchased at the local department store, either.  I’m talking vaginal odor and discharge.

 

Let’s first start with the odor. It is normal.  We are animals; we have smells that can change based on hormonal cycles, our diets, or even the last time we had sex. 

 

Vaginal odor, in general has a musky smell.  It is healthy and there is actually some science behind how your smell is attractive to the opposite sex. 

 

So when we are doing an exam, one of the things we take notice of is smell, or more importantly – the lack of certain types of smell.  Vaginal odor can tell us a lot about vaginal health especially if something is wrong. 

 

You have to remember our background is science.  Smells are used as objective data so we can consider “problems”. 

 

Providers know this is an uncomfortable portion of your exam, but it happens every time you get examined whether you know it or not. 

 

We know it’s embarrassing to bring this up, but if it concerns you, just ask.

 

That goes for vaginal discharge just the same.  It will change based on your hormonal cycle.  If it becomes green, or some other unexpected color, changes in consistency - like cottage cheese, schedule an appointment – don’t wait.  

 

Be candid if you’re dripping green frothy discharge—don’t pretend you don’t know.  Ignoring color changes in your vaginal discharge can greatly affect your reproductive health.

 

Oh Bloody Hell

Women groan and wince all the time, when I need to examine them when they are on their periods.  Believe it or not, one of the best times to place an IUD is when someone is on their menstrual cycle. So it really is normal for us.

 

Bleeding is not a problem – I know you find it disgusting, but it really is ok.

 

The only exception to that is if it is really heavy.  Not from a “gross factor”, but from a difficulty in seeing what we need to actually see.

 

 

You Get Around Much?

Ok, so let's break down the whole misnomer about why we ask about number of sexual partners and why we are so preoccupied with all of those questions about sex. 

 

No, we cannot tell how many sexual partners you have had. 

 

We can’t tell when you last had sex, unless it was rough sex or forced sex.  We can’t tell if you have had anal sex, unless it was forced or not consensual.

 

But we do ask about whether you have oral, vaginal or anal sex and we do want to know the number of sex partners as a way to determine your risk factors. 

 

Let me give you a very real example of my interview with a young woman, that was “of age” to engage in consensual sex in her state of residence. 

 

I asked, “How many sexual partners have you had in the last year?” 

She responds, “Oh… a lot.”

“What is ‘a lot’ ”, I ask.  “For some women ‘a lot’ is 5, for others ‘a lot’ is more like 50.”

She is quiet as she considers what would be an appropriate number for her recent past.  She says hesitantly, “A lot, a lot… like closer to 50”.

 

If she was honest about her number –

1.    I’m thinking I’m going to test her for every known sexually transmitted disease I can think of. 

2.    I’m going to determine if she has had these encounters willingly, or if she has been trafficked.

3.    And I am certainly going to make sure she has a reliable form of birth control before she leaves my office. 

4.    I am also going to talk to her about her risk for acquiring HPV and the importance of how she will need to keep up with her pap smears throughout her lifespan. 

5.    And finally, I have a segway to determine what other behaviors does she engage in that are considered high risk.

 

You see how one simple question lets me determine her risk for all sorts of things? That is why we ask.

 

 We aren’t interested in how well versed you are in the karma sutra, whether you are an avid reader of Fifty Shades and we honestly don’t care as to what turns you on. 

 

It is all about risk identification – so relax.

 

 

Ink It Up

I can’t let a post about “down there” pass without some of my personal thoughts on tattoos. I have seen some that I thought were pretty, some that I am sure that you probably regret and some that look like you did it yourself.

 

 But the kinds of tattoos that will make your women’s health provider stop and actually consider them are the ones that take the phrase “tramp stamp” to a whole new level. 

 

The ones that name your vagina, claim your vagina for your partner or my personal favorite – ones that provide instruction on how to engage in a sex act.  Some of what I have seen is explicit and others are actually quite clever, such as “All You Can Eat” or “Exit Only”.

 

 I will be honest.  I don’t see these types of tattoos often, but it does happen.  So, if you are reading this and you know this particular portion of this post applies to you, I would suggest investing in professional tattoo removal.  Just sayin…

 



Hi, my name is Traci Santangelo! I am a Certified Nurse Midwife, a self-proclaimed birth geek and a momma to two of the cutest kids on the block! I am fiercely loyal to those that I love or consider as friends, and I’m lucky enough to be married to a man that “gets me completely”.  My family continues to be highly annoyed with my true crime TV addiction, but I can’t get enough of it!  If you want to see me annoyed, tell me about a provider that didn't treat you right or lied to you. Although I consider myself a darn good nurse midwife, I really think I should have been a travel writer – after all, “vacation” is my favorite word.

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