Dear Infertility_Season 3_Episode_7_Vulvovaginal Health 101: Audio automatically transcribed by Sonix

Dear Infertility_Season 3_Episode_7_Vulvovaginal Health 101: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi. I'm Kristyn Hodgdon, an IVF mom, proud fertility advocate, and co-founder of Rescripted.

Staci Tanouye :
And I'm Dr. Staci Tanouye, a board-certified OB-GYN striving to make reproductive and sexual health fun and empowering for all.

Kristyn Hodgdon:
Welcome to Dear (In)fertility. This season, we're going back to the basics. From menstrual cycle red flags to what you need to know before you start trying, we're giving you the tools you need to take control of your overall health and fertility.

Staci Tanouye :
Does birth control cause infertility? Do painful periods mean that I have endometriosis? We're here to answer all of your real-life questions and provide you with patient-centric advice and support so that you can be your own best health advocate.

Kristyn Hodgdon:
Now let's dive in and talk about everything sex ed failed to fill you in on.

Kristyn Hodgdon:
Hi everyone, and welcome back to Dear (In)fertility. I'm your host, Kristyn, and I'm here with Dr. Staci Tanouye. Hi, Dr. Tanouye!

Staci Tanouye :
Hi, Kristyn.

Kristyn Hodgdon:
How are you? I know that this topic is one of your favorites, so really excited to dive in all about Vulvovaginal health.

Staci Tanouye :
I talk about this topic endlessly all the time. It is one of my favorites.

Kristyn Hodgdon:
Yes, I see it all over Instagram and it's actually something that as long as I've been doing this, I have not really talked about it all or dove into. So let's, let's dive in! Vulva vers vagina. I think we're so used to, I almost wanted to title this episode Vaginal Health because that's so what we're used to hearing. But why? Why is it vulvovaginal health? What is the vulva versus the vagina?

Staci Tanouye :
And that's a good question because it's a really important distinction, and a lot of what we do for care and for health, and I think I've tweeted out before to like I really appreciate that society is normalizing the word vagina. But what we really mean when you say vagina is vulva like 99% of the time, if someone say my vagina, they actually mean their vulva. And so the vulva is everything external, so everything you can see, touch externally is the vulva. Everything internal that gets inserted in any way, shape or form, everything internal is vagina. And these two are very distinct because although they're similar and kind of part of this, the same reproductive system, they are treated a little bit differently in terms of how we care for them and the health and what they can do for themselves and the environment that we have to maintain with both and so similar, right next to each other, but they are still different. And so whenever you hear someone say vagina, I guarantee you they mean vulva.

Kristyn Hodgdon:
I know I'm guilty of that because, you know, all the parenting sites and everything say you should use the appropriate terms with your kids, but I.

Staci Tanouye :
Well, we use vagina when we're.

Kristyn Hodgdon:
... My daughter. Yeah. And now I'm, like, questioning it.

Staci Tanouye :
Like, by all. By all means, keep using vagina. Like, we can't detract from that. Like, we should say that word to make to keep it normal. But now we also have to add in another one. We have to add it, we have to add in vulva, and so we know both of them, and we know the differences between the two.

Kristyn Hodgdon:
Totally. Absolutely. So, you know, I think vaginal health, vulvovaginal health has been so stigmatized, obviously, for obvious reasons. But why are you so passionate about bringing it to the forefront?

Staci Tanouye :
For just like what you said, right? Like it is stigmatized. I think we have an entire hygiene industry that is based around that stigma, that is marketing and making money off of how you feel about your body, and that's just, to me like so absolutely wrong. And so the more we can talk about it and normalize it and teach people what you really need versus don't need, I think, I think that's super important because that industry is not always in your best interest. That industry is out for themselves, it's out for to make a buck off of you feeling shameful about this trip or your body, you feeling insecure about this body, so you, part of your body, so you need to fix it in some way. So that's what this industry is doing. They're selling you a product to fix something that doesn't need to be fixed.

Kristyn Hodgdon:
Well, let's talk about that. So how should you actually care for your vulva and your vagina?

Staci Tanouye :
Yes. So the vagina, again, everything internal, the vagina is completely self-cleaning. So you need nothing to clean or maintain your vaginal health if you're doing fine at baseline. Obviously, if you are having issues or symptoms as something's going on, like see your doctor, we can work on that. But for the most part, a healthy vagina needs nothing. The vagina's self-cleaning. I mean, we talked about in other episodes what vaginal discharge is. Vaginal discharge is the normal shedding of the vaginal mucus, the cervical mucus, and all of the exfoliation of the cells in the vagina. And that naturally sheds and that's its natural mechanism for cleaning, is vaginal discharge, that's your cleaning mechanism. And so discharge is totally normal and you don't need to do anything to help that along. Your vagina takes care of it on its own. It's very smart, but it's also very sensitive, so don't mess with it. And that's why, like adding, doing any sort of insertion while cleaning products like douching is totally wrong and will throw people off and actually makes you more prone to things like bacterial vaginosis and yeast infections, so.

Kristyn Hodgdon:
Yeah! because I'm just thinking, I've actually never used any of that stuff, but I'm just thinking like sense and like I'm so I kind of gave up any like fragrance a couple of months ago and like, so any sense like, makes me sensitive and like the thought of putting that in up there.

Staci Tanouye :
Yeah, yeah.

Kristyn Hodgdon:
It's just like, no, thank you, but.

Staci Tanouye :
At one point, people made, like, scented tampons. And I can't think of anything worse than.

Kristyn Hodgdon:
Oh my god.

Staci Tanouye :
Like a scented tampon. Like, no, absolute hard stop, no.

Kristyn Hodgdon:
Well, that's actually a really good segway because like what, when it comes to like menstrual products, what are your thoughts on like tampons and like the clean, you know, quote-unquote clean tampons and all that stuff?

Staci Tanouye :
Yeah, I think, you know, we have to get down to the basics of that tampons particularly are regulated by the FDA as a medical product. So they had, so it has to meet certain standards to be to come to market. And so when you think about, when people like put these really kind of inflammatory statements about your tampons are toxic, your tampons are trying to kill you. Well, they're not because they're pretty rigorously tested and have to be approved as a medical device by the FDA to be able to even go to market. So there is some pretty strict testing that goes into all of those kind of chemicals that people talk about that is very strictly regulated in the tampon industry. So don't think it's not, don't think it's willy nilly, that.

Kristyn Hodgdon:
I did not know that and.

Staci Tanouye :
That all changed in the, in the early early nineties, like 92 to 95 was a big change in how that was regulated and how what could, what processes could be used to process the tampons to decrease some of those chemicals that people think about and talk about, that was all regulated back in the early nineties, and so it's significantly less of a concern, now your tampons are safe. Certainly, we talk about not wearing a tampon for more than 4-8 hours, 4 to 8 hours total, because you can't increase your risk of things like toxic shock syndrome. And that's a whole other topic that we won't get into. But, but yeah, your tampons are fine, right? And same thing with any period product. I tell people that the most important distinction, the way to choose your period product is what you feel comfortable with, what you feel comfortable with using, what you can afford, because some of these newer, fancier things are expensive. So don't think you have to spend a lot of money, what you are comfortable with, what you are, what you can afford and unscented. Those are like my three requirements for menstrual products, and that is it. If you are someone who likes the organic tampons, who feels better using them, by all means, go ahead, it's totally fine. But don't feel like you have t,o and don't feel like a regular tampon is trying to kill you because it's not.

Kristyn Hodgdon:
Well, it's so crazy to me because I didn't know that tampons were regulated by the FDA, first of all. But second of all, like we talked about, like influencers or companies that kind of play off the whole birth control is bad for you. And like, it's the same thing with this. It's like.

Staci Tanouye :
Yes.

Kristyn Hodgdon:
Marketing can make you believe something that is not even.

Staci Tanouye :
Right.

Kristyn Hodgdon:
Research or true at all.

Staci Tanouye :
Right. And I mean, we talk the same thing goes for the food industry, too. I mean, food industry, this whole clean movement, like take it with a grain of salt, like, yes, we all want to be healthier. We all want to put less kind of toxic stuff into our bodies and be healthier about that. But we also have to be cognizant of what we need and what we're comfortable with, and what we have access to. And so we can't fearmonger people into not using things that we already know are safe. And right now, in terms of like tampons and period products, I don't know, maybe the organic tampon is healthier, safer for you, but no one knows that for sure because we have zero evidence to say that it is. We have none, there is none, no evidence to say that you get less toxic shock syndrome with an organic tampon versus a regular tampon. There's not one source out there that you can find that will tell you that. But that's kind of what's being inferred with this whole movement, and it's simply not true at all. And that just, if someone's telling you that, they also don't understand how toxic shock syndrome works either and how that whole process, that's again, another topic, but.

Kristyn Hodgdon:
A new whole episode, yes.

Staci Tanouye :
Yeah. Like maybe the stuff is better for you, but no one knows that it's all inference and we know that what is out on the market that's, that has been on the market since the mid-nineties is safe, so you're okay to continue using it. If you want to use a newer product, you are okay to try that too. But we shouldn't stigmatize basic period products because there's more important things that we need to think about, like access.

Kristyn Hodgdon:
Absolutely.

Staci Tanouye :
Sorry. That was like a whole tangent of like.

Kristyn Hodgdon:
No. It's really important. Like, we're constantly fed information all day, every day on social media and through advertisements, and it's important to know what's actually rooted in, you know, studies and research versus like just pure marketing. So.

Staci Tanouye :
Right.

Kristyn Hodgdon:
I appreciate it. So with vaginal discharge, I know it's something that people are uncomfortable talking about a lot of the time. But what's normal when it comes to vaginal discharge and what, what are things to look out for that might be like imply that something might be wrong?

Staci Tanouye :
Yeah. So again, vaginal discharge is normal, it's the vagina's normal cleaning mechanism. Vaginal discharge is normal when it's clear to white to slightly yellow tinged and color. So that would be the full range of normal color. A normal amount is anywhere from 1 to 5 milliliters per day. And if you ever take a little panty liner and like pour five milliliters of water onto it, it's quite a bit. And so if you have more discharge than your, your best friend, you guys are both probably very much in the normal range, so, so just keep that in mind, vaginal discharge is normal and even sometimes a larger amount more than your next door neighbor is probably normal too. Vaginal discharge is not odorless, it has a mild natural odor to it, that is common and is normal and doesn't need to be changed either. The basic rule of thumb is if you have your underwear and in order to smell your discharge, you have to bring it right up to your nose. That's probably normal. Like if you have to bring something all the way up to your nose to be able to smell any sort of scent, that's fine, you're, you're doing fine. If there's something, if there's an odor that's overwhelming that you can smell without doing that, with your underwear or pad, further, much further away, that might be something that you need to check out. As, as for color, any bright colors you need to be checked out, bright yellow, bright green. If you are getting pink or red mixed in with your discharge, that's usually blood-related, and that means you're having spotting or bleeding in between periods. And we want to know about that, too. If your discharge increases significantly more than your normal or if you're getting itching or burning or really thick consistency discharge that's irritating, that all needs to be looked at.

Kristyn Hodgdon:
Okay. And can, and can any of that mean a yeast infection?

Staci Tanouye :
Yes. So yeast infection, typically, there is a wide range of what people can experience because you don't always have an increase in discharge. Sometimes it's just itching and burning sensation. Some people will get the, the traditional textbook thick white cottage cheese-like discharge, that's pretty typical of a yeast infection. But yeah, itching, burning, thick white discharge, and any combination of those.

Kristyn Hodgdon:
Got it. And what about UTIs? Like, why do some people suffer from chronic UTIs?

Staci Tanouye :
So UTIs are when bacteria gets into the urethra and goes up the urethra and can get into the bladder, and if it gets out of, further out of control, it can even go up the uterus and get to the kidneys. So any of that whole system is the urinary tract, and so that's what people refer to with urinary tract infections. That happens because in people with vaginas have shorter urethras, and depending on anatomically the angle of your urethra, sometimes bacteria can get in there more easily. UTIs are typically from e-coli bacteria, which I hate to say it as from our poop, that whole system is all connected. So that's why we always say wipe front to back, because you don't want to get bacteria from the back near the urethra and it goes up the urethra and causes a UTI. Same thing with UTIs that are related to sex. Sex, there's a lot of friction involved in that. We like friction and we don't like friction. We don't like friction because it can rub against the urethra and cause tiny, tiny little micro-abrasions and bacteria can get up into the urethra from that, and that's why some people get sex-related urinary tract infections. And so, yeah, recurrent UTIs is more anatomical and also kind of bacterial related and some people are just more prone than others.

Kristyn Hodgdon:
Yeah. Isn't it funny? Like the thing, the random things we're taught growing up like pee after sex or like you have to pee after sex or you'll get a UTI, or you can't throw your tampon for too long or you get toxic shock syndrome, like all these, like, little tidbits, but like, none of us actually know or at least.

Staci Tanouye :
Why.

Kristyn Hodgdon:
Like why.

Staci Tanouye :
Like why, why? Why are we supposed to do that, again?

Kristyn Hodgdon:
Yeah, exactly. So I've been hearing a lot lately and, and in a lot of ways this is like from companies in the industry. So I don't know how much of it is valid and true, but like that, the vaginal microbiome is so important. Can you talk about that a little bit?

Staci Tanouye :
Yeah, the vaginal microbiome and really every part of our body has its own microbiome, right? Microbiome just means like the normal flora bacteria that lives in that normally and creates this nice normal homeostasis. So your skin has its own microbiome, your gut has its own microbiome, and your vagina has its own microbiome. And they're all a little bit different. But the vaginal microbiome is the normal bacterial flora that lives there and creates this nice balance of the vagina being happy. It's the predominant bacteria in there is lactose, lactobacilli crispatus and it's a very specific lactobacilli because or lactobacillus, because it actually produces hydrogen peroxide which is acidic, which then acidifies the, your vaginal discharge, and that's what you want. That's what keeps that environment happy and comfortable and should be not noticeable to you almost at all. And anything that throws off that microbiome is throwing off that homeostasis and that can cause these symptoms and then open up the door for potential infections or overgrowth of certain things.

Kristyn Hodgdon:
And what I mean, there's a ton of different things like bacterial vaginosis, like, what could come from the vaginal microbiome being off?

Staci Tanouye :
Right? So if your PH gets thrown off persistently, then a bacteria called gardnerella might overgrow because it likes the higher PH, and that would cause bacterial vaginosis. So gardnerella in and of itself can be normal in very, very low levels. But if the environment gets thrown off, and then we get a different environment with a different PH that allows that gardnerella to proliferate more than what's normal, that leads to bacterial vaginosis, which is that kind of thin, watery gray discharge that's kind of fishy smelling, can be irritating, and can be pretty annoying to people too. And so that, that is, you know, a PH gets thrown off, the vaginal microbiome gets thrown off, and it allows this other bacteria to proliferate. Same thing with like yeast infections. Yeast infections are not as PH involved or dependent. They're pretty much independent of PH because your PH is pretty stable, they're more bacteria-dependent. So when the bacterial kind of environment gets thrown off a little bit, everyone has little bits of yeast that are normal at a normal low level, but if your bacterial environment gets thrown off, then that yeast can proliferate further and cause a yeast infection.

Kristyn Hodgdon:
Got it. So how do you kind of know? Is it the thin grey discharge and fishy smell that makes you kind of alerted to whether your vaginal microbiome is thrown off, or can it be thrown off and you don't even know it?

Staci Tanouye :
A little bit of both. And so that's kind of the beauty of why the vagina is so smart is that the environment can be thrown off, it's thrown off by a lot of things. I mean, sex and semen being probably the most common, period blood being another common thing. Semen and period blood have higher PHs than what the vagina is used to. But again, if we go back to what we were talking about, how the vagina is self-cleaning, that it creates this discharge and exfoliates and kind of washes that out on its own, that's, it's self-cleaning and kind of self-stabilizing mechanism. So you put semen in it, that's more basic, the vaginal discharge is going to kind of over the next couple of days, wash it out and bring itself back to normal. So it will get thrown off with semen and sex, it will get thrown off by your period. But it's, your vagina is built to return itself back to its stable, normal environment on its own. When it can't do that, when something is, when the vaginal microbiome is thrown so off that it can't kind of return to its normal bacterial environment, that's where we see issues like bacterial vaginosis.

Kristyn Hodgdon:
Got it. So yeah, just be aware of your discharge and if anything feels off, definitely let your care team know. So what is pelvic inflammatory disease?

Staci Tanouye :
So pelvic inflammatory disease or PID is an infection usually caused by gonorrhea or chlamydia. Those are the two most common sexually transmitted infections that usually get in the vagina and in the cervix. And then they go up the cervix into the uterus and then usually through the uterus into the fallopian tubes, causing an infection throughout the reproductive system, which then causes increasing inflammation and can cause inflammation to the surrounding pelvic structures. Depending on severity, it can be quite severe and people can be really, really sick, or it can be mild too. So sometimes PID actually needs hospitalization, sometimes it just needs some IV medications or IE or intramuscular medications just depending on severity. PID, again, caused by gonorrhea or chlamydia can also, if it if you're having an inflammatory reaction in your fallopian tubes, that's what can affect your fertility in the future, too. So STIs, we want to try to prevent those as much as possible with condom use because we don't want any inflammatory process getting to our fallopian tubes and causing damage to those tissues.

Kristyn Hodgdon:
Absolutely. And that's the reason why we need an annual pap smear, right?

Staci Tanouye :
Yeah. Well, an annual pap smear checks for different things, it doesn't even check for that. So, yeah, that's like, again.

Kristyn Hodgdon:
See? Another, another misinformation that I had in my head.

Staci Tanouye :
Yeah. Yeah. Pap smear screens for cervical cancer and human papilloma virus and STI testing is separate from the pap smear.

Kristyn Hodgdon:
Oh, okay!

Staci Tanouye :
So always a good idea to get your pap smear when it's recommended, also a good idea to get annual STI screening.

Kristyn Hodgdon:
Absolutely. So what is vaginismus? I know that this is something that can affect, you know, things when you're trying to conceive as well.

Staci Tanouye :
Yes, vaginismus is an involuntary contraction of the vaginal muscular walls. Whenever you try to potentially insert something like a tampon or a penis or a sex toy or whatever it may be, when you try to insert something in the vagina, the muscular walls close in on themselves and contract and don't allow whatever is there to be inserted, and that causes pain, and that's what vaginismus is. It's caused by a lot of different things, sometimes we can't pinpoint what the original etiology or cause was, sometimes there can be an underlying cause, like physical or emotional trauma in the past can be a cause. And there's a couple of other things, but it can, it causes pain, and that's why it can cause pain with sex.

Kristyn Hodgdon:
And how is that treated?

Staci Tanouye :
Is treated generally with pelvic floor physical therapy. So you find a really great pelvic floor physical therapist which is like the gynecologist best friend and, and they will actually evaluate your pelvic floor and the contraction of your, and the tension in your pelvic floor muscles. And they will teach you techniques of how to relax those pelvic floor muscles. For vaginismus specifically, sometimes it will involve some vaginal dilator work. So dilators are long thin either silicone or there's a couple of other materials that are used, they're kind of thin tubes. They start like the diameter of a pencil and get all the way up to the diameter of a larger-sized penis. And, and you use these to use your relaxation techniques to then practice inserting these dilators and you gradually go up in the dilator size as your pelvic floor gets more and more relaxed with the other work that you're doing.

Kristyn Hodgdon:
Okay. So there is, there is a possible treatment route. So hope is not lost.

Staci Tanouye :
Hope is not lost.

Kristyn Hodgdon:
....

Staci Tanouye :
Hope is not lost. Vaginismus can be pretty well treated.

Kristyn Hodgdon:
Good. Well, I feel like the theme of this season is just busting all of the myths that we have been, like, grown up to believe and didn't really know the truth behind, so thank you. And lastly, I just wanted to ask you, because I know you're so passionate about this topic, what would you rescript about how people think of vulvovaginal health?

Staci Tanouye :
I would script kind of the entire industry. I hate that this industry targets a vulnerable point in our bodies, and it's a point that makes, yeah, it just makes us more vulnerable to that marketing. So people believe it. I mean, I believed it for a long time before I was a gynecologist. This market, it markets to teenagers and it tells teenagers that your vulva needs a glow up and that you should smell like peaches and cream, and that's just not true. And so I wish people could understand that a lot of that marketing is shame-based. And we need to get away from that and realize what is normal, and normal is good and healthy. And so, again, the vagina is everything internal and doesn't need any extra cleaning because it's self-cleaning. The vulva is everything external, it needs some gentle cleaning, but it doesn't need any fancy products, so it really just needs water, use your hands to kind of clean out the folds with water and water and hands is all you need externally. If you wanted to add an extra cleanser, add a mild unscented cleanser, you don't need fancy soaps, you don't need fancy washes, you don't need to smell like a piña colada, like you just don't. And so less is more, avoid that shame-based marketing, we got to get away from that. Normal is good, normal is healthy, normal is normal smells and odors and normal discharge. And this is all signs of a healthy vulva and vagina that doesn't need to be changed.

Kristyn Hodgdon:
And your OB-GYN doesn't care what your vulva looks like.

Staci Tanouye :
No, no, we don't. Hair, no hair, whatever your labia look like, like we do not care, it's all normal, and it's all good and fine. Your normal.

Kristyn Hodgdon:
I needed that validation myself, so.

Staci Tanouye :
Yes! Don't ever apologize for not cleaning or shaving or anything like that. Like, you're fine, you're normal, you're good. You came to see me, that's what's important.

Kristyn Hodgdon:
Absolutely. Well, this is awesome. Thank you so much, Dr. Tanouye, and until next time!

Staci Tanouye :
Thank you so much!

Kristyn Hodgdon:
Thank you for tuning into this episode of Dear (In)fertility. We hope it left you feeling more educated and empowered about your reproductive and sexual health. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe, and to join Rescripted's Free Fertility Support Community, head to Rescripted.com.

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