Dr. Daryl Daley is a Senior Registrar at the May Pen Hospital in the Department of Obstetrics and Gynecology in Jamaica, where he is active in the training of young doctors, residents and medical students. In addition, he is a senior member of the European Society of Aesthetic Gynecology, a fello
Below are his answers to some of the most common questions that persons have for their OB/Gynecologist:
1. What are some things that you wish every menstruating person learned about their bodies/vaginas during adolescence?
- Firstly, menstruation is a natural and normal process. It and other bodily changes such as the development of breast tissue, defines the onset of puberty. For years, there has been a negative stigma attached to menstruation. This stigma should not exist. Parents and guardians should feel comfortable discussing this topic even before it’s onset. The average age for puberty is between 10 and 14 years of age.
- When a female infant is born they have around two million eggs present within their ovaries. At the onset of puberty, this number falls to five hundred thousand. These eggs contain hormones such as estrogen, that are responsible for prominent female characteristics such as breasts, hips, excess gluteal (buttock) tissue, bone health, development/maturation of the genital tissues etc.
- The menstrual cycle has two phases - a follicular phase and a luteal phase. The average cycle lasts 28 days (from menses to menses). In the follicular phase, due to hormones controlled by the brain, an egg undergoes maturation and is released on day 14 (mid cycle) and is referred to as ovulation. During this time, the lining of the womb is shed and menstruation occurs. Menstruation usually lasts for 5-7 days. After Ovulation, the lining of the womb begins to rebuild, if there is no pregnancy, the lining sheds and menstruation begins again, and a new cycle starts with the development of another egg. When all the eggs are finished, then menopause occurs, which typically occurs at around the age of 51 years.
- The first few periods can be abnormal in flow and regularity due to the fact that the brain is not fully developed, and adolescents should be made aware of this. Also, during ovulation, the discharge from the vagina may become a bit heavier and appear to be “sticky”. They should also be made aware of other changes such as mood swings and breast tenderness that can occur.
- Lastly, contrary to popular belief, pain during menses is NOT NORMAL. There are some societies that exist where mothers encourage their daughters to bear painful menses. Painful menses need assessment - this could be a sign of ENDOMETRIOSIS
2. What is a cervix?
The uterus or womb is made up of a body, fallopian tubes and a cervix, with the ovaries attached to the back of the uterus. The cervix is also referred to as the “mouth of the womb” or opening of the womb. The cervix is located at the top of the vagina. It is the organ that becomes dilated to allow the passage of babies from the uterus, through the vagina and to the outside world. It also allows the passage of menses to the vagina.
The cervix feels like a rubber button and varies in size and length depending on genetics, if there was a previous pregnancy or if a person has undergone previous cervical surgery.
Note: when you measure the cervix by inserting a finger, you are not measuring the full cervix, what you are feeling is the external cervix.
3. Does pubic hair really contribute to odors and smells? Is it advised to keep the bush low?
Yes, long pubic hairs can harbor bacteria such as pubic lice and scabies. Additionally, a lot of hair can hide lumps and bumps which could be a sign of underlying sexually transmitted infections. Pubic hair also traps sweat which can lead to unpleasant odors overtime. Generally keeping the hair low or absent is more hygienic.
4. What are your thoughts on natural birth control methods? What would you advise someone who does not want to practice hormonal birth control methods?
The rhythm method or withdrawal method is a method of contraception which involves abstaining from sexual intercourse around the time of ovulation and/or withdrawing the penis before ejaculation. Though it may be beneficial for some couples, I personally do not recommend it because pre-ejaculate can contain active sperm. Additionally, a menstruating person may have an abnormal cycle and may ovulate at a time that is different from their scheduled ovulation, resulting in unplanned pregnancy.
In my opinion, the best non hormonal contraceptive method is the copper intra uterine device (copper T) which is placed inside the uterus. It lasts for up to ten years, and the copper is anti sperm. The condom is effective as well.
5. Do you think feminine washes are necessary?
Personally, I am not a fan of feminine washes. The vagina has natural bacteria that allows it to clean itself. Feminine washes can change the natural flora or environment of the vagina causing bacteria and yeast to over grow.
6. What is recommended for persons who have a dry vagina and why does that happen?
A dry vagina could be a physical or a psychological problem.
Physical problems include endometriosis, vaginal masses and infections which could contribute to painful sex- if sex is painful, a female will not become stimulated. Also, premature menopause (menopause before the age of 40 years) can occur, resulting in decreased levels of estrogen (which is responsible for keeping the vagina moist). Low levels of estrogen result in an atrophic vagina (dry).
Psychological problems include emotional detachment from your partner, resulting in someone finding it difficult to become stimulated.
When there is a dry vagina, the patient should be assessed in a multidisciplinary manner with a gynaecologist and/or sex psychologist. The necessary investigations can then be done.
Note: lubricants and estrogen creams can also be recommended depending on the cause of the problem.
7. What is recommended for persons who have an excessively wet vagina and why does that happen?
Different strokes for different folks. Some persons produce more lubrication than others. Unfortunately, there is no medication we can give to prevent this from happening. If this is a problem for you, do a gynecological assessment to see if there is a physical problem causing this.
8. There's a popular belief that persons who have sex often have a big/loose vagina. How true is that? Does the frequency of sex affect the tightness or looseness of a vagina?
The frequency of sex by itself does not affect the elasticity of the vagina. There may be some truth if there is a large phallus/penis, that repeated intercourse with that partner may cause the pelvic floor muscles to become damaged thus causing the vagina to not maintain its normal tone.
9. What actually determines how loose or how tight a vagina is?
A combination of factors - genetics, hormone levels and the history of previous vaginal deliveries. Estrogen is responsible for maintaining the tone of the pelvic floor muscles. Also, some women may experience damage to the pelvic floor during vaginal delivery, especially with repeated deliveries and the birthing of large babies.
If there is any concern, visit your gynecologist. Surgical and non surgical options to repair this condition are also available now.
10. How do you know if your vagina is healthy?
Every vagina has a discharge, which is normal. However, if this discharge develops an odor, itching or color change, it is recommended to visit your gynecologist. Also, if there is abdominal pain or fever and urinary symptoms present with the discharge, this may signify an underlying pelvic infection which requires prompt treatment.
Eat well, exercise, keep hydrated, no douching, avoid scented perfumes or soaps to the genital area, change disposable period care products frequently, use cotton under wear/sun dry and practice safe sex - these practices all promote a healthy vagina.
Also, visit your gynecologist for a yearly assessment.
11. My vagina releases air and makes farting noises during sex and other physical activities. Why does that happen and how normal is it?
Vaginal flatulence or vaginal garrulity/vaginal fart is the involuntary passage of wind/gas from the vagina. There is not a lot of data on this topic, but it can affect up to 70% of persons of varying ages. Most persons experience this during sex but it is common during oral sex, digital penetration/fingering and during exercise such as sit ups and jogging. This does not pose a serious health risk.
12. What are some things that you do NOT advise persons to do to their vaginas?
Do not place foreign bodies in the vagina - avoid fruits and garlic. Do not douche. Do not use scented soaps or perfumes. Do not self treat discharges.
13. What are some practices that you advise persons to take to promote vaginal health?
Practice safe sex. have a healthy and balanced diet, increase probiotic intake, exercise, change period care products frequently (especially disposables), wear cotton underwear and sun dry underwear. As well as, visit your gynecologist for a yearly assessment, screening and Pap smear, if necessary.
14. How does one know if a product is good for the PH of the vagina?
The vagina has a normal PH of 3.8 - 4.5, so stick to products in this PH range.
15. How effective and important are kegel exercises and how does one do them?
Kegels are important, they help to keep the pelvic floor in tune and can also heighten sexual experience. Additionally, they help persons who suffer from stress urinary incontinence (involuntary loss of urine when laughing, sneezing, coughing or exercising).
How to perform kegels :
Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. Once you've identified your pelvic floor muscles you can do the exercises in any position, although you might find it easiest to do them lying down at first.
Perfect your technique. To do kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three.
Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
Repeat three times a day. Aim for at least three sets of 60 repetitions a day (A lot! But studies prove this is most effective versus 15-20 times).
16. Would you advise sex on your period and can you get pregnant if you have unprotected sex during menstruation?
Firstly, not all vaginal bleeding represents a normal period, especially if a person has irregular cycles. A person with irregular cycles can become pregnant at any time because it is hard to determine when they ovulate. So a person who is bleeding, theoretically, can become pregnant if they have irregular cycles.
The presence of blood can increase the likelihood of the transfer of sexually transmitted infections, even with a condom. For these reasons, I do not recommended sex during menstruation.
17. Is it safe to have sex while your menstrual cup is inserted?
There is no clinical evidence to support that it is not safe during sex. You should also check with the menstrual cup manufacturer.
Note: (Twistie does not recommend sex with a menstrual cup inserted).
18. What determines a low or high sex drive?
Physical and Psychological causes.
Physical causes such as endometriosis or vaginal masses/infections/premature menopause can cause painful sex. Psychological causes, such as emotional detachment can also cause this. It is important to be assessed by a gynecologist and/or sex psychologist .
Depression and other psychological issues can also contribute to this and may warrant the intervention of psychiatrist.
A full assessment needs to be done, ideally by a gynecologist first.
19. Will your vagina ever be the same after giving birth?
Yes, it can be. Some vaginas return to normal or near normal vaginal tone after vaginal delivery.
20. Why does my vagina itch during my period?
During the menstrual cycle, there are fluctuations of many hormones. These hormones act on the natural environment/flora of the vagina. As a result, the environment is altered and can result in the overgrowth of bacteria or yeast causing vaginal itching. This does not happen in every person. It's important to ensure there are no other external factors contributing, such as irritating under wear, not sun drying the under wear, using scented soa
ps or perfumes, douching, not changing period care products frequently, not exercising frequently or not having a balanced diet.
Thanks for sharing with us Dr. Daryl!