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20 Questions To Ask Your OB/GYN

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:

Daryl Daley, OB/GYN

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.