Dr. Kate White MD, Monica Ramos, Mia Barron (Narrator), "Your Sexual Health: A Guide to Understanding, Loving and Caring for Your Body"
Get bite-sized sex health tips from the gyno who’s seen it all. Dr. Kate (White, M.D., M.P.H., OB-GYN) gives front-line advice on gyno health, period health, sex health, and reproductive health, dispelling old-wives’ tales and offering fresh research, with topic titles such as “your vagina should smell (and taste) like a vagina”, “treat your vulva like the Hope Diamond", “we don’t care if you’ve shaved”, “a partner who doesn’t have a clitoris may not know where yours is”, “if you have eggs and your partner has sperm, think about contraception”, and “there’s no wrong or unnatural way to deliver a baby.”
Dr. Kate fills in the gaps left by modern sex education in an accessible and prescriptive way. Your Sexual Health provides answers to your burning questions about your reproductive health (and yes—even questions about vaginal burning!) and tells you things you may have never even thought to ask.
As one of the country’s leading gynecologists, vice chair of academics, director of the Fellowship in Complex Family Planning at Boston Medical Center, and associate professor of OB-GYN at the Boston University School of Medicine, Dr. Kate White arms listeners with questions to ask of their own “doctor downstairs.” Addressing topics like taking care of your vaginal health, regulating your menstrual cycle, eliminating painful periods, choosing the right birth control, and achieving orgasms, you’ll understand your body in a new way through 69 easy-to-digest sections. And while many books about women’s health care focus on the experiences of heterosexual women, Dr. Kate provides a friendly, inclusive guide for all listeners with female parts, regardless of gender identity or sexual orientation.
Throughout Your Sexual Health, you’ll learn how to
Understand how your body is normal—and notice when it’s not.
Have periods that don’t ruin your life—or your clothes.
Get in touch with your body and your partner for the best sex of your life.
Protect your body from STDs and STIs.
Learn the often-normal causes for occasionally abnormal pap smears.
Discover the right contraception for your body.
Your Sexual Health is the perfect high school graduation gift or college graduation gift. It’s filled with trustworthy and approachable information, making it your board-certified bedside confidante until you can see your gyno.
Contents
Introduction
Part I. Gyno Health
The land down under
You may be calling your parts by the wrong names.
Your labia are normal, no matter how long or short they are. Your vagina should smell (and taste) like a vagina. Protect your parts, not your panties.
Douching your discharge is dangerous.
All that itches isn’t yeast.
Waxing won’t give you herpes — but your skin may look like it
does.
Never go back to front.
Treat your vulva like the Hope Diamond.
(Almost) everyone gets HPV at some point.
You don’t need a yearly Pap, but an annual visit is a good idea.
An abnormal Pap doesn’t mean you have cancer. We don’t care if you’ve shaved.
If you don’t feel comfortable talking to your gyno, find another
one.
We wantto hear about your sex life.
Part II. Period Health
Bleed, rinse, repeat
It’s normal to not be normal sometimes.
What you think “regular” means is different from what your
gyno thinks it means.
There’s more to period products than tampons and pads.
Your periods will change throughout your life. You’re not going to get toxic shock.
There’s no totally safe time to have sex and not get pregnant.
You don’t have to live with heavy periods.
You don’t have to live with pain during periods.
You don’t have to live with PMS.
Listen to your gut (and your uterus).
Part III. Sexual Health
Desire, dryness and dildos
Masturbation is a wonderful teacher. Your first time may not be what you expect.
A partner who doesn’t have a clitoris may not know where
yours is.
You may need more foreplay than you’re getting. Keep a bottle of lubricant at the bedside.
Sex shouldn’t hurt.
No glove, no love.
Orgasms don’t often come from intercourse alone.
It doesn’t matter how you get an orgasm. It’s not all about the orgasm.
Take care of your toys.
Treat anal intercourse differently than P-in-V sex.
It’s OK if you want more sex than others do. It’s OK if you don’t want sex as much as others do. It’s OK if you don’t want sex at all.
Consent is only the beginning. Trigger warning: unwanted
sexual activity.
You can get an STI from sex that isn’t P-in-V. Even if you trust your partner, let me test you for STIs.
Part IV. Reproductive Health
How to plan your fam
If you have eggs and your partner has sperm, think about
contraception.
If you’ve never gotten pregnant, it doesn’t mean you can’t get
pregnant.
You should only use contraception if you want to. The pill protects you from more than pregnancy. The pill isn’t your only birth control option. The ‘morning-after pill’ is good for mornings-after.
Pulling out is not pointless.
All birth control is safer than pregnancy.
Even abortion is safer than pregnancy.
You can use more than one method of birth control.
You get to control your contraception.
Birth control won’t hurt your fertility.
Abortion won’t hurt your fertility.
Part V. Pregnancy Health
Baby (on the) brain
Make no assumptions about your fertility.
Use an app to track your cycles. It may take you a year to get pregnant.
If you’re younger than and you’re not pregnant after
months of trying, get thee to a gyno.
If you’re or older, give it only months of trying before
seeking help.
There’s nothing wrong with needing help to get pregnant. There’s no wrong or unnatural way to deliver a baby.
Miscarriage is incredibly common. The postpartum period can be rough.
Your body will change after you have a baby. Having a C-section won’t save your vagina.
Even if you’re not having that much sex, you still need birth
control after you have a baby.
Sex after pregnancy may be different. Afterword
Introduction
Growing up, my body below my waist was a mystery. I went to Catholic school until I was , and my public schools weren’t much better at teaching me the things I needed to know about sexual health. I didn’t know what vaginal discharge was, so was horrified to see wetness on my underwear at age and worried I was peeing myself. My well-meaning mother told me in college that oral sex was perverted. It wasn’t until medical school that I finally learned the basics (and then some) about my reproductive health.
You shouldn’t have to go to medical school to learn the fundamentals about your body. But where else can you get sexual health knowledge? The internet is a mixed bag of the good, the bad and the intentionally misleading. Unlike your doctor, your search engine isn’t board-certified to practice medicine. If you’re turning to your siblings and friends for insights, they usually don’t have access to information that’s any better than you can find (despite how confidently they may give you advice). Even savvy, smart people have been confused by misinformation or conflicting recommendations.
Maybe you know the basics but want more details about how your private parts work and how best to use them. You can find yourself lost trying to get the knowledge you need to make the best choices about your health. It’s tough to find good information about sex toys because they make some people blush or giggle. Or about how birth control affects your periods, because the glossy pamphlets you get in the doctor’s office are a sales pitch. Or about abortion because it’s so politically charged. And you’ll rarely see a doctor’s office brochure about anal sex.
That’s why I wrote this book.
Your Sexual Healthis full of the critical knowledge and secrets I’ve learned from being an obstetrician-gynecologist and a health writer for more than years. This book offers answers to the questions patients and reporters have asked me repeatedly — and the questions you’ve maybe been too embarrassed to ask. The information in this book will help you make solid decisions, feel less anxious and control your reproductive destiny. Consider this book your crash course in better sexual health.
Note: This book is intended for people with a vagina, of any identity or orientation. Gendered language and references to hetero or lesbian women reflect the limitations of published research that hasn’t caught up to the times.
Part I. Gyno Health
The land down under
You may be calling your parts by the wrong names.
Your labia are normal, no matter how long or short they are. Your vagina should smell (and taste) like a vagina. Protect your parts, not your panties.
Douching your discharge is dangerous.
All that itches isn’t yeast.
Waxing won’t give you herpes — but your skin may look like it
does.
Never go back to front.
Treat your vulva like the Hope Diamond.
(Almost) everyone gets HPV at some point.
You don’t need a yearly Pap, but an annual visit is a good idea.
An abnormal Pap doesn’t mean you have cancer. We don’t care if you’ve shaved.
If you don’t feel comfortable talking to your gyno, find another
one.
We wantto hear about your sex life.
You may be calling your parts by the wrong names.
You’ll hear the word vaginaused to refer to the genitals of a person assigned female at birth. The vagina is an amazing organ — it can stretch to accommodate nearly anything that’s put inside it, and almost any baby on its way out. But the vagina is insidethe body. The only way you can see the vagina is with a speculum and a hand mirror.
The part of the anatomy you caneasily see is the vulva. Your vulva begins at the clitoris and the skin (hood) covering it. Packed with nerve endings, this is the most sensitive spot on your body, and the only human organ dedicated purely to pleasure. The vulva then extends down to your perineum, the skin and muscle in between the opening of your vagina and your anus.
In between, you have two sets of lips (labia). The outer set is called the labia majora. This is what forms a cameltoe when you wear tight clothing. The inner set is called the labia minora and can be pierced if you’re adventurous. Go to MayoClinic.org and search on vulvato get a closer look at all the parts described here.
Knowing what’s where will help you understand how your body behaves — and help you talk with your gyno when something seems funky.
Your labia are normal, no matter how long or short they are.
Genitals come in an array of shapes, sizes and colors. Some people have thin labia (minora) that extend out beyond the plump ones (majora). Other people’s thin labia are totally covered. No matter what you may have seen in porn or on a partner, yours are just fine.
Unethical doctors will prey on people’s body insecurity and offer them cosmetic surgery for their labia so they can match up to some mythical ideal. But there are only two indications for someone to take a scalpel to your nether region: for gender reassignment/realignment, or if your labia are long enough to cause pain with intercourse or tight clothing. Otherwise, accept your labia like you do the rest of your body, in all its quirky wonder.
And in case you’re wondering about how a partner may view your body? Any partner who sees you naked should count their lucky stars that they get to be that close to you, first and foremost. If your partner has anything to say about your labia — or any other part of your body — that’s not akin to ecstatic worship, it’s time to trade up to someone worthy of you.
Your vagina should smell (and taste) like a vagina.
Not berries, flowers or a tropical island. You have a naturally musky, pheromone-filled scent. And the taste of your vagina varies depending on where you are in your cycle — muskier around ovulation, and metallictinged when you’re bleeding. Attempting to cover up your scent with sprays and powders may trigger irritation of the vulva and vagina (contact dermatitis) and lead to more discharge and possibly an infection. What about those blogs that tell you to eat pineapples or avoid asparagus to improve the way you taste? There’s no science that proves there’s a relationship between your diet and your taste or odor.
If you notice a strange odor, particularly a fishy one, have your gyno check you out for a vaginal infection. Your gyno can take a simple swab of your vagina, and you’ll have results in - hours. Otherwise, you smell and taste just the way you should. And any partner who has a problem with the way your vagina (naturally) smells or tastes should lose the privilege to be anywhere near one.
Protect your parts, not your panties.
It’s not uncommon to be bothered by vaginal discharge — it’s one of the most common reasons for a gyno visit. When people don’t like the feeling of moisture on their underwear, they may use a pantiliner every day. But blocking your vagina with a pad is the worst thing you can do. When your vagina can’t breathe, it may react by producing even more discharge. This can happen even with reusable liners. Plus, tossing all those disposable liners is rotten for the environment. Save the liners for light period days.
If your panties get wet, simply change them. The reason we wear underwear is to protect our clothes. You shouldn’t use liners to protect your underwear. If you’re out and about, bring along a spare pair of underwear in a plastic bag. When you’re ready to swap, just zip the old ones into the bag. Easy-peasy.
Douching your discharge is dangerous.
A vagina naturally has discharge — same goes for many transwomen’s vaginas after gender affirmation surgery. Discharge is how your vagina cleans itself, keeps the tissue moist, gets you ready for intercourse and helps prevent infection. Think of it as daily intimate housekeeping. Your discharge should be clear, white, or off-white, though it varies in amount and consistency at different times in your cycle, at different ages, and if you’re on certain medications.
Wash only your vulva, with your fingers, water and a gentle soap. Don’t interfere with your body’s self-cleaning by putting soap or a washcloth into the vagina. And above all, do not douche,which is cleaning out the inside of the vagina with water, either alone or mixed, with other fluids. Douches are often sold in a bottle or bag, and you’re meant to squirt the fluids upward through a tube or nozzle into your vagina.
Exposing the vulva to chemicals and perfumes increases your risk of irritation and infection.
Even a baking-soda-only douche pushes bacteria from your vagina up into your uterus, where they don’t belong. This can cause pelvic inflammatory disease. And there’s no such thing as a “natural” douche — there’s no “safe alternative.” Bottom line: Your body knows how to clean itself. Let it do its thing.
All that itches isn’t yeast.
Many people assume that itching on the vulva means a yeast infection and immediately buy a drugstore treatment or start scarfing yogurt to fix it. But different vaginal infections can be mistaken for one another, and each needs different treatment.
Yeast infections tend to come with a thick, white, cottage-cheese-type discharge. If you have a discharge that looks like curdled milk and you can’t stop scratching, a drugstore treatment is worth a try.
Yogurt won’t treat a yeast infection, whether you eat it or put it in your vagina (and please don’t do that).
You may also get itchy with a bacterial vaginosis (BV) infection. BV is an overgrowth of bacteria that naturally live in your vagina. This infection can have a thicker, sometimes yellow discharge, and an unpleasant “fishy” odor. The difference in discharge can help you figure out which infection you might have. But even doctors are lousy at identifying an infection just by looking in your vagina.
If your over-the-counter treatment for a yeast infection isn’t making you feel much better in three days, head to the gyno’s office for a test to figure out what’s going on.
Waxing won’t give you herpes — but your skin may look like it does.
My patient had a full Brazilian wax before a dream trip to Greece. When she returned, she was terrified that her hot Grecian hook-up gave her herpes. She was thrilled to hear that it wasn’t herpes, but folliculitis — an irritation and infection of the hair follicles caused by waxing or shaving. These angry red bumps can be painful or itchy and can look like herpes. Here’s how to know the difference: A herpes outbreak, especially if it’s your first, is extremely painful. You may also have a fever and swollen lymph nodes in your groin. Herpes can appear on your labia and inside the vagina.
How can you prevent folliculitis? If you wax, use a fresh jar of wax that wasn’t used for anyone else. If you shave, change your razor more often than you do now. Old razors develop nicks in the blades that can cause tiny tears in your skin and put you at risk of an infection. If you’re prone to razor burn, buy cheap single-blade razors in bulk (or refillable blade cartridges) and toss them after each use. It may seem awful for the environment, but it’s healthier for your skin. If you get folliculitis, topical hydrocortisone cream can speed healing.
Never go back to front.
This goes for wiping and for having sex. Wiping back to front after using the loo brings unhealthy bacteria from your anus into your vagina and sets you up for a bladder infection. People with vaginas are prone to these infections, also known as urinary tract infections (UTIs). Since the passageway leading into the bladder (urethra) is so short, compared to how long it is in a penis, it’s easy for bacteria to climb up. No matter how quickly you’re trying to get out of the restroom, make sure to wipe from front to back. Always.
When you can, drink a full glass of water and pee after intercourse. This lowers your risk of UTIs even further.
Having vaginal intercourse right after anal intercourse poses the same risks. Anal play should be the last thing you do during a sex session. If you change your mind during sex and want to keep playing after anal, make sure your partner washes up — with water andsoap — before heading back to you. Same goes for sex toys.
Treat your vulva like the Hope Diamond.
It may not sparkle in quite the same way (and I definitely don’t recommend “vajazzling”), but it’s just as valuable, and you have only one. Treat it with care. That means no harsh chemicals on your nether regions. No perfumed sprays, no douches. Be cautious even with scented pantiliners. In the shower or bath, puffs and washcloths may be too abrasive for such delicate skin. And if you’re dealing with lots of vaginal discharge, use the mildest soap and laundry detergent possible. I like the formulations meant for babies, but any fragrance-free detergent is a good choice.
Let your vulva see the light of day from time to time. Go to bed without panties, even if you’re alone, to let your vulva and vagina breathe. Don’t like sleeping naked? Going bare under boxers or a nightshirt does the same thing. Change out of wet bathing suits or workout gear as soon as you can, especially if they’re nylon. And go commando if you’re feeling frisky and it’s context-appropriate.
(Almost) everyone gets HPV at some point.
You’ve probably heard of human papillomavirus (HPV), and how it’s the cause of most cancers of the cervix (and vagina and vulva). But you might not know how common HPV infection is. At any given time, about million people are infected with HPV and may not even know it.
HPV is so common that nearly all sexually active women, men and nonbinary folks get the virus at some point in their lives.
The good news is that most HPV infections clear on their own or become undetectable, and most infections never lead to disease (such as genital warts or changing cervical cells). If you’re under , you’re even more likely to clear your HPV infection on your own. If you’re a tobacco smoker, here’s another good reason to quit: If you do, your HPV infection will likely resolve faster.
The best way to prevent HPV is with the vaccine, available at your doctor’s office or pharmacy that offers vaccinations. Everyone from age
to , no matter their gender identity, should get the vaccine series. Some
people older than that — age to — may benefit, and they should talk
with their doctor. Even if you’ve had HPV in the past, the vaccine prevents getting infected with otherstrains that put you at risk of cancer. Beyond that, using external or internal condoms every time you have intercourse can reduce your risk of HPV infection. Notice I said “reduce.” Since HPV lives in the skin of your genitals, rubbing up against your partner — during intercourse or at any other time — can transmit an HPV infection.
If you get diagnosed with HPV, should you tell your partner(s)? The answer to that question is an unequivocal yes for every othersexually transmitted infection. But it’s a bit tricky with HPV. Partners with penises can’t be tested for the virus, and no one can be treated for the infection (except for the removal of genital warts or cervical cells if needed). And you’ll never know who gave the infection to whom. So, while I recommend honesty in all things sexual, you can be forgiven for not talking to your partner about your HPV infection. If you do decide to talk about it, come with information from your gyno or the Centers for Disease Control and Prevention (CDC) about how common the infection is, and how you both likely have it. You can also have your partner follow up with a doctor — or hand over this book.
You don’t need a yearly Pap, but an annual visit is a good idea.
Doctors have figured out that people (especially young people) were getting Paps too often. Yes, there’s such a thing as too much testing. Doctors started to detect abnormalities of the cervix that would have resolved on their own if they’d been left alone. All this testing meant that too many people were subjected to unnecessary and painful treatment, which for some led to complications with childbirth later. So, good news: No Paps until you turn
, then every three to five years after that, depending on if your gyno can also test for HPV at the same time. (Different rules apply if you’ve had an abnormal Pap at some point.)
Even if you’re not sexually active with partners with a penis, you still need to get regular Paps.
But don’t skip the annual exam completely. I tell my patients, “You’re more than just a cervix to me.” An annual visit is a great chance to talk with your gyno about any pelvic and sexual health concerns, lets you get checked for sexually transmitted infections (STIs) and gives you an opportunity to review birth control options. You may even be able to keep your pants on (what a relief).
An abnormal Pap doesn’t mean you have cancer.
If you get a letter from your doctor’s office or see your actual test results, Pap test language can be terrifying. “Low grade squamous intraepithelial lesion,” “undetermined significance,” “atypical glandular cells” — it’s no wonder my office gets calls from panicked patients who don’t know what their results mean. Pap tests offer a detailed look at the cells on your cervix. They can detect many different types of changes yearsbefore cervical cancer develops.
If you have an abnormal Pap test (including a positive HPV result), your gyno will recommend one of three things: stay on your normal testing schedule (because there’s no cause for concern), repeat the Pap in one year, or come in for a detailed exam of your cervix called a colposcopy. Your gyno will apply one of two solutions (vinegar or iodine-based) to your cervix and take samples from any areas that look even remotely suspicious (a biopsy). (Side note: Ask if you can cough when this is done — it helps with the pain.)
You may have more testing or treatment based on the results of the colposcopy and biopsies. If you follow your gyno’s recommendations, the chances of you developing cancer are slim.
We don’t care if you’ve shaved.
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