The Guide to Getting It On (101 page)

“He doesn’t put his whole hand in there, darlin, it just seems like you are very full because of the speculum. It is pressing you open from top and bottom and it is what you mostly feel. Also not all girls are a straight shot in. I had some discomfort on a regular basis until a male doctor pointed out that my cervix was tilted to the right-hand-side of my body. I now know to tell the doctor about this before going in so I don’t get banged in the wrong direction. Unless the doctor is using one of the new disposable speculums, they do come in different sizes as well. I am very petite and know that a smaller size will be more comfortable. Some of this comes from experience, but it is your part to speak out on these issues with your doctor.”
female age 33

“I am a very small woman. My first pap was done with the instruments they use to test small children for molestation, if that tells you anything. I have since had many pelvic exams, all of which have been done with standard equipment. Breathe deeply, and try to think of other things, and let the doctor do her job. And don’t let them give you an exam while you’re on your period. It’s uncomfortable for you, take my word for it.”
female age 22

Last but not least, for a report on getting a pelvic exam from half way around the world (count your lucky stars, girls in America!):

“Each examination room is shared by two doctors. So when I entered, there was another patient splayed out on the table, having a pelvic exam, right next to the door. She appeared to be accompanied by half a dozen people, both males and females; the preceding patient and her entourage were also there, in addition to my coworker and myself, and the two doctors. The door to the lobby was wide open. The first question the doctor asked me was translated as, ‘Do you have the sexy life?’ (As in, ‘Are you sexually active?’) Naturally, all eyes turned to me–foreigners are something of a novelty here–and of course, I’d just started dating a guy after six months of celibacy, so I said yes. After several more questions, I was led to a table in the corner of the room and instructed to disrobe. No paper gown, no curtain, no closed door. So, my legs spread for what felt like the world to see, up the speculum went.”
female age 24

A Very Special Thanks
to Maureen Whelihan, MD, the gyno-goddess of greater Florida, and to Rachel Pauls, MD, FACOG, Urogynecologist andDirector, Center for Female Sexual Health at Good Sam in Cincinnati.

CHAPTER

49

Male Genital Cleaning

W
ash your package daily. If you’ve got a foreskin, pull it back and wash there, as well. That’s it.

And if you aren’t thankful about the really good deal men get in life, compare the length of this chapter with the length of the one that’s before it. Dick maintenance is a breeze when compared to what a woman goes through. No periods, no pads, no tampons, no pregnancy, no vaginal infections, no gynecologist, few bladder infections and no shaving or waxing between your legs. Your worst problem is having smelly balls. And that only takes a shower to cure.

Be thankful.

CHAPTER

50

A Trip Inside Amber’s Vagina

T
here are plenty of reasons to take a trip inside Amber’s vagina. Let’s say you want to know what causes yeast infections in a woman’s vagina. Or your boyfriend’s finger starts to sting when he’s had it in your vagina for a while and you want to know why. Or maybe you want to know why it is unwise to assume that over-the-counter drugs will automatically make a vaginal infection go away.

Amber’s vagina will be our gynecological version of
The Discovery Channel.
So let’s look at what makes Amber’s vagina hum, besides sweet texts and kisses from her boyfriend.

For this to work, we will need to shrink until we are very small. So small that we can take a trip up Amber’s vagina. Given how a healthy vagina is fairly acidic, some of you might think of this as an acid trip. If Amber’s boyfriend gets his prayers for sex answered before we are done, it will probably feel like an acid trip.

Amber’s Vagina vs. The Vagina of a Rabbit, Hamster or Macaque

The vaginas of almost all mammals have a pH of around 7 which stands for neutral. They are neither acidic nor alkaline. This is very different from the pH in the human vagina. From puberty to menopause, the human vagina is acidic.

Before Amber went through puberty, the pH in her vagina was the same as the pH in her blood, which is about the same as the pH in water. But once puberty struck, Amber’s vagina became acidic. In fact, the average pH for adult women who haven’t reached menopause is between 3.5 and 4.7. After Amber goes through menopause, her vagina’s pH will go back up to around 7 and will almost become neutral again.

There are times when the pH in Amber’s vagina will briefly rise. During her period, the pH will go up to around 6 or close to neutral. It will go up for a few hours after she’s had sex. That’s because her boyfriend’s semen is not acidic, so it causes the pH of her puss to climb. So does her sexual lubrication. The pH in the vagina can also rise when a woman has a vaginal infection. In fact, a high pH is one of the hallmarks of some vaginal infections.

Amber’s Vagina—Home to Several Colonies of Bacteria

While we could view Amber’s vagina as a warm, wet, heavenly place that lots of guys and some girls would like to visit, it’s also instructive to think of it as a massively complex rainforest, an incredible ecosystem with bacterial flora and fauna that keep it all in balance.

One of the most important residents of Amber’s vagina is a bacteria called Lactobacilli. There are different types of Lactobacilli in Amber’s vagina. When things are in balance, friendly families of Lactobacilli produce hydrogen peroxide and lactic acid in amounts that are helpful. The hydrogen peroxide helps kill undesirable bacteria when they try to intrude. The lactic acid helps to maintain the acidic environment that’s so essential for healthy functioning. It also makes the fingers of Amber’s boyfriend sting when they have been basting inside of her vagina. This is a property of all healthy vaginas. Their acidic nature will make most people’s fingers sting if they stay in there long enough.

The Lactobacilli have tiny projections that stick out from their cell bodies. These projections clasp onto the cell walls of the vagina. This prevents other bacteria and germs from attaching at these points. You might think of it as aluminum siding for the inside of Amber’s vagina.

When Amber Takes Antibiotics and Things Go Wrong in Her Vagina

A very positive effect of the Lactobacilli is they keep the pH in Amber’s vagina low. This helps keep out unfriendly bacteria that can cause infections. If anything happens that causes the Lactobacilli ecosystem in Amber’s crotch to change, the stage is set for infections and uncomfortable conditions. For instance, let’s say Amber starts taking antibiotics for a lung infection. This kills off the wicked bacteria in her chest, but it also starts to kill off the friendly bacteria in her vagina. As a result, the lactic acid that’s produced by the good bacteria will decrease and the alkalinity in Amber’s vagina will increase. As the alkalinity or pH rises, fewer Lactobacilli will reproduce. A nasty spiral is created where the population of the good bacteria stars collapsing faster than the housing market.

As the population of the good Lactobacilli begins to crash, another of its important by-products (hydrogen peroxide) will suddenly be in short supply. With less hydrogen peroxide, unfriendly bacteria will have an easier time taking up residence in Amber’s vagina. Also, the Lactobacilli shield that was protecting the walls of Amber’s vagina will weaken. Unfriendly anaerobic bacteria will be able to invade the cell walls in Amber’s vagina. When this happens, Amber may get bacterial vaginosis or BV. One of the most common symptoms of BV is a discharge with a fishy odor.

Why a Vagina with an Infection Will Sometimes Smell Fishy or Bad

When the levels of hydrogen peroxide go down, there is even less oxygen in the vagina than normal. As a result, bacteria that grow in low oxygen environments start to flourish. These are called anerobic bacteria. Instead of processing oxygen, they feast on sulfur and produce sulfur-like compounds. This kind of bacteria is responsible for the smell of bad breath, smelly feet, and Limburger cheese. It is one of the reasons why a vagina that has an infection will sometimes smell unpleasant. A fishy smell is also caused by the cellular death and destruction that’s going on in the vagina as part of the body’s efforts to make things right again.

Why Yogurt Won’t Help

Lactobacilli is found in yogurt, so you would think that eating a lot of yogurt or plastering it between Amber’s legs would help her infection go away. Unfortunately, the kind of yogurt that’s in milk is very specific to cow intestines. So while yogurt might be good for Amber’s calcium intake and maybe for her digestion, the yogurt we eat is unlikely to help at all with problems in the vagina. Researchers are hoping to find microorganisms (aka “probiotics”) that will help treat conditions like bacterial vaginosis. This would provide a much more elegant solution than we currently have for treatment.

The Opposite Problem — Amber’s Vagina Becomes a Distillery

Another kind of vaginal calamity can occur when the population of Lactobacilli suddenly rises and too much lactic acid and hydrogen peroxide are produced. Natural sugars start being fermented into carbon dioxide, alcohol, formic acid and acetic acid. This causes itching and irritation. When this occurs inside of Amber’s vagina, her boyfriend will need more than prayers and flowers to get between her legs.

This kind of situation shares the same symptoms as a yeast infection: including itching, burning, painful intercourse and a slight discharge. It is often misdiagnosed as a yeast infection. This is why a woman who is having problems with recurring vaginitis needs both a sharp gynecologist and a good knowledge of how her vagina works. Over-the-counter drugs for yeast infections won’t touch these kinds of situations when the vagina becomes a distillery. (These conditions might be good for making beer and whiskey, but not for Amber’s vagina.)

A third problem that can occur in Amber’s vagina is when she really does get a yeast infection, commonly referred to as Candida. A fourth type of infection is caused by a protozoa known as Trich or Trichomonas Vaginalis. And then there’s Noninfectious Vaginitis. Instead of being caused by funky organisms, the source of irritation for Noninfectious Vaginitis can be anything from feminine hygiene spray and body soap to perfumed toilet paper, laundry detergent, exercise bike-seat irritation, and period gear.

Researchers’ Fascinating Findings about Amber’s Crotch

Not long ago, crotch doctors believed that the ecosystems in most vaginas were alike. They were wrong. Very wrong. We now know that there are five distinct communities of bacteria that can live in a human vagina. While these communities are fairly stable in some women, they can transition frequently in the vaginas of other women. (It might seem like there would be more vaginal infections in women whose vaginal communities transition more frequently. But that does not appear to be the case.)

Periods can have an impact on bacterial communities. The equilibrium in some women’s vaginas can fluctuate widely when they have their periods, while the bacteria remain fairly stable when other women have their periods. There can also be fluctuations after women have sex. And black women are more likely to have a kind of bacterial community that is different from what is found in the vaginas of white women. As a result, the vaginas of black women might have a different pH than the vaginas of white women. Researchers are just beginning to find out about the different ecosystems that are inside of women’s vaginas.