Wednesday, October 5, 2016

Savage Love: Solving vulvarian and vaginal issues

Sometimes you need more than the average gynecologist

Posted By on Wed, Oct 5, 2016 at 4:35 PM

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A question on your favorite topic. Just kidding, it’s a question about my vagina. I’m having a problem with the microbiome of my vulva and vagina. I’ve been going to my gyno for the last six months for recurrent bacterial vaginosis and yeast infections. She shrugs, gives me a script, the symptoms go away for a week or so, then they come back.

I understand the infections are likely due to an imbalance in my vaginal pH, but I don’t know what to do to fix this. I’ve used probiotic suppositories to boost the amount of lactobacillus and these help more than anything else, but the problem remains. I also wear cotton, loose-fitting undies and practice good hygiene and never douche or use anything scented.

The problem started when I stopped using condoms with my partner, but it’s not an STI. We’ve both been tested. There’s tons of sites online talking about this problem, but no one has a solution that I’ve found.

How the hell can women with this problem fix their pH?! Thanks a ton if you read this far, and thanks a million tons if you or one of your experts has any ideas to help.
Vexed Und Lacking Vaginal Answers

“I love that she used the word ‘vulva,’” said Dr. Debby Herbenick, a research scientist at Indiana University, a sexual health educator at the Kinsey Institute, and the author of Read My Lips: A Complete Guide to the Vagina and Vulva and numerous other books.

“Most people have no idea what that even is!”

I know what that is! (Full disclosure: I know what that is now. I didn’t know what that was when I started writing this column.) The vulva is (the vulva are?) the external genitalia of the female — the labia, the clit, the vaginal opening, some other bits and pieces. (Fun fact: Vulva is Latin for wrapper.)

The vagina, aka “the muscular tube,” runs from the vulva to the uterus. (Fun fact: Vagina is Latin for the sheath of a sword.) People tend to use “vagina” when referring to a woman’s junk generally, and while meaning follows use and I’m inclined to give it a pass, saying “vagina” when you mean “vulva” makes scientists like Dr. Herbenick rather teste. (Sad fact: Teste is not the singular form of testes.) Now back to your vulva and vagina, VULVA…

Dr. Herbenick recommends seeing a “true vulvovaginal health expert” (TVHE) about your problem, VULVA, and your gynecologist presumably qualifies as a TVHE… right?

“Not necessarily,” said Dr. Herbenick. “Gynecologists know far more about vaginal and vulvar health issues than most health care providers, but many gynecologists haven’t received deep-dive (pun not intended) specialized training in difficult-to-treat vulvovaginal health conditions. And if they have, it was likely when they were in med school — so years ago. They might not be up to date in the latest research, since not all doctors go to vulvovaginal-specific conferences.”

Is there a fix for that problem?

“Yes! If everyone lobbied for their doctors to go to events like the annual conference of the International Society for the Study of Vulvovaginal Disease (ISSVD),” said Dr. Herbenick, “we would live in a country with millions more happy, healthy, sex-interested women and others with vaginas and vulvas, too, like trans men.”

As for your particular problem—a tough case of bacterial vaginosis — Dr. Herbenick, who isn’t a medical doctor but qualifies as a TVHE, had some thoughts. 

“There are many different forms of bacterial vaginosis (BV) and different kinds of yeast infections,” said Dr. Herbenick. “These different kinds respond well to different kinds of treatment, which is one reason home yeast meds don’t work well for many women. And all too often, health care providers don’t have sufficient training to make fine-tuned diagnoses and end up treating the wrong thing. But if VULVA’s recurrences are frequent, I think it’s a wise idea for her to see a true specialist.”

A TVHE is likelier to pinpoint the problem. Even so, Dr. Herbenick warns that it may take more than one visit with a TVHE to solve the problem.

“I don’t want to over-promise, since BV remains a challenging diagnosis and often does come back at some point,” said Dr. Herbenick. “There’s no one-size-fits-all approach to BV, which is also why I think VULVA is best off meeting with a health care provider who lives and breathes vaginal health issues. The ISSVD is full of health care providers like that — they’re the Sherlock Holmes of vaginas and vulvas, none of this ‘shrug and here’s a script’ business. VULVA can check out for more information.”

Follow Dr. Debby Herbenick on Twitter @debbyherbenick

YOU CAN HELP: Wherever you fall on the debate about sex work — it should be decriminalized, it shouldn’t be decriminalized — everyone agrees that women who engage in sex work shouldn’t be punished. Yet thousands of women are incarcerated for prostitution or prostitution-related crimes. The Sex Workers Outreach Project (SWOP) has launched a pilot program to help these women. Go to to send a book to an incarcerated sex worker (books are in great demand), become a pen pal, or donate a book to a prison library. Since everyone agrees sex workers shouldn’t be punished, everyone should be able to get behind SWOP Behind Bars. I donated a book to an incarcerated sex worker today — it was easy! — and you can, too.

On the Lovecast, Dan talks guns and spit with the “Liberal Redneck” Trae Crowder:
@fakedansavage on Twitter

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Dan Savage

Dan Savage

In addition to being a nationally syndicated sex advice columnist and author of books, Savage can also lay claim to being the only person at his home paper to have actually converted his sexuality into a profession. He has a boyfriend and a child. He is also wealthy beyond the dreams of avarice and cheats at racketball... more

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