HEALTH

GOING DOWN THERE

YOUR EMBARASSING GYNECOLOGIST QUESTIONS ANSWERED

WRITTEN BY JULIE BURTON

“G ynecologist appointment” is probably not your favorite day on the calendar, but it’s a necessary one. It’s the only doctor that gets real up close and personal, so it’s easy for any woman to get anxious before heading to the gyno. We sat down with Dr. Jessica Pullen from Women’s Clinic of Johnson County and asked her the embarrassing questions for you. Her answers may make that next doctor’s appointment a little easier.

SIMPLYkc Magazine: Can you reassure us that every vagina size is normal?

Dr. Pullen: All sizes are completely normal. I’ve seen tens of thousands of vaginas. To complete training, you have to do a minimum of 200 vaginal deliveries. Most programs are set up to do vaginal deliveries your first year. Then you do a minimum of 200 C-sections your second year. You also must do 50 hysterectomies. And that’s not including the patients you see in the clinic. They want you to see as many patients as possible. So yeah, getting into the tens of thousands is easy to do. You’re normal.

SKC: Are there different size speculums?

Dr. Pullen: Yes, there are. There are metal speculums with two different builds. And plastic speculums that come in different sizes and shapes. It’s not associated with height. The vaginal cavity is larger after babies. Sometimes it’s just bone structure too. It’s nothing to be worried about.

SKC: Do you prefer women to shave or wax before an appointment?

Dr. Pullen: We don’t care at all. We’ve seen it all. Typically, I recommend against shaving with a razor. If you’re going to remove hair, I recommend getting a wax or using a bikini clipper. We see so many women with ingrown hairs and folliculitis.

SKC: The smell … do you notice a smell when doing a pelvic exam?

Dr. Pullen: There are different smells that are normal. Vaginal discharge is affected by your diet, lifestyle, and your activities. If there is a smell that’s foul or concerning, we want to check that out. I think women are more self-conscious about the smell than we really notice.

SKC: What is normal vaginal discharge? When should I see a doctor?

Dr. Pullen: The cervical mucus changes with the cycle. Normal discharge should be clear to white— maybe a slight yellow. But there shouldn’t be a strong odor, itching, or irritation. If you have something like cottage cheese consistency, you should get checked out.

SKC: I’m not interested in sex anymore—should I see a doctor about this?

Dr. Pullen: It can be very normal. It can ebb and flow with your lifecycle depending on your stress and whether or not you’ve gone through menopause. A large component of this is psychological. There are sex therapists for that. And sometimes it’s because of pain. There are things we can do to fix the pain. As you get closer to menopause it’s probably hormonal, and there are things we can do to help that too.

SKC: How does the vagina change after menopause? Is there anything you wish women knew about going into menopause?

Dr. Pullen: A lot of women don’t realize there are significant changes in the vagina as we go through menopause. We describe menopause as one year without a period. Menopause is typically associated with vaginal dryness and vaginal atrophy. The vagina loses its moisture and gets thin, and women can have pain or bleeding with intercourse. There are things we can do to help. The earlier we start helping you the less severe it will get. The other thing is that we like to see anyone having any kind of bleeding after menopause because oftentimes it’s the first sign of uterine cancer.

SKC: How far up can you see inside of us? What exactly do you see with the help of a speculum?

Dr. Pullen: We can see the cervix and the entirety of the vagina. When we do a bi-manual exam—when we put two fingers inside the vagina and push on the abdomen—we can feel the uterus and we can feel the ovaries. But we cannot see them. We do a lot of pelvic ultrasounds too to give us another view that’s not too invasive. SKC: Is it possible to get an abnormal pap if we had intercourse the night (or hours) before?

Dr. Pullen: It depends on the brand of solution you’re using for pap smears. Some brands specifically say the patient should not have intercourse 24 hours before because it will interfere with the pap results. A lot of doctors have gone away from using those types of brands. There are many brands that don’t require a patient to abstain from intercourse, so it doesn’t affect the pap. And usually, we can only tell if we put the vaginal discharge under a microscope and we’re able to see semen. You can see the sperm because they’re still alive within 48 hours. We can’t typically tell just by looking during an exam unless there’s signs of abuse.

SKC: What’s the most common STI in women?

Dr. Pullen: Most common is HPV. It’s so common that most people don’t think of it as an STI, and it’s common for your immune system to clear HPV. There are several types of HPV. We test for the ones that cause cervical cancer, and if you have one of those types some women will get a colposcopy. We recommend the vaccine for men and women. Next most common is chlamydia. It’s an infection where most women will have abnormal discharge, irritation, or pain. They can get pelvic inflammatory syndrome from chlamydia too and that can get women pretty sick. Left untreated, it can cause problems with fallopian tubes and cause infertility. It’s more common in the 18-28 age range, so we usually screen for that unless they request us not to. It’s treated by antibiotics. Herpes is very common also. There are treatments to take care of symptoms, but it can’t be cured. It’s very painful so people know when they have it. But they tend to spread it right before an outbreak.

SKC: Why don’t biopsies get pain blocks? When will we get pain control for things like colposcopy?

Dr. Pullen: In my personal experience, patients don’t have a significant amount of pain from colposcopy. It’s more uncomfortable from the speculum sitting inside you for a longer amount of time so that pressure is definitely there. If you had a colposcopy and it’s abnormal, you’d also have a leep, and this requires four injections into the cervix. The biopsies tend to be the pain equivalent of two hard pinches. Most women would prefer to get two pinches rather than being stuck with a needle four times. Some doctors use a topical anesthetic, which I use. If I have someone who is anxious, we can give them something to relax. A lot of doctors will offer that too. We try to make it as comfortable and fast as possible.

SKC: Is there anything else you wish more women knew?

Dr. Pullen: I think it’s important to go to the gynecologist every year. With the pap smear guidelines changing, some women don’t think they need to go in every year, but it’s important that they do because there are things other than cervical cancer that can go wrong. It’s good to have a doctor look inside the vagina to make sure you’re healthy. And get a breast exam every year too. If you have a question, ask it. It’s very unlikely someone hasn’t asked it before. That’s our job. We do everything we can to make you comfortable.