Dr. Rich Farnam:
It’s awkward, but we have to talk about it. If you’re struggling to ask your OB-GYN questions because you’re too embarrassed, you’re not alone. In this video, we’re going to answer those questions and help you bridge the gap.
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Hi, I’m Dr. Rich. My passion is to empower women with practical knowledge about the world of women’s health. Today we have Darcie Camacho. She is our research coordinator and emergency department nurse. Thanks for coming.
Darcie Camacho:
Thank you for having me. So working with Dr. Farnam at an urogynecology office, I know a lot of my friends are scared to ask their doctors certain questions. So they’ll ask me. Some of the questions include. So I’m asking for a friend, Dr. Farnam.
Dr. Rich Farnam:
Asking for a friend
Darcie Camacho:
Does my vagina look normal?
Dr. Rich Farnam:
So you’d be surprised, this is not at all an uncommon question, and people can get embarrassed to ask about this. So, what we have to understand is there is a wide variation in shapes, sizes, probably the number one thing is what’s called the labia. So there’s the labia majora, which are the big ones and the labia minora, which are inside. All right? So those may be as small as one centimeter, or they may be as long as seven centimeters. So the range that you might observe may not be the range that actually exists for society, the range that different people will have. So I would say that almost always that is just normal variation. People have different sizes and shapes of noses, ears, everything. So rarely, rarely there are women who actually have an enlargement of the labia minority to the point that it’s actually physically uncomfortable, particularly with certain specific activities, namely bicycling, horseback riding, and this kind of thing. And there could be a circumstance where a surgical repair reduction is warranted. Okay. Now there is a whole separate field of cosmetic gynecology where people are displeased with the appearance and seek out a repair. There’s nothing wrong with that. People may want to, maybe it gives them better self-esteem and that’s totally fine.
Darcie Camacho:
And Jessica, there you have it.
Dr. Rich Farnam:
Perfect. And moving on to question number two.
Darcie Camacho:
Is it normal to leak when I cough, laugh, or sneeze?
Dr. Rich Farnam:
So incontinence, urinary incontinence, or leakage is a very common condition. So actually 1/3 of all women will have /this. And just like the first question, nobody wants to talk about it. Fortunately, most of these cases are mild, minor, maybe once in a while to a dinner party, if I laugh really loud and we can just do exercises and that will keep that in check. But if this gets worse over time, then there are certain treatments that we can do for that. There are physical exercises we talked about. There are medications that can help and in bad cases, we could actually look at doing some type of surgical repair. Now, what would cause this? Why would somebody leak? Well, most people think is just part of aging. In fact, that’s what a lot of people tell their friends, tell their children is going to happen.
Dr. Rich Farnam:
The reality is this is a disease condition and it is caused by weakness of the connective tissue. Now, primarily this happens because of childbirth, but there are a number of other risk factors, including heavy lifting, some type of instrumented delivery, if there are forceps or a vacuum that can actually increase that risk, smoking, anything that affects the tissue quality. There are certain genetic diseases that actually predispose to the weakness of the connective tissue. So in those cases, if someone’s bothered to the point where they really affect the way that they live and their quality of life, if you’re planning your life around your bladder, time to see a doctor. So let’s get in there and let’s talk about the options. Again, some of the minor in the office procedures, some of the minor surgical procedures. So it is common and there is an easy treatment. So was this Jessica? Who’s the culprit here? Pretty sure it’s Jessica.
Darcie Camacho:
I know Monica is going to ask me, “What kind of exercises?”
Dr. Rich Farnam:
Monica. All right. So the exercises would be something called Kegels. Everybody’s heard of them, essentially it is a way to tighten the pelvic diaphragm, the muscles that support the pelvis, and just like any other muscle, you have to provide strength. Now the root cause is actually a weakness of the connective tissue. Now we can’t fix per se the connective tissue. We can improve it, but we can’t fix it. But we can strengthen the muscles to compensate for that weakness. And ultimately, we can get a, I would say, stabilization of the symptoms and maybe even get some improvement. But if we’re looking to get this out of our life, that’s usually going to be a surgical option.
Darcie Camacho:
So the next question is, why does sex hurt?
Dr. Rich Farnam:
So this is also a no-no question. People don’t want to talk about this. So the term, the medical term for this is dyspareunia. So we’re going to hear a lot of fancy medical terms. I think the key to understanding sexual pain is to be very curious about the patient’s history. So we have to understand, when does this happen? Does it happen only in the beginning? Does it happen only with deep penetration? Does it happen even without sex? All of these different conditions are going to uncover a differential of a number of different causes. So if we just want to talk about one cause which would be what’s called deep dyspareunia, so only pain when you’re in the sex act. So deep inside, and when you feel pain. So that’s usually anatomic. So that means that there’s something in there causing the pain. I would say most commonly would be something called endometriosis. Also, there’s something called fibroids, which are smooth muscle tumors in the uterus that can cause that.
Dr. Rich Farnam:
Now, if we’re talking about pain only at the opening, oftentimes this is an issue of either the nerve endings, either they’re hyperactive or there is what we call vaginismus, another fancy word, which means there could have been something in the patient’s history that makes them have a negative thought or connotation about sexual activity. And involuntarily the muscles will just contract, but that can even prevent you from having sex. And so that would be totally different management. That would be more of a physical therapy type of strategy. And when we’re talking about menopause, so as women on average 51.3, but anywhere from 45 to 55 or surgical menopause, we’ll have a withdrawal of estrogen from the tissues and the estrogen causes strength and vascularity to the tissues. When that recedes, when we don’t have that anymore, the tissues get very sensitive and very dry.
Dr. Rich Farnam:
And we’ll call this urogenital atrophy. And that’s usually a pretty simple solution. Usually, we just replace the estrogen that’s been removed. But that’s honestly, that would be just the tip of the iceberg. There are so many other things in the differential. It is a conversation that fortunately Monica came up with. So in that circumstance, come on in, let’s take a deep dive into this, figure this out, and we’ll come up with a treatment option that is tailored to the cause in that particular circumstance.
Darcie Camacho:
That wasn’t Monica, I hope you’re happy, Aunt Tina.
Dr. Rich Farnam:
All right, moving along. That’s all the time we have today, but if your question hasn’t been covered yet, don’t worry! Drop it in the comments below and be sure to check out my Part 2 video which reveals more answers to your important health concerns. Click here to keep watching, and subscribe to stay informed on the latest advances in the world of women’s health!
