Date: 19 January 2017 11:34
For some women, preparing for a visit to the gynecologist is more involved than prepping for a hot date. I asked midwife Lauren Guehl, of Lonestar Midwives, if it really matters whether she's working with a freshly mowed lawn. "All I want is for women to be clean," Guehl said. Just showering in the morning before an afternoon appointment is fine, and she said actually feet are usually stinkier than anything else.
Guehl said there are lots of theories about whether to shave, wax or leave it alone, but according to Guehl, that's just personal preference — doctors truly don't care. The only time they do care is when women continually shave or wax and come in to have bumps and ingrown hairs assessed. "Obviously their bodies don't like their method of hair removal, so they need to find another system."
One of the biggest issues women are afraid to talk about is what happens to their vaginas after they have a baby. Guehl explained that a woman's vagina is sort of like an umbrella. It is designed to open up larger than its original size to accommodate a baby's head and body, then it neatly closes back up — at least relatively close to its original size. Vaginal exercises, such as kegels, can help maintain the pelvic floor. Sometimes though, the baby barrels out and overextends the 'umbrella' like a forceful gust of wind in a hurricane. Women often think the loss of their vaginal tone is just a casualty of having a baby, but Guehl said it doesn't have to be.
While loss of tone is totally normal, it is also totally fixable. If her vagina feels over-stretched, but the woman is happy with her sex life, there's probably no reason to interfere. But for some women, sex may feel very different or less enjoyable than it did before baby, and that's less than ideal. They might feel self conscious, or the loss of sensation can cause their enjoyment or interest in sex to tank.
In that case, Guehl urges women to talk to their doctors very honestly. They definitely won't be the first or last woman to have this problem. Guehl said vaginal rejuvenation should never be done at the sole request of a woman's partner, but if it's bothering the woman it's definitely an option. Depending on the reason for surgery, the procedure is sometimes covered by insurance, so women don't have to suffer in silence.
A woman's vagina might be technically running in tip top shape, but if she's never in the mood for sex, she can sometimes feel broken. "We should be able to bill for therapy," Guehl said. Women come into her office all the time saying they just have no sex drive. Their husbands want them to have their hormone levels checked, which Guehl said really isn't accurate. They want a prescription like female Viagra, which isn't typically effective at boosting their sex drive very well either. She said the secret is that most women's sex drives tank because life gets in the way.
Guehl said she's seen so many couples get divorced within four years of having children, and not because her libido died or he got complacent. Guehl said the fact of the matter is that life with littles gets busy. She sees this trend a lot in stay-at-home moms who are touched by their children all day and just need personal space at night to regroup before they get pawed again in the morning. It's natural for babies to need more attention than adults, but she said that doesn't stop some men from feeling rejected.
Being patient and understanding that this won't last forever does help, but Guehl also encourages women to make time for themselves and their partners. It's hard with a new baby, but she said she's horrified at how many women come in for a checkup a year after having a baby, and they've never left the child for even a few hours. "Your marriage can't survive that." She said most of the time, going away for a vacation fixes things and there's no medical issue. "New parents take classes on how to give the baby a bath, but that's not the kind of stuff you really need to learn," she said.
Painful sex isn't necessarily something you just have to deal with. Factors like ovulation, dryness and friction burns can all cause pain, and Guehl said sometimes sex hurts. "The moral of my story is that as long as it isn't severe, and as long as it is occasional, sometimes painful intercourse is normal." If it is a repetitive problem, or it affects your quality of life, then it should be investigated. Don't hesitate to bring it up with your doctor. She might just tell you that a little lube goes a long way.
Another casualty of childbearing, or even age, is loss of bladder control. After delivering a baby, vaginal tone may be great, but the pelvic floor is still weak and some women can't sneeze without needing to change their undies. Guehl said women can talk to their doctor about ways to strengthen their pelvic floor, but the main question to ask is, "How much does it affect your quality of life?"
She said if you can't walk down the street without fearing a sneeze, it's probably severe enough for medical intervention. But if it only happens when you laugh too hard every once in a while, your doctor might have you wait to do anything drastic — establishing a pattern of a problem is key diagnosis and treatment. She added that factors like whether you're done having children forever or even for a while is important to note, as well.
Although gynecologists and midwives are experts on the front end, they are well-versed in the inner workings of the rear entrance as well. Hemorrhoids are another subject women are embarrassed to broach, but again, Guehl said they are often treatable. There is a simple procedure doctors can try that ties off the hemorrhoids so they shrivel up and die. This is a good first step and short-term solution.
If a woman knows she's having more children and the threat of more hemorrhoids is on the horizon, a temporary quick fix might be just the thing to attempt first. It could permanently fix the problem, but if not there are more invasive procedures like a rectum dissection to try. That procedure is much more painful to recover from, so again, weighing the benefits and risks with her doctor is the best course of action for any woman who suffers from a permanent pain in the rear, Guehl said.
"Everyone knows babies don't fix marriages," Guehl said. Plenty of women grow up knowing they want three or four kids, but if they are overwhelmed by their first child it's not going to get better with a second, third or fourth. Guehl said it doesn't mean they shouldn't ever have another. But she advises women to be honest with their doctors about how they're feeling. They might need to give themselves more time to heal and adjust before they add another baby in the mix, and talking it through with a doctor can help a woman come up with a plan. Hormones can affect the desire for children as well. But if you know that during ovulation you desperately want a baby, and a week after you ovulate that feeling is gone, then it's probably best to hold off. Your doctor can help you space out your family so that you don't get completely overwhelmed trying to stick to a plan you came up with before you had kids.
Guehl said people often come to midwives with preconceived notions of birthing in the woods on the back of a whitetail stag with a songbird as the doula. But a midwife is a medical professional whose job is to help you achieve the ideal birth for your individual pregnancy. Some women are hell-bent on a vaginal delivery because they think it's what their midwife wants, but Guehl said it's not her body and she wants what's best for the woman. "In the same way we can choose our reproductive rights, we should be able to choose our delivery options as well to some extent," she said.
A woman came to her once who had a C-section with her first delivery. She insisted on a vaginal birth for her second pregnancy, but after discussing the risks that were specific to her pregnancy, she decided to schedule her second C-section. Guehl said women are subjected to public judgement by "Sanctimommies" the world over, however a lot of the pressure is put on by the woman herself. "Women torture ourselves to breastfeed. Then we torture ourselves if we can't. Nature is not predictable," she said. "All I want is for people to be happy and come back to me for the next baby."
"The one thing I wish people would ask more often is for my advice," Guehl said. Women come in with advice from their sisters, co-workers and 'Dr. Google,' but they fail to understand that their healthcare provider actually has access to their specific medical records. Medicine is not a one-size-fits-all business. Guehl said doctors are there to assess your individual needs and find what works for you, not what worked for a friend. Trust their medical expertise.
If a woman doesn't trust her doctor, that's a big red flag. One crappy office visit isn't enough reason to leave, Guehl said. But if there's a chronic history of leaving the office unsatisfied with your care, then it's time to look elsewhere. "Women think they can't switch providers, especially during pregnancy," Guehl said. "But that's just not true." She said it only takes about two days to completely switch over to a new office, and it's well worth it. If a woman trusts her doctor, then she's more likely to feel comfortable asking those embarrassing but vital questions, and she'll end up with a better quality of care.
Weird smells, sensations and growths aren't anything you'd want to discuss with a stranger on the bus. However your doctor is in the medical field because they want to help. Building trust will in turn build the confidence you need to ask those squirm-in-your-seat questions. And keep in mind, they've seen hundreds or even thousands of bodies over their career. There's often a solution to your problems. All you have to do is ask.