Our Bodies, Ourselves (9 page)

Vulvas have their own scent, just like other parts of our bodies and the bodies of our sexual partners. It's normal for vulvas to smell a little musky or acidic and, during menstruation, to smell somewhat metallic. It's also typical for vulvas to smell different at different times of the menstrual cycle. If a male sexual partner ejaculates inside your vagina, that can alter your scent, too, especially for a day or two after ejaculation. Products that scent or deodorize the vulva or vagina were not designed with our health in mind and play on women's insecurities.

If the scent of your vulva seems particularly strong or unusual, and that change sticks around for more than a few days, it could be a sign of infection. Make an appointment with a health-care provider and, until then, avoid using any commercial vulvar or vaginal treatment or medication not prescribed to you, including over-the-counter yeast infection treatments. If you don't know for sure what the cause is, taking the wrong medication can worsen the irritation and make it difficult to diagnose what if anything is wrong. (See
“Vaginal Infections,”
)

Throughout our lives there are times when taking care of our reproductive and sexual health involves getting help from health care providers. Many of the chapters in this book, including “Abortion,” “Sexually Transmitted Infections,” “Birth Control,” “Pregnancy and Preparing for Birth,” and “Navigating the Health Care System,” discuss the types of providers and the specific kinds of care they offer, how to find a provider, how to access care if you don't have health insurance or your insurance doesn't cover the care, and what to expect at a visit.

Most of the time, we visit a provider for our sexual health when a particular need arises: We need birth control or are pregnant or have an unusual vaginal discharge. A gynecological health care visit is also recommended if you have complaints about or issues with your period or any part of your menstrual cycle; if you are experiencing pelvic, vaginal, or rectal pain or discomfort; or if you're experiencing unexplained vaginal bleeding, spotting, or any unusual discharge.

It's also a good idea to have periodic visits once you are sexually active. Since most sexually transmitted infections (STIs) have no noticeable symptoms, it is wise to be screened for STIs before and after you have sex with someone new, if you are sexually active with more than one person, or if you think or know your partner has had sex with someone else. It is recommended that you have a gynecological exam by age twenty-one, even if you are not yet sexually active.

Other reasons to see a provider include:

• You want to start or change prescription contraception.

• You miss three periods or your periods become increasingly heavy or irregular.

• You have unusual genital discharge (which you might notice on your underwear) that lasts for more than a few days or that causes itching or burns or smells bad.

• You have a lump in your breast, or any bumps, sores, swelling, or redness in your genital area.

• You have persistent pelvic or genital pain with menstruation, urination, or sex, or in general, such as when sitting or walking.

• You have unexplained pain in your lower belly or around the pelvic area.

• You have vaginal bleeding that lasts for more than ten days, bleeding at times other than during or around menstrual periods, or flow during periods that becomes unusually heavy or light.

• You are planning to get pregnant.

• You find out you are pregnant.

• You are experiencing a miscarriage.

• You have problems, pain, or discomfort following labor and birth, a miscarriage, or an abortion.

Many different types of health care providers offer reproductive and sexual health care to women, including nurse-practitioners, physician assistants, midwives, and doctors such as pediatricians, family practice physicians, and obstetrician/gynecologists (ob-gyns). Some of us obtain care from providers who specialize in women's sexual and reproductive health, while others obtain gynecological care from primary care providers or internists (internal medicine doctors). Different providers have different training, styles, availability, billing practices, and expertise.

You can get the get the care you need in a variety of places, including private medical offices and health care clinics. Some clinics provide low-cost or free services. Family planning clinics such as Planned Parenthood that are funded by Title X (a federal funding program overseen by the U.S. Department of Health and Human Services) offer a broad range of related preventive health services, including routine physical exams; education on health promotion and disease prevention; breast and pelvic exams; cervical cancer screening; STI prevention, education, testing, and referrals; and pregnancy diagnosis and counseling. Title X clinics are required by law to see all women, regardless of ability to pay. To find a Title X clinic in your area, visit opaclearinghouse.org/search.

© Wendy Maeda

Because many health care visits related to our sexual and reproductive health will include a gynecological exam, this chapter provides an overview of what to expect.

A routine gynecological checkup generally includes an examination of your breasts and a pelvic exam, which includes an external genitals examination, a vaginal exam using a speculum, an internal exam of your uterus and ovaries, and sometimes a rectal examination.

• Schedule on a period-free day.
Since menstrual fluid can affect the results of some tests, try to plan your pelvic exam for a day when you won't have your period. Of course, it's not always possible to plan in advance, so if you have your period the day of your exam, call your provider's office or the clinic and ask if you need to reschedule.

• If you have symptoms, avoid sex and tampons.
If you are having an unusual vaginal discharge or other symptoms that you want evaluated, it's best not to use any medications
in your vagina, have sex, or use a tampon for a day or two before your appointment so the vaginal secretions can be seen and tested. And if it's possible that you have a sexually transmitted infection, abstain from sex until you can get tested (see
Chapter 11
, “Sexually Transmitted Infections”).

• Write it down.
Do you have questions about discharge, pain, contraception, or anything else related to sexual and reproductive health? It can be easy to forget important questions, even when you really want to ask them. Writing down your questions in advance can help you remember to cover everything you need during your appointment. If you chart your menstrual cycles, bring that information with you, especially if you want to ask your provider about anything related to menstruation or fertility.

• Bring support.
If you think you'd feel more comfortable, ask a friend, partner, or parent to come with you into the exam room. Your provider may ask her or him to leave at some point to ask you personal questions, but you can request the person stay or get invited back quickly. Similarly, if a parent or guardian has come with you to your exam and you want privacy, you have the right to ask that person to leave.

When you arrive at the clinic or office, you'll usually be given forms to fill out that ask important questions about your health history and any current health issues or problems you are experiencing. Complete these as fully and honestly as possible, as your answers will help determine your course of care. The information you provide and any test results are confidential.

In the United States, your health information is protected and private according to a law known as HIPAA (hhs.gov/ocr/privacy). You should be notified of the practitioner or clinic's privacy policies in writing, and you will be asked to sign paperwork regarding your privacy, including approving to whom your information can be released and under what conditions. (For more information, see
“Rights Regarding Medical Records,”
)

If the reason for your visit includes vaginal pain or irritation, you may be asked to urinate
into a cup so your urine can be analyzed for signs of a urinary tract infection or for a pregnancy test. (Even if you are certain you aren't pregnant, your health care provider may require a pregnancy test before prescribing birth control or inserting an IUD, or as part of a diagnostic workup for a problem like abnormal bleeding or pain.) If you don't need to give a urine sample, use the toilet anyway—gynecological exams are much more comfortable if your bladder is empty.

When you are brought to the exam room, the person doing the initial health assessment—usually a medical assistant, not the provider who will give you the exam—will take some basic measurements, including your height, weight, heart rate, and blood pressure. Then you will be given a gown to wear during the exam and the medical assistant will leave the room so you can undress in private. Sometimes, especially if you are a new patient, your provider may meet with you before you get undressed.

Let someone know if you feel uncomfortable being alone with the provider during the exam. You can ask to have a medical assistant or another attendant in the room. If your provider is a man, many offices do this automatically.

Once you are in the gown, your provider will come in and review your health history (the questions you answered upon arrival) and ask follow-up questions about that history or any current problems or concerns. If you have been doing regular
vaginal self-exams
or charting your
menstrual cycle
, you will be able to tell your health care provider about any changes you have noticed, or simply help her or him understand what is normal for you. If you know anything about the size of speculum that works for you or where your cervix can be found, tell the provider.

Having a gynecological exam is an intimate and invasive experience. But providers who do them over and over again sometimes forget this. If this is your first exam or you have had a negative experience with previous exams or you are feeling very anxious, let your provider know. Ask her or him to go slowly and explain each step as it happen.

Before beginning, your health care provider should wash her or his hands or use antibacterial gel. For the exam itself, your provider will wear gloves.

Many health care providers begin by performing a clinical breast exam. This involves examining your breasts for any possible signs of breast cancer or other breast problems. Usually your provider will begin by visually inspecting your breasts, looking for skin changes or visible lumps. Then your provider will use her or his fingers to feel all parts of your breast, looking for lumps or unusual textures, and check your armpits for swollen lymph nodes.