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Blinging out Your Lady Bits: Waxing, Vajazzling, Piercing and Other Women’s GYN Modification from Your Ob/Gyn’s Perspective

8/30/2016

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I can’t tell you how many disclaimers I’ve heard from women prior to their pelvic exams.  “I’m bleeding, haven’t had a chance to shave, etc.” are common disclosures before I do pap smears.  Believe it or not, unless a woman is pregnant or just in for a quick annual exam, I expect there to be some kind of change to have brought her to the office, and as long as she’s bathed that day, there’s generally not an issue.  After thousands and thousands of exams, I’ve seen countless self-modifications in grooming, piercings and body art.  Unless you’ve misplaced something in yours (where’s my comb again?) or had a truly unique example of body art (ie, a vagina with an owner’s manual), it’s unlikely to make an impression.  So, let me tell you a little about some of the more common things we see and our perspective on them.

Au natural:  For those women who opt out of hair removal, that certainly makes sense from an evolutionary perspective. Pubic hair may have evolved to help keep dirt out of the vagina, warm the genitals, or for pheromones. There is no shame in this management as it is the natural look.  The only time it would be an issue is if it reaches a length to braid since it can catch in the speculum (ouch!), or after a vaginal delivery and laceration repair (long hair can get tangled in the suture, and if you ob/gyn has to trim it in order to finish the repair, we are definitely NOT your local spa, so there may be some uneven edges).  We also do some trimming with clippers prior to cesarean deliveries.

Waxing: A very common management for women.  Generally neither particularly beneficial or harmful from a health standpoint; however, the microtrauma from frequent hair removal may predispose to folliculitis or occasionally cellulitis requiring antibiotics as well as susceptibility to herpes infection.  If this is your preference, and you aren’t having problems, then go for it!  If you are requiring frequent trips to your doctors office for symptoms and still want some control over your pubic hair, then clipping may decrease your symptoms in comparison to waxing or shaving.

Vajazzling:  In case you’ve missed it, the trend of applying Swarovski crystals to freshly waxed skin has become something of a phenomenon.  While this can help your mons be all matchy-matchy with your favorite 90s jean jacket, the application of adhesive glue to freshly waxed skin does provide an increased risk of trapping bacteria in the follicles, which in turn predisposes to infection. Also, it seems like it would be little uncomfortable for your significant other.

Labial and Clitoral Piercing: According to some women, these piercings can enhance their sexual experience and orgasms, and others feel a bit more naughty or adventurous after having these piercings placed.  For clitoral piercing, it is often preferable to pierce the clitoral hood rather than the clitoris itself to decrease (NOT eliminate) the risk of nerve damage. If you’re interested in heavier bling, the labia can accommodate larger jewelry, although this may predispose to stretching.  However, even for women adventurous enough to give this process a try, there may not be enough skin available to provide a safe piercing.  As far as safety goes, allow adequate healing time after the procedure, be sure to use a reputable piercing store (to minimize, although not eliminate, risk of infection), and make sure to pick a low-allergen material.  Obviously, it has baseline risks of bleeding, infection, nerve damage (among others) as well as possibility for traumatic removal if caught on clothing or during intercourse.  Also, the piercing would need to be removed during delivery of a baby or surgery.  Lastly, be aware that depending on location of the piercing, condom perforation may be an issue predisposing to unwanted pregnancy or transmission of STDs.

Douching:  The practice of using various chemicals to “clean” the vagina.  Per the American Congress of Obstetricians and Gynecologists, this practice should be avoided in favor of mild soap and warm water for vaginal cleaning.  Health risks of douching show increased rates of bacterial vaginosis, pelvic inflammatory disease, difficulty conceiving, ectopic (tubal) pregnancy and even cervical cancer.  Also to be avoided is placing anything you may eat in the vagina.  Regardless of what Dr Oz may say, a tampon soaked in yogurt doesn’t necessarily help with yeast infections, particularly if you don’t know how to take it out (and wait a few weeks to have it removed because you’re embarrassed).  I was tempted to mail that one to him and suggest a part 2 episode on how to remove tampons.

Thus concludes your friendly ob/gyn’s perspective on some common genital modification techniques.  So, please don’t stress before your next pelvic exam, it’s all good!

Nick
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What is my Rh status and why do I need to know it?  (How to keep your blood from hating your baby!)

8/23/2016

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​
​How do I know my Rh status and what does it mean? At your first prenatal visit, you will have a lab test to determine your blood type and your RH status.  The Rh status tells us whether you have a particular protein on the surface of your red blood cells.  This is kind of like a pirate flag to Rh negative blood cells.  90% of Caucasians are Rh+ and have this protein.  This frequency varies somewhat with other ethnicities.  However, if you are Rh negative and don’t have this protein, you will need to take special precautions during the course of your pregnancy.  

Why is being Rh negative a problem when you are pregnant? If you are Rh negative, there is a high likelihood that your baby will be Rh positive.  This is simply based on the fact that your partner is likely Rh positive (a pirate!).  Essentially, this means that your blood and your baby’s blood will likely be incompatible.  This incompatibility will not likely have any effect during your first pregnancy; however, if your baby’s blood leaks into your blood, which is a frequent occurrence during labor (and occasionally sooner if you have bleeding), your blood will develop antibodies against the Rh factor.  Much like you would keep a lookout for pirates after you saw them the first time, these antibodies patrol and attack any proteins that they see in the future.  This is called Rh sensitization.  In a future pregnancy with an Rh positive baby, your blood can attack your baby’s blood. 

What does it mean that my blood can attack my baby’s blood?  Once your blood has developed antibodies against the Rh factor, it can attack your baby’s red blood cells and kill them.  If this happens, it would essentially cause your baby to have anemia and can cause jaundice (yellowing of the skin), as well as more serious complications, such as brain damage, miscarriage or even stillbirth.  

How do we prevent sensitization?  If you are Rh negative, you will receive a shot called Rhogam during the time that your blood is most likely to be exposed to your baby’s blood (essentially, it provides a diversion for all of those pirate cells). This will prevent your body from developing antibodies and attacking your baby’s blood.  Rhogam is administered at 28 weeks because it will protect you from antibody formation for 12 weeks (essentially up until delivery).  Once you deliver, we will check the baby’s Rh status from a blood sample; if your baby is Rh positive then you will receive another dose of Rhogam to prevent any antibody formation that could have happened during bleeding from delivery. 


Would I need Rhogam any other time during the course of my pregnancy if I am Rh negative? Most women only receive Rhogam at 28 weeks and after delivery if their baby is Rh positive.  However, if you know that you are Rh negative and have had any of the following complications, you will likely need Rhogam to prevent sensitization: miscarriage, abortion, ectopic pregnancy, stillbirth, molar pregnancy, vaginal bleeding in early pregnancy, or abdominal injury during pregnancy. 


Bottom Line: If you are pregnant, you need to know your Rh status! If you happen to be Rh negative, make sure that everyone that takes care of you while you are pregnant (especially urgent care or the ER) is aware so they do not forget to administer Rhogam to prevent your blood from becoming sensitized!
Pam
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A Rose by any Other Name: Are my Lady Bits Too Big?

8/16/2016

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Especially with Doctor 90210 and other plastic surgeons offering labia shortening procedures, not to mention the option to mention spas offering the change to “bling out” your lady parts (Google vajazzle!), I get this question from patients all the time.  The labia are the part of the vulva that look like lips.  There are two sets of them.  The outer labia- aka the labia majora is larger (length can vary from 7 to 12 cm) and covered in pubic hair; the labia minora is smoother, smaller (length can vary from 2 to 10cm) and protects the vagina.  Just like your breasts, there may be some asymmetry- meaning if you look down there with a mirror, one labia may be larger or smaller than the other.  Remember all labia look a little different and this is normal.

Why are my labia bigger?
Just like any other part of the body (breasts, etc), some women have larger labia than others.  This is just normal variance in anatomy.  Contrary to popular belief, it is not caused by masturbation, intercourse or sexually transmitted diseases, although childbirth can sometimes change them.  For some women their “enlarged” labia can get in the way of certain clothing, cause irritation, discomfort pain or prevent them from engaging in certain activities such as gymnastics, horseback riding, cycling or even having sexual intercourse.   Weight gain can contribute to enlargement of the labia especially if followed by rapid weight loss resulting in sagging and an elongated appearance.  Labial piercings can also contribute to a longer labium because of the weight of the piercings.

Can surgery fix it?
The answer is first talk to your gynecologist.  First and foremost, you want to ensure that there isn’t a congenital abnormality, infection, abnormality from previous trauma or disease process which may require different treatment.  When patients come in wanting to surgically trim their labia, I usually try to talk them out of it because it is often not needed.  I also try to show them pictures of vulvas because they all look a little different, but that does not mean that they are not normal.  Unless there is a serious functional problem with your labia- inability to perform certain activities, surgical intervention is not the answer.   While the perception is that labiaplasty is a minor procedure, serious complications such as pain with intercourse, scarring, hematoma (severe bruising), and infection can and does occur.  Also, the recovery process is no cake walk.  Multiple sitz baths are required daily and great care has to be placed in order to minimize the risk of infection.  Special tight garments have to be used to decrease chafing in the area.  Lastly, if the purpose of the surgery is just cosmetic, it likely will not be covered by insurance and can cost anywhere from $3000 to $8000, and even if you elect to undergo surgery, the results you seek can’t be guaranteed. 
 
Ladies, labia come in all shapes and sizes, so unless your labia cause significant symptoms, learn to love yours J

Pam
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The Pregnancy Cookbook: How to Put a Bun in your Oven (predicting ovulation and your fertile window)

8/9/2016

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For some couples, getting pregnant requires little more than making googly eyes at your partner; however, for many others, pregnancy doesn’t come quite so easily.  Here we look at a few ways to increase your chances of successful conception by helping you to determine when you ovulate and in turn, when to plan intercourse.

What is ovulation? Ovulation is when your ovary releases an egg.  This window of opportunity for the egg to get fertilized is actually pretty short: 12 to 24 hours.  However, sperm are able to survive for a lot longer (from 3 to 6 days) and still fertilize the egg.  Ideally, having sex the day you ovulate would maximize your chance of pregnancy, but even having intercourse a few days before ovulation can result in a successful pregnancy, since sperm can survive for so long.  However, having intercourse after ovulation though is likely going to just result in a missed opportunity.  

So how can you best predict the optimal time to have intercourse and get knocked up?  Ovulation usually occurs halfway through your menstrual cycle, roughly day 14.  The average woman has a 28 day cycle counting from the first day of one period (day one) to the first day of the next period. But, as with everything pregnancy-related, there's a wide range of normal here (anywhere from 23 to 35 days).  If your menstrual cycle is not within this range, you should consider consulting with your doctor because you are not likely ovulating and may need an evaluation to figure out why.   

How to predict the big "O" (no, not that one..get your mind out of the gutter)?
Get an online app!  There are multiple apps that can help you predict your fertility window.  All you have to do is enter your last menstrual period and it will calculate your fertility window.   Remember to have intercourse on everyone of these days 1-2 times per day to maximize your chances (a common misconception is that having intercourse so frequently will affect the quality of your partner’s sperm). Personally, my favorite ovulation app is “Glow” because it’s very easy to use and gives a percent of successful pregnancy based on the day and your personal profile based on information you enter.  Really, though, there are hundreds of apps out there so download a couple of them and play with them until you are comfortable- remember most of these apps are free! 

Buy an ovulation predictor kit.  You can buy these kits at any pharmacy.  They look like pregnancy tests, and all you have to do is pee on a stick. These tests are looking for a rise in luteinizing hormone, which peaks 12-24 hours prior to ovulation.  They are pretty accurate and can really help you predict ovulation. The downside to these tests is they can be pricey- $20-50 per kit per cycle.  

Don't waste your time with these...

1.  Charting your basal body temperature: the idea is that you chart your temperature first thing in the morning.   During the first half of your cycle estrogen dominates and your temperature will be lower than it is in the second half of the month, after ovulation.  This is tedious and generally a complete waste of time because by the time you see a rise in temperature, ovulation has already occurred and you have missed your precious window of opportunity to have intercourse- ughhh...

​2.  Cervical mucous tests:  the idea is to check your cervical mucous everyday- closer to ovulation will go from white/ cloudy and stretchy to copious thinner clearer and a slippery consistency similar to an egg white.  If you try to stretch it between your fingers, you'll be able to pull it into a string a few inches long before it breaks. Now I know what you're thinking..pretty gross right? The only thing I have known this test to do is cause my patients a lot of confusion and anxiety. 

So, now you know a little more about how to plan intercourse in order to increase the odds of pregnancy.  Scheduled sex probably sounds a little tedious, but it should still be fun for you and your partner.  Just relax and don’t put too much pressure on yourselves, and then practice should make a perfect baby!
Pam
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What to pack for the *other* Labor Day!

8/2/2016

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We get this question from new moms all the time- what should I take to the hospital for me and my newborn?  There are hundreds of sample lists online and most are so long, it would probably require you to have to “check a bag”! In reality, your hospital room isn’t very large, and overpacking in a tiny room will likely be more of a hassle, not to mention make it less likely to find what you really need.  Here is a list of essentials of what moms really need for the big day:

1.       Most importantly, bring ID and your insurance card. Important phone numbers written down for your nurses are also very helpful. 

2.  If you are a first time mom, labor can be a very lengthy process. Unless you are okay with watching talk shows and reruns of The Big Bang Theory, bring your own entertainment: Ipads/Laptops- a way to watch movies, read books, music playlists and  keep friends and family updated on social media! Hospital guest wi-fi may be slow and unreliable, so you may want to download certain books and movies before your big day.  Also, decide how you are going to capture that special moment- if it is a special camera/video, make sure you bring chargers/extra batteries for ALL of your electronic devices. 

3.  Moms, the hospital already has a lot of pads and underwear, but bring a robe, comfy sweat pants or pajamas, and flip flops (They may also serve the purpose of shower shoes!).  Nursing tops and bras are good ideas, but the hospital already has breast pumps/nursing pillows if you need it.  Your milk may not come in until you leave the hospital, so bringing your own is likely unnecessary.

4. For your little one: The hospital will provide diapers/wipes/suction bulbs/blankets/bottles- pretty much everything you will need for your newborn, so don’t waste space or energy packing any of these.  All you really need is a couple of cute outfits that you want to take baby's first pictures in.


5. With that being said, don’t forget your toiletry/makeup bag so you can look great in those first pictures with your baby!

6. Also, you should pack at least one extra set of clothes that will fit you after you deliver.  After all, who wants to go home with their butt hanging out in the breeze from their hospital gown?

7. Last but certainly not least, the car seat!  Learn how to use the car seat before you leave for the hospital so you are not struggling the day of discharge.

Fortunately, no matter how hectic your “labor day” is, you won't forget the most important part of your list..your baby :)


Pam
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