The Science of Women’s Health: Ob/Gyn Reveals 10 Truths You Need to Know

Dr. Jen Gunter (00:00:08):

That's a loaded question. I wish people would just forget the word hymen. It is probably the most misunderstood body part. So let's talk about pubic hair. Everybody wants to talk about pubic hair. It's so fascinating.

 

Mel Robbins (00:00:20):

I saw online that if I eat pineapple that my vagina is going to smell better. Is that true?

 

Dr. Jen Gunter (00:00:27):

Yeah. No, that's a load of garbage. So it's a vagina, not a pina colada. Your vulva shouldn't be smelling like a tropical fruit drink,

 

Mel Robbins (00:00:35):

But I want my husband Chris, to go down and drink the pina colada. Hey, it's Mel. Do you ever feel completely overwhelmed by the conflicting medical and health advice on the internet? Well, today you and I are busting medical myths and misinformation with a world renowned double board certified medical doctor. That's right. The amazing Dr. Jen Gunter is in the house. And look, if you're shy about these kinds of TMI things, don't you worry your friend Mel is going to go ask the embarrassing questions on both of our halves. I will go first. Should you sleep in underwear at night? Is wearing a thong bad for your vagina? How do you properly clean your lady parts? Anyway? What are the shocking period symptoms that nobody talks about? Don't lie to me. You've thought about these questions before and I know you want the answers. I sure do. And that's exactly where we're going today on the Mel Robbins podcast. Dr. Gunter, thank you for jumping on a plane and coming all the way to the Boston for the Mel Robbins podcast. We are thrilled that you are here.

 

Dr. Jen Gunter (00:01:41):

Well, thank you so much for asking me and I'm

 

Mel Robbins (00:01:43):

Thrilled to be here. So I'd like to start by having you speak directly to the person that is listening right now, and can you tell them what they may experience in their life and with their health if they listen to everything that you're about to share and they take the research back advice that you're about to give them?

 

Dr. Jen Gunter (00:02:04):

Yeah, I would say that if you take home one thing from what I'm talking about today is that the importance of facts of evidence-based information that will help you advocate for yourself in the doctor's office. It'll help you figure out what you're seeing online is truth or trash. And it'll help you feel less alone with your own body if you actually know the facts about it.

 

Mel Robbins (00:02:25):

Well, one of the reasons why I was so excited to talk to you, Dr. Gunter, is because you are the number one OBGYN that people turn to around the world to debunk all the myths that are out there about women's health. And we are going to get into every aspect of women's health. We're going to talk about menstruation and menopause and how to take care of your body. And before we do though, I just want to know, how did you get into being a OB GY and why have you become the doctor of reason and the doctor of research online?

 

Dr. Jen Gunter (00:03:04):

Well, I am probably more motivated by anger than anything else. When I was in medical school, I was really bothered by the fact this was in the mid 1980s. I was really bothered by the fact that everybody who was teaching me about the women's bodies were men and they were all good men. They weren't creeping me too men, but still, it was like, wait a minute. I thought this was the second wave of feminism. And I was reading my feminist literature, and here I was being taught about a woman's body by all men. And so that bothered me and I thought, well, I'm going to go into OB GYN. So that was the motivation for that. And the myth busting also kind of came from that. I had a significant personal health problem that resulted in a lot of city of health issues for my kids. And I got sucked into a lot of disinformation and found myself in that weird spot between medicine and not knowing and was trying to navigate it. And I thought, if it's really hard for me, what is it like for other people? I was always this annoying person in grand rounds at the back, like correcting everybody. I thought if it could affect me, then how does it affect everybody? And so I just decided that I was going to try to clean up the medical internet and here I am,

 

Mel Robbins (00:04:23):

Thank God. Why is real information about women's health so hard to find?

 

Dr. Jen Gunter (00:04:29):

I think that we do a bad job about teaching people about their bodies in school. So people start out without the information they need. They have limited times with doctors. They don't get listened to many of the times, some of it because the doctors aren't trained appropriately. Some because they have a 12 minute visit and then disinformation is sexy. It's a lot easier to tell people that you can solve their problem with some crazy restrictive diet or with some supplement or something else as opposed to talking about the things that are much more complex and harder to distill to sound bites. So I think it's this really sort of complex array of things that is all together affecting women.

 

Mel Robbins (00:05:10):

So you do a ton of debunking online. What is the current state of social media in terms of what it's talking about and what rises to the top when it comes to women's health and how is that making so many of us feel like we're in the dark when it comes to our bodies?

 

Dr. Jen Gunter (00:05:27):

Yeah, I mean fear cells on social media, fear cells in general with the media, but you see a clip and someone's telling you, if you don't take this hormone, this is going to happen. If you don't take this supplement, this is going to happen and you watch it and this person may be their doctor or researcher or they seem like they know what they're talking about. And so you become afraid and then you're much more likely to watch that. And then what happens is the algorithm feeds you that over and over and over again. The algorithms are so smart. It's why I get fed shark attack videos all the time. I'm scared of those. So once I see them, I watch them to the end. So the algorithm is not your friend

 

Mel Robbins (00:06:03):

When it comes to women's health. What is your approach to alternative medicine?

 

Dr. Jen Gunter (00:06:09):

Well, I believe women deserve facts and evidence-based medicine and alternative medicine is existing outside of that universe. And so I would say to anybody who promotes that, do not think that women deserve science. Do not think that women deserve studies. Do not think that they deserve the funding to know what's actually happening to their bodies. So yeah, I think that if your therapies are good, you should prove it. We shouldn't be going based on what you say, we should be going on. Facts. Women deserve facts.

 

Mel Robbins (00:06:37):

It's true. And I feel so bad for all the young girls that are out there probably getting all their information from influencers on social media.

 

Dr. Jen Gunter (00:06:48):

I mean, there's good influencers and there's ones that are not at all. And it's difficult to have a changing body as it is whether you're going through puberty, whether you're going through the menopause transition. But then if you don't have the facts to have that foundation, it just makes it so much harder. And that's really why I do what I do, because I don't want people to be going what the, I want them to have the empowerment that comes with knowledge.

 

Mel Robbins (00:07:13):

Well, it makes a lot of sense if you also don't know, and then you're experiencing this on your own and then you're too embarrassed to ask a question. Even when you do see a doctor, you're going to just completely start going, oh, there's something wrong with me. Oh, my body's the bad one or the one that smells bad, or I'm doing something wrong.

 

Dr. Jen Gunter (00:07:30):

Absolutely. And you might not even bring it up with your doctor because you think it's normal for you to be like that.

Dr. Jen Gunter (00:07:46):

Pubic hair.

 

Mel Robbins (00:07:46):

Your pubic hair. Thank you. I'm trying to be fancy here. So let's talk about pubic hair.

 

Dr. Jen Gunter (00:07:50):

Everybody wants to talk about pubic hair. It's so fascinating. It's something

 

Mel Robbins (00:07:53):

I'll tell you why. As a 56-year-old woman, I'm going to share something that I don't think I've ever shared publicly.

 

(00:08:00):

When I got engaged at the age, I guess I must've been 26, 27, I had this bachelorette party and my friends bought me this ridiculous thing to dress up in that just was this weird kind of series of ribbons that was tied together like a teddy. And when I stepped out, everybody was like, because I didn't do anything to my pubic hair. I mean, this would've been back in the early nineties, like trimming waxing Brazilian wax. This was not a thing. And so I had my first ever pubic hair grooming at my bachelorette party. Oh my goodness. Where my girlfriends were literally trimming around this thing that they had put me on. And it was the first time that I'd ever even known that this was a thing. And so when I look now fast forward and I'm 56 and I look at how obsessed even teenagers are about their pubic care. First of all, it's kind of sad. And secondly, I just think that there's probably a lot of misinformation about what you should do down there, what you shouldn't do down there, why to be careful around it. And so I'm just going to turn the mic over to you.

 

Dr. Jen Gunter (00:09:11):

Yeah, well, and it's not surprising that people have those questions because I swear every second month, every woman's magazine talks about pubic hair. It's the most important thing in a woman's life.

 

(00:09:23):

So yeah, I mean, we have pubic hair for a reason. Most likely it's to protect the skin, to help maintain the pH, help to trap moisture in. So it's probably less important now, as it was say 10,000 years ago when we didn't have the kind of coverings and ability to protect ourselves from the elements that we have now. And so it's a personal choice like any hair removal. And obviously with society it has sort of waxed and waned, pardon the pun, with importance. A lot of it, I think our current obsession with it is related to the fact that showing pubic hair used to be a sign of nudity. That was the sign of public nudity. So when people started removing more and more like in clubs and things like that, they could start to show more and more and more. So that was kind of part of the definition of public nudity.

 

(00:10:22):

So I think it's got that sort of titillation associated with it, but no one gets worked up if they see a dude's pubes hanging out from his swimsuit. Right, that's true. That's okay. It's okay that it sort of melds into the hair on his thigh. No one's freaking out going, oh my god. So I think it's just a personal thing. If people do all kinds of body modifications, people pierce their ears, they pierce their nose, they get tattoos, they remove pubic hair. Some of these things are more reversible than others. And I just think if you like it, that's fine. Just to keep in mind that if you start developing irritation, if you start developing problems, then that could be part of it. And sometimes we see issues when people have been removing pubic hair chronically, their skin starts to get drier. If that doesn't bother you, and you're just like, well, I'm just going to use a moisturizer, that's okay.

 

(00:11:07):

You're adults and you make a choice. But there really isn't a medical reason that we would recommend it. Apart from there is a condition called suppurativa, which is a chronic inflammatory condition of a sweat glands on the vulva. It also can affect in your armpits and other places, you have these specialized sweat glands. And for people with that condition, removing pubic hair with laser can sometimes be helpful. But people have to remember, when you remove pubic hair, it's traumatizing to the skin. You're raking a razor over the skin, so that's causing irritation or inflammation. It can introduce infection. We see lots of infections related to pubic hair removal. We see injuries and all kinds of things. So it's just people make choices all the time.

 

Mel Robbins (00:11:52):

Is it normal to feel embarrassed by the fact that you didn't know any of this?

 

Dr. Jen Gunter (00:11:57):

The reason why people don't know is nobody talks about it.

 

(00:12:00):

So if nobody explains to you the names of your body parts when you're first using them, if nobody talks about it in school, if every message you've seen has been damaging or that you're dirty and disgusting, you walk through all the stores and you see all of that. You watch a movie and there's no foreplay and no pubic hair. And so everything that you've seen, you see women's magazines that tell you the most important things, your pubic hair and you see all this, of course, it would be normal to say, well, how did I not know this? You didn't know this because the system was stacked against you because we haven't even been able to say vagina in print until when was it? Maybe 15 years ago, 20 years ago. I might be wrong. And maybe this is one of these truthy sounding things, but I heard it wasn't until the Vagina Monologues that the New York Times could put vagina in print. So if saying the word vagina has been basically forbidden in public until what, 1990 ish, how could people know?

Dr. Jen Gunter (00:13:07):

That's a loaded question. I would say that there is a large industry out there trying to make you think that your vagina is a broken heap of something that is the worst possible thing you could imagine. If you walk into any grocery store, drug store, you see shelves and shelves and shelves of products designed for the vagina and the vulva. And none of them are necessary really except menstrual products. But you see all these things. And of course, even if you don't have any symptoms at all, how could you not be affected by all of that? So I think the big thing that we're getting wrong is that the vulva and vagina needs some kind of extra special care.

 

Mel Robbins (00:13:47):

They don't,

 

Dr. Jen Gunter (00:13:48):

No, the vagina is a self-cleaning oven takes care of itself. You don't need to do anything there. And the vulvas just skin, I mean, people have been taking care of their vulvas for tens of thousands of years without special wipes and washes, and nobody died out because of that. So I think it's really important for people to remember that there's really nothing special that's needed. You can use a cleanser down there if you want to on your vulva on the outside where your clothes touch the skin, not inside, just like you use a cleanser elsewhere on your body and that you're good to go.

 

Mel Robbins (00:14:19):

So just so I get the terminology right, and I'm embarrassed that I'm about to clarify this as a 56-year-old woman, but I'm going to ask anyway. So the vulva is the stuff on the outside. It's like the curtains and the vagina is the inside.

 

Dr. Jen Gunter (00:14:33):

So the vagina's inside where you would reach inside to pull a tampon and that type of thing. The vulva is where your clothes touch the skin and the vestibule is where the two meet.

 

Mel Robbins (00:14:42):

Okay. Wait, so now you just added a third thing I did. So the vulva is the outside?

 

Dr. Jen Gunter (00:14:47):

Yes.

 

Mel Robbins (00:14:47):

So as you're sitting here listening to Dr. Gunter, if you're sitting, it's what's pressing against your pants or your underwear if you're wearing it. Exactly.

 

Dr. Jen Gunter (00:14:56):

Okay. Exactly.

 

Mel Robbins (00:14:57):

And then when you open that up, you call that the vestibule.

 

Dr. Jen Gunter (00:15:00):

Yeah. So think about a doorway, right? So if you're outside on the street, you're looking at the building face, that's the vulva. If you step in the doorway, that is the vestibule. And if you open the door and go in, that's the vagina.

 

Mel Robbins (00:15:11):

So does your vulva and vagina have a pH?

 

Dr. Jen Gunter (00:15:15):

Sure. Everything. Your skin has a pH, so your skin has a pH, your mouth has a every party body that has water, it has a pH. And so the vagina has a pH that's between about 3.5 and 4.5, it acidic. And that exists as part of controlling the vaginal ecosystem. That is what allows the good bacteria to grow that stops the bad bacteria from growing. It's what keeps the whole thing as it needs to be. The skin pH is a little bit higher. And so what you don't want to do is introduce products into the vagina, even water, because that can actually damage that ecosystem and that actually can cause the pH to rise. So an elevated pH in the vagina is a sign that there's something wrong. It's not a cause, it's the result. And so you can't change it with any kind of product. It's an inside job.

 

Mel Robbins (00:16:07):

So is there a pill or a supplement or some sort of product that we need in order to clean or balance the pH of our lady parts?

 

Dr. Jen Gunter (00:16:17):

No. So the whole balancing of pH is this big myth. Anyone who tells you that you can balance the pH of your vulva vagina has outed themselves as being an idiot on the subject. So you can't do that. There's no product that can do that. And I always tell people, you should be blocking people online if they're talking about that.

 

Mel Robbins (00:16:35):

So how do you know if your pH is off?

 

Dr. Jen Gunter (00:16:37):

Well, if you don't have any symptoms, you don't need to worry about it.

 

Mel Robbins (00:16:40):

And what symptoms would I be looking for?

 

Dr. Jen Gunter (00:16:41):

So if you have a discharge that's different for you, if it's yellow or green or has a smell or it's got blood in it, if you have itching either inside or on the outside, you should see your doctor. We check your pH of the vagina to help us make a diagnosis of some conditions. But an elevated pH in itself is not necessarily a sign for that. Anything needs to be done medically. Also in menopause, the pH of the vagina rises if you're not using estrogen.

 

Mel Robbins (00:17:11):

You said that the vagina is a self-cleaning oven. What does that mean?

 

Dr. Jen Gunter (00:17:15):

That you don't need to do anything to it. When you think about a self-cleaning oven, if you took any abrasive cleaners to it, you would damage the inside of it. And so that's what that analogy is all about. So you don't need to add anything to it. You're going to damage it.

 

Mel Robbins (00:17:28):

Got it. Well, now I'm thinking about my oven because I always spray something in there before I turn the dial. So I'm both being marketed to incorrectly for my oven and I'm being marketed incorrectly for my vagina.

 

Dr. Jen Gunter (00:17:42):

Well, I just want to say I am certainly not an expert in oven technology, and I get around oven cleaning by just not doing it.

 

Mel Robbins (00:17:50):

So I saw online that if I eat pineapple that my vagina is going to smell better. Is that true?

 

Dr. Jen Gunter (00:17:56):

Yeah, no, that's a load of garbage. And I think it's really important for people to know that anytime they hear someone saying that, the underlying message is they want you to believe that your vagina stinks. It's this all based in this idea that they want you to think that there's something wrong or bad or dirty with your body to sell a product or sell a diet or to just get attention and clicks. So you can't change the odor of your vagina with any kind of food.

 

Mel Robbins (00:18:21):

What if you don't like the odor?

 

Dr. Jen Gunter (00:18:24):

Well, if you think that there's something different, medically different, you should go in and get evaluated and get tested to make sure that what's going on is not a medical condition. And if there isn't a medical condition, then I think it's important to talk with your medical provider what's bothering you. But many, many people are really affected by that disinformation I spoke about earlier about all the shelves and shelves of products that they've been subjected to. They've often had awful things said to them by men about how their bodies smell. I spent a lot of time undoing harmful words from men.

 

Mel Robbins (00:18:59):

I am sitting here reflecting on what you were saying about the way that there's been so much misinformation, and I've always been completely paranoid about smell. And I can think all the way back to college and hearing a male friend talking about somebody he had hooked up with and that she smelled bad. And for the first time, I think it was the first time I ever thought to myself, wait a minute, does everybody talk about this? Do we smell bad? And it has been something that stuck in my mind and has made me absolutely paranoid. So do not worry about it unless there is something that makes you worried and then go talk to a doctor.

 

Dr. Jen Gunter (00:19:44):

Yeah. So your experience is really common. I would say that I have this conversation once a week in the office. I'm not kidding. Once a week I'm undoing damage created by careless awful commentary from men. And often this is commentary that comes in the bedroom. Imagine you're supposed to be with somebody who loves you and they tell you that you stink. What kind of person does that? So yeah, there's this whole industry, this industry of feminine freshness. If you look at even today, the marketing, they tell you if you can invest in feminine freshness, you'll have more confidence. You'll have more confidence. Uncrossing your legs. I've seen that in an advertisement. This is all built to sell product. And I would say that the least educated person about a normal vuln vagina is a man.

 

Mel Robbins (00:20:36):

Well, they don't have one. So it helps to actually understand the equipment that you're trying to fix. You mentioned that you can clean the outside, but you don't want to put anything on the inside. So is there a particular type of product or product to avoid when you're thinking about cleaning your body and your vulva and the vestibule?

 

Dr. Jen Gunter (00:20:59):

Yeah, so generally I tell people to avoid everything associated with a feminine hygiene industry. If the wash is specifically for the vulva, it's just part of the pink tax. That's the best thing about it is you're paying more. But studies tell us actually that using these feminine hygiene products are associated with a higher risk of infections and other problems. So you don't want to use those. And they often have fragrance. And there's also the destructive messaging. It's a vagina, not a pina colada. Your vulva shouldn't be smelling like a tropical fruit drink. It should smell like a body part. So there's all that destructive messaging. So what happens is you can get a buildup of sebum on your skin just like you can anywhere else. And some people want to wash that off. And so a cleanser, just a cleanser like you would use for your face, a gentle facial cleanser. I use either a CeraVe product or use se, just whatever's on the market. But you want to be a cleanser, not a soap, because soap raises the pH of the skin and soap is drying. So a cleanser is the best thing, but it doesn't have to be a special vulva cleanser. A gentle cleanser that you use for your face is just fine. Unscented.

 

Mel Robbins (00:22:05):

I had to laugh at the pina colada thing because I literally was sitting here thinking, but I want my husband Chris to go down and drink the pina colada. You know what I mean? So I am literally subject to the marketing,

 

Dr. Jen Gunter (00:22:16):

But you know what? He should think that your normal body is like that. It's exciting that you don't need sort of this artificial smell to make you enticing. That's all marketing.

 

Mel Robbins (00:22:33):

I had never thought about it that way. Now let's talk about discharge. Is discharge normal?

 

Dr. Jen Gunter (00:22:38):

Yeah, it's normal to have up to three to four milliliters of discharge a day. And so your vagina is constantly shedding cells. That's part of the way it protects itself. There's mucus coming out and the cells actually bad bacteria attached to the cells, and it's kind of like a way to flush things out. So it's a constantly sort of cleaning process, if you will. I mean, cleaning's not the exact right term, but it's an analogy. So go with it. So the discharge is just part of the normal healthy ecosystem. Just like you have saliva, that's part of your normal healthy ecosystem in your mouth. Everything's lubricated so it doesn't feel dry stuck together. So you'll have up to three to four milliliters of discharge, which is pretty significant. And I actually had a viral moment on TikTok where I showed people what normal discharge look like on my underwear, and people freaked out. They hadn't seen that. We use all these euphemisms to talk about discharge, and I'm like, look, this is normal. It's a normal amount of discharge and get over it.

 

Mel Robbins (00:23:35):

So is it like blowing your nose in a Kleenex sort of situation?

 

Dr. Jen Gunter (00:23:39):

Well, it can vary. Some people can have very little, they might have almost nothing. And some people can have a healthy stripe on their underwear and anything in between, and that's okay.

 

Mel Robbins (00:23:48):

I have never heard anybody explain discharge and connect it to saliva. But when you talk about it in that context, it makes perfect sense. And again, 56 years old, anytime I see discharge, I'm like, something's wrong with me. That is bad. I don't want that in my underwear. You said three to four milliliters. How much is too much?

 

Dr. Jen Gunter (00:24:12):

Well, everybody's different. And obviously when we talk about that volume, we're talking about within two standard deviation. So if you're soaking a mini pad, you should probably go in and get that checked out. That would be at the upper limit of normal. But many, many times I have women come into the office and they think that their discharge is abnormally heavy, and they show me, and I'm like, no, that's normal. And also when you ovulate too, you'll get this really heavy, thick mucus that can even be dripping out of your vagina into the toilet.

 

Mel Robbins (00:24:45):

What should you look for in terms of, okay, I want to go see my doctor when it comes to discharge? Because having two daughters, this is one of those things that I hear them kind of complaining about or if they ever complain about anything like, is this normal? Is discharge normal? And so other than it seems like too much, is there a color? Is there a smell? What should you look for?

 

Dr. Jen Gunter (00:25:08):

Yeah, so discharge white to clear discharge is normal. Even a little bit of cream, if you have discharge that is dark yellow, if you have discharge, that's green. If you have discharge, that's got blood in it. Those are all reasons to see a healthcare provider, if there's an odor associated with it, if you have an itch, if you feel irritation, if you have pain with sex, those would all be reasons to see a healthcare provider. And also if you think you could have been exposed to a sexually transmitted infection,

Dr. Jen Gunter (00:25:45):

Yeah. So I would say one of the biggest myths is that a penis is a reliable way to achieve orgasm. And I would say it's probably the least reliable way. So many, many women are made to feel that if they don't have an orgasm with penile penetration, that there's something wrong with them, and that's actually normal. Lots of people don't, there's nothing wrong with you. If penis and vagina sex isn't what gives you an orgasm. This idea that both people should orgasm at the same time is also that's Hollywood, which invests what zero seconds in foreplay. The idea that you need. Some people need a lot of foreplay, some people want a lot of foreplay. The idea that you should just orgasm like that. Also, that's a Hollywood myth. And the idea that orgasm is needed for pleasure. So pleasure, desire, all of these things are important in this sexual experience. And so if somebody feels very satisfied with their sexual encounter and they haven't had an organ, that's also okay. We shouldn't be making sex necessarily goal oriented. Obviously, if that's what you like, that's different, but it's important for us to understand. There's a big wide range of what people,

 

Mel Robbins (00:26:56):

I think that's really important because I would imagine if you're having trouble having an orgasm with penetration, or if it's taking you longer than you think it should, and you start to develop a story in your head that there's something wrong with you or that this is very hard for you to do, I would imagine that all of that stress and the story you're telling yourself also interferes with your ability to have an orgasm.

 

Dr. Jen Gunter (00:27:21):

Absolutely. Things that take you out of the moment. So mindfulness plays a big part in a good sexual experience and things that are taking you out of that. Just like is there a pile of dirty laundry? Different things can take you out of that moment, right? So yeah, I think it's just really important for people to understand that it's a pleasure is generally the goal. And again, people have different desires, different things that they want to get out of sex. And so it's important to think about that whole range of experience. But in general, I would say the biggest myth that I undo is this idea that the penis is the bringer of the orgasm. I mean, obviously there's lots of people who, lots of women having sex with women who have a fantastic, amazing sex. There's people who have fantastic, amazing orgasms with vibrators, get over the penis. I mean, it's great, but it, it's not the be all in the end all.

 

Mel Robbins (00:28:15):

If somebody's listening and they do have trouble having an orgasm, do you have particular advice or recommendations that you would give to somebody?

 

Dr. Jen Gunter (00:28:24):

Well, there's a couple of good books that I would recommend Come As You Are, I think is a really great book by Emily Nki and Better Sex Through Mindfulness by Dr. Lori Brodo. So those are a couple of good books that I recommend. A sex therapist can be helpful, just learning the mechanics, understanding things and exploration, getting a vibrator, trying different things, seeing what pleasures really sort of thinking about all the different tools that might be available to you.

 

Mel Robbins (00:28:56):

So if you're having sex and it's pleasurable, but it's painful, what do we need to know?

 

Dr. Jen Gunter (00:29:02):

So I would like people to know that pain with sex isn't a normal experience, and if you have pain with sex, your healthcare provider should be helping you out. Too often I see people who just say, well, I told my doctor, he said that was normal and it's not normal. So pain with sex is a medical condition and it can be caused by many different things. So a yeast infection can cause pain with sex, for example, the changes with menopause can cause pain with sex. People can develop tight muscles around their vagina condition called vaginismus, which can cause pain with sex. People can have a nerve pain condition, they can have skin conditions that can cause pain. With sex, there's many, many different things that can cause it. Endometriosis can cause scarring at the back of the vagina, and that can cause pain with sex. There's a condition called a painful bladder syndrome. So you think about all the different structures that are around there, so many, many different things can cause pain with sex. So it's important to get an evaluation and get a diagnosis so then you can hopefully get the right treatment.

 

Mel Robbins (00:30:01):

Dr. Gunter do all vaginas, self lubricate.

 

Dr. Jen Gunter (00:30:05):

Everybody makes vaginal discharge, but there's going to be a spectrum with sexual activity. There's also going to be a spectrum about how much lubrication is made in response to it. There could be a whole different reason for that. Stress could play a role. Your physical health, the amount of foreplay you've had, how you're feeling at the moment. And so if you need lube, great. You need lube. And if you don't need lube, great. You don't need lube. If you just like lube because you like it, great, you like lube, why not try different things?

 

Mel Robbins (00:30:34):

I take it we should be avoiding the lube that smells like a pina colada.

 

Dr. Jen Gunter (00:30:37):

Well, I would just tell people to be mindful that there are lubricants that can be irritating, and there are lubricants that have what's called a high osmolality, and those can actually cause damage to the vaginal mucosa. They can be irritating over time. They can even cause some changes that might make it easier for you to contract HIV if you're exposed. So to just be mindful about the warning, the warming ones like that. So there is certainly potential for irritation with some of them, and some of them I think have menthol in which can also be that provides that warming or cooling sensation that could be very irritating to the tissues. So as a gynecologist, I always recommend people if they're having any kind of issues, a silicone-based lube tends to be really very well tolerated, but there's lots of good water-based lubes. You can use oil. So there's lots of different options available. And obviously if you use something and it irritates, you don't use it again.

 

Mel Robbins (00:31:37):

That was a big word, the osma. Yeah. How would I even know if it has, I can't even say

 

Dr. Jen Gunter (00:31:44):

It. Yeah, well, you would have a copy of the vagina Bible or you would go to my blog, the agenda and you'd be able to look up some of that stuff. So osmolality is basically the concentration of the molecules and water. And when you have a substance that has a high osmolality, it's going to pull water away. So we know the osmolality of the vagina is around like 180, 200. And so if you have something that's much higher than that, actually, again, this is a bit of analogy, but can dry out, the vagina, can pull water out, and that can actually cause some damage to the cells. And we see some of these products have very, very high, especially the things like the warming or the cooling or other types of things. So what

 

Mel Robbins (00:32:28):

Are the like nos? So as a gynecologist, if I'm looking at a lube, what do I want to get? What's your favorite lube?

 

Dr. Jen Gunter (00:32:34):

Well, obviously as a gynecologist, we're going to give the more sort sort of general answer because there's different situations, but I would say in general, the least irritating lube is a silicone-based lubricant, but not everybody likes the way that feels. So each lube has a different slip or feel to it, and there's lubricants, and obviously you can't use oil-based if you're using a latex condom, it can weaken that.

 

Mel Robbins (00:33:01):

Wait, okay, I didn't know any of this. So hold on a second. So does that mean coconut oil, olive oil? What kind of oil do you

 

Dr. Jen Gunter (00:33:10):

Recommend? So some people use oils, but they also are commercial oil-based lubricants as well. So anything or an oil can weaken latex, so you can't use that, but you can use water-based and silicone-based lubricants with latex condoms.

 

Mel Robbins (00:33:23):

So Dr. Gunter, what is the hymen? Does it break when you have sex? What is this thing?

 

Dr. Jen Gunter (00:33:29):

I wish people would just forget it. Forget the word hymen that just erase it from the collective knowledge. It is probably the most misunderstood body part. When we're infants, we have a pretty large hymen. It's a big, what we call mucosa, this big membrane that covers a large part of the vagina. And if you think about when you are an infant, you're leaking stool and you're leaking urine, and it would kind of make sense that you might have a bit of a barrier there. But then as you grow, the hymen basically becomes a nothing burger. And when you get exposed to estrogen, when you start to go through puberty, it just becomes like the vagina. Some people, a very, very, very small percentage, might have a little bit of tightness left in that hymen when they're older. That would be the minority that would be like I run a specialty clinic where I see people have pain with sex, then I might see that once every two years.

 

(00:34:32):

So again, that shouldn't be something in somebody's common collective. I tell people, think about the hyman like baby teeth. It's something you had at one point in time. It's served some kind of purpose and now it's not an issue. So the hyman doesn't break with sex. There's no cherry to pop. It's not a freshness seal. Most people don't have any bleeding the first time they have sex. So this is this whole myth that has sort of been created by I would say the virgin industrial complex. Virginity is a social construct. It's nothing physical. You can't tell. There's actually been studies we can't tell looking at somebody whether they're sexually active or not, we can't tell based on physical exams. Really? Yeah, I didn't know that. Yeah, so it's this whole awful industry and there's these awful doctors offering to rebuild ahy, which isn't even a thing. It's just, it's so awful and it's so predatory, and it's all made to make women feel as if they're damaged or spoiled, which is how different is that than making women feel that they stink. Everything is about making women feel smaller and damaged. And whenever you hear any message, you always want to think, okay, if I keep that thought along the rest to the conclusion, does that make me less of a person? And if it is, then that thought is wrong.

 

Mel Robbins (00:35:53):

It's so true. I've never really thought about the enormity of the messaging. I don't ever hear women or men standing around talking about how somebody's ball stinks or that once a guy loses his virginity that something happens to his penis.

 

Dr. Jen Gunter (00:36:12):

Or the more erections the guy has, the more rubbery and fla that his penis might get, right? That's another big myth. The more you have sex, your vagina's going to get stretched out. I'm like, have you even ever seen a woman? What is wrong with you? Does your mouth get stretched out from eating? What is wrong with you as a person to say that?

 

Mel Robbins (00:36:30):

Well, I'm sitting here laughing like it. I bought into all of these myths,

 

Dr. Jen Gunter (00:36:37):

Right? I mean, but if those things got stretched out, then what would happen when you had a big bowel movement? Seriously, your body is designed, your muscles, everything's designed to stretch and come back and has elasticity. And this idea that the only body part that gets worn out or overstretched is the vagina is this big patriarchal awful myth. That's so true. Yeah. I mean, it bounces back after you have a kid again. If we worried about things getting stretched, then how does that work with an erection? Think about how the skin is stretched and then it goes flacid. Well, my gosh, if you have four or five of those, your penis is going to be ruined.

 

Mel Robbins (00:37:19):

Unbelievable. You're the best. Oh my God, I wish I knew you when I was in my teens. I've spent decades living as if these myths were

 

Dr. Jen Gunter (00:37:30):

True. Well, I think if I ever write an autobiography, it's going to be titled, wait a minute,

 

Mel Robbins (00:37:35):

That's a great, great title for you. So wait a minute, do you need to wear

Mel Robbins (00:38:12):

Now, I remember growing up, my mom always used to say, you got to sleep without underwear on because you got to let it all air out. And that seemed to make sense to me. But now I'm sitting here going, wait a minute, does your vagina need to breathe at night?

 

Dr. Jen Gunter (00:38:27):

Now your vagina doesn't have lungs, so no. Oh my God, no. I mean, no, you don't need to air it out. The one minor exception might be if you're wearing latex against your skin all day, something that traps moisture and causes rubbing and irritation. So in the same way, if you think about a baby in a diaper that it's so occlusive because it's meant to stop any urine from getting outright. So the idea that if you've had something occlusive on your skin for long periods of time, yes, it is good to give your skin a break from occlusion, but that's not what underwear is. I'm always like, when people say that, have they seen underwear? What underwear is like that? Well, what about

 

Mel Robbins (00:39:15):

Shapewear? Does shapewear, is it bad for your vagina

 

Dr. Jen Gunter (00:39:20):

Health? No, it's not. Your vagina's on the inside, nothing on the outside is going to affect it. So if your shapewear is irritating your vulva, then it's probably a bit too tight. Just like if it's irritating in your groin or something else. Just like if your shoes are too tight and they're uncomfortable, but if it's comfortable and you're fine, then where would you,

 

Mel Robbins (00:39:39):

I saw something online where a person was going off, of course, about the fact that lace underwear can give you a yeast infection.

 

Dr. Jen Gunter (00:39:48):

No, I don't know where people come up with these things. I think though, again, follow it through to the end, who wears lace? Loose girls, right? Black lace. So if you think about this white cotton underwear myth, where does that come from? Well, who wears black lace underwear in the fifties? That would've been those kind of girls, right? I mean, awful patriarchal ideas. So yeah, I mean, the idea that the color of your underwear is going to have some kind of health repercussion. Well then why isn't my green shirt affecting my skin? Why isn't your black shirt affecting your skin? How does the color of fabric only uniquely affect the vulva? Right? That doesn't make any sense at all. So no, I mean, lace is fine. Again, if it's irritating you, if it's in the, we've all put on underwear where it's just caught in the wrong place in your groin or just like the wrong place, then put a different pair on that's really about the fit.

 

Mel Robbins (00:40:50):

So obviously a thong is fine as long as it's not irritating you.

 

Dr. Jen Gunter (00:40:54):

Yeah, exactly. Everything's fine as long as it doesn't irritate. Look, if you want to wear something that's too tight, look, I personally, I like to be comfortable, but I'll admit I have worn uncomfortable shoes. They looked cute. So each to their own.

Dr. Jen Gunter (00:41:24):

Yeah, so unfortunately diagnosing a yeast infection or bacterial vaginosis over the phone or remotely is very difficult because the symptoms can overlap a lot and there's lots of things that can produce identical symptoms to a yeast infection.

 

Mel Robbins (00:41:38):

What are the differences between them?

 

Dr. Jen Gunter (00:41:40):

So bacterial vaginosis is a change in the vaginal microbiome that has allowed emergence of what we call anaerobic bacteria. So bacteria that is less healthy for the vagina, normally that bacteria is kept in check by the good bacteria. So it's been allowed to overgrow and it has changed the bacterial makeup of the vagina. And it can produce an odor, it can produce a discharge, and that can be a little bit irritating as well. Sometimes people get an itch, everybody's different. A yeast infection is an overgrowth of yeast. The pH of the vagina remains the same where the pH rises with bacterial vaginosis. And we don't really understand why people get recurrent yeast infections or we all have yeast in our vagina. We have yeast on our skin, we all have yeast everywhere in small amounts. And why for some people, yeast starts to overgrow. We don't really know. There certainly are some factors that are linked to it, but so sometimes it could be that people acquire a strain that's more virulent, more aggressive. There may be local immune system issues with the vagina as well. Estrogen in the vagina can sometimes increase their risk of yeast infections. That's why we see more in pregnancy as well. So there can be lots of different reasons for that, but other things can cause itch as well. So people can develop a dermatitis of their vulva and it can be very itchy

 

(00:43:00):

And they can be misdiagnosed as having a yeast infection. So it can be hard to tell over the phone. So I always tell people, if you believe you have a yeast infection, obviously it's ideal to talk with a healthcare provider, but if you end up using an over-the-counter product and you don't get better, then you absolutely need to be seen because the majority of yeast will be treated with an over the counter product. So that should work about 95% of the time. So if it hasn't worked, then you need to be seen because then either if you do have yeast infection, you might have a resistant strain. So you need to have that checked out. But the more likely thing is that you never had a yeast infection to begin with. So you get one remote treatment. And if that doesn't work, then you really need to escalate it.

 

Mel Robbins (00:43:44):

And again, it's the same factors if you're having pain while having sex, if there's a smell that's not normal or bothers you if the discharge has changed, if you're itchy, those are all the same symptoms.

 

Dr. Jen Gunter (00:43:57):

And the problem is, is they can overlap with many different conditions. So you can get itch and irritation from low estrogen and menopause. You can get itch and irritation from bv, bacterial vaginosis. You can get itch and irritation from yeast. You can get itch and irritation from a dermatitis on the vulva. So sorting those things out, it's actually, if you're a specialist, it's not that hard if you ask the right questions and do the right tests. But it's important if you have those symptoms to see someone who can help you.

 

Mel Robbins (00:44:24):

There's a lot of stuff online about boric acid being used to balance the pH of your vagina. Is that true?

 

Dr. Jen Gunter (00:44:33):

No, you can't balance your pH of the vagina. If you put acid in the vagina, it's just going to return back to its pH, the pH that it was very shortly after that boric acid doesn't work by raising the pH of the vagina, by the way, or affecting the pH of the vagina. It works because it's basically a detergent, it's like bleach basically. It kills everything, which if you have a serious yeast infection that can't respond to other medications, then that might be an option. And we also use it as part of a multi-step regimen for bacterial vaginosis, because the boric acid can destroy biofilms, which are complex bacterial colonies in the vagina or complex colonies that can allow bacteria to persist.

 

Mel Robbins (00:45:22):

Is that something people buy over the counter?

 

Dr. Jen Gunter (00:45:24):

And there's been a huge explosion of this, and I see people who come in who have been using boric acid for months or using it all the time. And the thing is, it kills your good bacteria too. So you don't want to be using it. You don't use it to just touch up your pH or touch things up. People do that all the time. And it's advertised. There's influencers on social media that advertise because paid to. And I would say that boric acid is probably the most misunderstood thing out there. And I'm not the only person who's sort of seen this explosion of people using it. I was talking at a medical conference a few years ago, and I mentioned that, and these other OBGYNs who do the same thing I do like, oh my gosh, I was seeing that same thing. And yeah, it's a tool that we use in very specific situations, but it's not something that you should be using chronically and the very rare situations where we may recommend that you should really be under the guidance of someone who understands chronic yeast infections.

 

Mel Robbins (00:46:19):

Wow. I'm just kind of letting all this sink in because you're right, the internet is this huge wild west of misinformation. And if you also put that against the backdrop of a history of chronic shaming of women for just normal body function and being marketed to for all of these products that we don't need and in fact can damage the way that your body is naturally designed to work, it's kind of scary.

 

Dr. Jen Gunter (00:46:53):

I mean, the internet is an amazing propaganda tool. It's also an amazing research tool. And so any tool, it's like a car. If you drive it correctly, you can go and see amazing places. You can visit the Grand Canyon, you can go to the Redwoods in Northern California, you can go to New York City, you can do amazing things in a car, and you can also drive on the wrong side of the road and kill someone. So it's like any tool, if it's used correctly and you're taught how to use it, it can be amazing. And if it's used incorrectly by, and again, there are people who are wanting to use it incorrectly for malice, people wanting to use it incorrectly just to sell products and who just don't know any better. So you get all that as well. And so if you don't know how to sort it out, it can be a problem.

 

Mel Robbins (00:47:34):

Holy cow. You are just lining these things up and knocking them down. Dr. Gunter, I feel like right now is a great moment to take a break. And during the break, here's what I want you to do, digest what we just talked about, but share this with anybody that you care about because we all need this information. Everybody deserves the truth. And that's what you're getting from Dr. Gunter today. And when we come back, we're going even more TMI Stay with us because we're going there and we'll be waiting for you after a short break. Hey, it's your friend Mel, and because you're here with me on YouTube, I took out my own ad because I wanted to say one thing. First of all, hit subscribe because that really helps support this channel helps me bring you free videos. Second, make sure you take advantage of this free workbook that I've created as a thank you to you for subscribing to this channel.

 

(00:48:25):

This workbook is going to help you answer the single most important question you could answer in life, which is what do you really want? It's a surprisingly hard question to answer, but now it's not because you have the science back approach that I use in my work, in my marriage, in my life to help me get to the truth about what I actually want. This workbook uses science. It is free to you. You can get your hands on this puppy in just a minute. Click the link below and it is yours as my thank you for being here and supporting this channel. Again, this is going to help you answer the question, what do you want? Because if you can't answer that question, there's no way you're going to get it. So use science and let me support you in answering the question and gaining the clarity and the courage that you need to figure out what your next move is. Alrighty, take advantage of this, Mel robbins.com/what. Hit subscribe. And let's get back to the video. Welcome back, it's your friend Mel Robbins, and you and I are here with Dr. Jen Gunter, and I am asking her all the questions that we've been afraid to ask our doctors. And Dr. Gunter is showing up. So Dr. Gunter,