First up! Meet Chailee Moss, MD!

Why don’t we understand how the female orgasm works? After years of scientific research, the male body is understood but when it comes to how women work, we are a long way behind. Why is there this gap in knowledge?

It appears research has been hindered by the assumption that the female body works in the same way as the male body and that for women, arousal is all in the mind. There’s also a general attitude that studying sexual pleasure isn’t important and that female orgasms aren’t important to study as they serve no purpose for reproduction.

Researchers are slowly correcting these assumptions and making surprising discoveries.

We’ll take you behind the scenes to two orgasm labs to bring you the latest research on how orgasms work for women. We’ll also hear from Callista, who struggled with excruciating pain during sex for many years but was told the problem was all in her mind. Her journey to diagnosis shows how little is known, even amongst gynaecologists and doctors, about female sexual pleasure.

Many women understandably deal with sexual dysfunction in silence, some harboring shame, embarrassment and fear that things will never get better.  It can be overwhelming trying to find a provider that can help you. You may have reached out to your gynecologist to discuss your declining libido or pain but were met with a blank stare and even worse, told to “...relax and drink a glass of wine” or that “pain with sex is normal, use a lubricant.”

Perhaps you have gone to 8 different gynecologists and have been repeatedly told you have chronic yeast or BV or even both and no matter how many medications you have tried you’re left with the same symptoms. Or you’ve been told you have vulvodynia, vestibulodynia, and/or vaginismus but left the office without a concise treatment plan or an understanding of what any of the V- conditions actually mean.

Maybe it was a diagnosis of lichen sclerosus, lichen planus, or lichen simplex chronicus and you’re not confident your provider knows the up to date, optimal treatment guidelines. They may have handed you some kind of steroid with vague instructions and a warning about cancer.

I get it. I know what you’re going through. By the time my patients walk through my door they’ve usually experienced at least one of the above scenarios. They feel defeated and confused. I understand the confusion and fear that comes with a diagnosis that is not well known by your provider and the frustration that comes along with seeing multiple providers only to be left with more questions than answers.

So let me assure you that your pain is not in your head and your desire to have a fulfilling pain free sex life is a reasonable expectation. I fully understand the difficulty in finding a compassionate, knowledgeable medical provider when your pain lies between your belly button and your knees but at the Centers for Vulvovaginal Disorders we have answers for all of these questions and the up to date, optimal treatment guidelines to having a satisfying, pain free sex life.

It is possible and you deserve it!

-Tara Ford, PA-C

When a patient comes to me complaining of vulvovaginal irritation one of my first questions is, “Do you use soap on your vulva?”  I am often met with a quizzical look and the dreaded response, “Yes, of course, I separate the labia and soap up down there!”

When I hear that answer my heart sinks. The goal of vulvar care is to keep the vulva dry and free from irritants and unfortunately women have been told for eons that our vulvovaginal areas need to be cleaned.

The tissue in the vulvovaginal area is very sensitive and the harsh chemicals in soap and other products marketed to keep your private area “clean” can really harm you in the long term. I see it everyday. Even the soaps that are for sensitive skin or marketed as gentle should never be used on your vulva. Also, the vagina cleanses itself naturally in the form of normal, vaginal discharge. So avoid using douches as these products can upset the natural balance of organisms in the vagina as well.

So what’s a girl to do?

Water. Your vulvovaginal tissue only needs water. Put some water on your hand while you’re in the shower and wash around (no washcloths) or if you have a removable shower head you can give her a quick spray. That’s it. Water. Trust me, be gentle. Your vulva will thank you.

-Tara Ford, PA-C

Are you concerned that you have more vaginal discharge than normal? Many of my patients ask about vaginal discharge and my first point is to make clear that vaginal discharge is normal. All women have some sort of discharge throughout their lifetime, some more than others. It is also normal for the amount of discharge to change throughout the menstrual cycle, peri-menopause and menopause. Some patients complain that they need to wear a panty liner otherwise they soak through their underwear and other patients complain that their discharge has disappeared.

So, the natural question becomes, “What is normal?”

Well, what is normal for one woman is not normal for another. Everybody has their own unique body chemistry and it is normal for that to change throughout one’s lifetime. So, if you find your underwear is wet or sticky and mostly white or clear, that is usually “normal”. If you find your discharge to be green, yellow, gray, and/or has a malodorous fishy smell that could be an  indicator of an infection and should be evaluated. If you are menopausal and notice that your body is not producing vaginal discharge and you’re feeling irritated and sex has become painful you should be evaluated for vulvovaginal atrophy.

Otherwise, if you feel that at certain times of the month you are too wet, I have a couple of suggestions. You can carry an extra pair of underwear in your purse and change your underwear when needed. I caution the use of pantiliners daily as they can irritate vulvar tissue. Instead, I recommend reusable cloth pantiliners that you can wash with gentle detergent. Mama Bear, Luna Pads or GladRags have some great products available.

I hope this helps to ease your anxiety about your vaginal discharge. Again, if the discharge is colorful, malodorous, and/or you’re experiencing vaginal dryness and irritation seek out medical attention. If not, this is your normal and there is nothing to worry about.

-Tara Ford, PA-C

I am seeing an increase of younger patients coming to my office complaining of low desire or having no interest in sex. Some of these patients are in their early 20’s. Yup…20’s. Hormone levels naturally begin to decline in your 30’s, so what is going on?

Although it is difficult to isolate one major cause I do see that many of these women are on birth control pills. Some of these women were put on birth control pills as early as 13 to help them with painful periods or to regulate their cycles. What many people don’t know (medical providers included) is that the birth control pill can negatively affect your sex drive. You’ve probably suspected it, but let me confirm it...the birth control pill can negatively impact your sex drive.

Let me try to explain:

Birth control pills suppress your own natural production of hormones (mainly estrogen and testosterone). They also increase a protein called SHBG (Sex Hormone Binding Globulin). The role of this protein is to bind to testosterone making it unavailable for your body to use. If you have normal levels of testosterone and normal levels of this protein everything works as it should.

But when you’re on the pill, your SHBG level increases and your testosterone level decreases so you have a lot of SHBG proteins binding up what little testosterone you have. Women (like men) need healthy levels of testosterone to have healthy sex drives and our bodies need our testosterone to be unbound or free.

It’s important to note that not all women who take birth control pills suffer from low desire and that many factors come into play when a woman has little to no interest in sex. I encourage women of every age on birth control pills to pay attention to their body. If you begin to notice a change in your desire, a blood test to check your hormones can help identify if the birth control pill is a factor.

-Tara Ford, PA-C

Vaginismus is a condition in which the muscles in the vagina spasm involuntarily preventing vaginal penetration. This involuntary spasm can prevent women from inserting a tampon, undergoing speculum exams and having intercourse. Vaginismus is a major cause for unconsummated marriages.

The cause of vaginismus is unknown, however fear, anxiety and pain can be contributing factors. An in-depth medical history and physical exam as well as a psychosexual history that focuses on all dimensions of sexual functioning is necessary when evaluating a woman with vaginismus. The anxiety and fear surrounding vaginal penetration can have negative effects on desire, arousal and even orgasm.

Many patients with vaginismus also have pain with attempted vaginal penetration which creates a very complex pain cycle that can be very difficult for a patient to break on her own. Women oftentimes purchase vaginal dilators from the internet with the best intentions only to find they’re too fearful to even open the box when they arrive.

If you’re reading this and this is resonating with you, I understand why this is happening to you and can help you. The traditional treatment for vaginismus includes counseling/education, anxiety management and progressive dilation with cylindrical plastic dilators of increasing size. Sometimes the use of botulinum toxin can be helpful or more intensive psychotherapy may be recommended BUT, in general, most patients complete treatment successfully (pain free intercourse) within 2-5 months.

-Tara Ford, PA-C

Dr. Goldstein sheds light on why an estimated 20 million women will, at some point, experience vulvovaginal pain.