Category Archives: The Vagina Dialogues

Vaginal Steam Baths – A Douche By Any Other Name…

A spa in California is offering vaginal steam baths , in which spa-goers squat or sit on open stools over a tub of hot steam, as a cure-all for menstrual disorders, digestion and mood –

The V-Steam. Inspired by an ancient ritual practiced for many years in Korea. The steam from the herbal tea rises and absorbs into your skin & orifice. This steaming treatment stimulates the production of hormones to maintain uterine health, aids regular menstrual cycles, helps correct digestive disorders while soothing the nervous system. The natural antibiotic and anti-fungal properties are said to help maintain internal health as well as keeping your skin looking young.
30 min. $50 Series of 6 for $180

It’s a douche, folks.

A $50 douche made with mugwort and 13 other herbs and having a fancy Korean name – Chai-Yok. True, the water gets up there as steam, and if you don’t squat just right over the steam bath, I imagine it may not get up there at all. But in the end it’s a douche.

We docs strongly advise against douching, since we know that women who do it have higher rates of vaginal and pelvic infections. Not to mention that the vaginal mucosa is highly absorptive surface, meaning anything you put in there is likely to end up in the rest of your body. And so I ask – what herbs are they using, at what doses, and what side effects might they have?  Not to mention what might be growing in those wooden tubs they have you squatting over…

Fertility aid? Right – Prove it.

The Koreans aren’t the only ones who use vaginal steam baths. In South American cultures it is called Bajos, and it’s being promoted all over the web as a “rainforest” fertility aid, using every possible herbal combination under the sun.

No surprise then, that the owner of the California spa credits Chai-yok for her pregnancy achieved at age 45 after “trying for three years”.  I notice she does not say how she “tried” to get pregnant, which makes me wonder if she is leaving out some little detail that may have led to her reproductive success, something like, oh I don’t know, maybe… fertility treatments? Not to mention, she may just have a little itsy-bitsy conflict of interest in making her claim, since she’s the one selling the V-steam? This, however, has not stopped websites from using headlines like “Vaginal Steam Baths Could Cure Infertility and Bad Periods“. Dumb.

The thing that upsets me is that the owner of this spa is an orthopedic surgeon. I can forgive his Korean wife for buying into unsubstantiated folklore medicine, but what’s his excuse? He and his wife can V-steam all they want in the privacy of their home, but where does he get off offering unproven, and potentially harmful, treatments for infertility and menstrual disorders? Shameful.

Bottom Line

I’d avoid the vaginal steam spa if I were you.  Especially if you are prone to yeast infections, since yeast love a warm moist environment.

Regarding Vagina Jokes

Now, before you start posting your funny vagina steam comments here, head on over to the Yelp spa review site, where someone has probably already posted your joke. It’s one of the more hilarious comment threads I’ve ever read. And if you do post a comment here, keep it clean, okay? Oh wait….

More on V-steam from around the web

  • Orac weighs in on what he calls “Steamed Vajayjay Woo”, and wonders when Oprah will try it.
  • Dr Manny Alvarez at Fox News calls the V-Steam ludicrous and says its health claims “Don’t hold water with me”. Was he trying to make a little joke? You go, Dr Manny!
  • Dr. Lisa Rankin starts off on the right side of Medicine and tells us that Wormwood, one of the ingredients in the V-Steam, can be neurotoxic. But then she goes on to tell her readers to ignore her concerns and listen to their bodies instead…. C’mon Dr Lisa. You can’t have it both ways.  Are you on or off the wooden stool?

Image from Wikipedia

Mrs Goundo’s Daughter

Don’t miss the Washington DC and New York City premieres of this documentary about one couple’s journey to obtain asylum in the United States in order to save their daughters from the horror of female circumcision.

Mrs. Goundo’s Daughter is the sensitively told story of a Malian mother’s fight for asylum in the US to protect her two-year-old from female genital cutting. To stay in the US, Goundo must persuade an immigration judge that her US-born daughter, Djenabou, will suffer this procedure if Goundo is deported. In Mali, where 85 percent of women and girls experience clitoral excision, Goundo and her husband are convinced they would be powerless to protect their daughter from her grandparents, who believe all girls should be excised. The film bridges Goundo’s two worlds, expertly interweaving scenes from Mali of girls preparing for an excision ceremony and scenes from Philadelphia where those who have survived the procedure share their stories.

Kudos to my good friend Janet Goldwater and her fellow filmaker Barbara Attie for once again taking on the issues of women in their documentaries. Previous films from these two include Motherless, the story of men and women who lost their mothers to illegal abortions, I Witness, the story of the Pensacola Florida abortion clinic bombings and Rosita, the story of a Nicaraguan family’s struggle to obtain an abortion for their 9 year old child, impregnanted during a rape.
Mrs Guondo’s Daughter is being shown at Silverdocs/AFI Discovery Film Channel Festival in Washington DC on June 17 (12:30 pm) and June 20th (12:30 pm), and at the Human Rights Watch Film Festival in NYC on June 21 (7 pm), June 22 (4pm) and June 23 (9pm).

Vitamin D Deficiency and Bacterial Vaginosis – Causality or Guilt by Association?

Bacteria-coated vaginal epithelial cells in Bacterial Vaginosis

In a recent study sure to get a lot of media play, researchers have found an association between low vitamin D levels and the vaginal infection called bacterial vaginosis in pregnant women.

Bacterial vaginosis (or BV for short) is the most common vaginal infection in women, and in pregnancy has been linked to premature labor and delivery. Despite this, interventions to diagnose and treat BV in pregnancy have had only modest impact, and then only in the subgroup of women with a history of previous preterm birth.

The results of this study, if confirmed in larger trials, would suggest that vitamin D deficiency may be the cause for bacterial vaginosis in pregnancy, and that supplementation of this vitamin might be worth investigating as an intervention to prevent preterm birth.

It’s an interesting idea, but just a hypothesis at this point. Although the study is well-done, it does not prove causality. Both BV and vitamin D deficiency are incredibly common conditions, both in pregnant and non-pregnant women. To find them together in the same patient would not be unexpected given their relatively high frequency in general. (In this study, almost half the women had BV – that’s a very high incidence.)

On the other hand, the researchers did find a dose-response relationship between vitamin D levels and BV incidence, and that would support a real effect rather than mere association. Interestingly, vitamin D deficiency has also been linked to periodontal disease, another condition that is found to be associated with preterm labor and delivery.

The most intriguing aspect of this study lies in the fact that all three conditions – vitamin D deficiency, preterm birth and BV – occur more often in African American women, individuals whose darker skin requires longer sun exposures to convert vitamin D to its active form. Preterm labor in this group has been especially hard to explain because this increased risk is independent of socioeconomic status. Could Vitamin D deficiency in African American women be the common factor that explains this increased risk? Wouldn’t it be neat if correcting that deficiency were to prevent preterm labor and delivery?

Unfortunately, most things in medicine these days don’t present solutions that are so neatly packaged as this one. Not to mention the fact that BV was present in almost a quarter of the group with the highest vitamin D levels in this study, which would argue that something other than vitamin D is at play. So while it is intruguing, it is much too soon to jump on this bandwagon. But I will be watching the parade closely.

By the way, most prenatal vitamins carry about 400 IU of vitamin D. Emerging data are beginning to suggest that higher doses of vitamin D may be necessary, but this remains controversial. I am comfortable recommending vitamin D supplementation doses up to 800-1000 IU daily in my non-pregnant patients. These doses are safe, and in my experience, usually result in vitamin D levels in the mid 30’s ng/dl.(equivalent to the highest levels in this study). If you are pregnant and have questions about vitamin D, it’s best to talk to your doctor before going above current dose recommendations (200-400 IU daily).

Ending Genital Mutilation, Village by Village

Ten villages in Western Niger have decided to end female circumcision and genital mutilation in response to a campaign by Unicef and other NGO’s. SInce 1998, the rate of female circumcision has dropped by 50% in Niger, and was outlawed in 2003. Still, villages in the western part of the country have been resistant to change until now. Education villagers about the health risks of female circumcision has proven to be a persuasive and effective approach.

Female circumcision leads to obstructed labor and birth trauma due to scarring of the genitals. I learned early in my career that if I was delivering a women who had had a previous clitorectomy, I needed to cut a good episiotomy, even if she had had prior children, because the scarred upper portion of her genital tract would massively tear at delivery.

The most tragic consequence of female genital mutilation is the formation of fistulas – holes between the bladder or rectum and the vagina that cause a woman to constantly leak urine or feces. It is estimate that over 200,000 women in Niger suffer from fistulas, which causes them to be ostracized by their villages and abandoned by their husbands. The risk for fistula is compounded among young women who are married and give birth in their teens – in Niger, half of all girls are married by age 15. Unicef is working to persuade the Niger government to raise the marriage age to 18. In the meantime, educating fathers about the health risks of early childbearing for their daughters has prevented early marriage in some families.

This sort of approach, which respects the dignity of villagers and uses education rather than punitive methods, appears to be effective in moving groups away from tribal customs that negatively impact the lives of women. Kudos to Unicef and other NGO’s involved in the campaign to end female genital mutilation.

The V-Word

The Onion has a hilarious article this week that epitomizes our relationship to the word Vagina. (Hat tip to Rachel).
Renowned Hoo-Ha Doctor Wins Nobel Prize For Medical Advancements Down There.

STOCKHOLM—In recognition of her groundbreaking work treating life- threatening diseases of the privates, renowned hoo-ha specialist Dr. Victoria Lazoff was awarded the Nobel Prize in Lady Medicine this week.

The world’s foremost authority on ailments down south, Lazoff led a team of cutting-edge hoo-ha doctors to develop new strategies for detecting abnormal growth in…you know, that area.

What makes this article so funny is that it’s so true. We’ll do anything to avoid saying the word vagina, won’t we?

Of course, my sisters and I don’t call it Hoo-Hah. That’s too silly. We call it Virginia. (As in Yes Virginia, there is a Santa Claus… Oh, never mind….)

Seriously, though, why do we hate to say the word “Vagina”?

I think I have it figured out. Vagina is just not an easy word to say. Try it – Vagina.

Your mouth has to open for the “Va”, then go to the pucker of the soft G and then to the vertical open of the long I then back open for the “na” at the end. It’s a work out.

Now try saying it over and over again out loud – vagina, vagina, vagina, vagina…. It’s exhausting, right?

But guess what? It’s easier if you say it softly. Go ahead, try it – Vagina, vagina, vagina, vagina…

See? It wants you to say it softly. (Vagina)

Which has got me thinking that maybe the word vagina is just not meant to be spoken outside of an intimate conversation.

So when we hear it in a crowd, or spoken too loudly, or in mixed company, we get uncomfortable.

But What About the Vagina Monologues?

Hasn’t that play removed the taboo on the word Vagina by now? Brought it out of the closet and into the vernacular?

I’m not so sure. (And here’s where the Feminists kick me out of the club…)

My five sisters and I went to see the Vagina Monologues a few years back. We even had front row seats. No one was more suprised than me to find that despite the fact that I talk about this stuff all day with my patients, and say the word vagina at least 20 times an hour, I was very uncomfortable sitting in that audience. More so even than my sisters. It all seemed so – personal.

Save it for your shrink! I wanted to yell out. I don’t want to know this about you. Really. This is Broadway, after all, and I paid a lot of money for this ticket. Couldn’t you just sing “I Enjoy Being a Girl“, or something?

Of course, if one of these women were to tell me that stuff in my office, I’d jump right into the discussion. It seems right in a doctor’s office. And I think I could read it in a book or memoir. After all, a book is really a conversation between two people – the writer and the reader. (Just like me and you….)

But listening to vagina talk, right there on a stage, before hundreds of strangers (including a few men), it seemed – well, wrong.

Which is not to say that women should not learn about their vaginas, and feel comfortable with their vaginas and love their vaginas and all that. Because they should. And they should feel comfortable saying the word vagina.

But maybe the whole world doesn’t need to hear it.


So go ahead, say it.

But say it softly. And keep it private.

G-Spot Collagen Injections

Niko enjoys the bouncing cab ride a little more than she expected.

They call it the G-Shot. Collagen is injected on top of the G-spot (if it exists) to enhance its size. The G-Shot was invented by a Doc in LA (of course) who claims it enhances sexual arousal and gratification.

I hadn’t heard of the G-shot till yesterday, when OBS Housekeeper emailed me asking if it was for real. Apparently, Niko had her G-spot enhanced in the season opener of Lipstick Jungle. Talk about product placement – it was a silly plot angle that really made little sense in an episode that was about much more serious issues.

But what about it? Is the G-Shot legit?

Smells like a racket to me.

My definition of a racket? Any expensive medical procedure (in this case $1850) not covered by insurance, whose clinical outcomes have been reported on a website and in the media instead of a peer review journal. Not to mention those three little words that should set alarm bells ringing whenever you read them in conjunction with an invasive medical procedure -“Results may vary”.

Is the G-Shot safe?

The shot uses FDA-approved collagen, which, if administered correctly (into the vagina and not into the urethra), should be relatively safe. Urologists for years have been using collagen to “bulk up” the urethra as a treatment for urinary incontinence, although that treatment has yet to be proven to have more than limited efficacy.

But take a look at this partial list of possible complications from the G-Shot website –

Bleeding, Infections, Urinary retentions, Accelerated collagen re-absorption, No effect at all, Allergic reactions, Hematoma (collection of blood), Collagen site ulceration, Urethral injury, Hematuria (blood in urine), UTI (Urinary Tract Infection), Urinary Urgency, Urinary Frequency, Increased/worsening nocturia (waking up several times at night to urinate), Change in urinary stream, Urethral vaginal fistula (hole between urethra and vagina), Vesico-vaginal fistula (hole between bladder and vagina), Dyspareunia (Painful intersourse), Need for subsequent surgery, Alteration of vaginal sensations, Scar formation (vaginal), Urethral stricture (abnormal narrowing of the urethra), Local tissue infarction and necrosis, Yeast infections, Vaginal Discharges, Spotting between periods, Bladder Pains, Overactive Bladder (OAB), Bladder Fullness, Exposed Material, Pelvic Pains, Pelvic Heaviness, Collagen injected into the bladder or urethra, Erosion, Fatigue, Damage to nearby organs including bladder, urethra and ureters, Alteration of bladder dynamics, Post-operative pain, Prolonged pain, Intractable pain, Failed procedure, Varied results, Psychological alterations, Relationship problems, Decreased sexual function, Possible hospitalization for treatment of complications, Lidocaine toxicity, Anesthesia reaction, Embolism, Depression, Reactions to medications including anaphylaxis, Nerve damage, Permanent numbness, Slow healing, Swelling, Sexual dysfunction, Allergy to Collagen material, Collagen migration, Nodule formation

and you tell me – Are these risks you are willing to take for a procedure whose “results may vary”?

But what about the product testimonials?

Ah, the product testimonal. The hallmark of every new product marketing campaign. There is nothing that sells a product better than a woman with a story to tell who is being paid to tell it.

Product testimonials are not proof of efficacy. They are nothing more than a single person’s experience with a product or procedure. Even if it is a true experience, the circumstances are not controlled for other variables that might be effecting the outcome, including the placebo effect. And there has to be a significant placebo effect of G-spot enhancement.

Think about it. Suppose you are someone who actually believes the G-spot exists, making you a bit impressionable to start with. Now, I’m gonna’ put something into your vagina that you will be able to feel. It might be a bit uncomfortable, but not very much so. Or, as Niko says when Brooke Shields asks her if she is in pain – “I don’t know what I’m in, all I know is that I can’t sit through a 2 hour dinner.”

But what if I’ve told you that the uncomfortable sensation is really a sexual sensation? (Ah, the fine line between pain and pleasure..) Now, every time you notice the sensation, you’re going to naturally think about sex, aren’t you? And the longer the sensation lasts, the longer and more often you’re gonna’ be thinking about sex. In fact, you’re thinking about sex a lot more than you normally do. All the time, actually. And every time you have sex, that little bump I made is going to get knocked around, reminding you of what a sexy gal you’ve become, reinforcing those positive sexy feelings you are experiencing, and wait a minute – was that a multiple orgasm you just had?

Now, suppose instead that I injected a lump of collagen into your vagina and told you that it might make you feel uncomfortable. That sitting might be difficult for a few days. That there are potential side effects such as pain with intercourse or painful urination you’ll need to watch out for.

Now imagine how you would feel every time the cab you’re sitting in goes over a pothole. Scared? Annoyed? Angry?

See? The power of suggestion. In this case, not a placebo, but a nocebo effect.

Bottom Line

If the G-Shot proponents want to prove it really works, then they need to run a placebo-controlled clinical trial. It’s easy enough – one group gets the g-shot, another gets an injection of saline into the same spot, and the third group gets an injection of collagen into some other spot in the vagina.

I’m not holding my breath waiting for the trial. Nor should you.

Instead, I’d take that $1850 and spend it on something that will make you feel good about yourself. Maybe a food delivery diet. Maybe a dance class or a new bike. Or that trip to France or night course you’ve been thinking about taking for years.

Because if you’re feeling good about yourself, then feeling turned on isn’t that much of a stretch.

And that’s because your biggest erogenous zone is not the G-spot.

It’s your brain.

Pubic Hair Dye

That’s right. It’s called Betty – Color for the Hair Down There”. Its the solution to that vexing problem faced by greying gals, redheads and bottle blondes who get outed when intimacy reveals their true colors.

I’m surprised someone didn’t come up with this idea sooner. Too bad they didn’t, because I suspect pubic hair dye is a product idea that’s come a bit late to the market. My own market research on the latest trends among women in styling of that area would suggest that there’s not much hair left down there to dye…

But let’s just say you’re a bit behind the times in that area, and feel the need to coordinate your colors. Should you consider Betty?

Is Betty Safe?

The manufacturer claims the product is “specially formulated to avoid irritation”, has natural ingredients with flowery herbal names, and “no ammonia or parabens”. But Betty does contain PPD – that’s paraphenylenediamine, the chemical found in almost all hair dyes. PPD is listed as high hazard on the Cosmetic Safety Database and is the ingredient responsible for most allergic skin reactions to hair color. PPD-enhanced henna tatoos can cause extremely severe skin reactions.

Pubic hair borders on some very sensitive areas of the body. The hair near the midline comes precariously close to the mucosal surfaces of the inner labia – skin that is almost like the inner surface of the lips on your mouth. This kind of skin would be much more permeable to the chemicals found in hair dye and certainly more likely to be irritated.

My advice would be to avoid this product.

Don’t Dye For Me

And please, please, don’t think about dying your pubic hair to impress your doctor, as Ralph seems to have done…

I love it! I have salt and pepper hair and a gray beard. Some grey down there and now it’s black. I can’t wait to shower at the health club or go to my doctor for a check up. I know he won’t say anything but he will think Wow hair so black down there. – Ralph (testimonial from Betty website)

We docs don’t care what color your pubic hair is.


Mrs Hughes on the Gyno Office Visit

My eldest daughter in a high school junior, and that means it’s time to start looking at colleges. We’re heading out tomorrow on a road trip through upstate New York and New England. (Just me and the girls – Mr TBTAM has to work.)

Given the ambitous schedule we’ve given ourselves, things may be a bit quiet on the blog for awhile.

In the meantime, here’s a little something to keep you smiling – Mrs Hughes on menopause and the gynecologist’s office.

(Thanks to sis Ronnie for pointing me to this video.)

Dyspareunia: A Funny Word for Something Not so Funny

“Dyspareunia” is the medical term for painful intercourse.

I always liked the word, although it does sound a little whacky. Today I saw a patient who has dyspareunia, and decided to once and for all figure out the origin of the word. Turns out it derives from the Greek word “dyspareunos”, which means “badly mated”. To go even further into the Greek origins, “par” or “para” means beside or side by side, and “eun” means bed, so “pareunia” means to be side by side in bed, and is the ancient Greek term for sexual intercourse. Adding the prefix “dys-” means that what’s going on in bed is not so good.

Of course, outside of medicine, we no longer use the Greek terms, because it leads to too much confusion. “Hey, honey, do you wanna’ pareun?” makes it sound like you are offering up a serving of dried fruit. (Well, depending upon how old you are, maybe you are…) But if you like prunes as much as I do, either a pareun or a prune will do nicely, thank you very much.

Since I brought it up, let’s talk about what causes dyspareunia and how we treat it. In decreasing order of frequency of occurance in my practice, the causes of dyspareunia are:

Menopausal dryness
That’s easy to treat. Lubricants, vaginal estrogens, and keep having sex. The old adage “Use it or lose it” really does apply here. Sexual activity (even masturbation) increases blood flow to the vaginal tissues, helping lubrication. So, let’s go ladies, you’ve got some work to do…

Yeast infections.
Most women don’t know that vaginal dryness can be a symptom of a yeast infection. Well, it can be, and in my experience, is frequently the only symptom. When it is the only symptom, I often find yeast called Candida Glabrata, a strain resistant to standard over-the-counter remedies. But whatever strain of yeast you have, I can easily treat it, and that should solve the problem of dyspareunia.

Desquamative vaginitis
An inflammatory condition of the vagina that we treat with steroids and antibiotics. If you have dyspareunia, make sure your doctor looks at your vaginal secretions under the microscope right there in the office, otherwise this condition will be missed. Desquamative vaginitis can be chronic in nature. It is similar to, but not as bad as lichen planus (described below.)

Post partum dryness
Due to low estrogen levels while breastfeeding. Treat it with vaginal estrogens. Use a good lubricant. And have sex, if you can manage to stay awake for more than 2 seconds after hitting the sack.

These are non-infectious conditions that cause vulvar pain, sometimes with inflammation of the entrance to the vagina. Technically, vestibulitis and vulvadynia are separate entities, but since there is a lot of overlap, we often treat them the same. Vestibulitis may be associated with genetic variations in the proteins that mediate inflammation. Both vestibulitis and vulvadynia can be difficult to treat. We use low dose antidepressants, topical anesthetics, anti-inflammatory meds, interferon injections and, as a last resort, resection of the involved tissues. Changes in diet can be helpful in some patients. There are lots of other things you can do yourself to help the symptoms, see the resource list below.

Lichen planus
An uncommon chronic inflammatory condition of the mucous membranes of the vagina and mouth. We treat Lichen Planus with steroids and antibiotics, although it can be very difficult to treat. A new drug called tacrolimus shows promise in patients who don’t respond to typical treatment. If your partner has Lichen Planus of the vagina, be very, very nice to her because it is no fun to have lichen planus.

Something structural
A cyst, an abscess, a stricture, a hymeneal remnant, a vaginal septum, endometriosis, a fibroid – anything that’s getting bumped or pulled can hurt. Fix it, remove it, treat it, whatever, the pain goes away. Endometriosis treatment can be a little more complicated than some of the others, but it’s rare that we can’t control the symptoms enough to keep sex pleasurable.

Another fancy word, this one means an involuntary contraction of the vaginal muscles and vaginal opening. You can’t get in if the door is closed, so don’t try to force it, because it only hurts more. Make sure there’s nothing else wrong (see above). Then use biofeedback, relaxation, masturbation techniques, couple’s therapy, topical anesthetics, and sometimes dilators. Botox is being used for this condition with some success.

Whether or not you have dyspareunia, you should eat some prunes. They are very good for you. Now that I’m thinking about it, maybe I will post a prune recipe, would you like that?

Dyspareunia: Resource List
National Vulvadynia Association
AAFP Article on Vulvadynia
Vulvar Pain Foundation
University of Michigan Center for Vulvar Diseases
Diagnosis and Treatment of Atrophic Vaginitis
Yeast Infection Resource Center
Pamphlet on Dyspareunia

Photo: “Plums in a Tree”, used with permission from Category: Second Opionions, Food