Call Her Daddy - Girl Talk With a GYNO

Episode Date: August 28, 2022

Does hormonal birth control affect my fertility? How do I even know if I’m fertile, is that something I should be checking? How often should I be getting screened for STI’s? I recently had an abnormal pap - is this reason to panic? Constant UTI’s…is this normal? It’s time to finally make that appointment to see your gynecologist. Dr. Kameelah Phillips is here to explain why it is imperative to visit your OB-GYN and answer all of your questions regarding birth control, fertility, STI’s and more. Dr. Phillips is here to provide the facts and debunk any rumors you may have heard about women’s health. Daddy Gang, you’ve come to the right place for all of the answers.

What is up, Daddy Gang? It is your founding father, Alex Cooper, with Call Her Daddy. Hello, Daddy Gang. Welcome back to another episode of Call Her Daddy, a mini episode. Today, I'm having on a gynecologist. I have gotten so many DMs from women asking about STIs, about vaginal health, and just really questions that I know personally should be answered by a professional. I think there's also a lot of misconceptions around how to handle things, misconceptions around just quite literally our vagina. And I would say it's really important to educate ourselves on what's going on downstairs. So I hope this answers some of your questions. I tried to start kind of on a basic level just because I did see a lot of people asking some

just preliminary questions about even just going to the gynecologist, STIs, etc. So I hope you guys enjoy this episode and learn something because I definitely did. Love you guys. Enjoy. Dr. Camila Phillips, welcome to Call Her Daddy. Dr. Phillips is a board-certified OBGYN and women's health educator. So I asked my listeners to write in questions that they would want answered by an expert, and many were asking when and why should women visit the gynecologist? So it actually really varies from person to person. I see young people as, I don't know, 12, sometimes 13, 14. It really depends on what the situation is. And in those circumstances, it's usually painful periods. And the pediatrician is like, yeah, no, go see a gynecologist.

And I remember growing up with painful periods and being like on the bathroom floor and fetal position. Listen, yeah, missing out on things, not swimming, not going to the party. And just like really always vowed that I would never want to do that to my kid or not have options for young girls. And so sometimes I see people hopefully right before they start to have sexual experiences so that they can have questions answered factually, as opposed to like that back of the bus stuff. And then the next interval for some people is like this magical age of 21. That's usually when we start screening for cervical cancer, but you don't have to come in at 21. But I would say like in the 20s, because usually by then most people have had a little something down there. And I think it's great to have a verified resource that you have a relationship with

that you can check in on things. So first period or about to start a period until you're old and gray, all those things. Yeah. And I think that's great also to know, cause I remember my first experience with a gynecologist was because I had such bad periods. My cramps were awful. I was breaking out and it was just a whole hormonal explosion. I also think you saying, you know, your first sexual experience, when you do start having sex, you want someone that's trusted to help and guide you. It's a trusted person to go to. What are the risks of

not going to the gynecologist? And listen, when people come to the gynecologist, especially if you're sort of shy or leery about the situation, or you're really young, like I don't even touch you. I don't need to touch you. Like it's just a conversation, right? So I encourage people to come, but there are risks. Some of the risks that I most commonly see are potentially sexually transmitted infections that haven't been picked up in a while. So I see someone who hasn't come in in like two years and they come back with like a chlamydia and they're like, when did I get that?

And I'm like, oh no, there's been 10 partners, you know, maybe in that time, like legit, I don't know. So usually STIs that maybe linger a little bit longer than they should have. I think quality of life issues, you know, bad periods, acne, fibroids, like people just thinking, oh, this is what my stomach or periods are supposed to be like. And there's actually something going on. Ovarian cysts, God forbid cancers. So that's kind of what you miss out on. And they're basic health maintenance things. So look, I'm the worst person about going to the dentist.

So I get it. People don't always want me in their stuff, but I got like three cavities fixed today because I don't go to the dentist, you know, same kind of thing. It's the same kind of thing. What happens if you do let an STI linger for a little bit too long? Best case scenario, nothing, right? That assumes that you may be identified it, it stayed between you and the other person, and you both got treated. Other scenarios include maybe you've given it to other people, that it's actually had a negative impact on your own fertility. That is when an STI like a

chlamydia or gonorrhea spreads up beyond the vagina into the uterus. And most importantly, your fallopian tubes or belly that's called pelvic inflammatory disease or PID. And the worst outcome from that, other than, you know, sometimes being really sick and people get hospitalized is that it can really damage your fertility. And so, you know, one episode, certainly multiple episodes can have long-term impact on your fertility. Someone asked, I have been on hormonal birth control for 10 plus years. How much of an impact does birth control affect women's bodies regarding fertility? I would say zero.

I love it. But listen, if birth control, long-term birth control, especially affected women's reproduction and ability to have kids, we would have absolutely seen it in all the data by now. And the thing is, is for example, if this person is on the pill, you take a pill every day because your body, your liver and your kidneys chew it up and spit it out every day. So while you can have some suppression, for example, of the ovaries and the uterus, once you stop taking the pill, everything wakes up again. Some people have a little bit of a delay for that, but there's no long-term effects. And if anything, we know that for example, being on the pill for an extended amount of time actually decreases your risk of ovarian cancer and endometrial cancer. So, and if you were a heavy bleeder, it prevents you becoming anemic. So there are actually some great benefits,

but no long-term fertility issues. That's so helpful. And so I think the question that so many women stress out about is how the hell do I know if I'm even fertile? Is there a way to get your fertility levels checked early on in life? What are your options for that? If I want to have kids later, how do you even know if you're fertile? What do we do? Yeah. This whole fertility thing. I'm so glad we're talking about it because it always sneaks up. Oh, I'm going to have a little bit of a struggle. Fertility is not created equally or fair. It just isn't. And so these are really good questions to start asking. There's no magic ball that's going to be like at 34, you will be out of commission.

We don't know that. But my closest thing that I say to people, your best indicator is if you have a period every month, say you're not on birth control, that means your ovaries are smart enough to gather up a few follicles, pick a special one, ovulate it, it travels down the tube, it implants, there's no sperm. So guess what? You flush it out. So that means basically your body is working. Otherwise we tell people, sometimes you got to try, right? If you're like in the space in your

life where you want to get pregnant, you got to try. And then the other thing that's really popular now is people come in asking for a fertility test. And basically it's a blood test called A-alpha-meri-heri, AMH. I try and explain to people, it is not a fertility test. Okay, we don't have that. But what it is, I'll explain really briefly. It's a blood test that gives us a marker of what's going on in your ovaries of a certain protein or hormone. If that level is between a range, then we say, okay, you probably are fine right now, not talking about six months from now, two years from now, but right now that,

you know, if you were thinking about getting pregnant, you should be able to do it on your own. What we really do with this numbers, it's for couples who are kind of, who are using IVF. It helps direct doctors to know like, this is probably someone we can get pregnant or know her ovarian reserve is like on its way out. So that's really how we use it. But GYNs have co-opted it and the public has co-opted it to do it for something else. So it's not a fertility test. It's not predictive, but if you take the test and say your number's a little crappy, then you're like, let me do something about that. And maybe that's when you have earlier conversations about egg freezing that you wouldn't have

otherwise had. That is so helpful. Okay. The classic also someone stressing out saying, I feel like my birth control has decreased my sex drive. Is this common? And what are my options? If I feel like now I don't have a sex drive because of my birth control. I do see that not a ton, ton, but I do see it. Usually I'm focused on like, let me tell you the scary things before you hear it on a commercial. So we talk about those things, but yeah, your

birth control can sometimes diminish your drive, your libido. And it's basically because with birth control, we sort of mask that up and down that happens, the progesterone and the testosterone and the estrogen that flows through the month as you are about to ovulate, that basically makes you horny, right? So then you go out and you seek sperm with birth control, mute all of that. And so those natural ebbs and flows can get blunted over time. Got it. So an option is to change birth control, maybe consider some non-hormonal options, or maybe something that has less of an impact on your libido. But I also tell people like, let's not kid ourselves.

If you've been in a relationship for five years, maybe you should like look at your partner. And I'm not saying leave somebody, but check in. Like sex gets a little mundane and monotonous for everyone. So maybe don't blame me and my drugs that I'm peddling, but just check in. And maybe don't blame me and my drugs that I'm peddling, but just check in and maybe that's good. You know, a little sexy night or you guys go to the store and like try and inject like some life and energy into the relationship. But yes, that is a side effect of birth control. I will admit that. I appreciate that advice. Okay. How many plan B's is too many plan B's?

People wrote in saying, I have heard that if you take too many plan B's, it ruins your chance of fertility. And now I'm freaking out and scared. Don't be scared. There's not a such thing as too many plan B's, but it will mess up your cycle and you'll just be on and off crazy, weird bleeding, like a stuck pig and not know what's going on with your life. So that's more of the issue with plan B plan B like sis, you got, you're clearly in need of birth control. So let's just find to me, the issue is like, let's just find something that works for

you. Again, if you can't take a pill every day, then don't try to. A patch, a ring, an IUD, an injection, like that to me more indicates that we just have to find something that works better for you. Obviously, you and I are very fortunate with the states that we currently live in. But is there anything that you would recommend women adjust about the way that they care for their reproductive health given the overturn of Roe v. Wade? Yeah, I do think that it is more important to pay attention to your cycle. I think people who are not living in states that are so fortunate actually need to put some effort into tracking their period so that they can make sure that it's coming in a timely fashion,

that they have prescriptions for birth control, not this monthly prescription thing, but three months at a time, because that decreases the chances that you miss or you skip or you have issues. I do think it is actually important and I'm not dissing the plan B every two. I do think it's important that you keep plan B. When I was out in these streets, I had plan B in my underwear drawer, because I'm not playing with you and trying to slip up. So that's real. We got to get real right now. And as much as it's like, it used to be like, oh, hush, hush, like plan B, like, no, ladies, get that shit in stock. We are human beings, you can slip up, you can forget to end and it's like, take care of yourself.

Things can break. Absolutely. So I do think you should have plan B. And I do think depending on the state, it is over the counter without a prescription, 50 bucks. If that's tight for you, you need to have a plan B fund and also engage your partner. Because I think we also think all the time, like this is my burden. And biologically,

of course, we take the hit. But if you're sleeping with someone, they need to have skin in the game too. And that includes if your birth control prices jump up. Hello, split that shit with me. Yeah, absolutely. Yeah. Oh, hell yeah. And then the other thing, which I just think is important for young women, because again, IUDs get such a bad rap and they're really lovely and can improve quality of life. And they're very effective is to consider something more long acting, especially in like your twenties, thirties, where you're probably not trying to get pregnant. Like you are avoiding pregnancy, like the plague. So let's use something that we know works really well is pretty easily accessible and is reversible. If you don't like it, that's fine. We take it out. It's reversible. Such good advice. So let's talk

STIs formerly known as STDs, but everyone educate yourself. They're now STIs. So what is an STI and how often should we be getting tested for STIs? Yeah. STI stands for sexually transmitted infection. It can be a range of things. So there's HPV, which we'll probably end up talking about. There's gonorrhea, there's chlamydia, there's trichomonas, there's herpes, there's HIV syphilis, but how often, you know, that really depends on your sexual activity. I do even recommend people who are in monogamous relationships get checked regularly for STIs. Every time you change a partner, absolutely hard stop, no matter how amicable the relationship is, like just know what's going on, but minimum once a year, even if you're in a

monogamous relationship, I usually tell people otherwise who I know who are out like casually dating every three to six months. I had someone write in asking, does contracting an STI from your monogamous partner automatically mean that they cheated on you? It depends on the STI. So HPV, for example, is something like, and I'm going to use a heterosexual paradigm right now for this example. HPV, for example, the answer is no, because penises carry HPV from person to person to person. They do not get screened for HPV the way we do. And so if I go to the doctor, I come up with HPV. We really don't know if it was my first partner or my 12th partner, because that's just sort of how the virus works. And so I really try and get people like, please don't end up on the news. This was not absolutely him but if and however it was a chlamydia and three months ago

you were here and it was negative and now you have a new partner and you guys didn't both get tested and now there's a chlamydia we can make a little bit more of an, you know, an association. Are there any STIs that you should disclose to your partners for the rest of your life, even if you've been treated for them? That's really tricky. And I think it depends on your partner. And I do not say this in any way, shape or form to imply that you should not tell your partner like your sexual history. But I think HPV is definitely something that we should normalize and talk about because everybody has it. At some point in your sexual life, most of us will get HPV and there is an amazing vaccination to help lower HPV in this country and not enough people get it. So I would definitely say HPV. Herpes is another one that I do think that people should disclose.

It has a huge negative impact and that's another STI that like shit happens and it doesn't make you less than, it doesn't make you dirty, it doesn't make you undesirable. So I think in discussing it and disclosing it, it rips off that bandaid of shame that the whole stigma around herpes one or two, I think needs to stop. Also, it allows the person that you're about to engage with to make decisions about their own health. Yeah. I see it all the time. Patients come in and they're like, why didn't he tell me? Why didn't she tell me?

And I'm like, yeah, that's kind of apt. It is. Just disclose it. I've had people write in saying they were previously diagnosed with oral herpes and I'm so ashamed and scared and that I'm actually going to pass it on to a partner. First of all, how do you even explain oral herpes to a partner? And second, how do I manage it on my end to make sure I'm being safe? Yeah. So there are sort of two types of herpes we think about. Herpes orally, we call

it HSV1. Herpes of the genitalia, we call it HSV2. However, everyone has oral sex these days. So the one and two to me, who cares anymore, right? Often people get blood tests to see if they've ever been exposed to herpes one or two. That is not the best way to really discuss herpes and whether it can be transmitted or not. All it means is that at some point in your life, you're exposed. What is important is do you have outbreaks or cold sores either on your lips or your tongue or your genitalia or your penis, your labia, your anus? That tells me that clinically, yes, you have the potential to have what we call viral shedding, that you would be a candidate for a medicine that can help suppress the viral shedding. And it also tells me you need to talk to your partner about it.

If someone has an outbreak, is it something that like, if they're not having an outbreak, they couldn't pass it on? It's only if they're having an outbreak? So you can pass it on even if you're not having an outbreak. And that's that shedding that we were talking about. So that's why I think disclosure is really important because at least the person you're engaging with feels like they have say in decision making and risk taking and risk assessment. So that viral shedding, yes, can happen without the person actually knowing it. Sometimes people do have symptoms like a little itch or a tingle or like a little lightning feeling. And as you get to know your HSV infection, you can say, Oh, you know what? I think I might be having an outbreak. Let's just hold off tonight.

You know, let's hold off for a few days, just so you keep the lines of communication open and you keep each other as safe as possible. The other option for people who, you know, have a good number of outbreaks, usually it's six in a year, but you can even do it with one in a year, is they take a suppressive medicine on a daily basis to help decrease the viral shedding and outbreak. Let's talk about HPV because I think that it's really terrifying to a lot of people when they get diagnosed with it. And if they didn't get the vaccine for it, could you talk about that a little bit? Yeah. So upwards of like 40, 42% of like 18, I know we have sex younger than 18, but like 18 to about 60 year olds in the United States can get HPV at any point in their lifetime. We think of sort of two types of HPV. So there's high risk and low risk. And those are sort of bad categories because if you have HPV,

it's important to you. So it's not like one is less important than the other. That being said, low risk tends to identify genital warts. There's a class of HPV that causes little warty like lesions on the penis, the scrotum, the labia, et cetera. High risk are the ones that we do tend to pay particular attention to because if they are ignored, not recognized, go untreated, then yeah, you know, 10, 15, 20, and sometimes even sooner, depending on the type and how aggressive it is, it can lead to cancer. It can lead to cervical cancer. And I think the last I checked cervical cancer is like the fourth common GYN cancer in the United States. So it's not like it's a little deal. It's not like it's a little deal. So it's important. But that being said,

that's why communication around it is so important. That's why vaccination around it is so important. I literally in my career have seen genital warts almost go away because everyone has completed their vaccination series. And I'm like, I don't even see warts anymore. If I see them, it tends to be in like 50, 60, 70 year olds because they were outside of that range of vaccination. Got it. It's amazing. Genital warts can be very, very disfiguring and the treatments can be both uncomfortable and painful.

So the fact that I don't even see them now really speaks to how well it works. And HPV, the high risk types, typically we purposefully screen for them. Right now, the criteria says after age 30. So it's kind of a surprise sometimes when people come in for the first time and I'm like, yeah, I'm going to actually check you for HPV now. And it comes back positive that like always opens up a Pandora's box, but getting vaccinated and going for regular testing is really the best that you can do. Condoms do help, but don't completely eliminate HPV risk. Smoking is a huge risk factor. Other things that impact your health or your immune system

can impact, you know, HPV and how long it persists, multiple sexual partners. But listen, who am I sleep with everybody while you can sleep with everybody. We just, I just want you to know what the risks are like, carry on and I'll see you. Yes. So if someone gets back an abnormal pap smear, where do we go from there? First of all, it means don't panic. I hate making those like pap smear calls because everyone goes from zero to 10 and I'm telling there was no reason to go from zero to 10. Super common. I don't know if you've lived life, if you hadn't have an abnormal, it's really common. And I don't, I mean, I've had several over the course of my years. So it's kind of a common consequence of

sex and intercourse. And so what I would say though, is just follow up, just follow up. If your doctor was like, Hey, come back in a year. Hey, we need to do this next level of testing. If you haven't gotten your HPV vaccine, please do it. Just follow up. What we run into risk is when people don't follow up for like years, like me and the dentist. And then you end up with all this work. That's when people get into trouble is when they like put their head in the sand and I can't find them for two or three years. So we're going to end with a couple of questions, just about general women's health questions. How much discharge is too much? I'm concerned that I'm over the normal amount. What do I do? What's going on? Mm-hmm. So I would say there's, I always couch discharge into, into a few things. Does it smell

or is it itchy or is it somehow colored? So like a yellow or a green or a brown indicating blood. Some people's vaginas are super juicy and that is not necessarily a bad thing if there's no irritation, itch, foul odor, and then the rainbow of colors I described. Some people are like that. And so that is something that I try to normalize. It changes through the month. It changes with birth control. It can change with medications that you're on. So sometimes kind of keeping like a mental diary, like no, this time last month I was ovulating.

I got a little more wet. Yeah, this is normal. That kind of discharge is fine. But itch, odor, color, I think you should come see us. Great. Is it normal to get a UTI after every time I have sex? That really sucks. And I would say, no, not necessarily. So, you know, I would ask a few questions. Like if you're having sex with a penis, is it a condom? Now, listen, I'm not saying don't use condoms, but for some people there can be an irritation or allergy that then they interpret as a UTI. Are you going from anal to vaginal? That certainly can give people UTIs. Are you douching

after sex? That can give people there's so there's like a number of reasons do you hold your urine that all needs to be figured out this is where i do think it's helpful to go to a doctor because some people in particular have specific types of bacteria that literally have these little feet that like walk from your rectum to your urethra and it they need to be treated specially and then the other type of specialist I would see is called the urologist. And those are like the bladder doctors. So there's some things, because now having a UTI after sex every time is not cool. How can we get rid of reoccurring yeast infections? What is the permanent fix or solution? Um, Ooh, this is a little bit tricky. Some people have recurrent yeast infections,

man, for a few seasons. Um, and, and they can be really tough. I would say one, you actually should go to the doctor for this because there are some yeast that are resistant to our typical antifungal treatments. And if you're throwing something over the counter at something that has total resistance and laughing at the product, then yeah, you're never going to get better. The other thing is behavior. So all the like aggressive cleanings and stuff like that. The other is thong underwear, changing that behavior, wiping front to back, all of those typical things make it a little bit more challenging and should be explored. And so the permanent fix is a little bit, sometimes antifungal, lots of behavior change.

Great. Okay. Last question. Is it normal to bleed during sex? If I don't have my period, I deal with this often. Sometimes it's just a little, and then sometimes it's a lot. So if there's not enough lube or maybe a condom, or maybe you guys were super aggressive. Yeah. You can have a little bleeding. You know, if you were smacking it, flip it, rub it down. Yeah. Maybe you can have a little bleeding. If it was sort of straightforward, you were well lubricated and it's a recurrent thing. I would definitely see a physician. It could be abnormal cells on your cervix. It can be an infection. It could be like little polyps inside your uterus.

You know, sometimes honestly though, it is nothing at all. And, but we can treat it or at least reassure you. And you're not like ignoring something potentially going on. But I think that happens a lot more than women care to acknowledge because sometimes we get a little freaking it gets rough. And yeah, you can have some bleeding. But I'd like to like go through that algorithm with patients just so I make sure we're not missing anything and that the bleeding is otherwise normal. I think that's great advice. And I think that just the concept of, Hey, if you have something that's just a little off and you're concerned about it, there is no harm in going to your gyno because then you also just get peace of mind.

I cannot thank you enough for coming on call her Daddy. There are so many women that listen to this podcast that are going to be taking notes. You just went through a crash course. Thank you. Yeah, totally. So helpful.