Should I Delete That? - Is this normal? with Gynae Geek Dr Anita Mitra

Episode Date: May 21, 2023

This week on the pod, Alex and Em are joined by none other than the Gynae Geek herself: Dr Anita Mitra, who is on a mission to make it less scary to own a vagina. Anita answers a bunch of your questions: from discharge to pap smears, cysts to douches and answers the most important question of all: 'what's the weirdest thing you've found up someone's vagina?' Anita shares how to advocate for yourself at the doctors and how to really get to know your own vagina.Follow Anita on Instagram @gynaegeekFollow us on Instagram @shouldideletethatEmail us at [e-mail] & edited by Daisy GrantMusic by Alex Andrew Hosted on Acast. See acast.com/privacy for more information.

Period pain is actually like a little bit like a mini labour pain and some people be listening and thinking there's nothing mini about it. Yeah. But it is basically because your uterus has to contract a little bit to help get the the blood out. Hello. Hello. We're in person.

IRL. And we have Olo, and I'm sorry, on my lap. I still, I don't have, I have nowhere to put her. She's in with us and she's just staring at all and giggling. I'm, it's so sweet. I think she thinks I look funny, which I love. But yeah, you'll have cute baby noises. Yeah, not, not cute to ever.

Am I going to be one of those mothers? I'm like, oh, my baby, I was like, shut up. No, they're cute. They're cute. Shut up. Okay, kick us off. Let's, should we go awkward? Yeah, let's go awkward.

Yes, let's go awkward. I am learning that the inside burp thing is not necessarily as inside as I think. And I know that you and Daisy are always saying, it's not an inside burp because we can hear it. And I'm always like, they're exaggerating. Like, they've heard a little something and they're just like, I don't know, they're just like jumping on it. Like, get a grip. And I was on the tube today. No, no, no, no.

No, you didn't. It's really loud on the tube. Like allergies are so loud Oh I see you thought you'd get away with it Yeah of course I did an inside burp Close my mouth I've got

I've got reflex today right So I did a I did a burb Rather large But it was an inside one They're not inside If you ever listen to the podcast back They're not inside the nerves

No I don't I haven't listen to the burbs I'm quite horrified That they've been kept in So what happened on the two Both the person on the left The person on the left of me And the person on the right

Me swiveled look at me And I was like, okay, that isn't, okay, the inside thing is not as inside as I thought. Right, so you'll listen to two random strangers on the tube. But when me, your friend and colleague, says to you every single day, please stop doing this because it's revolting. It's like, no, it isn't. Gaslight me. No, it's not. You can't hear anything.

You didn't hear anything. It's like, oh, they're just sensitive to sound. Just got really big ears. I've learned my lesson. It was awkward. There's no passing that off either. That's just nothing. That was all you, sweetie.

Yeah. The fun thing is about having a baby, not. my awkward, but she farts like a grown adult, sorry to put you on blast there, aren't it? And I'm obviously like, hatched the baby, and everyone's like, yeah, sure it is. It's like, no, it really is.

But no one's going to buy it, because she farsed like an old man. Yeah, my actual awkward, and it is the last time I'll talk about the street party. Okay. It's not good. Okay. I went out for dinner with my new friends. Oh, I know. So I went out for dinner with my new friends.

friends, with my street party friends, right? I'm not my next-door neighbour who says it isn't my friend, but the people who have a baby. Okay. And last night, we were talking about what we all did for a job, and she was like, what you do? And I hate telling people what I do, because it's stupid. But I was like, yeah, I have a podcast, whatever.

And then she was like, oh, cool, I'll listen to it. And it was like, no, don't do that. Don't do that. Because the last episode, the one that she'll have listened to will have been the one where I said, I think I've made friends. And she does the same job. And I talked all about her.

I talked all about her. And I talked all about her. And I said that we were friends. And now she's going to listen to her and feel like, well, that was a bit fucking presumptuous. Oh my God, I can't really remember what you said, but I do remember it now and I'm cringing. Yeah, you'd be like, I just, I feel like we're on saying, what are you playing? Yeah, I feel like we live really similar lives. I feel like we're going to be really good friends.

That's it. You said like you've got like similarities in your baby like at the same time. Yeah, yeah, yeah, so we're going to be friends. And I just told. And then she was like, because then she was like, oh, it's the last episode about it. And I was like, oh, we had like, um, Kaggy Dunnapol. She's, oh my God, I love her. I'll listen to the episode.

I was like, don't listen, don't listen to the episode. Don't do it. And don't listen to the one before either, because that's when I was talking about how much I didn't want to meet you. So this is bad, very bad. That is awkward.

Yeah, I'm going to need a fake job for the next time a neighbour asks me what I do. Say journalist. No, because then they want to read my work. I want to just, I want a new name. I need to go into witness protection. You know what I find is that when I say journalist, that seems to shut down the conversation.

I don't really know why, because if someone said to me, I'd be like, oh, tell me more. And I'm just like, oh, okay. I don't know, that always seems to shut it down. So I just say journalist a lot. Nice. Yeah, influence is not good because people are like...

Influence, yeah. I'm like, on Instagram. How is that? How's that? How do you do that? You're like, never mind, never mind. Take it back. Yeah, I don't know why I said that.

I'm an accountant. No one follows up on that. I'm an accountant. That is something that you don't respond to. Yeah. That's a hard stop. That's a hard stop. Except if I was ever pushed on it, it would be a disaster.

what do you do numbers yeah i'm an accountant i'm like oh my god it's so good i need an accountant you ever work freelance again i'd have to go into it's protection i just i think there's an inevitability here and it's that i'm going into it with protection i can't i've seen that as your desk yeah i can't i can't i can't have neighbors it's just not good for me i'm too socially awkward have you heard that song on ticot that's like i'm an accountant yeah it's such a good what do you do things that accountants do yeah where do you work places where accountants work Perfect. We'll put it on the Instagram, but that is, that's me.

No. That's that. Excellent. I'm a numbers gal. Always happened. Right side. Right side. Brain right side.

No. Obviously not. I'm going to lie. I'm going to lie to my name. It's going to lie to everyone. This is a new me. I'm rebranding. I'm a math girl.

Have you got anything bad? Yes. Yes, I have. Okay. Yes, I have. Okay. Bua's eating some grass. Boer's been eating grass.

She's in a cow era, apparently. I don't know. So it's Betty? Weird. She's eating grass all the time. I wonder if it's new grass, spring springing. Maybe. Because it's mostly when they feel sick, but she just seems to be doing it recreationally.

The fact that she is eating grass isn't in and of itself a bad thing. But what it's led to is not good. The other day she was being scatty as hell and I was like, what is going on? And I looked at her butthole and she had a little dingleberry. And I was like, oh my God. Obviously I made Alex deal with it. win it? It's just like, yes.

I didn't what that is, but a bit of poo hanging by a string of grass. Dingleberry. Dingleberry. Yeah, dangleberry, dingleberry. That sounds like I need a blatant book. Yeah, a dingleberry. Anyway, I was like, oh God, anyway. Then a couple of days ago I was walking with Arlo in the Papoose, which is...

What's in the Poohs? The Carrier, baby carrier. Oh, yeah. When Boober does a poo and Arlo's in the Papoos, my glutes are tested because I've got to squat deep down without like spilling Arlo. out, waking her up, whatever. And you know, Buo, after she does a poo, she runs away, like, she's done a grenade, launched a grenade, pulled the pin.

Anyway, she did that, she did the running away thing. I was like, oh, God, and she, like, wrapped us around my legs, like, three times. I'm like, this is so undignified, this is so embarrassing. And I was, like, running around trying to pick up a poo, and then she kept being so scatty, and I was like, what is happening? And then I looked, and it was like a fucking bulbul just, like, hanging from her ass. And I was, like, brilliant. So I had to put the poo bag in my hand and chase after her, like, getting to butt level

whilst having aloe in the papoos and I was like honestly my cords were burning and I was like squat lurching after her to try and get to her and I had to hold up her tail and when I tell you out it was like picking an apple literally I felt like the

like the ping of like the grass napping it was so bad and then she was fine again she was like oh thanks but it was literally like I plucked it from her bomb it was so bad I was like this is just so undignified for both of us I hate it

That's so gross. I thought this might have been the first time that you were going to get poo on your hands. No. Dog poo. No, no. Still haven't done that? No, I got baby poo on my hand earlier. I've got baby poo.

I've looked in the area and I was like, oh. A lot of poo. On my face, yeah. Oh, gorgeous. Well, you came in today, I've got sick all over my shoulder. You didn't say anything. Sick is different, you know? I think six, five, it's poo really.

Mind you, when their babies, is a poo, isn't really poo, is it? It sort of smells nice. Does it? I quite like the smell. Okay, that I don't like the smell. Okay, that I don't. like that hang around for long enough you'll get her okay anything bad you're my bad um my bad i went for i went for breakfast um with a girl that i know a long time for my old job and she was

telling me about her her dog died recently oh of old age it's a good like it's a good story it's a really good uplifting story no but it was like a positive end of life like the dog done you know and it was in no pain and blah blah but she was just talking about how awful it was and how hard it was and like what happened on the day and stuff and I was like I was listening and thinking I can feel like panic rising in my throat and I was just trying not to think of betty in that moment and you did it again you've done this before yeah honestly I was like I was trying to do breathing like breathing exercises while also listening to this story and trying to zone out from this story and trying to breathe and trying to stave off a panic attack because it's close.

And I was like, Betty's going to die Sunday, Betty's going to die Sunday, I can't take it, I can't live without her. It was awful. You've done this before. Yes, a lot. You hijack people's dead dog grief. I know. And make it your own. And it hasn't even that, like, she's like two. Literally two. Is she literally two? She'll be three in August. It was going to be eight in a couple of weeks. Oh my god. I know but I feel like I've turned a real corner into being like I'm giving her a good life yeah like I used to have that like neurotic panic also not to put words in your mouth but like yeah yeah but now I'm like it's okay like look at how happy her life is yeah look at what I'm giving her I don't know I don't know isn't it just awful that

they're just not they're just with us for a good time not a long time Yes. But we've talked about this before. We talked about this last time you had a breakdown that someone else's dog dying about how with dogs, it's like they're a part of your life, but you're their whole life.

Oh, God. So you just have to make it, like, so happy. Oh, no, she's gone. We lost her. Oh, God. God. I don't think I've ever seen you really cry before. She's got like, like mouth facing

down and everything. Do you want to cuddle-do her? Will that help? She looks quite as well as content, no way it too. No, she needs some love. Because now I feel sad for her that she's not going to be here forever.

Bua, do you want a cuddle? Actually, she's quite aloof. She's like, no, I'd literally rather die. She's like, you're weird, I fuck off. Get your fucking grip. I'm fine. Oh, it's just all a lot, isn't it? It's just a lot. But they don't know they're going to die

if that helps. Not really, no. Do you know what blew my mind in the day? What? When I think about AOLO and dogs, it applies to dogs too, but I just think I think

what they thought about it in the context of a baby. Yeah. They don't have words to think with. Uh, no. But humans, like a lot of humans don't. I read, I watched a TikTok that was like, I read, I read it that thing

much like I read it last one of me and you watched a TikTok. A classic. I watch a TikTok. It was like only 31% of people have an inside voice. No, but you still have the words. I don't think they do, though. I think they don't have, I think they just have it in like pictures and visuals rather than,

because to me, I have words in my head. But you know that you're hungry because you know what hunger is because you have the word for hunger. Babies and dogs don't have the words for hunger. No, but they know they need food. but they don't know what food is to say food well they don't say it but they know it but they don't have like

the internal things when they're like crying or barking or living no words yeah quite stupid really it's ridiculous people always say dogs are just so intelligent and so much more intelligent

and you think and I look at Batty and I'm like not you you are not intelligent is she yeah really intelligent Oh, do you know, yeah, yeah, got on late. Mine is not. On the internal monologue thing, I said on Instagram the other day, I've had the word bechamel stuck in my head for like two weeks.

Words get stuck in my head too. Bechamel. It's driving me up. I don't like bechamel sauce that you have with the lasagna. I don't like lasagna because I don't like bashmeal sauce. It's a beautiful world though, actually, Bashamel. I cannot get it out of my head. I wake up in the morning and you do love French book.

But I get up in the morning and I'm like, Bechamel. Oh, God, it's still there. It's like waking up with hiccups every day. And I just got Bechamel stuck in my head. Bechamel? Beshemel. Do you get a song stuck in your head? Yes, earworms.

I wouldn't have heard that time. I like it. Always. Do you ever get two songs stuck in your head? Sometimes. Oh, I hate that. And it's now really happening with baby songs. The wheels on the fucking bus are going perpetually round and round in my head.

Baby Shark. No, we're not there. And she'll never be there. Um, that song. by Jack's Victoria's Secret like it's rarely not in my head yes yes oh my god yes I know it's a good concept

good premise all for it but fuck me I can't bear it that tune it's just like yeah that's I get it I know Victoria's secret it's just like it will not be your right that was in my head for a very long time

and then I also have yeah and then Lizzo to be loved it like that kind of plays like a backing track to everything I do at the moment so annoying I know I know it's always like at the end of the day being like oh I'm crying on the tube I think she'd

I think it was to do maybe with HG or something and after my Instagram thing she's like I'm crying on the train and I was like this is your movie moment I would quite like to be alone on a train and crying right now because at the moment if I was on a train I'd be with Arlo so if I was crying on a train with Arlo it's very sad it's not movieish at all it's like well she's clearly having a fucking

break down let's avoid her in all costs there's a meme though and it's like what i thought i looked like having my oh you've seen it having my movie moment like head against the car window and then it's like what i actually look like and it's just your head like smacking like back and forth the gate of the window it's so good it's so true yeah i always think that like but i think crying in public alone as a woman is quite romantic and then crying in public with a baby yeah it's neurotic it's not good it's scary it's scary people are really fucking worried it yeah yeah so I've got to be really careful I've got to get a grip yeah I think you do yeah I'm fine because I'm fine um yeah um that's nice good good good

I don't have one that's the spirit you know you four go you forewent your good last time as well you just find something um well this is in our in RL in RL this is in I RL this is in real life we're in person this is nice I've been with Arlo all day which is lovely I'm all the way to my house was just very good of you because last, oh, the good should probably be that we've written the live show this time. Last time we did it on the day, on the day. Yeah, that was quite scary.

So, yeah, we've got this. Yeah, we did this. I hope that doesn't jinx it that we've done it in advance. I don't know, I feel like it goes against our brand a little bit. Yeah, it might as well, it could be really shit. Yeah. But it's going to be jazzy. I'm excited. I'm excited.

We've got a green room. How fun's that? They're like, do you want any snacks? We're like, no. Like, we're fine. In the end, we don't want to be awkward. We got pushed. and then I was like, can we have a Diet Coke?

And like maybe like an elderflower drink. Well, the flower was nice. No one's in there to an elder flower. Yeah. I think we talked about this before. It's such an upgrade on the last backstage. Yeah. Fuck you, John.

Changing room that we had. Even though I did like that place too. But yeah, it's definitely an upgrade. A lot more people. Double, more than double the people. Yeah, like, for, four, apple. I'm scared. I'm scared.

Cudreeple. I was like four apple. Four apple. It was waiting for a flower. A four apple. A four apple. Yeah, I'm quite scared. Oh shit, no, I'm really scared.

It would be great. Really? Well, no. I don't know. What if I got on? Like a magic ball? Okay. You put too much trust in me.

Like, don't, yeah. Will we? No. No, God, no, I can't do that. I can't promise you. It could be an absolute disaster. Probably might be. When you're listening to this, it's tomorrow.

Oh, shit. It is tomorrow. It's good for us. It's fine. This confidence building, morale. Okay. Nice. What's your good?

Oh, I'm just. I'm just happy to be here. I'm just happy. To be alive. Yeah, I'm happy to be live. Yeah, and also it's my wedding anniversary this weekend. Oh, happy birthday. Thank you so much.

I'm going to bath with Alex. So, again, we're recording this on Thursday. I'm going, I'm going, I'm going this weekend. Very nice. We might have a horrible time. I don't think you will. I think that's a lovely time. Bath is so nice.

We went together, you and I thought I should bring out my Alex here. Yeah. So now I will. Bath is so nice. You're going to that same place? No, different place. Okay. Just, we're going to bath.

It's going to be nice. I've not been. apart from that day. Excellent. You'll have a lovely time. Yeah, the fans go. Okay. Help you're running anniversary.

Like, me and Alex and Bua and Alaw. The gals. Have a good time. Thank you so much. We have... Oh, I love these episodes so much. I love expert episodes. Especially anything to do with, like, women's stuff.

Viginas. Viginas, hormones. I love anything like this. I find it so fascinating because we don't know... Literally don't know anything. Clearly. this episode is with the Geinie Geek, who I

absolutely love, we absolutely love I know Anita through the Eve Appeal and obviously this month is Gyneological Cancer Awareness Month, so we thought it would be a really good time to get her on the pod. I just, before we get going, I just want to

let you all know about a service at the Eve Appeal offers to anybody that needs it. If you're listening to this episode and you have any anxieties about anything that you hear, if you are due your smear test and your nervous, if you've just got any questions in general, the Eve Appeal offer a service called Ask Eve, which is a free and confidential service where you can basically talk to a gynecological nurse about gynaecological issues. So that is there if you're going to check

out the Eve Appeal website. That is really good. That is a really good service. It's amazing. It's absolutely amazing. And I know it's been, I know after I did my video about my smear test, a lot of people took it up. So use it. Like, that's why it's there. And yeah, I hope hope you enjoy this episode and we have already roped in Anita to come back and answer the rest of your questions. Yeah, there's so many more. Enjoy. Enjoy. Hi, Anita.

Hi there. Thank you so much for being. We are so lucky that you are here. Yeah, flying by the seat of our pants with very little prep as ever. We asked Anita yesterday if she'd come on the podcast and there's a space in her die because she's on maternity leave. Yeah, that well-known holiday that women have to take. Yeah, exactly. She had all the time in the world

to come and talk to us after having twins. But thank you so much for being here. No, it's a pleasure. I like it when the stars align. Yeah, and it's Kynological Cancer Awareness Month. So it was a bit of a no-brainer to have the Geinie Geek herself. I put out a question on my Instagram yesterday asking for, asking if anybody had any questions. And unsurprisingly, hundreds of people had questions for us.

And we're going to try and get through as many as we can today. But before we do, given us, I went for my smear test last week. I put a reel about it on Instagram because there's no such thing as over sharing. I wanted if we could just talk to you briefly about smear tests and the process and the taboo and all there is to know about smear tests, please. Definitely, sure. So the smear test is part of what we call cervical screening. So it's not actually a test for cervical cancer, as a lot of people think.

It's actually a test to prevent cancer. Okay. And it's the only gynecological cancer that we actually have a screening test for. and so we are able to prevent around about 2,000 cases of cervical cancer every year through the screening process. So we start at 25 years of age, okay, and there's a very good reason for that, okay? So cervical cancer in over 99% of cases is caused by the human papillomavirus, so that's HPV. And so the data suggests that about 80% of us will get HPV at some point in a life, but most of us won't know about it. Now, personally, I think it's

probably closer to 100% of us, okay, because that data is a little bit old and based on maybe slightly older tests, and I think that the tests that we have nowadays are actually a little bit better. So what happens is this virus is all over the place, okay? So it's just in the environment, it's on our hands, it's on our genitals, and some kind of penetration, so whether that's, penis and vagina sex or masturbation using sex toys, it gets the virus into your body and gets it into the cervix. Because when we have any kind of penetration, you get kind of little micro tears in the tissue, which sounds a little bit alarming, okay, but that's what happens. And the virus is able to get in. Okay. So if the virus gets in, then sometimes it's able to persist. And that's

the most important step in developing abnormal cells. So the virus lives in the cells and it starts to cause cell changes. Okay. And that's not cancer. So cell changes are things that we can pick up, but it's not cancer. Okay. So 90% of HPV infections are going to be cleared within two years. And they're cleared on their own without treatment. Yeah. So cleared, the body just clears it. I mean, there aren't really any kind of evidence-based ways that you can get rid of HPV yourself. I see lots of videos on YouTube and things like how I cleared my HPV. I would love to tell people if there was a way, and honestly I would, but it is just the immune system and chance. You can have all the green juices in the world. You can do all the, you know, like cleanses or

detoxes or whatever, there isn't really any evidence way of getting evidence-based way, mouthful, of getting rid of it. But for some reason, some people just can't. And it doesn't mean that you have something specifically wrong with your immune system, but for some reason it doesn't happen. So it starts to cause what we call pre-cancerous changes in the cervix. And if the virus is able to keep going and keep going, from about 10 years after getting an infection, you can develop a cancer if you haven't cleared it. Okay. So the idea of doing screening is to look for the virus. Okay. And if you have the virus, then we can look under the microscope at cells to see if they have any kind of abnormal features or if we think there might be cancer, but that's quite unusual.

And so if you had abnormal cells, then you would be seen in a place called the Kolposcopy Clinic. So this is a clinic. It's normally in the gynecology department of a hospital. where what we do is we do a speculum examination. So like the speculum is a little instrument that put inside the vagina so we're able to see the cervix. And then we put some dyes onto the cervix and have a look to see if there's any abnormal cells. If there are abnormal cells there,

if they're mildly abnormal, they're the kind that are probably going to go away on their own. So we'll invite you back to see you in six, nine, 12 months, depends on what it looks like. but if those cells are severely abnormal they're less likely to go back to normal on their own and that's when we might talk about treatment so by treatment we mean removing those abnormal cells and that is how we prevent cervical cancer okay you both look a bit stunned it's it's so straightforward but it is it is nuts that we there is actually so little

that we know about it so we go for the smear but then god for you know we get the back saying there's something abnormal and I think everybody just goes to panic stations but actually that is all really reasonable but we don't really have the context for why we're going yeah exactly and I think that we don't really kind of learn about it at all I don't remember ever learning about smear testing at school but I mean my kind of like guine education at school was rubbish so all the boys were taken out of the room all the girls were told about periods and I thought that a period was an egg cracking and the context coming out of your body I have read quite a lot since then.

I know it's not. It's actually the lining falling away. Sorry, I don't mean to make any kind of dig at people who don't understand what's actually going on in their body. I don't want to come across that way because I didn't know. And I literally remember being at university and I did a science degree before I did medicine

and I literally went to the library at university and read a book about gynecology to learn about what was going on in my body, which is just not the right way learn about these things. And also, I was in a very privileged position there because, first of all, I had access to a library with a gynecology textbook, but I could also pick up the textbook and understand what it's going on about. And for most people, that's not the case. And unfortunately, Dr. Google is just a terrible doctor and tells you that you have cancer if you Google anything.

You either have cancer or you're infertile if you Google any kind of gynaecological condition, right? Or you have an STI. So, I mean, it's just we really need to get better at doing. doing it. And that's why I wrote a book a few years ago, which is called The Geinie Geek, Your No Nonsense Guided Down their Healthcare, because I just really wanted a book that I would have wanted to read several years ago, several decades ago, because I'm quite old now, but, you know, that actually just tells you the basics, because if no one ever tells you, how are you supposed to know? Yeah, well, that's the Eva Peel's line, isn't it? Like, know, you're normal, because if you don't know what's normal, then you don't know what's not normal. And so many of us have,

thing, you know, anything ranging from like irregular periods to symptoms that we don't know to mood changes, like ovulate, there's just so much of it that we're just, we're learning about now, like, outside natural cycles, I actually think are quite useful in women educating themselves. That was, I didn't know I ovulated it. I thought, I thought when I was having a period I was ovulating until I got natural cycles. And I now have a kid, so that's terrible. I thought that until you got natural cycles, because I told me that that wasn't the case. And I was like, what? I thought that's when, I don't. I mean, yeah, I do think that you can actually just learn so much from yourself.

And I get so many people saying like, oh, Anita, can I call you about this? Oh, can my friend call you? And everyone's just like, oh, God, I need to speak to a gynecologist. And actually, when I talk to a friend or a friend of a friend about a gynecological condition, I'm not actually giving them any medical advice or telling them what kind of treatment they need. I'm actually just kind of having that basic chat that like, okay, this is not normal. maybe need to go and see your doctor. And actually, you know, we can all do that. So if we actually talk to our friends, that's how you learn what's normal. Because whatever your period is

to you, if that's the only period you've ever had, and that's the only period that you've ever known about, you're going to think that's normal. And there's actually so many people that I see. Like, for example, the first chapter of my book starts with a story about a lady who used to have such heavy periods that she used to sit on like a bath towel for the first few days and couldn't leave the house. And she thought that that was completely normal. And I always like to understand what's gone on in my patient's sort of journey before they actually end up sitting in a consultation room with me. And often they'll just say, look, I just didn't know that this was not normal. And then when I did, I wasn't really sure how to talk to the doctor about it. I felt

embarrassed. And there's so many, there's so many really individual aspects to why people don't seek help. And if we don't know why someone isn't coming to see us, then we can't really get a better public health message out there. We can't really help people. So I really appreciate all the patients really who've educated me about what a day in their life is like, how they feel about talking to a doctor about gynecological health and I think that that's probably helped me to have more constructive conversations with friends, family, patients and also the public via social media. If we get into some of the questions that we've had from followers of the podcast, one of them just leading on from that was from somebody who asks how to get your doctor

to listen when you know something is wrong but they dismiss it as normal pain because I guess not every doctor is like you and that they go so far as to look at the context of your patient's life like for a lot for a lot of women they are dismissed yeah so how is best for them to advocate definitely um so the women's health strategy which was um uh something that the government decided to do um it was last year or the year before i don't know time has gone in a bit of a time warp for me at the moment but um basically they put out a call to um get evidence from um women about their experiences of female health care. And they found that 80% of women who responded to the call

and there was 100,000 responses felt that they hadn't been listened to by a healthcare professional. And I've spoken about this before on social media and I actually got a lot of hate from other doctors for actually speaking out about this. And obviously anybody who's had hate on social media knows that it's really uncomfortable. but I just felt really passionate that it's something I had to talk about because as a medical profession, we need to do better. And I think that we are still quite behind in the way that we do talk to patients. I mean, if you look at how, for example, like our grandparents would have experienced healthcare, you go to the doctor, you tell them what's wrong, and whatever the doctor

tells you is gospel, and there would be no kind of like back and forth. Whereas I feel that we should be having a very kind of dynamic conversation. It's not, it's not me dictating to you what you should do and not listening to you. You have to, you have to get the full story. And you can't really get that with that kind of very kind of, all-fashioned style of having consultation. So my advice, if you feel like you're not being taken seriously, is first of all, it's really important to the way that you tell your story. So take a list, okay, of the really important points that you want to get across. Okay, I love it when patients have lists because I'm like, right, this is going to be a really efficient conversation. So take a list. Take a friend with you.

Somebody who can be there and say, no, actually, you're much worse than you're making it out, someone who's going to stand up for you because it's hard in that situation. Also, giving an idea of how your problem is actually impacting your life. Because if you say, well, I'm having really heavy bleeding, that's one thing, and you should be listened to. But if you say, I'm having really heavy bleeding and I can't leave the house and I'm spending, you know, hundreds of pounds on period products, I can't do, you know, any kind of like sport, I can't look after my kids, all of these kind of things.

This is giving somebody an idea of what it's like. like to be you. And then I think if you're again dismissed, I think it's okay to ask, can you explain what you think is going on? Can you explain why you think I do or don't have a problem? And it doesn't have to come across as aggressive. I think it just is really important to have, as I say, that sort of two-way conversation. So not to let yourself be fobbed off with like, well, it's just women's. Absolutely. Absolutely, because if it's affecting your life, there's no set criteria for what you have to put up with. Because, you know, what I put up with, for example, as a heavy period, someone might think, well, that's nothing.

But someone else might think, well, if that's a heavy period, like, I can't go on. So, you know, we all have different thresholds of what we will accept. So it's not a sort of set criteria. That's such a good piece of advice to get someone to come in with you because unfortunately, often, We're not good at advocating for ourselves. You know, like, I would, I go in feeling strong with the doctors, like, and I'm going to get, you know, I'm really going to advocate for myself. And I end up kind of, I don't know, like, wilting away a little bit.

But if I go with my sister or with my friend, I feel very strong. And I'm like, no, we're not leaving here until you have the proper answer. So I think that's such a good piece of advice to get someone, and someone who has experienced your symptoms. Witnessed. And, you know, it's very difficult. And, you know, I personally have been to experience. where I also didn't advocate for myself.

I had a miscarriage a few years ago now, and I was at work, and actually one of my colleagues said, well, if you're not bleeding and you feel fine, then you can carry on working, can't you? And I was just in that moment was like, yay, okay. And you know, so this is me, as a gynecologist,

telling everybody out there stand up for yourself. And I admit that even in times when it's hard, I haven't been able to either. So if someone's listening and thinking, well, it's really hard, it is, I know. Yeah. Yeah. I'm really sorry. Yeah, that's awful. It's something that happens to lots of us.

And I think that as a population, we're not really very good at dealing with a lot of these things. And people don't really understand the kind of the mental health implications that come with a lot of these kind of gynecological and reproductive problems. And, you know, this is from a gynaecologist, you know, my colleague who deals with this kind of thing day in, day out. So there's a lot of work to do. Yeah, I'd say. Another question, which I'm super interested in the answer anyway, because this was definitely for me. And it turns out I hadn't avarian cyst, so I was wondering if it was connected.

But this person says, why would only one side hurt for ovulation slash period pain? Okay, this is a really interesting question. and I feel like now I'm making this entire podcast about me, which is not. No, we love her. Take the laugh. So, ovulation pain happens because you get, the question is about ovulation pain, isn't it? Ovalation or period. Okay, yeah.

Ovulation pain, no one really knows what happens, but when we ovulate, okay, we, when we're developing an egg before it gets released, it develops in something called a follicle, which is actually kind of a, a, um, a. small cyst on the ovary, so a cyst being a fluid-filled sack. The word cyst always fills everyone with dread, okay? But that's just how our ovaries work. We make tiny little cyst, a maximum sort of three to four centimetres. And then what happens is we get a surge of a hormone called LH, so loutinising hormone, and it helps the egg to be released. And when that happens, it can be quite uncomfortable. And some people think it's because a little bit of fluid gets released when we ovulate from that little fluid-filled sack. And some people think it's because there's a little bit of cramping pain because you need this tiny, tiny little smooth muscle

cells in the ovary that help that egg to be popped out. So no one really knows, but irrespective of that, it can be quite uncomfortable. And I remember when I was a medical student, I'd gone to Fiji to do my elective. And I was on this tiny little island. It was literally like three days from civilization and um i was like oh my god i think i've got appendicitis oh my god what's going on and i was just it was just so awful i was in so much pain and then i kind of had a moment of being a bit sensible and i was like no i need to think about it you're ovulating it was ovulation pain oh my god but i only ever got ovulation pain on my right ovary okay and so i just thought the left ovary did nothing. And actually, when you have a scan in early pregnancy, you can see something

called a corpus luteum, which is a little egg shell that gets left behind after the egg has come out. And the corpus luteum makes progesterone and is what keeps the pregnancy alive to start with before the placenta kicks in. And actually, both of my twins came from the left ovary. So I had two corpus luteum in the left ovary, which is so interesting because honestly I just thought that leftovery does absolutely zero lazy yeah exactly so if you do get it it is a kind of reassuring sign that you are ovulating um but if you don't get it it doesn't mean that you're not ovulating essentially doesn't mean there's nothing there doesn't mean there's something wrong on the other side yeah exactly so it could just be in the same with a period pain if that's hurting on

one side yeah so again no one really knows but for some people it it kind of hurts more on one side. And we just don't really know why. I definitely have that like every other month more than yeah. Really? And I don't know why. Really weird. So period pain is actually like a little bit like a mini labour pain and some people will be listening and thinking there's nothing mini about it. Yeah. But it is basically because your your uterus has to contract a little bit to help get the blood out. So it's how it's how period pains are. Yeah. Yeah. So it's actually like a many labour planes. When I was having contractions, it was all I could explain. I was just like it just feels like, it actually felt like having the coil inserted, but it also like at the

beginning, they just felt like, there's like period cramps. So it's, it's, it's the uterus pushing the lining out. Yeah, yeah, absolutely. That is, I can't believe I didn't know that. Oh, well, again, why would you know if no one's ever told you? But I mean, that's why often if your period is quite heavy, it can be more painful because the body's kind of trying to push everything out a little bit more, especially if there's clots and things and that can be quite uncomfortable. How would somebody know that they were pre-menopausal? Okay, so the average age for the menopause is 51 years. Okay, so the menopause is the term given to the last ever period you have. You don't know that you are having your last ever period

until 12 months after, because we can confirm that when you've not had a period for 12 months, you are post-menopausal. Okay. Okay. So perimenopause is the time leading up to that last period. And what happens is you will notice changes in your sort of menstrual cycle periods can become very erratic. You might not know when it's going to happen. It might become very heavy. It might become very light.

And you also start to get what we typically know as menopausal symptoms. So the most common ones being things like hot flushes, night sweats. But there's so many other kind of really vague symptoms. of the menopause. So things like mood changes, changes to sleep, concentration, aches and pains, heart palpitations even. And so it's really all based on kind of learning about the symptoms and working out if that's what's going on for you. Now, 10% of people will have what we call an early menopause. So that means menopause before the age of 45. 1% of us will have a premature menopause, which is menopause before the age of 40. okay after 45 there's no point doing any kind of blood tests to check for the menopause because everybody's hormones are going to be all over the place at that point so you might if you take your blood test on one day you might have like ridiculously high levels of fsh for example which is a hormone that we often test

for but there may be if you do it a few days later it might be really low and within the normal range so after 45 because they're going to be all over the place it's much better for us to take into account what kind of symptoms you're having. And you can use things like HRT if you have terrible symptoms and you can use it even before your period stop. Now, I think a lot of people who are listening to this podcast are going to be much less than 45 and a lot of people do worry about the premature menopause.

Okay, so as I said, 1% before the age of 40, 0.1% before the age of 30 and 0.01% before the age of 20. So it's very rare. If your mother had an early or a premature menopause, you are more likely to have one yourself. And they may be associated with autoimmune conditions, so things like diabetes, thyroid problems. You don't typically tend to get so many problems with people presenting with menopausal symptoms. It's more sort of irregularity of the menstrual cycle. So if you do go to see a doctor and you're having problems with your periods and they say, well, let's check some hormone levels.

Just want to reassure you that one of the blood tests that we do, so FSH, is the thing that checks for menopause. So if you are under the age of 45 and you're having that kind of blood test done and everything is normal, then your doctor will have been able to rule out premature menopause. Right. So is menopause solely based on how many eggs you're born with? Is that it? So yeah, essentially. So we are born with millions of eggs.

And as soon as we're born, well actually before we're born, the eggs start dying away. And so by the time we reach puberty, then we've got sort of tens of thousands of eggs left. And every month, you'll release one, maybe two. but every month you'll start to mature about 10 eggs get them ready to be released and then one chosen egg gets released

but it's a normal process that the eggs will die off so the older we get the fewer eggs we have and so they just run out basically yeah yeah as part of this maturation process so it's like a conveyor belt

your ovary is a very very special place it's like a factory there's always a production line going on. So you're always preparing eggs ready for the next cycle. So at any given time, there'll be sort of like four or five different stages of production going on so that you always have an egg ready for the next cycle. And so, yeah, it's completely normal for most eggs to not ever get released. But the menopause happens because we essentially run out of eggs. And that's just because like some people are born with more or some people produce more each month. So no one really knows why some people will have it slightly earlier than others, but

the premature menopause is usually not because you've run out of eggs, actually. It's because the ovary for some reason that we don't understand has stopped responding. Right. So when you actually go through the premature menopause, you do still have about a 5% chance of what we call spontaneous pregnancy, so getting pregnant without any kind of treatment because of the fact that there are still legs there. And every now and then you might actually release one. But it's a slightly different process with that premature menopause. So the one that happens before the age of 40 in 1% of people so that people are not panicking. Okay. Okay. That's so interesting. I was going to ask, sorry, kind of link, but can you ovulate without a period? Yes. And can you

have a period without ovulating? Both. Can you? Yes. So having a period without ovulating is called an an ovulatory cycle okay so if we take it back a step so i don't want to get too sciencey but basically you the textbook says you have a 28 day cycle okay actually only about 10 to 15 percent of us have a 28 day cycle but anything from 21 to 35 days is classed as normal okay so um three to my math is really bad 35 days seven weeks yeah yeah no five weeks

five weeks okay there we go that's how bad that's how bad my math is today oh my goodness so the first day of your period is day one of the cycle

okay and if you've got that mystical 28 day cycle then you will ovulate on day 14 yes and then the day you ovulate

is kind of what programs when your next period is going to be. So if you ovulate earlier than day 14, your period will come earlier than 28 days. Right. If you ovulate later than day 14, your period will come later than 28 days. Right.

So it's that process of ovulation that sets when you're going to have a period. So if you don't have a period, a period. Sorry, if you don't ovulate, what happens is the lining just continues to get thicker and thicker because you're not making progesterone. Progesterone's only made when you ovulate. And that stops the lining from thickening so much and develops the lining a bit more to become more receptive to allowing a pregnancy to implant. Okay. Yes, okay. And so you will basically just continue thickening up that lining and at some point the body goes well

I can't really continue this anymore so it's time to have a period and that lining just sheds now you can ovulate if you haven't had a period before that so you could just randomly ovulate so you might get people who for example a common situation would be somebody who's stopped using the pill for example so the pill being the most common form of contraception in this country. If you stop it, then some people might find that not having a period for a couple of weeks, a couple of months, longer than they might expect, and then just suddenly, out of nowhere, they ovulate because the ovary sort of kicks back into, into function.

And then your body's working again. And we never really know when that's going to happen after you stopped using hormonal contraception. So that's why if you're stopping any kind of contraception and you don't want to get pregnant, it's always really important to use other forms of contraception in case you just get that sort of random ovulation when you're not expecting it. Okay, interesting.

So we had a woman on the podcast who didn't know she was pregnant until she gave birth. And part of the reason she didn't know she was pregnant is because she had a period or she had a bleed every month when her period was supposed to be, so it felt like a normal period. How is that possible if, Yeah, so it does happen and it's really interesting because you do hear of these kind of stories and, you know, as someone who's previously been pregnant, I think, how could you not know that you're pregnant?

Because literally your whole body is hijacked. And trust me, I definitely knew I was pregnant. But you do see people that it happens to and I do believe them that they genuinely didn't know. Because a lot of people say, oh, they're just in denial, but I mean, there's only so much denial. I don't think it can really come for everything. And I have seen, I have had patients who've come in and literally had a baby and said, I genuinely didn't know I was pregnant. And I believe them.

So there can be a couple of things going on. It might be someone who has irregular periods anyway. And so is having random bleeds throughout pregnancy because a lot of people do for various reasons have bleeding in pregnancy. Right. And it can be really quite distressing. for a lot of people, but that can, it can look like a period. Yeah. And so that can be a reason of what happens.

Yeah, exactly. But some people can just still have this kind of regular bleed every month. Yeah. We just don't really know why. It's so fascinating. Just while we're on personal questions, this isn't from me, but I've just seen one that's actually, I'm quite interested in. This person said she's had ovarian cysts before.

Does that heighten chances of cancer in the future? So ovarian cysts are really common, okay? So remember that I said that our ovaries make little cysts in order to release an egg, okay? So there are about half of the ovarian cysts that we see are things called functional cysts. So cysts that have formed due to the ovary functioning as normal, okay? And so these are really, really common. And actually most of these kind of functional cysts are going to go away on their own. And normally, if we see one, then we would wait between three and six months and then do another scan and see if it's gone away.

And most people, it will have gone away. Can I ask you really quickly to tell us what they're made of? I think I already know, but I just, I don't know if you know. You're thinking of the hairy ones with teeth. Teeth. They're the different ones. They're not. Oh, sorry.

Yeah. So you're all thinking about dermoid cysts. Okay. I know someone with them dermoids. So dermoid cysts are cysts that form from the germ cells of the ovaries. So they are the cells that, you know, are turning into the eggs, and so they can turn into any kind of tissue of the body. Now, these are a kind of cyst that is not going to get away on its own

because it has solid contents, okay? So a lot of them, they contain teeth. I've seen one that contained a little bit of jaw before. They usually always contain hair and, like, fat and oil kind of cells. I kind of love it But yeah It's a lot of people are probably like

vomiting in their own mouth now But when you say you saw a jaw What do you mean Well so what we do is So those kind of cysts We often remove Okay Because if they

They get very big They can be really painful They can cause the ovary to twist That's something called Averian torsion That sounds painful Yeah it's very very painful I've seen plenty of people

Having a very entortion and it's an emergency. We need to take them to theatre, irrespective of what time of day or night it is. And what we do is usually a keyhole operation and we untwist the ovary because otherwise if it's left for a long time, the ovary can actually die away.

And so when we remove dermoid cysts, we often cut them open because we're fascinated to see what's inside. And patients will often say, you know, I really want to know what's inside and I had a really cool patient last year and she was like, she'd given her sister name and she's like, me and my colleagues really want to see what's inside.

So can you take some photos? I was like, yeah, sure. And she absolutely loved it. I've literally never seen anyone happier after an operation. She was great. And yeah, so we just had a look and that's what we saw her inside. How big is this? I'm thinking, tiny, but...

No, so they, we normally want to remove them. If they're more than five centimetres, that's when we become sort of interested in thinking about taking them out. Okay. But some of the biggest cysts I've ever removed have been like 30, 40 centimeters. They can be really, really big. And size doesn't really correlate very well with risk of cancer. So I haven't actually answered your question at all, which is classic me.

But, you know, having ovarian cysts doesn't increase your risk of getting ovarian cancer. Because actually, a lot of people who have ovarian cancer have never even had a cyst before in their life. but also cysts are so common we probably all have them at some point maybe and then they just sort of go away but certainly you know having a lot of people have a scan

I'm told you've got a cyst it doesn't mean that you have an increased risk of ovarian cancer okay and both of those dermoid cyst and the functional cysts both of those are benign and nothing to worry about other kinds of ovarian cysts that we can see are things such as endometriomas

these are a type of cyst that people with endometriosis have okay they're also called chocolate cysts so water so I know it's not as nice as it seems they're very painful um so endometriosis is a condition that affects about one and ten um of us and it means that you have tissue that's similar to the endometrium so the lining of the womb growing outside of the uterus okay so it's only meant to be inside that uterine cavity and that's what you shed when you have a period now in endometriosis it can grow on the peritoneum, which is the lining inside the pelvis. It can grow on the bladder, on the bowel, it can even grow in the chest in about 10% of people who have endo. And it can

grow on the ovary. And so what happens is that this tissue, wherever it is in the body, responds to your female hormones in the same way as it would if it's in the uterus. So it thickens up throughout the cycle. And then when you have your period, it wants to shed. but it's got nowhere to go. And so it can be really incredibly painful. So that's why people with endometriosis have such bad period, period pain? Yeah. So it tends to be very, very painful periods.

And over time, this kind of like bleeding and inflammation cycle can cause scar tissue. So inside your abdomen can become very scarred and organs can stick together in a way that they're not meant to. Periods don't necessarily have to be heavy. heavy. But a lot of people can have heavy periods. And often people who have endometriosis have a higher chance of having something called adenomyosis, which is where the endometrium, so the lining, grows into the muscle layer of the uterus. And what happens is over time, again, that sort of thickens up, bleeds very, very intense cramping pain. And the uterus isn't able to sort of stop the bleeding

in the same way that it normally would and so the period can be incredibly heavy as well and so just going back to endometriomas they are it's where you have a deposit of that endometrial like tissue on the ovary and then they sort of bleed into themselves and it looks like chocolate

well quite like Nutella when you chop it open yeah because it's digested old blood and they've I can be different from Nitella. Yeah, well... I can handle teeth and jaws, but... Other brands of chocolate spread are available,

just to let everyone know. Just to keep firing through them, because there are so many. What do cancerous lumps in the vulva feel like? Should we see our doctors for all lumps? Quite a lot of questions along that. Like, are lumps common on the labia? Yeah, so lumps and bumps are just so anxiety-provoking, and it's really difficult to say,

yes this is normal no that's totally not normal unless you can see it okay so if we think about what can cause common lumps and bumps you can get things like inggrown hairs I mean look we're probably all had an ingrown hair

is bloody painful isn't it but sometimes it's just so deep and you can't really tell that it doesn't really have the same little head as normal does it so it just takes a while to get to the surface and that can be you know really you're like I don't know is it is it not? So that's something that's really common.

And would a doctor judge it? And I know you're going to say no. I hope you're going to say no. But if you went to the doctor with a lump that turned out to being growing hair, no one's going to laugh at you, right? No, no. Definitely not. I mean, you know, you have to remember that I have a slightly different, my judgment's a bit coloured by the things that I see, okay, because actually my job at the moment is I'm doing a fellowship to specialize in advanced gynaecological cancer surgery. Okay. So I see, you know, the most unusual and quite sad cases. Okay. So because I do see people with awful cancers on their vulva, I just really think that everybody, if you're worried, should go to the doctor because you can just end up leaving these things. And this is also one of the reasons why I absolutely cannot stand the feminine hygiene industry. All these like washing. and things that people are, you know, sold and that are promoted all the time.

I really think that it stops us from going to the doctor in certain cases because I've actually seen a couple of people now with Volvo Cancer who said, I didn't go to see a doctor because I used this and that and X and Y and, you know, all these things and it just delayed it. Now, look, I want to be completely honest with you. very rare in young women. It's much more common in people who've gone through the menopause, but it's still something that we all need to be aware of. If you have, so yeah, lumps and bumps, if you're not sure what it is, go and see someone. There's also lots of different

kinds of cysts that you can get and abscesses, which can be really painful and knee-treating, even though they're not cancer. But what I would say is that if you've got very bad itching or irritation, and that's why you want to use something like, you know, various brands of feminine hygiene wash that I won't name. I would like to see you and see what's going on because a lot of people will have things like thrush, you know, something very simple. And if you have thrush, actually, it's probably going to go away if you stop using those washes because actually those washes increase your chance of getting thrush. They wash away. the good bacteria that we want there.

But the other thing is that there's a condition that some people might have heard of called lycan sclerosis. And this is a chronic inflammatory skin condition that can affect people of any age. Okay. And what it is, is where you get inflammation going on in the skin, it's very, very itchy. You start to get, we call it in textbooks, a change in the architecture of the vulva. It basically means that, you know, everything changes in how it looks. and feels because of this inflammation that's going on and you get scarring.

And it's not just older women that get this. I've seen lots of younger women. I did a post about it a while ago now. And actually quite a few people said, I actually found out I had this when I was a teenager. Okay. So it's not just for older people. And if you have that condition, then you do really need to use a steroid cream that your doctor will prescribe.

because actually if we leave it untreated and you have years and years of this inflammation going on, then actually there's a small risk of it turning into a cancer. So that's why I'm just so passionate about, you know, not self-treating and not mask. Exactly, exactly. What should we be using to wash our vaginas then? What is the defaulvers, sorry? Yeah. So what is the definitive answer to that?

Well done for correcting yourself. So it's okay. So remember that the vulva is on the outside, the vagina is on the inside, and you got it right, well done. But you should never wash inside your vagina, okay? Washing the vulva, water. Honestly, water. Really? Yes.

Even if you've been like sweating. Yeah, yeah, absolutely. Yeah. I mean, you could use a little bit of soap on the outside. You know, if you're having a shower, using shower gel or whatever, you know, wash or, you know, around the outside. but don't start kind of like putting the soap all around the vulva and like on and between your labia and all that kind of thing it doesn't need to happen it's literally just simple water um because i don't think i can do that need i mean we can no we can we can we can we can after so long of using soap and shower gel i just don't know if i could

okay so it depends on what you mean by using soap to wash your vulva so what i'm talking about is you wash your, like, you wash, I don't know, this is what I do in the shower guys, but wash my, like, abdomen, wash the tops of my thighs and then kind of like wash where the top of the thigh meets the, I don't know what even the word of it is. With soap. Yeah, with soap. Yeah. I do not clean inside my labia with soap. Okay. Okay, so washing all the bits that are kind of like skin, but anything that is more kind of like So you know the tissue on your vulva where the labia are and where the entrance of the vagina is very similar to the skin inside your mouth? So it's not really skin, it's actually.

No toothpaste. But that kind of like really delicate tissue that's like more kind of like we call it a mucous membrane. Do not use soap on that area. You wouldn't put soap in your mouth. No. Well, exactly. There you go. You got it right.

Thank you so much. Pleasure. Okay, water. Just a quick, like we are going to wrap up in a second, but I've had quite a lot of questions about vaginismus. Okay. But also just in a more general one, generalised question, this girl says, why does it still hurt to have sex with my partner of six years? I wonder if you could let us know. I mean, obviously vaginismus would be one of them, but if there were any other factors and if it should be a cause for concern.

Yeah. So vaginismus has got quite a lot of airtime these days because a lot of people have been talking about it in particular. Can you define it for people who don't know what it is? Yes. So vaginismis means. when you involuntarily contract the muscles around the vagina with penetration. So that doesn't have to be just sex. So it could be when you want to wear a tampon, when you're having a speculum examination to have a smear test or sexual health screening test, so many different things. And so it's basically because there is a connection between the brain and our muscles.

around our pelvic floor and our vagina. And sometimes we can work out a reason for why it might be happening. Sometimes we can't. But for some reason, the brain just says, no, I just need to clench, essentially. And that's what it is. But you can't often stop it from happening. We can all hopefully clench on command when we're doing our pelvic floor muscle exercises. But some people just can't stop it happening.

It's really distressing, actually. And for some people, it might be related to, previous trauma, it might be related to a sexual assault, for example, but also some people can get it after having a traumatic childbirth, an awful experience at the doctor's surgery, just so many different things. And it's, although it's a link between, it's the body and the brain, isn't it? You know, they're so connected. But it's not quite, you know, it's not as simple as saying, well, it's all in your head because that's a really dismissive way of putting it. But in these situations, I think that actually a doctor is not

the right person to help you. You actually really need, you know, a psychologist, psychotherapist counseling, because that's actually what's going to really help. Some people might find using dilators useful, but that probably isn't necessarily the best first thing. That's like a fixing a symptom rather than the... Yeah, absolutely. So looking at why it's happening and then going down that route. Some pelvic floor physiotherapists are really good at this kind of thing as well because, you know, whilst we need to keep our pelvic floor strong, sometimes it can be a bit too tight.

That's an overshare on my part, but that's currently what I'm experiencing since having a baby. It's too tight, so I'm a pelvic floor special. A pelvic floor physio is helping me try and relax that now. Yeah, that's really important. And so, you know, you asked what else could be going on. And actually, we do see people with chronic pain conditions often experiencing vaginismus. And so a lot of people with endometriosis actually have very tight pelvic floors. Because if you've got chronic pain all the time, then it's sort of a, it's like a defense mechanism almost, isn't it?

But other things that I'd want to think about would be, you know, if you're having pain when you have sex, are there any skin problems? We talked about lichen sclerosis, but you know, you can get even simple things like you can get eczema on your vulva. All of these kind of things, you can get a lot of vaginal dryness. You know, we think of vaginal dryness as being something that only affects people after the menopause. But actually, you know, particularly if you're using progesterone, only types of contraception, they can actually increase the dryness that you experience. People who are breastfeeding often get terrible vaginal dryness because our hormones are quite different. Sorry, does it run out of liquid? Your hormones are quite different when you're

breastfeeding and it's almost like a little bit of a menopausal state. So I want to know if that's something that might be going on. But so many, so many different things. Sometimes we find sort of a biological reason for what it's happening. But in other cases, we don't find a reason. But it doesn't mean that you can't get help. And often I hear people saying, well, I need a general anaesthetic for my smear test. And, yeah, we can do that.

But I always think that actually is probably more productive to start looking at why it might be happening and start looking at what we can do because there's going to be other things that you want to do in life besides having a smear test that are going to be impacted. or having that kind of pain or tightness. Just on the other side of the dryness, we've had lots of questions about discharge as well.

Oh, yeah, I was to ask you a question about discharge. Yeah, I wanted to know how it differs during the cycle. Yeah, because that's something you told me, that it's when you're releasing an egg, I'm going to butcher this, but when you're releasing the egg, it's like sticky and clear, but I don't know the other ones. Yeah. So the word vaginal discharge just means any fluid that's coming out of the vagina. Okay.

Just before you explain it, is there ever too much? Is there ever too much? Should we be worried if there's too much? So again, it's really individual, isn't it? Because what one person thinks is too much is, you know. The things that are sort of what we call red flags when it comes to vaginal discharge are if it's very itchy or irritated, if it's bloodstained. Okay. So bleeding when you're not. having a period is something that needs attention. Bleeding after the menopause, always you need to go to the doctor. There is no such thing as a period after the menopause. Yeah, my granny thought she was having one of those.

Yeah, so that's why I really... It's just giving me a sad face. My sister's just given me a sad face for that. She brought the mood down, sorry, carry on, we'll talk about the discharge. Or if you've got a lot of pain associated with the discharge, but the absolute amount is, you know, very individual and depends on where you are in a cycle. So when we talk about changes in discharge, with the menstrual cycle, we're talking about people who are not using hormonal contraception,

okay, because that will change it, and I'll touch on that in a second. But so after your period is often the time when you feel often quite irritated, often the time when people think, oh, have I got thrush? Have I not got thrush? And you might actually get thrush, okay? And it's because of the change in hormones when you are having your period, because all hormone levels are quite low. And lots of people think, oh, is it because of like certain tamper, ponds that I'm using or whatever and okay it might be but actually there is a sort of biological reason for why you might feel a bit dry itchy irritated after your period and this is absolutely the time when you really should not be using any of these kind of washes that I mentioned okay

lots of people think they need to clean after their period no you don't need to but when you are getting towards ovulation then your discharge will change and it will come much more clear and slippery. And around about the time of ovulation, you get what we call an egg white discharge. And so if you were to sort of stretch it between your fingers, it would make a really long kind of like... Yeah, exactly.

There we go. That's a good word. Yeah. Good, yeah. And the reason it's like that is because the body is making a way for the sperm to get up inside the uterus and get to the egg. Okay. And then afterwards, you will go back to having that kind of like, sticky, slightly clumpy, thick discharge again.

So it's kind of quite watery around ovulation. And so it's quite interesting because I've noticed over the last few years, there's definitely a fashion for people wanting to stop taking the pill because I think there's a lot of bad things written about the pill online. And obviously if you don't like it, doesn't agree with you, then do stop taking it. But, you know, there's not actually as much. harm associated with a pill as the internet will lead you to believe.

But I've noticed that since people have stopped taking it so much, so many people are coming and talking about this discharge and they're like, oh my gosh, I don't know what's happening. It's so watery. It's actually because you're ovulating because the combined oral contraceptive pill stops you from ovulating. That's how it works.

And it thickens up the discharge in the cervix to stop the sperm getting in. So if you've been on it for many years, you've probably not had that. And then suddenly you're like, oh, wow, like what's going on? And it's actually your body just working completely normally. So interesting. So interesting.

God, I literally, we could talk about this for days and I really want to. So please, we can you come back next to. I'll have you can't throw awareness one. Before you go, can I ask? This wasn't my question, but it's really good. Just as a fun one to finish on, you're probably going to say you're not allowed to answer it. What's the weirdest thing you've ever found up someone's vagina? A disco ball.

No. A real-sized one? No, no, obviously. A key ring size one. Oh, Jazzy! Yeah. I love this. Did they know?

Yeah. Did they know? It's all, you know, experimentation. Did they have an explanation? No, just having fun. Just feeling, put some Sophia Lusbextron and just thought, ooh. She was very, very embarrassed. I didn't go there.

Oh, bless it. That's a bummer. Literally. Yeah, no, that is rough. Sparkly, though. Fun. Oh, this has been great. Thank you so much.

Pleasure. We've got so many more questions. You're going to have to come back if that's okay with you. Any time. Thank you so much. Should I delete that is part of the ACAS creator network.