Ever wondered if your discharge is ‘normal’ or what you can do about down under dryness? From post-baby sex to vaginal douching, a gynaecologist answers ten questions she’s commonly asked in clinic. A must-read for anyone with a vagina

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Tania Adib  fields any number of vagina-related questions every day. As consultant gynaecologist at 25 Harley Street , London’s integrated women’s wellness clinic and Queen’s Hospital, she’s seen and heard it all and isn’t the remotest bit shy about sharing her wealth of gynaecological knowledge, from heavy periods to why you might be getting headaches after sex.

She also specialises in the management of the menopause  and takes a holistic approach that incorporates both hormone replacement therapy   and a strong emphasis on lifestyle modifications.

We asked her for the most common questions that women asked her in her practice - and they weren't necessarily what we expected. To quote Robin William’s character in the film Patch Adams, Miss Adib ‘at your cervix’... .

I am having a great deal of discharge. Is that normal?

“Yes. Discharge is a really good sign that your vagina is behaving as it should do. These mucous secretions are cleaning your vagina, and keeping it in a healthy state. The mucus should be clear or white and not have a strong smell to it.

The amount of discharge you produce depends on which point of your menstrual cycle you are at. Discharge is usually more plentiful and can be quite stringy when you’re ovulating, breastfeeding, or are sexually aroused. However, if you experience changes to your discharge, you should book an appointment with your GP or gynaecologist.

For example, if it becomes curd-like and thick and you’re experiencing itching, it’s a sign you may have thrush. If there is a strong odour, like fish, it may be bacterial vaginosis. Any accompanying pain or other symptoms – such as blistering around the vagina need to be checked out. This may indicate a sexually transmitted infection.”

I get clots in my period. Is this something to worry about?

“Clotting will be normal for some women, however, it does show that your periods are heavier than they probably should be.

So why do clots happen? When it comes to menstruating, your body usually knows that this kind of bleeding is non-harmful, so it doesn’t need to clot in the usual way, as say when you cut your knee. Anti-coagulants usually thin the blood, allowing it flow freely. A heavy period overwhelms the natural anticoagulants – hence the clots.

Heavy, clotty periods can be very inconvenient, they can also be harmful to wellbeing. If a patient came to me with blood clots, I would be concerned she might be anaemic due to the heavy blood loss.

The first line of treatment would be tranexamic acid, which has a chemical action that reduces bleeding. Controlling your periods with oral contraceptives or the Mirena coil is another option. The coil provides contraception and can lessen periods, although you should be aware that symptoms may get worse initially. If that doesn’t work, and you don’t wish to have children, there are other surgical options, such as an endometrial ablation. The latest techniques mean they can be done under local anaesthetic in day surgery, or if you prefer under a general anaesthetic. The overall success rate of this operation is about 80 per cent in stopping or lessening periods.”

I am worried that I smell when I have my period- should I use a bidet or douche?

“A bidet, fine. A douche, never. Douching – the practice of sluicing water up your vagina with a pumped device – is associated with a range of health problems. Douching upsets the natural balance of bacteria in the vagina (called vaginal flora), which can cause infections such as thrush or bacterial vaginosis. Even more worryingly, some studies have linked douching with increased rates of cervical cancer and ovarian cancer. Use unperfumed, gentle soaps to wash the vulva area daily, or more if needed during menstruation. It’s important to remember that the vagina itself is self-cleaning. The mucous discharge all women have is doing the job of keeping it clean and healthy. When it comes the inner mucosa of the vagina (the part inside the vulva) just water to wash away any menstrual blood or sweat is fine. This could be via bathing, a bidet, or the shower. Just don’t douche! The vagina will sort itself out."

Why do I get a headache after sex?

“If you feel a bit headachey after sex, the first line of management would be to ensure that you have drunk enough water, as vigorous sex can cause dehydration. There is a phenomenon known as benign HAS (headaches associated with sexual activity). HAS is a rare condition – less than 3 per cent of all headaches reported – and it generally affects men more than women, although nobody can be certain how common it is, because people may be embarrassed about reporting it. One theory is that the exertion of sex leads to the blood vessels dilating. Headaches can last a minute or two, or up to day.

If you do suffer from HAS, it’s important to discuss it with your GP – although headaches are usually benign, your doctor will want to rule out more serious conditions and there may be treatment available.”

Is it possible to be allergic to semen?

“Absolutely – it’s considered quite unusual, although one study has suggested the incidence could be as high as 12 per cent. Semen allergy, also known as seminal plasma hypersensitivity, generally affects women more than men and is caused by antibodies in women’s bodies recognising semen as harmful, and going into an overdrive response.

Women may experience inflammation, an itchy sensation and swelling of the genitals shortly after contact with semen. Luckily reactions tend be localised, and I’m not aware of any cases where women have gone into anaphylactic shock, although theoretically, this could happen.

For women who experience semen allergy, I usually recommend they stick to condoms. However, it can be tricky when women want to get pregnant. They may experience discomfort until conception. In severe cases, assisted reproductive technology has to be utilised.”

Does post-baby sex hurt?

“It can do. Often there are issues like bruising from birth trauma, or an episiotomy. You should only attempt to have sex when you are ready – six weeks is usually recommended as the healing process should be well under way, although some women will have sex before then, while others will wait longer. The other thing to bear in mind is that just after you have given birth your oestrogen levels are very low , which can thin the vaginal skin making it drier and causing discomfort. Breastfeeding  also dampens down oestrogen, so that can be an issue for nursing mothers. Use a water-soluble lubricant to lessen problems with post-partum sex.”

When I’m having sex I often get ‘fanny farts’ – any ideas how to stop them?

“This is simply air getting trapped in your vagina. It happens when air is pushed in during penetrative sex and then released, like a cork being released from a bottle. Women who have had babies are more prone to fanny farts and certain sexual positions, such as when the woman is on all fours, means it’s more likely. You can expect that embarrassing sound during fast, furious sex, so taking it slow might reduce the likelihood. Learning to laugh about them might be easier!”

I’m 60 and still want to have sex, But I’m so dry. What can I do?

“Vaginal dryness is a real issue postmenopause. A vaginal moisturiser can help, alongside a water-based lubricant to be used when having sex. HRT containing oestrogen may also restore moisture levels, however, not all women can take HRT and many are wary because of the small but elevated risk of breast cancer associated with taking hormones. Another option is to use topical oestrogen. This can be applied straight to the vaginal area, which although not ideal, has the advantage of being effective at lower doses. Anyone wary of oestrogen may prefer this as a smaller amount reaches your bloodstream and it can be more effective than oral hormonal regimens at getting to the place that needs it to be.

For those who want to avoid oestrogen completely, and find that creams and lubricants work for them, a new treatment called The MonaLisa Touch  could be the right choice. The laser works on the tissue of the vaginal mucosa, boosting collagen and restoring function.  This simple procedure is performed in clinic, with three treatments often required alongside a top-up treatment once a year. Success rates are about 85 per cent.”

Can you get blackheads on your vagina?

“The vagina is skin, just like anywhere else. As it’s usually quite warm and damp down there, you can get blocked pores and lumps and bumps, as you can in other areas. Pimples or blackheads on the vulva area (where your pubic hair grows) can be caused by shaving and waxing in particular. As blackheads are blocked hair follicles, it’s unlikely that you would get them on the inner mucosa of the vagina (the moist part of the vagina within the labia majora, the outer lips of the vagina), but there are other reasons for lumps and bumps, such as blocked glands for example, or ‘Fordyce spots’, which are small white or yellow bumps in the inner part of your vulva and the labia minora (the smaller lips surrounding the vagina). These are not harmful, and they can accumulate as you age.

Then there are varicose veins, which are associated with pregnancy and age, which look like bluey raised lumps. Although most lumps and bumps are not serious, it is essential that you see your GP, who may refer you to a gynaecologist. In rare cases, a darkening patch may indicate pre-cancer cells, so it needs to be checked by an expert in gynaecological cancers.”

I’ve got a huge spot ‘down there’. Should I squeeze it?

“It sounds like a Bartholin’s cyst. There are two glands at the entrance of the vagina that secrete a fluid by means of a duct that keeps the mucosa inside the vulva moist.  On occasion, this duct can become blocked and a cyst will form. About two in 100 women will develop one of these. It may not be painful initially, however, it can become infected. If that happens, the cyst will become uncomfortable and start emitting a smelly discharge. My recommendation would be not to squeeze, as this may spread the infection. Go to your GP and ask for a referral to a gynaecologist who will be able to treat the cyst. This will be done by either marsupialisation or a word catheter.

Marsupialisation simply refers to the surgical drainage of the cyst and is usually performed under a general anaesthetic, so you’re asleep throughout. A small incision is made by the doctor, and the cyst is allowed to drain. Dissolvable stitches are then used and healing occurs over a month or so.

Alternatively, the cyst can be drained using a small rubber tube called a word catheter under local anaesthetic. A small cut is made in the swelling to drain the fluid or pus and the catheter is then inserted into the gland and held in place by a tiny water-filled balloon. This stays in place for four weeks to allow complete drainage and healing.”

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Follow Tania on Twitter  @TaniaAdib