The Vagina House

Urge Strategy

2011-03-24T04:52:00.000-07:00

In my long-ago post about urinary frequency I mentioned two strategies to combat frequency and urgency that are, stand back, NON-prescription. Whhaatt? It's true. We will talk about the first one today.

Now, I am a friend of the bladder. We should all give this amazing organ the proper respect and, for heaven's sake, GO WHEN YOU NEED TO GO! We expect small children to. Shouldn't we hold ourselves to the same standards? This is for emergencies only, people... It should not be used to get through a weekend camping trip without using the latrine.

We have all, I suspect, had moments where we have pushed our bladder too far. We did that thing where we keep saying, "just one more patient" or "I'm just going to wait until the end of this meeting" or "I'll get through this child's bath and then go" and then, all of a sudden, things have the opportunity to go VERY badly. If we are young and strong and blessed with good genes, we will probably make it to that blessed bathroom and get our bums down before anything escapes. But sometimes, we don't. We would like to think we would simply stop waiting too long. But we know we probably wont. So, in this scenario, what can we do to improve our chances of escaping dry?

Urge strategy! This is a brilliant little exercise, a game really, that we play with our minds and body to trick it into submission. When you get a crippling urge to go to the bathroom, one that you feel may overwhelm your power to suppress it, try the following steps...

1) Stop what you are doing. Sit down if you can. If that isn't an option, stand up very tall and straight and tense.

2) Do 5 very hard, very fast pelvic floor contractions. Don't let the contraction fall all the way to resting in between. The object is to get those muscles tense and alert. Hope you've been practising!

3) Now, try and relax the rest of your body and sing a song to yourself. Yes, a song. Something easy that you don't have to think about-"Twinkle, Twinkle Little Star" is my favorite.

4) The urge is probably significantly less now than when you started. Stand up and WALK to the bathroom and DO NOT DELAY!

Does that all sound totally crazy? It actually makes perfect sense when you think about it. Voiding is a very complicated set of signals between our bladder, spinal cord and brain. Our bladder says "gotta go soon" and sends that message up our spinal cord to our brain where it is processed. Our brain sends back the message "OK, I'm on my way" down the spinal cord to the bladder again. Bladder should follow suit by continuing to stay relaxed until you get to a bathroom, get your pants off and sit down. Then we send another message that says "Brain, we have arrived. Let's relax our pelvic floor and squeeze the urine out." Our brain, bladder and pelvic floor are having this big conversation that we totally take for granted. We can take advantage of that communication by breaking a part of the cycle through distraction. And that, my friends, can buy us time.

By squeezing our pelvic floor we send the message "Hey bladder, I'm not there yet." We increase the tension in our pelvic floor to help hold the urine up. By singing a song we say "Hey brain, I'm not there yet. It's OK, just give me a little while and we'll get this thing done." By allowing ourselves to let the crest of the urge wave to pass and then walking to the bathroom instead of RUNNING FOR THE HILLS, we let our bodies natural ability to keep us dry manage the situation.

This, like all behavioral interventions, takes practice. When I teach my patients how to do this, I tell them to practice in a safe place-not during the meeting at work, but at home when accidents suck, but are not the end of the world.

EMERGENCIES ONLY!

Dou-la-la: Weekend Movie: The "Natural" Cesarean

2011-03-20T04:18:00.000-07:00

I thought this was just terrific. Having come from a mostly nurse midwifery education, I am still very drawn to the birth experience. Having had one very non-traumatic, natural vaginal delivery with my first child and a totally-traumatic, emergency c-section with my second, I am fascinated by the type of experience this movie portrays. Clearly, this is in the setting of a non-emergency or elective c-section.

I am amazed and proud of how the health care team-OB, midwife and anesthesiologist-have altered their roles to make this a meaningful birth which the family will remember fondly.

This is about 11 minutes...but it will make you cry.

Dou-la-la: Weekend Movie: The "Natural" Cesarean: "This is a great portrayal of new possibilities. Cesareans can be made gentler, kinder, and more mindful of the humanity of all parties. I..."

The New Feminism, Part II

2011-03-18T14:39:00.000-07:00

THE NEW FEMINISM, PART II

This is the second part of my musings on the new feminism. FYI-if you are worried this is a political statement, you should be. But it probably isn't the statement you are thinking...

I used to be surprised that my patients had never looked at themselves. They couldn't even address their genitals by name-it is often "down there" or "it" or "that." "I never look at that." They certainly never used a possessive pronoun. They might say "vagina" but it is rarely "my vagina." Why is this?

I feel like women feel fairly detached from their genitals. We don't HAVE to look at them. They are hidden-an inner sanctum. Many of our introductions were at the time of our first menstruation, when we are either taught to stifle our vagina with pads or stuff them with tampons, taking care to change them regularly so no one knows what is happening. Not too long thereafter we are taken to a special doctor (gynecolo-what?!? sounds like an unpleasant person) to make sure everything "down there" is ok using a speculum (looks like a torture device) because that part of our body is so supremely difficult to visualize and understand that it takes a specialist and special piece of medical equipment to see if things are NORMAL. And that's just your vagina-the gynecologist never mentions your labia, urethra, clitoris or anything else you could look at, identify or, god-forbid, touch. At this appointment sometimes it seems we are the domain of another. That we are too complicated to understand...ourselves.

We wonder why our daughters are so willing to "give it up." I say because it rarely seems theirs to begin with. If you give a teenager an unopened box and say "give this to the first boy who cares" but tell them NOT to open it, the transaction may be relatively smooth. If, on the other hand, you show that same young woman the wonders inside that box and say "this is yours, it belongs to you, take care of it," I would imagine giving away that possession would become a much more thoughtful action.

I am proposing that long before menstruation little girls should know what they own. I have 2 boys and they KNOW their penis. Why shouldn't they? The see it, feel it, touch it, use it everyday. There is no way around it. Shouldn't little girls get the same education? Shouldn't they grow up knowing that between their legs, inside all that Georgia O'Keefe flower-petal folding, that they own something beautiful and strong? Shouldn't they know the proper names for their equipment? Shouldn't they know that their clitoris, urethra and vagina are all separate and distinct and wondrous in their own way? This is the new feminism, people. My wish for women is that when they come to see me and I show them their body in my little pink hand-mirror that they do not recoil. They see themselves as they have always known themselves. From the beginning.

2011-03-15T17:20:00.000-07:00

"We all take our anal sphincter for granted."-Dorothy Doughty

I just got back from the annual SUNA (Society for Urological Nurses and Associates) Pelvic Floor Disorders Symposium in New Orleans. I will say that I needed this badly since I was beginning to feel burned out. It had been 5 years since I last went to this conference which was far too long. I took hands-on courses in biofeedback, went to lectures on pharmacology and incontience-associated dermatitis. I learned about billing, research, and the current state of the international continence nurse. It was all terrific but there were 2 sessions which really got me excited. And those were about...poop.

The first session was about the psychosocial impact of incontinence for both the patient and the healthcare provider-specifically in the setting of being unable to cure the problem. There were 2 speakers-one was a clinical health psychologist and the other a midwife from the UK. The midwife, Louise Mott, suffered an incredibly traumatic obstetrical injury which resulted in her suffering from intractable fecal incontinence. She told us her story of paralyzing fear, isolation and depression. She told us about her search for a cure which resulted in her realizing that there was none. Finally, she gave us insight into how peer support groups gave her back her ability to love her children, her husband and herself. She was funny and sad and brutally honest. She was terrific. I took home several messages from this session. One, it is important to distinguish the difference between treatment and cure. The second is that simply by asking and listening I am engaging my patients in treatment.

The second session was about bowel disorders as they relate to the pelvic floor. What I found so great about this lecture was that it discussed normal bowel function as well. I'm sure somewhere in my training I learned about how a normal person defecates. I don't remember much about it, though. The speaker, Dorothy Doughty, presented the content with levity but also impressed upon the audience how significant bowel disorders are for our patients. Irritable bowel syndrome effects 7-10% of people worldwide and 2-10% of community dwelling adults experience fecal incontinence. Not small change.

These are just a few missives. I am going to start writing more frequently since I have a bunch of subjects to talk about now including specifics on IBS, fecal incontinence, fistulas, painful bladder syndrome and more. Again, if there any subjects you are interested in my discussing please leave a comment.

Everyone-recognize your sphincters today! Perhaps I should start an annual Sphincter Recognition Day... Get my husband to work on a visual for that!

By the way, that chart is a real thing. I use it for my patients. Ah, Bristol. What a way to get famous. "It's a crap!"

The Vagina Tree?

2010-08-28T04:02:00.000-07:00

My friend at work sent me this link on Friday. It was welcome because I had a particularly challenging week. Evidently, this tree in Thailand recently grew its pubic mons, making what formerly looked a little like a vagina look, lets face it, A LOT like a vagina. It is 100 years old and a local who saw it claims after seeing the numbers "008" in the bark recently won the lottery.

Lucky vagina!!!

"The Inner Sanctum"

2010-08-20T11:06:00.000-07:00

THE NEW FEMINISM, PART II

This is the second part of my musings on the new feminism. FYI-if you are worried this is a political statement, you should be. But it probably isn't the statement you are thinking...

Curves Shows Women How Making Small Changes Can Lead to Surprisingly Big Health Benefits

2010-04-29T03:25:00.000-07:00

Curves Shows Women How Making Small Changes Can Lead to Surprisingly Big Health Benefits

I will be speaking along with my collaborating MD at this lecture series. I will be speaking specifically about NON-SURGICAL treatments for vaginal prolapse and urinary incontinence but you can also learn about the very cool robotic surgeries we can do to correct problems. Let me know if you are interested-you do need to be registered!

Urinary Frequency

2010-04-09T12:06:00.000-07:00

Seriously~I can't decide if my patients would like this as a gift, or hate it! I had a suggestion from a follower to discuss urinary frequency. I think it is an interesting subject because it is not as straight forward as it sounds. "I pee a lot." Well, what is a lot? Technically, urinary frequency is defined as voiding more than 8 times during the day or more than once at night. Frequency at night is termed "nocturia" and is treated somewhat differently than daytime frequency. The definition does not vary by age or sex but bladder capacity does decrease with age.

The first thing we do to evaluate a person for frequency is to have them keep a detailed voiding diary. This is usually accompanied by a groan-especially when the receive the "hat" for them to measure their voids into. But, honestly, this is one of the most important evaluations tools I have. Some people have a sense of voiding frequently but when it comes down to the actual amount of voids per day on the diary they are shocked and amazed. Most women would overestimate their number of voids per day. So the diary takes the "frequency" scenario out of the theoretical and into reality. Sometimes just from the diary I can educate a patient that voiding 6 times a day and once at night is totally normal. No procedures, co-pay only. Low tech, high yield. Good stuff.

Sometimes people do have frequency. I have seen patients on the extreme side who void 25+ times a day. Then it becomes a task of identifying why they void so often. There are a few mechanisms that can be at play. The first is habit. Some of us were taught to void before we get up, before we leave a location, before intercourse, after intercourse and before we go to bed. If that were what I was used to I would be going to the bathroom more than 8 times today alone! If the frequency is truly out of habit, we have to re-arrange they way they think about voiding.

Sometimes people have urinary frequency because of detrusor overactivity, AKA overactive bladder. Most people associate this with urgency and leaking but, especially in the younger set, overactive bladder causes bladder contractions which signal a person to void but that are not strong enough to cause leakage. These patients also often have a good, strong pelvic floor so that their main symptom is frequency and NOT leaking. These patients are often treated with medicine or nerve stimulation to decrease the spasm in the bladder and then experience fewer voids during the day and at night.

For patients who struggle specifically with nighttime voiding, it is often helpful to look at lifestyle and medical history for clues and easy fixes. Sometimes patients have too far to get to the bathroom from their bed and wake frequently to avoid wetting the bed. Fix-bedside commode. Pregnant women or patients with significant lower extremity swelling can put their feet up during the day and see a difference at night. Patients who take a diuretic can sometimes be managed differently and see less nocturia under the supervision of their doctor.

Frequency and whether patients treat it, like everything I do, is based on bother. I pee 5 times a day and if I was peeing 10-I'd be pissed... Sometimes 10 voids feels normal for a person. If it bothers you, see someone.

Next-timed voiding and urge strategy. Techniques EVERYONE can use-without a prescription.

Opportunities and Thank Yous

2010-02-05T20:22:00.000-08:00

A few weeks ago I did a lecture on urinary incontience in the childbearing female for the Ohio certified nurse midwives at their annual event. I was so nervous about this! For those of you who don't know, I started my advanced practice nurse life as a midwifery student! One of my former preceptors saw me speak at the University about a year ago and asked me to present. I was so honored to be sharing the specialty information that I have aquired for those women who I could only describe as mentors!! I mentioned in my last post that the lecture I did before this had several doulas in attendance. I have been so involved in learning and refining my skills in urogynecology that I have forgotten how spectacularly lucky women are to have women caretakers and nurturers! Thank you to everyone who participated!

In April my office will be involved in OSU's RPAC (recreation center) "How the Health Are you?" health fair. We will be doing the Trampoline Challenge 2010-giving young, active women the opportunity to test their pelvic floor strength by jumping on a trampoline. Those of you with stress incontinence who have ever done this know what the end result often is! Participants will earn cool buttons for the jumps. The goal of this is to promote discussion about non-surgical treatments for stress incontinence! More info as the date gets closer!

Finally, I have been lucky to have a Family Nurse Practitioner in my office for the last semester. I have been interested in taking on a student for several years but due to the specialty of my practice, a long term student just hadn't made sense yet. This student was a referral to us by a happy patient! By bringing his energy and enthusiasm to the table, he has made the quarter into a real opportunity for learning for me! Today is his last day and as a gift for completion I crafted a little gift-as seen above! Thanks Al, and good luck in all your NP adventures to come!

Stay tuned everyone!

Re-energized!

2010-01-28T03:09:00.000-08:00

What happened???? As many of you know I have a birthday in my house right before Thanksgiving and, honestly, it is all downhill from there! But I'm back!

Had the pleasure of doing a talk last night for Healthy Women, Healthy Families at OSU. It has become an annual lecture for everyone in the community-nurses of all types, allied health professionals and totally-medically unrelated people. Although it was a much smaller group than last year, they were very enthusiastic about the subject titled "The Female Pelvic Floor and Goldilocks-Too weak, too tight and just right!" There were many good questions about how to incorporate pelvic floor education into practice for both female and male patients. I am excited when I think about the folks I spoke to last night passing on the message to others to empower patients to love their pelvic floor!!

So, I am opening this little forum up to suggestions for further posts... I have a lot I can talk about but since there has been a long and dramatic p..a..u..s..e.. I thought it would be a good time to ask if there are subjects of interest.

Thanks for following!

Kegels!!!

2009-11-25T09:07:00.000-08:00

I don't know why I haven't posted on this before... Seems pretty obvious to me. Thought I would share with everyone my personal (and professional) pelvic floor routine.

I recently gave a lunch and learn in which I discussed the pelvic floor in all its states-too loose, too tight and just right. During the discussion I asked the participants if they had ever been taught how to do kegels by a GYN or family practitioner. One woman told me that in her whole life-having gone though 6 different GYN's-that NO ONE had ever asked her to squeeze around her finger during her bimanual exam. She said she thought maybe they thought it would be weird and sexual. I think this is an atrocity.

Most women do not experience the neglect mentioned above. They have a GYN who at least mentions the word kegels at some point or they read about them in a magazine. They may have at some point at least tried to strengthen their pelvic floor. Unfortunately, many are just not educated enough to know how to begin. So here we go...

First-you do not need any equipment to do these exercises. There are many money-making schemes with barbells and weights to improve an exercise which does not need improving. Buy something more fun with it like ice cream or lubricant.

To learn what muscles to contract you can do 2 things. The first is to try and stop the flow of urine while voiding. If you can, you have located the pelvic floor. If you can't, DONT PANIC! The muscles may just be too weak to stop the flow. Instead, place one finger inside your vagina and squeeze around it. If you feel movement, you have found the muscle. Alternatively, you can do this during intercourse-your partner will tell you if you are doing it right...TeeHeeHee.

Now, four times a day, attempt to squeeze the muscle and KEEP it squeezed for 3 seconds. Then relax for 3 seconds. Do that three times for a daily total of 12 exercises a day for one week. At that point you should feel stronger and better able to hold. Now, increase the number of exercises to 5, holding for 5 seconds and relaxing for 5 seconds in between. Do that for a week. Every week, increase the hold/relax time by 2 seconds and the reps by 2 until you can hold for 12 seconds and do 12 in a row. 12 IN A ROW!! Yep!

We'll talk about quick flicks on Friday!

Happy Kegeling! Happy Thanksgiving!

What happened?!?

2009-11-03T02:59:00.000-08:00

That, my friends, is how fast a month can go. I have various and sundry excuses for my absence-broke my toe, seem to have gotten viral-induced asthma (not terrific to have a chronic cough during H1N1 outbreak...), and started a moms club. Lots on the plate.

But I will return! With vagina info and discussion! Stay tuned!

Labiaplasty

2009-09-29T07:29:00.000-07:00

Labiaplasty. Oh, yeah. That's a real word. It is also a real thing.

As a welcome back to the blog world after finishing my little diatribe, I thought we could explore the world of pelvic plastic surgery. One of my women's health crusaders mentioned a few posts back that many women think all external female genitalia look the same-which is so NOT TRUE. Not all penises look the same, right? There is a what I believe to be porn-induced preconcieved notion about what vulvas are supposed to look like. Usually hairless, like a sad newborn rat, slightly pulled apart to expose the goodies underneath. What is funny is that from a biological standpoint, that is exactly NOT what they are supposed to look like. Hair traps bad things and keeps them from entering. And the goodies are supposed to be hidden! Natural women have many layers. It should be mysterious. And it keeps spiders out.

Vulvas are short, long, floppy, nearly non-existent, and lopesided. They match the surrounding skin or they dont. They have or do not have hair depending on not only the inclincation of the person but their hormone level as well. Some are skinny and some are fluffy. They are truly like fingerprints.

Unfortunately, there are people out there who plan to make money off telling you that your vulva is not up to societal standards. There are doctors right here in Columbus, Ohio who provide patients with labiaplasty, vaginoplasty and clitoral hood reductions. These procedures can make symmetry where it did not exist before. It can create a "newer, younger looking vagina." I'm not saying that if a woman feels like the size and shape of her labia keep her from running marathons without discomfort that she shouldn't have this as an option. I'm saying, there aren't that many of us who run marathons... Be proud of your vagina. Luxuriate in its hiddeness. Ask Georgia O'Keefe, they really are beautiful.

2009-09-25T05:20:00.000-07:00

If I leave you with anything besides a half-dead analogy, it is this. Women must start talking again. About the good, the bad, and the bizarre. There is nothing dirty or scary or gross about our houses, ladies. Just the regular stuff, except perhaps in a different location. This is the preface to the dialogue. Now, it's your turn.

2009-09-25T05:19:00.000-07:00

Talk to your healthcare professional. A good one will engage in this discussion even if they don't have the expertise to treat it, even if they are not entirely comfortable. They will help you find the person you need to deal with pelvic health issues. And if they don't, move on to the next one.

2009-09-15T03:13:00.000-07:00

All of these conditions are treatable-some with surgery, often times without. But, and here is the kicker... You MUST acknowledge their existence. If you think something is amiss in your house-how long to you wait before the issue is a problem? If the faucet is dripping, call before there is a flood. If there is a crack in the floor, have someone look at it before the piano falls into the basement.

2009-09-15T03:10:00.000-07:00

Well, that sounds horrible! I'm selling my house on ebay right now! Sometimes the vagina house is move-in ready and requires very little maintenance. Sometimes you should have kept your home warranty past that first year. It's about understanding your house and the specs in the neighborhood-your vagina and the vaginas in your family.

2009-09-14T04:43:00.000-07:00

16% of American women between the ages of 16-64 report chronic vaginal pain at some point during their lifetime. This can be painful intercourse or constant, intense and debilitating vaginal burning. There are many names for vaginal pain, all which can be difficult to diagnose correctly and all which have a profound effect on a woman's sexual life.

2009-09-14T04:40:00.000-07:00

Prolapse is the bladder, rectum or uterus pushing against the vaginal walls creating a bulge. Think bowed basement walls... Symptoms run the gamut from imperceptible to outright discomfort. 40% of women over the age of 40 and 50% of women who deliver a baby vaginally experience some degree of prolapse.

2009-09-13T12:03:00.000-07:00

Incontinence. Some statistics. Stress incontinence is leaking urine with physical stresses such as coughing or laughing. 50-75% of women will NOT tell there clinician they have this problem and those who do wait an average of four years before doing so. In the U.S. more pads are sold for incontinence than for menstruation.

2009-09-11T13:44:00.000-07:00

Women talk. We talk about periods and orgasms. We scare the crap out of each other about childbirth. However, I have noticed that there is a point where the body talk ends. Schedules, homework, cell phones and promotions fill the space for discussion about our bodies. This can cause women to settle for physical experiences which decrease their life satisfaction-such as...

2009-09-11T13:42:00.000-07:00

Women are great at giving unsolicited advice. I'm sure autism and self-breast examination have benefited from this trait. Lives have been saved and diagnoses made on account of the flapping tongue. Although the information may not be 100% accurate and the intent, perhaps, not always benevolent, a dialogue is opened and dialogue can drive action!

2009-09-11T08:22:00.000-07:00

So, what of all this vagina house talk? Interesting analogy-but why? Because vaginas don't always do what we want them to. Women of any race, age, body type or childbearing status can have problems. 7 babies or none. 16 years old or 90. 100 lb. jockeys or 300 lb. body builders. And you, or me...Or your mom, wife, sister, aunt or daughter. I want women to talk about their vaginas.

2009-09-05T09:01:00.000-07:00

The final possible insult on the vagina is vaginal childbirth. I was a midwife-in-training, people. I love, and fight for, vaginal birth. However, it may not be the best thing for maintaining the structural integrity of the vagina house. I mean, the bed falls through the ceiling. Actually, a bunch of drunk college students jump up and down on it until they push it through the floor. Never the same...

2009-09-03T03:04:00.000-07:00

The third stressor is childbearing. I equate this to placing an 80's style waterbed (is there any other kind?) upstairs in a campus apartment. This could (and probably will) cause the ceiling of the room beneath it to sag. Now, leave that bed there for about 9 months-gradually filling it up to over-full. What might happen here?

2009-09-03T03:01:00.000-07:00

Second point of discussion is gravity. Don't architects have whole classes about gravity? Unfortunately the original design of the vagina was probably for an animal that walked on all fours-notice the conversion back to an actual, functional house. Standing places the back wall pointing at the ground...tricky.

2009-09-02T03:42:00.000-07:00

Oh, yeah! That's Mister DNA from Jurassic Park! The first stressor is heredity. Some architects just don't hire quality builders and some DNA does not build quality tissue. The studs may rot out or the drywall may be bowed. Problems such as leaking urine or prolapse-when the walls of the vagina cave in-may occur and often run in families like red hair or a bad temper!

2009-09-02T03:40:00.000-07:00

Easy, right? What I have just described is a vagina in a vacuum-think of an architectural biodome. Perfect climate, level foundation, premium construction materials and money is no object. This is a house free of physical stressors which it may encounter in the real world. Let's talk about those stressors now.

The Vagina House-Slide 5

2009-08-26T04:46:00.001-07:00

I describe the open vagina as a living room. When I am looking through the front door the cervix is the far wall with the uterus just beyond it. There is a ceiling and an attic above it (bladder) and the floor with the basement beneath (rectum.) The sidewalls are described as just that.

the Vagina House-Slide 4

2009-08-25T07:31:00.001-07:00

The vagina is often thought of as a hole, although this is not necessarily an accurate representation. It is more like negative space-a collapsible room which only opens up with impingement upon something or someone. Think of a sock, pre-foot.

The Vagina House-Slide 3

2009-08-24T04:16:00.000-07:00

The doctor I work with often makes reference to the vaginas architecture. This is usually in relation to a vagina that has been ravaged by some type of natural disaster-cancer or radiation, sometimes disease. It is rarely in reference to a happy, healthy vagina. That is, however, where we will start. The perfectly built vagina.

The Vagina House-Slide 2

2009-08-21T17:32:00.000-07:00

My husband of 10 years is an architect. He has always wanted to design-I have never wanted to design anything, nor should I be allowed to. He has never wanted to do anything remotely medical. In dealing with his co-workers, I have noticed that people are much more comfortable talking about design than vaginas. So let's talk about the design...of the vagina house.

The Vagina House

2009-08-19T16:57:00.000-07:00

I am a women's health nurse practitioner-I have a masters degree in nursing. I have always wanted to work with vaginas in one way or another. For a while I helped babies find their way out of them. I know how to put speculums in them and check for problems inside of them. Now, I help them stay dry and in approximately the right place. I want women to talk about their vaginas.

Thank you vaginas and lovers of vaginas!!

2009-08-15T12:29:00.000-07:00

I want to say "thank you" for all my vagina peeps who came out to Pecha Kucha last night. I work with such a truly wonderful group of people-most offices would not have done that! Our patients are lucky to have interaction with each of you!

Thank you to my friends who supported me from afar. I will get the video up ASAP so you, too, can enjoy the bounty of "The Vagina House."

Most of all I need to thank my wonderful husband who convinced me that even if I wasn't an artist, I had something valid to say in this venue. His artwork added levity and interest to what can be a heavy topic. I couldn't have done it without you!

Gooooooooooooooo...Vaginas!

Vulva

2009-08-13T12:04:00.000-07:00

I attribute this post to my good friend, Dell, who asked me on the phone a few months ago "What should my little girl call it?" And by "it" she means the girly parts. I have two little boys and there is no question what to call their boy parts. I was surprised by her question and was unsure how to answer. And that has got me thinking...

My mom called it our "bug" as in "Wash that bug!" Only in my adult years have I learned the origin of that word (which I will keep to myself-shudder.) I remember reading The Vagina Monologues and just cracking up about the myriad of nicknames for womens genitals. There are some great ones! I also remember going to the bathroom when my oldest son was in the midst of potty training and him being very concerned about my lack of phallus. "How do you pee?" "Well, with a different hole. Girls have a urethra..."

Then I stopped myself because I had started the overly clinical conversation I have always dreaded. The conversation which my son will tell his friends about and be laughed at. How do you simplify anatomy for children without falling back on nonsense words that I fear convey no respect for women or their awesome parts...

Let's face it. There are grown women who can't say "vagina." I have heard the Oprah may have turned a corner but that whole "va-j-j"thing made me crazy. Alternatively, do we really want 3 and 4 year old girls talking about their vagina when it is probably not an accurate descriptor anyway? They probably don't have much to do with their vagina-they don't wipe their vagina or clean their vagina or even see thier vagina most of the time.

So, I've decided to go with vulva. Seinfeld jokes aside-I think it is the most accurate word for a little girl to use when discusing her girly parts. It is mostly outside. It is what they wipe and see if they look and feel if they touch. Now, I'm not saying deny the vagina-I would never suggest such a thing. But I think somewhere between bug and vagina-there is vulva. At least until it's tampon time.

But enough from me! What do you think? What was yours named? What do your little girls call it? I would love to hear everyone's opinion!!

The Vagina House

2009-08-11T06:59:00.001-07:00

Just for those of you who don't know, I am doing a presentation this Friday titled "The Vagina House." It is kind of a manifesto about women's health and how important I think it is for women to have an open dialogue about what is happening inside thier bodies. I am super excited about it and hope to have a video of it in the near future.

For those of you in the Columbus are who would like to attend, please leave a comment and I can get you the information!

For those who are coming, I'M SO EXCITED!!

Let's talk, people!

Discharge.

2009-08-04T08:08:00.000-07:00

Yeah, that's what I said. Discharge. It sounds like such a dirty word... Secretions are better. Anyway, I'm here to dispell some rumors about this stuff. Most people associate discharge with a pathology of some sort. Yeast infection, bacterial infection. We try to treat it, corral it, or wash it away. Have you ever stopped to consider...

The vagina, as I tell all my patients, by nature should be wet and fluffy. Think about what it would be like to walk with no moisture in your vagina? TERRIBLE!! Now think about putting something in there without it! WORSE!! WD-40, anyone? Women have no problem adding moisture in this particular scenerio, but cringe at the thought of something being in there under normal, working circumstances.

If it doesn't smell like bread or fish-leave it alone. If it does smell like any type of food product-get it checked by someone who cares! Do not just randomly insert medications into your vagina which will swing the fragile ecosystem into a tither. Find out what is overgrowing and treat it appropriately. And for heaven's sake, DO NOT DOUCHE! You will just push whatever is causing the problem up further inside. If, on the other hand, it smells like wet earth-fine. It is. Be happy you have it-a lot of my patients pay $90 a tube to get that smell back.

Pain part two.

2009-07-30T10:02:00.000-07:00

So, are you one of those people who walks around all day with your shoulders above your ears? And you wake up in the middle of the night with wicked neck pain? That is sort of how I explain pelvic pain to my patients. It's like they are walking around all day doing the worlds strongest kegel exercise.

Initiation of pain can come from lost of different sources. It could be vaginal dryness around the time of or after menopause. It could be pain from an unpleasant sexual encounter. It could be falling off your bike when your were 8 years old. Whatever the event, the experience of that pain sets off a chain reaction often referred to as the pain-fear cycle. My midwife friends know about this. Fear causes tension, tension causes pain, pain causes fear and around and around it goes. Women with pain during intercourse become very tense during the act, which causes more pain, which causes fear which causes tension. I am becoming redundent. But that is the point.

To fix dyspareunia (pain with intercourse) we first have to address the original cause of the pain. If women are atrophic (dry), we give them medications to plum up and moisturize the vagina. If there is some pyscological scarring, they need to work it out with an appropriate therapist. If they have chronic infections, those infection need to be dealt with. Then, we need to work on the tension component of the fear-pain cycle. Usually this is done with physical therapy.

This type of PT is a regimented program of Kegel exercises, set up to address not making the vagina stronger, but in fact to make it better able to relax. By using biofeedback techniques and good old fashioned practice, women can re-learn what a normal amount of tension is and employ exercies to combat the tension that causes the pain long term.

So, what do I suggest we all do? Kegel, and Kegel often. Use lots of lubricant-no reason not to. And stay on the seat of our bike-no falling. Beyond that-talk to eachother and our partners about our experiences and whether we are satisfied with our sexual lives.

Female Parts Walk for Hearts

2009-07-22T07:20:00.000-07:00

Totally unrelated to yesterdays post but I am so excited to get this out there. The American Heart Association has a Start! Heart Walk which is on August 22 this year. Having been touched personally by both heart disease and stroke I thought it would be great to support this association with a vagina-oriented team!!! I have posted the link to my site for fundraising and our team name is...................................

Female Parts Walk for Hearts!!! Love it!

I invite any of you to walk with us or to donate, either, neither or both. I would love to get a great big team of walking vaginas!! Here is the link:

http://centralohheartwalk.kintera.org/thevaginahouse

Blog ya later!

My coochie is on fire!!

2009-07-21T11:55:00.000-07:00

Pain.

I got my start in vaginas working with a doctor who had a very busy vaginal pain clinic. I honestly used to think all the vaginas in the world must hurt which is a hazard of working in a super-specialty... I have come to realize that it is not all of them, but I do continue to muse about the numer of women who experience severe or long-term pain at some point over the course of a lifetime. When we think about all we ask our vaginas to do, it's no wonder.

Something is going in there. No matter who you are, what age you are, what sexual orientation you are-something is probably going in.

For most of our lives something is coming out of there, too. Babies, menstrual blood, yeast, bacteria, mucous-you name it.

Often women will experience some amount of vaginal pain initally after childbirth. Some women have pain before they ever get pregnant. Many women who are in menopause or are post-menopausal have pain with intercourse. The common factor here is that pain is not normal, and something can be done to fix it. However, women are hestitant to talk to thier providers about these issues. They put it off as just being "normal for them" or something that happen after fill-in-the blank.

I ask you now-do not put this conversation off. Our lives are centered around our gender-our vagina is our gender and if our vagina is sick, we are not living the best life we can be. Sex is important, comfort is important. There are lots of things that can be done to work on the issue of vaginal pain.

I think this will be a two part series. I can talk a lot about this issue and how important it is us to talk about with eachother. More tomorrow!

The Pee-Pee Dance

2009-07-10T08:22:00.000-07:00

Pee? I thought this was a blog about vaginas? Welcome to my world. All sorts of important physiological events are actually tied up with our vaginas. Urinating is one of them and probably what I deal with the most. Some poo, some random other stuff, but a whole lot of pee. Usually pee when it is not appropriate to pee.

I've been lucky over the past few months to do some speaking engagements for nurses and nurse practitioners and the public in general about what I do. The feedback I've gotten has been tremendous-women really want to talk about this stuff-they just want someone else to start the conversation. One of the comments I've gotten the most often is about how fascinating the process of urination is. And it is. I'm amazed that usually we pee when we want to and don't when we don't want to.

Think about it. There is only one other thing (named above) where we EXPECT to be able to supress a desire indefinately and upon deciding we are at the point of no return go to the bathroom and expect to be able to reverse that mental trend and actually void? I am floored that anyone ever potty trains. Here's what has to happen in order for this to actually work.

Our bladder is like a balloon that fills over time and should remain relaxed during that filling. In the meantime, there is a hammock of muscles that form a seal around our urethra which remain contracted during the filling. These are both unconscious processes. We do not sit around and think about a relaxed bladder muscle-nor do we think "squeeze" to our pelvic floor. Also-these are opposite actions happening at the same time-not an easy neurological feat! Eventually, our bladder gets full enough to send a message to our brain which says "time to go!" Then we have to find the bathroom, get our various pieces of clothing off and get seated before everything reverses. The brain sends a message for our bladder to squeeze the urine out and sends a seperate message to our urethral sphincter to relax so it can come out. When we are done-all returns to the unconscious state of relaxed bladder, contracted pelvic muscles. Do you do anything else in a day that is so complicated? Talk about multi-tasking...

Why should anyone care? Because there are multiple steps that can make this process NOT WORK. Is the bladder relaxing and contracting correctly? Is the vagina behaving as a proper base for the bladder to do it's thing? Is the vagina behaving as a proper base for the urethra-that tube sits right on top of the vagina? Are the muscles of the pelvic floor strong enough to keep the urine in before the pressure above gets too strong? How are any of us able to get to the bathroom in time?

An interesting statistic and then ta-ta for now.

In the U.S. more menstrual pads are used for urinary incontinence than for menses.

Discuss. Tell me if I just bored the pants off you (no pun intended.)

I Think They're Gonna Let Me Do This...

2009-07-09T02:48:00.000-07:00

Well, after a rough start yesterday, I think Google and I can remain friends. I know my initial post sounded all angry and against "the man" but that is not what this will be about (most of the time.)

I have always been interested in the phenomenon of women talking to each other. For good or for bad, most of us are chatty people. In my experience, first as a midwifery student and now as a nurse practitioner (NP), women are very open about their experiences with their body during pregnancy and right after delivery. People will (inadvertently?) scare the heck out of their friends about their experiences during this time. For example...

"I was in labor for 2 weeks, pushed for 15 hours and then had a c-section."

"I ripped from stem-to-stern. It'll never be the same."

"My epidural didn't work except down one leg-it was horrible."

These all may be historically accurate and I applaud women for having the discussion. Now onto my wish. And that wish is why I started this blog.

I wish women would talk about their physical experiences AFTER babies and even BEFORE babies. Our vagina has a life unrelated to the event of childbearing. Childbearing does have a bit to truth serum in it and I want to extend it in both directions. Dialogue can spur action and, often, women hesitate to take action when it comes to their bodies. They put up with physical experiences that impact their quality of life because no one will start that dialogue. That is why I am here.

There is a way to leave comments-I believe it is after the date stamp at the bottom of the post. I also have a rocking e-mail site for people with questions (you know, about a friend...) that you may not want to post as a comment. thevaginahouse@live.com I welcome and encourage thoughts and suggestions for posts-although I can think of a lot to say.

Let's talk. I can't wait!

Warning-Controversial Body Parts Mentioned!

2009-07-08T12:34:00.000-07:00

So... I am a women's health nurse practitioner. I have a vested interest in women and their "parts." I do not call them parts-I call them by name-primarily, VAGINA! All I want to do is talk to women and people who love women about those parts in an attempt to give them their best life. I have been trying to set up this account for an hour and continue to be thwarted because of those parts.

Stay tuned. I want to talk about vaginas. I am going to see if blogger.com will let me. This is not porn people-it's our bodies.