If there's one word in the English language that seems to conjure uncomfortable shifting, darting eyes, and blushed cheeks, it's "vagina." Thankfully, celebrity gynecologist Sherry A. Ross, MD, (who treats Reese Witherspoon as well as Gigi, Bella, and Yolanda Hadid) is on a personal mission to turn that around and resolve our uneasiness around addressing sexual health with her new book, She-ology—The Definitive Guide to Women's Health. Period.
Meet the Expert
Gynecologist to the stars, Sherry A. Ross, MD is the author of She-ology: The Definitive Guide to Women’s Intimate Health. Period named one the six Most Life-Changing Wellness Books of 2017 by Prevention.com and Women’s Health Magazine.
"I feel strongly that doctors have to lead the fight to bring back communication with our patients," she told MyDomaine. "We need a dialogue, a community, a movement… Everything is connected in life, in love, and in medicine. So let's say the awkward words and ask the hard questions. Let's have the conversations. It's okay to blush or giggle or be totally serious. We can also have a good time. Make it a party. All that matters is that we create a dialogue with each other about our vaginas and ourselves."
So why should we talk about it openly? What difference will it make? Well, a lot, actually. "Talking about vaginas will lead to conversations about the health and welfare of women," she explained. "We need to change the status quo of our health care and make significant changes so that our daughters and sons will benefit. We need to start saying the word vagina loud and proud. We need to start a vagina revolution now!"
If you're part of the 65% of women who can't say the word, read on. We asked Ross all the questions you were too shy to ask, and she didn't hold back.
MYDOMAINE: In a recent interview, you mentioned 40% of women use code names for their vaginas. Why do you think this is?
SHERRY A. ROSS: Yes, it's true; one study of 1000 women showed 65% said they were uncomfortable saying the words "vagina" and "vulva," and 40% used code names when referring to their vaginas. There's more: A shocking 45% of women never talk about their vaginal health with anyone, not even their doctor. If you can't even say the word "vagina," how are we supposed to talk about it?
Women need to talk about their specific health care issues—issues that are often ignored and not dealt with. There are very few places where women feel comfortable talking about their vaginas without feeling judged, so at the very least, a doctor’s office should be a bastion of comfort. The inability to say the word "vagina" has been passed on in our culture from outdated attitudes, societal norms, and misconceptions about the vagina and sex.
The truth is a lot of women don't like their vaginas.
It doesn't help that our society as a whole is undeniably juvenile about our approach to the vagina. As an example, in June 2012, a bill was presented on the House floor seeking to regulate the use of the word "vagina" after Michigan Rep. Lisa Brown was banned from speaking because she used the term in a debate over an anti-abortion bill. "Brown's comment was so offensive, I don't even want to say it in front of women," complained Rep. Mike Callton, R-Mich. "I would not say that in mixed company."
A ban on a word that is a medical term used to describe our female genitalia? Politics and mainstream media will not allow the word "vagina" to be said out loud without some sort of backlash. We need to change this reality for the sake of women’s health, especially since there doesn't seem to be a problem in mainstream advertising for the treatment of erectile dysfunction.
I am counting on our younger generations of women to help lead the way and change the narrative on how we talk about our health, our bodies, and especially, our vaginas. Women need to take control of their bodies in every way. We cannot be afraid to ask uncomfortable questions. We need to learn and explore the changes our bodies experience throughout our lifetime.
MD: Why do you think women are shy or nervous when it comes to talking about their vaginas? Where do you think it stems from?
SR: The truth is a lot of women don't like their vaginas. One in seven women has considered getting a labiaplasty, which is basically trimming and tucking the lips of the vagina and tightening up the entrance. One in five women admits that they compare themselves to those vaginas seen in porn. We need to get the "V" out of the closet!
There are so many issues women need to discuss regarding their healthcare that have nothing to do with pap smears, periods, and menopause. Aside from the sensitive issues of painful sex, inability to have an orgasm, vaginal dryness with sex, and vagina insecurity, there are the difficult subjects of depression, anxiety, and hormone imbalance.
Talking about vaginas will lead to conversations about the health and welfare of women. We need to change the status quo of our healthcare and make significant changes so that our daughters and sons, will benefit. We need to start saying "vagina" loud and proud.
MD: How can we change the dialogue women have about their bodies and encourage them to embrace their sexuality and be open/honest about sexual health?
SR: The conversation needs to start at a young age with our girls, daughters, nieces, and granddaughters. It's not just one talk we need to have with our daughters. There are many talks about their bodies and overall health that need to happen depending on the developmental (and hormonal) milestones and what is age-appropriate. Before you start talking about human sexuality and sexual behaviors, you have to have created an environment where your daughter feels comfortable discussing other sensitive topics such as puberty, proper nutrition, body image issues, and alcohol, tobacco, and drug use.
When young girls learn about their body parts—"Here is my nose, my ears, my belly button"—they need to learn and use the word vagina from an early age so they become comfortable with their own anatomy. When mothers teach their daughters code names for their vagina, such as "vajayjay," this does not move the needle in the right direction of changing this narrative. If mothers or other role models to young girls don't initiate these types of sensitive topics, your daughter will find other ways of learning about her health and wellness from other resources. This is where the problem lies.
Social media and porn have damaged our children in how they look at themselves. It's important for moms to normalize these conversations between a mother and daughter. The more comfortable and candid you can make these conversations, the more relaxed your daughter will be when her breasts bud and period, body image concerns, and sexual health issues present themselves to her.
MD: What does a normal vagina look like? Or is there even such a thing?
SR: Shockingly, 50% of women wonder if their vagina is normal looking. Here's another misunderstanding many women agonize over. You know the saying, "No two snowflakes are exactly alike?" Well, the expression could just as easily refer to vaginas. There is no one right way for a vagina to look, meaning also that there's no such thing as a perfect one.
The labia, or lips—which vary from person to person—seem to be under the greatest scrutiny by my patients. Recently, a patient of mine tearfully confided in me that her boyfriend told her she had plus-size lips compared to others he'd seen online. The fact is that the two lips of the vagina are not identical, even on the same person.
Just as our two eyes are not identical, nor our ears or breasts, the lips of our labia are neither identical nor symmetrical. Likewise, a man's testicles are neither identical nor symmetrical, but we don't comment on how pretty a man's balls are, do we? Maybe we should start a campaign like "When yours are perfect, you can comment on mine!"
Do you know what's normal? Different is normal. Women are in search of the perfect vagina. The only qualities that make a vagina "perfect" are personal confidence and good health.
Your vagina is as young as you think it is.
MD: Can you outline some of the reasons many women don't like their vaginas? How can we bring back their confidence?
SR: As a result of social media, some women have been made to feel vagina insecurity. And I'm not just seeing this in patients, either, although it's definitely something that comes up regularly in my examining room. It's everywhere. An internet search of the word "vagina" brings up a variety of links, many leading to everyday women showing off their vaginas: YouTube videos of women talking about vaginal rejuvenation, websites devoted to discussing and examining anything vagina-related, and, of course, porn sites.
These are the reference points that women of all ages now use when seeking the ideal of the perfect vagina. Adolescent boys are having the same issues regarding the size and length of their penises, even though, like vaginas, no two penises or scrotums are the same. This is where I come in—with my agenda of vagina empowerment. I want to reduce your anxiety and help you have more realistic expectations about what’s normal by giving you an accurate view of the vagina in general. Believe me, the perfect vagina is actually a medical norm and not an aesthetic ideal.
Educating women on a women's anatomy is helpful along with explaining that different is normal. You need to get to know and love all parts of this fascinating area of your body. Know what your normal is so you will know when something is not normal or when a potential problem arises.
While a wide range of variety is the norm when it comes to vaginas, there are women out there who do have abnormal labia. But, again, this has nothing to do with aesthetics. For most, there's no denying that something isn't quite right. The most common symptom is the need to fold up their labia and push them into their vaginas in order to reduce the appearance of excess tissue or a bulge in their underwear or bathing suits. Other symptoms include labial pain, swelling, irritation, poor hygiene, and interference with athletics or sexual activity. Oversize or enlarged labia can impact athletics, such as running, bicycling, horseback riding, and swimming. Surgical procedures are available to improve these symptoms, as well as the appearance of the vagina.
MD: Is the vagina really self-cleaning? How should we care for it?
SR: A healthy vagina needs the same hygienic attention as any other part of your body. Between urine, sweat, and being so close to the anus, cleaning the vagina regularly is critical to prevent dirty bacterial buildup and to avoid the offensive odors that develop throughout the day.
You may have heard that the vagina is "self-cleaning." Well, it sort of is, but using nonfragrant soap and water on the vagina is okay, safe, and recommended. As a gynecologist, I suggest that you clean your vagina and labia every day as if it was any other part of your body. Use two fingers at the entrance of the vagina and one to two knuckles into the vagina using a gentle, nonfragranced soap.
MD: What are your thoughts on the trendy vagina facials, better known as vajacials, and "vagina steam treatments"?
SR: Everyone looks forward to a good facial, or a good "vajacial," as it's called when it's done down south. The Mayan women and traditional healers started vaginal streaming long before Gwyneth Paltrow made it a popular Hollywood beauty treatment. The idea is to have a medicated steam with mugwort and wormwood sprayed at the vagina that will ultimately be a uterine cleanse as well. The end result, so they claim, is some help in treating irregular periods, vaginal cysts, bladder infections, yeast infections, uterine fibroids, infertility, and even hemorrhoids.
Medical research studies are still needed to really prove these benefits from a vaginal steaming for me to recommend this ancient ritual to my patients. My concern would be that steam-cleaning could have a similar consequence of douching. It's important to clean the vagina on the outside but you don't have to do too much internal cleaning. The vagina has its own internal washing machine that keeps it cleaned and balanced. It's really all about the pH balance. As soon as something disrupts this balance, such as extreme heat or taking antibiotics, you can get a yeast or bacterial infection like you can from douching.
MD: Can our diet really impact the smell of our vagina? If so, can you outline the kind of foods we should/shouldn't eat?
SR: "You are what you eat" is an idiom for all things body-related. If you're a smoker, nicotine is a detectable flavor in urine as well as sweat. Too much garlic the night before a big gym workout, and you're reminded (in your perspiration) how garlic is the spice that keeps on giving.
Pungent foods and spices seem to take a fast lane in our bodies through the bloodstream, lungs, sweat, and vaginal secretions, creating especially intense smells under arms, on the scalp, in the genital area…everywhere. Foods that may give off a notably offensive odor include garlic, onions, mint, turmeric, curry, blue cheese and other fermented foods, cabbage, cauliflower, Brussels sprouts, broccoli, asparagus, vinegar, red meat, and perhaps other foods such as eggs, liver, kidneys, seafood, fish oil, milk, peas, and soy.
The good news is that there are foods that can combat offensive odors and actually add a sweet smell or taste to the vagina. Take note of the groceries to have handy in your refrigerator:
- Fresh fruits (especially pineapple)
- Fruit juices
- Vegetables (ones that are not aforementioned)
- Whole grains
- Greek yogurt
- Plenty of water
Nicotine should be avoided all around, and alcohol and caffeine consumed in moderate amounts. If your partner notices a different taste in your vaginal fluids, focus your first detective work on your diet. Has anything changed? Are you eating more beef, fruits, or vegetables, or are you focusing on one specific food group or single food (possibly in some new fad diet)?
New medications, especially antibiotics, may factor in taste and smell changes. Rule of thumb: If a food gives you foul-smelling urine, farts, or breath, chances are it will affect the taste and smell of your vagina. After a thorough examination of possible dietary changes, I would suggest seeing your health care provider to eliminate the possibility of vaginal infection.
MD: What should we never do when it comes to vaginal health?
- Never allow another person to touch you without your permission.
- Never neglect your vaginal health and wellness.
- Never feel uncomfortable talking to a health care provider about your vagina.
- Never settle for a health care provider who can't answer your questions.
- Never douche.
- Never neglect a vaginal itch or discharge.
- Never stop getting tested for sexually transmitted infections in between sexual partners.
- Never allow your new partner to skip wearing a condom.
- Never skip your birth control unless you are planning to become pregnant.
- Never stop demanding women's equality in and out of the bedroom.
Common Questions Sherry Ross Is Asked About Vaginal Health
What are some of the reasons my vagina itches?
"The itchy vagina can be challenging to figure out but is a common phenomenon. Once your health care provider has ruled out a yeast or bacterial infection, it's time to look at other environmental causes including fragranced body and laundry soaps, sanitary wipes/pads, warming gels, and scented lubricants, spermicides, feminine hygiene products, nylon underwear, diaphragms, condoms, saliva, semen, and stress, which are often the offending sources of the vaginal itch."
What are the reasons my vagina smells funny?
"The normal vagina tends to smell like a vagina, which all of us women know what that means. When there is an unusual odor, something is just not right down there. A classic smelling fishy vagina tends to be a bacterial infection, such as Gardnerella. Other causes for a strange or offensive odor include a sexually transmitted disease such as chlamydia, trichomoniasis, syphilis, and gonorrhea. Also, certain foods, medications, and alcohol can cause the vagina to have an unusual odor."
Is it normal to smell a strange odor from my vagina even if I just got out of the shower?
"A healthy and clean vagina has a certain natural scent and taste that should not be unpleasant. If you or your partner notice an offensive, fishy, yeasty, or foul odor, seeing your gynecologist would be recommended to rule out an infection. Your diet, including garlic, onions, Brussels sprouts, and red meat, can also create a different odor in the vagina. Smoking, alcohol, and caffeine also affect the vagina's smell and taste."
What exactly is the importance of pubic hair?
"The biggest mystery about a woman's body is why we actually have pubic hair. No one really knows the answer to this question. The suspected theories, some medical and some not, include that pubic hair prevents dirt and other floating germs to enter the vagina. It keeps our genitals warm, and it's the perfect cushion during sex, bicycling, and other forms of exercise that put pressure on our vagina. Pubic hair is also thought to create pheromones, which are invisible sexual smells that are sexually enticing and erotic to your partner."
What are the ways to keep my vagina young?
"Your vagina is as young as you think it is. With that said, a young vagina is a healthy vagina. Keeping the vagina clean and enjoying sexual pleasures keeps the vagina young regardless of age."
Intrigued to know more? Shop Ross's new book and break down the social barriers around vaginal health once and for all.
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Wong YP, Tan GC, Wong KK, Anushia S, Cheah FC. Gardnerella Vaginalis in Perinatology: An Overview of the Clinicopathological Correlation. Malays J Pathol. 2018;40(3):267-286.