The Vagina Bible. Jen Gunter
due to injuries during childbirth). He did not. Other surgeons had been successful before his time, and reading the work of his peers, it is clear his technique was not easily (if at all) reproducible. Sims also opened the first public hospital for women dedicated to repairing injuries from pregnancy and childbirth. Fistulas were a significant source of distress for women, and Sims hypothesized if he could device a reliable fistula repair technique, he could make a fortune. Sims was eventually asked to leave that hospital for refusing to follow various policies.
Sims did design a speculum for looking in the vagina to facilitate surgery, but this is not a bivalve speculum. Sims was also hardly the first one to design such a speculum. The first speculum may date back to Roman times (one was excavated at Pompeii), and a vaginal speculum was in use by surgeons in 1818, so before Sims’s time. In 1825, a French midwife, Marie Anne Boivin, modified the speculum, and what we use today is a version of her creation—a top and a bottom blade that can be opened so the sides (vaginal walls) and top (cervix) can be seen. Sims’s device has one blade and a far different sort of handle. It is infuriating that in addition to all the medically unethical and racist things that Sims did to women, he also erased the fact that the bivalve speculum was created by a woman.
While I believe there could be modifications to speculum design to make the experience better for women and provide a better view for providers, for now you can rest assured that the speculum being used by your provider was not designed by Sims, nor based on his design.
WHAT IF SPECULUM EXAMS ARE ALWAYS PAINFUL? There are two reasons: you have a medical condition or your provider has poor technique.
If you only have pain with pelvic exams, then the technique is likely the issue. If you are nervous beforehand or have had a previous traumatic experience, either sexual trauma or a traumatic exam with a provider, those memories can come back during an exam and may make you more likely to have pain during the exam, but they are not the cause.
If you have pain with a tampon or menstrual cup insertion or with sexual activity, then it is possible that you have a medical condition that causes vaginal or vulvar pain, and those may make pelvic exams more painful. However, even in these situations it is best to stop and regroup. Exam techniques can almost always be modified to lessen the pain experience. Many women tell me just knowing their provider cares to minimize their pain matters greatly.
The only situation where a painful exam should continue, and even then this should be with consent, is a true medical emergency—meaning you are hemorrhaging and your provider needs to stop the bleeding immediately to save your life or to prevent other complications, such as needing a blood transfusion. Outside of the emergency department, that is rarely the situation. It does not apply to cervical cancer screening, evaluation of pain with sex, or any other symptoms discussed in this book.
Some women put on a stoic face, others mistakenly believe pelvic and speculum exams are painful for all women, and some women are clearly in pain and ignored by their providers. As I am not one of those providers, I am not sure I have an explanation. All I know is I evaluate women with pain every day, and every day I hear that it was the least painful exam they have ever had. It is better to invest in the outcome and start with a little information, and then as the medical condition starts to improve more evaluation can be done if needed. A lot of testing can be done with just a swab, and so a speculum can often be avoided, with the exception of dealing with vaginitis. However, even then we can start with swabs and build confidence and devise strategies to reduce pain. A narrow speculum, which many women find they can tolerate, is also often all that is needed.
The Potential Downside of Fewer Visits
The annual gynecological exam is really a thing of the past. There are a lot of upsides to avoiding unnecessary testing. Women avoid physical exams that are intrusive and can be embarrassing and/or painful. There is also the benefit of reducing expense as well as worry from false-positive results. In medicine, we have jargon for these incidental yet medically meaningless findings that we are now required to prove are meaningless—incidentalomas.
There is one downside that has not been studied: women who do not see their reproductive health provider annually may have less of a rapport. When you see someone every three or five years, it is a lot harder to bring up intimate concerns than when you see them once a year. It is also true that when annual pelvic exams were recommended, many providers never asked questions about sex, and so these visits involved a lot of frustrating missed opportunities. I am not sure fewer visits will help that.
I often wonder if an annual check-in by phone would be helpful, so a gynecological provider can hear a woman’s story and let her know if she needs STI testing outside of the routine screening recommendations, ask about sexual health or other vulvar and vaginal concerns, and provide any age-specific reproductive health advice. Women are exposed to so much misinformation and disinformation that giving women the option of checking in quickly might be something worth studying.
BOTTOM LINE
• Annual pelvic exams are not recommended.
• A pelvic exam should not be painful.
• If a speculum exam is necessary, narrow Pedersen or Cusco speculums are the smallest and are often all that is needed.
• The bivalve speculum used for vaginal exams and Pap smears was not invented by Dr. Sims.
• The only regular evaluations related to vaginal health are cervical cancer and STI screenings.
CHAPTER 7
Food and Vaginal Health
THERE IS AN ONGOING MYTH that food has a direct impact on vaginal health. Over the past twenty-five years, I have been interviewed by multiple reporters on this subject. Many times, I gave a detailed account of why a direct gut-vagina connection is biologically impossible, yet headlines such as “Eat Pineapple for a Sweeter Vagina!” or “Banish Yeast by Ditching Bread!” always appeared. It seems the truth, “Your Vagina Just Wants You to Eat a Healthy, Balanced Diet!” isn’t sexy enough.
What’s the harm, you say?
This supposed direct connection between food and the vagina is a complete misunderstanding of how the body works, and facts matter. In addition, the idea of eating food to change the way a vagina smells supports the tired and destructive trope that there is something wrong with a normal, healthy vagina. It’s simply a different spin on douches.
The other issue with vaginal food fallacies is that they can lead to severe dietary hypervigilance and restrictions—essentially, vaginal orthorexia (orthorexia is an eating disorder with extreme attention to foods perceived as healthy and avoidance of foods believed to be harmful). I have lost track of the number of women who have told me they haven’t had a slice of cake or a cookie for years, trying to rid themselves of yeast, and yet they still have their same symptoms. The exasperation in these voices is not insignificant. And really, having a slice or cake or a cookie now and then is nice.
If you have a concerning vaginal odor, you should read chapter 43 and see a doctor or nurse practitioner—the remedy is most definitely not at the grocery store.
Can Fruit Change the Smell of My Vagina?
Vaginal discharge is a combination of epithelial cells from the vaginal walls, breakdown products made by healthy vaginal bacteria (lactobacilli), cervical mucus, and a small amount of transudate (fluid that leaks out between cells). See chapter 2 for a review. The biggest contributors to vaginal scent are substances produced by the lactobacilli, just as body odor is related to skin bacteria breaking down products made by specialized sweat glands.
Food will not kill lactobacilli, make it reproduce, or change the products of lactobacilli metabolism. For food to rapidly change vaginal odor in an eat-this-then-smell-like-that kind of phenomenon, a volatile substance (meaning something that can evaporate and produce a smell) would have to survive digestion or be created by digestion and then make it to the vagina. As only the tiniest bit of fluid from the bloodstream even makes it into the vagina, this would have to be a very potent substance. It would also have to somehow not affect body odor or the smell of urine.
Basically,