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Index
Praise
Title Page
Copyright Page
Dedication
Table of Contents
Introduction
Getting Started
CHAPTER 1 - The Vulva
The History of Clitoral Neglect
The Clitoris
The Labia and Mons
The Skin of the Vulva
The Vestibule
Anal Sphincters
CHAPTER 2 - The Vagina
Why Do We Even Have a Hymen?
Vagina: The Basics
CHAPTER 3 - Vaginas and Vulvas in Transition
Trans Men
Trans Women
CHAPTER 4 - Female Pleasure and Sex Ed
How Much Sex Are People Really Having?
The Sexual Response Cycle
Some Sex Facts
CHAPTER 5 - Pregnancy and Childbirth
Pregnancy Changes
Ancient Obstetrical Practices That Should Be Forgotten!
Perineal Trauma
Pain Control After a Vaginal Delivery
Healing Process: 6–8 Weeks and Beyond
Everyday Practicalities and V Maintenance
CHAPTER 6 - Medical Maintenance
Screening vs. Diagnostic Test
Menstrual Cycle Primer
The Potential Downside of Fewer Visits
CHAPTER 7 - Food and Vaginal Health
Can Fruit Change the Smell of My Vagina?
What About Garlic and Asparagus?
The Sugar-Yeast Connection
The Best Foods for Vaginas
CHAPTER 8 - The Bottom Line on Underwear
Really, white cotton underwear doesn’t protect against yeast infections?
What about a bathing suit?
Do I even need to wear underwear?
Does it matter how I wash my underwear?
But underwear irritates me . . .
CHAPTER 9 - The Lowdown on Lube
The Choices
Do I Need a Special Lubricant to Get Pregnant?
CHAPTER 10 - Kegel Exercises
Pelvic Floor Refresher
Pelvic Floor Muscle Exercises: Getting Started
Pelvic Floor Muscle Exercises: The Actual Exercises
Kegels Are Not Working for Me—Help!
Pelvic Floor Training Devices and Apps
Skin Care and Cleansing
CHAPTER 11 - Vulvar Cleansing: Soaps, Cleansers, and Wipes
Vulvar Cleanliness 101
Where to Wash
Water vs. Soap vs. Cleansers
Should I Use a Hair Dryer on My Vulva?
A Word on Wipes
CHAPTER 12 - Vaginal Cleansing: Douches, Steams, Sprays, and Potpourri
The History of Vaginal Cleaning
What Do You Mean by Intravaginal Cleaning?
How Many Women Are Cleaning Vaginally?
Where Are Women Getting Their Messaging About Douching and Vaginal Cleaning?
The Dangers of Vaginal Cleaning Regimens
If vaginal cleaning is so dangerous, why do women keep doing it?
CHAPTER 13 - Hair Removal and Grooming
The Culture of Pubic Hair Removal
Main Types of Hair Removal
A Rundown on Methods: Pros and Cons
Ingrown Hairs, Razor Burn, and Infections
A Gynecologist’s Personal Approach to Hair Removal
CHAPTER 14 - Moisturizers, Barriers, and Bath Products
What Is a Moisturizer?
Does the Vulva Need a Moisturizer?
What Is the Best Moisturizer?
Where Should I Apply a Moisturizer?
Any Other Issues?
Bath Bombs and Bubble Bath
Menstrual Products and Mythology
CHAPTER 15 - The Truth About Toxic Shock Syndrome
What Is Toxic Shock Syndrome?
The Complexity of Menstrual TSS, or mTSS
The Rely Tampon: An Important Menstrual History Lesson
Practical Advice for mTSS Safety
CHAPTER 16 - Are There Toxins in Tampons and Pads?
A Word About Regulations
What About Hidden Toxins?
What About Residues?
CHAPTER 17 - Menstrual Hygiene
Some Menstrual Basics
Disposable Menstrual Pads
Pantyliners
Reusable Menstrual Pads and Liners
Period Underwear
Tampons
Other Tampon Tidbits
Menstrual Cups
Menopause
CHAPTER 18 - Menopause
A Menstrual Cycle Review
Genitourinary Syndrome of Menopause
How Menopause Affects the Vulva
How Menopause Affects the Vagina
Symptoms of GSM
Tissue Changes During GSM
Is “If You Don’t Use It, You Lose It” True?
Do Changes of Menopause Get Worse with Age?
Medication-Induced GSM
CHAPTER 19 - Treating GSM
Attention to Vulvar Care
Vaginal Moisturizers
Topical Estrogen
Systemic Estrogen
Vaginal DHEA
Are “Bioidentical Hormones” Safer?
Do I Need Testosterone?
Nonhormonal Medications
Medications and Interventions
CHAPTER 20 - Cannabis
The Basics
How Might Cannabis Impact Sex?
What About Vaginal Medicinal Cannabis?
Are There Risks?
CHAPTER 21 - Contraception
Condoms
Estrogen-Containing Birth Control and Your Vagina
Bacteria and Biofilms
Does the hormonal IUD have other effects on vaginal bacteria?
Hormonal contraception and HIV transmission with vaginal-penile sex
Progestin-Only Contraception and Vaginal Irritation, Discharge, and Pain with Sex
CHAPTER 22 - Antibiotics and Probiotics
If I Take an Antibiotic, Will I Get a Yeast Infection?
What About Probiotics?
Should I Use Boric Acid Weekly to Help My Vaginal pH?
CHAPTER 23 - Cosmetic Procedures, Injections, and “Rejuvenation”
Labiaplasty
The “G-Shot”
The “O-Shot”
Stem Cells
Vaginal Rejuvenation
Sexually Transmitted Infections (STIs)
CHAPTER 24 - General STI Information
Am I at Risk for an STI?
Many STIs Are on the Rise
Incidence and Prevalence
What STI Tests Do I Need?
Is the Test FDA Approved?
Where Can I Get Tested?
I’m Under Eighteen; Can I Get Tested and Treated Without My Parents’ Knowledge?
What Do You Mean by a Reportable STI?
CHAPTER 25 - STI Prevention
STIs: There’s a Vaccine for That!
Barrier Protection
Pre-Exposure Prophylaxis (PrEP) for HIV
CHAPTER 26 - The Human Papilloma Virus (HPV)
Genital HPV Infection Is Ubiquitous
Understanding HPV Infection
What Is the Screening for HPV?
If I Had HPV and Now Test Negative, Could the Virus be Hiding?
What About Anal Cancer?
Can You Transmit HPV During Birth?
If I Have HPV, What Do I Tell My Sex Partner?
Can I Catch HPV from Sex Toys?
What About Genital Warts?
CHAPTER 27 - Herpes (HSV)
The Basics About HSV-1 and HSV-2
How Many People Have Herpes?
What Are the Consequences of a Genital Herpes Infection?
Diagnosing Herpes
Treatment
Emotional Consequences
CHAPTER 28 - Gonorrhea and Chlamydia
What Symptoms Do Gonorrhea and Chlamydia Cause?
Who Should Be Screened for Gonorrhea and Chlamydia?
When Did I Get Chlamydia or Gonorrhea?
Does Dormant Chlamydia Exist?
How Should I Get Tested?
What Is the Treatment for Chlamydia?
What Is the Treatment for Gonorrhea?
Follow-Up
CHAPTER 29 - Trichomoniasis
How Common Is Trichomoniasis?
What Are the Symptoms of Trichomoniasis?
What Are the Consequences of Trichomoniasis?
How and When Do I Get Tested for It?
Can You Catch Trichomoniasis Sitting on a Toilet Seat or Other Nonsexual Activities?
Treatment and Follow-Up
CHAPTER 30 - Pubic Lice
A Really, Really Bad Itch
The One STI That Is Decreasing
Getting Rid of Lice
Conditions
CHAPTER 31 - Yeast
The Yeast-Vagina Connection
How Common Is Yeast?
What Is a Yeast Infection?
How to Diagnose Yeast
When an Exam Is Just Not Possible
Treatment for C. albicans
Recurrent C. albicans
I Used a Yeast Medication, and My Symptoms Did Not Go Away
Non-albicans Species
Do I Have a Systemic Yeast Infection?
Therapies That Do Not Work for Yeast or Are Not Recommended
CHAPTER 32 - Bacterial Vaginosis
Sex and BV
Pregnancy and BV
Diagnosis of BV
Treatment of BV
Recurrent BV
CHAPTER 33 - Vulvodynia
How Many Women Have Vulvodynia?
How Do I Know If I Have Vulvodynia?
What Is the Underlying Cause of Vulvodynia?
Therapies
CHAPTER 34 - Pelvic Floor Muscle Spasm and Vaginismus
How Do You Get PFMS?
Symptoms of PFMS
How to Diagnose PFMS
If Sex Hurts, Should I Keep Having it?
Treatment Options
CHAPTER 35 - Skin Conditions
A Word on Biopsies
Lichen Simplex Chronicus
Lichen Sclerosus and Lichen Planus
Molluscum Contagiosum
Hidradenitis Suppurativa
CHAPTER 36 - UTIs and Bladder Pain Syndrome
A Word About Tests
Do I Have a UTI?
Waiting for the Culture
Treatment
Prevention of Bladder Infections
I Feel as If I Have Recurrent Bladder Infections, but My Tests Are Always Negative
CHAPTER 37 - Pelvic Organ Prolapse
Wait—You Mean My Vagina Can Fall Out?
What Exactly Do You Mean by Prolapse?
What Are the Symptoms?
What Treatments Are Available for POP?
Symptoms
CHAPTER 38 - Communicating with Your Provider
Your Vulva and Vagina Have a Limited Vocabulary
Tolerance
Other Compounding Factors
Even a Gynecologist Can Have Trouble Interpreting Signals
How to Think About Your Symptoms
CHAPTER 39 - I Have Pain with Sex
Some Questions to Think About Before You Start
The Physical Exam
Low Estrogen/GSM
Hormonal Contraception
Vaginal Infections
Pelvic Floor Muscles Spasm
Vestibulodynia
Scar Tissue
Vulvar Skin Conditions
Endometriosis
Bladder Pain
Mechanical or Technique Issues
CHAPTER 40 - I Have Vaginitis
Understanding Normal Discharge
Before the Appointment
Think About Symptoms
Ask About Tests
My pH Is Less Than 4.5
My pH Is Greater Than 4.5
Should I Get a Test of My Microbiome?
What About Cytolytic Vaginosis?
Help, I Have Recurrent Vaginitis!
CHAPTER 41 - I Have a Vulvar Itch
What Causes Vulvar Itching?
Anal Itch
No Cause for My Itch Can Be Identified
CHAPTER 42 - I Have Vulvar Pain
Acute Vulvar Pain
Chronic Vulvar Pain
CHAPTER 43 - I Have an Odor
What Are the Identifiable Causes of Odor?
What Are the Nonidentifiable Causes of Vaginal Odor?
How to Investigate Odor
What If My Workup for Odor Is Negative?
CHAPTER 44 - I Have Bleeding After Sex
What Are the Causes?
If There Is a Lot of Blood
The Next Steps
What Are Mycoplasma and Ureaplasma?
My Tests Are All Negative—Now What?
I Have a Fissure That Keeps Reopening with Sex
Putting It All Together
CHAPTER 45 - Medicine Cabinet Rehab
What are the Differences Between Lotions, Creams, and Ointments?
What I Would Remove from Your Bathroom
CHAPTER 46 - Internet Hygiene and Apps
Prep Work
How to Search
Help Build a Medical Internet
CHAPTER 47 - Journal of Old Wives’ Tales
Final Thoughts from Jen
References
Acknowledgments
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