beyond the pap: preventative care for all!

Language note: everyone uses different words for their genitals, and that is rad! In this post I am sticking with very basic anatomical words, but please feel free to change them in your head as you are reading to language that actually speaks to you and your body.

In this post, we’re gonna take on the annual exam. And even more than that, we’re gonna take on the idea of preventative care for people of all gender identities and with all different kinds of bodies. So, the question before us is:

what is preventative care and what does it have to do with me?

Usually, preventative care is talked about as “the annual exam” and is most heavily emphasized for people with female bodies. However, preventative care is much broader than that. And it’s not just about the pap smear! And it’s not just for girls!

And even if it was just about the pap smear, in the past few years changing guidelines around pap smears and pelvic exams have brought forth a lot of confusion. Raised on the idea of the “annual exam” – which has always meant breast exam, pelvic exam, and pap smear – those of us with vaginas have been thrown into confusion about what needs to happen and when. And for folks without vaginas – or who have a vagina now but didn’t grow up with one – it can be even more confusing because there is basically no helpful information out there.

Now seems like as good a time as any to attempt to decode all this nonsense, so here goes!

First Things First

Taking care of your health is a good thing. Anything you do that is healthy is preventative – whether it’s smoking one less cigarette a day or working out three times a week. Taking care of one’s health looks different for everyone. It can mean drinking lots of water, eating more healthy foods, walking around the block, jumping on a trampoline, going out dancing, running after your kids, taking fish oil, taking a warm bath when you’re stressed, keeping your asthma or diabetes well controlled, loving and respecting your body, doing genital self exams and breast/chest self exams, etc. Regular preventative care is another way of taking care of your body and your health. It’s not the only way, but it is an important one. This post will focus on this aspect of self care – regular preventative care, aka the “annual exam” or “well person visit.”

Who Needs What?

There are many different cancer and chronic disease screenings that are built into any preventative care visit. For people who have never had surgery on their chest or reproductive organs, and have never taken hormones for gender affirmation, this can seem like a pretty straight forward thing: a breast exam looks for cancer of the breast, a pap smear from the cervix looks for cancer of the cervix, etc. For those of us whose bodies are a bit more complicated, it can seem confusing. But it doesn’t need to be. The golden rule for preventative care is…

do all the basics, and then screen based on what is there

Simple enough, right? For young people the basics are vital signs, listening to the heart and lungs, feeling the thyroid, doing a belly exam, etc. These assessments check for many different types of chronic disease, including high blood pressure and heart problems. As you get older, the “basics” will expand to include screening for colon cancer and high cholesterol. But whatever the basics are for your age group, once they are taken care of screening should be based on the organs present. 

Think about your body, what is there, what isn’t. Maybe you’ve had a hysterectomy for treatment of severe endometriosis – you don’t have a uterus, but did your surgeon leave your ovaries or cervix? Maybe you are a transwoman who has developed breasts from hormone therapy and has no plans for genital surgery. Maybe you are genderqueer and have no plans for hormone therapy or surgery of any kind. Maybe you have a surgically manifested vagina or penis. Maybe you were born with ambiguous reproductive organs and had surgery done on your genitals as a baby. Whatever your story, this list can help you figure out what your provider should be screening for…

• Breasts, born with or surgically/hormonally created – If you have breasts now or had them in the past, you should have a breast/chest exam every year, and start getting regular mammograms as you get older. Even if you had your breasts removed surgically, some breast tissue still remains in your chest and should be checked with a chest exam. The exact age for first mammogram is usually between 40 and 50, depending on your family or personal history of breast cancer. Most providers recommend that you stop getting mammograms once you turn 75. 

• Vagina, born with – Some providers believe that the outside and inside of the vagina should be examined every year; others believe that you only need this exam if you are having symptoms like bumps, itching, burning, unusual discharge, or odor. Talk to your provider about it. Important note: a vaginal exam is not the same as a pap smear.

• Vagina, surgically created – The outside and inside of your vagina should be examined every one to two years, after you have healed from surgery. While you are healing, be sure to get all follow up exams and see a provider if you suspect any problems. Since surgically created vaginas aren’t able to “self clean,” it is important to keep an eye out for signs of infection even long after you have healed. You won’t ever need a pap smear.

• Uterus and ovaries – Traditionally, providers have done a “bimanual exam” every year to screen for uterine problems and ovarian cancer. This is the exam where the provider puts two fingers inside your vagina and puts their other hand on your belly – doing this, they are able to feel the size and shape of your uterus and ovaries between their two hands. There is no other screening available for ovarian cancer. While a yearly bimanual exam continues to be the recommended practice in the US, I wouldn’t be surprised if this changes soon – the fact is that, while bimanual exam is our only screening tool for ovarian cancer, it’s not a good screening tool at all. The accuracy of the exam also varies a lot with body type and individual anatomy. There are diagnostic tests your provider can order if you have symptoms of a problem with your ovaries.

• Cervix – Finally, we get to the pap smear! The pap smear’s only purpose in life is to look for changes in the cells of the cervix. The cervix is the very bottom of the uterus, which can be seen and felt at the end of the vagina. Cervical cell changes are usually the result of HPV, a sexually transmitted infection that is super common. Cervical cell changes are not the same as cancer. Usually, an abnormal pap result tells us that very early warning signs are present. Often, the body is able to heal itself from the HPV virus and the cells go back to normal. For this reason, most people who have a cervix only need a pap smear once every three years. Research shows very strongly that doing pap smears more often than that can lead to unnecessary scares and surgeries. Also, no one under age 21 needs a pap, even if they have been sexually active for a long time. I am pretty sure that number will change to 25 at some point in the near-ish future. For now, it’s 21. You can stop getting pap smears when you are 65. 

• Penis, born with or surgically created – There are no specific cancer screenings for the penis other than a general inspection (which involves the provider both looking at and feeling the penis). As with the vagina, some providers believe the penis should be examined every year, and others believe it should be examined only when you are having symptoms like bumps, pain, or unusual discharge. If your penis is surgically created, you should be sure to get all follow up exams while healing, and see a provider if you suspect any problems.

• Testicles, born with or surgically created – Same story here as with the penis. If you were born with testicles you can also be checked for hernias whenever you have a genital exam. If your testicles were surgically created, you should be sure to get all follow up exams while healing, and see a provider if you suspect any problems.

• Prostate – If you are young and have no symptoms of prostate problems, your prostate does not need to be checked on a regular basis. As you get older, an annual digital rectal exam is a good idea. For this exam, the provider inserts one gloved, lubricated finger into your butt and feels your prostrate from the inside. This usually doesn’t need to start until age 40 or 50, depending on a number of different factors. You can also have a blood test called a PSA done. For folks who are taking estrogen for gender affirmation, the PSA is not a good test because it can give false negative results – the digital exam is your best bet.

So, Wait: Should I Still Go Every Year?

Yes! If at all possible, you should! No matter who you are or what your body is like.

while not every single screening will be done every single time you go to your “annual” exam, you should go every year

Some years you will pretty much just needs the basics, and some years you will need more. But the basics are very important! In fact, your risk of high blood pressure and heart disease is much higher than your risk of cervical cancer. More people will die of these chronic diseases as well. And, spinning it another way, preventative care is an important and awesome opportunity to learn more about what health means for you and how you can be fully empowered in self care. For folks who take hormones for gender affirmation, this annual visit is also a chance to get routine blood work done to make sure you are still at the right dose and all is going well.

Bottom line: every year is the best plan, for everyone. And there are lots of resources out there to help make it possible for you to go every year.

But I Hate It!

I hear you. I feel the same way. Exams make you very vulnerable. They can be physically and emotionally uncomfortable. During the course of a preventative care visit you can have all sorts of transphobia and racism and homophobia and fatphobia slung your way, which is totally uncalled for. All these things can and sadly do happen, and they can make it very daunting and unappetizing to do the parts of taking care of your health that require a medical provider. But I promise, your annual exam does not have to be a bad experience. It can actually be a great experience. Along those lines, look for another post soon on how to choose a provider that will treat you with respect and dignity, and simple things you can do to make your exam the best experience possible.

Until then, xoxo,
Simon

 

 

 

borning: on moving from being a student to being a midwife

i wrote this piece recently and read it yesterday at the hand blessing held for my cohort of new midwives. it was our very last day as students. now, it seems, we are midwives. looking forward to licensure in october or november. here’s the piece. enjoy!

borning

standing on this precipice
i am thick with the unsure
 
i am a nowhere person
can’t go back 
but don’t know quite
how to move forward
 
i am scared
and fresh born
newly minted but cracking
feeling empty of experience
 
and i don’t know how to be
 
i look around
to search for myself
and for the first time i look
not up, to the mirror
but down, to my hands
 
and i don’t know them
i don’t know how to be them
but i am awed by them
i lean into them
mustering hope and ready to grown
 
because these hands
 
these hands have become
the first hands to touch new life
vessels for easing being into the world
 
they have learned the measure 
of a body opening
of a family emerging
these have been the tools
that help bring forth the babies
that change the world irrevocably
with their bloody sweet entrance
 
these hands have become
extensions of eyes
of tastebuds and inner ears
of brain cells
they have wallowed in the murk of
strange new ways of knowing
they have learned the measuring 
of space and of hope
by feel alone
they have discovered the tension of tissues
reading the stretch and give
of our physical selves
as love letters to the newest among us
that we haven’t yet to truly meet
 
these hands prod the unknown
slip slick over unseen skin and bone
dance across the soft spots 
of ears and of skulls
move systematically over and in
the most internal of organs
the soil and the ocean
touching people inside people
and calling them out
 
these hands have been taught 
to learn
to trust
the way of life unfolding
the feel of flesh yielding
the way a body moans open
when it finally lets go
and brings forth
and becomes two
 
they have been taught so much
 
and sometimes it feels like
too much
and too quickly
and with too much trepidation
 
so sometimes, staring down
i do know how to trust them
i don’t know how to ever trust
my own self
again
my intuition
my competence
 
but i AM these hands
and my future is seeded in them
and terrified as i may be
i can only have faith
i can only push with all my soul
i can only trust the process
and know
know that i will grow into these hands 
that i will yield and be born through them
that i will  yield and be born into them
 
and become something more
than a scared little once-girl
who has had a taste of creation

graduation station!

holy crap, friends – looks like the student boi midwife is really truly gonna become a for-real boi midwife! graduation today, followed by eight crazy weeks of intense clinical integration, presentation of my research results, and studying for my boards. then. i’m. done. by the beginning of next year i will be looking for gainful employment as a CNM. woah. if you are in the NYC area please spread the word that i’m headed that way and looking for work!

“fighting to get tested”

boi midwife rising up from the depths of a long silence with a brief plea to my fellow health care providers…

two times in the past month i have heard of gender variant people asking for STI testing and being refused. this includes being denied HIV testing.

seriously!?

in what universe does it make sense to deny anyone access to STI testing!?

one of the people i heard this from was pregnant at the time of being denied testing. the other was a very sexually active transfag of color who describes his experience here: http://transfagssexjournals.blogspot.com/2012/03/fighting-to-get-tested.html?zx=94b8da447726d492

this is infuriating and totally unacceptable.

so…fellow midwives and health care providers who work with gender variant and queer clients, please:

1. take a complete and accurate sexual history, without judgement or assumptions. don’t let your discomfort or confusion about our sex lives prevent you from assessing our health risks and opportunities for health promotion

2. discuss safer sex with us. honor the wealth of information we are bringing to the table but don’t make us have to teach you. make sure that the information you are presenting is relevant and useful. and keep a good grasp of your client’s anatomy during the discussion (i.e. I have a vagina so please don’t ask me questions that are only relevant to penises – don’t laugh, it happens to me all the time).

3. encourage us to get STI testing on a basis that is supported by evidence and appropriate to our individual risk factors. don’t make us get tested constantly simply on the basis that we are queer and/or gender variant, if we are very low risk. at the same time, don’t EVER deny us testing or downplay the risks we are being honest with you about.

xoxo, simon

ps – additional tips highly encouraged. comment away!

playing safe and having fun…sexy, safer sex after an STI diagnosis

Hello, friends! I was recently asked if i had any thoughts for folks continuing their sex lives after learning they have an STI. I put together this post with that in mind, but it’s useful for anyone who is sexually active. Also, it’s long so I have bolded STIs as I go along so you can hone in things most applicable to you. Resources are included at the bottom.

Disclaimers… I have done my best to make the content of this post comprehensive, accurate, and applicable to people with a wide range of bodies, gender identities, sexualities, and play preferences. That said, I’m sure it is lacking in important ways. So… Please share other good resources and information! Please comment with your gems of safer sex wisdom! Share what you know! Correct me if I got something wrong! Also, note that this post focuses on STIs other than HIV. There are many excellent online resources for + folks and I encourage you to check them out. * This is not intended as medical advice. Please see your provider! *

Safer sex looks different for different folks, depending on their anatomy, gender identity, sexual orientation, play practices, etc. How someone thinks about safer sex may change after learning that they have an STI. An STI diagnosis can be a scary, difficult, sobering, and stressful event – but it can also provide an opportunity to take stock of our lives, hone in on our priorities, build our communication skills, and approach our sexual and sensual lives with renewed creativity and sensitivity.

First, for people who know that they have an STI, disclosure is the first step to safer sex. It may also be the hardest step. It might be useful to talk through it with your health provider and ask what their other patients have found to work well. If you have a friend that has disclosed to you that they have an STI, you could also ask them what they have found helpful. Or, you could role play with a trusted friend to get some practice communicating confidently and easily. Some of the resources below also provide guidance.

Remember that you will build your communication skills over time, and stay grounded in the importance of full and meaningful consent. Consent isn’t limited to “permission” or “agreement” to engage in sexual or sensual acts; consent also means entering into these acts with all the information needed to make good choices about one’s health, safety, and well-being. Your commitment to disclosure will play an important role in building a culture of health, respect, and consent in your community. As you do this important work, be mindful of the impact that alcohol and drug use can have on your ability to communicate and make safe decisions. Also, remember that you still need to protect yourself, in addition to protecting your partners. Some STIs increase your risk of getting other STIs and even when that’s not the case, you can always get an STI you don’t already have. No one wants that. Continue to get regular STI testing, since many STIs can fly under the radar for a long time.

In terms of safer sex itself, a basic starting point is barriers and lubrication. Many STIs require contact with mucous membranes, blood, or other bodily fluids or secretions in order to be transmitted. For these STIs, barriers from mucous membranes and fluids are your best prevention. For sex purposes you can think of mucous membranes as the skin lining the soft, wet, protected areas of your body that open up to the outside world – for example, the inside of the mouth, vagina, anus, and urethra. Barriers greatly reduce the risk of getting or transmitting HIV, gonorrhea, chlamydia, trichomoniasis, and HPV. They also prevent unintended pregnancy, if that is a risk of the sex you are having.

Penises, dildos, sex toys, etc. should always be covered with a condom before they make any contact with your genitals, anus or mouth or those of the person you are playing with. Sex toys should also be properly cleaned on a regular basis. Anuses and vaginas can be covered with a dental dam for oral sex or rimming. Hands can be covered with nitrile or latex gloves during genital, genital area, and anal touching. Under those gloves, fingernails should be kept neatly trimmed and filed. For genital and anal play, plenty of lube should be used to prevent latex barriers from tearing, and to prevent damage to the sensitive tissues of the vagina and rectum. When engaging in sex that poses an especially high risk of tissue damage (rough sex, anal sex, fisting, penetration with large toys, etc.) lube is especially important. Consider having a thick lube on hand for these kinds of play. Also, avoid sex toys that are absorbent or cannot be effectively cleaned. And remember: barrier doesn’t equal boring! Safer sex can be just as sexy, only with more props!!

Dental dam side note… A little lube on the genitals or anus can go a long way for heightening sensation when a dental dam is used. Condoms or gloves can be opened up and used as dental dams if you aren’t able to find dams easily in your area, or if you don’t have one with you. Several of the resources below provide instructions.

Also remember: barriers are not the be all and end all of safer sex. Things get more challenging when you move on to the aspects of sex that you can’t just slap a condom or a glove on. Some STIs are easier to protect partners from than others. If you have an STI such as herpes, warts, or syphillis you need to think beyond fluids. These STIs, as well as things like crabs and scabies, can be transmitted by skin-to-skin contact regardless of whether body fluids are swapped. With the exception of syphillis, they don’t even require a break in the skin. I know that sounds daunting. But having one of these STIs does not mean you have to stop having sex forever. You just need to be more careful and communicative. How, you ask?? Here’s some suggestions…

Safer sex when living with herpes:

1. Consider treatment to reduce your number of outbreaks, and take good care of yourself. Anti-viral meds don’t cure herpes, but they can greatly reduce the number of outbreaks you experience. There are also a lot of things you can do to take care of yourself, reduce outbreaks, and decrease discomfort when outbreaks do occur: clean sores with saline twice a day; soak your genital and anal area in warm water with baking soda when you are having an outbreak; soak a clean cloth in cold milk or witch hazel and use it as a compress on sores; and boost your immune system and prevent outbreaks by getting adequate rest, reducing your stress levels, and eating a diet rich in vitamin C, B vitamins, zinc, and calcium.
2. Herpes sores are very contagious. Always avoid skin-to-skin contact during an outbreak. Herpes can be transmitted even when active sores are not present (due to viral shedding that you would have no way of noticing), but it is less likely. Don’t put your partner/s at risk when you have sores (which can be on your genitals, thighs, or butt). Also be careful not to share towels, washcloths, or clothing that comes in contact with your genital and/or anal area.
3. Know your body, and know your virus. Herpes outbreaks usually have what is called “prodromal symptoms,” AKA warning signs. This is often a tingling, burning, or pulsing feeling in the affected area before a sore forms. Get to know your warnings signs, and listen to them. If you feel like an outbreak is coming on, find other forms of sexual and sensual expression until your sores have come and gone and healed completely.
4. Cold sores are herpes too! “Cold sores” and “fever blisters” in the mouth or on the lips are Herpes Simplex Virus type 1, while genital sores are Herpes Simplex Virus type 2. You can transmit type 1 (“oral herpes”) to someone’s genitals or type 2 (“genital herpes”) to someone’s mouth! Apply the golden rules from #1 and #2 to oral sores as well as genital ones.
5. Check out resources by and for sexually active people who have herpes – these resources provide information about preventing transmission, address the emotional aspects of learning you have herpes, discuss disclosure to partners, discuss safer sex practices, etc. A herpes support network resource is listed below.

What to do if you find out you have syphillis:

1. The first stage of syphillis is a painless sore on the genitals. Sometimes there can be more than one sore but, unlike other STIs that cause genital sores, syphilis usually produces a single sore that does not cause pain. Because the sore doesn’t hurt and can hide itself away in a hard-to-see spot, people can pass through this stage without noticing. If you find a sore, go see your health provider. Do not have unprotected sex or skin-to-skin genital contact while the sore is present – it is highly contagious.
2. Get treated! Syphillis can be treated with antibiotics. Follow your health provider’s instructions for taking your medication, then follow-up with your provider to confirm that treatment was successful and the infection is resolved. Ideally, you should avoid sex until you get the all clear.
3. Continue to have safer sex after successful treatment for syphillis. You don’t gain immunity against syphillis so it is always possible to get it again, or to get another STI.

Safer sex when living with HPV warts:

1. HPV stands for Human Papilloma Virus. It is a very common STI that can play out in a number ways for people who have it: it can cause no problems at all, it can lead to cervical cancer (over a long period of time), and/or it can cause genital warts. Genitals warts from HPV are soft and fleshy growths in the genital and/or anal area. They tend to grow in big cauliflower-like bunches and are usually slightly lighter than the skin color of a person’s genitals, but in some cases may be darker. Similar to herpes, HPV cannot be cured and is contagious through skin-to-skin contact.
2. Get treatment, and take good care of yourself. While HPV can’t be cured, your health care provider can use a number of different methods to remove the warts caused by this virus. There are also a lot of things you can do to take care of yourself and reduce discomfort while the warts are present: take oatmeal baths (super soothing), keep your genitals and anal area dry after baths and showers by using a hair dryer, wear cotton underwear and loose fitting clothing, and boost your immune system with eating healthy foods, getting adequate rest, reducing your stress levels, and staying active.
3. Always avoid skin-to-skin contact when warts are present. Like herpes, HPV warts can be transmitted even when active sores are not present, but it is less likely. Don’t put your partner/s at risk when you have sores (which can be on your genitals, thighs, or butt). Also be careful not to share towels, washcloths, or clothing that comes in contact with your genital and/or anal area.
4. There aren’t as many easy to find resources for sexually active people who have warts, but you can look at resources for people with herpes (see above) – most of that information will be useful for you as well.

Okay, that’s it for now. I hope this info will help anyone diagnosed with an STI continue to have a fulfilling, consensual, and satisfying sex life. For more good info, check out the resources below:

• Telling Your Partner You Have an STD: http://kidshealth.org/teen/sexual_health/stds/stds_talk.html#
  Geared toward youth but useful for anyone. Gives details on the importance of disclosing STD status, and gives specific tips about how to have “the conversation” with potential new sex partners.
• CDC STD Fact Sheets: http://www.cdc.gov/std/default.htm
  Detailed information on various STIs, including how to prevent transmission
• Back Pocket Guide for Trans Men and the Men Who Dig Us: http://queertransmen.org/index.php?option=com_content&task=view&id=14&Itemid=29
  Lots of good safer sex info starting in “Doing it Safer” section (pg 4)
• Lesbian, Bisexual Women, and Safer Sex: http://www.avert.org/lesbians-safe-sex.htm
  A good basic overview that is helpful for lesbian and bisexual women as well as anyone else that has a vagina and has sex with other folks that have vaginas.
• GMFA Safer Sex website: http://www.gmfa.org.uk/sex/stis/index
  Focused on non-trans gay men, useful for anyone. “STIs” section has lots of good information about specific STIs, and “How Risky Is…?” details the specific risks associated with different sex acts.
  
• HC Support Network Herpes Transmission Facts and Tips: http://herpes-coldsores.com/herpes_prevention_tips.htm
  Detailed info about preventing herpes transmission, including tips on communication, suppression therapy, recognizing the early signs of an outbreak, safer sex between outbreaks, etc.
  
• Safer SM Education Project: http://safersm.org/SaferSM/SaferSMPamphlet.html
  Lots of good information on keeping your kink safe, sane and consensual. Much of this info is really helpful even if you tend toward the vanilla side of things.

tell me what you want what you really really want. or whatever.

finals are almost done! three more days to go.

and once i’m through with the quarter, i’m excited to spend the next month working on my research, trying to re-learn spanish, and – YAY! –  blogging.

on my current list of blog topics are:

safer sex while living with an STI
postnatal vaginas
gender-variant gyn care basics (geared toward providers)
stirrups be damned! tips for creating the best possible gyn experience

please feel free to post a comment letting me know what else ya’ll would like me to blog about. anything vagina-related, pregnancy or birth-related, or sexual health-related is totally on the table! it may take me awhile to get thru the list, but it’s a great learning opportunity for me as well as for readers (hopefully!), so i’m committed.

also, if you are a gender-variant/trans/genderqueer/etc. person and have specific DOs and DON’Ts you want me to include in my gyn care basics for providers, please email them to me at simonsays13@gmail.com. they will be blended anonymously into my blog post, as well as into discussions with my fellow student midwives, gyn preceptors, etc.

thanks for your feedback!

xo, simon

your vagina is smart and it knows what to do

working with vagina-having folks all day at the clinic, i am often reminded of the jarring lack of accurate, body-positive and sex-positive vagina information out there in the world. i am reminded of the significant portion of my own life i spent thinking of my vagina as the strange and rather unpleasant center of some mysterious world that i didn’t understand and didn’t particularly care to. i would like people to have better information about vaginas than i had. so i started this blog and, with the zeal of a new midwife-to-be, i hereby present you with a mishmash of vagina 101 that comes directly from my clinical experience in the past week, all grounded in the central truth that your vagina is smart and it knows what to do. if you already know all this about your vagina, yay! that’s fantastic. feel free to pass the info on to someone who doesn’t.

also, if you have a vagina and use another word for it, please feel free to substitute that word every time you see “vagina” in this piece. i myself call my vagina “my junk” or “my business.” for me, i find vagina too formal and gendered a name for that part of myself. but i’m not trying to force that on anyone else, so i just stuck with “vagina” and i will let you take it from there.

here we go!

1. your vagina is self-cleaning

it’s true! the vagina knows how to keep itself clean and healthy. all it needs is a nice rinse with water and it’s good to go. using anything else to clean the vagina tends to freak it out and mess with its natural balance. this can lead to irritation, itching, yeast infections, etc. some good rules for keeping your vagina clean and happy: always wipe from front to back after going to the bathroom, avoid put anything scented or harsh (strong soaps, bubble bath, “hygiene” sprays) on or in your vagina, avoid scrubbing the outside of your vagina (when washing you can just use your hand to separate the folds for rinsing), don’t scrub the inside of your vagina (ouch!), avoid douching or inserting any “hygiene” product into your vagina, and make sure that any scented shower products you use on your hair or body are fully rinsed off so they don’t collect in or on your vagina and cause problems. also, go pee before and after sex to avoid a UTI from unfamiliar bacteria getting into your urethra.

2. your vagina wants room to breathe

another key to good vaginal health is air circulation. we all spend most of our days with our vaginas covered by several layers of clothing, which is fine and good and all that, but does lead to en environment of trapped moisture. accordingly, we need to give our vaginas down time here and there to breathe some fresh air. a good first step toward this is making sure all your underwear has a nice, cotton, breathable crotch. the rest of your panties can be drenched in lace if you like that, but the crotch itself should be cotton. another easy thing you can do is make sleeping time free vagina time. instead of wearing regular underwear to bed, wear a nice loose pair of boxers or nothing at all. your vagina will thank you.

3. your vagina makes discharge and that’s normal

vaginal discharge is an important part of keeping vaginas clean and healthy. without discharge our vaginas would be sad and dry. life in general and sex in particular would be uncomfortable without it. you can expect to see discharge in your underwear. it’s normal! your discharge will vary in texture, smell, and amount throughout your cycle. it will also be affected by any sort of hormonal contraceptive you may use (whether to prevent pregnancy or manage period problems), and it changes over the lifespan. since no one tells us discharge is normal, it can seem strange, annoying, or dirty. it can have us totally convinced that something is wrong with us. but usually nothing is wrong with us, we just have smart vaginas! that said, vaginal discharge can also act as a warning system to let us know something is wrong. go see your NP, midwife, or doc if you notice that your discharge: smells super fishy, is super chunky, is an unusual color, is super frothy, etc. on a similar but unrelated note, you may find the occasional bump in the vicinity of your vagina. yes, this bump could be a sign of warts or herpes or syphilis. but it could just as easily be an ingrown hair or a totally non-threatening little sebaceous cyst (similar to a zit and i know it’s gross to think of zits on our genitals but there are glands down there so stuff happens). try to stay calm and seek the advice of your provider if needed.

4. your vagina likes lube

your vagina likes lube so much that it makes its own. your vagina likes lube so much that it is overjoyed when you provide it with extra. many of us who keep a big bottle of lube by the side of the bed consider it an absolute must have for sex. but many folks have never tried it. trust us and our big bottles of lube – everything is lovelier and safer with plentiful lubrication! that is my big message about lube. but some important sub-points: choose a good lube, and don’t use lube as a substitute for listening to your body.

choosing a lube: in a pinch, any water-based lube will do just fine. you can grab a bottle at the grocery store or get some free at planned parenthood or whatever clinic you go to. but in the long term, get a good lube. in general, i consider a good lube one that: does not contain glycerin or suger or  fragrances or chemical sweeteners for taste (all common lube ingredients that can promote yeast infections), is long lasting, and feels good to the people using it. there are also different lubes for different kinds of sex. for example, a thicker lube is required for anal sex. if you are lucky to have a good sex-positive sex toy shop in your area, they usually have a big lube bar with descriptions of each lube, sample bottles to try out (only on your fingers, of course!), and plenty of tissue to wipe the sampled lubes off of your fingers. if there isn’t a good place in your area you can shop online: http://store.babeland.com/safe-sex-lubes or http://www.goodvibes.com/content.jhtml?id=How-To-Choose-A-Lubricant are good places to start. a few warnings to keep in mind: always use a lube that is either water-based or silicone-based (don’t use oil-based stuff like lotion, vaseline, crisco), and don’t use a silicone-based lube with silicone sex toys.

listening to your body: vaginas make lube when we are aroused. when we desire sex or intimacy or make outs or whatever, when we are playing around with someone and enjoying it, or when we are thinking about playing around with someone and enjoying it, our vaginas make lube. that’s what we call being wet. if your vagina is not making lube in these situations, its worth stopping to think about what might be going on. it could be any number of things. but it is very important to take a moment to see if your body is trying to tell you something. maybe you are nervous or scared or are just not all about being sexual at that particular moment. maybe you’re not actually that into the person you are messing around with, or the things that they wanna do. maybe not enough time and energy is being put into foreplay or teasing. whatever it is, it deserves your attention. you never have to have sex you don’t want to have. on the other hand, if you are totally into it and still having trouble getting wet, then it’s worth a chat with your NP, midwife, or doc. they can help you figure out what’s going on and help get you back on a path toward well-lubricated and joyful sexy times.

5. your vagina has some special needs if you are post-menopausal or gender-variant and on testosterone

without a steady supply of estrogen, the tissue of your vagina goes through some big changes. the skin can thin out, become less plump and moist, and tear more easily. this is called “atrophic vaginitis” – it means the cells that make up your tissues are shrinking and getting more dry. this can make sex painful, or leave you with a sense of uncomfortable dryness throughout the day. post-menopausal women can consider combined hormone therapy and/or ask their provider for a daily estrogen cream that will make the vaginal tissue more pliant and healthy. for gender-variant folks who take testosterone, topical estrogen is also a good option. since it is not systemic, it does not counteract the testosterone you are taking. with a little estrogen your vagina may be much happier. but even if you have no interest in estrogen cream, please check in with your NP, midwife, or doc if you are having pain with sex or unexplained vaginal bleeding after your periods have stopped due to either menopause or T. these could be signs of larger issues that need to be ruled out.

ok, the end!

well, not the end at all. i have so much more to say about the care of vaginas but i think this is plenty for the day, and this blog post is way longer than i wanted it to be. let me sign off with this:

trust your vagina. it is smart and it knows what to do.

xo,
simon

this tiny tranny is gonna be a midwife someday!

says one of my roomies: “i’ve learned more about vaginas in the past few months hearing about your clinicals than i’ver ever known in my life. you should make a blog. you can call it Simon’s Vagina Rx.”

so, i followed her advice and i made a blog!

but i didn’t call it Simon’s Vagina Rx.

instead i called it Boi Midwife, because that’s me.

first post coming soon: “you’re vagina is smart and knows what to do.”

xo,

simon