Sonogram

Ultrasound is a cyclic sound pressure at average frequency of 20 kHz, above the human’s hearing ability.

Gynecologic sonogram works like a sonar in a submarine: it sends a beam out, and if the beam encounters a solid object (i.e. another submarine, a rock, a cyst, a fibroid, cancer) it returns its image by displaying it on the screen.  There are many other uses for ultrasound and you can do your own search for general knowledge.

There are two (2) types of diagnostic gynecologic sonograms that are typically used to visualize the female pelvis:

• Trans-abdominal, which is completely external: the transducer (ultrasound wand, or probe) is rolled on the belly/lower abdomen after the patient has drank enough fluid to fill the bladder that will act as the needed water medium for the sound waves.  During pregnancy (obstetric ultrasound), the amniotic fluid acts as the water-medium while the test is done to assess the development of the fetus; the parents-to-be benefit by being given an image photo of their baby.
• Vaginal, an internal procedure: the transducer is inserted into the vagina and is moved about the organs (uterus, cervix, ovaries, bladder, fallopian tubes) for best visualization.  To provide a water medium, the transducer is inserted into a lubrication-filled protective cover that looks like a condom.  This test provides the best imaging of the internal organs.

Vaginal ultrasound may pose a problem for women who struggle with vaginismus or are just nervous about ‘anything going into the vagina.’  A useful tip: let the person who does the test (the doctor, the radiology technician, etc.) know that you would like to insert the transducer yourself.  Once it is in, have them grab hold of it and proceed with the procedure.

If penetration is not at all possible, ask for a trans-abdominal ultrasound instead, and return for a vaginal one as soon as you have cured your vaginismus.

To learn more about the test and to see what the equipment looks like, click here.

Why Kegels?

Dr. Arnold Kegel (1894-1984) was the gynecologist responsible for introducing squeeze exercises for increasing vaginal muscle tone. The particular muscle, puboccocegeous (PC) is part of a trampuline-like network of muscles that comprise the pelvic floor that supports the pelvic outlet.  Today, these exercises may be known as Kegels, PC excericses, or Pelvic Floor exercises.

When should women do these exercises?

• Regularly, to enhance female genital health
• During pregnancy and after childbirth to facilitate recovery
• In the early stages of organ (uterine, bladder) prolapse to minimize the droopiness
• In case of injury/neurological deficit to restore muscle tone and function
• As an orgasm exercise…

However, contrary to common perception, doing the Kegels does not cure vaginismus, a condition that has nothing to do with the voluntary control of the pelvic floor muscles but rather with a somatic reaction to penetration and/or to vaginal use.

Penis & thrusting

Thrusting during intercourse is the rocking movement of the penis in the vagina, done rhythmically as per the male’s arousal.  It is the flip-side of rubbing the penis to arousal during manual sex or oral sex.

How deep does the penis thrust during intercourse? As deep as the vaginal depth allows, as deep as the male’s desire guides him, and most importantly: as deep as it is comfortable for the woman.

Does the penis come out of the vagina during thrusting, as in going in & and coming all the way out, in & out, in & out?  Most of you will say a definite NO, the penis does not come out of the vagina but rather stays inside during thrusting.

Surprisingly enough, there are quite a few who struggle with ‘what is normal’ and who will expect the vagina to endure their repetitive, rhythmic in & out powerful motions.  For the woman, these quick, ongoing penetrations will activate the tightening reflex of the vaginal ring (introitus), giving her discomfort and painful intercourse (dyspareunia) or even vaginismus.

Gentlemen, please respect vaginal endurance and stay inside when you thrust.  And ladies, do not suffer in silence!

Mikvah & intercourse

Observant Jewish women follow the laws of Niddah, a time when she is considered ritually impure and must refrain from any physical contact with her husband, including sexual abstention. Click here to read more about it.

The end of Niddah is signified by going to the Mikvah (ritual bath) where she immerses in a deep pool while following a particular bathing process for ritual purification.  Men go the Mikvah too for purification for Sabbath and Holy days. Click here to read more about.  Click here to take a Mikvah tour.

It is expected that the couple engages sexually upon the woman’s return from Mikvah (yes, same night), which should be a welcoming transition for the couple having abstained from any contact for nearly 2 weeks.  However, this mandatory engagement is a cause of great distress when the woman is reluctant to be intimate with her husband, or if intercourse is painful (dyspareunia, vaginismus).

Sadly, women will often submit while suffer in silence because they believe that they have no choice/it is their duty/they are the ‘only one with this problem.’  We encounter an endless stream of such cases, which often include husbands who are at a loss too about what to do…

But there is a (halachic) choice!  We urge suffering women/couples to seek religious and/or medical guidance in order resolve the situation and be able to live normally.

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

Vaginismus, returns?

Vaginismus is a common condition that affects women worldwide regardless of their culture, religion, education, sexual orientation, or family status.  Vaginismus is a somatic (body-mind) reaction to fear/apprehension of vaginal penetration.  It happens instantaneously and involuntarily.

Women with vaginismus tend to suffer in silence and shame, thinking they are the ‘only one’ with this problem, which is why prevalence is not available.  A certain measure of anxiety is typically associated with this condition, ranging from minimal to severe, the latter may also include panic and OCD (obsessive compulsive disorder).

Vaginismus is curable and the cure should be life-long as long as the woman follows discharge instructions, which should include specific management of the residual anxiety/panic/OCD.  In other words, once the woman can have vaginal penetrations without a problem, why fear them any longer?

Does vaginismus come back? It can, if the woman did not follow up on discharge instructions and is again ‘allowing’ the anxiety/panic/OCD to regain control and interfere with vaginal function.  Sad, isn’t it? To have gone through a treatment process only to then be non-compliant.

On a good note, it is rare that the woman will regress to a complete vaginismus: she will typically be able to have (some) penetration/s but with trepidation and under the effect of her un-managed anxiety.  In some cases, the vaginismus could remain cured but other somatic reaction/s may appear, such as IBS (irritable bowel syndrome), neck or back aches, TMJ (jaw joint pain), headaches, etc.

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

Vagina, sterile?

Women often believe that their vagina is a sterile environment and that special cleaning methods are needed to keep it as such.  If it were true, then men should have sterilized their penises before penetration, right?

Fact: the vagina is not at all sterile but rather a a host to many type of bacteria, all composing the vaginal flora that promotes vaginal health.

According to Ann S Botasch MD, the composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity, and disruption of this balance will lead to breakdowns such as irritation, infection, bleeding, etc.

So, ladies — make sure whatever ‘visits’ the vagina is clean and that you keep a balanced vaginal flora, but do not worry about the vagina being sterile.

Ovarian cancer clues

A new report just released, 7 Clues to Ovarian Cancer, raises the point that this dreadful disease is not as silent as believed to be, and that early detection may be possible.

We recommend reading the entire article, but here are the 7 clues (symptoms that were found associated with ovarian cancer):

• Abdominal distension
• Urinary frequency
• Abdominal pain
• Postmenopausal bleeding
• Loss of appetite
• Rectal bleeding
• Abdominal bloating

Orgasm exercises?

The vaginal wall is lined with involuntary muscles that keep it functional.   We cannot exercise these muscles nor command them to move this way or that way.

However, the area also has voluntary muscles that you can command, commonly known as the PC muscles, which participate in the Kegel exercises = tightening and relaxing these muscles as if squeezing the vagina shut.  These are good exercises to do for overall pelvic floor health or when instructed by your health care provider because of certain medical conditions.

Did you know that these PC muscles are also the ones that give you an orgasm? Yes, it is a unique phenomenon — they quiver, contract, and squeeze as you are enjoying the culmination of sexual arousal.  Many women also instinctively contract them in a rhythmic manner during intercourse, squeezing the penis to the man’s delight.

Important: an orgasm is often associated with intercourse, which is incorrect: an orgasm can be experienced by stimulating the clitoris without any vaginal penetration.

So ladies, you have 2 ways to keep your vagina in shape: Kegel exercises and (lots of) orgasms.

Voiding & sex

Many years ago it was believed that voiding (urinating) before and after having intercourse will guard against developing a urinary tract infection (UTI) , sending women running in and out of bathrooms in a frantic pace.

But was it urine in the system that caused the infection, or the penis’ rubbing/chafing the underside of the urethra (urine tube)?

Everything that is inserted into the vagina will slide against the underside of the urethra = an anatomical fact.   In some cases, this natural rubbing will cause irritation that may develop into a urinary tract infection, but it has nothing to do with urine that is housed in the bladder!

The most current medical research about this very topic (Recurrent urinary tract infection in women) states the following:

• Many factors thought to predispose to recurrent UTI in women, such as pre- and post-coital voiding patterns, frequency of urination, wiping patterns, and douching have not been proven to be risk factors for UTI.
• Strategies to prevent recurrent UTI in young women should include education about the association of recurrent UTI with frequency of sexual intercourse and the usage of spermicide-containing products.

Ladies, enjoy your sexual intimacy and save the running to the bathroom for when your bladder is full.