Two occurrences last week caught my attention and caused me to reflect on the conversations I have with patients about misunderstood gynecologic topics. While I was reviewing a weekly list of medical journal articles, one seemed particularly interesting. It highlighted the surge in sales of douching products in Mexico City that claim to improve the health of the vagina and make you feel fresh. Later that same week, one of the women in my bookclub reported on her daughter’s senior college thesis about the history of feminine hygiene advertising. I have now read the entire paper and am intrigued about the advertising business that has been built around shaming women regarding their bodies and their subsequent need to use a product to attract men and feel more fresh. Following are other frequent conversations about misunderstood topics.
1. Douching – It was initially advertised as both a cleansing process necessary after intercourse or menses and as a contraceptive that could kill sperm. While I am sure that Lysol would kill sperm that were still in the vagina, these are the slow swimmers that won’t result in a pregnancy. The fast swimmers are long gone and hunting for that lone egg. In regards to use as a “cleansing agent” for the vagina, it actually can contribute to infections by killing off the beneficial bacteria and allowing overgrowth of the yeast and bacteria that cause odor and discharge. As one of my colleagues loved to say, “The vagina is a self-cleaning oven and should be left to take care of itself”.
2. Waxing – This seems to have replaced douching when it comes to shaming women about a natural part of their body. 15-20 years ago women shaved their “bikini line” during the swimsuit season. Currently, most women remove all their pubic hair via waxing or shaving as a means of “staying clean”. Many of my patients have used the words “dirty” or “disgusting” when referring to pubic hair growth. An entire business industry has been built around women’s shame. Do you see any similarities with the advertising about douching? Pubic hair protects the tender vulvar skin and repeated shaving/waxing can lead to ingrown hairs, folliculitis and contact irritation rashes. Another side effect that I have written about previously is labiaplasty.
3. Dark menstrual blood or no bleeding is bad – Many women have lighter flow as they get closer to menopause or when using birth control pills or an IUD. Usually the lighter flow can be darker in color and thicker. This isn’t “bad” or evidence of an infection. When flow is lighter, it stays in the vagina longer and becomes combined with oxygen and bacteria, leading to the darker color and change in texture. Similarly, no menstrual flow due to birth control pills or an IUD is normal and not harmful. Both methods work to decrease the build up of the uterine lining, thus leading to minimal menses. I had to remove one women’s IUD as she didn’t feel feminine because she wasn’t having a period!
4. IUDs lead to infertility/cause abortions – This is only one of the many falsehoods around IUD’s. In the 1960’s, the Dalkon Shield IUD RARELY migrated thru the uterine wall and caused adhesions within the abdomen that could cause infertility. This is not a problem with the current IUDs. Both the Mirena and Paragard IUD work by inhibiting transport of sperm into the uterus and causing the sperm to die before they are able to enter the fallopian tubes, where fertilization takes place. They DO NOT cause a fertilized egg to abort. The MIrena IUD is the safest and most effective means of birth control for women of any age.
5. Birth Control Pills are dangerous – Actually, pregnancy is much more dangerous and should carry a black box warning! Although BCP can cause blood clots and stroke in rare cases, many more women die each year due to pregnancy related causes. The benefits of BCP are a reduction in the lifelong risk of ovarian cancer, decrease in incidence of ovarian cysts, decrease in monthly blood loss and prevention of pregnancy.
6. Drinking eight 8oz glasses of water a day – Although there is no detriment to this practice, most women think that if 8 is good, more water would be better. As urban legends go, this is probably the one that has the catchiest title and has no evidence behind it. If you have access to water and are not intensely exercising or living in a very hot climate, you will not become dehydrated. The problem is when women carry a water bottle with them all day, constantly sipping from it and then needing to use the bathroom every 1-2 hours. The majority of the patients that I see for urinary frequency improve when they simply decrease their fluid intake and limit intake to mealtimes.
7. Family history of “cancer” means that more “cancer” screening is better – Most cancers are not hereditary and are related to lifestyle. 10% of breast and ovarian cancer is hereditary, which means that 90% of these cancers are either chance occurances or lifestyle related. Uterine and cervical cancer is almost entirely lifestyle related. A relative with lung cancer or colon cancer does not increase your risk of “female cancer”. And more screening is actually worse, as it increases your risk of receiving a false positive diagnosis. Improving your lifestyle thru dietary change and exercise is a better deterrent to cancer than an increase in testing.
The bottom line is to have a conversation with your physician when you have a question that concerns your reproductive health. Realize that your doctor is not trying to sell you anything and has had at least 12 years of training to support her advice. Finally …..don’t believe everything you read on the internet. I am sure that someone out there is still trying to sell Lysol as a douching product.