Tag Archives: ASK AN OBGYN

Do I Still Need To Get Pap Smears? ASK AN OBGYN

Dear SuzyKnew! A few weeks ago, I heard on the news that the Pap smear may not be used anymore and that there is a better test to detect cervical cancer.  What’s the deal?


Sorry, no professional body of doctors has recommended getting rid of the Pap smear.  So you are not off the hook!  But there is a new test that you may get at your next annual exam.

For decades, the Pap smear has been the gold standard.  You know the one- during a pelvic exam; your doctor takes a swab of cells from your cervix.  These cells are sent to a lab for processing and an abnormal result means that you could be at risk for developing cervical cancer.  An abnormal result means you return for more testing and if needed your doctor takes a larger sample of tissue.  But there is a new kid on the block- a test recently approved by the FDA that specifically looks for the presence and type of HPV virus.

 Why this new test? 

With any test or treatment, doctors want to be as specific as possible so that they can target the treatment and rule out other possible causes of illness.   Because we know that there is a clear link between cervical cancer and the human papillomavirus (HPV), and almost all cervical cancer is caused by specific genotypes of HPV, doctors are now thinking, “why not add a cervical screening test that looks specifically at HPV?”   Guidelines from the American College of Obstetricians and Gynecologists state that women aged 21-65 could have both the HPV and the Pap test when they have a cervical cancer screening every three to five years.  There is no test to determine whether you are HPV positive or negative (unlike an HIV test), but the HPV cervical cancer screening can help detect and therefore reduce the cervical cancers caused by HPV.

HPV is an STI?

Yes. Approximately 30 strains of HPV are spread through sexual contact.  In fact, its one of the most common STIs.   The CDC estimates that 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually active men and women will get at least one type of HPV at some point in their lives. Rates of HPV are higher for women under 25, minorities and those with multiple partners.

 If I have HPV will I get cervical cancer?

No. There are hundreds of strains of HPV, and most HPV strains are harmless, at worst causing warts on the hands.  Most resolve on their own with no treatment.  But a few specific strains of HPV are more dangerous than others, and we also know which strains of HPV (namely 16 and 18) are directly linked to the development of cancer. HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).

SO what can I do to prevent cervical cancer?

There are three ways to prevent HPV and lower your chances of contracting cervical cancer:

  •  Get Vaccinated. HPV vaccine is safe and effective. It’s given in three shots over six months; it is important to get all three doses. It’s only effective in young people.  All boys and girls ages 11 or 12 years should get vaccinated. Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger.
  •  Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer. Next time you go for your annual exam, ask your health care provider if they are using both the Pap smear and an HPV-specific test.  You can share the information you have learned from Suzy Knew!
  • Have safe (protected) sex. HPV can be spread through all types of sex, vaginal, anal oral sex.

Take care.


Can RePhresh Vaginal Gel Cure My BV In 2015? ASK AN OBGYN

Dear SuzyKnew!,

I keep getting bad vaginal odor due to BV- three times in six months- and in between I get a whopping yeast infection. I have a new partner (and no, we are not using protection). There also seems to be some link with the bouts of BV and my period. A friend told me about a gel that is supposed to correct my pH, and I’d like to start 2015 right! 

Should a Sista’ give this RePhresh product a try?


Dear SuzyKnew! Reader,

BV (bacterial vaginosis) is the most common cause of vaginal complaints, and it is seen all over the world. BV occurs when there is an imbalance in the ecosystem of the vagina- simply put, when there is less protective stuff and more harmful stuff.

The vagina is a complex and dynamic ecosystem, and the acid-base (pH) balance is part of that. Have you heard of the Micro-biome? Well this is it. There are billions of cells working together in our bodies. In the vagina, estrogen (hormones), glycogen (glucose) and lactobacilli (good bacteria) are just some of the actors at play keeping our lady parts functioning well. The vagina is an acidic environment, which keeps bacterial growth in check. It does this on its own, with no help needed from us. Dr Oz famously called the vagina “a self cleaning oven”.   You can unintentionally change your vaginal pH by douching or doing internal cleanses. Douching = bad idea!  Any disruption in this ecosystem can result in an overgrowth of the bad stuff- which is associated with a higher pH that’s when BV can set in.

Vaginal pH changes during each menstrual cycle (in the presence of blood). So, yes, it is possible that you a tipping the balance around the time of your period. It is curious that you are seeing a connection with your BV and your new partner. Sperm also has a high pH and it is possible that your partner’s sperm could cause a pH imbalance. It is common for female-female partners to pass BV back and forth, less common with male-female partners, but possible. You may be unknowingly re-infecting each other. I would encourage you to use a barrier method, and make sure you both get evaluated by a doctor.

BV can be hard to kick, Even with powerful antibiotics and it has a high reoccurrence rate.  Many women – including us Sistas!- get the double whammy of treating BV with antibiotics, just to end up with a yeast infection, then take antifungal yeast treatments that can further upset the vaginal ecosystem. For someone battling this cycle, it’s necessary to replace the good stuff.   The simplest, healthiest (and most economical) thing to do is eat yogurt, drink keiffer or visit your health foods store for a probiotic supplement.   This helps restore the good bacteria in your whole body, including your vagina.

You asked about a pH balancing gel. The RePhresh line of products is actively marketing to our vaginas and promises to correct vaginal pH and to replace the good bacteria. RePhresh vaginal gel is a polymer gel.   There are just three studies on its effectiveness, and these show that after many weeks of using the gel, (between 6-12 weeks) that it can correct vaginal pH. It is expensive (a 12 day supply sell for $20.00). This product may help certain women if you have a pattern of BV and have tried everything else.  The company also has a probiotic pill called Rephresh Pro-B which is a basic probiotic supplement targeted for an audience that is concerned about vaginal health.  Probiotics are very helpful, particularly after you have taken a course of antibiotics. However, you do not need one specifically marketed for your vagina.

My advice- even though you can get these products over the counter, or on the internet, I recommend that you do this only in consultation with your doctor.   Certain medications or serious disease process can bring on a change in pH and vaginal irritation. You do not want to treat a symptom without understanding the underlying cause.

Take Care

What Birth Control Should I Take If I’m Pre-Diabetic? ASK AN OBGYN

Dear SuzyKnew!

I’m 29 years old and was recently been told by my doctor that I’m pre-Diabetic. I’m learning about my condition and read that women with Diabetes need special care during pregnancy.  I am not ready to have a baby just yet. Do I need to make any changes with my birth control?  Help a Sista out!


Dear Reader, You are correct. Whether you have a “touch of sugar” or are a type 2 or type 1 Diabetic, routine monitoring of your blood sugar level and regular visits to your doctor are key to maintaining good health. If you don’t want to start or add to your family, preventing pregnancy is a MUST.  However, an unplanned pregnancy is nothing you want to mess with, and can result in some serious health consequences.

Managing Diabetes is tricky business, especially for newly diagnosed patients.  You have your hands full now with diet, exercise, and glycemic control.  For most women in your position, they want a reliable birth control method and want to avoid pregnancy.

There are some methods that are better than others for a woman newly diagnosed with Diabeties:

Not so great: I wouldn’t advocate a natural family planning method, in which women predict ovulation and avoid intercourse during fertile times.  This is generally not a reliable method and carries a high risk of unplanned pregnancy.  I also would caution against using a barrier method alone (meaning just a condom and not in combination with a more reliable method).

Better: Methods that do not require frequent administration are great for Diabetics.  You need to focus on diet, exercise, glycemic control, and let’s not forget about dental care, right?  Adding another daily routine just opens the door to human error.   Many hormonal products have been developed with convenience in mind, such as the ring, patch, intrauterine devices, and contraceptive injections.  These tend to work well for busy women whether they are Diabetic or not.

Here is a word of caution about the use of hormonal contraceptives from the American Diabetes Association.- many birth control methods work by altering hormone concentrations. Hormonal birth control methods (patch, ring, IUD, pills, injections, implants) can affect your blood glucose levels.  So what should you do?  Here’s some advice:

 Have your A1C, blood pressure, and cholesterol checked 3 months after you start any hormonal birth control method (pill, patch, IUD, injection, ring)

 – Check your blood glucose levels frequently when you start any new method.

 –Keep accurate daily records of your blood glucose levels and insulin usage. Bring these to your doctor’s appointment.

 Best:  The most reliable method is a tubal ligation.  This is an option if you know for sure that childbearing is not in your future.  Since most 29-year-old women are not prepared to make such a permanent change, your best option may be barrier methods used in combination with a method with higher reliability, such as a intrauterine device, injection or patch.  Then you get the best of both worlds- protection from both STDs and pregnancy!

And don’t forget Emergency Contraception (EC).   Let’s face it, mistakes happen.  Diabetics should have a prescription or better yet, a supply of EC in the bathroom cabinet.

What About That Future Baby You May Have In Mind? Most women who have Diabetes can have healthy pregnancies under the close care of their doctor.   Women with Diabetes should their doctor before they become pregnant for preconception counseling.  And during your pregnancy, it is very important to have a doctor that will closely monitor your condition. Pregnancy can but a high level of stress on multiple organ systems including your kidneys, eyes and vascular system.  These are systems that are already stressed in a Diabetic.  High levels of glucose can cause serious health effects such as a miscarriage or birth defects in a developing fetus.

Millions of Diabetic women give birth to healthy babies each year.  Just make sure you are one of them, when your time is right.

Take care.




Can I Get Ebola From Sex Or Kissing? ASK AN OBGYN

Dear SuzyKnew!, Can I get Ebola from sex or intimate contact with an infected person that does not have symptoms? What if I kissed someone at a club and then he or she come down with Ebola a week later? Would I get it?  BTW- this didn’t happen, I’m just wondering if it could happen.


Dear Reader,

There is a lot we don’t know about Ebola, mostly because it has not been studied in a controlled environment with enough cases.   What we do know is scary for a lot of people.

Ebola is most frequently transmitted through the feces, blood or vomit of a person who is very sick, exhibiting high fever and other intense symptoms such as diarrhea and vomiting.   The CDC guidance says that a person is only infectious once they exhibit symptoms.  That is why the infections we have seen outside of the affected countries in West Africa are among healthcare workers or travelers from endemic areas who have taken care of very sick individuals as they are dying.

One thing that we do not know is how long the Ebola virus remains in the body if or when a person survives the infection.   There simply have not been enough studies to answer this.  There are several studies that have shown that Ebola virus can persist in semen for longer than in blood or other body fluids (the estimate is up to 100 days).  However, according to the CDC, sexual transmission of Ebola has not been definitively established.  But, to be on the safe side, the CDC has recommended that patients that recover from Ebola abstain from sex (including oral sex) for 3 months.

Similarly, Ebola virus has been detected in breast milk, but that information is based on a single patient.  Therefore, there is not enough evidence to provide guidance to mothers on when they can safety resume breastfeeding.

You asked specifically about kissing.   Although there are very few studies on Ebola transmissions through other routes: sweat, semen, vaginal fluid, saliva, tears, breast milk, etc.., we do know for certain that Ebola can be spread through the saliva of an infected person.   So my message to you is: if someone appears sick- don’t get intimate with them.  It’s unlikely that they have Ebola, but they may have another virus that will make you ill.

This is a good time to check in on your health in general.   Practice healthy habits to keep your body strong, such as good diet, exercise, get your annual flu shot, and stay calm.

Take care.

Can Heavy Girls Use Emergency Contraception? ASK AN OBGYN

Dear SuzyKnew!

Tell me more about emergency contraception.  I’m a big girl, and I heard that I can’t use it.  Is this true?


Dear Reader,

Emergency Contraception (EC) – also called The Morning After Pill – can be a lifesaver for women who experience unprotected sex and want to avoid getting pregnant.   The short answer to your question is that women of all shapes and sizes can use EC, however, for heavier women, progestin-only EC may be less effective.

First, some quick facts about EC: EC can be used up to 120 hours after unprotected sex.  It does not end a pregnancy and does not work if you are already pregnant.  It acts like birth control pills, which is what most EC is after all.

There are three types of EC.  1) Pills that contain progesterone (Plan-B, Take Action, Next Choice) is the most common and available without a prescription.   2) Pills that contain Ulipristal acetate (ella) is a newer product that you can only get from a doctor and may be a better option if you are overweight.  3) The IUD, is less commonly used, but it has the added benefit is becoming your long-term (and very reliable) birth control method.

How can I get EC if I need it?:  The good news is that brand name and generic products are now available in the family planning isle of most major pharmacy chains.  Progestin-only EC is legally available on the shelf without age restrictions and can be purchased by both women and men of all ages.    EC is sold on many Internet sites, including Amazon. Ella requires a prescription; but obtaining an online prescription is possible.

EC is definitely something that all sexually active women should have on hand.  Think of the “emergency” products in your bathroom cabinet: that miracle acne cream, your migraine pills or ointment for a nasty cold sore.  You always make sure you always have enough stock right?   EC should be on the shelf.  A zit will eventually go away, an unintended pregnancy will not.  Yeah, this is serious business.  Because there is a 120 hour effectiveness window, you don’t have a lot of time to mess around getting to a pharmacy.

How does weight change things?:  This is an excellent question and a relevant one since over 35% of  American adults are obese.  In addition, women with comorbidities such as diabetes or heart disease are at higher risk of pregnancy-related complications, therefore avoidance of unintended pregnancy is especially important.

Here’s the not so good news:  EC appears to be less effective the more you weigh, and decline steadily in effectiveness with increased BMI.   These findings have come out only recently as more EC products are introduced on the market and more women of varying weight are included in clinical trails.   More studies are in the works, but for now this is what I recommend: Calculate your BMI.  If your BMI is 26 or greater, you should talk to your doctor about which EC is right for you.  Your doctor may prescribe ella which appears to have less of a weight factor.

Take care.


Why Is My Vajayjay So Dry? ASK AN OBGYN

Dear SuzyKnew!

It’s embarrassing to say, but I’m basically dry as a bone done there.   Lube helps, but if I don’t use it every time I feel like I’m being ripped apart.   It didn’t used to be this bad.  Maybe it has to do with some medication I’m taking? or my age (I just turned 40)?  Why is this happening to me? 


Dear Friend,

Rest assured you are not alone.   Vaginal dryness is something that most women experience at one time or another, but we just don’t talk about.

Common causes of vaginal dryness are:

1-    Low estrogen- Our hormones fluctuate all the time.   They go up and down during our monthly cycles, after childbirth, with breastfeeding, and even after a miscarriage or abortion.  Over the long term, estrogen levels decrease as we age (although your age-40, which is on the outside of that spectrum, so don’t fret, you likely have plenty of time before you are having the menopause conversation with your doctor).   The good news is that if your vaginal dryness is linked to a life event, it may pass with a little time.

2-    Medications- If a medication dries out your mouth, nose or throat, you can expect that it will also dry out your vagina.  Decongestants and allergy medications are major culprits. Cigarettes will also dry you out.  And if you suffer from heart disease, depression, seizures or are fighting cancer, many of these meds have side effects that interfere with sexual pleasure in both men and women.   Ask your doctor if there are different meds for your condition that do not have sexual side effects.

3-    Irritants and Allergies-  It’s worth checking your bathroom cabinet and laundry room to see if you are using products with perfumes or dyes that may be irritating to your sensitive vaginal tissue.   Eliminate all products with dyes and perfumes and above all do not douche or use any vaginal deodorants.

4-    Low Arousal- When we are aroused, and feeling sexy, that’s the signal for our bodies to produce lubricant.   You may not be giving yourself enough time or the right foreplay stimulation to get those juices flowing.   Experiment, take more time in the bedroom, change up your routine, and see what happens. 

There are several products (the first two can be bought in most drug stores) that you should try to give your body the moisture it is lacking:

Lubricants– These are used during foreplay and penetration to reduce friction that can occur if your body is not producing enough of its own lubricant.   Always choose a water-based product, with no added herbals, flavors, perfumes or spermicides.   These additions may irritate your already sensitive tissue.  Common brands of vaginal lubricant include K-Y Jelly® and Astroglide®.   Do not use hand lotions or petroleum-based products, which cannot be used with condoms and may be irritating.

Moisturizers-  Vaginal moisturizers are designed to correct your pH balance and keep you moist for a longer period- usually 2-3 days.  Replens® and K-Y Liquibeads® are common brands.  Vitamin E capsules can also be used and are a more economical option.   Many women who suffer from vaginal dryness will use a moisturizer a few times a week and then double up with a lubricant for intercourse.

Topical Estrogens–  For women whose vaginal dryness has been diagnosed as a result of low estrogen levels, the treatment is to replenish the estrogen.   Typically, a doctor will prescribe topical estrogen gel or lotion (as opposed to taking an estrogen pill).

Introducing healthy fats (avocados, nuts) and staying hydrated (8-10 glasses of water per day) will also help you moisturize from the inside out.

Take Care and thanks for writing.

Ask your intimate question. Write to OBGYN@suzyknew.com

ASK AN OBGYN: Do I Still Need An Annual Pelvic Exam?

In July, the American College of Physicians (the governing body that sets the standards for how doctors in the U.S. practice medicine) recommended changes to the annual well-woman exam.    A panel of experts looked at over sixty years of scientific studies on conditions such as cancer, infections, and pelvic inflammatory disease.  This led them to question the value of one part of the well-woman check up, the pelvic exam.  In particular they questioned whether all adult women need this exam each and every year.

Ladies, you may be thinking- Wow, I’m off the hook!  Well, not exactly, read on…..

The well woman exam has three parts– Breast exam, Pelvic exam, and Screening and Diagnostic tests, the most important being the Pap Smear screening for cervical cancer.  The Pelvic exam consists of three parts- an inspection of the external genitalia, an inspection of the internal organs (using a tool called a speculum to see the cervix and vaginal walls), and a manual exam to feel the cervix, uterus, ovaries and fallopian tubes (in which the doctor inserts two-fingers into the vagina and presses on your abdomen).

After a review of all available studies, the panel recommended that if a woman is low-risk she does not need a pelvic exam each and every year.   Low risk in this case means: non-pregnant, no symptoms that would indicate illness, no present illness, no history of illness, or no relevant family history of illness.

This recommendation is a huge deal for health care practitioners and has led to a lot of heated discussion.  The Pelvic exam is often part of the routine when women come in for prescription birth control.  Some doctors are reluctant to change their practice.  Some women (including women who have difficulty accessing health care due to poverty, language barriers, etc..) may not see a doctor for years, and doctors that work in these health clinics feel that they need to catch women in the moment.

Other doctors welcome the recommendation.  Colombia University professor Dr. Carolyn Westoff is one doctor who has looked critically at why doctors have insisted on this exam for many years.  She wrote in The Journal of Women’s Health that frequent pelvic exams “may partly explain why U.S. rates of ovarian cystectomy and hysterectomy are more than twice as high as rates in European countries, where the use of the pelvic examination is limited to symptomatic women.”

There are several groups wrestling with this issue- the doctors and medical associations (in charge of your health), insurance companies (in charge of the health care spending), and legal folks (thinking about safety and consumer protections).

But while they hash this out- what should women do?

Here is some advice:

1)     Continue to schedule your annual exam.  Just because one test or procedure is being reevaluated, doesn’t mean we should “toss the baby out with the bathwater”.   You need a check up to catch some major stuff, like heart disease (leading killer of women in the U.S) and other scary stuff like diabetes.  And, importantly, you still need the other parts of the well woman exam, specifically the breast exam and screening tests such as the Pap smear.

2)     Follow your doctors advice.  Your doctor or nurse practitioner will treat you as an individual, looking at your personal history and risk factors.  If you need a pelvic exam they will give you one.   There are also specific recommendations of frequency of Pap smear and Mammograms.  Your doctor will tell you if you need these tests every year, or as is the case for most healthy women, you may need certain tests every two or three years.

3)     Share your concerns with your doctor.  Many women (see the SuzyKnew! posting on vaginismus) have real difficulty with a pelvic exam and may even avoid going to the doctor because of fear or pain.   If this is you, than the new recommendation may be music to your ears!  In any case, find a doctor that you can relate to and you can speak to comfortably.

ASK AN OBGYN: What’s The Real Story On Having Sex During Your Period?

Dear SuzyKnew!   What’s the real story on having sex while on your period?  Some of my friends don’t do it at all during their time of the month.  Other friends don’t care and say that they like it because it’s a safe time because you can’t get pregnant.  Is this true? I don’t like all the mess, but my man doesn’t think it’s a big deal.   What’s your advice? 

Dear  Friend,    There are many opinions on this.   On one end of the spectrum are women who embrace their powerful bodies each day of the month, and would likely reject a man who snubbed her because of a natural process.   On the other end are women who are highly influenced by cultural rules and taboos that call for women separating themselves while menstruating. Most of us are somewhere in the middle. So, the real deal is that there is no physical reason that women cannot engage in satisfying sex at any time of the month.  Unless she is in pain or suffering from an illness, she is capable of seeking out sexual pleasure whenever she wants.   In fact many women report increased sexual pleasure while on their period.  I’ve also heard from men who like the lubricating factor.

Now for the cultural considerations (I find this fascinating).   Many traditional religions (including Islam, Judaism and Hinduism) consider contact with a woman who is menstruating taboo.  The extent of this belief and practice varies with how conservative one is.  Christian texts have little to say on the subject, many scholars believe that menstrual taboos were used to keep women out of positions of authority in the church.    Many tribal societies still have “menstrual huts” and segregate women while they are on their period.   And even in countries with social and political equity (such as the U.S. and many Western European countries), menstruation is still a taboo subject and if often spoken about in code or not addressed publically at all.

 With all that said, let me address your specific questions:

Can you get pregnant while on your period? 

Technically, yes you can.  Here’s the skinny, we bleed during their periods, but also may bleed while we are ovulating.  Thinking you are on your period when you are actually your most fertile is dangerous business.  If you have irregular periods it may difficult to track where you are in your cycle.   The Fertility Awareness Method can help you out here.   Check out articles by the Roses of Fertility on SuzyKnew! for a guide to fertility awareness.

 How much mess are we talking about here?

Not much, really.  A typical period (with light and heavy days) is only a few tablespoons of blood and uterine lining.   To decrease the mess, you can wait until the heaviest days have past.  Other strategies include using the “man on top” position, having sex in the shower or lining the bed with towels.  WikiHow has a fantastic entry on this- check it out.

Here’s another option- You can also skip your period altogether. Many women have menstrual disorders with painful and debilitating symptoms that force them to miss work and fun.  Other women (I’ve seen this trend with busy moms and medical students) choose not to have a period at all out of choice or convenience.   See  Take Charge Of Your Menstrual Cycle! from SuzyKnew! Think no more tampons, no more cramps.  Several contraceptive methods can be taken under the advice of your provider to stop your periods.  These include: Depo-Provera, one type of intrauterine device (Mirena®), the birth control implant (Implanon) and a newer product called Lybrel.

Can I Get A STD From My Valentine Bikini Wax? ASK AN OBGYN

Dear Suzy Knew,

I’d like to get a Brazilian bikini wax for my man this Valetine’s Day.  But, I’m wondering if I can get a STD from this?


Dear SuzyKnew Reader,

Removing pubic hair (through shaving, waxing, threading, trimming, etc..) is a very common practice.   Looking at several surveys, between 70-88% of women and 58-78% of men admit to removing some or all of their pubic hair.   Pubic hair removal has also become more extensive over the years- a look through a magazine like Playboy from the 1960’s through the present day will show how dramatically hair has thinned out over time.   The Brazilian bikini wax is among the most extensive of the hair removal treatments, removing hair from several areas- most typically the pubis, labia, and anus.  This is an increasing popular method of hair removal.

So if everyone is doing it, what’s the big deal?   Pubic hair is there for a reason.  It acts as a shield to protect the delicate skin of your lady parts from debris and infectious particles.  Think of it like your eyelashes.   If you removed your eyelashes you could get all kinds of stuff in your eyes.  Granted, our lady parts are protected by clothes when we are out in public, but without the protective layer of pubic hair, during sex, at the gym or at the salon, all kinds of unwelcome germs can gain access.

What actually happens when the hair is removed?  There is a reason it is painful.   When the hair is removed, the skin is traumatized.  A small surface layer of your skin gets pulled off with the hair.  The follicle also gets inflamed from the mechanical removal of the hair.

Is there risk of infection?   Absolutely.  And I’m willing to bet most readers have had little bumps, redness, and irritation after hair removal.  Those are signs of an infection.   Once your skin is irritated, it is vulnerable to whatever germ it comes into contact with- a bacterial skin infection like staph, or even a virus such as molloscum or herpes.   Infection can be introduced from poor hygiene practices at the salon, or from a dirty towel, or from sexual contact with irritated skin. 

How can you protect yourself?  Here are a few tips:  1) Ensure that your salon is licensed by the state in which you live, and that your anesthetist is certified to perform the procedure or treatment you want.  2) Make sure your anesthetist washes his or her hands thoroughly with soap and water. 3) Make sure the salon practices clean care, meaning they do not double dip the wax and you have clean towels.   

After your treatment, remember that the area has had micro trauma.   Keep it clean, using a mild soap and water with an added antibiotic ointment if you see any irritation.  If the irritation is painful or worrisome, call your doctor.

Avoid unprotected sexual activity (rubbing, touching) in the area for a few days and until there is no signs of irritation.   That raw skin is an open invitation for any germ, including an STD.

A final word of caution. You should weigh the risks and benefits of extensive hair removal, like a Brazilian, if you have diabetes, liver or kidney disease, or are on immunosuppressant medications.    You may be more susceptible to infection and have delays in healing times.   In addition, if you have an active viral or bacterial infection on the areas you are requesting hair removal, please, please wait.   You do not want to unintentionally spread an infection to others.

So we just need to weigh the risks and benefits of any beauty treatment, right?   Choose the path that’s best for you, armed with information to protect your body and your future.

Keep it sexy! Keep it healthy!

SuzyKnew RN

ASK AN OBGYN: I Feel Like I’m Going To Destroy The World When My Period Comes!

Dear Obgyn,

When I was in my 20’s and early 30’s I was never moody during my menstrual cycle. Now that I’m 36 I feel like I’m going to destroy the world when my period comes.  Can you tell me a little more about how your cycle can change when you get older? What are some good online sites to go to?


Dear SuzyKnew Reader,

Yes my dear, just about everything shifts and changes as we age and our menstrual cycles are no exception. Most women begin to see changes in their cycles beginning in their mid to late thirties.

I like to think of the menstrual cycle as a monthly play- with different characters performing different scenes every week.  Estrogen and Progesterone are the leading ladies, with supporting roles from Prostaglandins, Luteinizing Hormone, and the mood stabilizing chemicals in your brain such as Serotonin and Dopamine.   There’s a lot going on here, and it’s not just happening in our reproductive systems.

The hormones that govern our cycles are part of the body’s Endocrine System and these hormones act on other parts of our bodies.  For example, Prostaglandins act on the uterus to cause cramping, but also are responsible for nausea and upset stomach that many women experience with their periods. Drops in Estrogen levels during a normal menstrual cycle can cause thyroid changes and in some women trigger migraines.  Drops in Estrogen for women in their 50’s and beyond have been associated with increased risk for osteoporosis.

And let’s not forget stress.  Women in their thirties can experience a lot of stress from the increasing responsibilities of work and life.   This causes a rise in the “stress hormone”, Cortisol, which can negatively affect different body systems, including our menstrual cycles.

Your Doctor or Nurse Practitioner may ask you to keep a journal for two menstrual cycles. This will help rule out any underlying medical condition that may be appear with PMS-type symptoms.

Check out the following websites:

1)    for a good breakdown of changes through the decades

2)    for info on perimenopause