Transcript
Brogan Driscoll:
Hello and welcome to Huff Post’s brand new weekly podcast, Am I Making You Uncomfortable? Presented by me Brogan Driscoll.
Rachel Moss:
And me Rachel Moss. This podcast is a frank, honest conversation about women’s bodies, health and private lives.
Brogan Driscoll:
We cover under-reported issues and tackle topics you’re too squeamish to talk to your mates about.
Rachel Moss:
Today, we’re talking about vaginal discharge. Later, we’re going to be joined by Dr. Anita Mitra, a gynecologist who’s better known as The Gynae Geek. She’s also the author of “Your No-Nonsense Guide to ‘Down There’ Healthcare”.
Rachel Moss:
Before we get into talking about vaginal discharge, I feel we need to just talk about vaginas off the bat.
Rachel Moss:
I feel it’s not a word that you say very often, especially when you’re growing up, what did you used to call your vagina when you were a kid?
Brogan Driscoll:
Yeah, I agree, I definitely don’t say vagina very much.
Rachel Moss:
(laughs)
Brogan Driscoll:
We should get that out of our chests first of all.
Rachel Moss:
(laughs)
Brogan Driscoll:
So, let’s just say vagina a couple of times each. Vagina.
Rachel Moss:
Vagina.
Brogan Driscoll:
Vagina.
Rachel Moss:
Also, let listeners know, we do know the difference between vagina and vulvas, because you know someone’s going to come at us with that as well. We’re quite bad at both saying those words, both of us, but we know we should.
What did you used to say instead of vagina?
Brogan Driscoll:
When I was younger, I used to say tinkle.
Rachel Moss:
Tinkle.
Brogan Driscoll:
Which is a bit weird.
Rachel Moss:
It’s very sweet, I like it and inventive.
Brogan Driscoll:
Very sweet.
Brogan Driscoll:
What about you?
Rachel Moss:
My mum went for a more traditional approach, we just called it Mini, which...
Rachel Moss:
...Is not very exciting. Yeah we just called it Mini, that was it.
Brogan Driscoll:
There are so many inventive ways of describing it. People say flower.
Rachel Moss:
I quite like foof. Foof.
Brogan Driscoll:
Yeah, rather than just actually saying what it is.
Brogan Driscoll:
Awful.
Rachel Moss:
You can joke around and call it different things, but it is important to know the proper words for it and not to be embarrassed about saying the proper words for it when you need to...when you go to the doctors, or something.
Rachel Moss:
I know a lot of women are so stressed about saying those words that it then stops you from actually looking after your body properly.
Brogan Driscoll:
Although we did have a weird little word for my vagina when I was younger, my mum’s always just been super upfront about things and the need to go to get health checks and not be embarrassed about things like that. But then my mum does work in healthcare.
Rachel Moss:
(laughs)
Brogan Driscoll:
So maybe she’s kind of banging her own drum there.
Rachel Moss:
You’ve had a priority boarding. (laughs)
Brogan Driscoll:
Yeah, but Rachel, this is like day in, day out this.
Rachel Moss:
It is.
Brogan Driscoll:
Women’s health, vaginas, all this kind of stuff is your life.
Rachel Moss:
It is. I primarily write about women’s health for HuffPost so I’m completely desensitised now. I can write about vaginas ’til the cows come home, quite frankly.
Brogan Driscoll:
(laughs)
Rachel Moss:
I do think that as a society, we’re getting a little bit better on the whole as well. One of the things we’ve spoken about before is how the internet has changed the way we talk about women’s health, vaginas and vulvas. The internet is obviously a place that is ripe for spreading misinformation about women’s health but it’s also getting the conversation started. There are good sides alongside the bad. And then you’ve got the in-betweens. You’ve got the GOOPs, which, for better or worse, has us talking, doesn’t it?
Brogan Driscoll:
That’s interesting that you class it as an in-between.
Rachel Moss:
I have a very love, hate relationship with Goop. I know a lot of people out-and-out just hate it and I do totally get that. God, I hope Gwyneth Paltrow isn’t listening to this.
Brogan Driscoll:
(laughs)
Rachel Moss:
For me, it’s just a kind of entertainment whether you’re looking at the Goop site or the Goop Netflix show. As long as you don’t take it seriously and take it for what it is, I personally don’t think it damages me.
Things like the vaginal candles that they were selling... If you’ve missed it, last year, there was a candle that did the rounds that supposedly smelled like a vagina but it was actually rose and cedar flavoured. Those things are crazy because your vagina should not smell like a cedar candle and you can just laugh at them.
But then there’s the darker side of it as well. There are obviously some huge names in the industry who hate Goop, one of them being Jen Gunter, who I interviewed last year.
One of the things that she said, not just about Goop, but all of these companies who sell wellness products for vaginas and vulvas, is that they peddle faux feminism. On the one hand, you can think that somebody is selling you a vulva product and that’s a really positive thing because they’re talking about vulvas and you’re thinking: “Whoo hoo, feminism, empowering”.
But when you actually put the brakes on and you analyse why they’re selling you that product, you realise that it comes from a culture of shame and it’s telling you there’s something wrong with your body. And it’s actually the complete opposite thing. There’s just a lot to digest out there and if you do consume that kind of content, don’t do it medically, do it for the giggles.
Brogan Driscoll:
In the same vein, there’s so much misinformation about vaginas and what you should be putting and not putting in them. There is also such a lack of discussion around discharge. I’ve never heard a podcast about discharge before. There might be one out there but I haven’t ever come across it so I’m glad that we’re talking about it today.
Brogan Driscoll:
We all know you as the Gynae Geek as you’ve written a fantastic book “The Gynae Geek: Your No-Nonsense Guide To ‘Down There’ Healthcare”.
Dr. Anita Mitra:
Thank you.
Brogan Driscoll:
You must be pretty comfortable talking about vaginas. Has it always been that way?
Dr. Anita Mitra:
It’s what I do every day. As doctors, we get desensitised to talking about body parts and things that other people feel are awkward. To be honest with you, I can’t really remember the day I suddenly thought it was normal but it’s just like a gradual exposure. When you’re at medical school, you start hearing these words every day in lectures and then you gradually start talking to patients and it just becomes normal.
Brogan Driscoll:
Do you think there’s been a change in the media and people feeling a bit more comfortable talking about these things?
Dr. Anita Mitra:
I have definitely noticed a change but when it comes to social media, you can end up in a bit of an echo chamber. Because of the accounts that I follow and the kind of people who follow me, I feel that in my circle, there’s definitely been a change and I notice that my friends are all very keen to talk about these kinds of things with me.
But I do still think that we do have quite a lot of work to do and I do occasionally find myself in situations where people are really not cool with it. I just remember a few months ago, I went to a crossfit session and I had a really bad period pain. At the end of the session, the coach said to me: “How did you find that?” and I said: “Oh my god, it was so amazing because before I started, I had a really bad period pain and now it’s completely gone because the pain of the workout was so much worse”.
Brogan Driscoll:
(laughs)
Dr. Anita Mitra:
That’s when I realised: “Okay, not everyone is cool with talking about it”.
Rachel Moss:
I feel we’re getting a lot better at talking about vaginas and periods, just about, in some situations but discharge is one of those things that we still don’t talk about. I can’t imagine talking to my friends about it, which is ridiculous, because there’s no reason.
For all our listeners, can you explain, from a really basic first point, what is discharge?
Dr. Anita Mitra:
Discharge is a word that makes everyone cringe, I think. There’s still a lot of work to do when it comes to discharge. It’s a kind of mucus that you find in your vagina that comes from the cervix and also from the walls of the vagina. Most people will see it either in their underwear or on tissue when they wipe, put on a pad or a pantyliner. It’s what the body makes to actually protect ourselves. It contains lots of protective compounds like peptides. They are little proteins that we actually call natural antibiotics and they protect us from bacterial infections and from viruses. Something that I always like to shock people with and say: “If you didn’t have discharge, you’d have a dusty vagina.”
Rachel Moss:
(laughs)
Dr. Anita Mitra:
Because literally, it lubricates your vagina and your vulva and it’s not just for sex either. It’s a tube and if it wasn’t there, it would rub together and you would get kind of a chafing.
Rachel Moss:
Comfy.
Dr. Anita Mitra:
So, it’s really essential and it’s also the reason why we exist. You need discharge to actually allow sperm to swim through the vagina, up through the cervix, to meet the egg. It’s got so many crucial roles. It’s one of these things that everyone thinks is a symptom, but actually, it’s so important for people to understand that it’s completely normal. It’s completely healthy and it’s how your body works.
Rachel Moss:
Yeah, absolutely.
Brogan Driscoll:
So interesting, I’ve learned loads already. It changes over your menstrual cycle, is that right?
Dr. Anita Mitra:
Yeah, absolutely.
Brogan Driscoll:
Can you tell us, why does it happen and any key points in the cycle?
Dr. Anita Mitra:
The menstrual cycle is the whole period or the whole amount of time, from the start of one period to the start of the next. So it’s about a month, say on average 28 days, and throughout that time, your hormones are changing all the time. And it’s the hormone changes that influence the character of the discharge and the amount that you produce.
After your period, you can often feel quite dry and irritated. I’ve noticed, these days, a lot of people online are saying: “Well, the reason you’d feel dry and irritated is because of using tampons”. There’s a lot of fear mongering around tampons but one of the reasons is because your hormone levels are very low at that point.
When they’re low, you don’t produce as much discharge which can be quite thick and sticky. And yet, you can feel dry, itchy and irritated. It’s one of the commonest times to actually get thrush or bacterial vaginosis, which are two abnormal types of discharge, that we’ll probably talk about later. As you increase the amount of estrogen that you’re producing, the amount of discharge will increase and it will become a little bit more silky, shall we say.
Brogan Driscoll:
(laughs)
Dr. Anita Mitra:
The amount of discharge really increases around the time you ovulate. A lot of people call it egg white discharge, it’s very thin, watery and really, really clear. As you go towards your next period again, it tends to thicken up and can become darker, white or even yellowy shades sometimes, grayish almost, and all of these things can be completely normal.
Dr. Anita Mitra:
I think the egg white discharge is really interesting as well. I’ve noticed that a lot of people are quite keen to not take the pill these days or are stopping it because they’re thinking about trying to get pregnant. They get quite freaked out about this egg white discharge because they’re thinking: “What is this?” If you take the contraceptive pill, you won’t get that egg white discharge because it happens from ovulation. So, a lot of people who’ve maybe been on the pill for many years are suddenly asking what it is. But it’s completely normal, healthy and a really positive sign that your body is working normally.
Rachel Moss:
Yeah, that’s so interesting. On all of those points about how the pill affects it, I’ve also heard from a lot of women who say they’re using discharge to track their fertility or their ovulation. Is that something that works? What are your thoughts around that?
Dr. Anita Mitra:
It can, definitely, be really helpful to let you know when the most likely time that you’re fertile is. You can essentially look out for the egg white discharge as a sign that you are ovulating and that would be the time to concentrate on having sex. But then again, timed intercourse isn’t really proven to increase your chance of pregnancy because you can miss it. So, if you’re waiting for that discharge and then you start having sex, you might have missed it. The idea is using it to pinpoint when you’re probably going to ovulate and then start having sex at least a week before, if you really want to be optimising your fertile window and it’s what you’re aiming for. But equally, I wouldn’t use that as a form of contraception, if you’re trying not to get pregnant.
Rachel Moss:
Fair enough. So, when should people worry about discharge?
Dr. Anita Mitra:
Well, a lot of people worry about discharge in general. The most important thing is to get to know what’s normal for you and be aware of those changes in the cycle.
If you’re getting blood-stained discharge, when you’re not having your period, that is something to be aware of. If your discharge is associated with a really bad pain in your lower abdomen or you feel unwell, that’s something to see a doctor about.
If it’s very itchy, very irritating and if it has a foul smell, those are all signs that this is something that needs a bit more attention. There are kits available in the pharmacy these days which you can use to see if it’s thrush or bacterial vaginosis but these things are really worth speaking to a healthcare professional one-on-one. You just want to make sure that you are treating the right thing.
Rachel Moss:
Those problems that you mentioned, thrush and BV, what causes those?
Dr. Anita Mitra:
Thrush is a yeast infection caused by a special yeast called Candida. It’s something all women have in their vaginas at some point, often just in really small amounts but sometimes the amount of candida can increase in quantity and take over. And then you get what everyone calls a “cottage cheese discharge”.
It’s really common and I don’t think I really know anyone who’s never had thrush in their life before. It’s particularly common in pregnancy and it can also be more common in women who take the contraceptive pill because of the amount of estrogen. It’s often recurrent and, in a small number of cases, can be associated with diabetes. In most people, it’s not and doesn’t signify any kind of sinister underlying cause but it’s definitely something very irritating. Recurrent thrush is a massive problem though and it is something that’s worth treating properly, whether it’s due to an underlying condition or not.
Rachel Moss:
That’s so fascinating and super important that we all know about it. Another really interesting area that you study is the vaginal microbiomes which sounds super scientific and quite scary.
Can you break it down for me - what does that actually mean, what does it involve and why is it important?
Dr. Anita Mitra:
Oh, I think the vaginal microbiome is very friendly.
Rachel Moss:
Oh great. (laughs)
Dr. Anita Mitra:
We have all heard that there are friendly bacteria in your gut and in your vagina. That specific kind of bacteria is called Lactobacillus. Women have lactobacillus in their vagina, some people have pure lactobacillus, some people have less, some people don’t have any at all.
But generally speaking, if you have a good amount of lactobacillus, it’s associated with health states. When you don’t have lactobacillus, you tend to have more of what we call anaerobic bacteria. These are species that can cause irritating discharge, a nasty smell and tends to be associated with what we call bacterial vaginosis. It’s not always unhealthy. For some reason we don’t understand, some women do actually tolerate a bacterial vaginosis-type microbiome very well but generally speaking, in the population it is lactobacillus that we prefer.
We see that having lots of lactobacillus is associated with a lower risk of having a premature baby and of getting cervical cancer. Lots of different health outcomes are related to the microbiome and lots of exciting research is looking at the links between endometriosis and different gynecological cancers, such as ovarian cancer. It’s a really exciting area of research that’s going on at the moment.
Rachel Moss:
It sounds like it. There’s just so much in that area to learn about and it’s kind of mad that we don’t learn about it in school, the proper scientific words for these things, and yet we are bombarded by pseudo-science for what we should supposedly do to our vaginas and vulvas. Things like vaginal steaming and douching, and all those things. They’ve been debunked a lot but I wondered if you could go over firstly, why they’re not so great, and secondly, what should we be doing instead to ensure that we are keeping our vaginas and vulvas healthy?
Dr. Anita Mitra:
A lot of it does actually relate to the vaginal microbiome. For example, if you use feminine hygiene washes, douches and wipes, they actually wash away the lactobacillus. Although lactobacillus is meant to be in the vagina, it doesn’t cling on very strongly to the cells there. Whereas other bacteria, such as the anaerobes I mentioned earlier, are actually really good. They can build this scaffolding, called the biofilm, onto the vagina.
A lot of people tell me that they want to use washes because they feel quite irritated or like there’s a smell but it’s a vicious cycle. If there is any lactobacillus there that you really want to grow, it washes it away and then just more and more unhealthy bacteria will grow. That’s why it’s quite problematic and women are often quite reluctant to stop using these washes when I tell them to. But when they actually do, they say: “Wow, it did actually work”.
We’re always taught if something smells, we should wash it more, but that’s definitely not the case for the vagina. You really don’t need to wash inside your vagina and you only need to use water on the vulva. It won’t cause you any harm not to use soap. Some people actually find that just even a really mild soap can cause a lot of irritation because we’re washing away this healthy bacteria.
Rachel Moss:
That’s good to know. And cheap.
Dr. Anita Mitra:
Exactly.
Brogan Driscoll:
(laughs)
Dr. Anita Mitra:
London’s finest.
Rachel Moss:
Yeah, why not.
Dr. Anita Mitra:
That’s also why we don’t need to use things like eggs and all sorts of other weird and wonderful things that various celebrities may have told us to put into our vaginas. I’ve just seen this huge, wellness thing opening up when it comes to vaginas and some really scary things out there. A few months ago, I saw an advert for gummy bears that apparently change the taste of your vagina.
Rachel Moss:
I remember them.
Dr. Anita Mitra:
All of these products that are coming out, whether they are, washes or vitamins, or whatever...I’ve even seen sheet masks for vulvas...
Rachel Moss:
Yes.
Brogan Driscoll:
You got sent one.
Rachel Moss:
I got sent one.
Dr. Anita Mitra:
Yeah, please don’t use it.
Rachel Moss:
It was so strange, it went straight in the bin...
Dr. Anita Mitra:
Good. I think a lot of these products are fake female empowerment because they are basically using a woman as a consumer, making them feel self-conscious unnecessarily about their body and telling them that their vagina isn’t good enough, not clean enough, not healthy enough, if they’re not using all of these products. It’s quite scary and unfortunately, none of them are backed up by any science. Sure, you need a healthy pH in your vagina. And that’s what a lot of them will tell you on the packaging but using these products is not going to improve the pH. Leaving it alone, letting the good bacteria grow and do its thing, that’s what maintains a healthy pH.
Brogan Driscoll:
Well said. Talking about discharge, why is there such a taboo around it?
Dr. Anita Mitra:
It’s something people always see as kind of a dirty thing almost. There’s also a bit of confusion about what it is and why we have it. So hopefully, we’ve managed to clear a little bit of that up today. I think that a lot of people are concerned that they’ve done something wrong in terms of having too much sex or having sex with the wrong person or whatever. There’s often a lot of connection between the way that the female body works and sex. That’s because in text books, it’s often called the female sexual reproductive tract or the female sexual organs and always got the word sex or reproduction linked to it. Most of us aren’t really using our genitals for sex or reproduction all of the time.
Brogan Driscoll:
The first memory I have of discharge is when I was on holiday and there was this white thing in my pants. I asked my mum about it, she promptly told me that it was thrush and then went out and got me some medication for it, which is just bizarre. And she wasn’t particularly anti-sex education. She showed me a tampon when I was about five and really tried to make us aware...I don’t think she thought you’d get it that young. I must have been about 12. My sister got it a few years later and it was absolutely fine. So, who knows? Clearly, there needs to be more education around this.
Rachel Moss:
That was a submission we had from one of our listeners. She had a discharge for the first time and her mum didn’t exactly know how to tackle it. For any parents who are listening, how should they go about talking about discharge with their kids so that nobody is embarrassed or uncomfortable?
Dr. Anita Mitra:
When you become a parent, you’re suddenly expected to know all these things, aren’t you? And that’s one of the problems women don’t understand and that’s not their fault. If you’ve never been told something, if someone’s never taught you, then how do you know?
So that’s why, I think it’s really important to spread the word about discharge to women of all ages so that they can educate people in their family, their friends and everyone around them.
The main thing is just to emphasise that it is normal and often girls will start to see it before they start their periods. So, it can be a sign that they are entering puberty and that periods may be starting. It could be a good cue to start talking about periods as well, if that’s something that you haven’t addressed. Just to tell them that, is a reassuring sign but also let them know the things that might be concerning, if it’s itchy, irritating, if it smells or if there’s blood associated with it.
Rachel Moss:
That’s really interesting, it made me think when we just listened to that, I started my periods quite young. I spoke to my mum about it recently and asked: “Were you surprised because I was so young?” She said that she’d noticed and kind of expected it because of discharge in my knickers.
Rachel Moss:
Would that be the case?
Dr. Anita Mitra:
Yeah, absolutely. What’s happening is that you suddenly start producing much more estrogen and all the hormones that you need for a menstrual cycle. That’s why the body starts to produce discharge but you can’t really predict and say: “Right, so today you’ve had discharge, so in three months you’re going to have your first period”.
Rachel Moss:
Yeah. (laughs)
Dr. Anita Mitra:
It’s not quite that easy, but it’s definitely a sign that things are starting to happen.
Rachel Moss:
And when we’re going into menopause, does it then change again?
Dr. Anita Mitra:
Yeah, definitely. One of the symptoms that everybody associates with the menopause is vaginal dryness and there are many other symptoms associated. The reason you tend to get more vaginal dryness with the menopause is that you do produce less estrogen, and again, that’s one of the controllers of the amount of discharge that you’re producing. You’re also not going to be ovulating, so you’re not getting that egg white discharge so it just tends to be much dryer and irritating as well.
There are things that people can do about that as well. If you are going through the menopause, don’t feel that it’s something that you need to put up with. You can have vaginal lubricants, moisturisers, vaginal estrogen creams or even HRT. There’s lots of different options out there, so do discuss it with your GP and don’t feel it’s just one of those inevitable things that women have to put up with.
Brogan Driscoll:
We ask every guest on this podcast the same question, what makes you uncomfortable?
Dr. Anita Mitra:
I think willies. (laughs)
Brogan Driscoll:
(laughs)
Dr. Anita Mitra:
I know that sounds really bad because I’m a gynecologist and I look at vaginas all day and I basically spend my whole life trying to tell people that it’s okay to be comfortable with vaginas. It’s just what you’re used to, isn’t it? And I’m not used to seeing willies.
Rachel Moss:
What is it about them?
Dr. Anita Mitra:
It makes me feel uncomfortable. So, I do really empathise with people who find vaginas uncomfortable, because hands up, there’s things that make me feel uncomfortable too.
Rachel Moss:
Probably best you’re a gynecologist then. (laughs)
Dr. Anita Mitra:
You know what someone actually once asked me: “Why did you become a gynecologist?” And I said: “Well, aside from many sensible reasons, just because I don’t really want to work with willies”.
Rachel Moss:
Great.
Dr. Anita Mitra:
Each to their own.
Rachel Moss:
I know, I love.
Brogan Driscoll:
Oh, that’s so good.
Dr. Anita Mitra:
Does that sound bad? (laughs)
Brogan Driscoll:
(laughs)
Rachel Moss:
(laughs)
Brogan Driscoll:
Great, thank you so much for coming here to answer all of our uncomfortable vaginal questions.
Dr. Anita Mitra:
No, it’s a pleasure, any time. (laughs)
Brogan Driscoll:
I’m Brogan Driscoll, and you can find me @brogan_driscoll.
Rachel Moss:
And I’m Rachel Moss and you can find me @rachelmoss_.
Brogan Driscoll:
This podcast is produced by Crystal Genesis and our sound engineer is Nag Kirinde.
Rachel Moss:
You’ve just listened to Am I Making You Uncomfortable? And our # is AIMYU.
Dr. Anita Mitra:
Oh my gosh, I didn’t even get to tell you my favourite fact about myself, that my surname is the Greek word for uterus. (laughs)
Rachel Moss:
So good.