Vaginal Dryness
Vaginal dryness is probably the most common cause of painful sex, but it’s also the easiest to deal with. Vaginal dryness can be caused by the pill or antidepressants (both lower libido) or by inadequate arousal. To remedy the problem, indulge in more foreplay before the act (easy enough) and use a water based lubricant.

Vaginal Infection
If pain is severe or you feel itchy and irritated down there, it could be an infection (like of the yeast variety).  If you think you have an infection you should see a doctor. Over-the-counter medicine like Vagisil can help with itching or pain.

Vaginismus
Vaginismus is involuntary tightness of the vagina due to contractions of the pelvic floor muscles. If penetration is regularly painful enough to make it nearly impossible, it’s time to see a doctor. There’s no known cause or quick cure for vaginismus; according to Google Health, “treatment involves extensive therapy that combines education, counseling, and behavioral exercises. Such exercises include pelvic floor muscle contraction and relaxation (Kegel exercises).”

Uterine Problems
If the pain feels like it’s coming from deep in the pelvis, or if you feel like he is bumping into something in there, the pain is likely caused by the uterus. Uterus pain can be caused by fibroid growths, tilting of the uterus, or a prolapsed uterus. Again, you need to see a doctor if this pain is consistent and severe.

All in all, one instance of pain during sex probably isn’t anything you need to worry about, but if sex is consistently painful and adding foreplay and lubrication into your routine don’t help, you should be seeking medical advice. After all, sex should be pleasurable, not punishment (no matter what your Sunday school teacher taught you).

"Hm. That doesn't smell right..."

Got a health question? Don’t trust those “Doctors” at the University Health Center? Are you scared of Web M.D. because it always tells you you’re gonna die? Ask a real doctor, our friend Dr. Lissa Rankin. She’s here every Thursday to answer whatever you throw at her – like the ultimate cure for a hangover! – so ask away. Leave your question in the comments or send it over to us. Don’t be shy; she’s waiting for ya!

Q: After unprotected sex I noticed my urine becoming really smelly on a consistent basis, which is a new thing for me. There are no other symptoms-no burning or itching or anything, just the smelliness when I pee. Could this be an STD??

A: Usually, healthy urine has almost no odor (unless you’ve been feasting on asparagus or other foods or vitamins that are known offenders).  If you are dehydrated, your urine will be more concentrated and may have a stronger smell. Also, if bacteria have contaminated the normally sterile urinary system, which happens when you have a urinary tract infection, you may notice an odor.

Most of the time, when women approach me complaining of foul-smelling urine, they’re actually smelling their vagina. If you have a vaginal infection, such as bacterial vaginosis or trichomonas vaginalis, you may notice that your vaginal discharge, when it mixes with your urine, smells icky.

While it could be a sexually transmitted disease, such as trichomonas infection, which causes a vaginal infection characterized by a foul-smelling odor, most STD’s do not cause your urine to smell. Sex however, can trigger urinary tract infections, and infected urine may smell icky.

I would suggest a visit to the gynecologist. Make sure they check out your vagina, as well as your urine, to make sure there are no infections either place. And if you’ve had unprotected sex, go ahead and get tested for everything while you’re there. You can set a good example for your partner and feel more secure about next time.

–Dr. Lissa Rankin’s book, What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend, will be published by St. Martin’s Press in Fall 2010. She invites you to join her Pink online community (www.owningpink.com/forum) or read more of her writing at Owning Pink (www.owningpink.com).

Talking sex with your doctor isn’t always easy. Whether you are afraid she will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I know this sounds strange, but I think my boobs are weird. I’m way past puberty, but they look pretty much the same as they did when I was younger, only marginally bigger. The boob is cone shaped and my nipples are super light and don’t really look the same as what I see in movies/on my friends. Is there something wrong? Should all adult female breasts/nipples look the same?

A: All boobs and nipples are different. Every single one of us has boobs like snowflakes. Keep in mind that the boobs you see in movies and magazines are often the result of plastic surgery and airbrushing. If your boobs look different, you’re not alone.

I had a friend growing up who was super self-conscious about the shape of her breasts. She called the “Tube Boobs” and joked that she had to curl them up like a garden hose to put them into a bra. Inside her bra, they looked just like any other boob and no one was the wiser. There was nothing wrong with her, she just happened to be born different.

If your boobs are cone shaped, then celebrate. Woo hoo! You have cone shaped boobs! Madonna would be jealous. Honor your differences and learn to love your body just the way it is. There is nothing wrong with it and it’s those differences (yes, even nipples!) that make you uniquely beautiful.

–Dr. Lissa Rankin’s book, What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend, will be published by St. Martin’s Press in Fall 2010. She invites you to join her Pink online community (www.owningpink.com/forum) or read more of her writing at Owning Pink (www.owningpink.com).

My abs are tight. My legs are toned. But what about my lady parts?!

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: Everyone is always talking about Kegel exercises. Do those things really help? And do we really need to do them? I’ve had a boyfriend for 3 years (and we’ve been having regular sex for the entire time), so is it possible that I’m not as “toned” down there as I could be? Is that something I need to worry about?

A: Do the rest of you know what a Kegel exercise is?  It’s an exercise to strengthen the pelvic floor. To do Kegel exercises, contract and release the muscles surrounding the vaginal opening. If you’re not sure what I mean, run to the restroom, pee, and try to stop your urine mid-stream. Those are the muscles we’re talking about here.

How can Kegels help you? Let’s break it down into three ways- sexual enhancement, prevention, and treatment.  Because these muscles tone the vagina, they can be used to enhance intercourse. By contracting these muscles, you may offer additional pleasure for you and your lover, especially if you’ve had a few babies and things have become a bit loosely goosey down there.

What about prevention? As we age, our tissue gets weaker and our risk of pelvic prolapse and urinary incontinence increases.  What’s pelvic prolapse? Well, believe it or not, your uterus, bladder, vagina, and rectum can all sort of fall out. I’ve seen uteruses hanging between people’s legs and herniations of the bladder and rectum into the vagina. This looseness in the vagina can lead to incontinence, pelvic pressure, difficulty with urinating and having bowel movements, and a whole host of other unpleasant symptoms. Kegel exercises help prevent pelvic prolapse and incontinence.  By toning these muscles, you help keep things tucked up inside, where they belong.

Kegels help to treat these same conditions. If you’re suffering from pelvic prolapse or incontinence, doing Kegel exercises may be so effective that you can avoid painful surgeries. Although it may not be effective enough, we always start by recommending Kegels. They’re cheap, safe, and easy to do at home. Reminds me of a time I walked into labor and delivery and the nurses were all sitting around a table silently. I couldn’t figure out what they were doing. Were they having a séance? Meditating? Finally, one of them, seeing my confused gaze, said, “We’re doing Kegels!” So yes, you can do them anywhere.

Do you need to do them? Not necessarily. If you’re young, healthy, and have a happy sex life, there’s no need to add yet another thing to your busy To Do list.  But it can’t hurt. If you think of it- sitting in class, in traffic or out to dinner – why not contract and relax those muscles a few times? Use it or lose it, they say. And trust me, these are definitely muscles you don’t want to lose.

–Dr. Lissa Rankin’s book, What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend, will be published by St. Martin’s Press in Fall 2010. She invites you to join her Pink online community (www.owningpink.com/forum) or read more of her writing at Owning Pink (www.owningpink.com).

"Hm. Maybe this job is better suited for a lady?"

[It's pretty obvious that the average CollegeCandy reader has some very strong opinions. Opinions that she likes to share with everyone on the site. We love a strong woman, so we thought we'd give her a real forum to discuss her thoughts, feelings, and perspectives. Every Friday I'll be featuring a hot topic (like the first-semester boyfriend!) and leaving it up to you, the readers, to duke it out. So, read it and get your debate on in the comments section below!]

Ok, let’s be honest, no one likes going to the doctor. Throw in a paper gown, putting your legs in stirrups and a “spreader” and it’s no surprise that a lot of us avoid going to the gynecologist like a plague of genital warts. But the truth is that there’s no way to really be in charge of your sexual life unless you bother to stay sexually healthy, and the lady-parts doctor is a necessary part of that.

While we try to give you hand with some of those problems here at College Candy, one of the biggest obstacles between “tear-my-hair-out terrifying” and “not my favorite thing, but bearable” is finding a down-there doctor you like, trust and feel comfortable around – and not surprisingly, a big factor for a lot of ladies is their doc’s gender.

It’s natural that a lot of girls are more comfy having another woman looking at their most private areas than they are having to spread their legs in front of a man. And aside from just the physical exam, there’s also the fact that you need to be comfortable talking about all of your most intimate problems and habits with your gyno, and there are some things that are just easier to say to someone who doesn’t remind you of your dad. Also, no matter how many years of school a man goes through, there’s nothing that can really teach someone what it’s like to  have a hoo-ha except having one; a female doctor definitely has a better chance of having experienced your issues herself, and potentially giving you some first hand insight.

There might be some problems with going to a female gyno, though. To start with, female gynecologists make up only one third of the current American College of Obstetricians and Gynecologists membership (though the number is on the rise). Depending on where you live, getting a female doc might mean traveling quite a distance for your appointments, which will only make you less likely to go. Also, the number of female down-there doctors has been steadily rising over the last twenty years, but many of the docs who have been practicing longest (and thus are the most experienced) are men.

And there’s nothing wrong with going to a male doctor. One of the biggest things that women mention when they worry about male gynos is the fact that there is at least an assumed attraction to women, and thus the lady-parts they’re looking at.  But regardless of sexual proclivities, just like any other doc, male gynos are trained to look at our junk as just parts, not as sexy things. And the truth is, no one is going to go through all of the time and expense of becoming a legit gyno just so he can scope out some girl-parts; there are easier ways. (Editor’s Note: like buying me shots at the bar…)

At the end of the day, the only wrong choice you can make about a gynecologist is not to go to one at all. So don’t let the fear of being a little uncomfortable put you – and everyone you sleep with - at risk. To find a gynecologist in your area (male or female) check out the ACOG physician directoryonline or talk to your lady pals and see who they would recommend. It’s really not as bad as you think.

What do you say girls: would you prefer to go to a gyno who has all the same parts as you, or would you rather go to a guy? Do you think that your doc’s gender matters at all? Let us know down below! (Tee hee – down below.)

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: This is a really gross question, but I have to ask someone.

I discharge…a lot. And it’s not just around the time of my period. It’s random and plentiful. Ew. Anyways, I don’t know what to do about it or if it’s caused by something serious? Help. I’m afraid to be with a boy because he’ll be super grossed out.

A: This isn’t gross, sweetie. It’s your body, and discharge is a normal part of being a woman. But I wish I had more information. Is your discharge white, clear, or greenish? Does it have an odor- like fish or fresh bread- or is it odorless? Do you have any vaginal itching or burning? Is it there all the time, or just in the second half of your cycle? Have you been checked for sexually transmitted diseases (STD’s) like gonorrhea and chlamydia?

Without knowing those answers, it’s hard for me to comment on your specific situation. If you haven’t seen a doctor about this issue, it’s time. Go in, let your gyno take a gander, and make sure you’re not missing something. Sometimes, an increase in vaginal discharge is the only sign we have that something’s going on down there.

But I’m going to assume that you’ve seen a doctor and that you don’t have a vaginal infection, STD, or abnormal pap smear.  If we’ve ruled those out, we’re left with the fact that every woman makes some vaginal discharge, and every woman is different. The amount of discharge your body makes depends on your own glands, your hormones, your anatomy, medications you might be taking such as birth control pills, and where you are in your cycle.

It’s common for your body to make more discharge at certain times of the cycle, as the menstrual cycle is under hormonal control, and those hormones can affect production of secretions. It’s also normal to make more discharge when you’re turned on – thus the wetness you feel when you’re sexually excited.  If you’re taking birth control pills, you may notice more discharge from the estrogen in the pill. Also, if your cervix happens to have the glands on the outside of the cervix instead of the inside (a normal variant we call ectropion), you may make more discharge.

If your doctor has told you you’re normal, there’s no need to worry. Trust me, guys will be so honored to be down there that they won’t be turned off by your discharge. In fact, some guys find a wet vagina to be even more stimulating. Some women have very dry vaginas and would die to have your problem.  It’s all part of accepting our bodies just as they are and  loving ourselves, secretions and all.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: My period is irregular every month. Sometimes it comes 6 weeks apart and other times it can be up to 9.  I am not on birth control (can’t handle the side effects) and practice safe sex with my boyfriend. The problem is that I get freaked out every month that I’m pregnant. How soon can I take the test? Are there any signs I can look for that will either tell me I’m absolutely not pregnant or that maybe I am?

A: Sounds like your periods are annoying, unpredictable and scary. Bummer about that.  Chances are, if your periods are that irregular, that you’re not ovulating regularly, but that doesn’t mean you don’t have to worry about pregnancy. Your ovaries can still spit out an egg from time to time. When you’re not ovulating regularly, your uterus doesn’t know when to bleed, and your hormones can be all over the place.  Why might you be skipping periods or not ovulating?

Common Reasons for Irregular, Infrequent Periods:

- You exercise vigorously (think marathon runners and competitive gymnasts)
- You have an eating disorder.
- You’re overweight.
- You’re young and your body just hasn’t matured yet.
- You’re under a lot of stress.
- Your thyroid hormones are out of whack.
- You have polycystic ovarian syndrome (PCOS).

What can you do about irregular, infrequent periods?

See your gynecologist. A thorough physical exam and laboratory evaluation are in order. If you can’t take birth control pills, progesterone therapy may help balance out your hormones, assuming there isn’t some other underlying cause.

In the mean time, what can you do about the pregnancy scares? That’s tricky. There’s no reliable sign to signal to you whether you’re definitely pregnant. Some people experience nausea, breast-tenderness, and fatigue in early pregnancy, but many women do not. Technically, a pregnancy test should be positive within two weeks of ovulation, but since you have no clue when or if you’re ovulating, that makes it tough to time taking pregnancy tests. You can try taking a pregnancy test four weeks after the first day of your last period, when you would expect your period to come if it was regular. If that’s negative, repeat it every two weeks after that until your next period comes.

But that’s just a band-aid. You’re better off getting to the root of the problem and seeing a doctor.  Good luck, honey. I hope you get it sorted out.

Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I am not in a serious relationship, so I don’t have sex very often. When I do, though, it always hurts. Sometimes even more than the first time. Why is that? Is there something I can do so it doesn’t hurt anymore?

A: Oh, sweetie, I’m sorry! Sex is supposed to be fun, right? Isn’t sex always easy, painless, and orgasmic in the movies? Maybe so, but what you’re experiencing is not uncommon in real life.  In fact, I suffered from the same problem myself back when I was in my twenties.  Have you seen a gynecologist about this issue? There are a number of reasons you may be experiencing pain, and your doctor might be able to help you.

Painful sex (we docs call is dyspareunia) is normal when you first have sex. Because your hymen may still be intact when you lose your virginity, sex often hurts in the beginning. But after a while, the pain should lessen and then resolve. If it doesn’t, a variety of conditions can be responsible, including vulvar vestibulitis (inflammation of the vestibule), vaginismus (involuntary contraction of the vaginal muscles), allergic reactions to things such as latex condoms, and endometriosis (when lining from the uterus gets on the ovaries, bowel & pelvic lining).  As women age, they also have lower levels of estrogen, which can make the vagina thinner, leading to atrophic vaginitis.  Many of these conditions can be treated, but it’s important to know the reason for your pain.  If you find yourself having sex regularly and are still having pain, be sure to tell your gynecologist. There may be a simple solution.

Feeling safe in a relationship is also an important part of making sure sex feels good.  Those who have had traumatic experiences with sex in the past, such as being the victim of a rape or child molestation, often experience pain with intercourse. As women, our bodies can be amazingly powerful at manifesting physical signals in response to psychological issues.  If any of these issues might play a role in the pain you feel, please see a therapist who can help you work through what you’ve experienced.

In the meantime, make sure that before you have intercourse, you are adequately aroused. If your partner isn’t already doing so, encourage your partner to assist you with a little foreplay.  If that’s not enough, try a personal lubricant like Astroglide. Sometimes, lubing up can decrease the friction against the vaginal wall, making things glide more easily and causing less discomfort. Also, certain positions may be more comfortable than others, so experiment with what feels better and listen to your body.

Most importantly, be honest with your partner about your experience. Don’t pretend you’re having fun when you’re not. You don’t want to train your body to endure pain when it’s supposed to be experiencing loving connection and sexual pleasure.  Doing so can train your body to shut down, which can damage your ability to be properly aroused in the future. Get help, be honest, and know that this won’t last forever.

In case it gives you hope, I’ll tell you that my story ended happily. After years of painful intercourse, the pain (caused by vulvar vestibulitis in my case) disappeared over time.  I think part of it was learning to live comfortably within my skin, part was finding the right relationship, and part was giving my body the opportunity to be heard. Perhaps, when you find yourself in a loving committed relationship having sex more regularly, this problem will melt away and you’ll be on your way to sexual bliss. Let’s hope so!

Let’s hope so!

Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I’ve been on the pill (normal combination pill) for 3 years. I am very happy with it. I never miss a pill, but I take it at very different times during the morning. Does this decrease the effectiveness?

A: It’s always better if you can take your pill as close to the same time as possible, but if you normally take it at 8am and the next day, it’s not until 11am, that shouldn’t make much difference. The one exception is very low dose pills like Yaz and Mircette (pills with 20 micrograms of estrogen). In this case, it’s more important to try to remember to take your pill at the same time.

Q: I was also wondering, is it possible to use the pill with the Mirena IUD? Would you recommend it?

I hear you, sister. I’m assuming you DO NOT want to get pregnant! While I appreciate the sentiment, I would not recommend using a Mirena IUD with a birth control pill. Both contain hormones that act differently. And since both the Mirena IUD and oral contraceptives are highly effective, I don’t see the reason to assume the risks of both. If you’re particularly worried about pregnancy and want to use double protection, consider condoms plus the Pill or condoms plus an IUD. But adding two hormonal methods together can really mess up your system.  

Q: And finally, when I’m having sex with my boyfriend we sometimes start without condoms and then later he’ll pull out and put a condom on and continue. How effective is this in preventing pregnancy when used in combination with the pill? We’re in a monogamous relationship & have been tested, so I’m not worrying about STDs.

A: If you’re religious about taking the pill, and you’re using the withdrawal method and you’re sort of using condoms, chances are good that you will be protected from pregnancy. But mostly, that’s because of the Pill, which in and of itself is highly effective. In general, withdrawing before ejaculation is not an effective method of birth control because sperm are present in the pre-ejaculate released before orgasm.  So if you want to do everything possible to protect yourself, put the condom on before you start fooling around and leave it on until you’re done and can safely remove it.

It’s all about assessing your own personal risk tolerance. No birth control is 100%, which means that sex can always result in pregnancy. That said, it sounds like you’re being very conscientious to try to avoid an unwanted pregnancy, and I commend you for that.

Is your partner opposed to wearing a condom during sex? My gut tells me that maybe you would be feel a bit more comfortable if he did. If so, maybe it’s worth having a chat with him about this. Remember, it’s your body, and if anybody gets pregnant, it will be you. Listen to your heart, and honor your body.

Get to know more about Dr. Lissa on her website, www.owningpink.com

Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

After so many of you wrote in to ask Dr. Lissa Rankin questions during CollegeCandy’s STD Awareness Day, we thought we’d bring her back more regularly. So, every Thursday she will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I am on the birth control pill and I want to stop using condoms with my boyfriend. I know he is clean, so I am not worried about STDs, but I am worried about pregnancy. Is the birth control pill enough to keep me from getting pregnant? Am I safe without condoms? I’m sorta freaking out, so any answers you can give me would be greatly appreciated.

A: Well, you know what they say- the only perfect birth control is abstinence (with one famous exception- and even that is highly contested!).  But the birth control pill, when taken daily – without fail – is extremely effective. Are you the type that forgets your pill from time to time?  Lower dose pills (ones that have 20 micrograms of estrogen, like Yaz or Lo-Estrin 1/20) are pickier pills, meaning that it’s more important that you take them at the same time every day.  But if you’re good about taking your pill every day, around the same time, you’re pretty darn close to protected (>99%).

If you’re not one of those “perfect users” of the Pill, you might want to consider something like Nuvaring, which is a vaginal ring you only have to think about once a month.  Or the Mirena IUD, which lasts for 5 years and is more effective than tying your tubes.

I’m guessing that, since you’re so freaked out about pregnancy, you’re going to be very responsible about birth control, and I’m high-fiving your right now for that. You go girl!  But if using condoms with your pills eases your anxiety, why not keep doing it?  If your boyfriend doesn’t mind and it gives you both peace of mind, there’s something to be said for being careful.

But if you’re taking your pills religiously and you’re willing to take the <1% risk of pregnancy, let your freak flag fly, girlfriend!