So, welcome guys. Welcome to My Vagina Hurts! It's a live stream with me, Reba the Diva. I'm a D.C. based sex consultant. I host a bunch of workshops that are pleasure positive for adults about how to have more pleasure in your sex life and today, I'm here with Doctor... I'm sorry, nurse practitioner, Jenna Perkins, and we are here at the George Washington Urology Clinic and we're talking about painful sex, okay? So, if you have a vagina, you wanna tune in and if you love people with vaginas that may be having painful sex, you definitely want to keep tuning in because we are gonna be talking all about reasons for painful sex, what might be causing your painful sex and things you can do about it. So if you're watching this for your partner, you can learn things you can do to help your partner and if you're watching this for yourself, please stay tuned. We're gonna try to record this so if you miss it, definitely shoot me an email or go to my website, which is sexpertconsultants.com or if that's hard, rebathediva.com/events which is where you can get to the same website, okay?
Should I introduce myself?
Okay, hi good people. So my name is Jenna Perkins, I'm formerly Jenna Lewis so that gets people get caught up a little bit. I'm making a transition to the new name. So I'm a women's health nurse practitioner in D.C., working out of G.W. I specialize in urology but my passion is really female sexual function and disfunction so I really enjoy working with women or anyone with a vagina or with a vulva and really promoting positive sexual experiences and if you have painful intercourse, I'd really love to help coach people to get over the pain and offer medical ways that are available for women to kind of get over the pain, so yeah.
I'm excited to be here.
Yeah, so let's jump right in. So I'm gonna ask you a couple questions. Let's start with how common is painful sex?
So painful sex is extremely common. The statistics are varying but some statistics say that one in four women will experience painful intercourse at some point in their life. That doesn't mean that it's gonna be a chronic problem for these women but one in four women will at some point have a sexual experience that is painful, so.
Wow, that's a lot of women.
It's a lot of women.
That's like, if there were two more people in this room--
It would be--
That's one of us is having--
Painful sex, wow.
And some of the limitations to the research is that we're not studying every woman so we don't really know if these women that are being studied are coming forward more because they have positive sexual experiences and so they're more open to talking about being sexually active or if a woman has had painful intercourse in the past, is she gonna be less apt to respond to these sorts of surveys or be a participant in this research. I mean, just from my own personal experience, I think that it's more common than we know.
Oh yeah, I definitely think so too but we don't talk about these things, so, you know, there is no... You know, it's not normalized, it's definitely stigmatized and if you're talking about painful sex, then it must be something that you're doing wrong or something that your partner's doing wrong and there's a lot of shame already involved in sex, in the way we approach it. So I think it's really important for us to, like, talk about these things and normalize talking about these things.
And I think that it's like, very prevalent in the media, that you see a lot of women who have non-satisfying sexual experiences or who are turning over or on the TV show because they have a 'migraine' or are not having comfortable intercourse but the media doesn't do a good job of exploring that more. It's, you know, what is displayed is that women don't necessarily enjoy intercourse. Not that women can have painful intercourse and that makes you not enjoy it as much. So I think that we see it a lot but we don't really, we don't dig into it. We just kind of see surface level.
That's so true. That's so true. And I think it's because there's a need for us to want to talk about it but we're all afraid. Like, if I'm saying something that you may feel is abnormal, then I'm not normal and there's something wrong and nobody wants anything to be wrong because then I have to go see a doctor and it's scary.
And then after you find a provider, like after you find a doctor or a nurse practitioner, if they're not familiar with it, then it becomes, like, "Oh well, if the expert doesn't know, "then something is wrong with me. "You know, something is really wrong with me, "this is not normal." And some of the research says that about 40% of women who have chronic painful intercourse or a diagnosis of what we call vulvodynia, so pain in the vulva. They can see three providers, so 40% of these women after seeing three providers, still don't have a diagnosis.
So even when you advocate for yourself and you say, "Hey, this is what's going on with me. "It hurts when I have intercourse. "I'm not enjoying sex anymore," you still don't get the help that you need.
Yeah, and that's hard because it takes a lot of bravery to say, "Okay look, I'm having painful sex "and I want to talk about it," and then to not get the care that you need the first time, it's kind of like, "I don't wanna do it again."
It's very deflating, yeah. Or if your provider says, "Oh, drink some wine." or, "Maybe you just aren't into your partner," or whatever the case may be. It's not always received well, where we do get that confidence to go and talk to our providers and so, that just continues the spiral. But I think things are starting to change. More providers are becoming educated about it and if the providers are educated, then we can educate our patients and you can educate your friends and your family and it just kind of snowballs from there. So I'm excited that research is, you know, becoming a big thing as far as women's sexual health. I think that a lot of providers are starting to do research and pay attention to the research and that's gonna really impact care.
So I'm excited.
So, let's talk about, let's get to the nitty-gritty. Let's talk about the reasons for painful sex. I know that we talked a little bit last time about vaginal dryness, right. And so let's talk about that. What could be some causes for vaginal dryness?
Yeah, one of the big causes is hormonal shifts so that can be natural or unnatural.
Okay, so natural like menopause?
Yeah, menopause. Menopause is a big one, probably the biggest one. It's something that a lot of women come to expect with menopause and so it's just one of those things that a lot of women don't seek care for. It's like, "Oh yeah, I'm going through the change "and so I'm gonna have some dryness." That's normal but nothing is normal if you don't feel good about it.
That's true, that's true. Say that again! Nothing is normal if you don't feel good about it, okay.
If you're not comfortable with it, then talk to your provider. Ask them, dryness, vaginal dryness is probably one of the easiest things to treat in menopause. We can use some very simple methods to get you more comfortable, so don't just sit on it and say, "Okay, well I'm going through the change, "this is what I can expect."
That's so true, yeah. "It's gotta be this way because this is part of getting old "and getting old means I'm not allowed to have pleasure."
Don't deny yourself, honey.
Old people have tons and tons of sex and so it's our job to make sure that it's pleasurable sex, that it's enjoyable sex.
True. Very true.
Yeah, so menopause is one of the natural cause. Breast feeding is another big natural cause, so--
So, we're talking about vaginal dryness, right?
Now how does breastfeeding cause vaginal dryness? How does that work?
When you're breastfeeding, you don't have a period, so the easiest way to explain it is that you have a hormone shift that kind of mimics menopause.
So you can be menopausal with a brand new baby. So you're not having those shifts in your hormones that provide the lubrication that you really need to keep being wet and moist and going. So breastfeeding can be a very trying time for a couple.
Yeah, well, because speaking from my other experience, you know, breastfeeding is... Especially when your baby is hungry, honey, and you're already like, I was, yeah... No, breastfeeding is hard. And then, you know, not being able to have good sex, like, that's even harder. You're breaking all hell, what do I do to relax? What do I do?
Yeah, lots of things.
Well, we'll talk about that. Stay tuned, we'll talk about that. Okay, so we're talking about vaginal dryness. We said, menopause, hormonal shifts. So things like menopause, breastfeeding. What else causes hormonal shifts?
Being on birth control is a big one for young women.
So birth control.
Yeah, the pill. So not necessarily the local forms of birth control. So the condoms and like, even the IUD's, even if it is hormonal, it doesn't cause the same hormonal shifts that a systemic treatment would. So the pills, the shots, the implants. Those all give you a little bit of hormone and it basically tricks your brain into thinking that you have a surplus and so our bodies do this great thing of negative feedback and so we think that we have a surplus, then we're gonna create something to get rid of that surplus, right?
But we really don't have a surplus of these hormones, then you functionally have less than you need.
Oh, I see.
The dryness issue, so yeah.
So that's one of the unnatural hormone shifts, so that's something that we don't necessarily know to expect so it can be really surprising when you're 18 years old with vaginal dryness.
Yeah, so if you're on birth control, it's very possible that you could be having like, dry, experiencing a dry vagina?
Yeah, very possible. Very possible. Extremely possible. And that can mean that you're more prone to things like urinary tract infection.
Oh wow, okay and that brings us to another, I think, you know, reason for pain during sex and that is sexual infection.
And it doesn't have to be a STI, it could be a urinary tract infection.
It could be something as simple as--
Yeah, so if you have any sort of vulvar irritation, so the vulva is the outside of the vagina. The vulva is really the most important part of the female genitalia, in my book. It's probably not the most important part. I think everything is important but it's oftentimes ignored and so I don't think, the importance of it isn't recognized as it needs to be. So if the skin is irritated for any reason, an infection, whatever, an allergic reaction to something like Monistat, treating an infection, then you are definitely gonna have more risk for pain.
That makes so much sense.
My advice to women is if you're self-treating for yeast infections and you're doing it a lot, then one, it might not be a yeast infection and two, you might be kind of harming yourself by using a lot of these creams that you might be sensitive to, so I would try, anything you're gonna try on the vulva, you wanna try elsewhere on the skin first.
Just to make sure that you're not gonna have an allergic reaction to it.
True, okay. That's good advice.
So we talked about vaginal dryness and we said causes of vaginal dryness are menopause, breastfeeding, birth control. Any other causes for vaginal dryness?
Not being in the mood. So, if you're not that excited, then you're not self-lubricating and then it's gonna take a lot more, it's gonna be a lot more friction when the penis is trying to enter you, if you don't have that natural lubrication. So, just making sure that you're getting as much foreplay into it as possible. Foreplay is--
Definitely. Okay, so... So we're done with vaginal dryness, right? We've talked about--
Well, sometimes, and there can be other reasons to have vaginal dryness, so just, if you don't fall in these categories, don't feel like, "Whoa, what's wrong?" There can be other reasons so make sure you talk to your provider.
Yeah but if you're experiencing, you know, a dry vagina--
And vulva, then you definitely, on a regular basis, I think you should definitely see your healthcare practitioner. And that's your OB-GYN, right?
Your OB-GYN, your women's health nurse practitioner, that's what my position is, a urologist, if you have a urologist, a primary care physician, if you trust them, primary care docs are great, or primary care providers are great at plugging you in to resources. So even if they themselves can't necessarily help you out, they might know someone who specializes in this, who can help you out.
Interesting. Okay, so don't be afraid to share with my practitioner, especially if I trust them because they could, even if they're not the right person, they could definitely tell me who to go to.
Exactly. If you have someone that says to you, you know, "I don't know what to do," then it's not a reflection of their education, necessarily, because a lot, most providers have no idea about this. So, don't necessarily blame them because a lot of us just don't know but definitely continue to seek out those resources, Don't give up the fight.
Yeah, I think that's really good advice.
So tell me a little bit about muscle tension. Because I know that's one of the big reasons.
Yeah, so muscle tension in the pelvic floor is something called pelvic floor disfunction, it used to be referred to in the latter years as vaginismus and so you might hear that a lot. What it is, is basically the muscles that control the bladder, the muscles that control the bowel movements, those vaginal muscles that are your seat muscles, your core, right?
Like, how I'm sitting.
Exactly, it does everything from sitting to standing to balance, you know, your pelvic floor is really your core. So if those muscles are too tight or too lax then you're gonna have some form of disfunction with any of the organs that are controlled by it.
So I can be too tight, my pelvic floor can be too tight?
What causes that?
A lot of things, so if you have any of the reasons that cause vaginal dryness, that causes irritation externally, and so your muscles can do a response of tensing up and if you have chronic pain externally, then your muscles are gonna chronically stay tight and then they can be unable to relax sometimes. That can happen, so.
Yeah, you know, this is a good time to kind of talk about trauma, right?
And, what's trauma?
So trauma is just anything that causes discomfort and has the potential to cause long term lasting effects, right? So you can have trauma that is chronic and ongoing or you can have one traumatic experience that leads to chronic, ongoing issues. So trauma can be emotional, it can mental or it can be physical.
So, how does our body respond to trauma? Like, is there... If I've experienced trauma before and I'm not experiencing trauma anymore, why would my... I feel like sometimes my body responds in the same way. Why would that be?
That's textbook PTSD.
It's post-traumatic stress disorder. So your body has memory, your muscles have memory. Muscle memory is a real thing, and so if your body is conditioned to bike riding and having pain, when you go to bike ride, your muscles are gonna say, "Oh, no, no, no, "I don't like this activity, "I'm gonna go ahead and tense up."
Yeah, I don't like this, let's not, so, yeah. Because it's learned.
Because you've been doing that for so long.
So if I've been experiencing pain for a really long time, right, and then I'm not experiencing anymore because I went to see the practitioner and they told me, "Okay, this is what is going on," it's still possible for me to still experience pain because my body is having a traumatic response.
Your muscles are not able to relax. And when you think about sex, you really need these pelvic floor muscles to be able to be relaxed, so that they can accommodate a foreign object, right, so a penis or a thing or a toy, you need to have the space for that and if those muscles are just doing this, right, it's not gonna let anything in.
And if it does, then it's gonna be painful or uncomfortable.
Yeah. So pelvic floor disfunction goes hand in hand with other cause of painful intercourse. So, just because you treat the dryness, doesn't necessarily mean that your pain is gonna go away, right. So you sometimes will need to learn some exercises and some stretches to relax those muscles that have a condition to stay tight for so long.
Now let's talk about the opposite of feeling too much muscle tension. You mentioned that it's possible for the pelvic floor to be too loose. Now, is what... Too lax. What causes that?
So there are some genetic disorders that cause connective tissue to be very relaxed and so then it sets you up to have muscles that don't function properly. It can also be atrophy of the muscles. So if you're not necessarily exercising the muscles or exercising at all, then your pelvic floor muscles can become relaxed--
And become weak too.
And so then you can't use them and...
It's a very interesting thing because my patients that have the super tight pelvic floor muscles are also weak. So you can be weak and have tight muscles.
And still have tight muscles, yeah.
You can still be very weak because muscle function needs both the relaxation and also the contraction.
So, you know, if I'm trying to curl a dumbbell, first I have to relax my muscle and then when my brain is ready, I squeeze. If my muscle is stuck like this, then I'm doing this motion, right.
And that's not gonna make me stronger.
You're very weak, right?
I'm still weak.
You're still very weak. Versus doing this big motion, where you can use the entire length of the muscle fiber to contract.
Yeah, that makes sense.
So you can have things like incontinence, where the muscles that control the bladder, so the pelvic floor muscles are too tight, so when you go to cough, sneeze, you know, they can't squeeze any tighter, so then you leak.
Oh, because the muscles are still weak.
Or the muscles are so lax that you can't squeeze, so then you leak.
So is it true that you can get a leak in pelvic floor from having too many partners?
Because... I have a teenage son and I overheard them talking and he was saying--
Blow the walls out--
Well, he was saying that he, he was talking about an experience that he had and he was saying that it felt like it was very loose, and he was like, "She must be having sex "with a lot of different people "because it feels very loose." And I was trying to explain to him that it doesn't matter how many people you have sex with, that doesn't, that has... Like absolutely nothing to do with how--
Loose you are.
Like, tight or loose you are.
Did you hear that? Okay? Did you hear me, because that's real. People think that all the time. They think that, "Oh my God, "if I have too much sex, "my vagina is gonna be loose." And that's a man--
I mean, and then you hear people talk about loose women, too, right? I mean, that probably has something to do with it and it is absolutely 100% not true. I cannot do an exam on a woman and say, like, "Oh, you are this big, "so I know you've been with--"
"Because you've been with 25 partners, "now you are large! "You are very loose!"
Your pelvic floor muscles provide the, kind of, structure and so everyone is gonna have different musculature. And that has no bearing on how many penises have been inside of her.
No. No bearing on it at all, whatsoever.
If a vagina can, you know, if a nine pound baby can occupy this space--
And you know, a lot of women do have trauma after delivery but a lot of women do not. So then a penis that's, on average, 6 inches is not gonna do a whole lot.
I had a friend tell me that, she just had twins. Congratulations girl, you know who you are. And she was saying that she feels tighter than she was before she had twins. I was, like, wait. I was trying to explain to her before this, you know, women who are about to have babies are always like, "I don't want to stretch out my vagina," and I try to explain to them, like your vagina can stretch, it's like a rubber band, it's not like, you know, gonna pop or anything.
So you can definitely have some post-birth trauma and some things that can happen but those things can happen if you 0 babies or 10 babies.
That's so true.
I've heard women electing to have C-section because they wanna avoid the pelvic floor disorder and then you can have a C-section and still happen to have a--
A pelvic floor disorder.
Because a lot of it has to do with genes and genetics and so you can't really fight that, so yeah.
No, you can't. Interesting. Since people try to fight it all the time, so...
I don't want any women out there who feel like they are a little bit more relaxed or, you know, looser to be ashamed of the number of partners that you've have--
And you're like, "Well, I shouldn't have this "because I've only had one partner or I've had no partners, "and I feel, you know, very relaxed or loose."
That does not matter.
It doesn't, it really doesn't. And I think a lot of that is done to shame us and to, like, make us feel bad about our bodies. If you think about it, you don't do that to people with penises.
So let's not allow that, kind of, like, patriarchal attitude to govern the way that we treat each other and ourselves.
And we really need to take ownership over understanding our own bodies so we can combat these notions.
That's true. So if you understand that, then it's gonna be a silly idea to you so you're not gonna perpetuate that.
So we have to educate our girls and boys and we have to educate grown men and women about the way their bodies function.
That is exactly why I started doing this work, because I realized so many grown people have no idea about how their own bodies work and I mean, not to, don't feel ashamed. I mean, we just don't know, we're not taught in sex ed class, like, how our bodies work, what our vulvas are supposed to look like and feel like, what our vaginas are supposed to look like and feel like, we're not taught any of these things and so, we're supposed to just magically know them once we become of age and we just don't. And it's crazy that anybody would, like, think that that's acceptable, you know what I mean? But anyway, that's why I do what I do.
That's why we do what we do.
And it goes into, again, if you have questions about your body and you go to your healthcare provider and you're like, "Okay, I wanna get to know myself, "I wanna do this exam, I wanna, you know, "get in touch with my womanhood." You do the exam and it's a provider at the end of the table, you've got sheet over you, you know, they don't even look at your face. You don't know what's going on under the sheet. They're like, "Okay, done," you know. Do I look okay?
What's going on? Please tell me.
What did you just do?
What happened? So I really make an effort to try to do an exam with my patients.
So every patient is offered a mirror, so if you wanna see exactly what I'm doing, then you can do that and I'll make sure that I point out all of the anatomy. I'll show you where your vulva is, what your, you know, vestibule is, what the vagina is. We can go through all of that and I think that's just the most empowering experience, like it's really my favorite part of my job is doing those exams.
I really, really love it.
Interesting. So, we've talked a lot about what causes vaginal pain during sex, or vulvar pain during sex and so, let's kind of, take it back and talk about, we've talked about the reasons for these causes and pain. So let's take it back and talk about solutions but before I do that, let's take a pause for the cause and say hey, if you're tuned in on O.school, welcome. Please ask any questions that you may have for Nurse Jenna or I, or you can ask any questions over here on Instagram, hey guys! If you have any questions for us, we will definitely field them live while we're talking, we're gonna be here until 07:00pm today, so stay tuned, and so let's... Oh! Also, if you're on O.school and you like what you hear, leave a tip. We appreciate it, okay. Okay, so, let's bring it back. We talked about vaginal dryness, we talked about reasons for vaginal dryness and so let's talk about solutions for vaginal dryness.
How do we solve vaginal dryness? Regardless of whether it's of like, whoa, if it's caused by menopause, like, what will you do?
Yeah, so you can do hormone replacement, so the reason that you have a lot of dryness in menopause is the estrogen that your tissues are used to getting and the testosterone that your tissues are used to getting, to promote blood flow or elasticity is not there because you're not making those hormones anymore.
Wait a minute, so testosterone is what's responsible for elasticity and lubrication down there?
Part of it, yeah.
A major part of it, yeah. And a lot of women are like, "I don't have testosterone, "what are you talking about?"
Well, if you don't have testosterone, you probably have a dry vagina, so there's that.
Testosterone is your friend. Testosterone and estrogen, they go hand in hand as far as, like, vaginal, vulvar function. Yeah, so we can fix that. So we can give you exogenous or external estrogen and testosterone. And so that's a really simple way and a very common way to fix the issue at hand in menopause.
Now does that, like, is that medicine, like widely available, like is that like a normal thing?
Yeah, so there are lots of vaginal estrogens that are FDA approved on the market and you can get with prescriptions. Testosterone, there are none that are FDA approved for the treatment of women with sexual disfunction for testosterone but you can get testosterone compounded, so made at a specialty pharmacy and that's something that I provide a ton of prescriptions for. I prescribe it every single day, all day long. But the estrogens are super common, you can go to any OB-GYN and tell them you have vaginal dryness and most of them will be willing to give you your prescription for vaginal estrogen. Even breast cancer survivors.
Because we're giving you a very, very low dose.
So that's what we can do if we have menopause and that's leading to vaginal dryness. What if we're on birth control, or what if we're breastfeeding?
So for breastfeeding, it's a little bit more difficult because we are always weary of doing anything with a woman who is either pregnant or breastfeeding and so we don't recommend that you use medications while you're breastfeeding. Some women will use a vaginal estrogen cream while they're breastfeeding to help with their dryness but that's a choice that you have to make with your provider, so that's something that you would definitely talk to your OB-GYN about, or your woman's healthcare nurse practitioner about so that you can talk about, like, the risk and the benefits of it.
Now what about birth control?
So the easiest way to fix it if birth control is causing it, is to take away the birth control.
That means you're gonna have a baby and that's what causes vaginal dryness all over again
Right because then you're gonna be breastfeeding and then you won't have a sex life.
And then you have a baby, so like, sex life what?
Oh, what's that?
So there are forms of birth control that, again, don't cause the dryness so usually I recommend, like, the Mirena IUD or some of the other hormonal progesterone IUD's, I think that those are really great options. They have great bleeding profiles so you might not have like, super heavy painful periods with the hormonal IUD's, the non-hormonal IUD's are another great option that don't cause vaginal dryness but they can cause some of the heavier bleeding. Or the Peraguard is the one IUD available in the US that's copper, non-hormonal, and it does cause, like, super heavy periods for some women, some women, not all women. Those are the options.
And then always, the fertility awareness method is not one that we teach a whole lot because--
Oh, that's like the riddle method?
The riddle method.
Isn't that also like the pull-out method?
No, so the pull out method means you pull out and pray. So the Pull-out method is not very scientific.
That's how I got pregnant.
That's probably how I got here-That's how most people got here. Yeah, so the pull-out method is a little bit different. You can incorporate the pull-out method into your fertility awareness method, but the fertility awareness method is just making sure that you know when you are most fertile, and so you avoid having risky intercourse in that time.
Well, and there's apps for that, right?
If you trust them.
If you trust them, and if you trust your period, So if a woman has irregular periods, I would not recommend doing the fertility awareness method.
That was me.
Yeah. So, you're like, "I'm having periods every, "you know, 20 to 58 days, like--"
No, I was pregnant through 13 weeks before I found out, so yeah.
It does sound average, yeah.
So, yeah, anyway. Yeah, so okay, so we said--
All of these methods are options.
Yeah, these are options for if you're having vaginal dryness. If you know that it's caused by menopause, we just talked about all of the--
Like vaginal estrogen creams, the hormone replacement therapy.
Yeah, and then if you are experiencing vaginal dryness from breastfeeding--
So for breastfeeding is difficult. Definitely you wanna use lube and vulvar moisturizer.
Lube and vulvar moisturizer.
Let's talk about lube for a second. Because that's also true if you are on birth control. You can be using lube and vulvar moisturizer.
I think every woman should be using lube.
Let me ask you a question about lube, okay. As we get older, our bodies are going to decrease in the hormones that help us produce these...
Lubrications, right. So, it's important for you to start using lube now so it's not a big deal or a big difference to you or your partner later, okay? So if you're in your twenties and you're watching this and you're like, "I don't need lube because I'm very wet." Okay, girl, yeah that's true but let me tell you something. You could be wetter. You could be wetter. It's very true that you could be wetter, so if you use lube, you will be wetter. Your partner will enjoy it more. It's just a fact, okay.
You will enjoy it more.
You will enjoy it more. So, dry fiction is the enemy of pleasure. I say this in countless workshops all the time. Dry friction is the enemy of pleasure. So you need to make sure that you are lubricating, okay? Nobody wants to feel this when they're having sex. It hurts. It's hot. It's causes cuts on the inside of your vagina that lead to infection, okay? So if you're not using lube and you're getting infections a lot which cause vaginal pain, it could be because you're not using lube. Use lube, okay.
Lube is your friend. And make sure that you're using a good quality lube.
Yes, and lets talk about the qualities to look for in a lube. Okay, what makes it a lube a good quality lube?
So I am a fan of minimal ingredients in most aspects of my life, but especially with my lube. So, you wanna look on the ingredient list, if it has a lot of things that you can't pronounce, maybe you wanna put that back on the shelf.
Put it back. If it has, like, alcohol or glycerin, like all of these things that are not soluble and soluble means like, dissolvable with water, you wanna stay away from those, okay?
Yeah. You also want to make sure that you are not allergic to the lube, so a lot of the lubes nowadays that are on the market, like with the warming sensation and things like that, they have a ton of chemicals in it and you can be allergic to them. So again, if you're gonna venture out to try one of those, make sure you try it somewhere like on your wrist or on your arm so that you can make sure that you don't have an allergic reaction.
Very true. And you wanna make sure you're also looking for things that are water-based, in terms of lubricant.
Well, I like--
Okay, no, you're right, you're right. Silicone is great, it has a good slip, it has much more slip than water based, but I say water based, especially if you're gonna use them very, very often, is because water based lubes are a lot more soluble, I think.
The silicone lubes, it takes you a little bit more of the washing--
But that's, but that's the good thing about silicone, though.
Is that it tends to stick longer--
And last longer.
So that you don't have to reapply it, so a lot of my women who are having like, you know, severe vaginal dryness and vulvar dryness, don't necessarily wanna keep putting on this water based lube all the time.
Yeah, that's true.
Because you have to keep applying and keep applying and keep applying, versus the silicone, you can put a little bit and a little bit really goes a long way.
That's so true.
So it's really like different strokes.
Different folks, that's so true. And now there are also, there's the hybrid silicone-water based lube. Now that's my personal favorite. I think to me, it feels the most like my natural wet texture, right, because silicone is very, like, slick, it's like, you look at it and what you see is a porno, that like--
You know, right, you all know what I'm talking about, okay.
That's really slick, but I mean, it's good, especially, you know, it's really good, it's good lube but I like the silicone-water based because yeah, there's also something about it that re-wets, you know? So, on contact, because it's silicone but it's also water. It kind of gives you that--
It kind of gets into the tissue and sits on the tissue at the same time.
So it's like using lotion and a body oil.
Yes, yes, to stay moisturized.
Yeah, that's it. Yeah. So the moisturizers and the water based lubricants are like lotions so those are great at really seeping into the tissue and getting the tissue to go comfortable that way and then the silicone kind of sits on top of the tissue, which is great for that slick you enjoy, so.
Yeah, especially if you like it, kind of rough.
So, I mean, I have never met a patient that enjoyed the pain that comes with vaginal dryness, so, I don't think that's a kink, I've never heard that it's a kink. If you thought it's a kinky thing,
Make you feel like a fire poker.
Yeah, like I'm really excited to burn.
Hey but if that's your thing, don't not yucking your yum, at all, but no.
Yucking your yum, I like that.
Yeah, not gonna yuck your yum. To you, boo.
So I mean, we are both sex experts and you know, she likes a water based and I like a silicone so my advice would be go out and try good quality lubes.
Some good lubes. I can recommend some good name brands, I'm not getting paid to do this. Wicked Lubes makes great water-based lubes, if that's what you're into and that's what you're looking for. They also make a really good silicone one too. Also, Uberlube, Uberlube is great. I love Uberlube, it is like the Mercedes Benz-Look at that! Look at that, it's pretty too.
I promise they're not paying us for this.
They're really not.
[Together] But they should be!
Uberlube, if you're out there-
Cut us a cheque.
Cut us a cheque, honey. but no, Uberlube is great.
And you can see, maybe we can put it in the camera. Yeah. So it's... You know, very slick and slippery, so... And my hand's gonna stay wet actually for a very long time.
Yeah, I mean, I like it. Feels really good. It's very moisturizing and it's not like, sticky, you know what I mean? It's very, like...
You should have done the sound before--
I should have.
So we could hear the difference, yeah. But this is, I love Uberlube. Anyway--
I should probably put some in my hair--
I know, right? Maybe it does work.
No, it does work for your hair.
It does, I know this from experience, right. I love Uberlube.
I also love coconut oil.
Oh, yeah, we talked about that last time. Coconut oil is great.
In a pinch, if you need some.
Even if it's not in pinch, I love it. It's kind of like my--
I use it for everything else, so I mean, why not?
It's very cost effective. I mean, you talk about minimal ingredients--
That was just one ingredient. Natural from the coconut itself.
A lot of people are like, "You can put that in your vagina?" Yeah! You can put it inside the vagina, put it on the vulva, it's great as a moisturizer. You can just use it straight fresh out of the shower, the same way that you would use like a body oil or shower oil. So I keep a little canister in my shower. I'm like, who needs lotion, I'll just throw some coconut oil on.
Wait a minute, wait a minute, I'm sorry. We take a pause for the cause again. Mia says that Uberlube is used in salons?
It is. It's really used in high end hair salons.
Oh honey, I'm gonna try it on my next blow out, that's right.
I did not use Uberlube for this blowout, so do not judge it or anything.
What, I just learned... Look, sexperts are always learning something. I just learned something, oh my goodness.
My hand feels so soft right now, I can't stop touching it.
Yeah, because its got Vitamin E.
Yeah, Vitamin E is great. Vitamin E is also found in coconut oil.
Yes, yes, it is. It's a natural source of vitamin E.
Yeah, you can get straight up vitamin E too, so, yeah.
Interesting! Well, so... Who makes Uberlube? That's a really good question. Uberlube.
Yeah, Uberlube is the name of the company. Hey Uberlube!
I know her. We should tag them.
Yeah, we will. I'll repost the video, I'll tag them. Anyhow, so lube is a great way to combat vaginal dryness. Even if, you know, you're gonna do, you know, the hormone therapy and the other solutions and options that we talked about, again lubricant, if you're not using it, lube is your friend.
Yeah, lube, lube, lube.
Yeah. Alright, so let's talk about some solutions for muscle tension. You talked about the pelvic floor being too tight. One, what can we do if we feel like our pelvic floor is too tight?
If you feel like it's just a little bit tight and it's not really distressing but this conversation just has something kind of, going off in your mind, you're like, "Huh! I've felt that before." Then you can start with very simple things, like doing yoga a few times a week. The hip openers and a lot of the stretches that you do in yoga are really, really great at helping the pelvic floor to relax and also at strengthening the pelvic floor, so to optimize muscle function. So I recommend, if it's something that is not necessarily bothering you but you wanna just explore a little bit more on your own, I would recommend some yoga.
So let's talk about yoga for a second because you know I've been told, "I hate the hippy crystal stuff."
Yeah, me too.
So, what I'm realizing, kind of, as we're having this conversation, is that the sacral chakra, sacral chakra--
Yeah, the sacral chakra is our pelvic floor and so this energy that we're housing in our, you know, in our loins, in our muscles, really, that energy center is our pelvic floor. So taking care of your pelvic floor and making sure that it is in tip top shape is important not only for your physical health, but for your spiritual, emotional health, especially you know, when we talk about chakras. And for those who don't know what chakras are, they're just the different energy centers inside of the body, and when they, you know, become out of wack or out of line or there is disease or infection or something in there, it usually manifests in like, some kind of blockage of that chakra. And those that manifest in this kind of disease, like the tightening of your pelvic floor and loosening of your pelvic floor. And again, those things and these things are hereditary and like, there are things that we can do about it but it just, it literally just dawned on me, like, the center of our sacral chakra is the pelvic floor and also, like, what is necessary for sexual function.
Interesting. Take notes.
Yeah, so yoga is awesome. It's a really great way to get connected with your body, get in touch with your body, allow you to relieve some anxiety because the same way that having sexual disfunction can cause emotional stress and trauma, having emotional stress and trauma can cause pelvic floor disfunction.
Yes, that's very true.
I see a lot of my patients who are coming in. They are in law school and it's finals and they're like, "I've never peed so much," or, "I've never peed on myself before today "and I have so much stress and what is going on?" And it's like, whoa, where do you carry your stress?
Like, for me I carry it in my neck. Do you carry yours in your pelvic floor? And you might, you really might.
Yeah, no, that's so true. I do know a few people who experience, you know, bed wetting and things like that during times of high stress and you don't even think that stress can contribute or manifest itself physically in the way that you're able to use your pelvic floor.
I mean, have you ever heard the saying 'Scared shitless?'
-Yeah, because poop literally comes out--
Because your pelvic floor is like... You know, like, I cannot function right now because I'm so distressed--
Yeah, like, I'm overwhelmed or when you get so scared, you pee yourself.
Or you get so stressed, you pee yourself. That's true.
It's all connected.
And perfectly normal. And if that's happening to you, definitely go see your healthcare provider.
Yeah, come see me. If it is distressing you and you keep having these issues, then come to me, I'm more than happy to talk to you about ways that we can help you.
And where are we again?
So we are currently at G.W., George Washington. I'm a part of the medical faculty associates, so we're doing the outpatients centered care here. Yeah, so you can find me if you search Jenna Perkins, talk doc, DLC, DLC you can find me there. You can find my profile, you can read patient reviews and you can schedule an appointment with me, that's probably the easiest way to do this.
Cool. So I have a question, so what you say, I'm reading from one of our viewers here, what would you say to a patient who feels like using lube is an acknowledgement of a less than 'juicy' vagina. We hear so many songs celebrating having a wet pussy, that some feel insecure about it. So what would you say to a patient who is like, you know, I don't wanna use lube, because I got that wet, wet.
Yeah, there is a song by Rihanna where she says--
I never had to put a lip gloss on it.
Yeah, I love that song but it's so not true. It's so not true! I mean, you can be juicy some days and some days not be juicy at all.
Or someone just worked on your damn nerves, like you can not be in the mood--
The man or the woman or your partner or whoever you're with, it could depend on where you are in your cycle or how stressed you are so, so many things affect it, that I would say, if you have a man that it telling you, "You're not juicy enough for me," I would say that he's not making you juicy.
Oh, you ain't man enough for me, honey.
Exactly. But I acknowledge that it does spark a little bit of insecurity when we talk about the need for lube because there is this idea that there is some magical unicorn women, walking around, never having to use lip gloss and it's like, okay, they're just missing out.
Yeah, and then we think about women that we see like, on a porn, who's vaginas are like, gushing.
You know, and you're like, "Wait a minute, what? "Mine doesn't do that and so this must be bad and--"
Well, they are porn stars. Like forget that they are experts in the field for a reason, they're not putting, like, average Jane in a movie, so that's not really entertaining, so don't listen to rap music and expect to get your sex ed from there because rappers don't know the first thing about comfortable sex.
First of all, these rappers know nothing about your vagina, nothing.
Nothing about it.
And I know they don't because we don't know anything about our vaginas or vulvas.
Exactly. So if you don't know, then how can anybody else know, okay? So, you gotta know for yourself, okay. So then when people say dumb things to you, you can be like, "Okay."
Yeah. Yeah. I would just say, if you feel insecure about it then, I don't know, I kind of wanna say you shouldn't, but like, if you feel that way then that is something that maybe you wanna come in and we can talk about. You can also be discreet, like you don't have to be like, "Okay honey, "Like, let's whip it out, I gotta put some lube on it." Like, you can be discreet.
Yeah, you can definitely be discreet and I like Wicked lubes because they have these flavored lubes that are delicious. They come in like caramel, salted, salted caramel, vanilla bean, mocha java, candy apple, they are so good.
I would never!
They are so good.
See different strokes for different folks.
Bu look, so I put a little bit when I know I'm gonna get some oral sex, I put a little bit down there, you know, as a nice little treat. It's like, I look like chocolate and I taste like caramel.
I never wanna taste like salted caramel, like--
I always like it, it tastes really good. I'll give you some.
It's really good.
I don't know!
It's really good!
I'm gonna have to look at the ingredient list. I'm like--
I promise you, and it's sweetened with Stevia root, it's really good.
Look, I am not one those people who would like, sell you candy in a jar and be like, "Put this on your vagina." I'm not that person.
It's no Uberlube, not gonna lie. For flavored lube, you know what I mean?
I just feel like a vagina should taste like vagina, not salted caramel.
Yeah, you're right. You're right, you're right.
I don't know. But no judgment, if you're into the salted caramel, then be into the salted caramel but don't feel like you--
Have to. Don't feel like you have to, don't feel like, oh you vagina tastes so-that you have to put like, no, don't do that. I don't do that because I'm not advocating for that at all, whatsoever. I do enjoy, like, the surprise, because it's a surprise, like, I don't think anybody is gonna think that I'm walking around tasting like salted caramel. And I mean, look, no one walks around tasting like salted caramel, I want everybody to know that. No one tastes like flowers, no one tastes like roses, no one tastes like one of our Starburst or pineapple, no one tastes like that. Vagina tastes like vagina, okay. It just does. Okay, I just wanted to put that out there.
If you're dealing with things like odor, that's something that you wanna get checked out. You know, do a little sitz bath, spray some water before you go in to have your sexual encounter and see where things go from there. Like, if you're feeling insecure about the way that you smell, that might be a sign of an infection, so don't try to cover it up with other things.
Yeah, don't do that.
Yeah, so we're on opposite sides of the line for that, I'm like no flavors near me. If my husband tried to like, give me some flavored lube, I would be like, "Where did you find this?"
Oh my gosh, no, flavored lube is great.
I'm also super vanilla too, though. Like, I talk about sex all day long but--
No girl, sometimes that makes the vanilla bean and the mocha java and I'm making a latte. Yes, good. Anyway. Well, someone is asking what brand are we talking about. For the flavored lubes that I was talking about, I was talking about Wicked brand lubes, and I like Wicked Aqua flavored lubes, those are the water based ones that are P.h. safe, they're sweetened with Stevia.
Yeah, so this conversation just goes to show try it out, see what you like, see what you are attracted to and as long as you are not allergic to it or you're not having any adverse reaction, like infections, yeast infections, all those things.
If you're feeling any itching or discomfort or any unusual discharge after use, definitely discontinue use and see your healthcare provider.
Yeah, come see me. So sex should not hurt unless you want it to hurt. So if you want it to hurt, then go ahead and you know, have your kink and do it but--
Again, if you aren't sure if you want it to hurt, I teach a class called 50 Shades of Play. It's all about introduction to kink and what's the difference between kink and fetishes and how to how to fulfill. I talk about BDSM and how to fulfill those, kind of, needs in your relationship, how to take your own sexual inventory, if you wanna get into BDSM and it's something you can do with your partner too. I do a partner session or one on one, I do both.
That's cool. I don't necessarily teach a whole lot of BDSM-I'm more so, like, okay, it hurts but you don't want it to hurt, so let's see what we can do about that. But yeah, sex is fun, it should be fun. It should be pleasurable.
Pleasurable, yeah. You should be enjoying it and if it's painful, you should be enjoying that pain. If you're not enjoying that pain then you should figure this out, okay. So if you think you're having any of the symptoms that we talked about: muscle tension, vaginal dryness, what are other reasons? Let's really quickly, so we talked about vaginal dryness and all the host of reasons. Muscle tension and the host of reasons. Sexual infection or genital infection, okay, and the host of reasons that that might be. But what else? Are there any like--
Yeah, so skin disorders are a big one. So you can have something as innocuous as eczema on the vulva--
On the vulva, interesting.
And that can be super uncomfortable, or we kind of touched on the infections or yeast infections can cause skin changes and that makes things irritated. Dryness can cause changes in the tissue and so that can lead to further pain. So skin changes are something that's big. So look in the mirror, if anything looks abnormal to you, come in, you know, we'll do a mirror exam together, we can talk about way that we can address it, if it's anything that is truly, indeed abnormal. And then another big cause of it can be nerve damage. So if you have too many nerve endings in the vagina, in the vestibule, so that very small area that is like the, opening.
Yeah, the opening.
Yeah, the fancy opening between the labia and the vagina. So if you're having pain there, it can be because you have too many nerve endings or nerve endings that are hyper sensitive and so what might be pleasurable might be interpreted by your brain as being painful.
Interesting. So I was reading on WebMD, and--
Nothing good ever comes from that.
Well, you know, I searched, like, vaginal pain and the number one diagnosis is endometriosis. So let's talk about that, like what, how do I know if that's, there's this commercial out now, like, "Are you having painful sex? "Please tell your doctor." And it's a woman, like, screaming at herself, like, "Tell your doctor that you're having painful sex!" So, and it's an endometriosis commercial, so let's talk about it. What is it? How do I know if I have it?
Endometriosis is a condition where the uterine lining is somewhere outside of the uterus. So the uterine lining responds to those hormones that we talked about earlier. So as your cycle progresses, the uterus builds layers in order to accept an embryo implanting in it, right. So it makes a very comfy area. If you do not get pregnant, then everything slops off and then that's how you get a period. So what you see is the uterine lining being shed during your mensies or during your period.
Okay, so that's what a period is. Just your uterine lining shedding, okay.
When you have endometriosis, that uterine tissue is outside of the uterus and so, it's still gonna be doing it's thing, it's gonna be increasing and slopping off, but if it's on your bladder, if it's on your bowels, if it's on your ovaries, that is a whole lot more painful than just being in the uterus.
So you have severe pain, especially when you're on your period.
So painful periods, painful sex.
It's something that--
Might be endometriosis.
Endometriosis is difficult because it can only be diagnosed with surgery.
Wow, so like in order for them to tell me that I have it, they have to do surgery to determine if I have it?
That seems really backwards.
Yeah, so you can look on ultrasound and see if the uterine tissue is on the ovary or you won't be able to see, unless it's severely bad, you won't be able to see with imaging if the uterine tissue is outside of the uterus so the only way you can go in and really see it, to do exploratory surgery. So--
So that's why a lot of people with endometriosis, have endometriosis and don't--
Don't get treated.
Don't do anything about it.
Yeah, I mean, I think that's, I mean that's a tough decision, right? Like if you were to sit here and tell me, "Okay well, Reba, you said you're having "painful sex and painful periods "and we've tried everything else "and you may have endometriosis, "but we have to do surgery to find out," I would definitely wanna make sure that we've exhausted every single possible option first.
Yes, and many, many women who have endometriosis also have pelvic floor disfunction.
Because of that response, right, that tensing response that you have whenever you have any sort of pain. So now you're dealing with two different pain syndromes. You're dealing with endometriosis and also the pelvic floor disfunction. So you definitely wanna be going to see a physical therapist, if you think you have endometriosis so that you can one, rule out pelvic floor disfunction, just to make sure that, you know, the issue is not just your pelvic floor and two, because it'll help you long term with your healing, if you decide to get a surgery, then having a pelvic floor physical therapist working with you is gonna be a really, really good option.
So PT for the world.
Well, I think that's all our time.
Yeah, that's it? That flew!
I'm kind of sad, I wanna talk more.
Let's take a couple questions if you guys have any more.
If not, thank you so much for tuning in. It's been a pleasure talking with you guys and answering your questions and talking about sex.
All day long, baby.
Yeah, and so if you don't have questions but there is like, some kind of topic that you want us to cover on our next live stream, I'd love to hear that from you guys. Otherwise, thanks for tuning in.
Where can we find you? How do we get in contact with you?
Yeah, so I recently started an Instagram page and it's DisvoHerHealth, so that's Discov-H-E-R-Health, so you can find me on my Instagram page there and always you can just google my name, Jenna Perkins, or Jenna Lewis is my maiden name, and talk doc, DLC, DLC. You can find my profile or you can schedule an appointment with me if you are in the metro D.C. area.
What kind of insurance do you guys take?
We accept mostly everything.
Yeah, Medicare, Medicaid, all the, well, most of the other insurances. So we accept most everything.
Yeah, so if you're on, if you're in the area and you're looking for a high quality medical professional...
Here you go, okay. Also, again, I'm Reba the Diva. I teach sex ed workshops here in the D.C. area and virtually, if you wanna reach me on social, I'm @RebatheDiva, www.rivathediva.com and @RebatheDiva on all things social. Thank you guys, for tuning in. Can't wait to see you guys again. I think we wanna talk about, I dunno, birth control?
Birth control next time? Okay, let's talk about birth control. Alright guys.