Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm your host, Caitlin Whyte. And in this episode, we are going to be going through all those questions you shouldn't be embarrassed to ask your OB-GYN. And joining us for this conversation is OB-GYN, Dr. Peyton Marr.

Well, I am so excited to jump into these questions today. As a woman myself, I feel like I've felt a bunch of these heading into the OB-GYN office. So, let's start off with something like vaginitis, vaginal discharge, vaginal odor. That can of course be super embarrassing to bring up, but why is it important to let your doctor know about these issues and conditions?

Dr. Peyton Marr: There's a ton of things that can actually cause this vaginitis. And what really is vaginitis? So, it's an inflammation or some type of infection of the vagina that, you know, can be associated with a spectrum of symptoms. Like we're talking itching, burning, discharge odor, sometimes a fishy odor, and irritation in general. These infections most commonly are caused by bacteria. And in the vagina, we have bacteria normally that's there. But what happens is there's a pH in the vagina and it's normally an acidic pH. And how it keeps its acidity is estrogen. And so, estrogen will increase the glycogen in our good tissues and that will lead to lactobacilli, which I'm sure a lot of people have heard of, because they always talk about, you know, getting your probiotics and making sure that it has lactobacilli in it. And this lactobacilli, it increases our lactic acid, which is acidic and makes the pH less. And so, that acidic environment, it's protective against these organisms that can grow and take over the vagina. But they all, you know, will live there at certain times.

And so, it's important that you bring it up just because we need to figure out what's causing it, right? It could be an infection. So, you know, 22-50% of women have bacterial vaginosis, and it's very common in reproductive age women. And sometimes they'll see like a thin gray discharge with a fishy odor or, you know, a lot of people are familiar with yeast infections, which is like a burning, itching, kind of swelling, what we'd like to say cottage cheese-like discharge.

But you know, other things can cause it too besides these bacteria. It could be dermatological conditions, soaps, laundry detergent, menopause. Because if you think about menopause, we have a lack of that estrogen. That estrogen, like I had kind of said before, is what keeps the environment acidic.

Host: Gotcha. Well, jumping into our next big topic here, I mean, sex, obviously, is something we should bring up with our OB-GYN, but so taboo in our culture. I want to focus on, like, painful sex and just maybe issues we're seeing in that department. Why bring up sex at the doctor's office?

Dr. Peyton Marr: Yeah. And so, you know, sex in general should be enjoyable, and it should be fun. And like you had kind of mentioned, it's a taboo topic. So, we see lots of patients that are embarrassed, you know, about having maybe painful sex, or maybe they're not having an orgasm, or it's just something that people don't openly talk about and they're uncomfortable. So, it's important that they can open up to us about that so that we can kind of figure out, again, why this is happening. Because there's a bunch of different causes for things like this and factors that contribute to it. And most of the time, you know, this is a lot of different things that are leading to issues. Sometimes it can be menopause again, you know, that lack of estrogen and they have a decreased lubrication and it's making sex unenjoyable. Or, you know, there's relationship stresses between partners that's leading to an inability to connect and an inability to enjoy sex. Sometimes there's a history of abuse that's in the picture as well, or underlying depression and anxiety, and that can kind of cause some problems with connection and can also lead to just being anxious about the actual act of sex and not enjoying it.

Some other medical conditions would be like diabetes, high blood pressure. Sometimes those things can play a role as well, medications that you're taking or just being in the postpartum phase as well. A lot of women after they have a child, they do not feel like they want to have intercourse, and that can happen too. Most of the time, we break it down into like four groups. And like your first one would be your just sexual disinterest or arousal. So, a lot of times, that's our postmenopausal women because with that decrease in estrogen and testosterone, it just leads to having no desire.

And then, you know, our second one would be where we talked about orgasm where you just have a delay in orgasm intensity or a lack of an orgasm. Other ones is kind of that pain that you had mentioned, like genitopelvic pain disorder. So, that's actual pain with any type of penetration or just any type of touching in general and an anxiety that, you know, you will feel pain, that it's coming.

And then, I had mentioned medication. Just a big one I wanted to point out was SSRIs. You know, our antidepressants, our anti-anxiety, those will lead to decreased libido, and that's a known side effect of those. So, you could be on a medication and just be like, "Why is my libido so low?" And it could be just because of that medication. It could be there's nothing wrong with you. You know, it could just be we need to titrate that medication a little bit different.

And I will say that one main thing I've noticed is that a lot of women aren't getting enough clitoral stimulation or they're not using water-based lubricant. And those are the two things that I would say to try first and see if that helps.

Host: Well, on that note, let's also talk about STD testing. Obviously, something that's super important to keep tabs on, but maybe a bit embarrassing to bring up to your doctor, that maybe you have more than one partner, or something along those lines. How can we talk about that in an office setting?

Dr. Peyton Marr: A lot of people view this as private and that's totally normal, that's okay. Just the main goal, especially with my patients, is just to make them feel comfortable so that they can ask about STD testing. They can ask about when they should be getting it. They can ask about having multiple partners. I mean, there's no dumb question when it comes to our health and taking care of our bodies.

But the same kind of goes for us on the medical field, right? Like we have to ask these questions to know the answers too. So, some people will get offended if you ask, you know, "Do you want STD testing today? Or do you have more than one partner?" And you know, we're not judging you. It's truly we ask everyone these questions just so that we can treat you better.

So, I would say that it really starts with forming a relationship with your doctor. If you don't click with someone, go find someone else. They're not going to be, you know, hurt by that. That happens in this field just like, you know, friendships. It's the same type of thing. I would say also just confidentiality is number one. So, no matter where you go, your doctor is not going to say anything to anyone else about this. So, that should at least give you some relief with that and feel comfortable opening up.

STD screening, in general, I feel, should be viewed like a yearly mammogram or your annual visit. It's a screening to help prevent long-term consequences of infection. The CDC actually recommends that if you are sexually active and less than 25, that you're tested for gonorrhea and chlamydia yearly. And so, a lot of people don't know that as well. And then, women that are, you know, greater than 25 if they are sexually active with multiple partners or a new partner or a partner with an STD, then, you know, the CDC recommends they be tested as well. All adults between 13 to 64 that are sexually active should be tested at least once for HIV, which a lot of people don't know that as well. So, I mean, there's no harm in being tested for HIV because I think that that also used to have a little bit of a stigma to it as well, but it's actually recommended.

And then, you know, when you're pregnant, we test everyone for STDs multiple times throughout the pregnancy, and that's just a standard of care. That doesn't mean that we're judging you in any way.

Host: Absolutely. Some really great info there. Thank you. Now, this next one is something I know I think about any time I head into the doctor's office or even getting like a massage or something. You know, I want to be a good patient. I want to be a good client. I want to make sure I'm shaved and showered and all clean to go. But is that something that you really think is a big deal on your end? What's the doctor perspective of that?

Dr. Peyton Marr: No. I just want to say that we know these exams are not fun and can be totally uncomfortable. And I know that, like, you're exposing yourself, and you want to be the best that you can be, but we do this every day. So, if you don't shower right before you come and see me, I'm not going to notice and I'm not going to care at all. So, there's no reason to apologize or be ashamed of your body in any way.

I get a lot of questions about shaving too. I mean, if that is what you prefer, then sure. But you know, sometimes it can lead to irritation and play a part in, you know, vaginitis and infection. So if someone is having recurrent irritation or vaginitis and they're just uncomfortable, sometimes, you know, it could be like ingrown hairs or things like that, so just kind of like circling back to that. But if that is your preference, then that is totally fine.

Host: Great. Well, let's wrap up this conversation with heavy bleeding. Why is something like that critical to bring up during an appointment?

Dr. Peyton Marr: You know, I think the main reason people are scared to talk about heavy bleeding is because a lot of the time they have had like an accident in the past where they've bled through their clothes in public and that causes like a certain level of PTSD. And so, they don't want to bring it up almost. And, you know, that is not normal that if you are bleeding through your clothes, like you should never have to do that. And you should definitely seek OB-GYN or your primary right away to discuss the options because the main thing is figuring out why you're bleeding so heavily. And I mean, there's so many different causes. I would say some of the main things are fibroids, which are, you know, benign tumors inside the uterus; bleeding disorders where you can't really like clot your blood well; say, you're having some type of ovulatory problem where you're not ovulating like you should be or polyps or, you know, even cancer.

Host: Great. Well, doctor, my last question here, I'd just like to end on some advice. You know, sometimes it's easy to be sitting in our homes saying, "Okay, my appointment's tomorrow. I really have to bring up this sex issue or this vaginitis issue." But once we're in the dress on the table, it might feel like then you're like, "I don't want to bring it up. I don't know. I'll just talk about it some other time." What advice would you give to people who are trying to maybe psych themselves up to really tell these issues to their doctors?

Dr. Peyton Marr: Yeah. I would say, number one, just remember that we see this every day. We deal with this every day. We've been trained in this. To us, it's not super embarrassing to hear you talk about this. But I would also say that I'm a patient myself sometimes too, right? So, we understand how embarrassing it is and how much courage, you know, you have to have to bring it up. So, you know, I would just say try and power through. I like to have patients make like lists on their phones of questions that they have, because I also feel like, like you said, you know, sometimes you're in the room and you get really nervous and you kind of forget everything that you wanted to ask. So, I would just say write it down and it might make it easier just to kind of fly through it.

Host: No, absolutely. That is great advice. I've never thought of just writing it down and being like, "All right, I'm going to say it.”

Dr. Peyton Marr: Yeah, exactly. And then, you just say it.

Host: Well, really just some vital information. Thank you, doctor, for joining us today. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all of the other interesting podcasts in our library. I'm Caitlin Whyte.