Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And joining me today is Dr. Meghen Bokemper. She's an obstetrician-gynecologist at Bryan Women's Care Physicians, and she is here to discuss with us questions that we should not be embarrassed to ask our OB-GYN.

Dr. Bokemper, thank you so much for joining us today. I want to start with some advice here, as a physician specializing in Obstetrics and Gynecology, what advice would you give patients who are embarrassed or uncomfortable discussing what we're about to discuss here today?

Dr Meghen Bokemper: I think I would tell all of my patients that we have an open door. We are happy to discuss anything and everything that you are concerned about. We want to be a resource for you. We want to make you feel better if you're not feeling good. And so, I would just want all of my patients to ask me anything, because hopefully we can help you, hopefully we can answer it, but you shouldn't be embarrassed to ask anything in our office.

Melanie Cole, MS: Well, because you're someone who specializes in women's health and we shouldn't be embarrassed about our bodies and the changes that happen from when we're a teenager until when we're post menopausal. So, it's nice to know that you're so open to some of these difficult questions. Let's get into some of them. One of the big ones is vaginal discharge. Dr. Bokemper, you must hear this every single day. Is this normal? What is it?

Dr Meghen Bokemper: Yes, I hear about vaginal discharge all day, every day. That sounds kind of weird when I say it that way, but it's a very normal part of the body. So, some vaginal discharge is completely normal, completely physiologic. It can definitely change throughout the month. During a normal menstrual cycle, it can be kind of a clear thin discharge, or it can be a milky white discharge, depending on where a person is during their menstrual cycle. I hear a lot of patients complain during pregnancy about an increase in discharge as well. But what I usually tell my patients is that if the discharge has other features, for example, if it has an odor, if it has a yellow or green color, or if there's any itching or burning or vaginal irritation associated with it, we probably need to do an evaluation for the discharge.

Melanie Cole, MS: Now, the next one. Are we supposed to use soap and water? Are we supposed to clean down there? Does it clean itself?

Dr Meghen Bokemper: This is a very, very common question. You should not be embarrassed to ask it at any age. But when I was actually even doing some of my training, I had a staff member that told me that the vagina, we should think of it like a self-cleaning oven. So, yes, it does, essentially clean itself. But there's so many products on the market that advertise vaginal cleaning, that advertise vaginal health, and so it can be super easy for people to be misinformed.

I think, overall, what I usually tell folks is that cleaning the outside skin, cleaning the vulvar skin, you know, on the labia, that we should clean with just a gentle soap or even just plain water if somebody is very sensitive. But we don't recommend any internal cleaning, just because that can alter the vaginal pH and that can actually predispose you to vaginal infections, vaginal discharge, and other irritation.

Melanie Cole, MS: Dr. Bokemper, what we're discussing here today travels the life course of women. So, I'm sure you see teenagers that are coming to see you for the first time and their specific group of questions when they get brave enough to ask them. And then, the middle aged and women in reproductive years, and the questions that they have. And then, the women in my age group and older, and the questions that we have. So, we're going to try and kind of hit one of each at least in this podcast today. So, let's talk about sex during your period. Is this something that can be done? Is it dangerous? Is it detrimental?

Dr Meghen Bokemper: You know, it's not dangerous to anything. It's a personal preference is usually what I tell my patients. If you and your partner don't have a problem with it, it's not going to be a problem at all. It just depends on if a person is comfortable with it during their cycle.

Melanie Cole, MS: Now, in my age group, after we have gone through menopause, breakthrough bleeding is pretty scary. Tell us about that.

Dr Meghen Bokemper: It is. You know, that's one of the red flags definitely in our field, is any bleeding after menopause. I usually tell folks who are coming to see me for that, that's an automatic you need to be evaluated. You don't want to wait to get evaluation for that. It could be as simple as what we call atrophy or thinning of the vaginal tissues. And just with time, that can cause a little bit of bleeding because the tissues become very thin like tissue paper. But what we don't want to miss is anything going on deeper inside like within the uterus or any atypical cells there, or worst case scenario would be cancer. And that's the one thing that we need to do evaluation for. So usually, when somebody has that complaint, we automatically bring them in for definitely an ultrasound, to look at the internal anatomy and an exam, and sometimes a biopsy if it is indicated, but it's not something to mess around with for sure.

Melanie Cole, MS: So now, this one kind of covers a few age ranges here. When we laugh, sometimes if we've had babies or if we're a little older, we pee a little bit. Is that something we discuss with you?

Dr Meghen Bokemper: I am more than happy to discuss that because I hear that concern from many women. And yes, the babies a lot of times are to blame. But a lot of times even in our routine annual exams, we always ask about bowel function, we ask about bladder function, and so that concern comes up. We have a lot of options to send you to, say, pelvic floor physical therapy. I do that quite a bit so we can help people with those symptoms and maybe get them under control. Sometimes if I feel like a person deserves evaluation with a urologist, we can do that as well. But nobody should ever be embarrassed to talk about that, because it's a very, very common thing that I get asked about and we have options to help people.

Melanie Cole, MS: Back to the younger ones for a minute, birth control. There's so many questions surrounding all the different birth control methods out there today. And sometimes young women, whenever they're sexually active, are a little embarrassed to discuss birth control, but sometimes they want birth control to control acne or painful periods or endometriosis, so many different other types of situations. Speak about birth control and the questions you get asked.

Dr Meghen Bokemper: I see a lot of women for birth control. I think birth control is different than what we counsel people on, you know, for safe sexual practices. And so, we still want people to be careful and to protect themselves. But I use the hormones that are contained in birth control to make people's periods better, make their cramping better, make their bleeding less, regulate their cycles, help them with skin concerns. And so, there's a lot of reasons why we use birth control. And they should be very open about what their goals are with us and what symptoms they want to treat and everything. And if contraception falls into that, that they want that, we're happy to do that for them.

Melanie Cole, MS: Is it safe to have sex while somebody is pregnant?

Dr Meghen Bokemper: It is, unless your physician has recommended not to. But otherwise, there's no concern.

Melanie Cole, MS: This is such an informative episode, Dr. Bokemper. I'd like you to tell me now, what are some of the most common questions, give me one or two, that you hear every day that women seem a little bit embarrassed to ask about.

Dr Meghen Bokemper: I would say, "Is it okay for me to be on my period when I come in for my exam?" And the answer is going to be most of the time, yes, it doesn't bother us. We see people with period concerns all the time. Very, very rarely do I ever have somebody reschedule and that's really only if we're maybe doing more of a procedure or something like that where we just don't want them to be on a day where they're having a lot of heavy flow. But I feel like a lot of people are concerned about that where, you know, they schedule their Pap smear months in advance and then, of course, your period shows up two days before that. But in all honesty, it really doesn't bother us.

Melanie Cole, MS: Give us one more before we wrap up.

Dr Meghen Bokemper: One of the most common questions I think I get that people should not be embarrassed to ask you about is, "Why does intercourse hurt?" It's a very popular one that I think finds its way into all sorts of visits that we talk about, or "Should intercourse hurt? Or "Why am I having pain with it?" And I think that that's a very valid concern for people to bring up because, one, you shouldn't be embarrassed. Two, we want to make sure there's nothing, going on, because there's reasons why if you have skin irritation on the outside; do you have tightness of the vaginal muscles or problems with your pelvic floor? Or is there something deeper on the inside with, say, is there a fibroid or something in the uterus? There's all sorts of things that can do it, but we don't want people to be afraid to tell us that part of their history, because I think it can be really informative. Honestly, with just doing a visit and doing an exam, a lot of times we can sort out what's causing their pain and then get them help for it.

Melanie Cole, MS: Dr. Bokemper, thank you so much for such an educational episode today. I hope you'll join us again so that you can give us more information because this is such an important part of our health for a woman as she goes through that whole life course from teen to older adult. So, it's so important the information you're giving us and so helpful to ease our fears and a bit of that uncomfortable feeling that we get sometimes. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review this podcast and all the other Bryan Health Podcasts. I'm Melanie Cole. Thanks so much for joining us today.