Your sexual health questions answered by a gynecology professional

One of the questions Terry Silvestrin, ARNP, a board-certified nurse practitioner and certified menopause clinician at MultiCare, always asks her patients: Do you have any concerns about your sexual life?

“It’s really important to talk about this topic,” Silvestrin says. “One of my missions as a nurse practitioner is to empower women, or anyone with a vagina, to understand their bodies, what feels right to them, and to voice their questions.”

Here are answers to five sexual health questions patients commonly ask Silvestrin.

Q: Do I look normal down there?

“Variations of this question are probably the most common ones I get,” Silvestrin says. “People can feel a lot of pressure for their genital area to look a certain way, but we’re all built differently, so there is no one right way to look.”

As long as your vulva — the external parts of your genitals that include the opening to the vagina and urethra — and the surrounding area is functioning the way it should, then rest assured you are “normal” and healthy, Silvestrin shares.

However, if you feel pain, discomfort or irritation in this area of your body, then you should make an appointment with your gynecologist or other health care provider to discuss your symptoms.

Q: I feel itchy and uncomfortable down there a lot. What’s going on?

Feelings of itchiness in the vaginal area are common. Yeast infections, which may become more frequent as you age due to drops in hormone levels, are often a culprit. But they aren’t the only one.

“Many conditions, such as bacterial vaginosis and sexually transmitted infections, can cause itchiness, too,” Silvestrin says. “If the itching doesn’t resolve or if it’s accompanied by other symptoms, then it’s time to see your provider. Guessing what the problem may be and trying to manage it at home can make it worse or delay proper treatment.”

Silvestrin also recommends being mindful of the products you use in or near the vagina. If you use lubricants or moisturizers, which can help with vaginal dryness, stick with water-based rather than oil-based products.

As for sprays, douches, lotions, wipes and similar items, often marketed as “feminine hygiene products,” you are likely better off leaving them on the shelf. They may contain harsh ingredients that disrupt the pH of the vagina, causing itchiness and irritation.

“We are bombarded with ad messaging that says you need this product or that product to keep the vaginal area fresh,” Silvestrin says. “Don’t buy into the hype. All that’s needed for cleanliness is regular showering.”

Silvestrin also recommends:

• Changing out of wet or damp clothes as quickly as possible following a workout or swim
• Wearing undergarments made of cotton, as they allow heat to escape

Q: Why is sex painful?

Pain during or after sex (also known as dyspareunia) is common. In fact, nearly three out of four women will experience pain during sex at some point in their lifetime, according to the American College of Obstetricians and Gynecologists (ACOG). However, just because it’s common doesn’t mean you need to endure it or give up sex altogether.

“If you’re routinely experiencing pain during or after sex, then it’s important to bring it up with your provider,” Silvestrin says. “It could be a sign of a medical condition or infection that should be treated.”

A variety of conditions, from uterine fibroids to endometriosis to vaginal infections, can lead to pain or discomfort during sex. Other causes can include complications from childbirth, symptoms related to menopause or perimenopause (the years preceding menopause), as well as lack of foreplay or proper lubrication. There may also be a psychological component.

“Once you’ve experienced pain during sex — for whatever reason — you may be likely to tense up during future sexual interactions,” Silvestrin says. “While this is a normal reaction to pain, it can make the situation worse.”

Bottom line — don’t suffer in silence, Silvestrin says. Even if there’s not an underlying medical condition involved, your gynecologist or other health care provider can help you find solutions to make sex more comfortable.

“Find a provider who listens, who you feel comfortable talking to about sexual concerns and who can help you explore options for addressing them,” she says.

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Q: I’ve lost my libido. What’s happening to me?

A person’s libido (sex drive) is highly individual and may change throughout the course of a lifetime. Changes in desire for sex and intimacy are common symptoms in perimenopause and menopause. This is due to natural loss of hormones like estrogen during these phases of life.

However, there may be other factors involved as well, such as medication side effects, medical problems, physical changes associated with aging, relationship problems and psychological concerns. Stress can affect libido, too.

“Stress plays a huge role in sexual desire,” Silvestrin says. “Mid-life can be a particularly stressful time for people. They may be juggling the demands of work and family with other responsibilities, all of which can lead to fatigue and lack of interest in sex.”

If you’re concerned about changes in your sex drive and you’re in a relationship, Silvestrin recommends being honest with your partner about how you’re feeling. Regardless of your relationship status, it’s a good idea to talk to your gynecologist or other health care provider, too.

“There are so many factors that can influence libido, and getting to the bottom of what’s going on can help determine next steps,” Silvestrin says. “Depending on your situation, that could include changes to the way you and your partner approach sex, stress reduction techniques, hormone testing, referral to a counselor or other options.”

Q: I’m not sexually active right now, so why do I need to see a gynecologist?

It’s important for anyone with a vagina, once they reach the appropriate age (or if they are experiencing troubling symptoms), to receive regular gynecologic care regardless of current sexual status, sexual orientation or gender identity.

Those who have had a hysterectomy should receive this type of care, too, Silvestrin shares. Even if your uterus and other reproductive organs have been removed, you may still experience issues with parts of your anatomy that remain, such as your vulva or vagina. You will also still benefit from preventive care.

“Your gynecologist, or similar provider, performs routine physical exams and cancer screenings that will help keep you healthy across the lifespan,” Silvestrin says. “Plus, when you have an ongoing relationship with this type of provider, it’s easier to address problems, such as menstrual issues, menopause symptoms or sexual concerns, when they arise.”

The ACOG recommends beginning routine gynecologic care between the ages of 13 and 15.