Skip to content

Prolapsed Bladder (Cystocele): Treatment options

Dr. Andrew Siegel discusses the treatment of dropped bladders.


Signs of the Most Common Vaginal Infections

Bacterial vaginosis
Vaginal candidasis
Trichomonas vaginalis
ODOR Vaginal discharge has an unpleasant fishy or musty odor Vaginal discharge has no odor Excessive vaginal discharge has an unpleasant, fishy odor
DISCHARGE Discharge is thin, milky white or gray Discharge is thick and white (like cottage cheese) Discharge may be yellow or green and frothy
Vaginal itching is sometimes present Vaginal itching/burning is usually present Vaginal itching and painful urination
CAUSE Caused by bacteria Caused by yeast STD – Caused by parasitic trichomonads

Vulvar Health Hints

by Caroline F. Pukall Ph.D., C.Psych.
Associate Professor & Director, Sex Therapy Service
Department of Psychology
Queen’s University

Listed below are some general hints for vulvar health. If you suffer from vulvodynia, this information will likely not provide a cure for, or significant relief from, your pain – but it may help prevent further irritation. Please note that you do not have to follow all of the vulvar health hints at the same time; rather, choose the ones that best suit your lifestyle and try them for a period of time. We recommend that you start with as many as possible, since many lifestyle routines may lead to vulvar irritation in those who are sensitive. Once you are using as many of these measures as is practical, you can gradually re-introduce, if necessary, the previous habits one at a time and watch for signs of irritation. Find what works best for you.

Laundry Care

  • Use dermatologically-approved detergent (e.g., Purex®, Clear®) on underwear or any other type of clothing/material that comes into contact with the vulva (e.g., pajama bottoms, exercise clothing, towels); Use 1/3 to 1/2 the suggested amount per load. Other clothing may be washed with the laundry soap of your choice.
  • Avoid using fabric softener and/or bleach on underwear or any other kind of clothing or material that comes onto contact with the vulva.
  • Avoid using dryer sheets on clothing/material that comes into contact with the vulva; hang-dry these items.
  • Double-rinse underwear and any other kind of clothing that comes into contact with the vulva.
  • If you use stain-removing products on items that come into contact with the vulva, soak and rinse them in clear water and then wash them in your regular washing cycle (given the restrictions above) in order to remove as much of the product as possible.

Clothing Choice

  • Wear white, 100% cotton underwear to allow air in and moisture out.
  • Go without underwear when possible (e.g., when sleeping).
  • Avoid thong (g-string) underwear.
  • Avoid wearing full-length pantyhose; try thigh-high or knee-high stockings instead.
  • Avoid tight fitting pants or jeans that may put pressure on the vulva.
  • Avoid spandex®, lycra® and other tight-fitting clothing during workouts, and remove wet bathing suits and exercise clothing promptly.

Hygiene Hints

  • Use soft, white, non-recycled, unscented toilet paper and 100% cotton pads or tampons.
  • Avoid using scented products such as bubble bath, feminine hygiene products (pads or tampons), creams, or soaps that come into contact with the vulvar region.
  • Avoid using feminine deodorant sprays, Vaseline®, and colored soaps in the vulvar area, and avoid douching unless recommended by your physician.
  • When you shower/bathe, do not use soap until the very end, and avoid applying it directly to the vulva. Use mild soaps such as Dove®, and avoid getting shampoo on the vulvar area.
  • Wash the vulva with cool to lukewarm water with your hand. Pat your vulvar area dry, do not rub. Do not use soap, wash cloths, or loofahs on the vulva; these can dry out and /or irritate the sensitive vulvar skin.
  • Many women wash the vulva too often which can further irritate the area ­ once a day is enough.
  • Avoid shaving the vulvar area.
  • Keeping the vulvar area dry is important; if you are chronically damp, keep an extra pair of underwear with you in a small bag and change if you become damp during the day at school/work.
  • If you suffer from repeated vaginal infections, avoid using over-the-counter creams which might irritate the sensitive vulvar skin. Instead, discuss with your doctor the option of a systemic, oral medication (e.g., Diflucan®). It is important to visit your doctor for an examination when you suspect you have an infection; self-diagnosis and treatment without confirmation may lead to misdiagnosis and unnecessary treatment that can cause more harm than benefit to your vulva.

Physical Activities

  • Avoid exercises that put direct pressure on the vulva such as bicycle riding and horseback riding. Use padded shorts/bicycle seats if you do engage in such activities.
  • Limit intense exercises that create a lot of friction in the vulvar area.
  • Use a frozen gel pack wrapped in a towel to relieve symptoms after exercise.
  • Enroll in a yoga class to learn relaxation and breathing techniques.
  • Avoid swimming in highly chlorinated pools, and avoid using hot tubs.

Pre- and Post-Sexual Intercourse Suggestions

  • Use a lubricant that is water-soluble before penetration (e.g., Liquid K-Y®, Astroglide®, Slippery Stuff®). If you find that these lubricants irritate you or dry out during intercourse, a pure vegetable oil (such as Crisco®, solid or oil) has no chemicals and is also water-soluble. Please note that Crisco® is not latex-friendly and therefore should not be used in combination with condoms.
  • A topical anesthetic (for example, Xylocaine®) may help before intercourse; discuss this with your doctor and ensure that you know how, where, and when to apply it.
  • To relieve burning and irritation after intercourse, take cool or lukewarm sitz or baking soda baths (4-5 tablespoons, 1-3 times a day for 10 minutes each).
  • Apply ice or a frozen blue gel pack wrapped in one layer of a hand towel to relieve burning after intercourse. Other ideas include a bag of frozen peas, or fill a dish-soap bottle with water and freeze it; these fit well against the vulva.
  • Urinate (to prevent infection) and rinse the vulva with cool water after sexual intercourse.
© Caroline F. Pukall Ph.D., C.Psych. – All rights reserved.
Comments or questions, contact the author

15 Easy Ways to Help You Remember to Do Your Kegels

15 Easy Ways to Help You Remember to Do Your Kegels

What are Kegel exercises? A Kegel exercise, named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor. To do Kegel exercises, you just squeeze your pelvic floor muscles. The part of your body including your hip bones is the pelvic area.

How to use your pessaries

Written by Helen Marshall, pharmacist

What are pessaries?

Pessaries are solid, bullet-shaped preparations designed for easy insertion into the vagina. They can be inserted using your fingers, or may come with an applicator. Pessaries are normally made of a solid vegetable oil that contains the medicine. The medicine is gradually released into the vagina as the pessary dissolves at body temperature.

How to insert a pessary

  1. Wash your hands.
  2. Remove any foil or plastic wrapping from the pessary and applicator (if supplied).
  3. If an applicator is supplied, push the pessary into the hole at the end of the applicator.
  4. Sit or lie down with your knees bent and legs apart.
  5. Gently insert the pessary into the vagina as far as is comfortably possible using either your fingers or the applicator.
  6. If you are using an applicator, depress the plunger to release the pessary then remove the applicator from your vagina.
  7. Wash your hands again.

Other useful advice

  • If you are pregnant, do not use an applicator to insert pessaries. Use your fingers instead.
  • Once in the vagina the pessary will melt and may leak from your vagina. You may find it more comfortable to insert the pessary before going to bed at night rather than during the day. If you do insert it during the day, sanitary towels can be used to prevent any staining of your clothes.
  • You should continue to use your pessaries until the course is completed, even if this means inserting them during your monthly period. If you do use them during your period you should use sanitary towels rather than tampons.
  • Some pessaries can damage diaphragms and condoms, making them ineffective as contraception. Read the printed instructions in the packet to determine if this applies to your pessaries.
  • EXPIRY: never use your pessaries after the expiry date as they may no longer be effective. Follow the printed instructions given with your pessaries.
  • STORAGE: store your pessaries in a cool, dry place.
  • Always keep medicines out of the reach of children.
  • If you forget to insert a pessary (miss a dose), insert the pessary as soon as you remember, and then go on as before.
  • Always use the pessaries according to the printed label or as instructed by your doctor or pharmacist.
  • Pessaries are only intended for vaginal use and must not be taken by mouth.
  • Inform your doctor or pharmacist if you accidentally use more than you were supposed to.
© 1998-2010 – All rights reserved. Re-printed with permission.

Urinary tract infection

Urinary tract infections are caused by microorganisms such as bacteria from the digestive tract. When these bacteria cling to the urethral opening, they multiply. The infection begins in the urethra. It can further go up in the bladder to cause cystitis. If it is left untreated, the infection may involve the ureters and eventually the kidneys, leading to pyelonephritis.

The urinary system itself prevents infection. The bladder and the ureters prevent backflow of urine to the kidneys. The prostate gland in men also slows bacterial growth by its secretions. But despite these safeguards, infections can still occur. An abnormality of the urinary tract infection can lead to infection.

Catheters and tubes placed in the bladder are the common causes of infection. Bacteria found on the catheter can readily infect the bladder. Diabetic patients are also at risk of developing infections. Any change in the immune system may be a contributory factor. It is not yet proven why women have more urinary tract infections than men. One of the factors probably is that urethra of women are short. This means bacteria will have quick access to the bladder. The urethral opening of women is also near sources of bacteria such as the anus and vagina. The use of a diaphragm was also found to have a contributory factor for the development of infection. Recurrent urinary tract infections are also common in women. It was found out that bacteria have the ability to attach to cells lining the urinary tact. Urinary tract infection may also occur during pregnancy. Though this is not a common finding, it is often serious. Infection may involve the kidneys. This is due to hormonal changes and position of the urinary tract during pregnancy.

Frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination are some of the symptoms. Pain can also be felt even when not urinating. Women feel an uncomfortable pressure above the pubic bone. Experience of fullness in the rectum is often felt by men. A small amount of urine is passed despite the urge to urinate is another common finding. Color of urine may vary from milky, cloudy and reddish if blood is present. If the infection has reached the kidneys, a fever may be present. Back pains, nausea, and vomiting are other symptoms of kidney involvement. When a child seems irritable, has unexplained fever, incontinence or loose bowel movement, and is not thriving, UTI can be considered.

In order to diagnose UTI, a sensitivity test can be performed. This is done by growing bacteria in a culture and testing them against different antibiotics. This is done after examining the urine for white and red blood cells and bacteria. Urine is further tested for pus. Urine sample is taken by collecting midstream urine. This is to prevent bacteria around the genital area from getting into the sample. If an infection does not clear up, doctors can request an intravenous pyelogram to visualize the kidneys, bladder, and ureters. A radiopaque dye is injected and series is of x-rays are conducted.

Antibacterial drugs are used to treat urinary tract infections. The sensitivity test is useful in selecting the most effective drug. The patient’s history is also consideration in the choice of drugs. The drugs most often used for uncomplicated UTIs are trimethoprim, amoxicillin, nitrofurantoin, and ampicillin. If the infection is not complicated; it can be treated with 1 or 2 days of treatment, though some doctors still ask their patients to take antibiotics for a week. Infections caused by Chlamydia and Mycoplasma are treated with tetracycline or doxycycline. A followup urinalysis may help confirm a urinary tract that is infection free.


Congenital Anomalies of the Vagina

Boston Children's Hospital

The Center for Congenital Abnormalities of the Reproductive Tract at Children’s Hospital Boston provides medical, surgical, obstetrical and psychosocial consultation and care to girls, adolescents and adult women, from birth to age 22, with congenital or acquired structural abnormalities of the reproductive tract.

The Center for Anomalies of the Reproductive Tract at Children’s Hospital Boston treats various congenital anomalies of the vagina, including:

  1. transverse vaginal septum
  2. vertical or complete vaginal septum
  3. vaginal agenesis
  4. MRKH (Mayer-von Rokitansky-Küster-Hauser’s Syndrome)
  5. agenesis of the lower vagina
  6. obstructed hemi-vagina with ipsilateral renal agenesis (OVIRA)

Types of Uterine Fibroids

Author: Paul Indman, M.D.

Dr. Indman believes that women should be as informed as possible so they can be directly involved in making choices about their own health care. This is especially true for the treatment of heavy bleeding. As there are a bewildering number of treatment options available, Dr. Indman takes extra time with his own patients to be sure they make the best possible individual decisions.

Dr. Indman has helped pioneer techniques in Gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals.

Uterine Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus (Submucous myomas) will often cause bleeding between periods and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called “hysteroscopic resection,” which can be done through the cervix without the need for an incision. Some submucous myomas are partially in the cavity and partially in the wall of the uterus (see illustration below). They too can cause heavy menstrual periods (menorrhagia), as well as bleeding between periods. Many of these submucous fibroids can also be removed by hysteroscopic resection.

Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many intramural fibroids do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all.

Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroid). These do not need treatment unless they grow large, but those on a stalk can twist and cause pain. This type of fibroid is the easiest to remove by laparoscopy.

While the above illustration shows small fibroids that are only in one area of the uterus, when fibroids get large they can take up the entire wall. In that case the outer part of the fibroid may be subserous, the middle part intramural, and the inner part submucous. The illustration to the right shows a fibroid that is partially intramural and partially submucous. This fibroid would be expected to cause heavy bleeding as well as pressure. The treatment of this type of fibroid depends on many factors, including the women’s desire to retain fertility.

© Paul Indman, M.D. – All rights reserved. Re-printed with permission.
You can follow any responses to this entry through the RSS 2.0 feed.

For Teens – When to see a gynecologist

When do I need to go?

A gynecologist is a doctor who has been specially trained in women’s reproductive health issues. You should talk to a parent or guardian about seeing a gynecologist (or another doctor who is specially trained in women’s health issues) if you:

  • have ever had sex (vaginal, oral or anal) or intimate sexual contact
  • are 21 or older
  • have lower stomach pain, fever, and discharge (fluid coming from your vagina) that is yellow, gray, or green with a strong smell. These may be symptoms of PID (pelvic inflammatory disease). PID is a general term for an infection of the lining of the uterus, fallopian tubes, or the ovaries. Most of the time, PID is caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhea that have not been treated. Not all vaginal discharges are symptoms of sexually transmitted infections.

In between periods, it is normal to have a clear or whitish fluid or discharge coming from your vagina. It should not itch or be uncomfortable. It should not smell badly. Read more about what your vaginal discharge should look like. Your doctor will tell you when you need to come back for another checkup.

Why do I need to go?

Getting routine gynecology care will:

  • help you understand your body and how it works
  • establish what is normal for you
  • find problems early so they can be treated or kept from getting worse
  • help you understand why it’s healthier for you not to have sex while you are a teenager
  • help you learn how to protect yourself if you do have sex
  • help you prepare for healthy relationships and future pregnancies

Getting care on a regular basis is important. Your doctor will talk to you about how to take care of your changing body, how to tell if you have a vaginal infection, why abstinence is the healthiest choice, and how to protect yourself from sexually transmitted infections if you are sexually active. A doctor will also talk to you about your period and will help you out if you are having any problems.

How do I make an appointment?

Talk to your parent or guardian. Or, if you don’t think you can talk to your parent or guardian, talk to someone else you trust about how to make an appointment. It is common to feel nervous about going to a clinic, especially when you’re a teenager. But being scared is not a reason to skip out. Some of your friends may say they don’t need to go, but it’s the smart thing to do. A check-up is one important way to keep yourself healthy.

What happens at a visit?

Part of your first visit may be just to talk so you can get to know each other. Your doctor may ask a lot of questions about you and your family. You can also ask the doctor any questions you have. You don’t have to be scared or embarrassed. Many teens have the same questions and concerns. You can also talk to your doctor about:

  • cramps and problem periods
  • acne
  • weight issues
  • sexually transmitted infections
  • having the blues or depression

During your visit, your doctor will check your height, weight, and blood pressure. He or she may also do the following exams:

  • Breast exam – It is really common for young women to have some lumpiness in their breasts, but your doctor will check your breasts to make sure you don’t have strange lumps or pain.
  • Pelvic exam – The doctor will examine inside your pelvic area to make sure your reproductive organs are healthy. The doctor will check out the outside of your genital area (the vulva) and will then use a tool called a speculum to look inside your vagina to see your cervix. Try to relax and breath. Finally, the doctor will feel inside to make sure your internal organs feel okay. There will be pressure, but it should not be painful.
  • Pap test – If you are 21 or older or within three (3) years of your first sexual experience, you should have a Pap test. This test is done to make sure the cells in your cervix are normal. The doctor will lightly swab your cervix during your pelvic exam to gather cells that can be looked at on a slide at a lab. It is best to have a Pap test when you don’t have your period. If there are any problems with your cells, you will be contacted.
If you are sexually active, it is especially important to have a Pap test. The Pap test helps the doctor know if more tests are needed to see if you are infected with the Human Papilloma Virus (HPV). Left untreated, this virus can lead to cervical cancer.

If it makes you more comfortable, you can have your mom, sister, or a friend stay in the room with you during the exam. If the doctor is male, a female nurse or assistant will also be in the room.


Graded Penetration Exercises for Vaginismus

What is Vaginismus?

Vaginismus [vaj-uh-niz-muh s] is a condition where there is involuntary tightness of the vagina during attempted intercourse. The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. Learn more »

  1. Have a look at your vulva with a mirror in good light after a bath or shower.
  2. Gently hold apart the outer vaginal lips (labia majora,) and try to identify the clitoris, urethral opening, vaginal opening and inner lips, (labia minora). Notice the difference in texture, colour and sensitivity.
  3. Allow your partner to be with you when you feel comfortable doing this alone.
  4. Try inserting one finger, if painful concentrate on breathing and relaxing. See if you can feel the pelvic floor muscles contract and relax. Try massaging the tender mound of muscle at the back of the vagina. Think of it as a knot of muscle similar to in your neck or shoulder.
  5. Guide your partner to do the same when you feel able and relaxed.
  6. Try inserting 2 of your fingers or a small vibrator. Use plenty of lubricant unless you are sufficiently sexually aroused. Expect it to feel tight and uncomfortable but notice how you can control the muscles and make it more comfortable.
  7. Guide your partner to do the same when you feel able and relaxed. Try to incorporate penetration into sexual play. The vagina actually opens and lengthens as you become sexually aroused making penetration easier and more pleasurable.
  8. When attempting penile penetration for the first time make sure you are aroused and well lubricated. Kneel astride your partner, facing his head and lining up your knees with his nipples; this achieves the right angle in most couples. Use one hand to splay open the vulva and use the other to guide your partner’s penis. Contract your vaginal muscles strongly for a few seconds and, at the moment of relaxation, lower yourself onto his penis guiding him in with your hand. If penetration is successful then don’t move at all but simply enjoy the sensation and offer each other congratulations. If you are a virgin, a certain amount of discomfort should be expected. Once you feel comfortable try contacting your vaginal muscles gently or rocking very slightly back and forwards; don’t attempt to move up and down on the penis until you can accomplish these movements without pain.
  9. Your partner mustn’t thrust against you but offer encouragement and be patient! Once sexual intercourse has been achieved in this position, you can experiment with other positions, and with male penetration and thrusting. You should always feel in control however, as unpredictable activity can cause anxiety, apprehension and vaginal tension.
%d bloggers like this: