Have a question for Dr. Rankin?

Lissa's book, What's Up Down There? Questions You'd Only Ask Your Gynecologist If She Was Your Best Friend, answers questions from women all over the world about their bodies- what's normal and what's not. Below,  Lissa has selected some of the questions that she most commonly hears. 

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| Vaginas | Sex & Orgasms | PMS & Periods | Pregnancy & Childbirth | Aging & Menopause | Boobs | Pee |

Vaginas

My crotch gets extra funky sometimes. Not to quote a douche commercial, but why do I have that not-so-fresh feeling down there?

Even once you’ve accepted that your vagina is supposed to smell like you, you might wonder why it gets extra funky from time to time. When I was in college, a friend of mine got labeled “Tina the Tuna,” because a few guys who went down on her told their fraternity brothers she smelled like fish. What made Tina tuna-like? Chances are she had bacterial vaginosis, a common type of vaginal infection.

Bacterial vaginosis (BV) causes the classic fishy smell and is caused by an imbalance in your vagina’s natural bacteria. In a nutshell, the good bacteria decrease and the bad bacteria overgrow. This causes sloughing of the epithelial cells in the vagina, which may result in a profuse vaginal discharge, as well as the release of smelly amines that result in a fishy-smell.

Other causes of funky crotch include poor hygiene and excessive sweating. After a few days of not showering, you’ll likely start to reek. Working out can also increase the funk, because your girly parts are full of sweat glands, just like your armpits. Some women naturally have more sweat glands on the vulva, and more sweat can lead to more odor.

If you feel like your crotch is funkier than usual or your partner mentions that you smell suspiciously like halibut, check in with your gynecologist. Chances are, your problem can be treated.
 

When I start spewing discharge, how do I know if it’s a yeast infection or something more serious?

If your vagina normally runs on the dry side and then suddenly you’re spewing gunk, chances are good that something is off. Many assume that all itching or discharge equals yeast. As it turns out, this just isn’t true. How can you tell the difference between a yeast infection and other causes of abnormal discharge? Usually, a yeast infection causes a classic itchy, burning, red cooch, mixed with the signature clumpy, cottage-cheesey discharge. But other conditions can mimic these same symptoms.

Take Ellen, my patient who noticed itching, burning, and increased vaginal discharge. When I examined her, it turned out her symptoms had nothing to do with yeast. Instead, she was reacting to the thong underwear she started wearing while working out because she had a crush on her personal trainer and wanted to look sexy and sleek in her gym clothes. And then there’s Mary, who thought she had persistent yeast infections, which turned out to be related to vulvodynia, a whole other condition that can mimic chronic yeast infections.

If you’re clawing at your cooch but you don’t have a discharge, it could be any number of things: an allergy to your new tutti frutti berry-scented soap, a dermatologic condition of the vulva, or waning estrogen levels, among other things. If you’re spewing discharge without itching, it’s more likely to be either bacterial vaginosis, a bacterial infection characterized by a foul-smelling discharge, or a sexually transmitted infection, such as gonorrhea, chlamydia, or trichomonas. If you can’t tell the difference, see your gynecologist. It’s pretty easy for us to help you sort it out.
 

What causes my yeast infections? Is it because I don't clean very well down there?

No. In fact, it may be that you clean too well. The vagina is supposed to be colonized with good bacteria like lactobacillus, which keep yeast at bay. But if you’re douching, taking antibiotics, or scrubbing with antibacterial soaps, you may be killing the very bacteria that protect you. When the normal milieu of the vagina gets thrown out of whack, yeast can take over because the good bacteria aren’t there to fend them off. If your immune system is weak, as it may be during pregnancy or with chronic health conditions, yeast may overgrow more easily. And yeast love sugar, so diabetics and those who eat foods loaded with sugar are more susceptible.

Where does the yeast come from? Usually, the yeast sprints over to the vagina from the anal area, hops on your maxi pad, or winds up in your vagina from your partner’s mouth (it can go the other way too). A few yeast buds in the vagina are normal. It’s when they reproduce and go haywire that you wind up clawing at your cooch.
 

The older I get, the dryer I feel. What’s up down there?

The vagina’s moisture level varies throughout your lifetime. When we are babies just born from mothers who have estrogen coursing through their pregnant bloodstreams, our girl parts appear plump, pink, and fleshy, responding to the estrogen we are exposed to in utero. Then, throughout childhood, our estrogen levels fall to negligible levels. During this time, the vagina is reddish in color, very fragile, and extremely dry. Then puberty hits and – wham! – estrogen reappears, making the vagina fleshy again and stimulating secretions that lead to vaginal moisture. Moisture peaks during pregnancy, when estrogen levels surge, and falls off temporarily in the postpartum period for mothers who nurse, leading to temporary vaginal dryness. Once we stop breastfeeding, the vagina regains its moisture. As we age, estrogen levels fall off and, unless we treat our bodies with hormones, the vagina dries out.

If vaginal dryness is bothering you, over the counter vaginal moisturizers like Replens may help. If your dryness is getting in the way of your sex life, talk to your lover about using saliva to lube you up. Not only will you enjoy the benefits of a little licking, but this natural lubricant can prevent chafing and pain that comes with vaginal dryness. If salivary lube fails to do the trick, try using a sexual lubricant like K-Y Jelly or Astroglide. Or experiment with jojoba oil or Vitamin E on the vulva. If that doesn’t do it for you, vaginal or oral estrogen replacement can do wonders to get your vagina in tip top shape.

Sex & Orgasms

Where can I find my little lost sex drive and how can I get it back?

A woman’s libido can be a slippery little sucker. Unlike men with decreased libidos, who often respond to a little vitamin V (Viagra), women’s needs go deeper. After ignoring women’s sexual needs for decades, pharmaceutical companies are finally paying attention, trying to make big bucks marketing a magic pill to turn us on. So far, studies show that no single thing gets us in the mood. While drawing blood flow to the penis usually does the trick to turn on a man, increasing blood flow to the clitoris or vagina doesn’t necessarily do the trick in women. Our needs tend to be more complex.

Here are some tips I recommend to my patients:

1. Schedule sex dates. If you’re up late doing the dishes, doing the laundry, and doing the children’s homework, you won’t feel like doing your lover. Plan ahead and make it happen.
2. Fake it ‘til you make it. Not that you should ever fake orgasm (I highly recommend against doing so), but going through the motions of being sexual can get your juices flowing, even when you’re not in the mood.
3. Buy the book 101 Nights of Greaaat Sex by Laura Corn – and use it. It’s filled with tear-out pages of sexy seduction scenes For Him or For Her. It works every time, if you’re daring enough to be a little naughty.
4. Experiment with erotic movies, books or magazines. Send your inner critic to time out and see how you feel. Keep an open mind.
5. Invite some sex toys into the bedroom. If you usually keep your vibrator in the bottom drawer, under a pile of magazines, yank it out and welcome it into playtime with your partner. If you’ve never experimented with sex toys before, consider going shopping.
6. See your doctor. A battery of tests can look for reversible causes that can be addressed. You might also consider a trial of hormone replacement therapy. While studies to support its use are limited, some patients report improvement in their libido when using low dose testosterone replacement. If your estrogen and progesterone levels are low, as they are in menopause and may also be premenopausally, you may benefit from replacing these hormones as well. Talk to your doctor about the risks and benefits if you’re interested in exploring how hormones might help your sex life.
    

I’ve heard there are health benefits to having sex and orgasms. Is this true?

Yeah for us! That would be a resounding yes. In addition to the giddy euphoric effects that make our toes curl, sex and orgasm (including masturbation) seem to have other health benefits. Beverly Whipple, PhD, RN, famed sex researcher, and Professor Emerita from Rutgers University, lists the following evidence-based benefits of sexual expression. Engaging in acts of sexual expression may:

1. Help you live longer.
2. Lower your risk of heart disease and stroke if you have sex twice/week or more.
3. Reduce your risk of breast cancer.
4. Bolster your immune system.
5. Help you sleep.
6. Make you appear more youthful.
7. Improve your fitness.
8. Help protect against endometriosis.
9. Enhance fertility.
10. Regulate menstrual cycles.
11. Relieve menstrual cramps.
12. Help carry a pregnancy to full term.
13. Relieve chronic pain.
14. Help reduce migraine headache pain in some individuals.
15. Improve quality of life.
16. Reduce the risk of depression.
17. Lower stress levels.
18. Improve self esteem.
19. Improves intimacy with your partner.
20.   Help you grow spiritually.

The evidence is mounting. Orgasm isn’t just good - it’s good for you.

I can masturbate just fine, but I can’t seem to have orgasms of any sort when I’m with someone else. What’s wrong with me?

Nothing’s wrong with you, sweetie. But there may be things you can do to feel more right. While it may not feel like it, it’s very good news that you’re still able to orgasm through masturbation. If you can orgasm with masturbation but not with a partner, at least we know your parts are all in working order. Some women can’t orgasm either way, which can signal physical problems, such as nerve damage or circulatory problems. But if you can get your juices flowing by yourself, we know that’s not the case.

Most women who can’t orgasm with a partner are able to orgasm alone, which signals a psychological barrier of some sort. Things like anxiety, depression, stress, embarrassment, guilt, alcohol, drugs, and fear of pregnancy or sexually transmitted infections may erect roadblocks to orgasmic bliss. Other issues, such as feeling disconnected from your partner, lacking trust, the presence of unresolved relationship conflicts, or a history of sexual abuse can also get in the way.

In addition to these common barriers to orgasm, many of us also suffer from religious or cultural hang-ups we learned as kids. If you still hear Great Aunt Gertrude’s voice saying, “Only bad girls enjoy sex” or “Sex goes against God’s will, and God is always watching,” it’s no wonder you freeze.
If you feel safe and comfortable, try masturbating in the presence of your partner. If you’re in control and your partner is supportive, you may be able to bring yourself to orgasm, which is the first step towards experiencing orgasm in other ways. Most of the time, you can learn to overcome these challenges, unfolding the flower within you. Talk to a good gynecologist or- even better- a sex therapist. We can help.
 

Does the G-Spot really exist?

According to the teacher in my Gross Anatomy lab, the answer is no. As we were dissecting the vagina, someone asked, “So where’s the G-Spot, Doc?” My teacher, in his thick Eastern European accent, said, “Zere is no G-Spot in ze human female.” Okay, good to know.

The rest of my medical training pretty much agreed with Professor Von Dispel-a-Myth. An expert in the field even told me that every part of the vagina has been examined under the microscope, and there is nothing on the anterior wall of the vagina that looks any different than the rest of the vagina. Therefore, the G-Spot does not exist. Period.

However, as is the case with much I learned in medical school, my patients tell me otherwise. Over the years, thousands of patients have sworn that there is a place felt through the anterior wall of the vagina that hits the oh-oh-oh spot – or, rather, is the spot. I believe in many things I cannot see, so I tend to believe my patients.

Hunting for data to validate their experience, I came across Dr. Beverly Whipple, who famously named the G spot after German OB/GYN Dr. Ernst Gräfenburg, who described a zone of erogenous feeling on the anterior wall of the vaginal canal. (A friend of hers suggested she name it the “Whipple Tickle”, but out of respect for Whipples everywhere, she vetoed this idea.) According to Dr. Whipple, the G spot definitely exists. When I asked her why some in the medical community vehemently deny its existence, she seemed baffled. She said, “I don’t know. I guess, because they can’t see it under a microscope, they think it doesn’t exist. But my career has been about validating what real women experience. And some- but not all- definitely experience pleasurable feelings when you stimulate the G spot area.”

Her belief runs so deep that she went on to conduct hundreds of studies aimed at validating the sexual experiences women relate. For one study in 1981, 400 female volunteers were examined. According to Dr. Whipple, a spot that empirically swells with stimulation was found in each of these women, although she admits that not all women appear to be sensitive to this type of stimulation.

So what is the G spot? Dr. Whipple isn’t sure. As Dr. Von Buzzkill said, no specific anatomic differences can be detected in this area. But she suspects a cluster of blood vessels, nerves, glands (including the “female prostate gland”), and part of of the clitoris may all merge to create a sensitive area that hits the spot. She believes the female experience more than the microscope, and I tend to agree with her.
 

I feel uncomfortable with all things sexual and get all wigged out whenever it seems inevitable. What’s my problem and how can I relax during sex?

Most of us have sexual hang-ups, some warranted, some not. If you’ve been raised to believe that you should banish the temptress within you and that sex is sinful, it’s no wonder you get wigged out. Maybe you’ve been the victim of rape or sexual molestation, which rocks your sexual foundation. Perhaps you barely know your sexual partner and don’t feel comfortable making yourself so vulnerable, or perhaps you know your partner well but don’t feel safe. Maybe you don’t feel comfortable in your own skin. If any of this sounds familiar, talk to a therapist. You deserve to process those experiences now, or they may continue to haunt you.

While hesitation about sex can show up to protect us, sometimes it just gets in the way of sexual bliss. Here’s a few tips to help you relax into your sexuality.

1. Know and love your body. If you’re not celebrating your body, it may rebel and put up red flags during sexual activity. Love yourself, just the way you are.
2. Do a body blessing every night before you go to sleep. Close your eyes and scan through your body parts, starting at the top of your head and working downwards. As you approach each body part, pay attention to any negative thoughts that come into your mind, such as “I hate my fat ass.” Turn it around into an affirmation, such as “Thank you, butt, for cushioning me when I sit.” Do this all the way down to your toes.
3. Try relaxation exercises before you engage in sexual activity. Take a warm bath or have your partner massage you. Close your eyes and take a few very deep, cleansing breaths together. Light candles and incense, turn on soft, tinkly music- whatever it takes to help you relax.
4. Go slow. If you’re feeling uncomfortable or nervous during sex, perhaps you’re not ready. If your partner is truly caring, he or she will not pressure you. Give yourself permission to set the pace.
5. Masturbate. If other sexual activities make you nervous, try pleasuring yourself instead. The more you can relax into your own sexuality, the more you can comfortably share it with someone else. If you’re able to masturbate by yourself without feeling uncomfortable, try masturbating together. That way, you have control of the whole experience, but doing it together can be highly stimulating for both of you. Once you graduate from that step, you may find yourself more comfortable with other sexual activities.
6. Breathe deeply during sexual activity. Deep breathing relaxes your muscles and alters your mind. Pay attention to your breathing throughout the whole experience.
7. Be silly. Sex doesn’t have to be so serious. What better way to release the nervousness than to laugh? Laughing releases endorphins and stimulates the body in a whole host of ways. Try some laughter yoga exercises. Here’s one – stick your thumbs in your ears and stick your tongues out at each other. Now laugh out loud as hard as you can. Sounds goofy, I know, but try it! I swear it works.
8. Talk about how you feel. Don’t be nervous in silence. If you’re feeling nervous, talk about it. If you don’t feel comfortable talking to your partner, talk to a girlfriend. Don’t judge yourself for your nervousness. In time, this too shall pass.
9. Acknowledge your fears. What is making you nervous? What lies at the root of your feelings? Are you living in the present moment, or is your past getting in the way? Write your answers in a journal.
10. Engage in activities that make you feel empowered. Train for a race, donate your time to a charity, campaign for a cause you believe in, or do a health cleanse. For more ideas about how to feel empowered, check out Owning Pink.com. Feeling empowered makes you feel more secure in vulnerable situations. Anything you can do to increase your sense of empowerment will follow you into the bedroom.
     

PMS & Periods

Why do I get clots when I get my period? Should I be worried?

Some women get all wigged out about passing blood clots, but actually, clots are good news. They mean that all of your clotting factors are doing exactly what they’re supposed to do when you bleed. I’ve had patients fish clots out of the toilet, put them in little Tupperware containers, and bring them in to show me. While I appreciate the, um, gift, rest assured that clots are nothing to worry about.

If you’re bleeding heavily, with or without clots, call your doctor right away. If you’re also dizzy, lightheaded, pale, or passing out, get thee to a hospital. But don’t stress about the occasional clot. It’s just nature doing its job.
 

I despise getting my period and my doctor says I can skip it with birth control pills. It just doesn’t seem natural. Is it safe not to menstruate? What happens to all that blood?

I swear, PMS turns me from Dr. Jekyll into Mr. Hyde. Why do I turn into a blood-letting, wild-eyed, raging lunatic before I get my period?

Studies have failed to elucidate a clear answer about what causes PMS. Most blame the fluctuations in our hormones and brain chemicals that happen during menstruation. But the truth is we just don’t know for sure (and believe me, we know-it-all doctors hate to utter those words).

Some suggest that PMS exists because we expect it to exist, and those who grow up believing that they will experience PMS do. One study found that when you trick a woman into thinking she will menstruate at a different time, she reports PMS symptoms just before she thinks she will menstruate, not before she actually bleeds. But try floating this theory to someone in the throes of crying spells and chocolate cravings. You’re likely to wind up with a Kit-Kat in your ear.

In her book Women’s Bodies, Women’s Wisdom, Christiane Northrup, MD suggests that we embrace the changes that happen with our hormonal cycles. Rather than cursing our hormones, she encourages us to rejoice in them, listen to what they tell us, and respond to their call. In the first or follicular phase of the menstrual cycle (days 1-14, where day 1 is the first day of bleeding, so usually the week of your period and the following week), creative energy is high and we are outgoing and attractive to others. New projects or ideas are best initiated during this phase. At ovulation, creativity peaks and we are receptive to others, a time we can optimize. After ovulation, in the weeks leading up to menses, progesterone dominates, as we listen and revel in contemplative reflection upon our creations and challenges. During this time, Dr. Northrup says, “Women are most in tune with their inner knowing and with what isn’t working in their lives.”

Premenstrually, in the phase commonly known as PMS, Dr. Northrup claims we are more intuitive, more susceptible to tearful emotion, more angry, more connected to our pain, and more in touch with old problems. She suggests we accept this as a normal part of womanhood, rather than deny it, honoring our natural cyclic ebb and flow, allowing ourselves this reflective time, and using our menses as a period of rest and rejuvenation.

Maybe we’re not supposed to feel cheerful, productive, and at top performance every minute of every day. In tribal societies, menstruating women were often isolated from the tribe, spending the time of their menses with other menstruating women, since blood was believed to attract predators and put the tribe at risk. I’ll bet those women had a really good time in the Red Tent, temporarily relieved of their duties and bonding with other women. If we could honor our bodies, listen to our hormones, and put life on hold, perhaps our premenstrual slow-down could help us get in touch with who we really are.

But I hear you, ladies. If you’re an attorney and a critical trial date is scheduled for the week before your period, you may be thinking, “Good luck getting a judge to understand my primal need for rest.” Indeed, we live in the modern world, but being attentive to our natural cycles can help us accept what is.
 

Do you have any natural tips for helping my PMS?

Yes. When my patients suffer from PMS, I recommend the following:

1. Eat a whole foods diet. You’ve heard it before, and that’s because it really does help. A whole foods diet means cutting back on sugar, refined carbohydrates, caffeine, processed foods, and saturated and hydrogenated (trans) fats. Instead, add fruits, veggies, lean proteins, and whole grains, especially during the luteal phase (second half) of your cycle. And I’m so sorry to break it to you, but that means bye-bye chocolate. Also, some women manifest gluten sensitivity and lactose intolerance with PMS symptoms, so if you’re suffering, experiment with cutting out wheat and dairy.
2. Increase essential fatty acids by eating nuts, seeds, and fish.
3. Manage your stress effectively. Try yoga, meditation, massage, or guided imagery CDs.
4. Engage in regular aerobic exercise. A good, long hike helps regulate your hormones and your stress, and it builds up happy-making endorphins.
5. Take a multivitamin and 1200mg of calcium a day.
6. Talk to an integrative medicine doctor about how supplements may help your PMS symptoms. Alternative medicine therapies like acupuncture and Reiki may also help.
    

Pregnancy & Childbirth

Is there a test that can tell me whether I’m fertile?

If you’ve put off pregnancy to pursue your career, waited decades for the right partner, or delayed childbearing to get ready emotionally, you’re just like many of my patients. Then one fateful day, you meet the perfect lover, your career is on auto-pilot, and you realize you’re ready. But wait! Is it too late? Wouldn’t it be great if you could simply take a blood test that would predict whether you’re still fertile?

Unfortunately, it’s not that simple. While a blood test called FSH (follicle stimulating hormone) can be ordered by your doctor, and FSH can also be measured more crudely by the over-the-counter First Response fertility test, these tests are far from perfect. While a high FSH level can suggest that your eggs are less fertile, a low FSH does not in any way guarantee that you will get pregnant. And I’ve seen women with menopausal level FSH tests conceive. So you just never know until you try. If you conceive and give birth to a child, you’re fertile. While you can undergo an extensive battery of tests to evaluate why you might be infertile, normal testing does not prove that you are fertile. And even those tests are imperfect. I’ve seen many women with abnormal testing go on to conceive naturally after years of expensive fertility treatment. When it comes to a woman’s ability to conceive, I’ve learned to never say never.
 

How late is too late to get pregnant?

When it comes to this stuff, I’ve learned to keep a very open mind. As we age, fertility wanes. Because there’s no way to really know whether you’re fertile until you try, there’s no easy way to predict when it might be too late. So how late is too late to get pregnant? Well, it depends. Technically, it’s too late to conceive spontaneously once you hit menopause. But fertility usually drops off long before menopause. By the age of 45, 87-99% of women are infertile. After that, it may still be possible to conceive, but most likely you will need donor eggs implanted via in vitro fertilization (IVF).

One notable exception to the rule that you can’t conceive after menopause comes to mind. My patient Maddy, who was diagnosed with premature ovarian failure (early menopause) in her twenties, was told she could never get pregnant. She never menstruated, and all of her blood tests indicated that she was in menopause. She was given birth control pills as hormone replacement, but, because she wasn’t using them as birth control, she was careless about taking them every day.

One day, Maddy, who is arguably the buffest woman I have ever met, came to see me complaining that her waistline was widening, and her pants didn’t quite fit. She had asked her husband, who happens to be an OB/GYN, whether she looked fat. Her husband (wise man) quickly answered, “Of course not, dear.”
Maddy showed up at my office, assuming she had a fibroid tumor in her uterus.

Long story short, we scanned Maddy’s uterus and found a fetus growing inside. I said, “Congratulations, Maddy! Your fibroid is a boy!”
Maddy’s story is one of many, but don’t let that lull you into thinking you can just sit around on your laurels if you’re hoping to become a mother. I absolutely believe that we make better parents by waiting until we’re emotionally ready to be parents. But I hate to break it to you- biologically speaking, the sooner the better.

I don’t mean to be a buzz kill to all you women out there focusing on your careers, waiting for the right partner, or sitting on the fertility fence like I did. But I think it’s empowering to be informed so you can choose the life you want to live, rather than seeing yourself as a victim of fate or circumstance. It’s your life. If you are one of those women who must be a mother of a child created from your own genes, don’t wait. Recognize the importance of your dream and make it a priority. Remember, there’s no perfect time to take a leap of faith. That’s why they call it a leap of faith. Believe.
 

What foods should a pregnant woman really avoid? Brie? Sushi? Swordfish? Lunch meat?

With morning sickness, heartburn, and a stomach that gets pushed up into your diaphragm, you may find it hard to eat anything when you’re pregnant. Add to that the laundry list of dietary no-no’s you’ll read about in most books, and it’s a wonder that pregnant women eat at all. So what can a pregnant woman eat?

I’m a big fan of moderation. Everything in moderation- even moderation. Pregnancy is not a good time to eat the same thing over and over again. A balanced, varied diet of whole foods, heavy on the veggies, fruits, lean proteins, and whole grains, will serve you well. Unfortunately, even if you eat all organic, hormone-free, wild-caught, free-range food, you can’t eliminate all risk. You also can’t live in fear.

The main reason you hear so much fuss about diet in pregnancy is because the immune system of a pregnant woman is naturally suppressed. It’s the body’s way of keeping you from fighting your baby as a foreign body. This natural immunosuppression makes you more susceptible to infections, and when pregnant women catch certain infections, the baby may be at risk. Also, because the fetus is so fragile, certain exposures, such as mercury, may affect their developing bodies.

To limit the risk to you and your baby:

1. Stick to fully cooked meats, fish, poultry, and eggs. Which means you can eat sushi, just pick the cooked shrimp, crab, or eel rolls.
2. Avoid unpasteurized dairy products, such as fresh cheese you might find at a local farmer’s market. If you can buy it at a regular grocery store, it’s probably pasteurized. But some specialty cheeses, especially foreign imports, may not be. If you’re not sure, go to a good cheese shop and ask.
3. Be mindful of the fish you choose to eat. The U.S. Food and Drug Administration (FDA) advises pregnant women to avoid the fish with the potential for high mercury levels (shark, swordfish, tilefish, king mackerel) and limit fish with lower risk to two meals/week.
4. Wash all fruits and veggies thoroughly, and try to eat organic if you can. If you don’t have access to organic produce or can’t afford it, avoid the “dirty dozen”- peaches, apples, bell peppers, celery, nectarines, strawberries, cherries, kale, lettuce, grapes, carrots, and pears, which may be most heavily laden with pesticides.

Is there any way to prevent stretch marks?

It’s bad enough that our babies forever alter our figures. But must we endure garish stretch marks to boot? While there’s no guaranteed way to avoid stretch marks during pregnancy, avoiding rapid weight gain is the ticket. If you gain 80 pounds during your pregnancy, you’re almost guaranteed to get stretch marks. But even if you slowly gain the 25-30 pounds recommended during pregnancy, they’re less likely (but still possible). If you do wind up with stretch marks, blame your parents. Whether or not you get stretch marks seems to be largely genetic.

As for prevention, the beauty industry leads you to believe you can prevent stretch marks if only you apply the right potion. In spite of the rumors, cocoa butter does not prevent stretch marks. The only cream I could find that has evidence to prove that it actually helps contains centella asiatica extract, alpha tocopherol (vitamin E), and collagen-elastin hydrolysates. But when I was pregnant, I couldn’t exactly find this at my local Walgreens.

The good news is that stretch marks shrink and fade with time. If you’re self-conscious about your stretch marks, tretinoin (Retin-A) may be used postpartum to help reduce the appearance of stretch marks. Laser treatment can also help.

Personally, I recommend acceptance. So your body changes after having a baby – so what? It’s a given. Remember that true beauty lies within and can’t be touched with stretch marks. It’s worth the sacrifice to bring forth a new life into this world.

I just gave birth and I’m overwhelmed with feelings of regret. My whole life has changed and I miss my old life. I can’t tell anyone how I feel- they will think I’m a horrible mother. What’s wrong with me? Where are all those maternal instincts they talk about?

I completely understand how you feel. Before the baby, you likely enjoyed 8 hours of uninterrupted sleep each night, a body that felt like yours, the ability to focus on your work, the undivided attention of your partner, and personal time to rejuvenate, relax, and pursue your passions. Now all of the sudden, those luxuries feel like a thing of the past. And to top it all off, you’re responsible for this helpless little person who is a bawling ball of need, unable to even thank you for all your sacrifices. To make matters worse, you may feel like you’re supposed to be instantly overwhelmed with feelings of love, tenderness, and joy for this creature you just brought into this world. After all, that’s how it is in the movies, right? You give birth, then your whole life is rose petals and fairy wings, right?

While they may not admit it, not even to themselves, I would put money on the belief that every mother has felt exactly like you at some moment in her maternal life. Having a child changes you. When you give birth, you also experience a sort of death- the death of life as you knew it. It’s only natural to mourn that loss of the self you know and love. It’s important to give yourself permission to grieve.

This doesn’t mean you can’t reclaim your self, rebuild your life, and emerge from your ashes as someone even better. But this doesn’t happen overnight. There’s a process we all go through, if we’re honest with ourselves. The first few months pass in a blur. On one level, every moment of being a new mother feels eternal- the tedium of night feedings and pediatrician visits and shaking the rattle over your newborns blurry eyes. On another, it passes in a blink. But over time, the grieving of your old life passes and you step into gratitude for the new life you’ve created.

When you choose to become a parent (or if circumstances choose you, as the case may be), it’s like standing at a crossroads. One road leads to a childless life, with all its joys and sorrows. If you choose that path, you may travel more, experience more adventure, retain your girlish figure, and enjoy more freedom. But later in life, you may long for the quiet joys of family. On the flip side, if you choose to take the path of motherhood, you sacrifice much. But you’ll likely be prone to moments of elation that you might have never known if you hadn’t had become a mother.

Patients have asked me whether I “recommend” becoming a mother. I tell them that I don’t buy into any of the romance of having a child. Personally, I could have gone either way. Had I chosen to be childless or had the Universe denied me the opportunity, I would have lived a very different, but certainly blessed and happy, life. Because I chose to take the other fork in the road, I can’t imagine my life without my beloved daughter. But it’s not black or white, better or worse. It’s just different.

There’s no point looking back. You have embarked upon the motherhood journey, and I guarantee that you have within you everything it takes to rise to the occasion. It’s all about how you respond to the change. To quote my friend Dr. Joanne Perron, who is an OB/GYN, yoga instructor, and sage, “Pain is inevitable. Suffering is optional.” Joy is a choice. Feel your feelings and know that it’s okay. But don’t fall into wallowing.

Keep in mind that feelings of inadequacy, doubt, and regret are common and normal. But the line that divides normal from postpartum depression can be fuzzy, and it’s critical to figure out where you lie in relation to this dividing line. How come many women feel just like you, but only a desperate few go on to neglect or hurt their children or themselves? Depression can devastate.

To figure out where you stand, check in with yourself. Can you still experience moments of joy? Do you feel hopeless, helpless, and worthless? Can you look ahead and see a light at the end of the tunnel or do you feel like you’re in a dark, dead-end cave of despair? Trust the truth that lies within you.

If you’re unclear about whether your feelings are normal, talk to a therapist or physician, who can screen you for postpartum depression. If you’re considering hurting yourself or your children, get help immediately. These feelings are nothing to mess around with, and the sooner you can process the change in your life, the sooner you and your baby will thrive.
 

Aging & Menopause

How do I know if I’m in menopause?

By definition, you have officially hit menopause one year after your last period or when your ovaries are surgically removed. While this is the technical definition of menopause, it’s not a very practical one, since estrogen levels begin to fall long before you’ve skipped a year’s worth of periods. Many women experience symptoms of estrogen deficiency even sooner than that. The term perimenopause comes in handy for defining that in-between time, when your hormones are declining but you’re not technically in menopause yet. If you’ve had a hysterectomy, you’re taking birth control pills, or you have a condition like fibroids that makes you bleed, it may be harder to tell when you’ve hit menopause.

Most women know when they are approaching menopause because their hormones go cuckoo. Estrogen withdrawal can lead to embarrassing hot flushes, pajama-soaking night sweats, sex-busting vaginal dryness, relationship-threatening mood swings, irritating forgetfulness, and changes in skin firmness that leave you thinking about Botox. It’s enough to turn a perfectly sane, capable woman into a basket case. Granted, some breeze through menopause. However, if you are one of those basket cases, see your doctor. We can help.
 

Now that I’m in menopause, it is inevitable that I’m going to be a fat cow?

Hey, easy on yourself, girlfriend. Don’t be calling yourself a fat cow. I prefer the term “fluffy.” But I hear what you’re saying. While it’s not inevitable, many women do experience weight gain in menopause, unless they change how much they eat and exercise. Because your metabolism slows down, you may gain weight if you don’t eat less or exercise more.

You might be one of the lucky few who can keep piling on the carbs without ever moving your booty, but those women are rare. The way I see it, menopause is a good time to reassess your health habits. As we age, eating well and exercising regularly are just part of building better lives. Let this be a time to optimize your wellness in anticipation of a long, full, vital life.
 

As I get older, my libido just isn’t what it used to be. Why is that?

It’s unclear whether declining libido happens because of beliefs or because of menopause. If your ingrained beliefs tell you that older women aren’t sexual, you’ll likely manifest your beliefs. On the other hand, if you believe that women are like fine wine, improving with age, your sex life will probably reflect this.

While a large part of your sex drive lies in your mind, hormones also play a role after menopause. Falling levels of sex hormones, especially androgens like testosterone, may affect how jazzed up you feel when it comes to sex. After menopause, your ovaries continue to produce some testosterone, the hormone most associated with your sex drive. But the levels drop off, especially if you have had your ovaries surgically removed, which may reflect how you feel about getting it on. Some evidence shows that replacing testosterone to increase blood levels helps women after menopause , so you might ask your doctor about whether testosterone replacement could benefit you.

Why all the hype around bioidentical hormones? Are they safer than synthetic hormones? If I take them, will I look as good as Suzanne Somers?

Bioidentical hormones are hormones synthesized in a lab to be identical in molecular structure to the hormones produced in your body. Synthetic hormones, such as Premarin and Prempro, are intentionally created to be unnatural, since pharmaceutical companies cannot patent a natural bioidentical hormone but can patent a drug with a unique formulation. Bio-identical hormones, on the other hand, are usually made in a compounding pharmacy (although a few pharmaceutical brands like Vivelle and Prometrium are also bioidentical hormones).

Before the WHI first released its surprising data about hormone replacement therapy in 2002, most women taking hormones took synthetic hormones. The WHI studied Premarin and Prempro, synthetic hormones manufactured from pregnant mare urine. After results were published, interest in bioidentical hormones skyrocketed. If synthetic hormones posed such risk, maybe bioidentical hormones would be safer. Many women discontinued their Prempro and switched over to bioidentical hormones.

Are bioidentical hormones better than synthetic hormones? I think so. One size definitely does not fit all when it comes to hormones. Because we can compound hormones, we can customize therapy and tailor your needs to just the right hormones at just the right doses. Plus, in my experience, women experience fewer side effects on bioidentical hormones than on synthetic ones.

But are they safer? We honestly can’t say. Because bioidentical hormone formulations cannot be patented, there is no incentive for any drug company to spend millions of dollars funding large studies to assess safety. So we must proceed with caution. While it’s reasonable to believe that bioidentical hormones formulated to mimic the hormones made in our own bodies may be safer, we don’t have good proof to support this hypothesis.

When my patients choose to replace their hormones after menopause, I use bioidentical hormones at the lowest possible doses to achieve our goals. But I always inform my patients that we cannot yet prove that bioidentical hormones are any safer than synthetic ones.

As for whether you’ll look like Suzanne Somers, I can’t say. She is certainly a beautiful woman who has clearly been blessed with some serious beauty genes. And yes, she is quite vocal about her use of high doses of bioidentical hormones. Maybe she should wear a disclaimer that says something like “Actual results may vary.”
 

Boobs

My boobs are two totally different sizes. I call them “Flip and Flop, a tale of two titties.” Is that normal?

Body parts are often asymmetric. My left foot is a size 7, while my right foot is almost an 8. The rings that fit my right hand are too big for my left hand. We don’t think much of it if our feet or fingers are different sizes. Boobs are the same way. No two are exactly alike.

It’s quite common to have some asymmetry in breast size. My patient Serena called herself The Cyclops because one breast was a perky A cup and the other was a slightly droopy C cup. She always felt self-conscious and considered getting an implant one side, until her boyfriend confessed that he loved her lopsided breasts. Think of your asymmetric breasts like you would a crooked smile or a beauty mark- they’re all subtle imperfections that makes you all the more endearing and unique.

I’m terrified of getting my boobs lopped off. Is there anything I can do to prevent breast cancer?

To decrease your breast cancer risk, here are some tips.
1. Have your children at a young age.
2. Breastfeed for at least six months.
3. Minimize the use of hormones after menopause.
4. Maintain a healthy weight.
5. Exercise regularly.
6. Practice monthly self-breast exams.
7. Eat five or more servings of organic fruits and vegetables per day.
8. Limit your intake of animal fats, particularly red meat.
9. Avoid alcohol, or limit it to no more than 1-2 drinks per day. If you do drink alcohol, take a folic acid supplement, which moderates this risk.
10. Increase your intake of superfoods high in antioxidants, such as kale, beets, carrots, beans, collard greens, brussels sprouts, and broccoli.
11. Drink green juice.
12. Avoid dairy or use organic butter, cheese, and milk, as they are less likely to be contaminated with human growth hormone or estrogen, which is sometimes used to stimulate milk production in cows.
13. Use extra-virgin olive oil, raw flaxseed oil, and cod liver oil.
14. Expose yourself to the sun, which increases your levels of Vitamin D.
15. Get mammograms (or investigate alternatives).
16. Know your family history. If you have a first degree family member who was diagnosed with breast cancer before menopause, consider talking to a genetic counselor.
17. Be aware of xenoestrogens, environmental chemicals that act like estrogen in the body and may increase your risk of breast cancer. While you can only do so much to avoid xenoestrogens in your own life (eat organic, avoid plastic, etc), heightened awareness and caring for our planet may help save us all.

Pee

When I laugh or sneeze, I always leak pee. What’s up with that?

You probably have stress urinary incontinence. The name might suggest that it’s caused by emotional stress (it’s not) or that it causes stress (it can). Actually, stress urinary incontinence is usually caused by a change in the angle of the urethra, the tube that connects the bladder to the outside world, and a weakening of the urinary tissues. Predisposing factors, such as childbirth, aging, and genetic factors may make you more susceptible to leaking urine under “stress,” which in this case entails things like laughing, coughing or sneezing. When this happens, the pressure inside the abdomen exceeds the urethral sphincter’s ability to hold in urine. And voila- you leak. But fear not – you’re not doomed to this fate for all eternity. Read on …

Have you ever known Kegel exercises to really work and eliminate incontinence?

Absolutely. In fact, my patient Elise did her Kegel exercises so religiously that her boss Andrea started suspecting something was seriously wrong with Elise. Elise would be sitting in a board meeting with a strained, serious look on her face, and when someone asked her a question, she seemed clueless, as if she hadn’t been paying attention. During lunch breaks, Andrea seemed distant and distracted. In the bathroom, Andrea noticed that Elise spent extraordinary amounts of time in the toilet. Finally, Andrea called Elise into her office.

Andrea confessed that she and the rest of the team suspected that Elise might be drinking on the job, using drugs, or suffering from some sort of mental illness. Elise seemed so inattentive, and Andrea couldn’t begin to imagine what she was doing in the bathroom for so long. They asked her to take a drug screen, which Elise passed with flying colors. With her job on the line, Elise finally confessed. She was plagued with urinary incontinence, and when I told her to do her Kegel exercises religiously, she took it to heart. She did Kegels in the board room, Kegels in her office, Kegels in the lunchroom. And whenever she used the toilet, she practiced starting and stopping the stream of urine until all of the urine was released.

When Elise explained what was happening, Andrea asked, “Well, is it working?” Turns out that Andrea, another patient of mine, was also suffering from stress urinary incontinence but didn’t believe that Kegels could actually work. She and Elise began egging each other on at work, reminding each other to do Kegel exercises (on break, instead of in the board room). Both reported significant improvement in their symptoms.

Elise and Andrea aren’t alone. Studies demonstrate that when incontinent women are compliant with these safe, cost-effective pelvic muscle exercises, they demonstrate improvement when compared to placebo treatments. , And as an added bonus, your orgasms may strengthen in intensity (woo hoo!) So yes, Kegel exercises may be worth the effort. They don’t always work, and some patients need to pursue further treatment, but why not try? You’ve got nothing to lose (as long as you don’t lose your job!).
 

Are there ways I can reduce the risk of getting UTIs after sex?

Yes. Here are a few tips:

• Empty your bladder before and after sex.
• Making sure you wipe from front to back to avoid contamination of the urethra with rectal bacteria.
• Drink plenty of fluids.
• Take Vitamin C supplements daily, which increase the acidity of the urine, making it harder for bacteria to grow.
• Take cranberry supplements.
• Wash your genital region before intercourse, and have your partner do the same.
• Try to avoid any cross-contamination between the anus and the urethra. If you engage in anal sex play, keep all contaminated body parts and sex toys far away from the urethra.
• Experiment with different sexual positions that reduce friction around the urethra.
• If nothing else helps, talk to your doctor about taking one dose of an antibiotic before you have sex each time. While regular use of antibiotics is best avoided, this may be the only way some women find relief from recurrent UTIs.
   

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