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Vulva culture 

I can’t solve my recurring vulva problems! Plus: I’m a lady who loves biking but not crotch pain. Can you help?

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Q A question on your favourite topic, Dan. Just kidding, it's a question about my vagina. I'm having a problem with the microbiome of my vulva and vagina. I've been going to my gyno for the last six months for recurrent bacterial vaginosis and yeast infections. She shrugs, gives me a script, the symptoms go away for a week or so, then they come back. I understand the infections are likely due to an imbalance in my vaginal pH, but I don't know what to do to fix this. I've used probiotic suppositories to boost the amount of lactobacillus and these help more than anything else, but the problem remains. I also wear cotton, loose-fitting undies and practice good hygiene and never douche or use anything scented. The problem started when I stopped using condoms with my partner, but it's not an STI. We've both been tested. There're tonnes of sites online talking about this problem, but no one has a solution that I've found. How the hell can women with this problem fix their pH?! —Vexed Und Lacking Vaginal Answers

A "I love that she used the word 'vulva,'" says Debby Herbenick, a research scientist at Indiana University, a sexual health educator at the Kinsey Institute and the author of Read My Lips: A Complete Guide to the Vagina and Vulva. "Most people have no idea what that even is!"

I know what that is! (I know what that is now. I didn't know what that was when I started writing this column.) The vulva is (the vulva are?) the external genitalia of the female—the labia, the clit, the vaginal opening, some other bits and pieces. (Fun fact: Vulva is Latin for wrapper.) The vagina, AKA "the muscular tube," runs from the vulva to the uterus. (Fun fact: Vagina is Latin for the sheath of a sword.) People tend to use "vagina" when referring to a woman's junk generally, and while meaning follows use and I'm inclined to give it a pass, saying "vagina" when you mean "vulva" makes scientists like Herbenick rather testy.

Herbenick recommends seeing a "true vulvovaginal health expert" (TVHE) about your problem, VULVA, and your gynecologist presumably qualifies as a TVHE...right? "Not necessarily," says Herbenick. "Gynecologists know far more about vaginal and vulvar health issues than most health-care providers, but many gynecologists haven't received deep-dive—pun not intended—specialized training in difficult-to-treat vulvovaginal health conditions. And if they have, it was likely when they were in med school—so years ago. They might not be up-to-date in the latest research, since not all doctors go to vulvovaginal-specific conferences."

Is there a fix for that problem? "Yes! If everyone lobbied for their doctors to go to events like the annual conference of the International Society for the Study of Vulvovaginal Disease," says Herbenick, "we would live in a country with millions more happy, healthy, sex-interested women and others with vaginas and vulvas, too, like trans men."

As for your particular problem—a tough case of bacterial vaginosis— Herbenick, who isn't a medical doctor but qualifies as a TVHE, had some thoughts. "There are many different forms of bacterial vaginosis (BV) and different kinds of yeast infections," says Herbenick. "These different kinds respond well to different kinds of treatment, which is one reason home yeast meds don't work well for many women. And all too often, health care providers don't have sufficient training to make fine-tuned diagnoses and end up treating the wrong thing. But if VULVA's recurrences are frequent, I think it's a wise idea for her to see a true specialist."

A TVHE is likelier to pinpoint the problem. Even so, Herbenick warns that it may take more than one visit with a TVHE to solve the problem. "I don't want to over-promise, since BV remains a challenging diagnosis and often does come back at some point," says Herbenick. "There's no one-size-fits-all approach to BV, which is also why I think VULVA is best off meeting with a health care provider who lives and breathes vaginal health issues. The ISSVD is full of health care providers like that—they're the Sherlock Holmes of vaginas and vulvas, none of this 'shrug and here's a script' business. VULVA can check out ISSVD.org for more information."

Q I'm a woman in my 40s, and I love biking! My husband and I often go for long rides on the weekend. Unfortunately, this makes various parts of my crotch sore, especially the clitoris. Certain bike seats are better, but none eliminate the soreness. Two years ago, we had a baby, which not only made my crotch more prone to soreness but makes it a lot less likely that we'll have sex except on weekends, often after biking. The sore clit makes sex more painful, but it also increases sensitivity, so the whole thing can be an alternating experience of "Ow!" and "Wow!" Am I causing my clit any permanent damage by the biking and/or the post-bike poking? —Bike Related Injury To Clit; Help Ease Soreness

A "I love biking, I love vulvas and I love babies," says Herbenick, "so I appreciate being asked to chime in on this question. That said, there's not a ton of research on female genital health in connection with cycling."

There's far more research on men and cycling, due to the risks of bike-seat-related erectile dysfunction. "The few studies that have been conducted on women and cycling—generally cisgender women as far as I can tell—found that cutout seats are linked with a higher risk of genital symptoms, as are handlebars that are lower than the saddle," says Herbenick. "So broader saddles and higher handlebars may be the way to go. Some of the research notes higher rates of genital symptoms among people who go on longer rides, spending hours in the saddle."

To decrease your risk of un-fun genital symptoms, BRITCHES, Herbenick recommends mixing it up. "Go biking some weekends and try other activities on other weekends. You might also take Dan's 'fuck first' Valentine's Day advice and apply it to your weekend rides. And if you're prone to post-sex semen leakage use a condom or have him come elsewhere pre-ride so you don't have the semen seepage issue to contend with."

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