The Vagina Bible: The Vulva and the Vagina—separating the Myth from the Medicine by gynecologist Jennifer Gunter is a lively, educational guide separating information from misinformation, presented in a clear, smart, sassy style.
“There’s a lot of money in vaginal shame,” writes Jen Gunter. She is known as the clever and outspoken OB/GYN on Twitter (@DrJenGunter—follow her!) who challenges celebrities and companies trying to sell us unneeded (and sometimes harmful) solutions for invented problems. She rips their claims and substitutes solid facts. All of this book is educational, revealing, and empowering. Examples:
- “[T]he other problem with doctors not asking about sex is women who have medical conditions that interfere with their sex life, typically conditions that cause pain with sex, end up minimized. Many women suffer for years not realizing they have a medical problem that has a diagnosis and treatment.”
- “It is hard to overestimate the damage done by Sigmund Freud in popularizing the myth of the vaginal orgasm. Only one third of women are capable of achieving orgasm with penile penetration alone…so the idea that everyone should be having orgasms this way results in two thirds of women believing there is something wrong with their sexual wiring when really they are perfect. Not orgasming with unassisted penile penetration is not a flaw, it’s a feature.”
- “MRI studies looking at anatomy during heterosexual sex reveal that the clitoris can be compressed by the penis, which is why some women can orgasm with penile penetration.”
- “Vulvar cleansing has never been studied. That is interesting, considering the array of products that claim to be gynecologist tested or approved…Some of these washes make claims they can reduce bacterial vaginosis (BV). They can’t. An external wash cannot possibly impact the inside of the vagina, and washing internally with one of these products (some women do that—please don’t) could definitely increase your risk of BV by killing good bacteria or irritating the vaginal mucosa.”
Parts of The Vagina Bible are so hilarious that you’ll want—as I did—to read them aloud to a companion:
- “Almost every woman has been told at least once…to wear white cotton underwear as a medical recommendation to prevent yeast infections and other vaginal mayhem. This makes it sound as if vaginas and vulvas are accidents waiting to happen. The vulva can handle urine, feces, and blood, and vaginas can handle blood, ejaculate, and a baby, so this idea that a black lace thong is the harbinger to a vaginal or vulvar apocalypse is absurd.”
- “I have read about plastic surgeons who do labiaplasty [surgical reduction of the labia minora] so women can look ‘sleeker in so-called athleisure wear.’ I know some people call this look ‘camel toe,’ but I prefer ‘labial cleavage,’ and the answer is not surgery—it is better-fitting athletic wear.”
- “I’ve stared at more male butt cracks (gluteal clefts) than I care to remember…What I never hear is that men should seek out plastic surgeons to get their gluteal clefts sewn shut. I also can’t imagine a similar industry for men that profits from surgically trimming penises so they look better in tight jeans.”
The second half of this book is a serious, comprehensive, scientific resource about infections, conditions, symptoms, and treatments. Dr. Gunter has been treating vulvar and vaginal diseases for nearly 30 years. If you have discomfort, pain, or other symptoms that might be a medical issue, read the relevant chapters of this book, then, armed with this information, take it to your doctor.
This guidebook to the care and functioning of the vulva and vagina by cheeky gynecologist Jen Gunter should be on your bookshelf. Thank you, Dr. Gunter, for this much-needed resource: The Vagina Bible.
If you’ve read my book, Naked at Our Age, or the advice given on this blog, I hope you’ve noticed the valuable information contributed by Ellen Barnard and Myrtle Wilhite, MD, co-owners of A Woman’s Touch. They are brilliant sex educators and compassionate human beings who devote themselves to women’s sexual health and pleasure, with a special emphasis on helping women with sexual pain and limitations.
I wanted to let you know how much I benefited from your workshop. Using some things that were discussed, the Vaginal Renewal Program you recommended, your books that I purchased (I went straight to chapter 11 — “When Sex Hurts” — in Naked at our Age), and some steamy stories from Ageless Erotica, I was able to have penetrative intercourse for the first time in 4-1/2 months. It can only get better from here and hubs is very happy.
I’m including this testimonial here not only because she specifically mentioned AWT’s Vaginal Renewal Program, but also because much of what I know about vaginal pain and self-help solutions I learned from Ellen and Myrtle. I consult and quote them often, and you’ve benefited from their expertise several times on this blog as well as throughout the pages of Naked at Our Age.
Ellen and Myrtle have been working for years on developing the best sexual health internal massage wand for women who have pain and/or limitations with penetration and with medical internal exams due to aging, cancer, or other issues. They (and we) were dissatisfied by the wands — aka vaginal dilators — that were available to women with sexual pain, either from doctors or online.
After years of research, they’ve designed and tested the FeMani Wellness Sexual Health Massage Wand, which has been perfected to their high standards. FeMani Wellness Sexual Health Massage Wand is ready for manufacturing — but their funds have run out.
That’s why I’m appealing to you. These amazing educators have been (and continue to be) generous with their expertise, helping anyone who needs them. Can you be generous to them now? You’ll be helping yourself and many other women who will be able to have comfortable, pleasurable sex because of these tools.
If you’ve been helped by the expertise of Ellen and Myrtle, either through my books or elsewhere, or you just want to help other women, can you assist with a donation of any size?* Go here to learn more.
* You know I don’t use this blog for fund-raising appeals. You may not know that I turn down about one worthy project a week, because I know you come here for senior sex news and views, not to be asked for money. But this project and these people are so special in our world that I had to make an exception.
Frustrated in Florida, age 61, had not had sex for nearly 12 years, until recently. She wrote in an email to me:
Apparently one’s vagina does change after not using it for a long period of time. I always thought sex was like riding a bicycle, but it is not. One can’t just get back on and ride! I experienced such pain during the attempted penetration that we had to stop. What a disappointing and embarrassing moment. My partner was very understanding, however I was just frustrated and disappointed.
I went to my GYN for an examination soon after and explained my circumstances. She gave me a thorough exam and said although I had many tiny lacerations and redness, my vagina seemed normal. She explained how one’s vaginal lining becomes thin after menopause and her advise was to abstain from sex for two weeks, using lubrication to aid in healing.
When we engaged in sex again, very gently, I was once again disappointed with the level of pain even though using lots of lubrication. We once again had to stop.
So now I am wondering if there is some way I can stretch my vagina for it seems like it has shrunk. (Perhaps it is just my imagination running wild!)
Have you had anyone else write you with a similar problem and if so is there a solution? For your information I have never been on hormones and my partner’s penis is of normal size.
No, it’s not your imagination, and yes, it’s true that the vagina will seem to shrink after a long period of abstinence, especially after menopause, and penetration will be painful or sometimes impossible. You’ll find a helpful chapter in my book, Naked at Our Age: Talking Out Loud About Senior Sex and several other posts about vaginal pain on this blog.
I’m disappointed that your gynecologist is not this helpful. Telling you you’re “normal” while you have lacerations and pain is not helpful, is it? Most doctors do not know how to diagnose or treat vaginal pain, and it ‘s wise ask for a referral to a sexual pain specialist.
Please read Vaginal Renewal Program by Myrtle Wilhite, M.D., at A Woman’s Touch, a wonderful sexuality resource center in Madison, WI. It tells you step by step how to massage and stretch your vagina. Here’s an abridged version:
* External Moisturizing and Massage: Increase the suppleness and blood circulation of the skin of your vulva and vagina with a five- to ten-minute massage with a moisturizing sexual lubricant like Liquid Silk®, a water-based lotion that will soak in and moisturize your skin, won’t get sticky, and will help you massage with very little friction.
Push in to the skin with circular strokes, and massage what’s underneath the skin, rather than brushing across the skin. Include the inner lips, the hood of the clitoris, the head of the clitoris and the perineum.
To complete your external massage, massage into the opening of the vaginal canal, using the same circular strokes. The massage itself does not need to be self-sexual in any way, but if that is comfortable for you, by all means explore these sensations.
* Internal Vaginal Massage: To massage inside your vaginal canal, we suggest using a lucite dildo which is very smooth and will not cause friction or tearing. Choose your size based upon how many fingers you can comfortably insert into the opening of your vagina.
After a session of external vulva massage, apply the same massage to the inner surfaces of your vagina with your dildo with lubricant applied on both skin and dildo. Rather than pushing the dildo in and out, use a circular massage movement. You are increasing skin flexibility so that your body can adjust to comfortable sexual penetration if you choose it.
You might also choose to use a slim vibrator for massaging the vaginal walls. Coat it in Liquid Silk and then insert it gently. Turn it on and let it run for about five minutes. You don’t need to move it around, just lie there and let it do its work.
* Orgasm: For women who stop having orgasms, the blood vessels literally can get out of shape, preventing future orgasms. If you are able to bring yourself to orgasm, do so at least once a week (for the rest of your life — seriously). This is preventive maintenance of your body.
* Kegel Relaxation: Kegels increase both the strength and flexibility of your pelvic floor muscles. Pay attention to the relaxation and deep breath part of the exercise. Learning to relax your pelvic floor will help you to avoid tensing up before penetration. (Read A Woman’s Touch’s Step-by-Step Kegels in this article about pelvic floor health.)
In my earlier book, Better Than I Ever Expected: Straight Talk about Sex After Sixty, I had interviewed a 75-year-old woman who had been celibate for 38 years and was in a new relationship. She was unable to have intercourse because her vagina had dried and narrowed to the point that penetration was impossible. She sought help from her gynecologist (a wonderful woman who bought dozens of copies of Better Than I Ever Expected to give to her patients!), who helped her.
Best wishes for a joyful resolution to this problem — please keep me posted.
Many women in our age group write
me that they’re experiencing pain with sex or avoiding sex because of pain. I
consulted several experts for their advice in chapter 11 of Naked at Our Age: “When Sex Hurts:
Vulvar/Vaginal Pain,” but reading that chapter is just the beginning of solving
that problem. You need a diagnosis – vaginal/vulvar pain can be caused by a
number of medical issues, and you need to understand why you’re having pain
before you can get it treated effectively.
receive a review copy of Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain
by Deborah Coady, MD and Nancy Fish, MSW, MPH. This book is entirely
devoted to sexual pain in women: the myriad possible causes, how to figure out
which one or combination is yours, and what to do about it.
power team: Deborah Coady is a gynecologist and a pelvic/vulvar pain
specialist. Nancy Fish is a therapist with degrees in social work and public
health, and she personally experienced chronic pelvic pain until Dr. Coady
helped her resolve it.
answer some questions that women our age often ask me:
Q. Many older women are reluctant to ask
their gynecologists about sexual pain because a) they’re embarrassed, b) they
think this is part of aging, and c) they fear their doctors will be dismissive.
What would you say to these women?
A: These feelings and fears are completely understandable. Unfortunately, the
medical profession has until now given too little attention to the sexual
concerns of women as we get older. Women often are dismissed or rushed when
they bring up their problems. And this is not the fault of the patients: A
recent survey of gynecologists by Stacey Lindau, MD of the University of
Chicago hints to their discomfort, as well as their lack of experience and
formal training in this area of medicine. While 60% responded that they
did ask about sexual problems at the first visit, only 14% asked about pleasure
with sexual activity. It is often up to women themselves to be pro-active, ask
the hard questions, and remember that they are entitled to medical therapy for
this medical problem, or referral to an MD who can help.
Q. My readers sometimes report that after
a long time without sex (due to lack of a partner or disinterest from a
partner), they try to have sex again — and they can’t: It’s too painful. What
should a woman do about this?
A: On average, about 5-6 years after their last menses, most women develop
thinning of their vulvar and vaginal tissues, often causing pain with sexual
touching or intercourse, or with urination after sexual activity, or itching,
burning and even surface bleeding after sex. This can occur even in women
taking systemic estrogen therapy. As estrogen levels decline both the surface
skin and underlying connective tissues thin, shrink, and lose elasticity. Most
pain is actually located at the vaginal opening itself, rather than deep inside
the vagina as previously thought. The good news is that since these tissues are
exquisitely hormonally sensitive, even small doses of estrogen, with or without
testosterone or DHEA, applied to the vaginal opening (the vestibule), can
reverse these changes within 2-4 weeks, and then even lower doses can be used
to maintain the improvement. Some women with severe loss of elasticity will
also be helped by a course of pelvic floor manual physical therapy, to help
normalize the connective tissue, and relieve the reflexive muscle spasms that
some women develop due to their pain.
Q. I like your questionnaire (107-111)
because women often don’t know how to pin down just where and what the pain is
that they’re experiencing. I recommend that women scan or photocopy that
questionnaire to show their medical professionals. Would it be a good idea to
carry a copy of Healing Painful Sex to
the appointment, too, in case the doc hasn’t heard of your book?
A: One of our missions in writing the book is that women would have it as a
resource to get their gynecologists informed and up to speed on treating sexual
pain. Many patients have done just this, and their MDs have actually been
grateful for the introduction to the book.
Q. If a gynecologist says, “You just need
lubricant” or – worse! – “Well, at your age, you can expect that,” what should
an older woman say to get diagnosis and treatment? I tell women to say, “If you
don’t know how to help me, please refer me to someone who does,” but that might
seem more confrontational than you would recommend! What would you advise her
A: I would advise her to say exactly that. We have to advocate for
ourselves and we deserve up-to-date treatment for sexual pain. A healthy
sexual life is a basic human right, even defined as so by the World Health
Q. How can a post-menopausal woman weigh
the benefits of HRT vs. the health risks if she’s experiencing vaginal thinning
A: There is absolutely no evidence that the small amount of estradiol or
estriol available for use at the vaginal opening is absorbed to any degree that
would induce breast cancer. The doses are tiny compared to HRT doses that are
meant to be systemic, that is, to go to all parts of the body. To help hot
flashes the doses need to reach the brain in quantities much much higher than
the topical estrogen will ever give. And with the evidence now showing that
estrogen alone does not increase the risk of breast cancer anyway, women can be
assured that topical therapy, especially if mostly applied to the vaginal
opening, is safe. It is also now known that the thicker and more estrogenized
the vulvar and vaginal tissues are, the less absorption into the body. So
a stable constant regimen is better than going on and off the topicals, with
the tissues thinning again in between.
Q. How do we educate our medical
professionals to stop being dismissive and take our sexuality seriously,
whether we’re 60, 70, or 80?
A: This is a work in progress, but educational outreach through professional
societies like NAMS, the International Pelvic Pain Society (IPPS), and the
International Society for the Study Of Vulvovaginal Disorders (ISSVD), as well
as patient advocacy organizations, especially the National Vulvodynia
Association (NVA) is helping. The websites of these societies all list health
professionals by area to help patients find a knowledgeable MD. We also need to
devote more time to formal education on sexuality and pain in medical schools
and residency programs.