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Vulva Va Voom

Biking booboos

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A question on your favorite 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's tons 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

"I love that she used the word 'vulva,'" said Dr. 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 and numerous other books.

Dr. Herbenick recommends seeing a "true vulvovaginal health expert" (TVHE) about your problem, VULVA.

As for your particular problem — a tough case of bacterial vaginosis — Dr. 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," said Dr. 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. "I don't want to over-promise, since BV remains a challenging diagnosis and often does come back at some point," said Dr. 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."

I have a question about biking and female genitalia. I'm a woman in my forties, 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? Any suggestions for decreasing crotch soreness?

Bike Related Injury To Clit; Help Ease Soreness

"The few studies that have been conducted on women and cycling — generally cisgender women — found that cutout seats are linked with a higher risk of genital symptoms, as are handlebars that are lower than the saddle," said Dr. 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."

To decrease your risk of un-fun genital symptoms, BRITCHES, Dr. Herbenick recommends mixing it up. "Go biking some weekends and try other activities on other weekends — maybe hiking or swimming?

Follow Dr. Debby Herbenick on Twitter @debbyherbenick. Reach Dan Savage at mail@savagelove.net.

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