“I was very unaware, many patients repeated the same doubts and false beliefs. I thought it was necessary to talk in networks about what happens in our body, in a medical way”. This is how Lorena Serrano, a gynecologist at the Catalan Health Institute, came up with the idea of ??opening an informative profile on Instagram. Many of the tips she gives in her @hello.gyn posts are now also collected in a practical book. Know yourself well, take better care of yourself (Planet).
Sexually transmitted diseases, menstrual cycles, menopause, gynecological pathologies, hygiene habits, taboos on sex… We talked about all this with Dr. Serrano, a Master’s in Senology and Breast Pathology from the University of Barcelona and a Master’s in Nutrition and Health from the Woman from the Complutense University of Madrid.
How far does the ignorance of women about our own body go?
Most women know very little about how their body works, more needs to be said. In medicine, women’s health has not been interested, there are physiological and natural issues such as menstruation that are not discussed. Attention is always taken by pregnancy and maternity. We forgot about gynecology.
The most surprising thing that has been found in consultation?
Women who put whatever stuff they can think of on their genitals. A patient had used bleach diluted in water to lighten them, because she believed that it was not normal to have them so dark. A mother brought her 14-year-old daughter seeking a surgical solution because she didn’t think she had normal vulvar lips, and she was a totally ordinary vulva. The lack of knowledge about STIs is also surprising.
From what he explains in the book, most people confuse the vulva and the vagina…
Almost everyone uses the word vagina to refer to all female genitalia and this is an example that we still have a lot to do. If we are not capable of calling things by their name, it is difficult to deal with these issues naturally. Hence the large number of euphemisms that exist to refer to our genitals.
Have we improved with knowledge about the clitoris? For some biology textbooks there is not yet…
Women of any age continue to come to the clinic concerned because they do not reach orgasm with penetration. They are sure that it is a personal problem, that it is not normal. This is a representation of how society has copied the model of male sexuality to female when in reality it has nothing to do with it. We still don’t know a lot about the feminine because she hasn’t been interested, but it is important that we keep in mind that the clitoris exists, that it is the organ of pleasure and that not all sexual intercourse means penetration.
Sexual health is health and sexual pleasure too. Do you prescribe self-examination for some patients to discover it?
Each case is different, the exploration is basic in the terms that each woman needs, with her times, but we cannot be afraid to look at an area of ??our body. Knowledge in terms of sexuality helps us to enjoy our relationships more, one she has to know what she wants in order to enjoy. Beyond self-exploration, which is basic, masturbation has to be something that every woman chooses. Although there are women who see this as taboo, we know that in menopause, when there is a lot of genital atrophy due to the lack of estrogen, relationships can be more difficult or painful and that masturbation helps (just like having sex with a partner) to improve discomfort.
Besides this, what other benefits does masturbation or sex with other people have?
Masturbation or sexual intercourse stimulates blood flow, thereby helping to improve sexual health problems. It is something that we can recommend, obviously treating all dryness problems first, treating with moisturizers or lubricants. In addition, sexuality has to adapt a bit to this situation, lengthening the preliminaries, establishing communication with the partner… Masturbating or having sex with the partner improves sexual relations itself.
He says we need to talk more about sex. In the 21st century, is it still very taboo in medical consultation?
It is a pending issue for many professionals, even in gynecology, since sexuality has always been linked to psychology professionals. For us it is a pending issue because we have the most medical, physiological, anatomical vision of the problems; instead, sexuality has a very important emotional aspect and more in women. It is essential that gynecologists at least have the basic notions to be able to clarify doubts. Patients usually don’t ask, it’s often you, the doctor, who has to ask.
What is female orgasm disorder?
It is the way we have to group all the possible alterations with orgasm and here we have female anorgasmia, the delay or decrease in its intensity… From a medical point of view it is not easy because there is an associated psychological and cultural dimension, with which We always recommend going to sexologists. In consultation, what we will always do is rule out medical issues, that there is no endometriosis, that some medical treatment may be altering their sexual desire, psychiatric pathologies, neurological disorders… If any woman feels that she is not enjoying sexual intercourse as you think you should, you should see your doctor.
Can lubricants change a woman’s sexuality?
Yes, they are recommended especially with the use of condoms because it can be drying and when using sex toys. Whenever there is a lack of lubrication there can be an alteration in relationships, pain. Young girls have a certain stigma, “if you have to use lubricant, it means that you don’t lubricate naturally”… That’s not the case at all, lubricant is a pleasure tool for women of all ages.
Is there enough talk about the negative effects of hormonal contraceptive pills? Discuss in the book the scientific evidence that they increase the risk of thrombosis…
What is happening right now is the other way around: only the side effects of these treatments are taken into account and not the beneficial effects, the uses as a treatment for other pathologies. This leads patients suffering from endometriosis with disabling pain to not take them, for fear of side effects, when in reality they are one more option. In addition to contraception, in gynecology we use them a lot to treat menstruation pain, ovulatory pain, polycystic syndrome… It is important to assess each case individually and always carry out a previous study. In fact, they have positive effects: they have been shown to reduce the risk of ovarian cancer.
We have finally learned that the rules do not have to hurt us. Is there already unity in the medical community on this issue?
If you have menstrual pain that prevents you from leading a normal life, your quality of life worsens and that is not normal. Sometimes the study is done and we do not find that there is a pathology. They can be primary dysmenorrhea, young women who secrete more prostaglandins, which are responsible for contracting the uterus and this can cause more pain. But what you have to do is look for the cause of the pain and not give it as normal. Luckily this topic is one of the most talked about.
Talk about menstrual dysphoric disorder, which most people don’t know about. What does it consist of?
It is not very frequent. It is a premenstrual syndrome taken to the extreme, a psychiatric pathology that has to be diagnosed by specialists in this field. Emotional symptoms can occur in the second phase of the cycle, and become disabling, affecting your personal and professional relationships and your day to day. We find depressions, very important anxieties in those days before the next period. It has been shown that this can be treated with lifestyle changes, contraceptives or other antidepressant treatments for those days of the cycle.
Tampons, pads, menstrual cups… What advice would you give?
At the medical level there is no better option than another, it is a personal decision that can change throughout our lives. I encourage women to try different alternatives that catch their attention, there are certain menstrual products that have the plus of being sustainable. You have to know that they exist, try them and use the one that best suits the person, or perhaps you should use several products at the same time.
No to vaginal showers, no to using aggressive soaps on the vulva, yes to hydration… Are we doing it very badly, in general?
There are still many people who wash their vagina because they have the idea that it is something dirty. The vagina cleans itself, it is an incredible organ that has a brutal capacity to self-regulate; if you wash it, you will have more urine infections. There are patients who do not wash their vagina, but clean their vulva with soap, perhaps with the same gel they use for the body! It is not necessary to do it, it is enough with the water. They have given us the idea that our vulva smells bad, is dirty and ugly. We carry prejudices from centuries ago, but the vulva has its smell, we cannot pretend that it smells like roses. Apocrine glands have a different odor and the discharge can also be mixed. But that doesn’t mean it smells bad! If you don’t feel well with just water, I recommend soft intimate gels that adapt to the mucosa.
STIs, sexually transmitted infections, have skyrocketed… What do we do?
Sexual habits are changing, and without calling fear, it is necessary to explain that they are there and there are ways to prevent them. We have condoms, vaccines such as papillomavirus… If we are not sure if we are infected, let’s go to the doctor to do tests. The condom does not protect against everything if infections are spread by contact between the mucous membranes, such as the papilloma virus, but that does not mean that it should not be used, because it does reduce the risk.
How does diet influence sexual and gynecological health? What scientific evidence do we have?
The diet we eat will influence certain cancers and chronic diseases. The problem is that if it is already difficult to talk about this in the prevention of pathologies that we have studied extensively, such as hypertension, diabetes, etc., it is even more complex in the gynecological field: it is difficult to find quality scientific evidence. We know that a Mediterranean diet with lots of fruits and vegetables, rich in antioxidants, can help us in any pathology. In the case of polycystic ovarian syndrome, it is related to a vitamin D deficiency.
Urine infection is very recurrent in women. What would you recommend?
It occurs more at menopause because the microbiota changes, and is in charge of protecting us from urinary infections. It can be prevented, there are several mannose-based supplements that have been shown to help reduce recurrence, but at younger ages it is always necessary to rule out that there is no urological problem. We can also give topical estrogen treatments to improve atrophy and that can help reinforce all these problems of vaginal infections in general.
Endometriosis is a problem that is very difficult to diagnose, a real ordeal for patients. Not studying enough?
Health professionals are increasingly aware that this must be looked at carefully. My approach is always: it may be endometriosis until the contrary is proven. This is not like a covid test, which comes out positive or negative, we rely above all on the symptoms that the patient explains from the medical history. If there are suspicions, additional examinations such as pelvic exams and ultrasounds should be done to rule out other causes, but it is very likely that we will not see anything because endometriosis will not always give us an altered image. I believe everything the patient tells me and I follow up.