8 Things I Never Learned in Health Class (and Have Been Too Afraid to Ask!)

By Dr. Jacqueline Kohl

My high school sex ed classes were a joke. No one in the room was comfortable, and everyone left with more shame than understanding. Many women are still hesitant to bring up their concerns in the office. Here’s a roundup of some questions you might be too embarrassed to ask.

• I had unprotected sex. What do I do next?

Sometimes condoms break or fall off, or we forget to use one. If you aren’t using reliable birth control, consider emergency contraception like Plan B or an IUD.  If the encounter is higher risk, consider medications to prevent HIV. Otherwise, make an appointment two weeks later to test for gonorrhea & chlamydia and discuss timing for other testing (syphilis, hepatitis B & C and HIV).

• When/how should I tell my partner I’ve had HPV or herpes?

Open and honest communication is important in any healthy sexual relationship. Condoms reduce transmission of sexually transmitted infections, including HPV (human papilloma virus) and herpes. No time is a bad time to discuss your history with your partner. If you aren’t using condoms, it’s definitely time to have the talk. Herpes and HPV are common (1 in 5 for genital herpes , 4 in 5 for HPV). Most people will clear these viruses on their own, and many never even know about it. There’s no shame in having previous exposures and there are ways to prevent transmission. 

• I pee when I sneeze (laugh/cough/run)-what can I do about it?

Urinary incontinence is more common with age and many women in their 30s and 40s experience leakage. Stress incontinence occurs when the pelvic support muscles are weakened (often through childbirth) and activities like jumping or sneezing (even sex) increase abdominal pressure. This causes urine to leak past the urethra. Kegel exercises or pelvic floor physical therapy can help. Surgery may be an option too.

• I do not enjoy sex or have orgasms with sex. Is there something wrong with me?

The focus of heterosexual intimacy is often vaginal-penile intercourse. For many women, this does not lead to orgasm. First, I recommend experimenting with different kinds of foreplay. Consider use of a vibrator for clitoral stimulation, or focus on different kinds of touch and intimacy with your partner. And don’t be afraid to experiment with masturbation to learn what works (and doesn’t work) for you. If those things don’t help, it may be time to evaluate for underlying conditions.

• My sex drive is too low (or high). What’s normal?

Libido is complicated and affected by many things—medical conditions, emotions, medications, relationships, stress etc. Some women rarely think of sex and are content without it; others desire sex daily. The bottom line? BOTH ends of the spectrum are normal. There is no ideal frequency of sex or desire for sex. I only recommend evaluating or treating low (or high) sexual desire if it causes you distress. Your doctor can help determine underlying causes and offer resources as well.

• Why do I have so much discharge?

Vaginal discharge is normal. Most women produce between 1-3mL of vaginal lubrication daily and more with sexual activity. This is enough to fill a panty liner, or cause moisture on underwear. Color and consistency can vary: white, clear, yellow, thick, thin, mucous-y can all be normal. A well-lubricated vagina is a healthy vagina—no need to treat this “problem”!  That said, any discharge associated with itch or irritation, foul odor, bleeding or abdominal pain should be evaluated ASAP.

• How can I protect myself during other kinds of sex?

Anal and oral sex, and the use of sex toys are common. Here are some tips to stay safe, no matter what you choose. With anal sex: lubrication and patience are key to prevent injury and good hygiene is important to reduce spread of bacteria. STI transmission can also be higher so in a non-monogamous relationship, always use a condom (and change it before engaging in other activities). A condom or dental dam can help prevent infection with oral sex. Also avoid oral sex if you have any mouth sores, recent dental work or have recently flossed/brushed your teeth. If using sex toys, be sure to properly wash and dry between encounters, consider condoms, and stay away from using household items.

• Finally: the question no one asks: what parts are “down there” and why do they look different?

Quick anatomy lesson: the vagina is internal, and the vulva is external. The vagina or birth canal is one of three holes. It’s where a speculum is inserted for exams and pap smears, and where a penis, sex toy or tampon may be placed. The vagina is separated from the anus by the perineum (or taint). The vulva includes the mons pubis (the top part just below the abdomen), and the labia or lips. There are two sets of labia (majora and minora)—one more external and one more internal.  Either set can be more prominent, and you may even have some unevenness from left to right (just like with breasts!) The clitoris is between the labia in the midline and sits above the urethra. Your vulva is uniquely you and might not match pictures or diagrams you’ve seen.

This list isn’t comprehensive of course, and individual patients may have different needs. Schedule an appointment, and don’t be afraid to share your questions or concerns with us today!

Author

Dr. Jacqueline Kohl M.D. Jacqueline Elyse Kohl, MD, is an experienced obstetrician and gynecologist at Philadelphia Women's Health & Wellness in Philadelphia, Pennsylvania. Dr. Kohl earned her Bachelor of Arts in psychology in 2006 at the University of Pennsylvania. In 2011, she earned both her master’s degree in public health as well as her medical degree from Thomas Jefferson University in Philadelphia, Pennsylvania. Upon graduation, she began her residency in obstetrics and gynecology with Abington Jefferson Health, serving as Administrative Chief Resident from 2014 to 2015. After spending two years working at the Hanjani Institute for Gynecologic Oncology in Abington, Pennsylvania, Dr. Kohl developed a special interest in gynecologic surgery using a minimally invasive approach, which she carries into her medical practice today. Dr. Kohl has also taken her medical expertise abroad by assisting with labor and deliveries at a district hospital in Rwanda. Dr. Kohl is a member of the American College of Obstetrics and Gynecology.