Now that we’re so upfront about primping female genitalia – think waxing, vajazzling and surgical enhancement – you’d think it was getting easier for women to talk about this part of their bodies. Especially when it comes to reporting anything unusual to a GP.
But you’d be wrong – and many women are dying as a result.
Each week Dr Catherine Adams, a psychologist working with people with cancer, sees women with often advanced cancers of the vulva, cervix, uterus or ovaries which could have been treated earlier – if they hadn’t been too embarrassed to see a doctor about symptoms like vaginal bleeding after menopause, pain during sex or lumps or sores on the skin of the vulva.
“Embarrassment is killing women – yet these are cancers that are often curable,” she says. “I see two or three women each month who’ve had unusual vaginal bleeding on and off for two to three years – yet this is a red flag that can lead to earlier detection of some gynaecological cancers. “
Back in the 1970s when the women’s movement was on a roll, a feminist group called the Boston Women’s Health Collective launched Our Bodies Ourselves, a ground breaking guide to women’s health which recommended women get acquainted with their genital area by squatting on the floor and using a mirror to check it out.
Yet 50 years on, that message seems to have got lost – if anything, we’ve taken a step backwards, says Dr Adams, a Conjoint Lecturer with University of Newcastle’s School of Public Health.
“We’re not encouraged to become familiar with how the vulva looks and to know what’s normal and what’s not – and that’s one reason why it’s become so easy to sell the idea of labioplasty as a simple procedure that ‘improves’ the look of the vulva. But women need to be able to notice changes and say to their doctor ‘can you have a look at this?’.”
While breast cancer captures a lot of limelight, other women’s cancers aren’t so high on our radar. Who knew, for example, that it’s possible to get skin cancers, including melanoma, on the vulva? And while we’re taught to be familiar with the feel and look of our breasts so we can be alert to any changes, the advice to be aware of any changes to female genitals isn’t so loud.
But a new campaign called Save the Box wants to change this by raising the profile of gynaecological cancers. By the end of this year more than 6000 women will have been diagnosed with one of these cancers – and about four will die each day – according to the Australia New Zealand Gynaecological Oncology Group which is also working to raise funds for more research into these diseases.
“Vulval cancer is relatively rare but it happens – about 300 women are diagnosed each year – and I’ve seen women with quite advanced vulval cancer who’ve been too embarrassed to tell their doctor about symptoms. There might be a lot of explicit images of women’s genitals online yet young women are often still uncomfortable about seeing a doctor, says Dr Deborah Bateson, Medical Director of Family Planning NSW.
Besides being alert to any changes that might signal gynaecological cancer, and knowing what the range of normal female genitalia looks like, it’s also smart to know how to keep the right balance of microbes in the vagina.
We’ve heard a lot about the importance of having a healthy balance of gut microbes, and it’s a similar story in the vagina which has its own delicate balance of bacteria – the vaginal microbiome – that can be easily disturbed, sometimes by products we think will keep things ‘fresh’, Dr Bateson points out.
“I see a lot of young women who are concerned about vaginal odour despite having no other symptoms – so it’s important to know that it’s normal for a healthy vagina to have a mild odour. Paradoxically, using scented products including feminine hygiene products can sometimes disrupt this balance leading to problems like bacterial vaginosis which can be associated with an abnormal discharge and odour,” she explains. “But the vagina is self-cleaning – it doesn’t need to be cleaned inside, and warm water or perhaps mild unperfumed soap substitutes are all you need to keep the vulva clean.”
What about talcum powder which made headlines recently when Johnson & Johnson were ordered to pay compensation to a woman diagnosed with ovarian cancer which she believed to be caused by using talc?
“There’s no need to use talc for health reasons and while it’s a personal choice it makes sense to avoid it – although whether it contributes to ovarian cancer isn’t completely clear,” Dr Bateson says. “So far the evidence shows an association between the use of talcum powder but no definitive proof that it’s a cause. “
As for personal lubricant, some women are concerned about products containing parabens – preservatives classed as endocrine disrupting chemicals – although they’re considered safe in the small quantities used, she says.
“Parabens are used in lubricants to prevent bacterial overgrowth and increase their shelf-life and while there are paraben-free lubricants, we need more research to understand the impact of parabens on our health. It’s important to remember that anything used on the skin of the vulva or vulval skin can potentially cause irritation.”