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    What is ‘down there’? revisited

    by Ngozi Osuagwu, MD | August 26th, 2019

    What is ‘down there’? revisited

    I often find myself looking down at the floor when I hear complaints about having a problem “down there”. “Where?” I ask looking at the floor. The reply is “you know what I mean.”  I laugh because when I wrote Letters to My Sisters, Plain Truths and Straightforward Advice from a Gynecologist that was published in 2006, I thought I could actually make people transition from using the term ‘down there’ to external genitalia or vulva. One of my daughters told me that would never happen. That does not mean I will not try.

    Regardless of the names one might call that area, I thought it was time to once again review the anatomy and discuss simple ways to take care of the vulva.

    I would like to share an excerpt from the book:

    ‘…I think the best thing to do is to get a mirror and one of those book lights. Don’t be afraid to look at your body. What you immediately see is your vulva. You have hair on the sides that extend upward. The area that has the most hair is called the mons pubis. When you look at the sides, the area that most lay people call the lip is the labia majora. For some women, both sides might be the same size, or one side may be bigger than the other. When you separate the labia majora, you will see the labia minora. It is so important to clean between the labia majora and labia minora on both sides. If discharge gets in the area, it becomes irritated. If you follow the labia minora upward, it splits and forms a hood on top. This is the area of the clitoris. Below the clitoris, you will notice a hole. This is the urethra, where urine comes out. Below this hole is another one, the introitus, which is the entryway to the vagina…’

    When it comes to the vulva, I have the following advice:

    1. Treat the vulva like your face –meaning that it is an important part of our body and should be treated with gentleness and care.
    2. Keep it simple – Sometimes most of the issues that arise in the vulva have to do with the things that we are doing.

    Vulva care includes the following:

    • Use unscented laundry detergent for your underwear – I personally use unscented laundry detergent for all my clothing because my family’s skin is very sensitive.
    • Do not use fabric softener or dryer sheets for your underwear – to avoid static, dry your clothing on low heat.
    • Use hypoallergenic/unscented body bar soap
    • Use cotton underwear – the whole underwear needs to be cotton, not just the crotch; 
    • Avoid the using thongs – it is okay for people to know that you are wearing underwear.
    • No douching – there is absolutely no reason to douche, if you are douching because you notice an odor, then you need medical attention. You cannot douche away a bacterial infection or a sexually transmitted infection.
    • Limit shaving of the vulva area – limit to the bikini line only.
    • Remember to always wipe from front to back

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    The book discusses common gynecological and women’s health issues in a series of witty and entertaining letters. These letters, all educational, offer suggestions on what approaches to take in tackling the medical problems that typically bring women to an ob/gynecologist. The letters are spiced with art, a poem and quotes. Although its emphasis is on gynecology and women’s health, it touches on some other medical issues that make women visit their doctors.

    The second half of the book briefly discusses the most common gynecological conditions and also provides an overview of sexually transmitted infections. A list of annotated websites dealing with the different topics in the book is provided for the reader who wants to pursue each subject in depth.




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