By Stacy McCrosson, MD, Virtua Obstetrician and Gynecologist

Let's be honest—it can be awkward, uncomfortable, or downright embarrassing to ask the doctor about what's going on 'down there' during an annual gynecological exam:

• "Is this smell normal?"
• "Oh no, a bump! What is it?"
• "Why can't I sneeze without peeing my pants?!"

What's a woman to do? 

By all means, you should ask. In my practice, women often come in for their yearly exams saying there are no problems. Then, when I'm ready to leave the exam room, often with my hand literally on the doorknob, they'll have 'just one more question,' something they felt funny asking about before. 

But let's get that conversation started now. Here are the top five most common blush-inducing issues. 

Odors

Typically, a strong vaginal odor is a sign of an infection. But that doesn't mean it's a serious infection or a sexually transmitted one. Bacteria live all over our bodies—on our skin, in our gastrointestinal tract, inside our vaginas. When there's an overgrowth of that bacteria, it can cause odor. Bacterial vaginosis is the most common vaginal infection, and it's easily treated. You also can take steps to prevent bacterial infection by avoiding clothing or activities that stimulate bacterial growth. Wearing thongs, soaking in a bathtub, and douching, for example, will all increase bacterial growth inside the vagina.

Discharge

The vagina is constantly cleaning itself, and vaginal discharge simply consists of dead cells exiting the body. That said, the amount of discharge produced can vary widely from woman to woman. I'll hear women say things like, 'I need to wear a pantyliner every day, but my friend doesn't.' But what's normal for them might not be normal for you. That said, depending on color, consistency, or other accompanying symptoms (odor, itch, or discomfort), discharge may also be a sign of an infection. With a simple pelvic exam, your doctor can tell you whether your discharge is normal or requires medical treatment.

Lumps and bumps

Women tend to freak out any time they feel a lump or bump down there—often jumping to the conclusion that they have a sexually transmitted infection. While they sometimes do, they also might have something totally benign—an ingrown hair, an inflamed hair follicle, a blocked sweat duct, or a pimple. Keep in mind that bumps surrounding hair follicles are more common if you remove hair from your bikini area. For example, if you shave your pubic hair, don't use the same razor you use for your armpits. You'll transfer bacteria from one part of your body to another, and that can cause problems. Also, be sure to replace the razor you use for your pubic hair at least once every three days to reduce the risk of infection.

Leaking

Leaking urine between trips to the bathroom (incontinence) becomes more common as we age and have babies. The drop in estrogen in post-menopausal women and the loosening and weakening of pelvic floor muscles after pregnancy are both common culprits. I often say I can pick out a mom from across the room because she crosses her legs when she sneezes. Talk about it at your annual exam so your GYN provider can determine what type of incontinence it is (stress incontinence or urge incontinence) and whether it can be treated with exercises alone or if medical intervention might be needed.

Problems with sex

Low sex drive, inability to orgasm, and pain during intercourse are all common issues with the women in my practice. I wish my patients would talk about them more. There can be lots of potential causes, and most of them are treatable.

Keep in mind that you don't have to wait for your annual exam to address any of these concerns. Make an appointment at any time. If you do decide to wait for your routine visit, be sure to mention to the office staff ahead of time that you're having a problem you'd like to discuss with the doctor. You don't have to tell the person on the phone what the problem is, but chances are that they'll allow extra time for your appointment if they know there's an issue beyond a routine checkup. You also can ask for the first or last appointment of the day, which tends to be when health care providers have the most time to talk.

It's okay to be a little embarrassed about these issues—go ahead and tell your GYN provider you're embarrassed, even. But talk about it. Be careful with self-diagnosis, and, when in doubt, make an appointment to be evaluated. So often, my patients come in fearing the worst when their issues are normal and treatable.

Make an appointment

Because finding the right OB/GYN can be challenging, Virtua makes the search a little easier. Call a Virtua women's health navigator at 844-896-6367 to find a provider who meets your needs. 

Virtua OB/GYNs, nurse practitioners, and midwives offer flexible appointment schedules at locations throughout Burlington, Camden, and Gloucester Counties.