Let’s talk about women’s sexual health

When it comes to women’s sexual health, it’s fair to say there are a number of taboo topics that need tackling. Thrush, discharge, low libido… it’s time to discuss these topics more openly to give those suffering in silence the confidence to reach out and get the support they need.

It’s time to replace the stigma with a spotlight.

Our latest AXA Health Chat (above) sees Jan Vickery, Propositions Lead at AXA Health and Dr Nikita Patel, Head of Propositions and a registered GP, discuss the burning (and itching) questions that might be causing concern for many women.

If you prefer words over watching, we’ve summarised the Chat below.

What are the different parts of a vagina?

Knowing which part is what can help you better describe what’s causing you concern during your GP appointment.

The part that you can see straight away is your vulva. It includes the external genital structures such as the labia majora (outer ‘lips’ – larger, fleshy and covered with pubic hair – helping protect the inner structures of the vulva), labia minora (inner ‘lips’ located inside the labia majora – thinner and usually hairless), clitoris, and the opening of your vagina, as well as your urethra (where your urine comes out).

It’s common to say ‘down there’ when speaking about any sexual health concern, but if you can, do be clearer with your GP on which part is concerning you. Don’t worry if you’re not sure about the correct terminology though – it really doesn’t matter. It’s more important that you can point to the area that’s bothering you.

Your sexual organs are part of your body, just like your hands and nose. Your GP will be experienced in examining and treating sexual health conditions – so please don’t be embarrassed to reach out and discuss what’s causing you discomfort and / or pain.

What to expect during a sexual health examination

Traditionally, your GP will first ask questions about your symptoms. However, if you do find it embarrassing to talk about, or aren’t exactly sure which part is worrying you, it can be easier to pop onto the bed and show your GP the specific area. This can be an easier option for your GP too, to ensure you’re assessed correctly and go down the correct care path.

What happens at a thrush diagnosis and treatment appointment?

Thrush is a common yeast infection. It’s usually harmless but can be uncomfortable and keep coming back. Symptoms in women include:

• White vaginal discharge (often like cottage cheese), which doesn’t usually smell.
• Itching and irritation around the vulva and vagina.
• Soreness and stinging during sex or when you need to urinate.

The NHS recommends seeing a GP if you have thrush symptoms for the first time, have thrush and are under 16 or over 60, it keeps coming back (more than 4 times in 12 months), thrush treatment hasn’t worked, you have thrush and you’re pregnant or breastfeeding, or you have thrush and a weakened immune system¹.

If you’re attending a GP appointment because you suspect thrush but over the counter treatments haven’t worked (such as a tablet, pessary or cream), it’s likely your doctor will need to take a swab from inside your vagina or labia to check for infection. This is done with an earbud-like swab – like how you’d swab your throat during a COVID test. If you’re feeling uncomfortable about having this done, you can self-swab in the toilet.

A sexual health clinic can also provide support if you think you have thrush.

Vaginal discharge: What’s normal and when should I see a doctor?

Discharge can be different for everyone. Some people get no discharge, some will get a line in their pants every day – and that’s completely normal for them. It can vary from being completely colourless and transparent, to whiteish with a tinge of yellow. However, if it’s getting very dark yellow or changing in colour, that’s a sign to see your doctor. For example, thrush might produce a white, cottage cheese-like discharge (alongside itching) while bacterial vaginitis can produce a greyish discharge along with a smell. Another infection is called trichomoniasis, where you might experience a yellow / green discharge.

While these infections are typical, they’re not absolute. What’s important is you know what’s ‘normal’ for you and keep an eye out for any changes.

Who should I see about a sexual health condition?

A lot of people are seeking help from a pharmacist, which can be helpful when GP access is difficult. If these treatments don’t work, or if you’re needing repetitive treatments, it’s important to see your GP to check that what you’re treating, is what should be treated e.g. is it thrush, or is it something else, like bacterial vaginitis that can also cause a bit of itching? Or is it a skin condition you have, such as dermatitis? Are you being irritated by something you’re wearing or using? Or is it a change in the architecture in your skin, such as lichen sclerosus – a skin condition that causes itchy white patches and can change how your genitals look and feel.

It’s really important to identify these conditions, as something like lichen sclerosus can increase your risk of getting cancer on your vulva, anus or (for men) – penis². The risk is low, but it's a good idea to check yourself regularly and see a GP if you're worried. Symptoms to look for include a lump, a change in skin texture, such as thickening, or an ulcer that doesn’t go away².

The key message: If you’re experiencing itch, have a go with over-the-counter treatments, as it’s quick and easy and most commonly caused by a condition such as thrush. But if it’s not working, regularly returning or you notice any skin changes – see your GP.

Sexual dysfunction – is this something a GP can help with?

This is an important subject to talk about and is absolutely something a GP can help with. Sexual dysfunction as a topic isn’t something we really hear much about. It’s not usually discussed – largely being considered a private matter. Whether it’s low libido, that you don’t enjoy sex or can’t orgasm – confidence can be impacted, especially when there’s lots of expectations from society around what sex looks like.

Different things work for different people. For example, you can still get pleasure from sex if you don’t orgasm, while foreplay can be enjoyed instead of penetrative sex. Knocking down these big expectations that society puts on us is really important, as it feeds into how you feel about yourself.

What about painful sex? Can a GP help with this?

There’s a lot of different conditions that can cause painful sex. All the way from the outside – your vaginal opening, to the inside – your cervix, or womb. The other consideration is that sex can be painful if you’re anxious about sex, which can cause you to tense up. Other conditions such as endometriosis can also cause sex to be painful.

It’s important to have an in-depth conversation with your GP to discuss which point/s during sex you’re finding painful. This can really help distinguish the cause.

Can you talk to your GP about low libido?

You can – it’s something that’s important and affects many women and therefore, it matters. Commonly, it’ll affect women going through the menopause or perimenopause.

It’s important to have the confidence to talk about this with your GP, as they can recommend treatments and strategies that can help improve your libido in the future.

Usually, your GP will routinely ask about libido during a menopause consultation – as it’s one of those symptoms that women don’t tend to bring up. Low libido can affect your relationship, which can trigger stress. A lack of intimacy can potentially have a knock-on effect on family life, too.

Libido is an important symptom to talk about. Once your GP is aware, it can be built in the management plan for you.

When should you be examined by a GP?

There are a lot of sexual health clinics around, so GPs more commonly see conditions that aren’t sexually transmitted, such as thrush and bacterial vaginitis. If you’re experiencing a bit of itching and discharge, you might only need to speak to your GP over the phone and do a self-swab. If this doesn’t provide answers, your GP would need to do a physical examination in-person to investigate further. This is also the case when it comes to skin conditions and any noticeable changes you see / feel.

Can an online GP help with sexual health conditions?

There are lots of discussions you can have with an online GP about your sexual health and wellbeing. But often, if over-the-counter treatment isn’t working or symptoms frequently return, it’s likely you’ll need further investigation with a swab or an examination with your GP in-person. A virtual consultation will be less likely to provide the answer/s and value you need to treat and manage your condition effectively.

Jan’s big takeaway

Know what’s ‘normal’ for you. If you see a change, it’s right to seek help.

Always consult your healthcare provider for an accurate diagnosis and appropriate treatment options.

References

1. Thrush in men and women – NHS
2. Lichen sclerosus – NHS