The lowdown on vaginal health

Amanda: We love talking about everything and educating parents, especially on everything down there. We love having amazing, insightful and exciting guests joining us on BabyYumYum. Our special guest today is Dr. Heather Blaylock, who’s chatting to us really about vaginal health. Tell us a bit about yourself, please?

Dr Blaylock: Thank you so much for the invitation. I always love to have opportunities to talk about sex and the clitoris and all the loveliness and the challenges and what we can do to help and make people’s lives more pleasurable.

I’m a medical doctor, a General Practitioner, and I’ve been working in sexual health for almost 10 years now from an aesthetic medicine background. I’m based in Somerset West, but I travel for my patients to Hermanus and into Cape Town. And, I’m a mom.

I love to be active. I’m out and about. I don’t sit still often unless I’m here at my desk doing my studying.

Amanda: What are you studying?

Dr Blaylock: I’m studying a diploma in chronic pain management at UCT. So, in sexual health, we deal a lot with sexual pain. It can be very complex because it’s often very layered and there can be trauma associated.

Amanda: When you say layered and trauma, are you speaking physical layered and trauma or emotional?

Dr Blaylock: Both. Chronic pain management has been revolutionised over the past couple of years in the way that we, as medical practitioners, approach patients.  We use our colleagues, our physiotherapists, occupational therapists, psychologists to all help as a team for chronic pain, because chronic pain is so complex.

Amanda: What are you finding are the most common challenges regarding women’s sexual health?

Dr Blaylock: The majority of patients that we see are  in perimenopause and post-menopause and dealing with the challenges that come with that stage of our lives, which ranges from physical changes, psychological changes due to all the hormone changes in our bodies.

Often we’re faced with women who are struggling with low libidos. They may have life changes. Divorces often happen during this kind of time as well, new relationships. It’s a very broad kind of time in our lives with lots of challenges.

Women often present with low libido, vaginal dryness etc…

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Amanda: What sort of age does perimenopause start from? I mean, I heard somewhere that someone said, the day you hit 40, you’re in perimenopause.

Dr Blaylock: In fact, the bad news is that it can even start earlier than that. It’s really just the change in our estrogen and progesterone levels that starts to decline. And it happens pretty gradually. And then there’s more of a dip when we’re closer to that time.

It’s very difficult to put into words because we only diagnose menopause retrospectively. You’re only menopause if you haven’t had a period for a total of one year. Perimenopause can be a really long period of time. It can last 10 years, 15 years and during that time a woman can experience changes in mood, poor sleep, night sweats, changes in energy, changes in libido.

I’m obsessed with Victorian history. In Victorian times, when you started going through perimenopause, they would have you thrown into a lunatic asylum because it would have been like:  she’s unstable, crazy, go lock her up.

Amanda: Thank God things have changed! Are you seeing perimenopause start earlier?

Dr Blaylock: We don’t often need to diagnose it or do blood tests to give it a label. Sometimes if we also look back and see how our patients did present five years ago and we think, oh gosh, she was anxious, you know, and we didn’t understand. Maybe that it wasn’t the dog barking at night or the little random problem, but it was that she was already experiencing these hormone changes.

We also mustn’t forget that premenstrual tension is also really difficult for some women to manage. For some women it just comes and goes and passes, and there’s maybe like an hour blip but for that other woman, it can be very traumatic, emotional and very physically painful. It can be the same kind of emotions and physical things as menopause.

And also now, because we’re living for so much longer, we are living more time in the menopause, post-menopause than we did pre-menopause. So, if we think about all the psychological and physical changes that are happening to us at that time, we have to now live with and adjust to and accommodate those changes for like 30 years now.

Amanda: Absolutely. Are the developments and advancements better than what they were from a treatment point of view? As you said, you know, you have a multidisciplinary team that you would get involved with. Am I right in saying that if you are going through menopause, there is help for you? And is it just medicinal or are there other things?

Dr Blaylock: Yes, there is help. There are a variety of ways that we can manage patients. Natural medicine combinations, therapy– we’ve got a great basket of things to offer our ladies and nobody should be struggling through this phase.

Amanda: I think that gives a lot of people hope. I want to start at the beginning. Let’s talk about vaginal cleaning and health. Does the vagina have its own like scrubbing system in it with like windscreen wipers and sponges? Do we need to really get down in there and clean? What’s the story down there? 

Dr Blaylock: Oh my gosh, I’m having a vision now of a bottle brush going up and down the vag. Okay, so firstly, just to distinguish anatomically, in case some of the listeners are not aware, the vagina is an internal organ, an internal muscular organ that you cannot see from the outside. So you can see the entrance.

The genitalia of a female on the outside, what we can see, is called the vulva. The vagina is a muscular tube that expands to accommodate a penis, for example, or during natural childbirth, the head and the body of a baby. So it’s like a concertina. So, it expands to accommodate, and then it goes back to its original resting state.

It operates at a very specific pH. If anything interrupts that pH, then things can start to go wrong. Our whole body is covered in various bacteria and fungi and little parasites normally that we don’t see, but they keep us in homeostasis. So the vagina is the same. We’ve got bacteria that live there that keep that area happy and in homeostasis and functioning at that pH.

The moment we start interfering with that, with douching,  or anything that’s fragranced, it’s not good. Even semen can interrupt it. Using toys, lube with fragrances or colourants etc can all interrupt that pH balance. And then bad bacteria can come and take over and cause other problems.

So when you’re talking about washing the vagina, the vagina doesn’t need washing. The vulva, yes. You just wash it like you wash the rest of your body. You don’t need special products–just need normal mild soap and water.

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Amanda: Do get washers that say that optimal pH balance and all those sort of things? Do they help in the case where the pH is completely out?

Dr Blaylock: So if the pH is completely out, you’re probably going to present to your doctor with bacterial vaginosis. You would notice because there’s a different smell or a discharge. If they are neutral products with no fragrances and no colorants and the Ph is correct, then by all means use them.  

We pay so much attention to, for example, our faces, the way we look and regenerating our skin and our face and keeping it hydrated. We should also be paying our genitalia that same amount of attention with the right products, if necessary.

Our sexuality is so much related to how we feel about ourselves internally and externally, and our sexuality is really how we present ourselves to the world. Coming from an aesthetic background, I think we should be also taking care of our vulva and vaginal area. If you wear nice underwear, you feel nice. So it’s about looking after the whole of you.

Amanda: Absolutely. So let’s talk about vaginal rejuvenation or vaginal plasticity. I want to hear more about it because you know, you hear all of these things, “have a Caesar, save the beaver”, those kinds of things. How does it work? What are the end results?

Dr Blaylock: Firstly, with vaginal rejuvenation we have non-surgical and surgical. So surgical will involve something like your labiaplasties or fat filling into the mons pubis and the labia majora. And that should be done by a plastic surgeon or somebody who’s got a lot of experience in that area because of the risks of infection etc.

The non-surgical rejuvenation things that we have available to us can also be internal vaginal or external valvular. If we’re talking about external, we can do filler enhancement of the labia majora and the mons pubis. We can do pigment laser treatments. We can do radio frequency and or laser external treatments for tightness and pigmentation etc.

Amanda: How successful are those things? Is there a huge difference that you see, or is it a subtle difference that only you would really know? Is it the same, as doing these treatments on our face and doing them on our genitalia.

Dr Blaylock: If we’re putting filler in our face, if we put one ml in, there’s a subtle difference but if you can afford to put 10 mls in, you’re going to have a big difference. If you’re going to do a facelift, you can obviously pull much tighter than if you try to do a lift with other aesthetic products.

 Internal laser treatments can either be done with a radio frequency machine or a laser machine. They basically do the same thing internally. They’re just delivering the heat energy in a different way. So what this does internally is that it can stimulate our own cells to regenerate and to make more cells. So it can help a little bit with lubrication issues in postmenopause.

What happens in perimenopause, menopause and postmenopause is that the tissue becomes thin, less pliable, less muscular and what we call atrophic. The color can change. It can be more prone to injury etc. because it’s thin. It’s like a tree that hasn’t been watered.

The laser and internal radio frequency treatments can increase tissue health rand can help those with those issues. You get some women who have the treatments and say they don’t really feel a difference. And then other women have the treatments and they say, “oh my gosh, my husband asked me to stop because I feel like it’s too tight.” Okay. Yeah.

It’s a series of treatments over a period of time. It’s very dependent on what the woman wants and needs. It’s quite important at the beginning to establish what her desires are and what the expected outcomes are. Sometimes expectations can be non-attainable.

If you’re working with a multidisciplinary team and you find something is not going to be obtainable by doing whatever treatment, you can then refer to someone else in your team that can assist with something that needs to be potentially fixed in another sort of way.

We can often identify people, women who have body dysmorphic syndrome or those unrealistic tendencies. Are they watching porn? Are they watching these beautiful Barbie woman with background lightning, lighting, etc. We don’t want them trying to do something physical to feel better if there’s something deeper that’s causing the distress.

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Amanda: That makes a lot of sense. And I think that’s amazing that you would pick that up and would work with that as opposed to just doing the job because it’s an income source.

Dr Blaylock: The other procedure we can do, which involves needles as well, is the platelet-rich plasma (PRP). You may have heard of the vampire facial. Basically, we can do the same in the vulva vaginal area. We take the rich layer, it separates into different layers in the test tube and we take the layer that’s rich in stem cells and growth factors, and then we can inject it back. We can inject it back anywhere into the tissue, including the clitoris.

Amanda: So is where you hear people talk about the orgasm shot or the O shot?

Dr Blaylock:  Yes. I want to just stress that this procedure is not for women who have orgasm problems. It’s not a treatment. It is really for women who want to experience heightened pleasure, heightened orgasms. So we inject PRP into the clitoral area. And also onto the area of the vagina, the anterior third.

So, where we would talk about people having the G spot, that would be the most commonly experienced, most pleasurable part of the vaginal area. It’s the anterior lower third.. It can be just a one-off, but often women will come back for that.

It’s a part of regenerative medicine, which means that we are stimulating our own body to produce more collagen, more elastin, more healthy tissue etc.

Amanda:  What is the secret to sexual health? How do you keep that like, sexual flame alive, essentially. Is it a mental thing? Is it a couple’s guidance? is it aesthetics? What do you feel works the best?

 Dr Blaylock: New relationships are full of rainbows and unicorns and fireworks and butterflies. When you’re a new couple, heterosexual or homosexual, it can be very sexually powered. There’s a lot of fire, a lot of passion. You can’t keep your hands off each other. You’re having sex everywhere all the time. And then over time, when your relationship is more established, that does tend to become less and less and less.

I have to stress that getting married can change that quite significantly. Moving in together also has an impact. Yeah.

Amanda: So, the big white dress and your big happy day can immediately change the number of times you’re having sex. Why? Is it psychological? What is it? Or is it like someone turns off a switch?

Dr Blaylock: So now you’re living together. There are life’s stressed. You have to have domestic chores. You have to split chores. You have financial concerns. You’ve got to talk about money. Then you’re going to introduce a new baby into the home or a pet, for example, where there’s also added stresses. Your attention is shifted away from your partner and, and shifted onto a new baby or shifted onto a puppy.

So, all of those things in life are added into a relationship. If you’re not paying attention to your sexual relationship and you’re not giving it the time, then it can sometimes be put to the side.

Also, couples can very quickly can get into a routine. You can learn very quickly sexually what your partner likes and they can work out pretty quickly what you like and gets you off. And so what happens is you engage in a sexual interaction and you go ABC, wham, bam, finished. So boredom can then creep into your sexual relationship. And so for a couple, it’s important to be constantly coming back to each other and speak, be communicating.

You’re going to talk about finances, about where we want to go on holiday. You’ve also got to put sex into that equation. Communication is key to have a healthy sexual relationship.

You need to be able to tell your partner what you want or what you like. You should also be able to say, “hey man, it’s been like three weeks and we haven’t connected sexually,” or , “you know, what’s happening? Let’s get together.

Let’s spice it up. If couples are mature enough to acknowledge the boredom, to acknowledge that time between sexual engagements is getting longer and longer, if you can communicate with your partner, you are way further than most couples. Then introduce a little bit of excitement, change the place where you have sex, have date nights, go away for a night, go away for a weekend, dress up, do roleplay.

It doesn’t have to be seriously off the wall kinky. You know, it can just be something that’s a change.

Amanda: You poke about women entering the perimenopause phase, whatever or you’ve been in your marriage for a long time, you’ve got kids etc,  is it too late in a marriage to try and find that sexual spark again at that stage?

Dr Blaylock: Absolutely not. But it is couple dependent. You’ve both got to be on the same page. Let’s not forget that we now also recognise andropause. This is when men start to experience symptoms falling testosterone. Even from the age of 35, men’s testosterone levels start to drop.

It’s not as pronounced as menopause, but they can experience what looks like a depression…low energy, low mood, low libido and maybe they’re experiencing poor erections. And what men tend to do is that they start to withdraw or they become confrontational and for example, start a fight so that they can’t have a sexual interaction with because they’re embarrassed about the erectile function.

Amanda: If men are experiencing erectile difficulties, they also sometimes feel inadequate, embarrassed. It’s an ego issue. Men are always supposed to be like up for it. They’re always supposed to be hard etc.  Also from watching porn, there’s that expectation of what they see on porn. They feel like they’re letting their partner down.

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Dr Blaylock: I’m in my 50s and can relate very well to those changes.

Amanda: Back to the aesthetic sort of treatments, are they pricey?

Dr Blaylock: I can’t really give you prices off the top of my head and you will find that many doctors. There is a range– obviously filler product is expensive.

Amanda: You can’t claim–medical aid wouldn’t contribute to any of this. It’s sad because often those aesthetic changes change your entire mental wellbeing.

Dr Blaylock: One goes hand in hand with the other. It’s a pity that they don’t. For example, breast reduction surgery can save the medical aids thousands of rands if the woman at a young age were able to go through that process of having the reduction and save herself the physical challenges, physiotherapy visits, days of work.

Again, it’s looking at the root of the problem. That is why talking about sexual health is so phenomenal when we get given a platform, you know, on radio or wherever to talk about it, because so many people don’t realise that they are not unique and that there is help on a series of different levels.

For example, in perimenopause and when we are premenstrual, we know that we need more Magnesium, Zinc and certain of the Vitamin B’s. Most of us are taking multivitamins anyway, but if the women who are struggling with PMS or perimenopause is moody and not sleeping, just having the correct doses of vitamin B’s can help and Magnesium can also help with sleep and pain control.

Amanda: We know that women who exercise on a regular basis experience less PMS, pain and mood changes and the same with the perimenopause and post -menopause .

Dr Blaylock: Just walking every day is the most wonderful thing ever. It’s great for your mind. It’s great for your body. it’s got so many amazing benefits. We have to keep moving. And doesn’t entail moving from your bed to the kitchen! We’ve got to do more than that.

Amanda: To wrap up, I think a lot of women are embarrassed to talk to someone about doing something with their vagina. How do you find a reliable professional who can do all of these treatments ? Do we just Google, “ find me a  make my vagina look nicer Doctor? Or how do we find someone like you?

Dr Blaylock:  I think a lot of our work comes from word of mouth, but from the sexual health point of view, We do have a big team called My Sexual Health.

We also have a website where you can find listed medical doctors in your area or pelvic floor physiotherapists, occupational therapists and sexologists and psychologists who work in your area. A lot of us do online consultations.

Find me on Instagram as Dr. Heather Blaylock and I’m busy putting up my webpage for the Hermanus practice and also for Dr. Novikova’s practice. Or you can reach me through the My Sexual Health platform and the receptionist will direct the patients.

Amanda:  Fantastic. And do we have to wait months to get an appointment to see you?

Dr Blaylock: No, you’re not.

Amanda: Okay, that’s so good. In closing is there anything that you want to say to our followers who are mostly a broad range of women.  I was thinking that sex is such a natural thing. And it’s such a beautiful thing. It’s like sex needs to be let out the closet.

Dr Blaylock: We’ve got all our beige suits closed in a closet and we want to be able to open the closet and let all the sequins and the sparkles out. Sex is so natural and so normal  and our genitalia are part of our humanness. I don’t understand why we don’t talk more about it when it can have such an impact in a positive or a negative way. And we should embrace it. It’s about embracing it and loving every single part of our body, even that little clitoris down there.

Amanda: It’s awesome for people to know that there are things that can be done, whether from a mental perspective or from an aesthetic perspective, and that there’s modern technology out there. There’s really clever people out there like you and we need the best resources to give us the best of what we can experience sexually. Thank you very much for your time and opening the conversation.

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