Transcript | Ep. 67: How to Demystify Vaginas with Dr. Jen Gunter

[Stinger]

[Clip from Big Mouth]

Narrator: As puberty begins, hormones are released and the sexual organs begin to change.

The uterus is the center of female reproductive activity.

Character 1: The uterus? I thought girls had vaginas.

Character 2: I thought that too, but I guess they don’t.

Character 1: Maybe vagina is like slang?

Hormone Monster: Did someone say vagina?

[Theme song]

Caroline: Hey y’all, and welcome to Unladylike, where we find out what happens when women break the rules. I’m Caroline.

Cristen: I’m Cristen. And Caroline, wow. Today, we are talking to the most famous gynecologist on Twitter and arguably the whole internet! A woman who’s been called both the “Joan of Arc of arc of vaginas” and the “vaginal antichrist”

[Clip from Jensplaining]

Jen Gunter: Push … push … Congratulations! It’s a ... whole lotta bullshit on the internet! I’m gonna use my lasso of truth and I’m gonna take down the wellness industrial complex. Let’s get to learning!

Caroline: That’s right, y’all. That’s Dr. Jen Gunterrrr — aka Jen — hosting her new CBC streaming show, Jensplaining.

Cristen: She’s an OB/GYN and pain medicine physician who specializes in vaginal and vulvar disorders — and fact-checking bogus health advice online and in the wellness aisle.

Caroline: She’s also just published our new holy text, The Vagina Bible: The Vulva and the Vagina — Separating the Myth from the Medicine.

Cristen: Caroline, truly, Jen is probably the person who’s taught me more about vaginas than anyone else ... and that includes my own gynecologist that I’ve been seeing for almost a decade

Caroline: Yes, I definitely encounter Jen more than my own gyno. Because Cristen, as you know, I spend too much time on Twitter, and Jen is one of the reasons why. Like, I can’t remember exactly when, but years ago, I noticed this super salty, super smart gyno debunking nonsense left and right, like douching for odor control; or the idea that summertime dries out vaginas; or pretty much like any abortion-related thing you can think of

Cristen: You and I truly owe our douche-free vaginas to Dr. Jen Gunter, Caroline! Because for nearly a decade, Jen has been on a one-gyno crusade to dispose of the patriarchal claptrap that insists vaginas are dangerous, dirty and/or deformed.

Caroline: And Jen sees her medical truth-telling as foundational to healthcare, reproductive rights and bodily autonomy in general.

Jen: Not understanding that basic physiology is how women get into trouble with products, right? How they fall — and when I say get into trouble I mean fall victim to people selling them stuff. And I think too often doctors talk down to patients, and I really believe that you can bring people up. With the right information people can just advocate for themselves in such a different way.

Cristen: But Jen’s outspokenness has also won her plenty of haters. Namely, Gwyneth Paltrow and her goop-ies, which yes, y’all, we’re gonna get into.

Caroline: This episode already has it all, Cristen. A vaginal antichrist! An A-list celebrity! And a lasso of truth Wonder Woman homage!

Cristen: Oh, but there’s so much more, Caroline. Because today, we’re having one big vulvapalooza! A clit parade! A ce-labia-lation! The good doctor is giving us a rundown of how to — and not to — take care of vulvas and vaginas, aka, the lower reproductive tract — or what I like to call my kit n’ caboodle

Caroline: Plus! Jen answers Unladylike listeners’ vulvar-vaginal-and-gender-inclusive-genitalia-related questions

Cristen: All to find out: What-the-clit is the proper care and maintenance of vaginas?

Caroline: And, two quick notes: 1) Our genitals don’t determine our gender identities, and any use of feminine pronouns and terms like “women’s healthcare” in this episode isn’t meant to suggest otherwise.

Cristen: 2) While Jen is a board-certified gynecologist, this episode is not intended to be direct medical advice. It’s information for y’all to consider and talk about with your own healthcare provider.

[Stinger]

Jen: For every woman who has ever been told usually by some dude that she is too wet, too dry, too gross, too loose, too tight, too bloody or too smelly. This book is for you

Cristen: That’s Jen reading the dedication to The Vagina Bible. And Caroline, based on those criteria, her new book is definitely for me! For just one example, a truly terrible ex once told me after I’d gotten a bikini wax that it “helped with the smell.”

Caroline: Wow, OK, fuck that guy, and by that I don’t mean don’t fuck that guy!

Cristen: I wish I hadn't! Also, he told me this right AFTER we'd had sex. And when I told my gyno about it, she was like, Oh yeah, sounds like a super common, super treatable pH imbalance called bacterial vaginosis. And how did she know? I'm gonna quote The Vagina Bible, Chapter: Bacterial Vaginosis, Verse: Fuck you, dude: "Odor after a male partner ejaculates is often reported."

Caroline: So, your vagina was doing something that vaginas often do — and not something your vagina should be ashamed of.

Cristen: Exactly! And on behalf of my vagina, thank you for saying that, Caroline! Also, The Vagina Bible notes that if you are concerned about your vulvar aroma, more pubic hair actually disperses smells. And confronting this kind of ignorance and angst with facts is what Jen calls her number-one vagenda.

Jen: My vagenda is really for every woman to be empowered about - with information about how her body works. You know we have this really important concept in medicine called informed consent. You know, we hopefully provide factual information to our patients about risks and benefits, and then using that information they make choices that work for them. So my vagenda is really to empower women with accurate information.

Cristen: Was there a chapter that you were especially excited to write, like information you were very eager to get into people's hands.

Jen: Oh, well when I first started the book I - I was you know most excited about the - all the information on skin care and douching and because you know this quote quote feminine hygiene unquote industry irks me to no end. Why is there no men's hygiene industry? They have junk. They have rectums, like what's up with that? So this whole like industry designed to tell women that their bodies are smelly or dirty or need cleaning or need to be tamed. So I was most interested - I really wanted to get that information out to women. I thought if I could just compile all those facts in one place I think that would be so helpful.

Caroline: Also helpful? Jen addresses transgender healthcare early in The Vagina Bible, with info like how hormone therapy can affect menstrual cycles, why trans men who have uteruses are likelier to have abnormal pap smears and how to recuperate from vaginoplasty.

Cristen: Yeah Caroline, we were happy to see that inclusion because doctor’s offices often aren’t the most gender-affirming spaces. For instance, according to stats Jen cites, half of trans patients have to tell their medical providers how to treat them. And nearly half of trans men and a third of trans women say they avoid getting preventive care in the first place because of the potential harassment, or outright denial of services, that they may face.

Jen: l including this in the book was just intuitive because you can come to having a vagina and a vulva in different ways. And I've seen patients who've been refused by other providers simply because they're trans and I just - I don't understand that. So I - I know what happens obviously, but I just felt that you know if people are looking towards me as as some type of spokesperson that also including the - the information in the book would also you know send a message to other physicians because I knew a lot of physicians were going to read the book, and maybe they needed to to know more as well.

Cristen: When we invited Unladylike listeners to submit quote-unquote vagina-related questions for you for this episode, we immediately heard from some folks who weren’t pleased with our imprecise terminology bcause the vagina is only the inside, while the vulva is the outside, and they meet at what’s called the vestibule. Now, the title of your book is The Vagina Bible. So what's your approach to the vulva/vagina language debate and how did you land on the title?

Jen: Well I think that first of all, there's a difference in what happens in the office and what happens in public discourse. And so the idea was that you know if I called this book The Vagina and the Vulva Bible, which I had wanted to at the beginning, that vulva would get dropped, and it would become more complex in a way that didn't suit how we speak about things in public. So you know, I think that there's you know colloquial ways we speak about things and medical ways, and obviously I want people to - to have the medical information, and I don't want to exclude the vulva, but you know you also have to be realistic and think, how am I going to get my message across to the most people.

Caroline: Jen wasn’t getting any messages about her anatomy as a kid. Back before she was writing the Bible on vaginas, Jen grew up in a household that took a very ... Barbie doll approach to them

Jen: I was taught they didn't exist. Probably. Yeah. So no we - there was no - the 60s and 70s you know people did not talk in public, even in the 80s the way way we do now. But it was never broached anything about you know women's bodies that you know that there was anything down there at all. Really. And my mother didn't even tell me about you know periods at all. I mean she hadn't been told by her mother. And - and I'm still struck by a story about what she told me years later that you know her own mother kind of laughed at her when she woke up covered in blood thinking that you know that she was dying. And you know so I think that sort of rite of tragic passage was something that was you know part of my upbringing that you didn't know about anything and you know you found out about it and dealt with it.

Caroline: Thanks to Judy Blume and Are You There God, It's Me Margaret, Jen learned about periods. And after a tweenage skateboarding accident landed her in the hospital, she decided she wanted to become a doctor when she grew up.

Cristen: By the time she headed to med school in the 80s, Jen was strongly pro-choice and feminist, which pretty much primed her to pursue gynecology

Jen: I just remember being so angry that all the lectures about women's health were from men. And it just bothered me that there were so few women talking to me about women's bodies, and so I think I went into OBGYN out of a place of anger, which is apparently how I do a lot of things. Anger is a - it's a bitch of a motivator.

Caroline: That ragespiration eventually led Jen to run a specialty clinic for vaginal and vulva disorders, which — we should note — means that she see folks with more chronic and intense symptoms than the average gyno patient

Cristen: Right. But even though their immediate healthcare needs might be more intense, the concerns Jen hears firsthand still ring familiar to probably anyone who has a vagina.

Jen: I sadly see a lot of women who feel that their vaginas and vulvas are broken. Really. Those are - that's the word that I hear a lot, that they're broken. And I think that was also a big impetus for me to to write the book because in many of these situations they didn't really have much wrong medically. What had happened was they - they'd had a symptom that instead of being treated correctly at the beginning was treated incorrectly either because of what they read online or misinformation from their doctor or you know what their mom had told them to do. And because of the societal shame about the vulva or because of misinformation from the medical community or whatever gaps there were, and there are lots of gaps, they ended up with with an issue that didn't have to be, right? And then there are people who feel that they're broken is they've really hard medical condition and nobody has treated it appropriately. No one has even given them a diagnosis. They've been suffering for 10 years or 15 years, and they've been told there's nothing wrong with them. They don't actually have have anything, but of course they do, they have symptoms. And and I give them a diagnosis. And so imagine being told for years there's nothing wrong with you but you've got an itch or you have pain.

Cristen: And is it your sense especially from your point of view as a gynecologist and seeing patients that a lot of women do not have accurate information.

Jen: Oh yeah, absolutely, I mean I think myths and mythology about women's bodies you know fester and foster because of misinformation. And so I think there is that you know we have for centuries, probably since the beginning of time associated women's body parts with shame, and so it's pretty difficult to get factual information about a body part that's supposed to be shameful right. I mean how do you bring up a word that shameful.

Caroline: That sense of shame or simply feeling belittled by medical providers is what lands a lot of us online trying to solve healthcare problems on our own. And that includes Jen. In 2003, when she was pregnant with triplets, Jen's water broke way too early. Only two of her babies survived, and both had severe health complications.

Cristen: Even for Jen — a practicing obstetrician at the time — it was tough to sift through all the health advice and bogus information she found online.

Jen: I made health care decisions I wished I hadn't because of things I found online, information that I actually found out later on was probably incorrect or definitely incorrect. And I remember what it was like to have no answers to have medical problems with literally no answer. And so I - I understood how - how the lure of the cure, how a site that makes you feel like they understand you, can really take hold.

Cristen: Even as her kids got older and healthier, Jen never forgot that 'lure of the cure' and how seductive it can be

Caroline: So, she decided to start spreading the truth about vaginas on the internet.

Jen: I thought, you know, we have to do better. And I kind of had this vision in my head of, like, my little stick with my little handkerchief that I you know rolled up my possessions and tied on my stick and put over my shoulder, and you know that I was going off into the world to fix the medical internet

Cristen: When we come back, Jen takes on Gwyneth, goop and internet myths gone wild.

Caroline: And later, Jen fields questions from y’all on everything from squirting and labia size to hormone therapy and more!

Cristen: Buckle up your menstrual belts!

[Midroll ad 1]

Cristen: We’re back, with Twitter’s resident gynecologist, Jen Gunter.

Caroline: The first step in fixing the medical internet for her was getting the truth out there in a way that made sense. So in 2011, Jen launched her blog, DrJenGunter.com

Cristen: And quickly, she realized that readers responded a lot more when she sounded less like Dr. Gunter and more like just Jen.

Jen: So I just thought I - I'm just gonna write like how I am and I'm not to talk like how I talk because I think that what drew me to those predatory sites was that veneer of authenticity. And I guess that didn't sit well initially with a lot of people in medicine, and they're like, Oh you can’t swear. And I'm like, well who fuckin made that rule, not me. I didn't make that rule. Oh the patriarchy made that rule. Right. Right. Right. Yeah. Fuck off.

Cristen: Then in 2015, Jen discovered a little website Gwyneth Paltrow had started — goop. A friend had sent her a goop article that warned underwire bras might cause breast cancer. For the scientific record, they do not. And Jen explained why in a blog post titled Hey Gwyneth Paltrow, a GYN says stop scaring women about bras and breast cancer.

Caroline: And as goop grew into a quarter-BILLION-dollar wellness empire over the next few years, Jen didn’t let up. She blogged about why Gwyneth’s endorsement of vaginal steaming was full of hot air. Why goop’s high-end vitamin packs were scientifically worthless.

Cristen: And perhaps most famously, how their $66 vaginal jade eggs could not — as goop claimed at the time — “balance hormones, regulate menstrual cycles, prevent uterine prolapse, and increase bladder control.”

Caroline: Around the same time Jen’s post went viral, a consumer watchdog group was also side-eyeing what goop was selling. And in 2018, the Santa Clara, California, district attorney’s office fined the company $145,000 for making “unsubstantiated” marketing claims

Cristen: And way more significantly, the settlement bars goop from selling “misbranded, unapproved, or falsely advertised medical devices”

Jen: Wellness is not your friend. You should have the same eye with wellness as you do for Big Pharma. They are the same thing. They are 4-trillion-dollar-a-year industry, and they've just been able to pony on to the societal shame about the reproductive tract and make it sound like they're your girlfriends trying to help you out, but really they're just trying to sell you a useless product just like the douche people.

Caroline: The douche people.

Cristen: Just like the douchebags. So it sounds like wellness is totally a misnomer.

Jen: Absolutely, there's no wellness product I would use. I'm - you know I consider myself pretty educated on wellness, more so than most physicians right. I've been to a conference. I went to a Goop Wellness Conference. I read a lot about wellness. It's - wellness is - is big pharma’s you know evil stepsister because they're - you know wellness doesn't do any studies at all. At least pharma does some. You know you can walk into any manufacturer of birth control pills or antidepressants and go to the end of the line and take the pill, and it will contain what it says. Right. So at least like there is that minimum standard in big pharma. You don't have that standard in wellness. And everybody gives them a pass. I'm so fascinated by that. This is a highly profitable industry that has to prove nothing. And yet somehow they're like here to save us. It's fascinating to me.

Caroline: Cristen, what’s also fascinating is how Gwyneth and her goop-ies responded to the criticism. They accuse Jen of condescending to women who simply want to exercise more autonomy over their health

Cristen: Ironic because that’s exactly what Jen is trying to do: debunk the bullshit that compels us to buy vagina crystals, or vulva beauty mists — which, yes, are an actual thing — and herbal suppositories that do nothing but feed our anxieties and drain our wallets

Caroline: Exactly. And despite the wellness industry’s claims that vaginas need TONS of products to really thrive, Jen’s advice is super simple

Jen: Yeah, I mean - I mean that's pretty much the same with most of your skin. Less is More. You know soap is drying you know cleansers are less drying, and when your skin is dry that that's the enemy of your skin. When your skin is dry the acid mantle cracks there, you're more likely to be exposed to a sort of you know environmental pressures that can irritate your skin. So you know you - skin care is - is less, it's not more. Products that have scents and smells are more likely to irritate you. And you know if you're trying to be gree,n isn't the greenest thing to use less, like to use less products, like that's that's the greenest thing is to buy less.

Caroline: So you have a lot of laugh out loud lines in your book. A lot of like I got looks in public reading the book not for the cover just for me cackling. And you - you do talk about something that Cristen and I have also talked about in our show, which is the fact that vaginas are self-cleaning ovens. So could you just explain that that concept a little bit.

Jen: Yeah I mean the vagina is so glorious in all its adaptive mechanisms. I mean you have vaginal discharge in this ecosystem that keeps everything perfectly healthy. We have good bacteria that's usually lactobacillus. But some women can have other populations of good bacteria, which maintain a low pH and produce other products that are sort of you might best think of as sort of natural antibiotics, if you will, sort of substances that kill bacteria. And so the low pH makes is hard for other bacteria to grow. It keeps everything in the right ecosystem. You also have this net of mucus that stretched over everything, which is a basically a physical barrier for the cells and and also probably you know transport mechanism for all the good substances that keep the cells healthy. And then the cells are shed very regularly. So about every four hours those that are the surface of the cells comes off and a new layer takes over like a conveyor belt and those cells float around in your vagina. The bad bacteria doesn't know if those free floating cells are attached to you or not, it just sees cells. Oh my God food. Let me attach! And then your body's like, haha this was the defense mechanism and fshh the bacteria goes out stuck on the cells in the discharge. It's so cool. That's why you shouldn't be reaching up in there to scoop out discharge, why you should just be leaving it all alone because your vagina’s got you covered.

Cristen: Hear that y’all?? If you’ve got a vagina, it’s got you covered!

Caroline: Love it. Also love all the old wives’ tales and new wellness woo-woo Jen fact-checks in The Vagina Bible.

Cristen: Yes. Here’s a sampler platter of scientifically bogus advice Jen debunks in her Bible. Here goes

[Curb Your Enthusiasm music]

Cristen: Plain cotton underwear keeps vulvas freshest. Boric acid rebalances vaginal pH. Sitting around in wet swimsuits causes yeast infections. In fact, Jen has seen more yeast-infection-related claptrap than any other gynecological condition

Caroline: There’s also the lie that vaginas can loosen up like old scrunchies, that birth control causes infertility, and peeing after intercourse prevents UTIs. It goes on and on and on!

Cristen: Fortunately, Caroline, the price is right to bust this old baloney. Dr. Jen Gunter, come on down and educate us on all the unmentionables!

Caroline: OK, so what is healthy vaginal discharge.

Jen: Healthy vaginal discharge would be white to cream color, could be clear. It'll be you know anywhere up to a kind of 3 even 4 milliliters on your underwear, shouldn't have a strong odor and it's glorious.

Caroline: Glorious. OK this is sort of like wellness-adjacent. What should we not put inside our vaginas to treat yeast infections.

Jen: Oh, the list is so long. But the most the most common ones I hear are don't - tea tree oil. Don't use that. Garlic, don't use that. Yogurt. Don't use those things. Don’t use anything homeopathic. Don't put any herbs in your vagina to treat yeast.

Caroline: Why do people think that they need to put yogurt or garlic in their vaginas.

Jen: Well, sadly those are things people used to recommend I guess. Back in the day - back in the day of lysol douches as well. So just because something gets recommended doesn't mean it's good. And I would like to point out that you know women don't stick random vegetable matter in their vagina or random food for no reason. Someone they viewed as a trusted source told them that, and the recommendation for garlic and yogurt is in fact in Our Bodies Ourselves.

Cristen and Caroline: Ohhhhhhh

Jen: Right? So you can see how dispelling that myth is almost impossible because it's in a trusted resource.

Cristen: Can you eat anything that will make your vagina taste sweeter?

Jen: No. And you know that mythology is no different than saying you should douche for your vaginal health, right. The implication is there’s something wrong with your normal vaginal ecosystem or your normal virginal smell. There is no direct connection between your stomach and your vagina. You know this idea that you could metabolize something and it would get into your vagina and only change the smell of your vagina but not changed the smell of your feces, not change the smell of your sweat, not change the smell of your saliva. It's just it's so incredible, and that's you know the thing about these myths is they don't even hold up to common sense. Which is why that's why myths are so pervasive because they're you know they're very like conspiracy-theory adjacent almost. Right. It's like a religion. People want to believe them.

Cristen: For the record, Jen says that “fiber is the best food for vaginas because nobody's happy when they have hemorrhoids.”

Caroline: That is the truth! When we come back, Jen grabs her lasso of truth and answers questions from y’all.

Cristen: Stick around!

[Midroll ad 2]

Caroline: We’re back with Dr. Jen Gunter

Cristen: And Caroline, you and I could talk to Jen about vaginas and things to not put in them for days

Caroline: True

Cristen: But! We also invited Unladylike listeners to submit their gynecological questions for Jen, and per usual, y'all delivered

Caroline: OK, so our first question is an anatomy question. So we will let it roll.

Emily: Hi, my name is Emily and I'm from Madison, Wisconsin. So I recently got my first vibrator and have never really used a tampon for my period, or I’ve tended to use pads, and I’m having trouble finding my vagina. Is there a specific way I could find it without having to go to a gynecologist? Thanks. Bye.

Jen: So for Emily, if you are using pads, I'm going to assume then that you're not having any trouble with menstrual blood coming out. So that means there's definitely a connection between the vagina and the outside world. Because definitely there are — It's not common, but there are conditions where there can be a septum or growth that actually restricts the opening of the vagina. So you know, I think the best thing to do is to is probably get a mirror and try to prop it up between your legs and to separate the labia and look and see what's in between and to start with your finger. Using a tool like a vibrator is harder than using your finger because you can then feel if you're touching something that's painful or not. And maybe try some exploration guided with with with a mirror and your finger to see if you can gently slide your finger inside the vagina knowing that the vagina is the inside part and maybe looking at like a diagram like in the front of the book The Vagina Bible so you can actually see what you're looking at. If you have troubles sliding your finger inside and you just can't do it, then you know these are things that gynecologists can help you with because sometimes it's nerves, sometimes people just don't know how far they can push because they just don't know. And we're happy to show you.

Caroline: All right Jen, next up we have an email from Katie! Should I do a dramatic reading? Alright Dr. Jen, this one’s for you.

Jen: Ok

Caroline: Female ejaculation!

Cristen: That's in all caps.

Caroline: That’s in all caps. Myth? Legend? Urine? I've heard so much conflicting information. Please enlighten us. Do I have a super cooch or do I need to do some kegels. Katie.

Jen: Katie, you should be writing copy. That's awesome. So yeah. So there are two things that people think about with female ejaculation. So there are two potential sources. So one is this Skene’s glands, which are tiny glands on either side of the urethra. And it is true that they can release a small amount of a milky substance you know during orgasm or during sexual activity. When I say small amount I'm talking about less than a milliliter. Right. So we're not talking about a gush or anything, a little bit of a dribble of something. So technically, medically, you could say that fluid from Skene’s glands could be considered female ejaculation, but it's not shooting across the room like a man or those videos that you see online. And I have to tell you, I watched a few of those videos. The large gush of fluid, so something that is definitely more than a milliliter or two, that is urine. There is no gland in the lower reproductive tract that can hold a large volume of fluid. So that's the first thing. You know anatomically there isn't something there. And there was a really well-done study where they took women who reported squirting, which is though - so I would say we would use squirting for the large volume of fluid and what they had they had them empty their bladders and then they did ultrasounds of their bladders while the women were stimulating themselves, and the woman had orgasms and released their fluid, and then the ultrasounds were repeated. And what they found was these women's bladders filled incredibly quickly during stimulation and that after squirting their bladders were empty, and the - the fluid was collected, and it was compatible with urine. And you know if that's bothersome to you, then kegels might be helpful. Also could be just the way you're wired, and a urogynecologist, a gynecologist that specializes in bladder problems, could do an evaluation you know because coital incontinence, you know releasing a fluid during sex, is something that sometimes we have treatments for would also depend on what is happening. The other thing I say is, you know, sex is wet and messy, and that's in my opinion why they make navy blue towels. Because I mean who - who buys navy blue towels like for their face or their bathroom like for everyday use like nobody. Right.

Caroline: Cristen's raising her hand.

Cristen: I do have some navy towels. But it's precisely because —

Jen: Sex towels.

Cristen: — They hide grossness

Jen: Yeah exactly. So - so the black I can't explain but the navy blue I'm like, What is up with that. So yeah. Those are for - those are sex towels, baby.

Cristen: Yeah actually that's what I have. Yes. That’s what I’ll tell myself. All right so this next listener question is from Camille. Is it normal to get dry itchiness around your labia and pubis? I'm always so concerned that I have an infection but I have no other symptoms like smell or irregular discharge.

Jen: So there are a couple of things could be happening. So one, that could be from using soap, which is very drying. And so switching to a cleanser or just stopping all cleaning products temporarily. Using wipes will make your skin drier definitely, so stopping all of those products. Pubic hair removal can make your skin drier because we think that one of the functions of pubic hair is to retain moisture because your vulva has a higher moisture content, and then - and sometimes dry itchy skin can actually be a sign of that skin condition like in some chronic which is eczema and can sometimes be a sign of other skin conditions as well. So I would say this is going on for that long is probably worth having someone just have a look to make sure that's not what's going on. And then options are you know not using soap, not using wipes. Making sure that you know if you're removing pubic hair thinking if you can not do that and if there's no skin condition and you know not removing pubic hair isn't an option for you certainly you can use a moisturizer on your vulva.

Cristen: All right. So we have a question from Chris. It's an email so I'll read that. Chris writes, My 16-year-old transgender son started testosterone therapy about eight months ago. I'd like to know how the addition of T to his body will affect the functioning and general health of his vagina now and in the long term.

Jen: Yeah, so testosterone therapy will have significant. It can have a significant impact on the vagina. Certainly you will see a clitoromegaly as well. So you'll see enlargement of the clitoris, but from the vagina standpoint the estrogen-dominated flora will be replaced, so the tissues will get thinner, and the discharge may change. And the biggest impact is that there may be pain with vaginal penetration. So some some trans men continue to use their vagina sexually. The other thing is you have to still get pap smear screening or cervical cancer screening, and so it can make that kind of screening more painful as well. And there are things that we can do, and I do go into that in the book about you know either giving a small amount of estrogen vaginally beforehand or using a smaller speculum. There are other you know there are definitely things that we can do to make that less painful.

Caroline: Ok, so our next listener question, we do have a voicemail. And this is from Sam who is not our producer. And it's kind of a two-parter so you're gonna hear something and you're gonna be like what. But then she corrects herself.

Sam: Hi, my name is Sam from Omaha, Nebraska. My question is I've always been told that I have an oddly shaped uvula, and I - I feel like that's not a thing. So I was just curious what the average woman looks like down there. Thanks. P.S. Hi, this is Sam from Omaha, Nebraska. I'm an idiot and how my last message I said I uvula, and I meant labia.

Jen: Sam, yes there is no such thing as an oddly shaped labia. Labia come in all shapes and sizes just like ears do and your nose does and your lips do and there is there's no sort of normal I would say. Certainly the majority of women will have labia minora that are 5 centimeters in width or less, but if yours are longer, there's nothing wrong with that at all. And I think it's important to remember that labia have erectile tissue, they have specialized nerve endings, and when you pull on the labia minora you pull on the clitoral hood. So it's a sexually responsive organ. And I think that most people have the size they have because that is how they were put together, and that's totally fine. There is this disturbing trend to make women hyper aware about their labia minora, and I've even heard some women being told that they have an outy vagina. I know right? That their labia minora are longer than their labia majora. You know would we ever say that to a man. Oh your penis is too big? Right. What would culture say that? Would culture say, “Oh, your penis looks too large in those jeans. We should do something about that.” Twenty-five years ago I was never once asked to reduce the size of a normal labia and now the requests are commonplace, and often it's mothers bringing their daughters in, and that's why I have that line in the book. If you are concerned about your the size of your daughter's labia minora stop looking. Because you're gonna give her a body image disorder. And if you have a concern call her pediatrician. Don't start saying things about it.

Cristen: This also reminds me of fantastic language suggestion that you made. Speaking about my - my own issues with wearing yoga pants I will often get a camel toe or as you put it labial cleavage.

Jen: Right. Right. Just like labial cleavage.

Cristen: And I'd just like to make that happen.

Jen: Yeah. I think we all need shirts that say love your labial cleavage. Like men get described as having a package, that's like a gift, right? A package is a gift. And women have camel toe. Fuck that, it's labial cleavage. And if you don't like it, look fucking somewhere else.

Cristen: Caroline, I’m not kidding when I say I want to make labial cleavage happen.

Caroline: Oh, you can make it happen anytime you want, Cristen

Cristen: Well I do make it happen anytime I put on yoga pants, truly

Caroline: All right y’all, well thank you so much for all of your questions. And if you still have questions about vaginas, vulvas or the lower reproductive tract in general, Jen told us how to find other reliable sources online.

Cristen: Yes. So a good place to start is the American College of Obstetricians and Gynecologists, or ACOG, they have a great website. And same with the Society of Obstetricians and Gynecologists of Canada. And something I did NOT know, Caroline? Jen writes that .gov sites tend to be higher quality than .edu, .com or .org websites because they're "typically curated by medical librarians."

Caroline: Oh! I’m still learning.

Cristen: I know, I know! And one final heads up from Jen: Just beware when you start seeing lots of words like detox, cleanse, pure, clean, natural. Those might be signs you are into some wellness woo-woo.

Caroline: Yeah. The vagina’s a self-cleaning oven, y’all. Let it do its work.

Cristen: Let it do its work! And to follow Jen’s work, head on over to her Twitter @drjengunter or check out her website drJenGunter.com

Caroline: Tell us YOUR thoughts: What were you surprised to learn about vaginas in this episode? What myths have YOU busted? We’d love to hear from you. Let us know on social @unladylikemedia.

Cristen: You can also email us at hello at unladylike.co or comment on the episode thread in our Facebook group.

Caroline: Head on over to our website, unladylike.co, to find this episode’s sources. There you’ll also find the transcription of this episode!

Cristen: While you’re there, sign up for our newsletter to get actual good news about women in the world every Wednesday.

Caroline: Unladylike is produced by Nora Ritchie and Sam Lee. Abigail Keel is our senior producer. Gianna Palmer is our story editor. Shruti Marathe transcribes our tape. Our music is by Flamingo Shadow, Amit May Cohen and Sarah Tudzin. Mixing, sound design, and additional music is by Casey Holford. Our executive producers are Chris Bannon and Daisy Rosario. Special thanks to Laughing Tiger Studio.

Cristen: We are your hosts, Cristen Conger

Caroline: And Caroline Ervin. Next week:

Lisa Hanawalt: people just don't understand being really into something without wanting to fuck it. And I'm like that's kind of stupid. Like do you want to fuck a bowl of ice cream? I mean maybe you do, I don't know. Sorry to be crass.

Cristen: What kind of ice cream?

Caroline: Is it Moose Tracks?

Cristen: Saddle up! We’re talking horse girls with Lisa Hanawalt, the illustrator behind our favorite the depressed horse, Bojack Horseman. And journalist Gray Chapman is leading us on a trail ride to Kentucky to visit the “gathering of the Juggalos for horse girls”: Breyerfest.

Caroline: Make sure you’re subscribed to Unladylike so you don’t miss our episodes. Find us on stitcher, spotify, apple podcasts or wherever you listen to podcasts.

Cristen: And remember, got a problem?

Caroline: Get unladylike.

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