Thanks to some excellent campaigns and awareness raising, women are becoming very breast aware and know what is normal and what to get checked out, but what about down there? As a woman do you feel you have the same level of knowledge?

Health on Female First

Health on Female First

The number one question asked by patients at The Women's Health Clinics across the country is: "Am I normal?" Managing director and urology nurse Emma Soos explains what women should do to help themselves.

"First and foremost, check yourself out, get familiar with your shape. Then if you spot a change you will recognise it and know it's time to seek advice. Women are aware of the changes their bodies go through as they age, but only those they can observe directly in the bedroom mirror. Yet the vagina changes shape, elasticity and goes through so much more as women go through puberty, childbirth and then menopause."

Here is what to look out for - at any age:

Pain - Aging apart, if you have never been pregnant and have persistent vaginal discharge or vulval pain, rather than taking over the counter medications you should get yourself checked out and tested. There is new PCR technology allowing a smear test to simultaneously test for seven STIs.

Discomfort - Persistent vulva discomfort and itching is not usually thrush. It is likely to be a skin condition and better to take advice rather than repeated anti-thrush treatment.

Bleeding - Bleeding in between your periods or after having sex is not normal and should be checked out even if your smear test is normal.

Lumps and bumps - As with your breasts, lumps and bumps in any area are not normal and should seek immediate advice.

If you are silent sufferer with Vulvodynia there are treatment options including Nu-V laser, studies have shown a 60-70% improvement with treatment.

Smear tests - Your number one priority - Be 'UpToDate' with your smear tests. Between the ages of 25 to 49 years of age, they are every three years. If aged 50 to 64 years they should take place every five years. For women over 65 years, they will be called if they have recently had an abnormal test result. We are increasingly witnessing women under the age of 25 years undertaking tests in the private clinics.

From your 40's and post children:

If you've had children and had to undergo an episiotomy but are still experiencing pain and discomfort you should seek advice and not simply put up with it. There are treatments that make the scar more supple and stretch.

It is common so have vaginal laxity after childbirth. This often improves over time but if you have a feeling that everything is coming down then pelvic floor exercises along with non-surgical tightening procedure will help you recover quicker.

Stress incontinence is very common if you had a long labour, spent a long time pushing the baby out or an instrumental delivery. There are surgical and non-surgical procedures which can help you so research your options. Women do not have to consider surgery but there are sadly few options readily offered by GPs so do your own research. Pelvic floor exercises are an important therapy to recover from stress incontinence but it may be a collagen deposition can strengthen the vaginal wall.

The age of menopause

Vaginal dryness, pain during or after sex, bleeding after having sex, vaginal laxity are common in this period due to lack of estrogen. Changes in the appearance of the vulva and prominence of the clitoris are also common during this period.

Stress incontinence - It is not a question of putting up with it. We know women want non-surgical alternatives and there are surgical options including slings and natural mesh procedure which are being performed by few. These were being performed before the invention of the mesh but long-term data is lacking. As with all procedures only time would answer if these treatments are safe and risk free. I recommend women do their research, find out the best options to suit them and then ask their GP to help with their decision.

Urge incontinence or urgency with increased frequency - This is a very common problem that most women suffer even if they haven't had children. We don't understand the exact causes of this but various factors contribute like the lifestyle factors, lack of estrogen and childhood habits of passing urine. Vaginal tightening can help with decreasing frequency and urgency.

To conclude

Whatever your age, I urge women to ask a doctor or nurse for help if they notice a change. No question surprises us or we haven't been asked before when it comes to women's genitalia.

What does surprise us is the lack of representation of women's health issues within education, the NHS and the press. We want women to have more access to information about their own bodies from school upwards. It sounds simple so we have launched a petition, we hope to achieve a wider representation of women's health issues.

Join and sign the campaign, here

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