Dr. Jodie Horton Expert

2,520

Board Certified OB/GYN

Discovered a new lump or bump on your vulva? Take a deep breath, there is no need to panic. Not all bumps and lumps on the vulva are scary or bad! It’s important to know your body and what is normal and what is concerning enough to see a doctor. Here are some common causes of changes in the skin in the vulva and vagina. 

There are several glands on the vulva, including oil glands such as Bartholin’s glands.  If these glands get blocked, a cyst can form. Bartholin’s glands are located at 4 and 8 o’clock on the vaginal opening and secretes fluid that lubricates the vagina. Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin's cyst. If these continue to grow or get infected, they can cause pain. 

Sebaceous cysts happen when oil-producing (sebaceous) glands near hair follicles get blocked. Sebaceous glands (oil glands) that lubricate the skin and hair get obstructed and cause a cyst. There may be one or multiple but are generally painless; however, they may grow to larger sizes resulting in discomfort and pain.

Genital warts are caused by human papillomavirus (HPV), which is the most common sexually transmitted infection. Often they have the appearance of cauliflower and will usually be more than one clustered together.  Sometimes they can appear flat and not raised. You can get them from skin to skin contact with someone who has the virus. 

Molluscum contagiosum is passed along by adults through sexual contact. They appear as multiple little red bumps with a crate in the middle. They can be very small or as large as a pencil eraser and usually show up in adults who have a weak immune system.

Shaving or waxing pubic hair increases your risk of ingrown hairs. This can cause a small, round, sometimes painful, or itchy bump filled with pus. Don’t try to remove the ingrown hair on your own because it can lead to an infection of the hair follicle called folliculitis.

Genital herpes is an infection caused by the herpes simplex virus. Herpes is transmitted by vaginal, oral, or anal sex.  An estimated one in five Americans has genital herpes. Herpes usually presents as multiple shallow and painful ulcers. In the first outbreak, you will also experience flu-like symptoms such as fever, swollen lymph nodes in the groin area, and pain. If you experience any of these symptoms, your doctor can swab the sore and do bloodwork to make a diagnosis.  There is no cure for the virus, but medication can control the severity and duration of symptoms.

It’s always a good idea to see a doctor if you’re unsure about changes to your body. If you have a new lump that doesn’t go away or have signs and symptoms of an infection, don’t panic.  Make an appointment to see your doctor about a diagnosis, treatment, and prevention in the future.   

With love, 

Dr. Jodie Horton

The clitoris is not just that part of the vulva that looks like a tiny button. It's made up of multiple parts that we can’t completely see. So let’s talk about the so called hard to find clitoris.

The clitoris is made up of the glans, the clitoral body, the crura, and vestibular bulbs. There is an external (the clitoral glans and hood) and internal part (the body, crura and vestibular bulbs).  It's not a well studied or understood part of female anatomy, but here is what we do know.

External Parts of the Clitoris

The glans clitoris is the pea-sized external part of the clitoris.  It's located just above the urethra and is highly innervated. It's said to have 8000 nerves making it super sensitive. The glans do not have erectile tissue, so it doesn't swell or grow during sexual arousal. On top of the glans is the clitoral hood, which is formed by the two sides of the labia minora that connect just above the clitoris. Clitoral hoods can vary in size and degree of coverage.

Internal Parts of the Clitoris

A majority of the clitoris is not visible. The glans are connected to the body of the clitoris that then splits to form the crura and vestibule glands. The bulbs divide right above the urethra and extend about 9cm. through both of the labia and down towards the anus. During sexual arousal, erectile tissue in the crura and vestibule will swell due to increased blood flow to the vagina. The increased blood flow is also responsible for an increase in vaginal lubrication when sexually aroused. It's also believed that women who experience vaginal orgasms are really experiencing clitoral orgasms because the clitoris encircles the vagina.  

And there you have it! The clitoris uncovered. For the sake of women and men everywhere, may the clitoris no longer be ignored and be appreciated.

With love, 

Dr. Jodie Horton

Sources: https://www.scientificamerican.com/article/the-clitoris-uncovered-an-intimate-history/

No two women are the same, nor are their periods or their choices of feminine hygiene products.  Some women may not think about what most feminine hygiene products are made of, but there is a lot to consider when choosing. You can choose the size, absorbency level, applicator type, and scented versus unscented. Then there are menstrual cups and period panties to consider. The options are endless, so let's talk about some of your choices.

Pads 

Pads are among the earliest feminine hygiene products around, but things have changed over the last 100 years. Pads are offered in various lengths and absorbency levels. The advantage is that nothing is inserted into the vagina; however, some feel that pads are uncomfortable and aren't practical when doing physical activity.  Some women even will use tampons with pads depending on their flow.

Tampons 

Tampons are the most popular choice of feminine care products used by women age 41 years old or younger.  Like sanitary pads, tampons come in different sizes and levels of absorbency. The advantage of tampons is that they are easier to use during physical activity. Urinary tract infections and toxic shock syndrome are rare, but there are steps to avoid complications. It's recommended that you use the least absorbent tampon to manage your menstrual flow and change your tampons every 4-6 hours. There is concern about the chemicals in tampons linked to cancer, disruptions of hormones, and unnecessary allergic reactions. In fact, the FDA does not regulate or require companies to test or disclose potential harmful chemicals used in these products.

There is now a huge market of organic cotton tampons. The difference between organic and conventional tampons is that organic tampons use 100% organic cotton to claim that no pesticides are used. However, these companies may still bleach the cotton, increasing the potential risk of toxic byproducts such as dioxins. There is no scientific evidence to date to say that organic tampons are safer than conventional tampons. It's important to read the labels, do your research and use tampons as directed. 

Menstrual Cups 

Menstrual cups collect your blood flow rather than absorbing it like pads and tampons. They are also becoming an increasingly popular choice among women. If you are not familiar with the menstrual cup, it's worth looking into the pros and cons. Menstrual cups are a reusable product made of rubber or silicone that can last up to 10 years if properly taken care of.  It can hold more blood than tampons and pads. Depending on your flow, the cup needs to be changed every 6-12 hours. Another benefit is that it is an eco-friendly alternative to the product waste of tampons and pads and is cost-effective.

Period Panties 

Period panties are underwear that have built-in period protection that you wash and re-use. Period underwear is discreet, and the thin absorbent layers stay in place when compared to pads. They can also be used with tampons for heavy overflow or at the end of your period when there is not enough flow for a tampon. The disadvantage is rinsing out your underwear at the end of the day, which means more laundry. On those heavy flow days, you may have to change your underwear in the middle of the day, which can be inconvenient. One last thing to consider is the cost. It can add up to get a full cycle set, but the underwear could last several years to be worth the investment.

With all the choices for feminine protection, women must be educated about their options to better manage their menstrual cycle—rather than being managed by it.

What questions do you have about tampons, menstrual cups, and other feminine hygiene products?

With love, 

Dr. Jodie Horton 

The vagina has a very delicate ecosystem. After the bowel, the vagina contains the most bacteria in the body. The function of this bacteria is to maintain the vagina’s pH between 3.8-4.5 in order to remain balanced and healthy.

Maintaining a good vaginal pH prevents the overgrowth of yeast and bacteria that thrive in a less acidic environment. Semen can upset your vaginal pH balance because the pH levels of semen are higher than the pH levels of vaginas. When Semen enters the picture, this can mess with the growth of healthy bacteria aka vaginal flora.

Unprotected penetrative sex with a man changes the pH of your vagina because semen has a pH of between 7.1 and 8. During sex, the pH of your vagina rises in order to create a more alkaline environment to protect the sperm and encourage fertilization. This can also encourage the growth of certain bacteria. While this rise in pH is immensely helpful for conception, it does open you up to the risk of infection.

Some of the steps you can take to avoid this complicated relationship are:

• Use condoms. By doing so, semen is not introduced to the vaginal canal
• Always pee after sex to flush out some of the semen
• If you're prone to yeast infections, try making a shift in your diet. Cutting out sugar and carbs can help to get your gut and vaginal health back on a healthy track, thus limiting these infections and creating a healthy pH balance
• Wash with warm water, but keep in mind that the pH of water is 7 (wow, I know) so this can potentially contribute to any infection however chances are slim
• Last but not least, never douche and don't use soap with dye or perfumes

Here's to a hopefully not so complicated relationship in the future! 

With love, 

Dr. Jodie Horton

Did you know that when sexually aroused, two major glands in the vagina releases natural lubricants to make sex comfortable and enjoyable? You may not even be aware that these two glands exist, but they are constantly working together so your vagina can function smoothly!

Bartholin's Glands

These glands secrete mucus to provide vaginal lubrication during sexual arousal, similar to the Skene's glands. You won't be able to see these glands, but if you are imaging the vaginal opening as a clock, they are located at 4 and 8 o'clock. Fluid from the Bartholin's gland is combined with other vaginal secretions as a lubrication fluid and is slightly acidic. The glands can become blocked and inflamed, called a Bartholin's cyst. Those can become quite large and infected. In some cases, it will form an abscess that requires drainage and sometimes removal of the cyst.

Skene's Glands

These glands are located on each side of the urethra and look like small dimples or slits. There is debate about the Skene's glands function, but it's believed that it secretes fluid to lubricate the urethral opening and the vagina. These glands are also the source of female ejaculate. These glands produce a milky white discharge because of increased blood flow to the vagina during sexual arousal. The discharge is made of enzymes and proteins similar to male prostate fluid, which is often referred to as the female prostate. Then there is the controversial debate if Skene's glands are the source of squirting during an orgasm. Squirting is different from the female ejaculate because it is a sudden expulsion of large amounts of fluid containing urine during stimulation. This is in contrast to the female ejaculate, which is a few milliliters of transparent whitish discharge.

Don't feel pressured to squirt - many women don't! You can still have pleasurable sex and earth-shattering orgasms without it. Every vulva, vagina, and clitoris is different and finds pleasure in different things. 

With love, 

Dr. Jodie Horton

Have you, or are you experiencing an 'orgasm gap' in your relationship? Try to think about the last time you had an orgasm with your partner. If it's every time...bravo! However, studies have found that heterosexual women are less likely to have an orgasm than men, lesbian, and bisexual women. 95% of men said they usually or always climax compared to 65% of heterosexual women who said they usually or always orgasm. 

The term orgasm gap was coined to describe the disparity of orgasms between couples. This is believed to happen because of the lack of understanding of female anatomy and the vulva. 

Research found there are several reasons to why the orgasm gap exists. 30% of men said they thought the best way to help a woman orgasm is through penetrative sexual acts, but more than half of  women pointed to clitoral stimulation as a way to make them reach climax.  

Another reason is confusion about the vulva, particularly the clitoris in both genders. An understanding of your anatomy and the anatomy of your partner can dramatically affect your sex life. 

Knowing your own body can empower you to guide another person around it, increasing your pleasure and their confidence!

With love, 

Dr. Jodie Horton

Most people use the word vagina to describe the visible, external parts of the female genitalia, but this area is actually called the vulva. Most people are not comfortable with the word vulva because it itn't a word that we commonly use. The vulva is the external female genitalia that includes the clitoris, clitoral hood, the inner and outer vaginal lips called the labia majora and minora, the urethra (the hole you pee out of), and the vaginal opening. The vagina itself is actually the muscular tube that leads to the uterus.

So let’s talk about the vulva! There is no such thing as a “normal” vulva. Women often ask me, "Is my vulva normal? Should my labia look like that?". The reason so many women wonder and ask these questions is because we have not been properly educated about our bodies! We haven’t been given accurate information and it most likely wasn't discussed in sex-ed. Keep in mind that vulvas look as different as anything else on our bodies. Everyone’s vulva looks different and there is great variation from woman to woman. Women also see pictures of the vulva from medical drawings or porn where the vulva is manicured, bleached, and symmetrical.  In the absence of pain, rash, persistent itching, sores, bumps, and infections, all vulvas are normal.  

The inner labia as well as the outer labia may vary in size, and one side may be bigger or longer than the other.  The difference may be small or several centimeters so that they peek out and are asymmetrical.  These variations are all part of the natural variety in vulvar anatomy.  It’s also normal for labia to change as we age and after vaginal childbirth.  As we get older, women make less estrogen which means the skin becomes thinner and dryer.  There may be less hair and may go white.

Knowing your anatomy can be helpful in understanding and appreciating your body. Remember that vulvas are not one in the same, we are all special and unique...that includes the female genitalia!

With love, 

Dr. Jodie Horton

There are many factors that can affect a woman’s sex drive. One thing to keep in mind is that women’s libidos naturally fluctuate over the years!

Highs and lows in libido commonly coincide with changes in the following:

• Age
• Relationships
• Illness
• Sleep
• Medications
• Mood; Depression, Stress and Anxiety
• Pregnancy
• Menopause
• Hormones
• Physical health
• Just to name a few

So how do you know if your sex drive is low? Good question. In this case, symptoms primarily include:

• No interest in any sexual activity including masturbation
• Never, or rarely have sexual fantasies or thoughts

On the contrary, if you have been craving more sex than usual and having more sexual fantasies or thoughts, your libido most likely is on the higher level. 

Sex drive varies among women but if it's something you feel like you are lacking, then you can always seek help. Making lifestyle changes to improve your physical and emotional health can improve your overall wellbeing and in turn, let your libido soar. 

For many women, emotional closeness is an essential prelude to sexual intimacy. Problems in your relationship can be a major factor in low sex drive. Work on improving your connection with your partner by resolving conflicts, learn to communicate better, and work on trust issues. 

Most women will benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, medication or hormone therapy. 

If you are having any unfamiliar symptoms with your sex drive, and feel like something could be off, it’s important that you talk to your doctor who can dive deeper into what might be causing this in which they can run tests and prescribe medications based on what you’re experiencing. 

What questions do you have about your sex drive?

With love, 

Dr. Horton

For many women, nipples are erogenous zones with heightened sensitivity, which may cause sexual arousal. The nipples’ sensation travels to the same part of the brain as sensations from the vagina, clitoris, and cervix. But, for some women, nipples are not an erogenous zone when stimulated. 

The science says that nipple sensitivity is influenced by a host of factors including the body’s estrogen and progestogen levels, the location of your nipples, the placement of your nerves, and your breast tissue. 

The good news is that the entire body is one big erogenous zone so you can find other sensitive areas that can bring you pleasure!