Many women who have had a hysterectomy are told that they don’t need to return to their gynecologist because they won’t need PAP smears anymore. This makes me s/mad because gynecologists do more than provide PAP smears. Except…some gynecologists don’t know that. Gynecologists are vulvovaginal experts. They are who you go to if you are a woman with a sexually transmitted disease, they are who you go to if you have a vulvovaginal infection and they are who you go to to get your vulva screened. ‘Cuz, believe it or not, you can develop vulvovaginal issues without a uterus or cervix. It’s true!
Lately I’m seeing an increasing number of women who aren’t getting proper vulvar screening after a hysterectomy. Looking at the vulva – actually, having someone else look at the vulva is vital. Lots of issues can result overtime, unnoticed and ominous in nature.
Please, allow me to list my two main grievances:
Grievance One: The vulva must be checked after hysterectomy because women go through menopause. When a woman goes through menopause, her sex hormones drop. When sex hormones drop, the genitals can shrink. Some of this shrinkage doesn’t create any symptoms. Other times, the shrinkage causes pain or becomes dysfunctional. The clitoris can get really small and painful. The labias can start to resorb into the rest of the vulvar area. The opening of the vagina can get really sensitive. The genital tissue can get dry and thin and can crack easily creating pain, bleeding and more avenues for true infections. And then there are the mock infections. When the external genital area on a woman (the vulva) and the inside (the vagina) shrink and wither, this is called atrophy. This can create pain with pressure or friction in the vaginal canal. This can feel like painful sex or painful gyno exams (that you aren’t having because you have been told not to go to the gyno anymore) and painful sitting even! But, you won’t know why you have these weird feelings because no one is inspecting your genitals anymore.
Grievance Two: Your vulva has some skin. Between your legs there is skin! And skin can have skin disease! So, the biggest ones you will hear about are Lichen Sclerosus and Lichen Planus. These can cause shrinkage, resorption and/or disappearance of parts of the genitals. These disease processes, if left undiscovered and untreated can create pelvic pain. They can also do crazy things like, in the worst cases, close the opening of the vagina. In some cases these skin diseases can even cause cancer. But, again, if you stop going to the gynecologist to have a thorough vulvar screen, you may never know what’s going on.
How do I know this happens? Well, because I see it. I see it in my clinic. I’ve had women who haven’t had anyone, not just a gyno, but any experienced eye look at their vulva in seasons, nay – years, nay…decades even.
So while it’s encouraged, awesome and neat that women are looking at their own vulvas more, what is additionally necessary is that a discerning healthcare provider look at the vulva too. In the most extreme cases – it could save your life. In some of the less extreme, but still extreme cases, it could save your quality of life.
And that is that.
If you have any questions or comments, please leave them anonymously in the comment section below or email me at [email protected] I will respond to them, I promise, I’ll get my rear in gear and do it.
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