Secret Sex Questions Answered
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Secret Sex Questions Answered

Even the boldest among us have trouble asking the doctor certain questions. Here are a few that make most women blush -- with answers from the experts.

You won't know unless you ask

I found a lump on my vagina. What could it be?

There are many things that can cause lumps on the vagina and the vulva, the outer genital area, says Stuart Fischbein, M.D., a Los Angeles-based ob/gyn. One common kind of lump, really a pimple-like cyst, forms when a sebaceous skin gland becomes clogged. If it's not bothersome, you can let it be, but if it's a source of discomfort, your doctor can drain it. A cyst also can form when a Bartholin's gland, which produces a natural sexual lubricant and is found at the base of the vagina, gets blocked. These cysts can grow as large as a peach and often get infected, so they are usually opened, drained and treated with antibiotics. Generally, an inclusion cyst occurs after childbirth when a piece of skin gets buried after an episiotomy, an incision made to ease delivery of the baby. The buried skin continues to produce cells, creating a lump, which can be excised in a simple procedure.

Genital warts, which are caused by the human papilloma virus (HPV), are another possibility. (Although HPV is a sexually transmitted disease that's been linked to the development of cervical cancer, there are many different strains of HPV, and just because you have warts does not necessarily mean you have cancer.) The warts appear singly or in clusters, with individual warts sometimes as small as a pencil tip. They're usually painless but can cause itching, discomfort and burning. Although warts can be removed by surgery, lasers, freezing or with a topical drug called podophyllin, they tend to recur and may need to be treated more than once. A powerful cream called Aldara, which appears to boost skin's natural defenses, can also help clear the lesions.

Cancerous tumors on the vulva and vagina, which can be seen and felt as lumps near the opening of the vagina, are rare but becoming increasingly common among women under 40. Typically very obvious in the early stages, these tumors are sometimes accompanied by discoloration or an itchy, scaly patch. In addition, "More than ninety-five percent of women with vulvar cancer have had symptoms months to years before they were diagnosed," says R. Allen Lawhead, M.D., director of gynecologic oncology at Atlanta Medical Center.

I've always had small, white bumps on my nipples. What are they?

Small white bumps on the areola are perfectly natural and quite common. These bumps, called Montgomery glands, produce a lubricant that helps keep the nipple soft, making breast-feeding more comfortable for mothers and their babies, says Laura Morris, M.D., M.B.A., F.A.C.S., a breast surgeon at Cancer Treatment Centers of America, in Goshen, Indiana. Sometimes these glands become clogged or enlarged -- even when a woman is not nursing -- but the problem usually resolves itself. "You don't need antibiotics or surgery," says Morris. "And even if they stay enlarged after pregnancy, there's nothing to worry about."

Vaginoplasty; pap smears

I've been hearing about new laser procedures to increase sexual satisfaction. What's involved? Are they risky?

More doctors are now offering -- and more patients are requesting -- laser procedures designed to enhance the appearance of the female genitals or tighten and support vaginal muscles weakened by childbirth or aging. With vaginoplasty or "labial contouring," surgeons trim vaginal lips, or labia, that are excessively large or uneven. Laser vaginal rejuvenation tightens the vagina, purportedly to increase sexual satisfaction.

So far, there is scant evidence to support the safety and effectiveness of such procedures, which cost upward of $4,000. Still, says Stuart Fischbein, for women who find intercourse painful due to oversized labia that get pulled into the vagina, for example, these procedures may be worth it.

I recently read that I can wait three years before having another Pap smear if my last one was normal. Is that really safe? Can I trust a "normal" reading?

A recent study of 128,000 women from the Centers for Disease Control and Prevention (CDC) suggests that for women who have a normal Pap screening it may be safe to wait for up to three years before their next one. This is true in part because cervical cancer is typically slow growing. (However, most doctors and the American College of Obstetricians and Gynecologists advise against this, partly on the grounds that annual exams check for more than just cancer. Also, the American Cancer Society recommends that women have three consecutive normal readings one year apart before switching the frequency.) To get the best possible test, it pays to ask your doctor a few questions. Find out whether she has direct contact with the pathologist at the lab that reviews the smears, says Stuart Fischbein. If your doctor and the pathologist don't communicate, the pathologist may not have all the information needed to make a correct diagnosis.

Also ask your practitioner about the tools (swabs, brushes or "spatulas") she uses to collect cervical cells. Research suggests that a cytobrush, which looks like a mascara wand, is more effective than cotton swabs at obtaining a good smear, and spatulas equipped with extended tips can reach further into the cervix to sample hard-to-reach areas. You could broach the topic by saying, "'Doctor, I've been reading about so many options lately, what do you use to do Pap smears?'" advises Fischbein. "If you offend somebody because you're looking after your care, you need a new doctor."

Finally, ask your physician whether she obtains cells from both the outside of the cervix and the canal that leads to the uterus. Sampling from both areas gives the doctor a better chance of catching abnormalities.

Anal itching; genital herpes

I've been experiencing anal itching. What's causing it?

Anal itching can be caused by many things, so some detective work is in order. Unless you've recently been diagnosed with a vaginal infection (which has now spread), yeast is not the culprit, says Edmund Leff, M.D., a colon and rectal surgeon in Phoenix and Scottsdale, Arizona. The problem may stem from too-tight clothing, poor hygiene or a dermatological condition, like psoriasis. Or, it could be a reaction to hemorrhoid creams, certain foods (spices; citrus fruits; vitamin C tablets; beer; or coffee and cola, as caffeine most often triggers sensitivity), or antibiotics -- especially tetracycline. In rare cases, the itching may signal a serious underlying medical disorder, such as diabetes.

While you're figuring out what's causing the problem, cleanse the area with moistened cotton balls after bowel movements and dust with a non-medicated powder to keep dry. Also avoid wearing snug underwear and eliminate suspected medications or foods. If the itching continues, discuss the problem with your doctor.

I recently came down with genital herpes, but I don't know how I contracted it. My husband isn't infected. What could have happened?

It's possible your husband does have the infection but doesn't know it. According to a surprising new study from the University of Washington, in Seattle, many people test positive for the virus that causes genital herpes but have never had the trademark painful sores -- or else had such minor outbreaks that they missed the signs. And, notes Anna Wald, M.D., M.Ph., medical director of the university's Virology Research Center, contrary to common belief, asymptomatic people appear to be capable of transmitting the virus. In the study, those who had no signs of disease still shed viral particles.

However you contracted the infection, improved treatments can minimize your discomfort. Approved in 1995, Valtrex has been shown to work as well as the standard herpes drug, Zovirax, but is taken fewer times a day. The newest drug, Famvir, appears to head off recurrences when taken continuously for a year, so it's often recommended for people who have frequent outbreaks. In a recent Famvir study, patients taking a twice-daily dose reported 80 percent fewer outbreaks than those who took a placebo. Side effects for all three drugs may include headaches and nausea.

Hysterectomy; jock itch

I'm scheduled for a hysterectomy and am worried about how it will affect my sex life. What can I expect?

The latest evidence, a large study from the University of Maryland, in Baltimore, should put your fears to rest. Researchers found that sexual functioning tends to improve overall after a hysterectomy. Among the more than 1,000 women studied, those reporting uncomfortable intercourse dropped from 41 to 15 percent, and the numbers of those having sex at least five times a month rose by 30 percent. Many women also experienced more frequent and intense orgasms. Why the changes? Many of the gynecological conditions -- fibroids, endometriosis, heavy uterine bleeding -- that lead to the procedure can themselves impair sexual functioning, explains Kristen Kjerulff, Ph.D., the study's lead investigator. "These women reported great improvements in symptoms and quality of life. Given that, we weren't surprised that their sex lives improved."

For those who do have sexual problems post-surgery, recent research suggests that Viagra could be an option, though it has yet to be approved for women by the FDA. In a Boston University Medical Center study of 35 women who had undergone hysterectomy and reported problems such as low sexual sensation and the inability to reach orgasm, only 22 percent complained of depressed sensation and just 18 percent were unable to climax after using the drug.

My husband has jock itch. Can I catch it during sex?

It's possible, so it's best to take precautions. Jock itch, a fungal infection that causes rash and itching, thrives in warm, moist areas and is most common in men who wear snug-fitting briefs, according to Jerome Z. Litt, M.D., assistant clinical professor of dermatology at Case Western Reserve University School of Medicine, in Cleveland. To avoid getting it in the first place, your husband should wear boxers, which help keep the groin area dry. Also, says Litt, "if a man has athlete's foot and puts on his shorts before his socks, he can drag the fungus into the groin area and trigger jock itch." So your husband ought to put on his socks first.

Mild jock itch can usually be cleared up in a few days with over-the-counter antifungal agents. Litt recommends Lamisil Cream, a nonprescription medication that's more effective than other antifungals like Desenex. In the meantime, your husband should use the cream before intercourse to help keep you free from infection. --Beth Howard

Beth Howard writes for many national publications, including Self.

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