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Women’s intimate health: The sobering truth about keeping quiet

May 23, 2018

Talking about your most intimate bodily functions can be embarrassing, but not seeking professional advice can have devastating consequences.

If you’re a woman, and you’ve got an irritating itch between your legs, or an unusual discharge, chances are you’re not going to tell anyone.

You might not do anything, other than hope it goes away. Or you might buy a treatment to save yourself the embarrassment of a doctor’s examination, worried that you’ve got a sexually transmitted disease.

“There's still a lot of self-stigmatization around common genital infections and sexually transmitted infections,” says Dr. Phillip Hay, Honorary Consultant in Sexual Health at St George’s University Hospitals NHS Foundation Trust, London. “It comes, I suppose, from the attitude women perceive from society as they grow up.”

Many of Dr. Hay’s patients who have bacterial vaginosis (BV), the most common cause of vaginal infections in women of childbearing age, feel profound shame. “The word they often use is ‘dirty.’ They’re embarrassed about the smell. I think they do talk more about thrush. It’s often used as a euphemism for any abnormal discharge.

“At worst women don’t engage in sexual relationships because they feel there's something terribly wrong with them,” he says. “When I first started doing research on BV we had a doctor in her mid-20s who came to us with BV symptoms. She had never entered a relationship as a consequence of it. She’d gone all the way through medical school without finding out that actually it was quite a simple thing to deal with.”

"A lot of women will suffer in silence because of embarrassment and shame about very intimate symptoms. Usually it can be sorted out relatively easily, and they need to go to see somebody to get it treated, managed and diagnosed."

– Dr. Phillip Hay, Honorary Consultant in Sexual Health, St George’s University Hospitals NHS Foundation Trust, London

The perils of a wrong self-diagnosis

Worrying about other people’s perceptions could mean that you suffer longer than you need to, which could impact your self-esteem and relationship. And delays in treatment – or an incorrect self-diagnosis – can, in some cases, have a huge impact on your health.

Women often confuse BV with thrush, for example. Yet these are two distinct infections, and BV – which, like thrush, is also common – can have severe repercussions if left untreated.

One study found that BV increases the risk of miscarriage, preterm labor, preterm delivery, and postpartum complications such as endometritis and wound infections. Research published in the British Medical Journal found that BV was associated with an increased risk of miscarriage in the first trimester in women undergoing in vitro fertilization, independent of other risk factors.

“We do know that women with bacterial vaginosis, trichomoniasis [a very common sexually transmitted disease] and possibly even thrush have increased rates of premature birth in pregnancy,” says Dr. Hay. “Also, women with bacterial vaginosis have increased rates of infections following gynecological surgery.”

Researchers have also found that BV increases the risk of women getting HIV, as well as other sexually transmitted infections including gonorrhea. Gonorrhea can result in pelvic inflammatory disease, which can make you infertile.

The stigma of gynecological cancers

While many women are often more open about discussing breast cancer – whether it be worries about finding a lump or their actual experience with the disease – few talk about gynecological cancers, which include womb, ovarian, cervical, vulval and vaginal.

Research by the Eve Appeal, the UK's gynecological cancer research charity, found that one in five women associate gynecological cancers with sexual promiscuity, and 34% would feel more comfortable talking about intimate health issues if the stigma around gynecological health and sex were reduced.

“This stigma is preventing women from seeking potentially life-saving medical advice, with a quarter of respondents saying that they are put off talking to their GP about gynecological health problems because they don’t want to discuss their sexual history,” the report states.

Yet cervical cancer is the seventh most common cancer in the world, according to World Cancer Research Fund International, which says that 528,000 new cases were diagnosed in 2012. About 270,000 women died from it that year, according to WHO.

Let’s get talking

Dr. Hay believes talking about women’s intimate health is key to eradicating stigma. “I think the more that people understand about their health and their bodies the better. The more likely they are to either see the right person or get the right thing from the pharmacist.”

Paulo Giraldo, Full Professor of Gynecology at the State University of Campinas, Brazil, agrees. “Talking about their intimate heath would help women understand the normal physiology of the genitals,” he says. “It would help them know what’s normal and what disease is.

“This understanding could result in them looking for medical support or even improving their intimate hygiene. If they don´t talk about their intimate health, there will always be a misinterpretation of symptoms.”

Shame, embarrassment and stigma, it’s easy to understand why so many women are reluctant to talk about their intimate health. But the repercussions of not doing so can be profound. It’s time to leave judgement behind and start a conversation.

Footnotes

  1. NHS UK: https://www.nhs.uk/conditions/bacterial-vaginosis/
  2. Journal of the American Sexually Transmitted Diseases Association: https://journals.lww.com/stdjournal/Fulltext/2007/11000/The_Prevalence_…)
  3. BMJ medical journals: https://www.bmj.com/content/319/7204/220
  4. Centers for Disease Control and Prevention: https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm
  5. Journal of the American Sexually Transmitted Diseases Association: https://journals.lww.com/stdjournal/Fulltext/2007/11000/The_Prevalence_…)
  6. Centers for Disease Control and Prevention: https://www.cdc.gov/std/pid/stdfact-pid-detailed.htm
  7. The Eve Appeal- Gynaecological Cancer Research Charity: https://eveappeal.org.uk/wp-content/uploads/2016/07/The-Eve-Appeal-Vagi…
  8. World Cancer Research Fund: https://www.wcrf.org/int/cancer-facts-figures/worldwide-data
  9. World Health Organization: http://www.who.int/en/news-room/fact-sheets/detail/human-papillomavirus…

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