Is This Normal? A Closer Look at the Vagina and What Happens During Menstruation.

We readily seek out tips to avoid falling ill, and take supplements to improve our gut health and overall vitality. But as women, taking care of our lady parts and gynaecological health doesn't come to mind as often as it should, often falling by the wayside amidst life's many priorities.

What is worth noting is that our bodies change as we grow and mature, and so do our vaginas. While some of these changes can be challenging to overcome, it takes knowledge, good habits and a positive outlook to safeguard our gynaecological health. But hey, don't fret. We are here to help!

Read on as Dr Clara Ong, obstetrician & gynaecologist at Gleneagles Hospital, helps us spot the difference between what is normal and what isn't, so we can take the right steps to address the discomfort instead of just tolerating it in the hope that it too, shall pass.

1. Is vaginal discharge normal?

Most women have vaginal discharge, but the appearance and amount of discharge is different for each woman.

Your vaginal discharge may also vary with your menstrual cycle, for instance:

Right after your period

Vaginal discharge may appear dry or tacky.

Before ovulation

Vaginal discharge may appear creamier and wetter.

During ovulation

Vaginal discharge may appear stretchy, slippery and clear.

However, note that not all discharge is normal. See a doctor if you have the following types of discharge and other symptoms:

• Foamy or greenish-yellow-grey discharge
• Blood-tinged vaginal discharge
• Bad odour
• Persistent vulva or vaginal itching
• Redness, soreness, swelling or experiencing a burning sensation at the vulva
• Abdominal or pelvic pain

2. Is there a right way to clean the vagina?

No-nos when cleaning the vagina

The vagina is a self-cleaning area. Thus, introducing the region to the following products and practices may not only irritate the area but also disrupt the 'good' bacteria that live in the vagina and keep it healthy:

• Vaginal douching
• Steaming
• Fragranced products

Once the vaginal microbiome is disrupted, it can throw off the vaginal pH level and cause the area to be more susceptible to vaginal infections.

No-nos when cleaning the vulva

The vulva is the area that lies outside of the vagina. This area includes the folds of tissue called the labia.

Products with fragrance or astringents can irritate the delicate vulva area and may mask any odours and infections that should be addressed by a gynaecologist. Moreover, these products can easily spread into the vagina and disrupt the natural vaginal microbiome there.

The right way to clean!

Mild soap and water are usually good enough to clean the vulva area. The vagina, on the other hand is self-cleaning, as mentioned above.

3. Is the length of my period normal?

4 to 7 days of bleeding is considered the usual duration of a period.

There is no consensus regarding the lower limit of a normal duration of menses, as there are no specific pathologies associated with a short duration of menses.

4. Is it normal to miss a period?

Most cycles occur every 24 to 38 days. Your cycle length refers to the number of days from the start (day 1) of one period until the start (day 1) of the next period.

Your cycle length may vary depending on your age:

18 to 25 years – Cycle variation ≤9 days

26 to 41 years – Cycle variation ≤7 days

42 to 45 years – Cycle variation ≤9 days

If your cycle does not occur within this window, you may have missed your period.

A missed period may occur for many reasons, including:

• Pregnancy
• Stress
• Drastic weight changes
• Medical conditions such as thyroid disorders or polycystic ovarian syndrome
• You are at the age of menarche (At the age you first start menstruating)
• You are in transiting to menopause

If your period is frequently late, be sure to schedule an appointment with a doctor, so that the underlying causes can be determined.

5. Are heavy periods and/or severe cramps normal?

Ladies, you would have experienced days with heavy flow and painful cramps. But how do you tell if what you're experiencing is something to be concerned about? Here are some red flags to look out for.

You have an abnormally heavy period flow when…

• You are frequently changing your tampon or sanitary pad, every few hours or less
• You are doubling up on pads, or using more than one pad at one time
• You are passing large clots

You have abnormally painful cramps when…

• Painful menstrual cramps worsen over time
• Your painful menstrual cramps last throughout the duration of menstruation or beyond your menstrual cycle and do not improve with over-the-counter painkillers.

If heavy periods and/or severe cramps are causing you to miss school or work, and preventing you from going about your daily routines, seek medical advice promptly.

6. Why is sex painful for me? Is this normal?

Painful intercourse can occur for many reasons ranging from structural to psychological and emotional concerns. If you experience painful intercourse, identifying when you feel the pain can leave you clues to the condition you may be facing.

Pain at sexual entry or penetration, including while putting on a tampon

This may be due to vaginismus, vaginal dryness, infection or trauma.

Deep pain during the course of intercourse

This may be due to endometriosis, or an infection.

If pain during intercourse persists and is affecting your quality of life, please seek medical advice.

7. Can having a fibroid or cyst result in infertility?

Fibroids & Infertility

Most fibroids do not affect a woman's fertility. Treatment may not even be necessary to get pregnant.

That said, some submucosal fibroids – a type of a fibroid that grows and bulges into the uterine cavity, may distort the uterine cavity and make it more difficult for pregnancy to happen.

Ovarian cysts & Infertility

Most ovarian cysts found do not affect fertility.

The types of ovarian cysts that can affect fertility include:

• Endometriotic cysts These are cysts caused by endometriosis, a condition that causes the tissue normally lining your uterus (endometrium) to grow outside the uterus.
• Polycystic ovaries These cysts may suggest that you have polycystic ovarian syndrome (PCOS). PCOS is a condition marked by many small cysts on your ovaries, irregular periods and high levels of certain hormones. PCOS is associated with irregular ovulation, which may result in trouble getting pregnant.

Our bodies are all different. Understanding what's normal and what needs further evaluation from a doctor can help you take charge of your health and feel more confident about your body.

Wish to book a consultation with a gynaecologist? Get in touch with Dr Clara Ong or your preferred gynaecologist today!