Who to have in your sexual health arsenal
Jensplaining’s Dr. Jen Gunter on when and why to see a gyno, therapist, or physio
If you're in the middle of an anxiety spiral about having a kid or weird goings-on with your vagina — or if you just have a simple question about sex and your libido — it's likely that you'll turn to the internet for answers long before going to your doctor, your friends or, perhaps counterintuitively, your partner.
The anonymity and sheer volume of information that comes with going online means you can avoid the potential shame and awkwardness of personal questions and graphic details. It also means you're less likely to get the definitive, breathe-a-sigh-of-relief assurances that only a certified professional can provide.
That's why we spoke with Dr. Jen Gunter, author of The Vagina Bible and host of CBC Gem's new show Jensplaining, about the different practitioners — from gynaecologists to physical therapists and psychologists — that can help answer your biggest sexual and reproductive health questions.
Who do we need to be aware of for the sake of our sexual and reproductive health?
Dr. Jen Gunter: There are many health care professionals who can help with reproductive health-related issues.
A gynaecologist or family physician might be the one most people think of. However, some kinds of pelvic pain, pain with sex, and incontinence issues (both bladder and bowel) can be treated by specialized pelvic floor physical therapists (often known as women's health physical therapists).
A sex therapist may be helpful for people having issues around communicating sexual needs or other sexual issues (like low levels of desire, for example) that some people may encounter.
A psychologist can also be helpful, and depending on their training, they may or may not be comfortable addressing graphic sex related issues. For some women, previous sexual trauma can have a lasting impact, both physically and emotionally, and so a psychologist can also be helpful here. A psychologist can also be helpful in times of stress, coping with a diagnosis, depression and anxiety, reframing issues about how your body is working, managing grief, and so much more.
How does someone get referred to these practitioners?
JG: Many times your doctor may make the referral. Where you live may affect the services that are available and how they are covered. Women in rural communities may struggle more to find a professional who can help. In many places, you can self-refer for physical therapy, psychology and sex therapy.
What is the role of a gynaecologist/obstetrician and what types of issues might you go to them about?
JG: An OB/GYN should be the person who helps with any reproductive health-related concerns. In many places, a family doctor can provide a lot of this care and sometimes even a paediatrician if they have a large adolescent population. The more complex issues though will go to an OB/GYN and OB/GYNS also perform procedures that not all family doctors or paediatricians [do].
An OB/GYN should also be able to help you with all aspects of your prenatal care, delivery and postpartum care. Low-risk women may see a family doctor or midwife for that care as well. Higher risk pregnancies should be seen by an OB/GYN and those with very specific risks may need to see a high-risk OB/GYN, also called a maternal-fetal medicine specialist.
An OB/GYN may perform cervical cancer screening and contraception management — so discuss the right form of birth control and then prescribe it. Sexually transmitted diseases screening is something that an OB/GYN can do as well. Many family physicians will do this as well. Cervical cancer screening doesn't start until 21 years of age, so typically that is not something a paediatrician will do.
If you have an irregular period, menopause concerns such as hot flashes, pain with sex, pelvic pain, an abnormal cervical cancer screening, lumps and bumps on your vulva or in your vagina, or incontinence, those things are more the bread and butter of gynaecology. But basically, if there is an issue, we want to help. If we are not the right specialist, we will get you to the right person.
What are gynaecological symptoms that you absolutely should not ignore?
JG: Periods that soak through your menstrual products onto your clothes. Period pain that keeps you from doing what you want to do. Pain with sex or an inability to have sex due to pain. Pelvic pain. Bleeding after sex. Vaginal discharge with a fishy odour. A yellow, or green, or bloody vaginal discharge. Vaginal bleeding after menopause. Persistent bloating. Needing to go to the bathroom all the time and/or pain with emptying your bladder. Concerns about exposure to a sexually transmitted infection (STI). Bleeding during pregnancy. Pelvic pain in pregnancy. I am sure there are others, but these come to mind.
What types of sexual health and reproductive issues might you be referred to a psychiatrist or psychologist for?
JG: Low libido can be related to stress and very often is a communication or relationship issue. Some psychologists may be comfortable addressing the issues related to libido and others may not. Women who have pain with sex often feel isolated or have issues communicating what they need to their partner, so a psychologist can be helpful here for many women. Again, it depends on their comfort addressing sex-related issues.
No medical condition is in a person's head, so I want to be very clear that referral to a psychologist or psychiatrist is not (or should not be) for that reason. However, depression, stress and anxiety can make any medical condition worse and of course, depression and anxiety are medical conditions. So anytime coping with an illness is challenging or anxiety or depression is an issue, a psychologist may be helpful. Symptoms in the reproductive tract can also sometimes make people revisit past sexual trauma, and so a psychologist can be helpful.
With chronic pain, a pain psychologist can help reduce suffering. A psychiatrist is more the person you see when you need medications for depression, anxiety or other mental health conditions, however, some do talk therapy as well.
Q: What is the role of a sex therapist, what types of issues might you go to them about?
JG: A sex therapist offers counselling for individuals and/or couples who are having sexual concerns, such as libido issues, orgasm difficulties or other performance-related issues, and other related relationship issues. Many sex therapists are also comfortable helping women who have pain with sex.
Q: What types of sexual health and reproductive issues might you be referred to a physical therapist for?
JG: A pelvic floor physical therapist can help with many kinds of incontinence (both urinary and fecal or stool), pain with sex and pelvic pain. They work on the muscles that wrap around the vagina and support the bladder and uterus. For reference, these are some of the same muscles that contract when you have an orgasm and the muscles that contract when you do Kegel exercises.
Q: Are there care providers or experts other than the aforementioned that readers should know about?
JG: In some areas nurse practitioners can do a fair amount of general gynaecology and even some midwives. This is regional and the certification required to do certain procedures can vary. This is also the same with low-risk obstetrics.
Q: What else would you like people to know?
JG: If you have a health concern please talk with your provider, If you feel dismissed, please try to find another provider who can help. If what your provider tells you doesn't sound right, you may be able to find some good information on SOGC (Society of Obstetricians and Gynaecologists of Canada) website.
I hope many of the things I have written about online, in my book The Vagina Bible and talk about on Jensplaining can be a source of fact-checking and self-advocacy. The CDC has fantastic information about STIs as does the American Sexual Health Association (ASHA). The North American Menopause Society has terrific information about menopause. The American College of Obstetricians (ACOG) is also a course of great information.
This interview has been edited and condensed.
Eva Voinigescu is a freelance journalist and producer. She writes about health and science, careers, and culture.