Supraja thinks her labia are too big, are they? Sara weighs in. Let's talk vulvas
Supraja thinks her labia are too big, are they? Sara weighs in. Let's talk vulvas
Hi, i'm Sara, And I'm Supraja, and this is Gyn and Tonic.
Supraja:Welcome back to Intimate Convals with your besties. Okay, we're doing it.
Sara:Welcome back. That was fun too, so do it. I'm taking Italian lessons. Ooh, i saw your note cards. I was trying to see what your mom had written on her Italian note card, doesn't? your mom speak Italian. It's like decent, i'm not a conf…. I didn't realize I'm…. This is what Sarah starts to gain confidence in her language skills. All of a sudden, everyone else who is fluent is decent. That's what make.
Supraja:People are like I understand all Spanish, i just can't speak it. So you don't speak it. Then Let's just be clear.
Sara:I'm just kidding, she's not kidding, it's my biggest…. It's my biggest….
Supraja:I'm not including you because I know you got it. You know what I'm doing. I understand all of Spanish, i just can't speak it. Then you can't speak it, i know.
Sara:I honestly do get annoyed. I don't get annoyed in life when people claim languages Like if someone spoke English that was a little broken. I'd be like, oh, you're still speaking English.
Supraja:You know what I mean. You're trying to just shave me.
Sara:But I do get really annoyed with people in the hospital, like medical professionals, who claim to speak medical Spanish because I'm like you're not, but just because you can be like, does it hurt in your head. It doesn't mean you're connecting with someone as a human.
Supraja:That's my biggest pet pee People don't use interpreters, but that's a topic for another time.
Sara:That's what we're talking about today. Actually, Sarah, everyone wants to hear about your date. I've been waiting to ask her.
Supraja:I'll give you snippets in the full story tomorrow. I'm on this ever ongoing journey of finding a life partner. That's the snippet. That's pretty good.
Sara:No, it's really good.
Supraja:I feel like I'm always telling people I want a tall brunette who's a nerd And let's do the scientists.
Sara:So I feel like, there's like, and he's a tall brunette, and he's a tall brunette I was going to say it twice And he's a tall brunette, so we'll see, i hope he's not listening to this.
Supraja:I'm like, are you sharing it with him Too soon?
Sara:If you are listening, these are all positive things. Sarah's smiling a lot. Check it out on YouTube. Okay, well, I know we have a meaty topic today. Actually, I've been feeling very anxious about that. I came in here today with a lot of anxious energy.
Supraja:Really Yeah.
Sara:And I think, maybe because I don't want to talk about my labia.
Supraja:I'm like all about this episode. I'm like let's talk about insecurity. Let's get vulnerable It's like my jam, i know.
Sara:And I'm like wait. Why did I pitch this?
Supraja:That's like my favorite question on like a hint or on a dating app. It's like I'll fall in love with you if you're vulnerable. I know it's true.
Sara:I was actually saying that to Adam the other day. We were talking about dating apps, or Yeah, we were talking about dating apps and like having gone on dates with people who like really have it together, and I think his app had said something that was like he like spent a lot of time in France or something, and I in my head is like no, no, i was not attracted to that. Like I thought it was cool You might speak French, but I was like is this guy some like very stuck up? like had a perfect childhood?
Supraja:no trauma person, and then he was like yeah, then you met me.
Sara:Were you disappointed? I was like no. I was like ooh, you have trauma. Well what are we talking about today? Okay, so we're going to talk about my labia.
Supraja:We're talking about GYN insecurities, specifically labia.
Sara:Yes.
Supraja:Because it comes up quite frequently. It comes up in clinic and we want to dismantle some myths, give you some facts and hopefully some reassurance or, if not, some guidance and how to seek help if it is a problem.
Sara:Yeah, I think I have always not been super comfortable talking about that part of my body, which is kind of ironic because it's my entire profession And I think with other people I have good objectivity and being like we're all so beautiful It like really doesn't matter. People really have all different shapes and sizes of bodies and it's all great. But especially, I think, growing up in like a very culturally conservative family you know, my family is from South India, originally from a village, very religious, And it just wasn't at all talked about. All of the emphasis in the subliminal messaging was all about men, like what men want, And from a very young age I think that seeps through to like the kids from their moms not talking about it and their moms not having autonomy over it.
Supraja:But this is so true because it was funny. I was just sharing this with the patient today because I had a patient referred to me whose mom is a health care provider and they have a really adorable Relationship and I was like you guys, i love your relationship so much. It's so funny because my mom has like no idea what I do. I know she knows I'm a woman's health care provider, but I remember one time at her asking me How do you pee when you're wearing a tampon? and I was like home, maria Maria.
Sara:Let's take a pee.
Supraja:Oh my, i need you to go home and put a mirror down below. We got multiple holes down below. But my mom is from Peru and little awareness of her own anatomy, so it's not a topic We ever talked about and it's not something I would have ever brought up to my mom to say like how should I groom What? what is like what, what's like what looks good, what say like? it's just not a topic we ever discussed until I really became a gynecologist.
Sara:I know now I, when I talk about it I'm like aware that it might be the first time someone's addressing it with that generation. You know they never felt comfortable talking about it or asking questions. Yeah, it's funny that it has switched so much, but that, like, those lessons are still kind of intrinsic, even if you Have kind of thought your way out of really feeling that way, like so Sarah needs Sarah do my pap, and I think before I walked, in I was like Sarah, my.
Sara:I have labial hyper-trophy. I just want you to be prepared.
Supraja:I know patients come in all the time and they're like I haven't shaved my legs or I haven't showered today and here, and we do not care. We're gonna do a separate episode on this. But here comes super gel. Like giving all these, like warnings, i'm like what?
Sara:are you doing? I was like, okay, we'll take a look at that like very professional and I was like I was like this is scaring me more.
Supraja:But you told me and I'm choosing to- believe you, i'm choosing to let it go that.
Sara:I have very normal labia, but I never like I don't know, you don't like wake up with age eight and like have all the women in your life show you their labia? Yeah, this is normal, this is not normal. I mean, that's just me, yeah. and anyway it has helped me reframe and realize that It's worth a longer discussion of just understanding like what's normal, what's not normal, and when it matters or doesn't matter.
Supraja:and spoiler probably as normal and doesn't matter all of us have our own insecurities and we get really preoccupied with this Perception of something that we think is abnormal about our body.
Supraja:But other people are unlikely to think that and It can result in, you know, emotional and physical distress for people, and so we're hoping to, you know, address some of that distress, and it can be a wide spectrum. For some people, it's like I don't love the way my labia look, but for other people it can actually be Prohibitive and keep them from wanting to be intimate with other people or wear yoga pants or do things that they worry other people gonna talk about, and so That's not something I really understood until I became a gynecologist and people started bringing it up. I'm worried about how long my Libia are. Does this look abnormal? I'm like no, but it's made me be more conscious about reviewing anatomy with patients and letting them know this is your Libia Major, this is your Libia Major, and going over the each little part so that people know, oh, and I'm letting them know this looks normal, this looks normal, giving them reassurance and then, if it comes up, it comes up.
Sara:That's essentially what I did at SuperJ's visit. So I was like, let's sign you up for therapy. I know, Oh my God, this is a long time coming. Side note this is still the best espresso martini I've ever had.
Supraja:And I'm getting this is so good, I like to feel it a little bit You do. It's kind of like this I have a salad for dinner. I'll give you the recipe later, but it's. I know I love my espresso martini. It's breakfast.
Sara:DMS for her recipe.
Supraja:It's because it has a creamy base, and I'm all about a creamy base. espresso martini, it's so good.
Sara:Yeah, so I think you said a few things that I think are super important. One there's so many factors involved with our preoccupation on that part of our body And for some people it really is an issue, and that issue can be stemming from different things, like for me, it probably stemmed more on the side of my own feelings about my body than really any physical characteristic, and it's not to say any of that is less real, but the way you approach it is different.
Sara:Right, i had to do a lot of self work and I, honestly, i did have a therapist, although I don't know that we got to my labia, i got a lot of other issues we got to My therapist, and I don't talk about my vulva.
Supraja:We never got that far. I quit before that happened.
Sara:But yeah, you had, i had to do a lot of self work of like. Is this something that I'm disproportionately focused on? And if that's the case, there's not. It's like a moving target. You know what I mean, because it's not based in an actual problem. It's based in my feelings about my body that are much more layered than that. So there's that. But then, on the just physical side of it, a lot of people can have issues Like if it's getting stuck in your clothes, if it's causing constant irritation, if it's causing pain, if it's causing pain during sex. You think of anything else?
Supraja:It's keeping you from wearing certain types of clothing because of the like, the level of discomfort, like you can't wear tight pants, you can't wear certain types of underwear, you feel like your labia are being dragged into the vagina when you're intimate with your partner That's what people will say or it's chafing and rubbing while you're having like intercourse with your partner or foreplay. You know those are all. Or sitting down, like patients will say, like I'm sitting down for hours and I'm uncomfortable. I'm not shuffling in my chair. So you know, whenever I'm evaluating somebody for their discomfort or their concerns, you know it's also like what is like actually bothering you about it, and there's lots of different components. There's the physical component, but also what's the emotional component?
Sara:Is it?
Supraja:really something that's bothering you or is it ideas coming from other people? And you know, I think that's like a huge topic in itself. But and the other thing being like, where are these ideas coming from? Like, is it like Super Joe saying something, like she you?
Sara:know it's all about like men watching porn, like how we like idealize, like a weird prepubescent body. I mean, to be fair, i'm just going to mention the Kardashians on every episode because, although I know there's lots of controversy about them and like idealistic body standards, they did have a big role in making more curvy bodies attractive, i think. Anyway, so there's like no comment.
Supraja:I did finally catch up. Oh, you did. I got to episode. I finished episode three on Google this weekend, So I'm waiting for that episode where Kylie brings up what kind of beauty standard are we setting for the world to be continued?
Sara:But I think traditionally, at least in like my memory what was really put up on a pedestal was like being super skinny, having a flat chest, like not being very curvy, and with that comes having a vagina that doesn't have. well, i said vagina and then a vulva, a vulva, a vulva, and we'll tell you about the difference. There is really jazz to teach you about vulva and having, but having a vulva that's hairless, has like very little tissue, which, again, is just what we think men, cis men, want.
Supraja:Like who has made that beauty standard?
Sara:Right.
Supraja:That's the standard.
Sara:Yeah, there are all sorts of people who want all sorts of things and it's all beautiful. You know, this is my self talk.
Supraja:You guys are being let in.
Supraja:But it's like interesting to explore this and I especially explore it with some of my younger women who come into the office and you know they want a labiaplasty and they want their labia surgically corrected, and I think it's a longer conversation and I think you know people should ultimately do what they feel is going to make them feel confident and beautiful. But I think it's also important to explore, like, why do you think that's going to make you feel confident and beautiful and like, is it you know what your partner is hoping you'll look like? Is it something that is always been a person? And I don't think one reason is correct. I just think it's important to understand, like, why you feel like this before doing something that could be permanent.
Sara:Yeah, having a real conversation with yourself about if this surgically is going to fix that feeling, and for some people it will. Yeah, some people maybe not so much. Okay, well, tell us about pelvic anatomy. Sarah, go off. I think you should start out to in or up to down.
Supraja:Whatever, well, whenever I do, you have a method vulver didactic lectures.
Sara:Okay, You know.
Supraja:I'm no BGYN, but I also run a vulver clinic once a week, and so I do a lot of didactic lectures on vulver anatomy, because a lot of people aren't aware about their anatomy Patients, my mother being one of those examples which you may be listening to this Maria is going to love this, maria Elena is listening, but providers are also not aware of anatomy. You know, i'll often get emails saying this patient has a red spot on the vagina and I'm like it's not the vagina, it's the vulva.
Supraja:But I think the more we're aware of our own anatomy, the more we can advocate for ourselves, the more we feel comfortable knowing like, actually this is normal, this is a normal anatomical variant. Yeah, and I thought those are my favorite kind of visits where I get to review that those parts of the exam with the patient. I always use the right terms, but essentially, like, if you think about the borders of the vulva, this is a little bit debatable, but in general it's. You know, the top border is your mom's pubis, so it's that fatty pad of tissue above your pubic bone where essentially pubic air grows, unless you groom your pubic air away. Then you have your inner groins, where, like where your inner thighs are, and then the bottom border is the skin between the vagina and the anus.
Supraja:It's the skin, the perineum, essentially where people tear when they have a vaginal delivery. And then, as you go inside, the next layer you hit is the labia majora. Most women have flat labia majora. That's not the larger labia that we're referring to And the not me. And the labia majora is what grows hair. Then that's what some people will groom and not I'm just kidding, well, i'm not actually well, anyway, we'll get into that later.
Supraja:But then there's the labia minora, which are the smaller lips, and those are what can vary in shape and size, kind of like our breasts. They can be asymmetrical, they can be identical, they can be longer, and I'll always like point them out to the patient These are your labia majora, this is your labia minora. And then within the labia minora is the entrance to the vagina or the hymenal remnants, so you know. And then the hole where you void from or purinate from the urethra is within the labia minora. So you know, that's like a basic understanding of vulva anatomy. But the labia minora can vary from one woman to the other. They can be asymmetrical, they can be areas of discomfort, they can, you know, have dermatological conditions. There's so many things that can go on And and you super just going to tell you about some resources where you can look up the many different types of labia.
Sara:Large labia project. What was the other one?
Supraja:The vulva wall, the great wall of vulvas. Yeah.
Sara:We just said that wrong. I'm sorry, but I have looked at the large labia product a lot. I think it's so helpful and it's helpful to tell other people too.
Supraja:I bring it up during visits because patients will be will tell me like I want to. I, my other doctor, mentioned I should consider labia plasty or something like. like the doctor, yeah, i had a patient come to me one time. She's like well, i should consider that right. And I was like let's talk about that You're like.
Sara:Why Like? because they told me to Like. Okay, we're taking names, folks, that's good.
Supraja:Let's explore that. But well, i have a textbook that I bring with me to clinic and we'll go through pictures and I'll say this is what your vulva looks like. This is normal, this is a normal variant. Um, you know and I will frequently use the example of breasts Like nobody's two breasts are identical. Nobody like we. Just every part of our nothing is always symmetrical, and I love showing people photos and they're like oh, you're right, that is what my vulva looks like.
Sara:Yeah, i guess to review the times where it might be worth further investigation. If you are having a lot of emotional distress over it, it's still worth talking about whether or not the response the you know the way to fix that is surgery or something else. It's still worth bringing up with doctor.
Supraja:And I love it when people bring up these kinds of topics and you can spend the whole visit good Like talking about it and exploring it. I can give you my perspective. Those are fun.
Sara:I think those are fun business and also a good point of like. We're not all built the same and not you're not going to buy with every doctor the same. So if you're in a doctor's, is it where it's a really simple answer and it might not have addressed all the anxieties you have about it. Maybe that's not the right doctor to have the conversation with, but there is someone out there who hopefully you could have a really productive and nuanced conversation with. And then, two, there are physical things that can suggest someone should talk about it or have it looked at. Or, if it is painful, irritated. Other times where you're noticing it excessively, like sitting for a long time, that you feel discomfort. And then I know, Sarah, you've mentioned like the length is a little bit controversial but there is technically a cutoff.
Supraja:There's like a subjective measurement that people will use to say like well, i guess you could consider this hypertrophy, but there's really no like standard, like it's just a subjective number. But when you measure the labia you start at that. If you separate them, separate the labia menora apart, and you start at one tip and go to the other tip in a horizontal direction, you're not super stretching it, you're just gently separating. They say six centimeters, but I have lots of patience, like that's quick to hit. I have a lot of patients who have labia much longer than that and they're not bothered and you don't need to do anything about it.
Sara:Then it's not an issue.
Supraja:yeah, I've also had patients with labia shorter than that and it's one side is causing discomfort and we've ruled out other causes and we've surgically corrected it and they felt better. And so, there again, there's no one standard, it's really each individual case.
Sara:Yeah, and I think too, sometimes when we have really strict definitions we adhere to which, like we just said, this one, we don't personally adhere to it like that in our practices, but when you do, you're not really accounting for other factors. Like I take care of a lot of trans and gender diverse individuals who are on testosterone, which makes parts of that part of the anatomy bigger or smaller, and it's not really taking that into account. There's lots of things like that that can affect your anatomy. I think the highlights are what you said, like it either should be causing you great distress or causing physical symptoms that are bothersome. Do you want to? so yeah, so if you meet all that, have this great nuanced conversation, and you really feel like surgery is the best option, that is usually an outpatient surgery. Sarah's our Bulbar specialist here, so I'll let her tell us all. So I do, do, do.
Supraja:I do do labiaplasties, but again, i do this like heavy screaming process to really, like you know, understand the patient's perspective and, you know, answer any myths, concerns. You know, go over pros and cons with patients before we do this because again it's, it's permanent, we're changing a part of your body and it's a really sensitive part of your body. But once we've decided like this is the best option, i tell people there are multiple people in medicine who can do this gynecologist, urogynecologist, plastic surgeons. When I specifically do it, i don't do it for cosmetic reasons. So if you're going to a provider because you know the like, the cosmesis is the most important thing to you, then I tell people like I'm not your best surgeon, i'm doing it for functional or physiological reasons, meaning you're having discomfort, you're okay if it doesn't look perfectly symmetrical, granted, i obsess and do my best to make it look perfect literally.
Sara:Well, i feel, because you know going in, that there's so much emotional weight to the surgery you're about to do, which maybe is true for a lot of things but I feel personally connected. Yes, so it's true, it does carry. I I think I obsess when I do those surgeries too.
Supraja:I literally went home after the first one I ever did one of these I did as an attending and I went home and I like sobbed in the shower. It was like, yes, i like I was like, oh my god, is she gonna like it? like so nothing we do is cosmetic other than like the incisions we close. But you know we've done so many, that's not you know that big of a deal to us anymore. But like I feel like this is just like so different from everything else we do that I want the patient to be happy, i want her to feel confident, and so I put a lot of pressure on myself and that's why I heavily counsel patients like you can also go to a plastic surgeon. but it was funny because when I spoke to a plastic surgeon once she was like, oh, he's also like big egg chest.
Sara:I think it's like when I just put the new boob in.
Supraja:people are happy, i think it's because I'll follow some plastics people online and they're like no, that's not my process. I, like you know, i meditate before the OR, i channel my, like I like superwoman pose before I scrub. But yeah, so I tell people there are many different people who do them. There's many different techniques. You know I do a straight cut, like curvilinear technique, but other people do like wedge techniques. What I'm trying to say is that there are many different surgeons who do this and you know I think it's fine to shop around, talk to people, go to who you feel like is listening to you, who's who you feel like you vibe the most with.
Supraja:And you know it is an outpatient procedure. In general these, usually once the patient is under anesthesia, takes about 30 minutes. You know I've done them as quick as 15, 20 minutes, but in general it takes about 30 minutes and you're just removing the excess skin so that the labia menorah is flush or even level with the labia majora, so that it's not extending too much further out, and then you're just putting a few stitches and those, you know, after the surgery, the, the labia, what remains, gets puffy. And so I tell people you're going to feel puffy and swollen, you're going to feel like you're waddling. It's uncomfortable. That discomfort usually lasts for about one and a half two weeks. You'll you'll still be healing for a total of like four to five weeks, but the most of the discomforts in the first two weeks and the stitches pop off on their own. And you know I like the description of them popping off.
Sara:They just like yeah and I have people, i draw it out for them, measure it and then in the office I'll I'll like put a dot on their vulva and have and make sure that lines up with the picture we've agreed on, and then I show it to them again, just because it's, i don't know, no one's spending all their time like looking at their vulva and you want to make sure that you're doing what they wanted you to do. Is people do have such like intimate feelings about it.
Supraja:I feel like when I've done these with the residents, they probably think I'm a psycho because I'm like so meticulous, and but it's like it's it's so important. I want the patient to know. Like you know, i know this matters and um, but yeah, it's actually a pretty straightforward surgery, um, and the recovery is not too bad. It's about a month. You can go back to work after a week or two if you want to. Should look beautiful after, and I think you know it generally does. I've seen some unfortunate cases from not from and I didn't do.
Supraja:I've seen some unfortunate cases from abroad and those make me really sad, and so I think it's important to abroad like um, i don't know what I'm going with this.
Sara:I'm just saying we know that there are very gifted surgeons abroad as well.
Supraja:Well, like no, i had this one patient who had it done after the delivery, like oh like shortly after the delivery of her baby in another country, and you know they even sewed a perperonium so it would be more comfortable for her partner. So you can just imagine the approach that her like the objective and the agenda was very sexist.
Sara:Yeah, it's very different and so I.
Supraja:That's why I like mentioned, like you know, um, like no, like you know, know who you're going to ask questions, how many of these done have you done? what's your technique? what do you think? yeah, i think those are all really important questions that I would ask anybody who is doing surgery on me yeah, um, and I mean I think you're very data driven, which I think is great.
Sara:In your personal life too, when you make choices, i feel like I am very instinct based personally, not necessarily in medicine, my medical practice, but at least like when I make big choices, i'm trying to think of I was at a doctor's office. I think all those things are important. And then I think it's also important to trust your gut, like if you feel like this person is just kind of rushing you through, it is not really explaining it to you, well, find someone else. There's lots of other doctors who will do it, you know. So I think making sure you feel really heard and that it's someone you're going to be able to go back to and ask more questions afterward, or that you could reach out to if you had concerns about it even afterward, is really important yeah, so that's my procedure itself.
Supraja:Yeah and all of this is just this episode is to prove to me that my labia is normal and Sarah's promise to build me up so I think you know we wanted to conclude the episode with, you know, appreciating how different each of our bodies are and different does not mean abnormal, unless it's causing some kind of physical or emotional distress. So then, explore it, ask questions. But I think it's really important to really know our bodies and celebrate them and talk about our friends. And I think we're lucky because you know I'm like super good, look at my Volvo, what does this look like?
Sara:literally we were like, i think it was New Year's or something and. Sarah wanted to like show me how she groomed, so she just lifted up her skirt and I really was really funny, because it was like me, sarah, and then two other gynecologists and then my other best friend who was not in this and she was like closing her eyes and like am I allowed to look? They were serious. they were like this is what I do?
Supraja:Well, because I like to grooming so seriously it was great because I feel like my whole life, the way I groomed was based on what I thought was expected of me, like this is what a guy wants me to look like when he went where I like in my bed. And it wasn't until I, you know, met somebody who was like, oh, i like the opposite. I was like, oh, i never thought about that. And I was like, okay, so I changed things up and I was like actually, i like this, this is more convenient.
Supraja:I think it's like we're so fixated on what mainstream wants, but like everybody's different and every like, and at the end of the day, you know, yes, i was changing things up for different partners, but at the end of the day, I figured out what I liked about myself, what made me feel feminine, what made me, what made my life convenient, and so I feel like it took me getting into my early 30s to really own that, and so now I love look at my full thumb.
Sara:Yeah.
Sara:I mean I have had partners before who had a lot of comments about my body not my bulb up but had comments, i think, that I would have known to run but like would comment about me shaving my legs and things like that, where you do feel like, oh, there's one standard of beauty that I'm not quite living up to, but then they, i shouldn't have stayed with those people, you know. I mean, maybe for other people it wouldn't be such a big deal, but for me it did affect myself worth. And then with Adam, like he just tells me how much he loves like every single thing about me, including all of my body, which I just choose to believe him and it's great, you know, but I think it does mean there are people who are going to love you for how you love yourself. Yeah, those are the people that you want to find.
Supraja:And I think if you just give off that sense of confidence and like this is my body, i own it, i love it, yeah, like the right person is going to think that, yeah, that's hot. And if they don't like, like, run.
Sara:And I'm already wondering if my ex is going to listen to this.
Supraja:I've tried to think. I hope mine doesn't, because I hate him so much. Just kidding.
Sara:But let's wrap this up.
Supraja:Let's celebrate our bodies, let's own it, let's ask each other questions and find a GYN that you trust and have good rapport with that, so it can be, you know, a fun, reassuring conco.
Sara:Yeah, find one like Sara who will then start a podcast with you and do a whole episode about it. Love ya, love ya, bye.