Sexual Wellness

STI Screening & Support

Gonorrhea

Gonorrhoea is a sexually transmitted infection caused by bacteria. It is sometimes known as ‘the clap’. It can affect the urethra, cervix, anus, throat or eyes.

Syphilis

Syphilis is a sexually transmitted infection (STI) that can cause serious health problems if left untreated. However, it's easy to cure if found early.

Trichomonas 

Trichomoniasis is a sexually transmitted infection (STI) caused by a parasite called trichomonas vaginalis. In Australia, it is more common in people from regional and remote areas and less common in urban areas. Trichomoniasis can affect females and males.

HSV

Genital herpes is a sexually transmitted infection (STI) that is caused by herpes simplex viruses (HSV) types 1 and 2. This is the same type of virus that causes cold sores. Around 1 in every 8 sexually active Australian adults have genital herpes. Genital herpes can cause outbreaks (flare-ups) of blisters or sores on the genitals and anus. Once infected, you can continue to have outbreaks of symptoms throughout your life.

HPV 

Human papillomavirus (HPV) is a common infection that is the cause of almost all cases of cervical cancer. For most women, HPV is cleared on its own by the body’s immune system within one or two years and will not develop into cervical cancer. In some women, the infection does not go away and can increase the risk of cell changes developing in the cervix. In rare cases, these cell changes can result in cervical cancer.

 

Sexual Pleasure

 

Orgasms

An orgasm is a reflex that occurs after the build up and release of sexual tension in the body. You might be most familiar with a genital orgasm, which occurs either through ejaculation of a penis or through vaginal or clitoral stimulation. Orgasms however, are complex and there exists a spectrum of arousal and pleasure that exceeds the genital orgasm.

It is common for those with a vulva to experience difficulty achieving an orgasm, which can be largely attributed to what is known as the ‘orgasm gap’. This gap is a result of our societal understanding of sex, and it’s largely accepted definition of penetration, which fails to consider that for the majority of individuals with a vulva, clitoral stimulation is needed to climax.

Given that no two bodies, or vulvas are the same, there is no one size fits all approach to pleasure and achieving an orgasm. It is also important to note that sexual intercourse or practices that don’t end in orgasm are not a failure, and can still be enjoyable for those involved.

A few simple ways to support your personal pleasure:

• Understand your own unique body - understand the basic anatomy involved in an orgasm, explore self-touch and consider any barriers to pleasure that might be present such as shame, fear, lack of confidence or trauma

• Explore your body - learn what works best for you! Practice makes perfect when it comes to understanding what movements, touch or practices bring your body pleasure

• Advocate for your pleasure - open communication in a relationship is an important part of achieving sexual pleasure

Foreplay

Foreplay refers to acts of intimacy that come before penetrative sex. Foreplay is a combination of sexual and non-sexual physical, emotional and psychological practices that occur between sexual partners. There are many different types of foreplay, and foreplay will look different for everyone however examples of foreplay include:

• Kissing

• Touching

• Massage

• Flirting

• Complimenting your partner

The recommended amount of time that most women need to build desire, calm the nervous system and prepare the vaginal tissue is 20 minutes of foreplay.

Benefits of foreplay include:

• Increases natural lubrication

• Boosts emotional connection

• Enhances pleasure and orgasm

 

Sex with a chronic STI

For those with a chronic STI, such as genital herpes, engaging in sexual practices can bring about feelings of anxiety, fear and sometimes shame. Ways to navigate sex with a chronic STI are:

• Open communication with your sexual partner about your sexual health and any symptoms your might be experiencing 

• Explore other ways of connecting with your sexual partner through touch, massage or kissing to avoid passing on the infection. Physical touch can be incredibly powerful, and intimacy does not always have to result in penetrative sex

• Utilise a barrier method due to the ability of microbes to be passed back & forth between sexual partners. Invest in high quality, pH friendly condoms such as ….

• Use a high quality, pH friendly lubricant to decrease dryness and reduce friction

Sex with a chronic infection

Chronic infections such as thrush, bacterial vaginosis or UTIs can make sex less than enjoyable for some. To decrease discomfort during intercourse:

• Practice good hygiene! Wash hands and any sex toys thoroughly before use to reduce the risk of transferring microbes

• Open communication with your sexual partner about your sexual health and any symptoms your might be experiencing 

• Utilise a barrier method due to the ability of microbes to be passed back & forth between sexual partners! Invest in high quality, pH friendly condoms such as ….

• Use a high quality, pH friendly lubricant to decrease dryness and prevent tearing

• Ensure you urinate post sex and wash the vulva to reduce symptoms and prevent reinfection

Painful intercourse

Painful intercourse is a very common experience, with approximately 75% of women experiencing painful intercourse in their lifetime. There are a range of factors that may contribute to painful intercourse, including

• Insertion pain - commonly occurs due to issues that affect tissue integrity such as stress, vaginismus, inadequate amount of foreplay, emotional trauma etc. Insertion pain may also be related to an infection at the opening of the vagina or physical trauma

• Deep penetration pain - this type of pain is often caused by internal inflammation that may be related to conditions such as endometriosis, adenomyosis, ovarian cysts or pelvic inflammatory disorder. Deep penetrative pain may also be due to a structural issue such as uterine prolapse, retroverted uterus or constipation

• Tissue irritation, burning or stinging - may be a results to a reaction to a topical irritant found in condoms, lubricants or sex toys. Tissue irritation is also common in cases of vaginal atrophy, vaginal dryness, thrush, BV and tissue damage. Conditions such as lichen sclerosus & vulval dermatitis may result in irritation of the outer vulva

To reduce painful intercourse:

• Speak to your healthcare provider about investigating and addressing the underlying driver of your pain

• Explore other forms of intercourse & intimacy, other than penetrative intercourse

• Use a bumper (OH-NUT) to allow the user more control over the depth of penetration

• Invest in high quality, pH friendly lubricant & condoms to reduce sensitivity and friction

• Explore pelvic floor physiotherapy to reduce vulval sensitivity and pain

• Pain reprocessing therapy can be extremely beneficial to reduce fear, anxiety and emotional distress associated with sex

 

Vaginal Microbiome Health

 

Much like the gut, the vagina has a microbiome of its own which has the ability to influence the risk of infection, fertility & sexual health. Unlike the gut, which thrives on a diverse microbiome, when it comes to the vagina less is more. We want the vaginal microbiome to be dominated by one species – the lactobacillus species. A lactobacillus dominant microbiome is important for:

- protection against UTIs

- reducing transmission of STIs

- reducing incidence of bacterial vaginosis + thrush

- supporting fertility

 

Factors that affect the vaginal microbiome include:

-   Antibiotics

-   Medication (such as the oral contraceptive pill)

-   Diet

-   Alcohol

-   Stress

-   Smoking + vaping

-   Genetics

-   Gut health

-   Hormones

-   Unprotected sex + multiple sexual partners

-   Chemical Exposure

-   Immune function

 Unusual symptoms such as changes in discharge, odour or discomfort, or presence of recurrent infection is suggestive of sub-optimal vaginal microbiome health.

The role of the vaginal microbiome in recurrent infections

Elevated pH - We want the vagina to be an acidic environment as this creates a barrier that protects against unwanted bacteria and infection. A vaginal pH above 4.5 provides an environment that encourages overgrowth of opportunistic bacteria and subsequent vaginal symptoms. 

Low levels of lactobacillus: lactobacillus species are integral for maintaining the balance in the vaginal microbiome. Lactobacillus are protective, and produce anti-fungal and anti-bacterial substances that keep opportunistic bacteria at bay and help to maintain a healthy pH

Common recurrent infections that are driven by sub-optimal vaginal microbiome health include:

 

RVVC

-   Chronic or recurrent vaginal thrush caused by an overgrowth of the yeast Candida. This can be due to shifts in the vaginal environment that are unable to be brought back into balance without intervention. In RVVC, it is common to experience a flare-up of symptoms in relation to intercourse and certain points in the menstrual cycle (eg. In the lead up to your bleed or at ovulation)

-   Common symptoms include a thick discharge, itching, burning, irritation, painful intercourse urination, yeasty odour

 

Bacterial Vaginosis

-   Vaginal dysbiosis caused by anaerobic bacteria resulting in a rise in pH (above 4.6) and depleted levels of protective lactobacillus species

-   Common symptoms include:  grey or clear discharge, fishy or foul odour, vaginal dryness, itching, a burning sensation worse for sex or urination

-   Microbes involved: Ureaplasma, & Gardnerella are the most common

 

Aerobic Vaginitis

-   Vaginal dysbiosis that is driven by aerobic + intestinal bacteria, resulting in a high level of vaginal inflammation

-   Common symptoms include: thick, smooth discharge that could be white or yellow in nature, itching, irritation & pain

-   Microbes involves: Strep B, E.coli, Enterococcus faecalis

 

Dietary Support For The Vaginal Microbiome 

As always, utilising food as medicine can help to foster a healthy vaginal microbiome and reduce the risk of infection. Foods to include for vaginal health: 

-   Foods rich in essential fatty acids such as salmon, sardines + flaxseeds to support tissue repair

-   Prebiotic rich foods to support the health of beneficial bacteria in the vagina such as garlic, onion, asparagus, Jerusalem artichoke & green bananas

-   Fermented foods: using food as medicine through incorporating probiotic rich foods (such as yoghurt, kefir, kimchi & sauerkraut) can support beneficial levels of lactobacillus in the vagina

-   Green tea: a potent source of antioxidants, green tea helps to neutralise free radicals, reduce inflammation + support a healthy vaginal pH

-   Garlic: a broad-spectrum antimicrobial, garlic also has potent anti-fungal & anti-inflammatory properties making it a good food to incorporate to utilise food as medicine when treating specific microbial overgrowths

-   Sugar: sugar can be incredibly inflammatory for vaginal conditions, and many microbes implicated in recurrent infection feed off sugar. Opting for a low to no sugar diet is beneficial, finding sugar-free alternatives for your favourite sugar containing foods

 

Supportive lifestyle practices for the vaginal microbiome

-   Avoid using soap, body wash or “femfresh” products in the vaginal area - the vagina is self-cleaning and these products affect the pH of the vagina, making you more susceptible to infection

-   Wear organic cotton / bamboo underwear to allow the area to breathe

-   Change out of sweaty clothes post workout to allow the area to breathe

-   Opt for organic sanitary products

-   Find a pH friendly lubricant + condoms

-   Ensure adequate personal + sexual hygiene: wipe front to back, urinate or shower post intercourse and wash any sex toys thoroughly in between uses

  

Testing

Given the overlap of symptoms when it comes to vaginal health conditions, testing is crucial in order to identify the specific microbes at play, to inform specific treatment.
⠀⠀⠀⠀⠀⠀⠀⠀⠀
Different microbes require different modes of treatment to eradicate, however all vaginal microbiome conditions require restoration of the protective Lactobacillus species (which should dominate this environment) through supplementing with lactobacillus specific probiotic strains.