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Episode 41  -  The Truth about Vagina vulva: an interview with Dr.Melanie Altas
Melany Krangle & Suzie Sheckter

Speaker A: Welcome to sharing my truth with Mel and Suzie. The uncensored version where we bear it all.

Speaker B: We do 1234.

Speaker A: Hello, hello.

Speaker C: Welcome back.

Speaker A: Welcome back to share my truth, Pod. You're here with Melan Sue's. Don't forget to give us a cute.

Speaker C: Little five star sexy review on this five star review.

Speaker A: Tell us much you love us because we love you. You're going to really enjoy this episode. That's coming up right after we shut the **** up. I have a glass of rose in my hand.

Speaker B: She does.

Speaker A: And hey, babes.

Speaker B: Hello, darling.

Speaker C: How are you?

Speaker B: It's been a long week.

Speaker A: Too ******* long. And it's Tuesday.

Speaker B: Well, we're saying it's Tuesday.

Speaker C: It's Wednesday.

Speaker B: Can you believe it?

Speaker A: Can you believe it?

Speaker B: It's been very long. And yeah. Anyway, we just interviewed this incredible doctor, and she is a ***** doctor, essentially.

Speaker A: And our key and not a ****** doctor.

Speaker B: So this is the thing that we are you've got to listen, because this is the education that even Susie and I, who are very acquainted, I'd like to think so, with the terminology, especially Susie and I knew, obviously, what a ***** and a ****** were. But many people do not. And if you say the word *****, people get a bit weird about it, even though everyone that is the outside and the ****** is the inside. Yes. And I have to say, I understand why men don't know, because if women don't know, how are they going to know?

Speaker C: And why the **** would they care.

Speaker A: If we don't care what they call.

Speaker B: It, if we don't care that we're calling it the right thing? Absolutely. 100%. And that she is involved with this clinic. She's a doctor at this clinic, *****.

Speaker A: Okay, wait, hold on. I'm going to get it and then we can say it properly.

Speaker B: 1 second.

Speaker A: I did have it up and I had a glass of rose, and now I'm completely shot to hell, darling. Okay, so, yeah, dr. Melanie, which is amazing that her name is Melanie.

Speaker B: Dr. Melanie Altaz. Yes.

Speaker A: So the clinic is called the BC Vulvar Health Clinic. And it's obviously in BC. It's actually in a hospital in Vancouver. So if you're in Vancouver, you can go see her somehow, I'm assuming.

Speaker C: I'm not sure how it works.

Speaker B: I think probably the same as here have to be referred.

Speaker A: But she is the coolest doctor. She's so calm. Her voice was like the most soothing thing I've ever heard.

Speaker B: It would relax you if you just.

Speaker C: Went, oh, my God.

Speaker B: Most doctors are not like that. I'm sorry to everyone who's a doctor, but my experience has not been that. No, but op doctors often don't have very good bedside manner.

Speaker C: No.

Speaker B: Which I find quite strange as to why you became a doctor dealing with people. But anyway, that's a conversation for another episode.

Speaker A: She just has the most yeah, just the most wonderful energy. And she makes you feel comfortable talking about your ***** with her and you'll listen in this episode that I couldn't stop saying ****** when I meant ***** and she kept on being like, Susie, you had ******. ******.

Speaker B: But I think the thing we will stop talking in a minute, but the thing is this is really useful for men and for women because there is a lack of education. Women are not using the correct terminology for their own anatomy, therefore men aren't, therefore popular culture isn't, therefore nobody is. And that makes us quite ignorant as to everything surrounding the ***** ******, which of course impacts your health, your mental health and your sexual health. And so I think that's very important to think about that, whether you're a man or a woman, whether you interact with vulvas and vaginas or not.

Speaker C: That's right.

Speaker B: Just important to know that. And also that this particular clinic has a lot of resources and a lot of information. So even though they are in Vancouver, you could go and have a look and it might actually help you. If you are a woman or a person with a ***** and you need some help, this might say to yourself, okay, I'm going to look here, I'm going to get some information and then I might know where now to go or what to ask my general.

Speaker A: Exactly like, have you heard of vulvodynia? Because I definitely did not.

Speaker B: But it's what they deal with, it's.

Speaker A: What they're specializing in. And it's a very common with people with vulvas and they have an amazing instagram. It's hello, *****.

Speaker B: Follow them.

Speaker A: Look at their instagram while you're listening to this episode.

Speaker B: It's so good.

Speaker A: And here it is.

Speaker B: And here it is. And thanks for listening.

Speaker C: Enjoy. And thank you so much for taking the time.

Speaker A: I know being a Volvo doctor is not easy, so you must be very busy with all the ladies and their Volvas or the people with their Volvas. And so we do appreciate carving a little small hour for us. It's very appreciated and we're not going to take too much time with it because obviously we want to get to know you and we have so many questions, so many. It's unbelievable. Mel and I started talking about this and we are just floored with how much we're like, whoa, wait, actually, I don't know the answer to that.

Speaker B: We thought we knew a lot and we were quite well informed and then we're like, okay. Oh, my God. It's actually quite embarrassing. It is.

Speaker A: And sorry, Melanie, I just want to end this Melanie, sorry, because you're both Melanie. Can I call you Dr. Altus? Is that correct?

Speaker C: So my last name is Altaz, but yeah, just call me Melanie, though, throughout.

Speaker A: Melanie is my Melanie's. It's so good to be here with my Mels, but yeah, Melanie, if you could just give us a quick overview of who you are, what you do on a day to day, what are your passions. What does your ****** look like? Everything about it, I want to know.

Speaker C: Excellent. Yeah. Well, thank you for inviting me, guys. You have such a great platform for us to have this type of discussion. I love it. So my name is Dr melanie Altaz. I am a gynecologist in Vancouver, BC. And I work at a group of clinics called the BC center for Vulvar Health. So we see all things *****, so we see things vulvar skin conditions, we look after vulvar pain conditions. We see a lot of women post cancer who have sexual health concerns, and we also do a lot of general sexual medicine as well. So that's actually all that I do. I used to deliver babies and work overnight, but four years ago I left general practice just to work in the vulver clinics. Amazing.

Speaker A: Well, honestly, that sounds very intense and I mean complicated to us because obviously.

Speaker B: We'Re not in today remotely medical.

Speaker A: And I've spoken about this briefly on a podcast with Mel, and Mel was shocked when I told her, but I've actually never seen a gynecologist.

Speaker C: I'm 28.

Speaker B: I was very shocked.

Speaker A: And does that shock you? Or what do you kind of think about women who have never seen the GNO?

Speaker C: So I think that's actually I think fine and also really common. So I think we're really lucky in Canada that our family doctors do wonderful primary care and they're able to do the routine screening. So things like PAP tests, screening for sexually transmitted infections and at least for the most part, diagnosing and initiating some of the more common vulvar conditions, initiating management there. But certainly if someone has any chronic or recurrent vulvar conditions, that would be something I would say to see a gynecologist about. Okay, very interesting.

Speaker A: And I want to just bring the whole conversation to the room. Mel and I had a conversation before we brought you on, Melanie, and we were so confused. And I want you to give us a little bit about it, like talk about it. What is a vulvar? What is a *****? What is the ******? And let's just help our audience, help us, please.

Speaker B: A lot of confusion.

Speaker A: Oh my God, so much, so much.

Speaker C: Oh, absolutely. And there is so much confusion out there. And I can tell you in the media, when they mention the word ******, they actually usually mean the *****. So the ***** is everything that you can see externally, so it's basically what you can see with the eye. So it involves the ***** majora and menorah. So the larger and the smaller lips, it involves the ********. It involves what we call the vestibule, which is the soft opening to the ****** as well as the bladder opening. So all of that is called the *****. And the ****** is actually everything on the inside. So the ******, it's like a muscular tube that goes from the vestibule up to the cervix.

Speaker B: So why is the spelling of ***** sometimes *****, and sometimes vulvar with an r? Is there a difference?

Speaker C: No, it's essentially the same.

Speaker B: Yeah. Okay. Because I was looking at that and I've never thought about it, and I was like, oh my god, is there another word?

Speaker A: I didn't I was like, how do we not know this?

Speaker B: I mean, we knew about the ******.

Speaker A: And the *****, but we're like, what's the *****?

Speaker B: That was very confusing. So it's just a preference. Some people use the r and some people don't. Exactly. What do you think the impact of the fact that we don't use the words correctly has on women? The fact that I think my husband does know, but I think a lot of his friends would be like, it's the ******. What's the ***** like? Who's heard of that? I think a lot of men I'm 50, I think a lot of men in their fifty s forty s, thirty s younger wouldn't know the difference. And women don't even we say ****** all the time, or some kind of variation vaj, whatever we say. What is the impact on women, do you think? The fact that we don't use these terms properly.

Speaker C: Yeah, I would completely agree with you. We see many women in our clinics, and it's not that they don't use the proper terminology. They actually don't know the proper terminology. So, as you mentioned, vaj hoohah, we hear, or people just say down there, right? Yeah. And I think definitely ****** is the word that is much more commonly used. And as I'd mentioned, when people talk about the word say ******, they usually mean *****. And my feeling is that this is because our society is patriarchal and how we sometimes will see women through a man's perspective. So how do they relate to the man and with the ******? Yes, menstrual blood comes out, and that's where if you have a vaginal delivery, the baby comes out. But a lot of the time we're seeing the ****** as a vessel for the ***** or for something sexual. And when we look at the *****, it really has no impact for men. Really. It's truly a source of pleasure for women with the ********.

Speaker A: Interesting.

Speaker C: So it's where the ******** is. And when you see the ********, all that we're seeing is the little clitoral glance. The ******** is between eight to 10 CM in size, and the bulbs of the ******** go around the vaginal opening. So there are other parts of the ***** that are involved in pleasure and, androgynous zones, but they're not necessarily a source of pleasure for men. They're a source of pleasure for women. And my feeling is because of that, it's one of the reasons that it's not talked about very often. And then we start to attach a lot of shame, a lot of guilt, a lot of dirtiness to the word, to the word *****. But I think that's changing. We're seeing it a little. We're seeing it a little bit. Yeah.

Speaker A: Mel and I were just talking because we love the show Sex Education. Do you ever watch it? Do you have time to watch it?

Speaker C: I know a doctor.

Speaker A: You're like insanely busy, but it's amazing show and I recommend anyone watch it who has Netflix. It's incredible. What's her name? Gillian Anderson.

Speaker B: Yes.

Speaker A: Is the psychologist doctor sort of a.

Speaker B: Sex burt, but she's a doctor and she uses the word vulver, but everyone sort of makes out that she's really intense and it's like too sort of they sort of make fun of her almost. And I think that's the same thing. I mean, if you honestly, in your everyday conversation said the word ***** to women and to men, I think they'd make fun of you.

Speaker A: Well, they just ridiculous. They'd just be like, EW. It's kind of a grosser word. I don't know why I have that impression. But it's not the same word, of course, as ******, where it's like it's your ******, it's your VAG. It's more fun, it's friendly, velvus just sounds very clinical. Clinical, exactly.

Speaker B: But it's got to have an impact. If women can't even use the correct terminology for their own body. That's what it is. I mean, it's amazing. If you think about it, it's completely crazy.

Speaker C: I would completely agree with you. And it definitely reinforces the shame that a lot of women have about their bodies in general, about their sexuality and their sexual pleasure. And that women's sexual pleasure is not something that's talked about or valued because of that. I think there are so many things where we see these long standing kind of ripple effects. Yeah.

Speaker A: So is that what you're like in your day to day? What are you seeing the most from women coming in or people with vaginas coming in to your clinic or to your office and talking to about you their problems? Is there a most not spoken about. But what is the biggest problem that you're seeing or issue that you're seeing right now?

Speaker C: So one of the most common vulvert conditions that I see is around vulvar sexual pain. And that can be a condition that we call vulvodynia, which is a vulvar sexual pain condition where it's not due to another cause. So it's not due to a skin condition, it's not due to hormonal reasons, it's not due to inflammation. So that's one of the conditions that I see. And I also see a lot of sexual and vulvar pain around menopause when women are in their early 50s, late forty s and perimenopausal going into menopause when their bodies are losing the estrogen. And estrogen is responsible for elasticity stretchiness. So when women go through menopause, the tissue can become thin and easily irritated and cause day to day discomfort. But it can also cause pain with intercourse. Those are probably the two most common things that I see amongst many, many others.

Speaker A: Right. So vulvodynia, is that correct?

Speaker C: That's correct, yes.

Speaker B: Vulvodynia.

Speaker A: It's not a disease, obviously. It's a medical issue disorder.

Speaker B: Is it a disorder?

Speaker C: So I would say it's a medical condition, yeah. Or a diagnosis that's actually really common. So women who have vulvodynia, so most commonly they'll present with pain, with touch at the vaginal opening. That's the most common presentation. Not all people present that way, though. And for many women, it prevents them from having insertional intercourse, and whether that's with a ***** or with a sex toy, with a finger, for other women in a non sexual context, they'll also have trouble inserting tampons or menstrual cups, or they may have trouble having internal examinations by a physician. And surprisingly, it's actually way more common than you would think. So many people will think, I've never heard of this someone not able to have sex because it's too painful. Good. But we think, conservatively, about 8% of the female population has velvetynia, and there are some studies that suggest it's even up to 16%.

Speaker B: Wow. And does it present itself at a certain age? Is there an age range that you see that mostly that's when it starts or maybe when most people have the courage to come and see you.

Speaker C: So it can affect anyone of any age. And we'll see there are two different kinds of vulvody. One of the subtypes is what we call primary or secondary vulvodynia. And primary vulvody is someone where they've had the pain right from the very beginning. So maybe the first time they tried to put the tampon in, the first time they had sex, they weren't able to do it. But then there's another subtype called secondary vulvody, and those are women where maybe they could have pain free sex for many years, and then something happened and they're now not able to have insertional intercourse.

Speaker B: Is there a psychological piece to that? Something's happened, triggered it.

Speaker C: So for some people, there are there are so many contributing factors. It's a condition where there's actually a lot of layers to it. So when a care provider makes a diagnosis, one of the parts of the management is actually to try to figure out for that individual what is actually contributing to their pain. And for some people, it'll be nerve. So they may have nerve inflammation, nerve damage. They may have pelvic floor dysfunction where their muscles are really tight. And there are some people where there may be an anxiety, a stress fatigue component causing it. It's something that we call central sensitization. So that's where your nervous system is upregulated. And when you have an upregulated nervous system, it can make you vulnerable to developing pain in your body. And things that upregulate the nervous system are those that I just mentioned, like PTSD, stress fatigue, anxiety.

Speaker B: And in turn, that's going to cause potentially sexual dysfunction, isn't it? Because the stress that's going to cause you, that you're going to avoid sex it's going to cause problems with your relationships and on and on? It sort of goes from my point of view would imagine.

Speaker C: Absolutely, yeah. It can be a contributing factor to the start of the vulvar pain, but then it can be a factor that perpetuates and even kind of snowballs. So it plays a bigger role down the road. And one of the reasons that it does that is because a lot of women with vulvody will, when they seek out care with their care provider, because vulvody is not very well known in the medical communities, a lot of women will actually be dismissed, and they may have an exam, and they'll be told, your skin looks normal. I think this is all in your head. Just have a glass of wine. I've had someone where they were told just to have a glass of warm milk.

Speaker A: Like a child, like, excuse me.

Speaker B: I believe it.

Speaker C: Yeah. So many women will be frustrated with the health care system. They're not getting answers. But then that uncertainty, fear and frustration, you can imagine how that would increase anxiety. It would have an impact on the relationship, on the sexual part of their relationship. And so you can see how that compounds and gets bigger and bigger. Yeah. Actually, almost two thirds of women will have to see three or more physicians before getting a diagnosis of velvenia.

Speaker B: Oh, I believe that 100% wild.

Speaker A: And you've said it's very common. How much percentage did you say again?

Speaker C: So conservatively? 8%.

Speaker A: Right.

Speaker C: Likely up to 16.

Speaker B: Wow. It's a lot of women is there.

Speaker A: Something where it gets confused with something else and people are being misdiagnosed?

Speaker C: So sometimes when people present initially, it may be confused for a yeast infection. Okay. And some women will even self treat for a yeast infection before they see the physician, but then it doesn't work. And then they may go and see their physician. The physician sounds oh, it says it sounds like a yeast infection. I'll just give you this prescription. Or maybe they do an exam and a swab and the swab comes back negative for yeast. And then eventually they're just kind of their physician is just shrugging their shoulders and saying, everything's come back negative, your skin looks fine, everything looks normal. It's all in your head.

Speaker A: Right. And especially because the symptoms to this are like anything that could be a yeast Eviction or like an STI. Right. Like itching burning hurts when you pee. Does it hurts to have sex? And of course, the women all bear these horrible things. A lot of men sometimes don't. So, yeah, I can understand why this would get so confusing, but you'd think that is that why your clinic is so incredible? Is that it's kind of teaching other clinics that this is what exists? Please treat your patients as such.

Speaker C: Yes, absolutely. So one of our goals and passions for a lot of the team members in our clinic is to increase public awareness as well as community provider awareness. So we do a lot of outreach, we do a lot of talks within the medical community. We have a really active social media presence, and we feel we've reached a lot of people through there. And right now, we're working on some resources for family physicians to help them diagnose this early on and to also start management, because vulvodynia is not something we're taught a lot about in medical school or in our residency training. And so I do understand why community physicians, they don't know what this is because they've never heard of it either. So we're trying to come up with really easy, efficient, accessible ways that community physicians can access the tools to diagnosis earlier on. And we're also trying to reach out to patients so that they know how to advocate for themselves when they experience these frustrations within the healthcare system. So what are ways that you can bring this information to your family doctor and advocate for yourself?

Speaker B: Is the clinic a provincially funded clinic? Is it private? Like, how does somebody come to see you? Do they go through all the normal channels and then they're referred to you by their GP or whomever they've seen? Or is it something else? No.

Speaker C: So we are a government funded clinic. So we're located at Vancouver General Hospital, right in the hospital setting. Patients are referred by their community provider, and that may be a family doctor, gynecologist, midwife, nurse practitioner, just sends in a routine referral, which they can get from our website. Unfortunately, the wait time is very long, so it is about a year and a half. But when you think about that, we see on average about 300 women a year with vulvodynia. So imagine like, we're seeing 300 people a year with this condition. But when you think about it, if the population of British Columbia, if 16% of that female population has Velvenia, we're still probably only seeing about 1% to 2% of women with vulvody. So there are so many people out there who are afraid to talk to their family doctor about it, or if they're dismissed by a family doctor at the initial time that they bring it up, then they may just accept that that's what their life is going to be.

Speaker A: Are there people coming from all over Canada or even all over the world even, to come see your clinic? Or is that even possible? Because I know it's BC. Government funded. I'm assuming so. Are there clinics in Toronto? Have you seen other clinics elsewhere that you're like, this is great, we're actually making a difference? Or is it like, there's not enough of these, we need more? Obviously we do, but you know what I mean.

Speaker C: Yeah. So our clinic, we don't see people from outside the province, so we see people from British Columbia and the Yukon as well. We're kind of connected, and it's just because of our resource and our wait time, we actually don't have the resources to serve our province. As far as we know we are the only kind of one stop site for vulvodynia management. So we have a multidisciplinary clinic where we have a pelvic floor physiotherapist, we have several psychologists, we have a couple gynecologists and we have nursing and clinical care support for patients. So as far as I know we are the only kind of one stop place for vulvodynia. There are definitely many other people who are able to recognize and treat vulvodynia but then they would have to set up their patients within the community with a community physiotherapist, a community psychologist. And also because of our limited resources, unfortunately we just provide short term care for people. We're not able to provide the longer term care for people. So we do actually eventually set up our patients with community resources. We do however offer a fellowship. So an advanced training program for gynecologists to come and spend six months with our clinic developing an expertise in vulvar disorders as well as sexual medicine. And those gynecologists go back to their community. So so far we've trained three and they've stayed within Canada, one in Manitoba and two in Ontario. So I would say they would also be experts in vulvodynia.

Speaker A: And I know you did schooling in Toronto a little. It was but you chose to move back to Vancouver.

Speaker C: Is that where you're from? No, I'm actually from yes. And you know, it's kind of a funny story because I went to school, medical school in Toronto and at that to when we were interviewing for residency positions we would travel to the location to be interviewed and the interviews happened in January. So we came to Vancouver and it was a beautiful sunny day and people were just wearing sweaters. And then the next stop was Edmonton. The next stop was Calgary and by that time I decided that Vancouver was the place for me. Yeah.

Speaker A: That is so great.

Speaker B: Yeah. In January. That's a way to do it. Definitely.

Speaker A: I'm from Edmonton. If I got that trip to Vancouver I'd been like, yep, moving, moving quick.

Speaker B: Definitely not a fan of the snow. No. But what are the other conditions? What other things should women know about in terms of ***** health?

Speaker C: So in sort of another set of clinics where we look after the vulvar skin conditions, one of the most common things that we see are just an inflammation of the skin due to daily irritants that people are putting on their skin. So we would call that like a contact dermatitis or a contact inflammation. And particularly now there's so much marketing out there about feminine hygiene products. We'll see a lot of women who will be putting all of these weird over the counter things on their ***** that actually are not necessary at all. So vulver skincare is very simple but it can become easily irritated. So a lot of the time, we're actually talking to people about their vulver skincare, what to do on a daily basis, which actually just involves washing the skin, at the most once a day with warm water and really mild or bland unscented products on the skin, like a soap to wash the skin. So you don't need to use wipes. You don't need to use anything with essential oils in it, anything that's fragranted any of the exfoliants that people are using or the douches.

Speaker B: None of those exfoliants.

Speaker C: Yeah, I have an exfoliant because I.

Speaker A: Wax, though, and so you have to wax.

Speaker B: Yeah. Okay.

Speaker C: Or no, that's what people use it for is if they wax.

Speaker A: Yeah, because then if you don't exfoliate.

Speaker B: It'S like getting grown hairs. Yeah.

Speaker A: And it's a more pleasant wax experience if you exfoliate.

Speaker B: Well, I've had the whole thing where.

Speaker A: They take the laser.

Speaker B: Laser.

Speaker C: Yeah.

Speaker B: So it's all gone. It's much easier.

Speaker C: Me, too.

Speaker A: What's the best thing for your ******?

Speaker B: Wax?

Speaker A: Laser shade.

Speaker B: Very good question.

Speaker C: Yeah, nothing in the ******. Don't wax your ******, please.

Speaker A: **** it.

Speaker B: That would be tricky.

Speaker C: Yeah. So that definitely varies. There are a lot of different beliefs about that. There are some people who think that the pubic hair actually plays a role in protecting the skin and providing natural oils. And sometimes people who kind of follow that or who believe that that's important would maybe recommend trimming the hair just with scissors if you want to keep it short, if you didn't like it. Oh, natural. Which is also totally fine. Yeah. A lot of people really like the laser because they like that look. It feels more comfortable to them. A lot of people think it's cleaner, and it prevents the ingrown hairs that some people can get with wax. With waxing or shaving. Yeah. So there's nothing really clear in that area of one, this is better than the other. Now, I would say people who have a skin condition, so some of the chronic skin conditions, like eczema or lichen, sclerosis, or some of the common ones we see, then I would definitely stay away from waxing or shaving. Shaving.

Speaker B: You can get that on your *****.

Speaker C: You can get eczema. Yeah.

Speaker B: Wow.

Speaker A: That's so itchy.

Speaker B: And that's very hard to get rid of. Almost impossible, because the one thing you said I think is really interesting, you're talking about women using all these products to stay clean or whatever, that smell nice or whatever. But I've heard of I can think of friends or people that I know, women that I know who've altered their routine because a man, I'm afraid, or a partner, has said something to them, has commented on how they smell, when it could actually be perfectly normal. And so it sets up this whole thing in your head. And then, obviously, you go to shoppers drug mart and buy every single product you can possibly find, and that starts. This whole thing, doesn't it?

Speaker C: It absolutely does. Yeah. And we will see that where people almost become obsessive exactly about their skin and because of something external to themselves, either someone said something to them or they've heard a message through social media or in advertisements and definitely see it. And then it kind of starts the mind going and ruminating. And in that case, we'll see people will overwash the skin, and that will cause problems, cause problems itself. And it's really too bad that it's always such a sad situation. When I hear someone who's been really impacted by something that a partner has.

Speaker A: Said, how do we love our vaginas? Vaginas and vulvas.

Speaker B: It's hard to not say the word, doctor.

Speaker A: It's hard not to say it.

Speaker C: Yeah.

Speaker A: How do we love our vulvas more? Do we do the mirror thing every day? What is the one thing? Do we talk to her? What do we do?

Speaker B: Why do we need to do the mirror thing?

Speaker A: Just to look at her and just bask in her beauty. That's what I would do if there was something I was like, you're great. You do a lot for me that I don't give you credit for.

Speaker B: Fair enough.

Speaker C: Yeah, absolutely. I think that's something that you could certainly do. I think everyone would be different in what would work for them. But I think one of the most important things is to recognize that vulvas come in all shapes and sizes and that everyone is different and recognize that everyone's completely normal. And then to start the education when people are younger. So even with children, teenagers, whether that comes from their parents, their mother comes from their friends or their family, or online messages, that this is just a normal, beautiful part of the female anatomy. And I think that's when you'll see that, those messages will kind of become almost like, deep in your bones, something that you truly, truly believe in.

Speaker A: And what is the biggest education part of it? Is it just that we should be saying *****? Or is it, hey, every single ****** is different, like fingerprints. What is the education on it that you would love for it to just be normalized?

Speaker C: That is a great question. So I definitely think by using the appropriate anatomy anatomic terms is really important. And then perhaps it would go back to the sex education in junior high and high schools about ensuring they use the proper terms and moving away or not moving away, but including beyond contraception and STIs, including a little bit about female male sexual pleasure from that younger age. I would think that's really important.

Speaker B: Yeah.

Speaker A: So not just STIs, let's get into the ********. Let's get clitorate. I was, like, creeping your instagram, like the ***** clinic instagram, and I'm like, yes, let's get clitorate. Everyone needs to be at this time 100%.

Speaker B: I think there's just so much ignorance. I think. Like I said, I'm 50. I think it's taken me an entire life to learn all these things. And I find it fascinating that younger women who have so much access compared to my generation, to information, still aren't actually getting it. I don't mean getting it understanding, not getting the information to them, not understanding the right pieces, living in a lot of shame, like, we talked about cleanliness. But I also think about women getting quite obsessed about how their *****, how it looks down there, like, all the.

Speaker A: Surgeries happening, obsessed about it. Do you have an opinion on these? What is it called? The ****** plasti. What is the deal with this?

Speaker C: Yeah, I think the one that you're referring to is the labioplasties. Okay? So that's externally, where women, or even, sadly, teenagers, feel that their ***** are not the right shape, they're too large, they hang down too much. Maybe they're uneven or asymmetrical and want them to look a certain way. And so they'll seek out surgeons who will do what they call labial reductions. And vaginal plasty is tightening up the ******. Right.

Speaker B: Internally, if you've had a child right? But where is the message coming that your ***** doesn't look right? I mean, where are they getting that message? They've got to get that message somewhere to possibly decide, I want to have surgery. I can't even imagine where they're getting that message.

Speaker C: ****.

Speaker B: ****. But why does that tell them that theirs is wrong? Because everyone else's is.

Speaker A: Because the hot girls have these itty bitty, teeny, tiny little baby vaginas. Vulvas.

Speaker B: Vulvas.

Speaker C: Goodness. Yeah, that's where we think it's coming from, ****. Nowadays, it's so easy to access. It, like, super easy. And that's what many people see on ****, and that's both men and women will see that, or boys and girls will see that, and they think that that approach to sexuality is normal. But then they also look at the anatomy, and they'll worry about what's normal. And then that may be where you get someone commenting on someone else's genitals.

Speaker B: Totally.

Speaker C: That, oh, this doesn't look like what I've seen before. And all you've seen before is ****.

Speaker B: Right.

Speaker C: And you know what? What's interesting, though, is that I had always thought that that applied to just women wanting their ***** to look a certain way. But I've recently I think there was an article in the Atlantic or New Yorker magazine the last couple of months about that. Men are also doing these things to enlarge their penises as well. They don't feel they're larger, large enough. Isn't that it's just crazy on both.

Speaker A: It is really crazy on both.

Speaker B: The pressure. Yeah, the pressure. I mean, think you're worrying about your weight. You're worrying about how big your ***** are. You're worrying about how you look, your face, and then you're worrying about what most people can't see. It's terrifying. Absolutely terrifying. And I just don't think people talk about it enough. They don't normalize it. I mean, I have two daughters. I'm very open, I talked about stuff. They probably, most of the time, tell me to shut up. It's too much mum. But I just think that for some reason there isn't enough pointing to the right education. I mean, what you're doing is amazing and there needs to be much, much more of it, there really does. Because if people don't know what the ****** and the ***** is, then God help the rest of it. Right? I mean, you don't know the basic starting point. I think that's going to be my thing this week. I'm going to ask everyone. Do you know?

Speaker A: I think that's it it's a conversation starter.

Speaker B: It is.

Speaker C: Yeah, I agree. I completely agree. And I think that when we start talking about it or when we give people the language and the words to have these types of conversations, I think that's a great starting point and I think that will make things easier. We have quite a few of our friends where they have their teenage children follow our instagram and then they decide maybe once a week to have a conversation about one of the posts that we have and it's a great way to generate conversation.

Speaker B: That's so awesome idea because then if it's awkward, then you can use a medium and a lot of people do find it awkward. If you can use a medium like social media that teenagers are using and use that as the bridge between the sort of awkwardness I think that's an amazing that means that social media is actually doing something positive, if you can believe it.

Speaker C: Yeah, I agree. But yeah, and then just in a little bit of follow up to the labiaplasty, it's not just women having the surgery, paying for it and having their ***** look a certain way. There actually are so many complications of those procedures and we've received referrals for women who are in chronic pain because too much was cut out or someone cut a nerve or someone where their ******** was injured. Oh, my gosh. Yeah.

Speaker A: There are a lot of potential, like you're trying to look hot, let's say in quotations or whatever, and yet you can't even enjoy the one thing that you wanted to enjoy because you got this thing that it's exhausting and that's so sad. And are these young women that you're seeing that have it? Oh, so sad.

Speaker C: Yeah.

Speaker B: It must cost thousands of dollars.

Speaker A: Well, it is really crazy because I remember I remember when I was a young girl, of course, and my ***** started coming out a bit more, like it was always like this little thing like clamshell.

Speaker C: And then it came out a little bit more and I was freaking out.

Speaker A: To myself, being like, I don't know what the **** is going on, what is happening? I was trying to push it back in. I had no idea because I was like, what is going on? No one tells you that your baby is just going to one day come out. Obviously, it's not like flopping in the wind, but it's out there. And I'm like, I am weird, I am abnormal.

Speaker B: But it's like anything to do with sex, nobody has.

Speaker A: But that's the thing I'm like we don't talk about it at all.

Speaker B: But why women don't talk to other women about it is the thing. I don't because they don't know either. They get embarrassed either, though. There's so much we're so embarrassed about everything. And I talk to people and I say, for goodness sake, I'm British. I'm supposed to be super reserved. I'm not embarrassed. So you shouldn't be embarrassed. But yeah, people are so embarrassed about it. But I guess the key is more and more education. You just have to keep talking, keep being open, not being awkward. I guess that's the answer, isn't it?

Speaker C: I definitely think so. I think talking about it or even accepting that it may be awkward in the beginning when you talk about it, but is it okay to feel awkward? I think so. And then as you practice and talk about it more, then it'll become less awkward and less uncomfortable and kind of recognizing that maybe you'll say the wrong thing in the beginning, maybe you use the wrong word, and that's totally fine, just keep on talking about it.

Speaker A: Yeah, I love that. And I'd love to kind of conclude this conversation, this incredible conversation. And again, we thank you so, so much for taking the time with us. And I know our audience will really appreciate this, and it's been so helpful and educational, but we ask this to all of our guests who come on. And in just the spirit of sharing truths, what is the one thing that you would share with your younger self?

Speaker C: That's a great question. You know, it's funny. I was out to dinner with a friend on the weekend, and we were actually talking about something like this. So I've really recently, over the last few years, I would say kind of connected with sometimes when you get those little moments of joy, it'll just maybe last a second or two. And apparently they're called something, so they're called glimmers. And I think it's really important to connect with your glimmers. And that's actually what's guided me on my pathway to finding this niche within medicine. So recognizing that my moments of joy in medicine were connecting with people who were in a place of suffering, were in a place of being dismissed. And that's kind of where I found my flow and my connectedness and my peace within my practice. And so I guess if I could have done that years ago so I'm 50 now. If I had done this like 20 or 30 years ago, I think I would have maybe ended up where I'm supposed to be a little bit sooner. So connect with your glimmers.

Speaker A: Well, Doctor, you just gave me a glimmer, I think.

Speaker B: Yeah, definitely.

Speaker C: Good for you.

Speaker A: I felt somewhere at least, very good.

Speaker C: She can't help herself.

Speaker B: Sorry.

Speaker C: I love it.

Speaker B: She can't help herself.

Speaker A: It's embarrassing.

Speaker C: But thank you so much.

Speaker A: Melanie last little queries.

Speaker B: Just where can everyone go and find you your social media?

Speaker C: Tell us everything.

Speaker B: Tell us where they can find this great information.

Speaker C: So we are very active on our Instagram, so it's called Hello Volva and people can reach out. We respond to our private messages through Instagram. People can also find out a little bit more about our center at Bcvulverhealth CA. So that's our clinic center. We have a lot of handouts for people, and we also have an email address on there if you're more comfortable reaching out by email.

Speaker B: Okay, that's perfect. We will obviously mention that again everywhere. So people have that information, and even if they're not in BC, just that they know they can find somebody somewhere. I think that's half the problem is people just don't know it exists. So that's helpful just to know that. Yeah. But thank you so much for your time. It's great. For me, personally, I think, thank God people are talking about this, that people are being quote unquote normal about something that is completely normal and not awkward, embarrassed or whatever. I just think it's amazing.

Speaker C: Yeah. So much.

Speaker B: Thank you for having to speak to you again.

Speaker A: Yes, and I'll just tell our little listeners right now, if you have any additional questions, as I'm sure you do, as we did, if you have any questions, concerns, comments, DM us, you can Instagram us, email us, go to, leave us a voicemail. We'll share it all with Dr. Melanie, and we'll have you back on the pod if you would be so gracious with your time. Yeah, I can't speak anymore.

Speaker B: Thank you. She's in awe. She's so in awe.

Speaker C: I love it.

Speaker B: You guys are great and speak to you very soon, we hope.

Speaker C: Okay, wonderful. Thank you. Bye bye.

Speaker A: Hey there, misfits.

Speaker B: There's a new podcast for the odballs and weirdos who transcend all categorization. It's called Misfits making It Odballs, doing Cool stuff with a ponchant for the irreverently heartwarming. Humour comedian Lauren Laduiche thoughtfully interviews fellow.

Speaker A: Misfits you'll meet creatives from SNL, Netflix, late Night, Comedy Central, The New Yorker, Vanity Fair and more, as well as indie musicians, comedians, writers, artists and entrepreneurs. What we have in common, we're all balls and we're doing cool stuff.

Speaker B: Thanks so much for listening. Please rate and review this podcast and follow us on Social at sharingmytruthpod and leave us a voicemail on our to share your stories and experiences with us. We'll see you next time.

Speaker A: Bye bye.

Speaker C: It three, two, one. Yeah. Don't.

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