Yoni Wellness: Tips for Better Vaginal & Sexual Health w/ Janelle King

EPISODE OVERVIEW:  While missing from most wellness conversations, this episode is centered around vaginal and sexual health. I ask all of the questions you may be embarrassed or afraid to ask, but also things you may not even think to ask as it relates to your vagina and optimizing your sexual health.  Whether you have a vagina or are raising someone with one - this episode is for you!  

I have the pleasure of sitting down with Janelle King, a Registered Nurse, public health educator, and blogger over at The Nurse Note.  Her mission is to simplify information related to vaginas, periods and sex and deliver it in a straightforward way so that we can learn what our normal is and when we need to seek advice.  I ask her all the questions you may be too ashamed, embarrassed or didn’t even know you should ask about your vaginal and sexual health.  

In this episode we talk about:

• Knowing and recognizing the symptoms of, and differences between, bacterial vaginosis, a yeast infection or UTI
• How HPV can cause several types of cancer, namely, cervical cancer
• Why your partner should “freshen up” before sex too - especially if uncircumcised
• Condom negotiation and how to have conversations with a partner to protect your sexual health
• What might be causing your vaginal pH balance to be off 
• Conversations to have with your daughters about vaginal and period health 
• Unpacking the why behind the upward tick in STI rates 
• What to expect during a pelvic exam vs. pap smear 
• The implications of untreated STDs 
• Self-advocacy with STI screening and more!

How you can connect with Janelle: 

On all social media platforms - @thenursenote

Website - www.thenursenote.com

RESOURCES MENTIONED:

The Vagina Bible by Dr. Jen Gunter - https://amzn.to/3DHmgXL

The Period Doctor - @theperioddoctor 

Doctor Heather’s Advisory Cervix IG - @advisorycervixpod

Sex Ed in Color Podcast - https://podcasts.apple.com/us/podcast/sex-ed-in-color/id1439204319

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Transcript

Faith: Sista Circle Podcast community, today's guest is a special one, especially as we'll be discussing all things vaginas and sexual health. I'm so grateful to have with me Janelle King, a registered nurse with a master's degree in Public Health. During her nursing career, she spent many years educating young women about reproductive and sexual health is also an accomplished blogger and writer as well as a journey award winner. Janelle, welcome to the Sista Circle, Queen.

Janelle: Thank you. Thank you so much for having me. I'm really excited to be here.

Faith: And I'm so excited to have you here. I always like to start my interviews by setting in intentions. So, I'm really curious to know what is your intention for the women who will encounter your podcast or this podcast episode, rather?

Janelle: So my intentions are pretty simple. I want women to have a general understanding about vaginas, periods and sex. I want to increase their knowledge in these areas. I want them to understand where to access the resources and know when to contact the provider for symptoms that are abnormal.

Faith: So, who is Janelle? What do you do? And what is the mission?

Janelle: Yeah, that is the million dollar question. So I am a mother, a wife, and obviously a nurse. And my, my mission is fairly simple is just to simplify information related to vaginas, periods and sex. I provide information in a very straightforward, manner of fact way, so that really it's just to help with body literacy, understanding how your body works and answering some of the questions that you may be too ashamed or embarrassed or afraid to ask about your vagina periods and sex.

Faith: So what led you to become a nurse and a sexual health educator?

Janelle: It has been a long, long journey here and definitely not where I thought I'd end up. I started a lot of my work as a nurse working in sexual health. I was an outreach nurse, doing outreach for HIV initially. And then I transitioned into a teen and adolescent medicine clinic, where initially I thought we were just going to be doing like physicals and vision screens, but it ended up really just being a clinic, primarily talking to teens about sex, sexuality, birth control, doing a lot of STI, sexually transmitted infection, screenings, testing, treatments, so that's really where it started for me. And that's kind of how I developed an interest and passion for this area.

Faith: I mean, and the work is so necessary, so thank you for doing that work because it is so, so important. So, let's talk a little bit about vagina health. What are some tips that you would suggest to have, or to optimize your vaginal health?

Janelle: So the first thing and the thing that I recommend the most is to keep it simple. Keep your regimen extremely simple. If what you're doing right now works for you, then keep doing it. So that means if the process is working, the products that you're using are working, keep doing it. Now, it's important to know your normal. So that means knowing what your normal flow for your periods look like, know what your vaginal discharge, what's your normal for your vaginal discharge, what is your normal odor, so that if you have issues or when issues arise, you can point that out and seek a provider. Then my next suggestion would be to have a trusted provider so that you can turn to, ask questions, get treatment if need be. The last thing I'd say would be to let it breathe. You got to let your vulva and your vagina breathe sometimes. So I know people loved the tights and the tight jeans and that kind of stuff, leggings. Yes, ma'am, tights, leggings, all that stuff, but you have to let it breathe. It's okay to wear those things, but sometimes you just have to wear regular pants, cotton underwear, just give it a chance to breathe.

Faith: So for the vagina, we want to keep it simple. So one of the things that you may mention of was about like knowing your body and kind of what is a normal period, normal discharge, what is normal discharge and what is not normal?

Janelle: So discharge generally, so speaking, it will appear white or like a really milky color. It's not going to have an offensive odor. And then it's typical depending on where you are in your eventual cycle. So, around the time of ovulation, you might see it's more stretchy and clear color. Right after you have your period, you may not notice any discharge at all, so those are the generals. Now, discharge that sometimes is pink; it could be because you just finish your period and there's maybe a pinch of blood in that, but generally speaking, those are the parameters for a normal discharge. You're not having any itching or burning effect.

Faith: And so, what's not normal?

Janelle: Normal would be - so generally speaking, anything that's colored. So if it's like a green or a yellowish color, that would be assigned to pause, like there's something that there's maybe an issue arising from that. If you're having any itching with your discharge, if you're having any burning with your discharge, if there is an offensive smell, so something that's just totally not your normal, those could be indications that there's something more going on.

Faith: So I would imagine that some of those things that might be going on might be BV or bacterial vaginosis, maybe a yeast infection or a UTI. So, can you talk a little bit about what some of the reasons that you might get those common types of things such as BV, UTIs and yeast infections?

Janelle: Yeah. So BV or bacterial vaginosis, what it is is, it's an overgrowth of bad bacteria. So what happens is your vagina has a balance of good and bad bacteria. And when you introduce something that disrupts that pH, that's usually when you run into issues. So it could be a sexual partners, it could be a feminine wash, it could the not using condoms. What happens is then your pH and the bacteria, the bad bacteria overgrows the good bacteria, and then you start to have symptoms. So that would be like you start smelling, discharge, itching burn. With a yeast infection, what happens is that your vagina has its own volume, so the vagina normally contains yeast. And so, when you introduced something to cause that yeast to grow, it kind of overtakes everything. So, yeast likes to grow in warm, dark, damp places. So like staying in a bathing suit too long, staying in wet workout clothes too long, sometimes medication can disrupt the whole balance of your vagina and cause an overgrowth. Definitely take a look at maybe some of the products that you're using, the medications that you may be on because those could cause a yeast infection.

Now, a UTI - what happens is you introduce bacteria into your urinary tracts system. So this could be from not wiping in the right direction. So you want to wipe from front to back, and that it may introduce bacteria into urinary tract, you know, dirty hands, toys that are not cleaned, not drinking enough water, not using condoms, anything like that can - a UTI.

Faith: So you talked about how you could get BV from a sexual partner and how BV is basically bacteria. So I know that a lot of times women before sex, you know, we like to clean up down there. You know, let me freshen up a little bit, but what are some of the sexual, like cleaning up that maybe a guy should do? So if your man's been, like, let's say he's been laying around at home all day and maybe it's hot outside and balls are sweating and stuff. I'm sorry to be so graphic, but you know, like seriously. And then you come home and it might be attracted and it's like, let's get it in. Is that something that should be a common practice for them to kind of freshen up as well before you have sex?

Janelle: Yeah. I think it's a good idea. And also you got to think of men who may not be circumcised, so they have the potential to have more bacteria and that kind of stuff. So, they have to make sure they're cleaning really, really well so that they're not introducing any bacteria or anything else into your vagina, which then causes issues of yeast infections, UTIs, or BV.

Faith: So I'm actually really curious. What about the folks who might have BV or yeast infection and maybe they don't know what the difference is. So, how would you define, or what would be the differences between BV and a yeast infection?

Janelle: Classic yeast infection symptoms would be white discharge. It kind of looks like cottage cheese. It may have a yeasty smell. You will experience like itching and burning and your vulva and vagina may just be like red, like an inflamed red. Whereas BV, you could experience also like itching and discharge, of course. The discharge may be a, like a grayish color. Usually the big indicator, it has like a foul smell, so it tends to smell like a fishy odor. You can also experience itching, the itching and burning with BV as well.

Faith: And what would you say are the implications of not treating that, especially in a timely fashion, whether it's BV, yeast infections or UTI?

Janelle: So what happens, generally speaking with the UTI, it'll start lower and then it'll migrate up, so it eventually leads up to your kidneys. And so, it's just really painful. It's like, of course, antibiotics, hospitalization type kind of stuff.

Faith: So if I did I hear you correctly, if you have an untreated UTI, it can lead to a kidney infection.

Janelle: Yeah, because it moves up your system and it moves up into your kidneys, and so it just gets higher, higher, higher. And then it's really painful. I've had patients come in with really bad UTIs where it got up into the kidneys and you know, sometimes that requires hospitalizations and of course, antibiotics for treatment. So, definitely something you want to catch early, preferably. With a yeast infection, it's just very uncomfortable. And that's normally how you know you have a yeast infection because it's itching, it's burning, you can't sit still, you're wiggling in your seat just because of the intense itching and burning. But bacteria vaginosis, eventually, you know, long term it can lead to problems with fertility, but it's usually like, you'll have the discharge. It'll just be an odor, like people may be able to smell it. And so, you know, like I've had patients come in, like, "My partner told me that they can smell me." And so we'll test them for a whole bunch of stuff and you know, there it's BV.

Faith: If have any of these things, should you be having sex during that time?

Janelle: You definitely don't want to have sex during this time. You're having these symptoms. What you want to do is treat the infection first so stop having sex. Even if your symptoms go away and you start to feel better, you [unclear11:34] your treatments, usually antibiotics, and then resumes sex.

Faith: Okay. So, no sex during having a UTI or any of that stuff. Let's talk a little bit about waxing and shaving or just keeping a little, you know, forest down there. Is there a difference if you do any of these things, are any of them considered "bad"? Or what would you suggest?

Janelle: So my personal philosophy, first of all, like there's no medical indication - there's no reason that you need to get rid of the hair down there. It's actually, there's a job for it, and the job is to protect your vulva. This skin down there is very sensitive, and so the hair is a layer of protection helps to trap bacteria, all that stuff. And so, if you decide to shave - whatever you're doing, if it's working for you and you're not having any issues, then you can continue to do it, you just have to be safe doing it. So if you're shaving, that means, you know, using one razor, make sure it's always sharp. This razor that you're using in that area is only for that area, shaving in one direction. If you're waxing, you know, I would hope that you're having a professional do it because of just like the burns issue, but some people do it at home and they're very successful. I don't think I would be one of those people. So just be careful and make sure that you're protecting the skin down there because it's hot wax.

And then if you leave it and let it be, that's okay as well. Some people like to trim it back. So you just trim it down with scissors, just because sometimes some women may find that they have a lot of hair down there, it starts to have an odor and that kind of stuff. So, make sure you're washing properly and can kind of trim it down just so more air is able to circulate down there.

Faith: I am someone who switched over to like all natural sanitary napkins, maybe about five or six years ago. I believe I was listening to a podcast, knowing me. I was either listening to a podcast or reading some random book. And it said that a lot of this sanitary napkin as well as like tampons and such that it has a lot of toxins that are in them. And so I just made the switch and I really saw a significant difference how my vagina kind of reacted to it. And so, I think that a lot of the common products that we may use may be causing some discomfort or discharge, right? So, what are some of the products that we might be using or some of the common practices we might be engaging in that could be a little detrimental, if you will, to our vaginal health?

Janelle: Like you said, there's a lot of products and you know, these things are specifically marketed to make you smell like a garden roses and that kind of stuff. So, there's a lot of chemicals and scent in them and that can sometimes disrupt your vagina and your vulva. And so, like the wipes and the feminine washes they're not necessary. It's probably better to use something that's closer aligned to your vulva or your vaginal pH - mild cleanser or water, something like that, [unclear14:37] being, if you've been using the product forever and you're not having any issues, you can continue to do that. I think it's also important to wipe in the right direction, so front to back to not introduce any bacteria. If you're using sex toys, it’s important to clean them properly. I usually recommend that you not share them; if you're going to share them, you know, put some sort of layer protection, so whether it be like a condom or something on the sex toy, and then of course, like menstrual products. So, you could take a look at your menstrual products, kind of what do they contain. Is it all natural? Does it contain different toxins or soaps that you use to clean your body or the ones that you used to clean your clothes with? So, yeah, there's a multitude of things, and depending on how sensitive your area is that can cause a reaction.

Faith: So, I am a mama of two young girls. I actually have a two year old, who's almost three and an eight month old, but I'm really grateful to be a girl mom, but I also am like, oh my gosh, like, what are the conversations that I need to be having with her, whether it's now, or whether it's when she's a preteen or a teen about like vaginal hygiene and maybe like period health, right? How do you begin having those conversations, and when do you suggest that we begin having them?

Janelle: Yeah, I think that, you know, in the toddler stage is a really, really good age to ideally like to start at because kids are curious by nature. And when my daughter was that age, she used to ask me like 12 questions in the span of two seconds. And so, I believe it's easier just because they're younger, they're curious; the questions I are usually like very superficial, so you can give an answer without all that awkwardness. But I think these have to be ongoing conversations that you have to normalize the conversation. And so, you know, we just started by naming the body parts, what they actually are, so she uses the anatomical name. And so, it's not always easy, and I definitely recognize that sometimes I'm like cringing on the inside, like, I'm really talking about this right now. But I think it's important to just have these conversations so it normalizes the conversation, so that she feels comfortable and safe coming to me and we can discuss these things so that she knows about her body and how it works.

Faith: Yeah. Amara who's my two year old, she actually knows her vagina by name. And now I can see that she's becoming a little bit more curious about the differences between like a man or boy and a girl. So, that'll be interesting as time progresses, so I thank you for that. I think that it is very important to begin the conversations early, again, so that we can normalize having those conversations, especially later on.

I want to switch gears just a little bit and I want to begin talking about sexual health. I recently did some research that just blew my mind and I'm like, what is going on? Let me just read a couple of things to you. So I read that syphilis, chlamydia and gonorrhea have surged for the fifth year in a row. And according to newly released statistics on STDs from the CDC for black women, syphilis, our numbers were 4.7% higher, gonorrhea 6.9% in chlamydia, 5% higher than our white women counterparts.

Talk to me, Janelle, what's going on, girl?

Janelle: Yeah, there's a multitude of reason why I believe why this is happening. And so, one is I would contribute to not knowing your STI status. And so sometimes with certain STI like chlamydia, you may not know - like you may not... it may be asymptomatic, so you're not experiencing any discomfort so you may not know that you're having it. And then you're having sex with multiple partners and spreading it that way. The second thing is having multiple partners like we're living in an age where having multiple partners is kind of the thing for young adults. And there are older women who have divorced and now back into the dating world, so that's something to look at - condom negotiation and maybe not using protection. So, not using condoms as frequently or not using them at all, not coming in for STI testing. So having a fear of healthcare and being judged, or just being afraid of being judged for getting STI testing, so there's that factor as well. There's also a smaller pool. Like, we only make up 13 percent, and if you live in a small community, like you may be recycling the same partners, right. And so, that increases your risk for an STI.

Faith: You mentioned condom negotiation, is condom negotiation like how you would haggle someone on, let's say, marketplace on Facebook. Like, what are you doing? What does it mean to like condom negotiation? No, I'm serious because I think that it's important because it sounds like it's something that we should be doing more of. So, what is it and how can we do more of it?

Janelle: So condom negotiation, so first being empowered enough to have your own condoms, whether it be like the internal condom or the male condom and being empowered enough to ask your partner to wear one. So like if you're in a non-monogamous relationship or an open relationship and you are having sex with multiple people or your partners, whatever the case may be, you know, having that conversation with that partner saying, "Hey, this is what we're doing. We're seeing a whole bunch of people, let's use these condoms; for you and I, we're using these condoms." So, being empowered enough to have the conversation and have that partner use the condoms.

Faith: So what if a woman gets a guy and he's like, "Oh, I can't cum using a condom." I've heard it many a times. So, what happens? What do you do in that situation?

Janelle: You might need to table the activities for the evening, make a trip to CVS and walk down the aisles and pick one that's more to his liking. There are enough brands and versions of condoms to still be able to do what you need to do to get the deed done while protecting your health.

Faith: So along the lines of protecting your health is having a conversation prior to sex about your STI or STD status. So, I know that for... I can only imagine that for a lot of women, it is kind of hard of a conversation to have. Are there any ways or suggestions or tips that you would for women who are like, you know, what I really need to impart this practice in my life; how do you begin to even have that conversation?

Janelle: Yeah, it's a very difficult conversation. It's not always easy. So I think you, ideally, if you're having sex with this person, you've been with them long enough to kind of feel the out, see like, okay, how do they respond to stuff and just be open and honest about it. Which is the approach that I would use. I recognize it may not work for everyone. You can write him a letter, send him a text if you're not a good oral communicator just to have the conversation. I think it's important to, first of all, know your status and then your partners should know their status because at the end of the day, it's your health, right? And you want to treat it right and not do anything to hurt your health. So, although they may be uncomfortable, you may be uncomfortable; I think you got to take a minute, sit down and talk about kind of like, this is my STI status, make a date of it. Like, "You know what we're going to do tonight? We're not going to Netflix and chill. We're going to head on over to such and such clinic. We're both going to get tested. We'll just make a day of it."

Faith: Speaking of going to get tested, where can you go get tested? And is it free or is it something that you generally have to pay for, particularly if you don't have healthcare insurance?

Janelle: It really depends. There are a lot of in like major cities, there are a lot of STI clinics that will either do it free or low cost. They have a sliding fee scale. There's family planning centers, they do a lot of STI testing. Your local health department may do STI testing. There's a lot of non-profit CDOs that also provide STI testing. So they're out there. CDC has a really... there's something on their website where you can put in your zip code. I think it's something with STIs and then you can find the ones in your area.

Faith: Oh, that's really good to know. Okay, so I actually am really curious around the importance of STI or STD screening. Well, before we actually about the importance of it, when did STDs transition STIs? I'm like, wait a minute, where did STIs come from? What's the difference? And why did they make the shift?

Janelle: Yeah, so STI - Sexually Transmitted Infections, as they are in fact infections, sexually transmitted disease, they're not really diseases they're infections. So somebody smarter than me who had more time than me decided, Hey, let's call them STIs. Let's call them what they are; they're infections, not disease.

Faith: Got it. Okay, so STI screening, what is the importance of it? Even if you might not be exhibiting symptoms, how often should you be going to get screened as well?

Janelle: Yeah, so the guidelines, you know, broadly speaking for individuals ages 13 to 64, once in a lifetime, you should get screened for HIV. Sexually active women under the age of 25; should be screened for chlamydia and gonorrhea at least once a year. And then women age 25 and older who are at higher risk, like higher risk behaviors, sex worker, multiple partners, things of that nature, should be tested for STIs yearly as well. And so, those are like the general guidelines. I think it's important if you are getting into any new relationships, multiple partners that you go into the relationship, knowing your STI status and your partner should know their STI status as well.

Faith: And so, do you suggest, so say for example, if someone is like, "Oh yeah, I got tested." Do you ask to see the results? Is it something that is kind of like easily shareable? Like, what does this process look? I think I've been out of the game for so long, so I'm really just curious what it might look like.

Janelle: You and me both. However, I would ask for the results and I have in the past. There's also - they have like STI testing, they have home kits now, so where you can like get it online and do it at home. So, you should be able to get the results one way or another. If you're doing it at a reputable place, or even if you're doing it, the ones that you're doing at home, they provide you with the results. So you should be able to get the results, that person should be able to provide you with the results so that you can see. I'm nosy, so I do. I would be that person like, "Well, let me see the results. When was your last STI screen? You say you were screened, is that like within the past three months or we're talking in the past three years?" So, definitely something that you want to talk about, I think it's important. So, getting those results, sharing those results with your partner, and if you both haven't been tested, just go do it together.

Faith: How often should we be having like a pelvic exam or a pap smear? And I actually I'm really curious to know what is the difference between a pelvic exam and a pap smear too.

Janelle: So, a pelvic exam is where your healthcare provider is looking at your reproductive system. So they may look on the outside, looking to make sure, you know, everything looks good. Taking the speculum, looking on the inside, looking at your cervix, looking at the walls of your vagina, you know, looking at what the discharge looks like. And those could be done pretty often. When I went to the teen clinic, we used to do them on individuals who would come in and present with issues. So your provider may, if you present somewhere and say I'm having issues with discharge or pain, something - they will do a pelvic exam. And a pap smear though is a specific test for cervical cancer. So, your provider is going to collect cells from your cervix and looking for abnormalities. And that usually begin at the age 21.

So the guideline for that, generally speaking, a pap smear, if you've had normal results in the past and you're between the ages of 21 to 29, you would get a pap smear every three years. Women who are between the ages of 30 to 65, it gets a little bit more convoluted. You too, if you've had normal results, you can get a pap smear every three years, or there's something else called co-testing where you would get a pap smear along with HPV testing. They do it kind of together, and that's done every five years. Or you can do HPV testing alone where that's done every five years.

Faith: I know that for the pelvic exam, you need to be like at least 18 years old. What I find to be interesting about that is the fact that the HPV vaccine, I know that that's something that is very, very - like, I know that at least it's a lot of marketing around it, because I see it on the TV, and I go into the doctor, I see it. And so, I'm really curious to know why isn't it until the age of the 18 that they have a pelvic exam, but yet the HPV vaccine is accessible for anyone, I think what is it, 12 years old and older. So, why is that?

Janelle: Yeah. So pelvic, generally speaking, pelvic exam start at 18. You can have them younger. We've had patients there we've done pelvic exams younger just because they were presenting with issues. So with the HPV vaccine, depending on when you get it, it's either a two or three dose series. It works best if it is given before initiating sex. So you get the highest level of protection if the vaccines are given before you start sex, so that's why they start give it at age 11, 12, or maybe even younger, depending on where you get your care from. So they want to give it to your child before they initiate sex, give you the highest level of protection against HPV.

Faith: And so, since it's now a vaccine status, I would imagine that means that HPV is very prevalent.

Janelle: Oh my goodness. Yes, extremely. It's everywhere. And so, it is not uncommon. If you've had sex, you've probably had HPV at some point in your life. The thing about it is most individuals; their system is healthy enough to clear the HPV virus so that you never have symptoms. What happens is, if your body isn't able to clear the virus is that's when you discover the symptoms of HPV.

Faith: And so what are the implications of having untreated HPV or if the cells from HPV kind of mature?

Janelle: Generally, HPV is like the biggest risk factor for women for cervical cancer, so that's why they kind of push the vaccine as the first line. They push for pap smears to catch the cells early enough to treat things of that nature. So I think with medicine, the best line of defense of course is prevention, so we want to prevent it by giving that vaccine to individuals young enough, we're the highest chance of protection.

Faith: So for the parents who are, I'm really on the fence about whether or not I should allow my daughter to get the HPV vaccine, what would you say to them?

Janelle: I would say it's the best defense against cervical cancer, and we did have patients, or parents come in and their concern was like giving the HPV vaccine gives them a license to have sex, and that's not the case. It's just like any other vaccine. We say, you want to give your child the best protection against this issue, which is cervical cancer, and getting the HPV is just one way of doing that.

Faith: That's good. I'm glad that you made mention of that. So, I really want to make sure that women are able to advocate for themselves particularly around our reproductive and sexual health. And I know that when you typically go in for an STI screening, they test for chlamydia and gonorrhea. But I remember back in the good day, I think I may have been in college or it may have been after college actually. But I had gone to the doctor and I asked, you know, what are you going to test for? And she said, "You know, gonorrhea and chlamydia." And I was like, "Oh no, I need to be tested for HIV. I need to be tested for syphilis, like all of the things." I've done a lot of research in the HIV and Aids space, particularly earlier on in my career. And I think that that was kind of like my scared straight, if you will, space. So, I really wanted to make sure that I knew. And so, how do you go or how do you work with your healthcare provider to make sure that you get the testing that would allow you to feel most confident about your status and just your sexual health overall?

Janelle: So I think it's important, like you said, to know what they're testing for. So when you go in and you're asking for STI screening, they may just screen for gonorrhea and chlamydia because they're looking for risk factors, so ask. You ask, "Okay, what are you actually testing me for today?" And so, advocate for yourself. And I'm really a big... like, I always tell my patients, ask for exactly what you want. So if you want syphilis screening, if you want to be tested for trick, if you want that HIV test, simply tell them like, "This is what I'm requesting today. I would like to go ahead. I know that you said I'm lower risk," but generally most times physicians or providers will go along with what you're asking for. And of course, if it's going to make the patient feel more comfortable, that's exactly what they're going to do. When I worked in the clinic, just off the top, we were screening for gonorrhea, chlamydia trick. We are going to do the HIV test in the clinic and we would do syphilis, but not every provider does that, so just go in knowing what you want and ask for that.

Faith: So you talked about risk factors and based on the risk factors is kind of what they then test you for, so what are they typically looking for?

Janelle: They're looking for how many partners have you had recently, are you using protection some of the time, all the time? Are you selling your body for sex? Are you injected drug user? Things like that.

Faith: Okay. Got it. Talk to me a little bit about like a pre and a post sex regimen. You know, we want to make sure that we've got that hygiene top notch. So, is there anything that you would suggest before sex that we do and then as well as like what afterwards should we be doing as well?

Janelle: Again, keep your regimen very simple before sex, make sure it's ideal if you're in the mood for sex, because then it makes it a little bit easier just because you get lubricated quicker and it's just more enjoyable that way. If you're using sex toys, make sure they're clean, if you're going to share, make sure you have a layer of protection for the sex toy and for yourself. Like if you're in a non-monogamist relationship, make sure that you're using condoms, dental dams, internal condoms, things of that nature. Post sex, I think it's important to pee after sex; that reduces the risk for UTIs. If you're going to wash up, you don't need to do it right away, but you definitely will get up and wash the outside of your vagina in the vulva area with a mild soap and open water. I think it's important to hydrate. Drinking lots of water helps to also make you want to pee, which helps to flush out bacteria that may have been introduced. Cleaning sex toys as recommended by the manufacturer as well.

Faith: You talked about a dental dam. Literally, I don't think that I've heard, heard about a dental dam since I watched Booty Call back in the day. You remember that movie, what do you call... that was a classic film right there with Jamie Fox and I forget the other folks. Anyways, so she was talking about the use of the dental dam. Do people use those and like where do you even get that?

Janelle: People do use them use?

Faith: That sounds like it had a question mark at the end of it.

Janelle: You're right, like they're not easy to come by. Like you would probably find them in sex shop, in a like sexual health clinics, a family planning clinic, your doctor's office may have them. I'm sure you can probably buy them online. They're not easy to come by like in a regular pharmacy, but they can be found if you want to find them.

Faith: Is there anything else that will protect you from STIs if someone is giving you or you're giving oral sex?

Janelle: They say, so you can cut a condom open and use that as a barrier. You can do a cling wrap, the cling wrap, you got to make sure the holes and stuff are really small. So there's a lot of stuff with that, but you can also use that as well.

Faith: Oh, okay. Yeah, you know, I think that a lot of times, and maybe I'm incorrect, but I think that a lot of times people may not be as aware or even as adamant about protection as it relates to oral sex.

Janelle: Absolutely right.

Faith: Yeah. And so, I think that one of the tips that I would just kind of throw out there would just be like, look at what you are putting your mouth on or what is putting their mouth on you prior to. But I think that that just reinstates the fact that it's so important to do that STD screening prior to having sex, particularly with a new partner. So, I actually am really curious about one thing in particular and that is, what are some of the implications of an untreated STI?

Janelle: Yeah. So when that happens for women, it usually leads to something called pelvic inflammatory disease. So it's a really painful infection in the pelvic area, requires a lot of antibiotic treatment, sometimes it requires for hospitalization. Long term untreated or just having multiple STIs can lead to fertility issues, problems getting pregnant, atopic pregnancies, so there's a multitude of things that happen when we have untreated or even just repeat multiple STIs.

Faith: Wow. That's actually pretty scary now that I think about it. So this is so random, but Janelle, bear with me. I literally was listening - there's a station on YouTube music that I was listening to and it was like 2000s hip-hop, and that Petey Pablo song, "how do you like it daddy?" You know which one I'm talking about back in the day. And so it was like, do you want it in the kitchen? Do you want it on the floor? Do you want your head? And all these like, you know, do you want it to hurt? And I'm like hurt? Like, should sex hurt? And if it does hurt, what might that be indicative of?

Janelle: Yeah, it shouldn't be painful. Like, if you're experiencing pain, like ouch just hurts, there's a problem with that. So, there's a multitude of reasons that could happen. It could be you're just not aroused enough so there's not enough lubrication down there - so friction. And that could be because of medication, you haven't done foreplay long enough, it could be you're having stress or issues around body confidence. So, that's a big one. It could be things like structurally, so fibroids, endometriosis, spasms, involuntary spasms of the vagina cervix that can make sex painful - infections. We just talked about a whole bunch of infections, so like having STI, yeast infection can make sex also painful. And then, you could have like a chronic pain it's called vulvodynia that's on the outside. So, where you're ex experiencing chronic pain in your vulva, your clitoris that makes sex just that much more painful. And so for that, I would definitely recommend pelvic floor specialist because there are a lot of people that specialize in how to relax and lose those muscles to make sex more pleasurable.

Faith: Got it. So in the event that you've ruled out an STD, you've ruled out the fact that maybe you're just not as aroused and maybe it might be something like fibroids or endometriosis. But how do you even begin to like discover whether or not you have an issue with either of those things?

Janelle: Well, hopefully, you know, you are going to your provider on an often enough basis where they're doing either you're passing your pelvic exams, where they can look for or feel for these issues. If you have endometriosis, I would think that you would know, unless it's like untreated or just unknown endometriosis because your periods would be painful. And usually if your periods are painful, they'll rule out a couple of things and then give you a diagnosis of something or send you for a internal vaginal exam or ultrasound.

Faith: What's actually interesting about endometriosis is that, I read that the common... I think that the typical amount of time that it takes to get diagnosed with endometriosis is anywhere from seven to 10 years.

Janelle: That is true.

Faith: Because I think that there's a special type of procedure that they have to do to kind of, you know, discover whether or not yeah, to take a look at it. So, that actually might not be as easy to kind of like come by.

Janelle: That is true. But your periods, some pain with your periods is normal. Like if you're having excruciating period pain, vomiting, can't get out of bed, things of that nature; there's something more than that. That's not normal and definitely needs to be checked up on. So, I think it's being persistent, advocating for yourself, having a provider that you trust that will go through a whole bunch of tests to rule out things that it may not be to help you get a diagnosis.

Faith: That provider and having someone that allows you to feel heard, seen and understood is so, so, so important. So important. I think that one of the final questions that I have for you, and you've been dropping some real gems, I've learned some new stuff since I've having this conversation with you, what are some of the resources that you would suggest for women who are wanting to learn more about their reproductive health, their sexual health, you know, periods, all of those things? What would you suggest?

Janelle: One of the books that I love, love, love, love, it's called The Vagina Bible, and I think it's by Dr. Jennifer Gun. That book, she's a GYN and she just breaks it down so that you understand how and what about your vagina in very simple terms. I love that book, that's one of the thing. Social media - I follow The Period Doctor. She treats teens, but the information that she provides about periods is just very generalizable. She's awesome. Dr. Heather Irobunda is another person I follow on Instagram. She's also a GYN. Fabulous! She talks about everything. She's hilarious and the messages are very digestible. She presents it in a way that you can understand, and she just actually started a podcast, it's called Dr. Heather Advisory Cervix, I think, podcast. And it's absolutely wonderful. There's another podcast that I listen to, it's called Sex Ed In Color. And so, these are sexual educators or sex therapists, people that specialize in sex and sexual, specifically targeted for people of color, so I think it's absolutely wonderful. Yeah, that's a very good one as well. And then there's another one called The Women Centered Podcast where they just discuss a lot about women's reproductive and sexual health. So, those are some of the resources that I tend to gravitate to or tell my friends or colleagues about.

Faith: Awesome. Thank you for sharing that. So, I'm going to ask an off the cuff question. I'm really curious to know - you seem very like chills in all of those things. What do you have in your wellness toolkit because I might need a little bit of whatever you got over there?

Janelle: I'm sure my husband would respectfully disagree with that. I just love talking about these topics. I love helping women learn about their bodies and it's a journey and a process for me, so I learn things every day. And I think that the more that we talk about it, the more that we share and make it normal, the more that we know, and we can help the next generation of individuals understand their body and not have so much stigma and shame around these topics.

Faith: Absolutely. Absolutely. So, what's in your toolkit for wellness though?

Janelle: For wellness - so my wellness tool kit looks like having a provider that I absolutely adore and love and that I can send messages to and that'll take my concerns seriously. Sleep is a big one, although it doesn't always work out the way I envision or want. Sleep is a big one. I try to eat healthy. I keep my vagina and vulva routine pretty simple. You know, that's taken a lot of trial and error and I think just continuing to learn and resources in the books, The Vagina Bible, oh, like that is a great book. And even up to now, I'm like, oh, this makes a lot of sense. So, knowing kind of your vulva vagina and how, like, is it sensitive? Is it not? What works best for it? I think that also helps as well. I drink a lot of water and I run on occasions, but I keep my toolbox pretty simple.

Faith: Okay. Okay. Listen, simplicity is good. As long as it works for you, that's what matters most. And as long if there's something that happens, you're like, "Well, let me see what I've got in my tool kit" - you can just pull it out.

Janelle: I will add, and then like have a good network of friends and family that will pull me up when I'm feeling down. Or I can just talk to when I have issues.

Faith: Communication is so important. It is so important. Nevertheless, Janelle, it has been an absolute pleasure chatting with you today. I just want to thank you again for taking out the time to chat with me. And I know that there are going to be folks who are like, "Well, I want to follow Miss Janelle. I need to know what she's doing and how can I follow along with her journey." So with that being said, where can folks find you?

Janelle: Yeah, so first of all, thank you for allowing me to talk about vaginas and periods on your platform. I appreciate that. I'm on all social media at The Nurse Note. And I also have a website, it's thenursenote.com. So, it has a blog where I talk about out different things related to vaginas, periods and sex. I also facilitate in-person trainings. I do written stuff. I do stuff on social media, so I'm kind of everywhere, spreading the word about vaginas, periods and sex.

Faith: Really cool, yes. And you laugh about it, but listen, it is so important because we are not talking about vaginas enough. We're not talking about our sexual health enough, so thank you for having this conversation and helping to normalize having it. So, where are you based out of actually?

Janelle: I am in Atlanta.

Faith: Oh, Atlanta, okay. Yeah, we need some of that in Atlanta too. But thank you again, Janelle. I appreciate it. And I'm sure that there are so many women who will benefit from hearing it.

Janelle: No worries. Thank you so much.