Worried about what’s normal “down there?”

Women are inundated with ideas about what they should look and feel like in their nether regions. We can help you separate fact from hype.

Ignore marketing and celebrity hype about products and treatments
Debra (Burt) Ames, CNM

Like an ear, a nose or a myriad other body parts, women’s genitalia comes in a variety of shapes and sizes. Unfortunately, due to the proliferation of marketing, celebrity endorsements and societal pressures, it’s become another area of the body for women to feel insecure about.

Like a fingerprint, every woman’s genitalia––including the pubis, labia, clitoris, vulva and vagina––are all different. But more than ever, women are subjected to a wide variety of ideas about what “perfect” looks like, when there’s no such thing. Even many textbooks portray the female genitalia as pink and smooth, with no hair and thin, trim labia; this doesn’t reflect reality.

The result is an increase in the use of unnecessary vaginal products––including douches and cleansers––and unnecessary cosmetic services, like waxing and even surgery. In fact, a recent report by the American Society of Plastic Surgeons showed that labiaplasty (a procedure in which the labia minor is trimmed to tuck up into the labia majora) increased 39 percent from 2015 to 2016.

Here are a few key things to remember:

Size doesn’t matter. There is no standard size and shape of a woman’s external genitalia. Some women have longer or thicker labia, and others are smaller or thinner. Texture can vary tremendously from relatively smooth to very wrinkled or bumpy, with lots of folds. Some women have a more prominent clitoris, and others are more hidden. It’s all fine.

Hair is normal. Currently, our culture seems to encourage women to remove all or most of their pubic hair. It’s fine if that’s what you prefer, but there is no medical reason to do so. Actually, in addition to the time, effort and discomfort involved, hair removal increases the risk of problems like irritation and infection from things like ingrown hairs for nicks from a razor.

Color may vary. The color of genitalia can range from pink to red, brown, or even purplish. Just like skin tone, the color of women’s genitalia varies. It can also change over the course of your lifetime, such as after childbirth.

Vaginas are self-cleaning. There is no need for you to wash the inside of your vagina, or to douche it, steam it, moisturize it or any of many other things we’re currently seeing promoted in the media.

All you really need to do is regularly wash your external genitalia with water, or if preferred, with a very mild soap, and forget the rest. Cleansers can strip the vagina of its healthy flora and increase your risk of yeast and other infections. Fragrances (including scented tampons) can also cause irritation and upset the vagina’s natural pH balance.

The amount of normal vaginal discharge varies from woman to woman, and changes at different points in a woman’s cycle. This is how the vagina cleans itself. The smell and consistency of the discharge will also change throughout your cycle.

When to see a women’s health provider

If you are considering using a new product or treatment for your vaginal area, talk to your women’s health provider first. Tell us your concerns. We will work with you to come up with a solution that won’t do more harm than good.

You should also see your provider if you experience:

  • Pain or discomfort during or after sex or other activities. There are some anatomical issues or conditions that can be corrected if they cause a problem.
  • New lumps or growths. It’s normal to get the occasional pimple or even a bug bite, but if you find a lump or growth, get it checked.
  • Whitish patches or a rash that’s not due to hair removal.
  • Intense itching, burning, or bleeding of the skin.
  • A discharge that is lumpy, gray, yellow or green.
  • Spotting between periods.

There are lots of products and trends out on the market that promise to rejuvenate or enhance women’s genital areas, preying on, or even creating, insecurity and unnecessary worries. However, it’s an area of the body that’s pretty low-maintenance: a daily, gentle, external cleansing with water and regular annual- or semi-annual exams by a women’s health care provider to catch potential problems early.

There is nothing you can ask us that you should be embarrassed about. We pride ourselves on our ability to get to know our patients and address their concerns without judgement so you can feel comfortable talking about anything. A big part of what we do in many cases is to set your mind at ease.

Have questions or concerns? Schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office.

Choosing the birth control method that’s right for you

Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.
Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.

Factors to consider when weighing your options

Anne Vaillant, CNM

A generation ago, birth control options were pretty limited: condoms, the pill, and the rhythm method (abstaining from sex when you are at your most fertile). Today, there are a wide variety of options, but it’s important to find the one that will work the best for you and your lifestyle.

Consider This

Effectiveness: When estimating the effectiveness of the various forms of birth control, it’s important to remember that they are calculated assuming you are using the method as instructed. For the pill, this means you must take it every day at about the same time to maximize its effectiveness. Start skipping days or taking it erratically, and its effectiveness decreases. Other options require diligence once a week or once a month. Some require regular trips to your health care provider. This requires a level of commitment.

On the other hand, options like a condom allow you to only think about birth control when you really need it—right before sex—but because condoms can tear or come off, you may be sacrificing effectiveness for convenience.

Price: Depending on your insurance, some birth control options are more affordable than others. Many options require prescriptions, while some are available over-the-counter.

Convenience: Some methods of birth control, like implants, are effective for up to three years, and even longer with IUDs. Once you have them, you don’t have think about birth control for significant periods of time. However, if you aren’t interested in a long-term option, you may be more willing to put up with the inconvenience of, for example, getting the shot every three months.

“Ick” Factor: Some women are more squeamish than others. If you will feel uncomfortable inserting something far up in your vagina, options like the ring may not be for you. Also, some require the addition of a spermicide before insertion, which some women find messy.

Allergies/Sensitivities: If you have any allergies or sensitivities, it’s important to know what each birth control option contains. Latex allergies may rule out some of the most common type of condoms (they are available in latex-free varieties). Some women have reactions to spermicide; others find the patch gives them a rash. If you are prone to urinary tract infections, the diaphragm may increase your risk for more.

Side Effects: Many forms of birth control (such as the pill, patch and ring) contain hormones—typically estrogen and progestin—that can result in a range of side effects, including some that are short-term and some that aren’t. Some women tolerate progesterone better than estrogen, so an option like the injection, which contains progestin only, may be a better choice.

Side effects aren’t all bad; certain forms of birth control, like the pill, can reduce the frequency, heaviness and cramps of your period.

At A Glance

The chart below provides a brief synopsis of the most common types of birth control, comparing them based on the factors described above.

Method Effectiveness Frequency Prescription Do-It-Yourself Estrogen
IUD/Hormonal 99%+ 5-7 years Yes No Yes
Implant 99%+ Every 3 years Yes No No
Vasectomy 99%+ Once/ permanent Surgery No No
IUD/Copper 99% 10-12 years Yes No No
Shot 94-98% Quarterly Yes No No
Pill 92-99% Daily Yes Yes Yes
Patch 92% Weekly Yes Yes Yes
Ring 92% Monthly Yes Yes Yes
Diaphragm (w/spermicide) 88% Every time you have sex (within 6 hours) Yes Yes No
Male Condom 82% Every time you have sex No Yes No
Cervical Cap (w/spermicide) 80% Every time you have sex (within 48 hours) Yes Yes No
Female Condom 79% Every time you have sex No Yes No
Sponge (w/spermicide) 76-88% Every time you have sex (within 24 hours) No Yes No
Rhythm Method (or withdrawal) 76-78% Every time you have sex No Yes No


Talk to Your Healthcare Provider

Your OB/GYN or certified nurse-midwife can help you choose the birth control method that’s right for you. Let them know what factors are most important to you, and be honest about any concerns you have.

For example, let your provider know if you want long-term or short-term—or even permanent—protection against pregnancy, as some options are easier to reverse than others. If you also want protection from STDs, condoms are the only option that offers this, but they can be used in conjunction with other birth control options to boost their effectiveness for pregnancy prevention.

Often, short-term side effects resolve in a few months, but if you are experiencing side effects that you find intolerable or concerning, talk to your health care provider about what you are experiencing and discuss other options.

If you need guidance about birth control, schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office. We’ll be happy to talk with you about your options and find birth control method that’s best for you.

Period Pain

Don’t assume that nothing can be done
Amy L. Metzger, CNM

Amy L. Metzger, CNM, says help is available for painful periods.
Amy L. Metzger, CNM, says help is available for painful periods.

Most women get a monthly period, but for some, it is a monthly ordeal.

Many of our patients report painful periods. This comes as no surprise; the American College of Obstetricians and Gynecologists (ACOG) says dysmenorrhea (the clinical name for intense menstrual cramps) is the most commonly reported menstrual disorder, with more than half of menstruating women reporting having some pain for one to two days each month.


Dysmenorrhea encompasses more than just painful abdominal cramps. You may also experience:

  • Changes in your bowel movements ranging from constipation to diarrhea
  • Nausea, or even vomiting
  • Pain in your lower back, or radiating down your legs

Try this at home

There are steps you can take to relieve or at least lessen your symptoms. You may need to experiment to find out what works best for you.

  • Over-the-counter pain relievers that reduce inflammation, such as ibuprofen, may help. Take with food to prevent stomach irritation. Start taking the pain reliever as soon as you think your period is about to start.
  • Apply heat to the area that hurts. A hot water bottle or heating pad usually brings some relief.
  • Exercise can help to limit cramps if you do it regularly.
  • Other lifestyle changes may also help. Be sure to get enough sleep and stay well-hydrated. Try reducing your consumption of caffeine and alcohol. If you smoke, quit.
  • Some women find relief in holistic treatments, including acupuncture, massage or herbal supplements. Talk to your provider before starting any supplements to reduce the risk of harmful interactions or side effects.

 When to seek help

If your symptoms are severe enough to impact your daily life – you regularly miss school, work or other activities – we can help.

We will talk with you about your medical history, symptoms and menstrual cycle. We will also do a pelvic exam and possibly an ultrasound to rule out any conditions that may be causing the problem, such as endometriosis or fibroids.

Once we’ve ruled out other conditions, we can work with you to develop a plan to reduce your symptoms. This may include some of the self-care options described above, or prescription medication. A variety of birth control methods can be used to treat dysmenorrhea, including the pill, the patch, the vaginal ring and intrauterine devices (IUDs). We can help you choose the option that works best for you and your lifestyle.

If you suffer from painful periods, schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office.

Fertility Facts & Fiction

Dr. Jacqueline Kates
Dr. Jacqueline Kates

What really helps to boost fertility

Dr. Jacqueline Kates, obstetrician/gynecologist

We’ve all heard some of the many “tricks” to help women get pregnant. But what really works?

Both female and male fertility is affected by a wide range of factors, including medical history, current health, age, family history, medications and environmental factors. Some women become pregnant as soon as they start trying, while others take longer or experience difficulties.

Here are a few things that may help:

  • Check your weight. Being overweight or underweight can affect the fertility of both men and women. Talk to your health care provider about your ideal weight, and steps you can take to try to achieve it.
  • Stop smoking. While everyone knows that smoking – including tobacco and marijuana – during pregnancy may be harmful to both mom and baby, many don’t realize it can also affect fertility in both women and men.
  • Learn more. You and your partner should talk candidly with your health providers about your desire to conceive, and any concerns you have. Be honest about your health and your use of alcohol, tobacco, drugs and any medications that might play a role in your fertility or ability to have a healthy pregnancy. Some medications, vaginal lubricants, or exposure to chemicals can decrease fertility in both women and men.


Before trying to conceive, talk to your health care provider to address any concerns and discuss how to optimize your health.

Our doctors and nurse-midwives are welcoming new patients in our Springfield and Westfield locations. Book online or call us at (413) 562-8306 for our Westfield office, or (413) 736-9978 for Springfield.

April is Sexual Assault Awareness Month

A call for action and awareness
Dr. Lydia Lormand, obstetrician/gynecologist

The statistics are shocking. According to the National Sexual Violence Resource Center (NSVRC), one in five women will be raped at some point in their lives. In eight out of 10 cases, the victim knows her assaulter (for college students, it’s nine out of 10). Perhaps this is why rape is the most underreported crime; 63 percent of sexual assaults are not reported to the police.

There may be many reasons why women don’t report being sexually assaulted. They can feel ashamed and embarrassed. They may blame themselves. They may think no one will believe them, especially if their attacker is someone they know.

That’s why at Women’s Health Associates, we believe that developing trusting relationships with our patients is essential – we want our patients to feel comfortable discussing any health-related issues with us, including sexual assault.

Beyond the legal ramifications of sexual assault, there is a tremendous toll taken on a woman’s health, both physically and emotionally. All of our doctors and nurse-midwives are trained to recognize the signs of sexual assault, and to talk sensitively with women about any concerns they have. An open, honest, and trusting relationship with our patients is imperative so that we can provide the best care possible.

In addition to the physical injuries or effects of sexual assault, which may include permanent damage, pregnancy, or sexually transmitted infections, victims of sexual assault are also at higher risk for:

  • Depression and anxiety, and difficulty concentrating
  • Post-Traumatic Stress Disorder (PTSD), including nightmares and flashbacks
  • Eating disorders
  • Substance use/abuse

What you can do

Everyone can play a role in helping to preventing sexual violence. The NSVRC offers these suggestions:

  • Be a role model for respectful relationships
  • Believe survivors and help them find resources
  • Speak up when you hear harmful comments or witness acts of disrespect and violence
  • Create policies at work and school
  • Ask your legislators to support prevention programs

If you are a victim of sexual assault, tell someone so that you can get the help you need. The assault was NOT YOUR FAULT, no matter the circumstances. Each survivor reacts differently, but it is a burden you should not bear alone. Even if it’s been days, months, or even years since the assault, talk to someone you trust, and be sure to let your health care provider know.

If you need a woman’s health care provider, the doctors and nurse-midwives at Women’s Health Associates are welcoming new patients in our Springfield and Westfield locations. Book online or call us at (413) 562-8306 for our Westfield office, or (413) 736-9978 for Springfield.