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Dr. Andrew Ditchik, 43



I'm nervous about going to my male OB-GYN. Will he get turned on giving my exam?
This is something that hasn't occurred for me, because it's such a clinical setting. You really move into professional mode. You're there as a provider of health care. You're there as a guide. You're there in some ways as a teacher, and it's important to maintain that distinction.

Sometimes I feel unfresh down there. Douching, sprays and powders are supposed to be unhealthy, right? What can I do?
In the absence of infection, normal vaginal lubrication keeps the vagina clean. When you bathe, you're not really cleaning out the vagina but the areas around it. Use some type of mild soap, Ivory or Dove. A lot of women end up with what they think are vaginal or vulvar infections, and it turns out they're using either an antibacterial soap, or soap with some other type of perfume or additive.

Will my OB-GYN freak out about my genital piercings?
If the piercing is between the labia, then obviously it's not a good idea to keep it in place if you're going to have a pelvic exam — or have sex, for that matter. But the majority of times, it might be something that you want to mention to the physician ahead of time just so that you can bring the subject up and control the conversation. We're professionals, we don't make judgments.  


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 I'd like my girlfriend to start doing kegels to strengthen her vaginal muscles. How do I tell her without sounding like an asshole?
You could bring it up while you're having sex. Say, "Honey, why don't you tighten your muscles around me? I want to see what it feels like." And, then if you say: "
That feels great. Can you do that next time?" If you integrate it into the play, it might be more acceptable that way.

Any tips on convincing your partner to have sex with you during your period?
Sometimes it's a little bit more uncomfortable for the woman because blood can be irrititaive. It's a lubricant, but it's sort of an irritating lubricant. But you could say: "It could be messy, but it could be fun, so let's not use the white sheets."

What is the strangest question a patient has ever asked you?

"Is it normal that every time I take a shower, my palms bleed?"

Does looking at vaginas all day affect your sex life?
Issues have come up with my own relationships, with my girlfriend or with my ex-wife. They wonder, "Don't you get aroused by the women? Could you still be interested in me?" Yes, I'm still interested in you. You're not on the table. You're not a patient. It's a completely different involvement.


Dr. Vanessa Cullins, 47

Sometimes I feel unfresh down there. Douching, sprays and powders are supposed to be unhealthy, right? What can I do?
Bathe daily, and consider those little Huggies baby wipes. You can carry them in your purse and use them whenever.

I'm not comfortable using my partner's sex toys because I know they've been used with other people. Should I insist on new ones?
My preference would be to get some new sex toys that are just for this particular union. Especially the penetrative sex toys. Bacteria and viruses don't live that long on inanimate surfaces, so technically soap and alcohol and water are okay. But if someone says "I'm not comfortable," she definitely needs to have new sex toys. She's never going to enjoy the sexual experience if she has it in the back of her mind that they're unclean.

Any tips for pre-anal-sex hygiene? Do I really need to have an enema?
Most people who have anal intercourse don't encounter a load of feces unless the person is sick or incontinent. The most important thing is never to go from anus to vagina — or from anus to mouth. Don't be moving that bacteria around.

Many women I know can't seem to have an orgasm during vaginal sex unless a finger is employed. Is there anything they can do to change that?
The woman-on-top position may allow the shaft of his penis more contact with her clitoris. Or he could figure out a way to stimulate her using another part of the body. Potentially, even clothing can result in direct stimulation of her clitoris. If she has a thong on, she could place the side of the thong up against her clitoris, then the motion of penetration may result in some direct stimulation. It takes experimentation, but that is what recreational sex should be about — finding what works best for you and him.

I'm worried that I will get turned on during my pelvic exam. What can I do to deal with the situation if it occurs?
Most women are not going to become aroused because of how clinical that exam is. It is not, however, impossible. If a woman becomes aroused during her pelvic exam or breast exam, she shouldn't feel embarrassed. In my opinion, it only needs to be addressed if she wants to address it. The provider is going to have a tendency to ignore it. However, if she is so aroused that she doesn't want the exam completed, then she should feel confident and assertive enough to say,"I don't want to do this at this point in time."

Dr. Aren Gottlieb, 33

What can I do to prevent catching HPV?
HPV is very common, but to say that someone should not to go out and have sex is unrealistic. Practice safe sex, and in the long run, limit the number of partners that you have.

What is the best way to tell a prospective partner I carry the herpes virus (but am currently outbreak-free with medication)?

There is no "best" way to tell someone, but you have to be honest. If you have an open relationship to begin with, then it really shouldn't be an awful thing to discuss. I think we really have to be able to talk about our sexuality and our past experiences because they will impact you in the future. And of course, you always have to practice safe sex.

I'm nervous about going to my male OB-GYN. Will he get turned on giving my exam?
If a patient feels at all uncomfortable then she's in the wrong environment and maybe should be concerned about it. All I do all day is look at vaginas. I can't imagine a man getting aroused after doing the same. It's just a job. We like what we do, but it's not that we're in love with the vagina.

I'd like my girlfriend to start doing kegels to strengthen her vaginal muscles. How do I tell her without sounding like an offensive boor?
Is there a good way? No. But it is something you could bring up in other ways. You might want to say, "Well I was sitting in the doctor's office waiting and I was reading in Glamour that doing kegel exercises can help you tighten your perineum and it can prevent you from having incontinence in the future." Something along those lines.

What do you think are the best terms to use for the genitals in a health setting and in a romantic setting?
I really hate it when patients come in and don't use proper anatomical language. To use the word "cunt" or "pussy," it's not appropriate. I feel like it is our job to educate the patients and the children that they bring, so I frequently use the appropriate word and I teach them that they have multiples holes. A lot of people think that the urethra, where they urinate from, is the same as the vagina, and it's not.

Dr. Sabria Ishoof, 31

What can I do to prevent catching HPV?
You can't. Any woman that is sexually active is going to have HPV exposure. Remember it's from genital contact. It's not just intercourse. It can live on your skin. It can live on the outer part of your vagina. Your labia. On the penis. But even no sexual contact can pass the virus.

I'm a guy whose penis is too big for several women I've been with. What can I do?
Try different positions. The more control she has over her vaginal muscles, the more control you can have over penetration. Put pillows under her bottom, which can tilt the pelvis up a little bit and allow a little bit more control. This is also good because you're not necessarily flat in an uncomfortable position where you can't control the extent to which penetration occurs. The other thing is lubrication. Make sure that if there's not enough natural lubricant that you use an artificial lube. I usually recommend Astroglide. It's not as drying as K-Y. But I wouldn't use baby oil, things like that.

Can those products give you an infection?
Well, you're dealing with very sensitive tissue. I've had patients come back with little funky infections like bacterial vaginosis, and I say, What have you been doing?, and it turns out they're using Crisco.

Will my OB-GYN freak out about my genital piercings?
I don't think genital piercings are healthy at all. You can cause a spreading infection, because it can spread to the abdomen from the top of the vagina. Genital piercings are raw. Anything that can live in the soil can live in the vagina. And believe it or not, there's some of the same species in both. So when you leave a piercing in, you leave a wick for infection to catch onto, kind of like in the '70s with the Dalkon Shield [IUD], which because a hotbed for bacteria.

Open relationships — good idea or invitation to disaster?
I think it's very dangerous emotionally and physically. Unless you are the one-person-in-forty sociopath, I don't think you can truly turn off your feelings like that. By swinging with these different partners, you might introduce infections, because no condom is going to protect you 100 percent. The people I know who've had those relationships? I've never seen them go more than two or three years.
 


Interviews by Ellen Kate Friedrichs.
Sex Advice From... appears on Thursdays. Have questions for the general public? Send them to .

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Comments ( 9 )

Dr Ishoof - you are the most responsible clinician in the bunch. My congratulations for being on the job even in a fluff interview.

GC commented on Oct 14 05 at 12:46 pm

---o, whipped cream with a cherry works great too. And maybe some honey BBQ dipping sauce and deep-fried blue-cheese sticks. The blue cheese has antibacterial properties of course, that will fix you right up, and give you a pleasant taste as well! (this was sarcasm for you cluless persons out there, although it just might make her taste better...)

commented on Oct 14 05 at 6:07 pm

Dr Ishoof is the reason I never want to go to a female obgyn again. She is judgemental and ill informed. Doctors like her are the reason many women are not as honest with their physicians as they need to be and do not receive the health care they deserve.

AJS commented on Oct 16 05 at 6:25 pm

I've always been on the fence about "Sex Advice From..." but this issue was stellar. People who are actually informed about what they're talking about, as opposed to people just trying to look cool? Fantastic!

EVL commented on Oct 17 05 at 12:15 pm

I totally agree with AJS. Dr Ishoof (?) is scary. I hope I never bump into such a ginecologist! She's one of these people who studied medicine in order to judge people and make them feel like shit. In my story as a patient I've met a couple of those doctors and it sucks.

SU commented on Oct 17 05 at 10:47 pm

Dr Isahoof : being condsending snd preachy to the pubic is not going to educate them.

kb commented on Oct 19 05 at 11:22 pm

Great article!

MM commented on Oct 24 05 at 9:55 pm

My compliments. This is the best Sex Advice column I've ever seen. The responses were great. Ask the same people more questions, and run the column again.

Love, Nathaniel

WNL commented on Oct 24 05 at 11:09 pm

After reading negative criticism of Dr. Ishoof, I want to take up for her a bit. I am a man so I don't know the feeling of going to visit a gynecologist, but I do consider it worth my while to learn how to spell it, if only as a common courtesy. And I say this with the full understanding that our culture has, with internet reliance becoming common place, largely relaxed its degree of fixation on always having exactly "correct" spelling. Still, "gine.." grinds me as a writer. Sorry.

When we ask advice, particularly sex advice, I feel we want an opinion. In this case, we get not only that, but a rather more educated one, and considering the potential value of the doctors' input on reducing infection ... well, I think it more than just a matter of opinion for them to point it out with genital piercing, and the comparison to the soil which Dr. Ishoof pointed out. And I didn't get the feeling that she was being judgmental in the sense that she made a character judgment about the people in question, those who might adopt some degree of piercing.

Her comments on multiple partners could more easily be construed as being somewhat judgmental, or if not that, I can see how a reader may take it that way, reacting strongly against any comments which might cast a negative light on hooking up, as such. Still, I felt like we should give her the benefit of the doubt, in the sense that we want her opinion. After all, that IS what we asked for, didn't we? She says she feels it is emotionally and physically damaging. That's an opinion, one borne out by her experience in exposure to women who have informed her of their multiple partner lifestyles. If we don't want her opinion, we need not have asked. Do we really want to confine contributors to some sexually PC patent responses? I think not. I would rather have it all, the whole gamut of opinions, and thereupon make my own judgments. I feel I am old enough to hear politely phrased, negative judgments, particularly professional ones regarding potential health problems, about sexual activity I am considering doing or already immersed in, and not get all bent out of shape, taking it personally.

I truly believe that if you look at vaginas all day long, that male or female, you will quickly, in a day, get over the initial quibbles and concerns that there may be some sexual feeling from doctor to patient. Furthermore, I feel that professionalism extends to other areas, such as judgments about diseases, and that it would be quite difficult to deviate from the development of this professional attitude, as a doctor is surrounded by the clinical environment, and every patient who comes to him for help is uneasy, a human being before him who depends upon his expertise and aid. He has great psychological incentive to deliver "the goods," which is help delivered with unquestionable ethics, paramount professionalism. Too, anyone who deviated from this wouldn't be in business very long. Consider the readers comments here, those who felt uneasy about some professional encounter and said they would not return to that sort of doctor again. I think the grapevine quickly weeds out those doctors who can't provide a stellar professional atmosphere, particularly in this sort of "touchy" issue.

Good answers Dr. Ishoof. You gave us valuable input to consider, and you did it with sufficient tact, I think, particularly in light of your relatively young age.

Also, thanks to all you doctors for providing us with a photo. That added a lot for me.

Love, Nathaniel

WNL commented on Oct 24 05 at 11:30 pm

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