Have you ever had a change in menstruation, an itch or a bump, or pain in your vulva?

All of these could be signs that there is something wrong ‘down there’.

But many of us are unaware of what’s ‘normal’ – and what isn’t.

This means we may be risking our long-term health, by not knowing when to get checked out or how to explain what we’re dealing with.

There is a huge range of ‘normal’ for gynaecological matters that people with vaginas haven’t been taught in school, at home, or otherwise. More often than not, something can happen to our genitals that we’re unsure of or nervous about, but we’re too embarrassed about our lack of knowledge to seek help or discuss it with doctors, close friends, or family.

To get to that point means knowing that something doesn’t look or feel right in the first place. When it comes to pain, for instance, people with vaginas are often dismissed or have internalised feelings that pain during sex or just on a day-to-day basis is to be expected when it could in fact be a sign of something far more severe.

Being aware of what is ‘normal’ for our vaginas, vulvas, cervixes, and uteruses, can help us and doctors to catch serious problems early such as cancer, endometriosis, polycystic ovary syndrome (PCOS), STIs leading to other health complications, and more.

It is for this reason that The Eve Appeal, a gynaecological cancer research charity based in the UK, has partnered with GlaxoSmithKline (GSK) to launch the Be Gynae Aware campaign, empowering those with gynaecological organs to familiarise themselves with those organs and what is healthy and unhealthy.

It is their hope that their campaign will help people to spot when something has changed or doesn’t feel quite right and be more confident when visiting a clinic or your GP to discuss the issue.

We spoke to Dr Anita Mitra, a gynaecologist at University College London Hospital who runs the successful and highly popular Instagram account The Gynae Geek, about why it is important not to ignore your gynaecological health.

‘A lot of the signs and symptoms… in a sort of worst case scenario, could be signs of a gynaecological cancer,’ she explains. ‘In most cases, thankfully, they’re not, but a lot of them are.’

‘It’s worth making sure that you do speak to a doctor and have any relevant investigations that they think are required because gynaecological cancers are often diagnosed late, and it’s so important that we educate people about the symptoms.’

But, even if the signs and symptoms are not due to cancer, it could still have an impact on our day-to-day life.

Dr Mitra continues: ‘These symptoms can have a significant impact on their quality of life, and it’s important for us to diagnose and offer treatments so people can continue to do all the things that they wan to do.

‘People with chronic physical health problems – it’s not just their physical health that is impacted, but also their mental health, and we don’t talk enough about the psychological impact of having a physical condition.’

Sadly, due to a lack of education and misunderstandings about gynaecological health from a young age, we are in a poor position to being able to notice if something’s wrong.

Dr Mitra advocates for teaching all genders about gynaecological health, even if it personally doesn’t affect them, as you may have friends, family members, or partners who are experiencing a gynaecological health problem.

‘I think a lack of formal education is definitely an issue,’ she notes. ‘But, there’s also the taboo around talking about it.

‘If it’s not something you feel comfortable talking about, it’s really difficult.

‘We need to talk about it from a young age to just make it normal, because there’s nothing wrong or dirty or shameful about talking about gynaecological health.’

People with vaginas are not supposed to talk about pain, even though almost everyone menstruates and at least one in ten British women experience pain during sex, according to a study publishing in the BJOG: An International Journal in Obstetrics and Gynaecology.

As Rachel Thompson writes in her book Rough: How Violence Has Found Its Way Into The Bedroom, ‘pain and sex are inextricably intertwined in many women’s sexual realities.’

Additionally, there is lots of embarrassment and perhaps a feeling of stupidity when it comes to advocating for your own gynaecological health – as we simply don’t know what’s going on.

‘I think it can be really embarrassing to go and explain something to someone who’s an expert something you don’t understand and you don’t know what to call it,’ says Dr Mitra. ‘I always use the analogy of talking to my accountant about taxes – I don’t understand it all, I feel like I’m saying the wrong thing, and she’s probably rolling her eyes.

‘No one wants to feel stupid.’

Dr. Mitra also feels that a lot of people often don’t want to make a fuss or bother doctors for something that can be considered trivial, which Covid-19 has undoubtedly impacted upon further: ‘People feel like they shouldn’t burden the health services or they are worried about getting Covid-19 from going into a clinic. Some people have also found it really hard to get appointments, but GPs have been working really hard, so that’s a whole other story.’

For trans and non-binary people, as well as other members of the LGBTQ+ community and marginalised communities, there is also the added fear of facing discrimination, medical racism, homophobia, and transphobia.

Trans people have often found that doctors and people are increasingly focused on their genitals anyway, so advocating for something being wrong with their gynaecological health can be extremely difficult.

There have also been cases of feeling dismissed by a doctor when explaining their gynaecological problems, particularly involving pain. To this, Dr. Mitra says: ‘I think this is a really tricky one. A lot of it is due to communication.’

‘As a doctor, what I want to know is exactly what symptoms somebody is having, how long they’ve been having them for, and how it’s affecting their life, because that really gives me an idea of the magnitude of what’s happening.

‘The other thing is to be persistent, because if you know that something is not right, then you need an explanation.’

Plus, if you’re feeling regularly dismissed, there is cause for going to another doctor who might better suit your needs and will listen to your concerns.

Dr Mitra has also been working with GSK and The Eve Appeal on their campaign, creating the Be Gynae Aware checklist, which lists a number of things to look out for.

It includes things such as abnormal bleeding, an itch or lump on the vagina, a change in discharge, skin changes and lumps on your vulva, pain during sex, or itching and pain.

The ‘Be Gynae Aware’ checklist

Keep track of these symptoms:

• Abnormal bleeding in between your regular periods, after sex, and after the menopause
• Pelvic/abdominal pain differing from your usual menstrual cramps
• Menstrual cycle changes (eg duration, amount of blood, cramps)
• An itch/lump on the vagina
• Change in discharge (eg volume, colour, smell)
• Skin changes/lumps on vulva
• Persistent bloating
• Change in bowel or urine habits
• Pain during sex
• Itching, pain, swelling or soreness of the vulva

Dr Mitra says of the checklist: ‘A lot of the symptoms on there are things that people probably would already be aware of, but there are things that people wouldn’t necessarily think are related to their gynaecological health, such as abnormal bladder or bowel habits, and bloating, which people often think are to do with the bowel instead.’

Dr Mitra’s final piece of advice regarding gynaecological health is this: ‘You don’t have to know in your head what the diagnosis is before you go to the doctor, because it’s no the patient’s job to work out what it is and I don’t want that to be a reasons why people are hesitating.

‘But, having some awareness of what could be wrong or what symptoms you’re exhibiting that doesn’t feel right is definitely a good thing.

‘If we can all learn what’s normal for us, then we’ll be much better at picking up what’s abnormal and we can end up with better health outcomes for everyone,’

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