What Every Woman Should Know About Vaginal Health, Hormones, and Painful Sex
Most women learn more about their vaginas from shame than from science.
We pick up bits and pieces from whispered conversations, rushed doctor's appointments, and a culture that treats reproductive health as either too clinical or too taboo to discuss out loud. The result is that a lot of women are walking around confused, uncomfortable, or quietly suffering, and they do not have to be.
On a recent episode of Sex Ritual Radio on KXFM, I sat down with Dr. Theresa Walsh and Dr. Diana Kumar, two OB-GYNs who co-founded Gliss Wellness, a national online telehealth platform dedicated to sexual and reproductive health. I met them at the Adult Video News Awards in Las Vegas, where they stood out immediately as two women who were doing something genuinely important. We talked for a long time, and I want to share what I learned.
BV and Yeast Infections: What Is Actually Happening
Bacterial vaginosis and yeast infections are two of the most common reasons women come to Dr. Walsh and Dr. Kumar, and also two of the most under-discussed.
BV typically presents as fishy odor and abnormal discharge. The standard treatment is metronidazole, either as a gel or an oral antibiotic. But here is something that only became scientifically confirmed in the last two or three years, though gynecologists had long suspected it: BV is often partner-dependent. If you have never had BV with any previous partner but keep getting it with your current one, he may be a carrier of the bacteria gardnerella. Treating him alongside you significantly reduces recurrence. If you have been treating yourself repeatedly without improvement, this conversation with your doctor is worth having.
Yeast infections involve itching and are treated with antifungals, either over the counter or oral prescription. Dr. Walsh is a strong advocate for the five-day Monistat rather than the one-day formula, which she finds too harsh and associated with higher rates of recurrence.
For women who deal with chronic recurrence of either condition, boric acid suppositories can help rebalance vaginal pH between infections. Vaginal estrogen, which we will get to shortly, becomes increasingly important as women age and estrogen levels decline.
Prevention basics worth knowing:
Change out of wet or sweaty clothing as quickly as possible. Tight synthetic fabrics create exactly the warm, moist environment that bacteria and yeast love. Cotton underwear allows the area to breathe. Sleeping without underwear, or at minimum without tight bottoms, gives everything a chance to air out overnight. And if you have been using tampons and noticing a correlation with recurring infections, switching to period underwear or a menstrual cup may be worth trying.
Painful Sex: Why It Happens and What to Do
Painful sex affects women of all ages, and the causes are wide-ranging. Before anything else, a good provider will rule out the serious stuff: STIs and, rarely, vulvar cancers or other conditions that require specific treatment.
After that, the most common culprits include endometriosis, structural changes from hormonal shifts, skin conditions like eczema of the vulva (which is more common than most people realize, particularly in women who have eczema elsewhere), and pelvic floor dysfunction, especially following childbirth.
Sexual trauma also plays a significant role, and this is where I work alongside medical providers. Trauma is stored in the body. The vagina can hold tension the same way any other muscle does, and breathwork and somatic therapy can create real physical release. I have worked with clients who have tried everything medically and still have pain, and when we work with the emotional layer together, the body begins to respond differently.
When something is tight or painful internally, the instinct is often to push through or stop entirely. Neither tends to help. What does help is slowing down completely, letting the sensations be present without forcing anything, and breathing specifically and intentionally into the area. Physiologically, the pelvic floor muscles respond to breath the same way any other muscle does. The exhale releases tension. With patience and practice, the vagina can soften and open in ways that feel impossible when the nervous system is braced.
If you have pain with sex, please do not keep quietly tolerating it. See a provider. Ask about pelvic floor physical therapy. And know that a sex coach and a medical doctor are not in competition with each other, they are addressing different layers of the same experience.
Understanding Your Hormonal Cycle
Here is a simple walkthrough of what is actually happening in your body each month.
During the first half of your cycle, your ovary prepares to release an egg. As the follicle grows and matures, it produces estrogen, which rises steadily. At peak estrogen, a surge of LH (luteinizing hormone) triggers ovulation. Once the egg releases, the follicle that housed it dissolves, and estrogen drops.
Progesterone then rises. Its entire job is to prepare the body for pregnancy, which is why you suddenly want to eat everything in sight during the two weeks after ovulation. Your body is fueling up in case conception occurred. If pregnancy does not happen, progesterone drops and your period begins.
PMS involves the hormonal fluctuation of this cycle and often reflects sensitivity to those shifts. Vitex (also known as chasteberry) has been helpful for me personally in regulating cycle length and reducing the more intense premenstrual symptoms. As always, talk to your doctor before starting anything new.
What Perimenopause Actually Feels Like (And What to Do)
Perimenopause is the transition before menopause, and unlike menopause itself (which has a clear definition: twelve consecutive months without a period), perimenopause is slippery. Most women do not realize they are in it until they are well past the beginning of it. It can start in the late thirties or early forties and last for years.
What changes: estrogen production becomes irregular and gradually declines. Cycles become unpredictable. Sleep is often the first casualty, specifically waking at 3 or 4 AM and being unable to fall back asleep. Mood becomes more volatile. The skin of the vaginal walls begins to thin, which can cause dryness, reduced sensation, and pain with sex. Libido often decreases, and when it does, it compounds everything else because desire is connected to so many other factors: sleep, stress, relationship satisfaction, hormone levels, and the medications being used to treat the anxiety and depression that sometimes accompany this phase.
None of this is inevitable, and none of it has to be permanent.
What helps:
Vaginal estrogen is one of the most low-intervention, high-reward options available. It is a cream applied directly to the vulva and just inside the vaginal opening, a few times per week, and it keeps the tissue supple, well-supplied with blood flow, and responsive to sensation. Dr. Walsh uses it herself and describes it as maintenance, the same way sunscreen and night cream maintain the skin on your face. It does not significantly affect systemic estrogen levels. It primarily keeps the local tissue healthy.
Hormone replacement therapy more broadly can address systemic symptoms like sleep disruption, hot flashes, and mood changes. This is worth discussing with a provider who specializes in perimenopause and menopause.
Lubrication belongs in every sexual encounter regardless of age. Both doctors were emphatic about this. Uberlube was mentioned as a current favorite.
And from my side: self-knowledge. One of the most common things I hear from perimenopausal clients is that they are frustrated with their partners for not touching them the way they want to be touched. But when I ask them what they want, they often cannot tell me. Before you can ask for what you need, you have to know what that is. Getting curious with self-touch and self-pleasure is not indulgent. It is foundational.
The Difference Between Endometriosis and PCOS
These two conditions are frequently grouped together on social media as though they are the same thing. They are not.
Endometriosis is when tissue similar to the uterine lining grows outside the uterus, on the ovaries, fallopian tubes, and sometimes on other organs. Every time you have a period, these out-of-place tissues bleed too, which causes inflammation, pain, and over time, scarring. It is significantly underdiagnosed. If you have been told that painful periods are just normal, please see a specialist. Endometriosis specialists can help preserve fertility and significantly reduce symptoms.
PCOS (polycystic ovary syndrome) is an endocrine condition involving irregular ovulation. It often comes with elevated testosterone, which can cause acne, facial hair, and hair thinning at the temples. Cycles can be very long or absent, and when a period does arrive, it can be extremely heavy. Treatment varies by symptom and individual, and the approach should always be tailored rather than one-size-fits-all.
How to Get Help
Gliss Wellness operates in every state and offers telehealth appointments, urgent care options, and the ability to submit a form and receive treatment without ever going on video, for those who are not yet ready for that. You can reach them at findgliss.com.
If you are dealing with the emotional or relational side of any of these challenges, that is where I come in. Helping women understand their bodies, communicate their needs, and reclaim their sexual aliveness is exactly the work I do in private coaching. Applications are open at roseheartsong.com.
The full conversation with Dr. Walsh and Dr. Kumar, including a deeper discussion of PCOS treatment nuances, hormone replacement options, and the research on partner-transmitted BV, is available on Sex Ritual Radio on KXFM and wherever you listen to podcasts.
Rose Heartsong is a certified intimacy coach and the host of Sex Ritual Radio. She works with women who are ready to understand their bodies, communicate their desires, and experience the kind of intimacy they have always wanted. Your heartsong is waiting.
