Ask it Anyway!

Thank you for taking the time to share your experience with us. We’re truly sorry that your HSG was so painful, and we appreciate you trusting us enough to tell us how our article made you feel.

After reading your feedback, we went back and reread the article ourselves. While we did mention that HSGs can be extremely painful—particularly for people with blocked tubes, endometriosis, adenomyosis, scar tissue, or other underlying conditions—we recognize that placing this later in the paragraph may not have adequately acknowledged or validated the experiences of people whose pain was severe.

Because of your feedback, we’ve updated this section to better emphasize that pain during an HSG varies tremendously and may be extreme, severe, or even traumatic for many women. All of these experiences are real, and none of them should be dismissed.

We created Femanual to be a place where women can learn about their bodies without their experiences being minimized or explained away. That means using honest, straightforward language—even when the truth is uncomfortable. It also means listening when our readers tell us we’ve fallen short.

Thank you for helping us make Femanual better. We’ll continue updating our educational content to reflect both the best available medical evidence and the lived experiences of the women who trust us to learn from it.

Thank you for being brave enough to ask this question. We’re so sorry that you’re dealing with both a painful medical condition and the lasting effects of sexual trauma. No one should have to navigate both at the same time.

First, know that you’re not alone, and it’s okay to tell your surgeon if you have a history of sexual trauma. You don’t have to share details if you don’t want to, but letting your surgical team know can help them provide more trauma-informed care.

During endometriosis surgery, vaginal or rectal manipulators are sometimes used to safely move the uterus or bowel and improve visualization. These instruments are typically placed after you’ve been completely anesthetized and removed before you wake up, so you won’t be aware of them during the procedure. While this may seem invasive, or even barbaric, from the outside looking in, it can help to remember that your surgeon is using these instruments not to cause you discomfort, but to perform a safer and more precise operation. They often improve visualization and reduce the risk of surgical complications.

That being said, regardless of the surgeon’s intentions, the thought of having instruments placed in these areas can still trigger a trauma response. Those feelings are completely understandable and deserve to be acknowledged.

If you’re worried about feeling re-traumatized, talk with your surgeon before surgery. Depending on your individual situation, they may be able to:

• Explain exactly what to expect before, during, and after surgery

• Minimize pelvic examinations whenever possible

• Limit the number of people involved in intimate parts of your care

• Avoid unnecessary vaginal or rectal instrumentation when it is safe to do so

• Use a trauma-informed approach throughout your surgical experience

If you’ve previously found certain strategies helpful, be sure to discuss those with your healthcare team. For example, pelvic floor physical therapy, relaxation techniques or stretches you’ve learned in therapy, or a short course of anti-anxiety medication before or immediately after surgery may be appropriate for some patients. In certain situations, you may also wish to discuss whether anesthetic techniques, including ketamine, are appropriate as part of your anesthesia plan. While these approaches aren’t necessary for everyone, they can be helpful for some patients with a history of trauma.

If you have significant anxiety or PTSD related to prior trauma, working with a mental health professional before surgery can also help you develop coping strategies and make the experience feel more manageable.

Bottom line: Your emotional well-being is just as important as your physical health. Letting your healthcare team know about your concerns gives them the opportunity to help make your surgery as safe and comfortable as possible. In general, because you’re completely anesthetized before any vaginal or rectal manipulators are placed and remain asleep until they’re removed, you won’t experience that portion of the procedure.

Douching is the practice of rinsing or washing the inside of the vagina with water or a liquid solution.

Despite what some products claim, douching is not recommended. The vagina naturally cleans itself and contains healthy bacteria that help maintain the right pH and protect against infection.

Regular douching can actually:

• Increase the risk of bacterial vaginosis

• Increase the risk of yeast infections

• Irritate the vaginal lining

• Increase the risk of pelvic inflammatory disease (PID)

The best way to care for your vagina is surprisingly simple: wash only the outside (the vulva) with warm water or a gentle, unscented cleanser if desired, and avoid putting soaps or cleansing products inside the vagina.

If you feel like the inside of your vagina needs to be cleaned because you’re experiencing irritation, abnormal discharge, a strong odor, or other concerning symptoms, it’s important to see a healthcare provider for a proper evaluation. These symptoms are not normal and often point to an underlying condition that requires the right diagnosis and treatment. Douching won’t fix the underlying problem and may actually make it worse or delay getting the care you need.

There are several effective treatments for endometriosis pain, but the right option depends on your symptoms, your goals (such as whether you’re trying to become pregnant), and the severity of your disease.

Treatment options may include:

• NSAIDs (like ibuprofen or naproxen) for pain relief

• Hormonal birth control (pill, patch, ring, or hormonal IUD)

• Progesterone-only medications, hormonal medications without estrogen that are commonly used to treat endometriosis pain

• GnRH agonists or antagonists, medications that temporarily lower estrogen levels to help reduce endometriosis-related pain

• Laparoscopic excision surgery, which removes endometriosis implants and may improve pain and, in some cases, fertility

If your pain is severe, isn’t improving with treatment, or is interfering with your daily life, it’s important to see a gynecologist - ideally someone who specializes in endometriosis. There are effective treatments available, but what works best for you depends on many individual factors. The most important thing is that you don’t go through this journey alone.

For a more in-depth discussion of each treatment option, be sure to read our full linked articles!

First, I’m really sorry you’re even having to ask this.

If this question is coming from a new diagnosis - whether it’s you or someone you love - cancer is overwhelming, and you shouldn’t have to figure it out alone.

Before we get into it: online information (including this!) can help you understand the big picture, but it’s not a substitute for care from a board-certified gynecologic oncologist, who is the right person to guide diagnosis, treatment, and next steps.

Now, let’s break it down.

Endometrial cancer is cancer of the lining of the uterus (the endometrium). It’s actually the most common gynecologic cancer in the US, and in many cases, it’s caught early because it causes abnormal or post-menopausal bleeding.

Cancers are typically described using both grade and stage:

• Grade = how the cancer cells look under the microscope

• Stage = how far the cancer has spread

You can think of grade as a measure of how “organized” or “normal” the cells appear. Lower-grade cancers tend to look more like normal tissue, while higher-grade cancers look more abnormal and tend to behave more aggressively.

Grade 2 falls in the middle - moderately different from normal.

Why does this matter?

The grade helps doctors estimate:

• How the cancer might behave

• The likelihood of spread

• What treatments might be recommended

But - and this is important - grade is only one piece of the puzzle. It always needs to be interpreted in the context of the full clinical picture.

Stage, imaging, surgical findings, and sometimes molecular features all play a role in determining the full picture and next steps.

If this is something you’re navigating, getting established with a gynecologic oncologist is key. They can walk you through what this means for your specific situation and help guide your care.

This is such a common experience, and you’re definitely not alone.

No matter what kind of sex you’re having - whether it’s with a partner of any gender, with toys, or on your own - it shouldn’t be painful. Pain during sex is common, but it’s not normal, and it’s not something you should just have to push through or accept.

There are a lot of different reasons this can happen, and I wish it were always a simple fix - but figuring out the why for you is the most important step toward actually improving it.

Your question actually inspired us to write a full article on this, where we break down the most common causes and what you can do about them.

Read more here: Painful Sex Article

First — I’m really glad you’re thinking ahead.

Endometriosis can affect fertility, but plenty of people with endo still go on to have healthy pregnancies. How much it impacts things depends on how extensive the disease is and whether it’s directly affecting pathways involved in conception, like causing tubal scarring or blockage or interfering with ovulation. And an ovarian cyst doesn’t automatically mean something scary — what matters is what kind of cyst it is.

Your next step is to be seen by an endometriosis specialist. Usually, this is someone who’s completed a fellowship in Minimally Invasive Gynecologic Surgery (MIGS) — though some excellent endo surgeons took different pathways, so fellowship status isn’t the only marker of skill.

How to find one:
- Ask a trusted OB-GYN, friend, or local women’s health community who they’d send their sister to
- Do a thorough Google search for “endometriosis excision surgeon” + your city
- Use reputable patient resources (like Nancy’s Nook) as a starting point — but still vet credentials and experience

At that visit, they’ll typically:
- Review your ultrasound (or repeat imaging if needed)
- Clarify whether your cyst looks like an endometrioma vs a simple/functional cyst
- Talk through how endometriosis could impact fertility in your specific case
- Lay out options based on your timeline (trying now vs planning for later)

If you’re trying now, many people can continue trying at home and only escalate to deeper fertility workup if pregnancy doesn’t happen after a reasonable amount of time (usually 6 months with endometriosis). If you’re planning for the future, ask about what testing can be done ahead of time and what a long-term plan looks like.

You don’t need to panic. You need clarity - and the right specialist can help you get it.

This is such a fair question. PCOS is one of those diagnoses where the internet throws 1,000 supplements at you and promises a “natural cure.”

Here’s the honest answer: PCOS is a broad spectrum, and whether a supplement helps depends on what piece of the puzzle you’re dealing with — insulin resistance, irregular or abnormal bleeding, ovulation issues, vitamin deficiencies, and more. Different supplements target different aspects.

That said, the ones with the strongest evidence (depending on your labs and goals) include:
- Myo-inositol (often paired with D-chiro-inositol) — may improve ovulation and insulin sensitivity in some people
- Vitamin D — if you’re deficient (which is common in PCOS)
- Omega-3s — may support metabolic markers in some individuals
- NAC — sometimes used for insulin sensitivity and ovulation support

But supplements aren’t magic. They work best when layered onto solid foundations: nutrition, movement, sleep, and — when appropriate — prescription medications to help correct metabolic abnormalities or protect the uterine lining if cycles are very irregular.

We absolutely do believe natural supplements can be helpful. The key is choosing ones that are evidence-based, properly dosed, and third-party tested — not just influencer-driven blends with fairy dust amounts of everything.

If you’re considering supplements, ask your clinician for basic labs (A1c, insulin markers if appropriate, lipids, vitamin D) so you’re not guessing. And give anything you try about 8–12 weeks before deciding if it’s helping.

And since you asked — we’re actually working on launching physician-formulated, evidence-based women’s health supplements built around this exact principle: real doses, real data, no gimmicks. If that’s your vibe, subscribe to our newsletter so you’ll know when they drop!

This is one of the most common anxiety questions we get as OB/GYNs.

Pregnancy requires sperm to enter the vagina and travel through the cervix. Grinding with clothes on — even if his underwear were damp — does not create a realistic pregnancy risk. Sperm do not travel effectively through layers of fabric, and a damp spot on underwear is not the same as ejaculation inside the vagina.

You’re not silly for worrying. Anxiety after sexual situations is very real. But in this scenario, pregnancy is essentially not possible.

If it would calm your mind, you can take a test in 2–3 weeks - not because I expect it to be positive, but because peace of mind matters.

You’re definitely not alone in feeling this — in fact, it’s one of the most common emotions people report after sex (especially women and AFAB folks). And the guilt can creep in even when nothing objectively “wrong” happened. So where does it come from? There are a few big reasons:

1. Old messages we never asked for.

For a lot of us, sex was introduced with a heavy dose of shame. Maybe it came from religion, culture, school, or your family — but at some point, many of us were taught that sex is “dirty,” “bad,” or something “good girls” shouldn’t do. Even if you’ve outgrown those beliefs

consciously, those messages can linger in the background, quietly influencing how you feel afterward.

It’s hard to fully step into your adult sexual self when some part of you still remembers being that high school girl afraid someone’s going to start a rumor that you’re a “slut.”

2. Disconnection from yourself or your partner. Guilt can also come from feeling out of sync with your own wants. If you went through with

it mainly to please someone else — or weren’t fully into it emotionally — you might feel like you let yourself down. This isn’t about blame; it’s about recognizing when your body says yes but your heart says meh. That disconnect matters. It can feel especially intense if you felt pressured, unsure, or weren’t totally present (like under the influence).

3. Worry about safety or consequences. Sometimes the guilt has more to do with what could happen next. Maybe you weren’t on

your usual birth control, skipped a condom, or feel anxious about an STI risk or an unspoken secret. Even if nothing went “wrong,” your brain can spiral into What-If mode —

and guilt is one of its favorite tools.

So yes, the feeling is common. But that doesn’t mean you have to live with it. If it’s a once-in-a-while thing, you might be able to talk it through with a trusted friend or just reflect on what didn’t sit right. But if it shows up every time — even when you’re with someone you care about and wanted to have sex — it could be worth exploring with a

therapist. Not because you’re broken, but because you deserve to feel safe, whole, and fully empowered in your sexual self.

Because spoiler: you are allowed to enjoy sex. Without the shame hangover. Without the emotional aftershock. Without apology.

Let’s unlearn the guilt — and make space for the good stuff.

Ugh, we’ve all been there.

UTIs (urinary tract infections) are the ultimate post-coital buzzkill. All that motion and friction during sex can help bacteria hanging out near the vulva find their way to the urethra — the tiny tube that leads to your bladder. Once they get in, they multiply quickly, and suddenly you're playing the “Is this pee or just the urge to pee?” game.

Here’s how to reduce your chances of getting one:

- Pee after sex. It helps flush out any bacteria that may have wandered too close to the bladder.
- Hydrate. The more you drink, the more you flush — literally.
- Use gentle hygiene practices. No douches, no floral wipes, no scented toilet paper.
  You don’t need to smell like Bath & Body Works.
- Choose breathable underwear. Cotton > synthetic. Let the area stay dry and chill.
- Consider a little lube. Friction from dryness can irritate your urethra, so if things are feeling a little Sahara, a fragrance-free lubricant can help.

If UTIs are still showing up like an uninvited ex, it’s time to call in reinforcements.
Some bodies just have worse luck. And that’s not your fault.

There are prescription options that can help:
- Urine-acidifying tablets that make your bladder environment less bacteria-friendly
- Low-dose antibiotics (either daily or just after sex)
- Vaginal estrogen, especially helpful if you are approaching or past menopause

And what about cranberry?
You’ve probably heard that cranberry juice can help prevent UTIs — and it’s… kind of true. Some cranberry supplements (but not the sugary cocktail drink!) contain compounds that may stop bacteria from sticking to the bladder wall. But they don’t treat infections, and they’re not a guaranteed fix.
We’ll break it all down in a separate question.

And if you do get symptoms — don’t wait.
UTIs are incredibly common and very treatable, but they can lead to more serious infections if ignored. If you’re feeling burning, urgency, frequency, or just something off, get checked out. Antibiotics can knock it out fast, and the sooner you treat it, the better you’ll feel.

Some cramping with your period can be normal — but normal looks different for everyone. Everyone’s uterus has its own personality. Some people barely feel a thing, while others deal with mild to even moderately strong cramps each cycle. A good rule of thumb: typical period cramps should respond well to over-the-counter meds like ibuprofen or naproxen (“Motrin,” “Advil,” “Aleve”) — and they shouldn’t completely derail your day.

But if the pain is so strong it keeps you from going to school, work, or just living your life? That’s not something you should have to grin and bear — and definitely don’t just ignore it. Conditions like endometriosis, adenomyosis, and fibroids can all cause more intense cramping — and we cover those in more detail in our articles — so check them out to learn more.

If your cramps are kicking your ass, you should talk to a provider. And if your concerns aren’t taken seriously? That’s a red flag — not a reason to stop asking. Studies show patients with conditions like endometriosis often see multiple doctors before getting the correct diagnosis. You deserve better. At the very least, severe cramps deserve an exam (with your consent) and an ultrasound to check your reproductive structures and see what might be causing the pain.

Sleeping with a tampon in is generally fine — as long as you’re not sleeping for more than 8 hours. (But let’s be honest — who’s really getting more than 8 hours of sleep these days?) The official guidance (from brands like Tampax and agencies like the FDA) is to change your tampon every 4 to 8 hours, so if you pop in a fresh one right before bed and take it out when you wake up? You’re good.

That said, if you know you’re someone who sleeps in, or you just don’t trust yourself to remember, maybe go for a pad or period underwear overnight. Better safe than sorry — especially when you’re unconscious.

So why all the rules? The main reason is to lower the risk of toxic shock syndrome (TSS) — a rare but serious bacterial infection that can happen when a tampon is left in too long. It sounds dramatic (and it kind of is), but it’s also very preventable. The key is to:

- Use the lowest absorbency that manages your flow

- Change tampons every 4 to 8 hours

- Never leave one in for an entire day or night

If you ever get sudden symptoms like a high fever, vomiting, dizziness, or a weird rash — take it out and head to the nearest emergency room. Again, super rare, super dramatic. But worth knowing.

Bottom line: tampons aren’t the enemy — just treat them like a guest who’s not allowed to overstay their welcome.

Yes — for some people, hormonal birth control can affect mood. But not always.

Everyone reacts differently to hormones. Some people feel totally fine. Others notice mood swings, anxiety, or even depression — especially when starting or switching methods.

We don’t completely understand why, but it may have to do with how the hormones (specifically progesterone) interact with the brain’s chemical signals — especially in people who are already sensitive to mood changes or have a history of depression.

That doesn’t mean you’re stuck. If your birth control is affecting your mental health, you have options:

- Try a different formulation — sometimes the brand, dose, hormone type, or even the delivery method (pill vs. patch vs. ring) makes all the difference.

▪︎ Some options, like the hormonal IUD, use a much lower dose and can have fewer mood-related side effects for some people.

- Consider a non-hormonal method, like the copper IUD

Either way - talk to your provider — your mental health matters just as much as your physical health.

The important thing is to listen to your body. You’re not imagining it, and you’re not overreacting.

Birth control should work for you — not against you.

Because your pelvic floor is a muscle — and sometimes, she needs a little backup.

That “oops” leak when you laugh, cough, or sneeze is called stress incontinence. It happens when pressure inside your abdomen (like a belly laugh) pushes down on your bladder, and your pelvic floor isn’t able to hold things in as well as it should.

It’s more common than you think — especially if you’ve been pregnant, given birth, or just haven’t paid much attention to those muscles in a while. Even athletes and younger people can deal with it.

The good news? It’s not something you have to just live with.

You can:

- Strengthen your pelvic floor (best done with a pelvic floor physical therapist — a true game changer!)

- See a urogynecologist (a specially trained OB-GYN who focuses on urinary and pelvic floor conditions)

- And for more severe or persistent cases, there are procedures and surgeries that can help

It’s nothing to be embarrassed about, and you’re definitely not alone. This issue is super common.

Your body isn’t broken — it’s just asking for support.

Nope — it’s actually safe, and in many cases, intentional.

If you’re using the pill, the ring, or the patch, the “period” you get each month is actually withdrawal bleeding (meaning bleeding because you stop taking the hormones) — not a true menstrual cycle. It was originally built into the schedule to make the method feel more “natural” and reassure users they weren’t pregnant. But medically? It’s not necessary.

Skipping your period by stacking birth control (i.e., skipping the placebo week) is totally fine for most people. In fact, it’s often recommended for things like:

- Painful periods

- Migraines

- Endometriosis

- PMS or PMDD

You’re not “building up blood,” and it doesn’t “need to come out.” Hormonal birth control keeps the lining thin — and there’s nothing dangerous about keeping things quiet down there.

And it’s not just the pill. Some forms of birth control — like the Depo shot, the hormonal IUD, or the implant — don’t include a withdrawal bleed at all. You might stop bleeding entirely while using them, and that’s perfectly healthy and normal, too.

Bottom line: if you’re skipping your period on purpose, you’re not hurting your body. But just know that different birth controls work in different ways — and your experience may vary depending on the method.

Before choosing one, talk to your provider about your personal preferences, especially around whether or not you want to have a period. There’s no one-size-fits-all answer, but there are plenty of good options. description

Yep — most discharge has some kind of scent. And that’s completely normal.

Your vagina is a microbiome, just like your gut. It’s full of healthy bacteria doing important work. That means your discharge may have a natural, slightly tangy, or metallic scent — kind of like pennies or a whiff of vinegar.

Think of it like other natural body cues: sweat, skin, even your scalp. Scent isn’t automatically a sign that something’s wrong — it’s often just your body being its clean, functioning self.

The important part is learning what’s normal for you. Get familiar with your body’s scent. She’s not your enemy — she’s your friend. And when you know what’s typical, it’s easier to notice when something’s off.

What isn’t normal:

- A strong fishy odor

- A sour or sharp smell that lingers

- A sudden change that comes with itching, irritation, or new discharge

Those could be signs of bacterial vaginosis (BV) or another imbalance. Totally treatable — just worth checking in on.

Bottom line: discharge has a smell — and that’s okay. You don’t need to scrub it away. You don’t need to douche it out. Just stay in tune with your body and trust yourself if something feels different.

Technically? Yes. Likely? Not super. But here’s how it works.

Sperm can live inside your body for up to 5 days. So if you have a short cycle and ovulate early — say, around Day 10 — and you have sex toward the end of your period, it’s possible the sperm hang around long enough to meet an egg. The same goes if your period is on the longer side and overlaps with your fertile window. It’s rare, but not impossible.

That being said, there is a method called fertility awareness (or natural family planning), where you track your cycle closely to avoid sex during your fertile days. It can work — but only if you have a good understanding of your body, ovulation patterns, and cycle length.

Everyone’s different, so it takes real tracking and consistency. Some apps can help with this, like Natural Cycles or Clue, which are designed for fertility-based planning.

And remember: sometimes what looks like a period isn’t actually one — spotting, hormonal shifts, or breakthrough bleeding can trick you.

So while your period isn’t the most fertile time of the month, it’s not a free pass either. If you’re trying to avoid pregnancy, using protection is your safest bet — no matter what day it is.

Kind of — but not in the way you might think.

Yeast infections are not STIs (that’s short for sexually transmitted infections), so it doesn’t mean your partner gave you something they picked up from someone else — like chlamydia or gonorrhea.

Yeast is something that lives on all of our bodies — skin, mouth, genitals — and it’s usually harmless. But when the natural balance in your vagina gets thrown off, yeast can overgrow, and that’s when you get symptoms like itching, burning, and clumpy white discharge.

Here’s the kicker: sex can be one of those things that throws off your balance.

Your vagina usually has a solid system in place — but when something comes in and messes with the thermostat, that balance can shift. Semen, fingers, toys — anything that changes pH or disrupts the internal environment — can lead to a yeast flare-up, especially if you’re already prone.

If you and your partner keep trading symptoms or you’re always flaring up after sex with the same person, your provider might suggest treating both of you to lessen the yeast load you’re passing back and forth — or explore other ways to prevent the imbalance in the first place.

Don’t be afraid to ask your doctor about it, and don’t let the stigma stop you from getting relief.

Short answer: it depends on your flow.

If it’s just light spotting or the very beginning or end of your period, your provider can likely still do the test with no issue. They’ll usually just clean the area first with a Q-tip to remove any visible blood before collecting the sample.

If it’s a full, heavy day — or if you tend to have a heavier flow in general — they might decide to reschedule. That’s not about being grossed out. It’s just that too much blood can make the sample harder to read in the lab.

That said, if you’re unsure what to do, the best plan is to just show up. Your provider can take a look and decide if it’s okay to go ahead. If the test ends up unreadable, they can always bring you back to repeat it.

You can also call ahead if you’re feeling unsure — they’ll give you guidance based on your timing and situation.

More importantly, know this: Pap smears are super important, and your provider should work with you to make them as accessible and stress-free as possible. If the bleeding makes you uncomfortable, it’s completely okay to reschedule for your own peace of mind.

However, in reality, you don’t have to feel embarrassed — providers see period blood every single day. Truly. It’s not a big deal to them, and it shouldn’t be a barrier for you either.